PPEERRÚÚ –– IINNTTRRAA IIII

ELDERLY ADULT
PROFILE

PERÚ – INTRA II
2004

DEVELOPING INTEGRATED RESPONSES OF HEALTH CARE
SYSTEMS TO RAPID POPULATION AGING
INTRA II – PERÚ

General Coordinator

Dr. Luis Varela Pinedo

Coordinator Team

Dr. Helver Chávez Jimeno
Dr. Antonio Herrera Morales
Dr. Francisco Méndez Silva

Dr. Miguel Gálvez Cano

MULTIDISCIPLINARY TEAM

Dr. Luis Varela Pinedo
General Coordinator INTRA II-Peru Project

Director, Gerontology Institute
Universidad Peruana Cayetano Heredia

Dr. Helver Chávez Jimeno
Titular member, Gerontology Institute, Universidad Peruana Cayetano Heredia

Dr. Antonio Herrera Morales
Correspondent member, Gerontology Institute, Universidad Peruana Cayetano Heredia

Dr. Fernando Portocarrero Salazar
Medical Director, Military Geriatric Hospital

Dr. Carlos Sandoval Cáceres
Resident Tutor in Geriatrics, Medicine Faculty, Universidad Nacional Mayor de San Marcos

Dr. Elizabeth Sánchez Yturrizaga
Executive coordinator, Consorcio Perú Envejecimiento y Desarrollo (NGO)

Dr. José Francisco Parodi García
Geriatric Physician, San Martin de Porres University

Dr. Pedro Vera Vílchez
Elderly Adult Social Program responsible, Hospital Nacional Cayetano Heredia

Dr. Juan del Canto y Dorador
Elderly adult program responsible
Health Ministry (MINSA)

Dr. Carmen del Pilar Estela Benavides
Elderly adult general direction

Woman and Social development Ministry (MIMDES)
Dr. Francisco Méndez Silva

Correspondent member, Gerontology Institute, Universidad Peruana Cayetano Heredia
Dr. Miguel Gálvez Cano

Resident Geriatric Physician, Universidad Peruana Cayetano Heredia
Dr. Luis Álvarez Cóndor

Physician, Geriatrics Service, Geriatric Institute Peruvian Aerial Force (FAP)
Dr. River R., Cersso Bendezú

Coordinator SBS, Elderly Adult Pilot Program, DISA II, Cañete-Yauyos, South Lima
Dr. Diana Rodríguez Hurtado

Scientific investigator office and technological development chief,
Arzobispo Loayza Hospital

Dr. María del Pilar Gamarra
Elderly Adult Attention National Commission President, Social Security (EsSalud)

Dra. Isabel Benate Gálvez
Elderly Adult Affairs Responsible

Primary Health Care, EsSalud
Dra. Blanca Deacon Castillo
Association Pro-Vida Peru President (NGO)

Dr. Felipe Aguirre Salinas
Executive Director, Association Pro-Vida Peru (NGO)

INTRODUCTION

During the last 50 years a decrease of the world's population natality and mortality
had been leading to the world's population aging. In the Latin American countries (Peru
among them) the population's aging is also a demographic characteristic. This has a great
importance, because it implies economic and social consequences; as well as changes in
work, housing, recreation, and education areas, and mainly in the health necessities that
will take place.

According to census and estimates, in 1970 the elderly adult population in Peru
constituted 5.54% of the national total. According to 1993 census, it was of 6.34%; that
means that in a 23 year period the elder adult population grew in less than 1% of the total
population. A real growth took place in the last 11 years, since for the end of 2004, it is
calculated that this population will arrive to 7.55% and for the 2025 will represent 13.27%;
this means that in next 20 years the proportion of elder adult population will be almost
duplicated. We are witness of a process of a quick demographic transition, so is our duty to
be prepared to confront these changes and their consequences.

The expectation of the Peruvian population's life has also changed in the last years.
In 1970 this was 53 years, for the 2004 is of 70 years, and is considered that it will reach 75
years for the 2025.

1. GENERAL CHARACTERISTICS

1.1 GEOGRAPHY

Peru is in the western and central region of South America, it limits for the west
with the Pacific Ocean, for the East with the countries of Brazil and Bolivia, for the North
with Ecuador and Colombia; and for the South with Chile. It presents a surface of 1 285
215 km², being the third country in territorial extension of South America after Brazil and
Argentina.

Located in a tropical region, the typical climate would be expected. However, due to
a great number of geographical peculiarities, as the Peruvian current that affects the
temperature of the adjacent sea and the Andes mountains that crosses the country from
north to south; Peru presents a wide climatic and ecological variety. Traditionally are
considered three geographical regions:

The Coast: to the west, next to the Pacific Ocean, is constituted by a narrow desertic
fringe that concentrates most of the Peruvian population (52%).

The Sierra: Central mountainous region that constitutes around 30% of the national
territory. It is conformed by mountain ranges and an extensive plateau. This configuration
implies that around 30% of the national territory it is located between the 2000 and the
4000 meters over sea level. 34.48% of the Peruvians habit this region.

The Forest: to the east, it constitutes the forest plains of the Amazon basin. This
region occupies 60% of the territory, but only 13.52% of the Peruvian population's habits it.

Since the year 2004 the country is conformed by 25 regions (the old 24 departments
and the constitutional county of Callao) whose first representatives, were elected in
November of the 2003. With this current and recent process of decentralization it is
expected that the country overcome the strong centralism that has characterized it for five
centuries. These regions are divided in counties (188) and these in turn are formed by
districts (1595).

Peru’s capital is the city of Lima, located in the central coast of the country. This
city was founded in 1535, beside Rimac River by the Spanish conqueror Francisco Pizarro.
From the beginning of the Spanish colonization until today Lima has been the center of the
political and economic power; configuration that has been prejudicial for the development
of the rest of the country and that has generated deep social and economic inequalities.

According to the 1993 census, Lima city had 5 854 608 inhabitants; the projections
of the National Institute of Statistics (INEI) for the year 2004 give it a population of 7 208
794 people that almost represents the fourth part of the national total

The second city of the country is Arequipa located at 2360 meters over the sea level,
in the Peruvian Andes. With 851 750 inhabitants, and located in the region of the same
name, concentrates 2.95% of the Peruvian population's.

1.2 POLITICAL - ECONOMIC SYSTEM

1.2.1 Historical aspects

Peru was one of the last countries in South America that reached its independence
that was proclaimed in 1821. Almost from the beginning of Peru’s republican life, the
government’s system was democracy, based on the division of the powers of the state,
government's alternation and congress's renovation by means of elections.

Peru has had 13 constitutions, the first one promulgated in 1823, and the last one in
1993.

1.2.2 Political Aspects

The Peruvian State is conformed by three autonomous powers:

a) Executive Power: The Peru has a presidential government's system. The executive
power resides in the President of the Republic who has chief of state functions. It is him
who directs the government politics, supported by a political-electoral majority, determined
by popular vote.

b) Legislative Power: Resides in the Congress that at the moment consists of an unique
Camera. The number of congress members is one hundred twenty. The Congress is chosen
by a five-year period. Their main functions are to give the laws and permanent inspection,
as well as the eventual reformation of the Constitution.

c) Judicial Power: Is integrated by jurisdictional organs that administer justice on behalf of
the Nation, and for organs that exercise their government and administration. The
jurisdictional organs are: the Supreme Court of Justice, the Superior Court, specialized and
mixed Tribunals, and Peace Tribunals. The Full Room of the Supreme Court is the
maximum organ of deliberation of the Judicial Power.

Parallel to these three powers, there are autonomous organisms that are:

· Republic General Controllership
. National Elections Jury
· People Defensory
· Public Ministry

1.2.3 Economic process in the last two decades

The Peruvian economy in the 80s decade had one of the highest hyperinflations in
the world, the reduction of the per capita income, and the increment the foreign debt. Peru
was also excluded of the support of the IMF and of the World Bank (ineligible country),
due to the incomplete payment of the foreign debt. In the 90s answering to this situation,
were applied programs of macroeconomic adjustment, commercial opening and structural

reformations that considered among other measures, the privatization of public companies,
and modifications in the administrative structure of the public sector. These measures
reduced the inflation drastically and created the conditions to recapture the route of the
growth and sustained development as well as a progressive reinsertion in the international
economic system. This process entered in crisis at the end of the 90s due to the impact of El
Niño phenomenon in the agriculture, the financial crisis of Asia, and the political instability
due presidential re-election of Alberto Fuijmori and its subsequent renouncement. All of
these factors limited the growth among the years 1998 to 2001. In July 2001 Alejandro
Toledo assumed the presidency; from then on the Peruvian economy has presented a slow
but stable growth.

The growth of the National Gross Product for the year 2002 were 4.85%, registering
an increment of 5.5% regarding the year 1998 that registered negative values. The rate of
inflation of the year 2003 was of 2.48%, something superior to that of the 2002 that was of
1.10%. The Chart 1.1 summarize some socioeconomic indicators and their evolution among
1993 - 2003

Chart 1.1 Socioeconomical indicators and their evolution among 1993 - 2003

National Gross Product 1993 1995 1997 1999 2001 2003
(NGP) 87375 107025 117214 117507 121132 130817
4.76% 10.69% 4.67% 0.13% 1.53% 3.92%
Millons of NS$

NGP growth, %

Inflation rate, % 39.50% 12.80% 9.15% 4.85% 3,90% 1.79%

NGP per-capita 3842.3 4548.3 4809.6 4657 4642.8 4853.9

Nuevos Soles per hab

Source: Análisis estadístico, Perú en números 1993 – 2002, Cuanto

1 dollar = 3.5 Nuevos Soles

The Social situation of the country is also reflected in the PBI structure. The
agriculture that contributed with 23.8% of the NGP in 1950, drop to almost the half by the
end of the 90’s. While the commerce, that in the 50s represented 4.1% of the PBI grew in
important form, reaching 14.4%; being the small and the informal commerce those that
contributed in great measure to this increment. Fishing that contributed in 1950 with 0.2%
it grew six and half times, reaching to 1.3 %. Graph 1.1

Graph 1.1 Evolution of the structure of the NGP, Peru 1950 - 1996

National Gross Product Structure, 1950 - 1996

100% 1996
80% 1950
60%
40% ManInufdauctsutrray MinMeriníaing PFesischaing CoCmeormciomerce
20%

0%AgArigcruiclutluturrea

Peru’s Poverty evolution is summarized in the chart 1.2. Total poverty is defined
like a situation in which the home income don't reach to satisfy a group of minimum
necessities (food and not food), contained in the Consumption Minimum Basket. The total
poverty diminishes from 1993 to 1998, while starting from 1999 increases due to the period
of economic crisis mentioned previously.

Chart 1.2: Perú: Total poverty evolution, 1993 – 2001

1993 1995 1997 1998 1999 2001
47,50% 49,80%
Total 56,80% 45,30% 42,70% 42,40% 34,70% 35,70%
71,80% 75,90%
Urban 42,40% 37,40% 29,70% 29,70% 31,40% 35,70%

Country side 90,10% 59,40% 66,30% 65,90%

Lima (city) -- 28,30% 25,40% 24,10%

Source: Encuesta Nacional de Hogares 1995 -2001; INEI

Extreme poverty is defined as the situation in which the home doesn't have enough
income to acquire a Minimum Consumption Alimentary Basket that satisfies the nutritional
minimum requirements in terms of calories and proteins. The evolution of this indicator is
in the Chart 1.3

Chart 1.3: Perú: Extreme poverty evolution, 1993 – 2001

1993 1995 1997 1998 1999 2001
17,40% 18,40% 19,50%
Total 28,30% 19,30% 18,20% 5,20% 4,70% 5,70%
40,00% 44,40% 45,20%
Urban 16,10% 8,90% 5,30%

Countryside 56,90% 38,40% 41,50%
Source: Encuesta Nacional de Hogares 1995 -2001; INEI

In chart 1.4 is observed that the unemployment level has stayed almost constant
during the last years, while the sub employment has grown almost 10% since 1995.

Chart 1.4 Peru: employment evolution, 1995 - 2001

1995 1996 1997 1988 2000 2001
92,10% 92.60% 92.20%
Employment rate 92,50% 92,90% 92,50% 7,90% 7.40% 7.80%
44,10% 52.20% 55.70%
Unemployment rate 7,50% 7,10% 7,50%

Sub employment rate -- 42,60% 41,80%

Source: Encuesta Nacional de Hogares 1995 -2001; INEI

1.3 HISTORY OF PERU AND THEIR ELDER ADULTS

In Peru, there are human evidences of human life that has more than 15 thousand
years of antiquity. Chavin culture is considered the most ancient of Peru, after this culture,
diverse cultural groups and towns developed in different regional spaces, among these
groups are the Paracas, Nazca, Mochica, Huari, Tiahuanaco, Chimu and the Inca cultures.

The Inca expansion takes place by the middle of the 12th century, reaching a
remarkable level of political and administrative unification based on conquest or
annexation of other towns or cultures of the Andean area. They extended the use of the
Quechua as the common language and built an extensive net of roads and tambos (depots).
They also redistributed the resources inside of an organizational system of social economic
planning that unified and respected the diversity of towns and cultures, as well as the
natural resources and economic areas, also very diverse.

Toward the year 1500, the Inca political organization had incorporated most of the
Andean social formations, forming the Tahuantinsuyo whose territories embraced from the
south of the current Colombia until the center of what today is Chile, also included Bolivia
and the north of Argentina. This vast and complex social economic formation had
sustenance in a theocratic government model, in which the Inca elite was located in the
peak of the system and were considered divinities.

In the Incan Empire, the base of the social and economic organization was the ayllu
that was conformed by groups of families. The Inca economy was based on the collective
work, the elderly adults maintained their labour status in a permanent way, carrying out
appropriate works to his biological condition. When arriving to very advanced ages the
ayllu took charge of their maintenance.

About other pre-inca towns and cultures, we doesn't have information regarding the
elderly adult's situation; but is probable that they were in disadvantage just as it was in
almost all the civilizations of the past.

In the year 1532, a conflict for the succession and control of the Inca throne started
between the brothers Atahualpa and Huáscar. The scale had leaned in favour of Atahualpa
when a group of Spaniards, led by Francisco Pizarro and Diego de Almagro arrived to Peru.
They went to the encounter of Atahualpa in Cajamarca and seeing the favourable
conditions, they captured and later execute him; this action began the process of the
conquest of the Inca Empire and of other towns of South America.

Socially a division took place between the colony of Spaniards and that of Indians;
arising intermediate sectors - the mestizos - characterized for their struggle to differ from
the Indians and resemble to or be assimilated by the Spaniards. The African Americans
were introduced in America like slaves. They constituted a category apart from the social
structure; their social inclusion has meant a long process. In this way, the Peruvian society
became multi-ethnic, multi-cultural and of many languages.

In this new economic structure the only native who was worth, was the one capable
of work, giving place to the abandonment of those no capable, among them the elderly
adult. The natives had to pay a tribute until they were 50 years old; the epidemics brought
by the conquerors and the implanted mining exploitation system raised the mortality
(especially the masculine one) at alarming levels. For these reason only a few people were
able to reach the age of 50 years.

It was also during this time that took place the establishment of medical institutions;
being founded hospitals and hospices under the help of the Catholic Church. After that the
teaching of a medieval medicine settled down

Peru’s independence was achieved by Simon Bolivar’s troops in the battle of
Ayacucho in 1924. After Bolivar leaved the country, each one of his lieutenants wanted to
take control of the new created Republic, this situation faced them in multiple wars for
political power. In this way, the first decades of independent life were characterized by a
political and social economic chaos. The country would not enjoy order neither peace up to
1845, year in that the general Ramón Castilla, was made president. Castilla was a skilled
ruler that began numerous and important reformations in the two periods of its presidency,
as the abolition of the slavery, the construction of railroads and of telegraphic facilities, as
well as the adoption of a liberal Constitution in the year 1860. Castilla also began the
exploitation of the natural resources of the country, as the deposits of guano and the nitrate.
In 1864 these deposits would unchain the first Pacific war (1864-1866) between Peru and
Spain, country that had taken possession of the rich guano islands of Chincha. Ecuador,
Bolivia and Chile helped Peru, defeating the Spanish forces in 1866.

The relationships between Peru and their neighbours were difficult from the
beginning of its republican life. The bordering problems mainly with Chile, gave place to
the second Pacific War with this country in 1879, in which after five years of war, Peru lost
part of its territories in the south. The period of post-war was characterized for a destroyed

economy and a conflict for power between the military commanders defeated by the
Chilean army; for this reason the next 30 years the Peru was governed by successive
dictators. After this period democracy returned but our republican life since then has been
characterized by the alternation between elected governments and civil or military
dictatorships.

In the initial period of the republic, the elderly adult population's marginalization
persisted. They were considered a devaluated work force, with very little acceptance in the
labour market.

By the middle of the XIX century, with the development of the national medicine,
under the influence of French, English and German medicine, the interest arose to satisfy
the necessities of the elderly adult’s attention, especially those of popular sectors.

The Society of Charity of Lima (Sociedad de Beneficencia de Lima) was founded in
1834 during the government of the general Orbegoso with the purpose of offering attention
to the helpless. This society established several hospices with limited functions, as the
Manrique, Castaño, Ruiz Dávila, and Corazon de Jesus housings among others.

In 1924 the San Vicente de Paul Asylum was built, today Geriatric Home,
belonging to the Society of Charity of Lima, for the attention of helpless elderly adults.

The creation of an Obligatory Public Health for the workers in 1936 is important,
because for the first time the workers had insured their medical care during their old age,
after the jubilation. This type of attention was extended in 1951 in the form of the Social
Insurance. The Pensions National System of the Social Security was created in 1973,
replacing the Pensions Fund of the Social Security, the Employee's Social Security and the
Jubilation Special Fund for Employees of Non-governmental companies.

The Peruvian Armed Forces created services of geriatric attention in the Military
Central Hospital, in 1975; in the Police Forces Hospital, in 1982; in the of Aeronautics
Central Hospital, in 1983 and in the Navy Central Hospital, in 1985.

In August 27 of 1982, were inaugurated in the district of the Rimac the geriatric
asylum that takes their benefactor's name, Ignacia Rodolfo widow of Canevaro.

In 1998 was created the Geriatrics Service in the Social Security Hospital,
“Guillermo Almenara Irigoyen”, while in the hospital “Edgardo Rebagliati Martins”, also
of the Social Security was created a unit of geriatric evaluation.

Recently, Geriatrics Services have been created in some hospitals of the Health
Ministry, such as “Cayetano Heredia”, “Archbishop Loayza”, “2 de Mayo”, “Sergio
Bernales” , but they are not implemented to work in a proper way yet.

The Geriatrics began as a discipline in our country by the middle of the XX century
by a group of physicians interested in this relatively new specialty; they decided to found
the Peruvian Society of Geriatrics in 1953, and their first president was Dr. Eduardo
Valdivia Ponce. This society was made member of the International Association of
Gerontology in 1957. Later on this group went in crisis because their members didn't know
how to come to an agreement in the identity of the institution.

In 1978 another group of physicians believed necessary to form the Peruvian
Society of Gerontology and Geriatrics. Their first president was the Dr. Miguel LLadó.
This society is recognized by the Peruvian College of Medicine and had been acting
through medical education courses of the specialty and through it official organ, the
magazine Geronto whose first number appeared in 1982.

In the city of Arequipa, the University Health Center “Pedro P. Díaz” of the
National University of San Agustín, created in 1979, has among its activities Elderly Adult
Programs and social projection programs as: psychological campaigns of Attention to
Children, Adults and Elderly Adults. In the Catholic University of Santa María, the
infirmary program includes, among it objectives, to guide their students actions towards the
human necessities of the women, newly born, boy, adolescent, young adult and elderly
adult in chronic and critical states

Most of geriatric institutions are concentrated in Lima. However, in the last years,
the Social Security has been carrying out an active work of forming services of geriatric
attention and other similar ones, in the main cities of the country.

In the year 2002 was approved " THE NATIONAL PLAN FOR THE ELDERLY
ADULT 2002-2006"with the objective of implementing coordinated actions between the
government organizations and the civil society in order to increase the participation and the
elderly adult's social integration. The coordination and evaluation of this plan is in charge
of the Ministry of Promotion of the Woman and Human Development (MIMDES).

The Health Ministry also had considered the medical attention according to the
stages of the vital cycle, developing norms for the elderly adult's attention in an integral
model of health attention.

August 26, day of the death of Santa Teresa Jornet Ibars, co-founder of the Order of
the Sisters of the Abandoned Elderly Adults, has been instituted as the Peruvian Elderly
Adult’s Day.

In the educational and formative field, the geriatrics course has been integrated in
some universities. Also, the specialty of geriatrics is integrated in the resident program.
Mastery programs in gerontology are dictated in diverse universities. In 1989, the Peruvian
University Cayetano Heredia creates a gerontology institute, which has for mission to carry
out and to foment the investigation in the geriatrics and gerontology area in Peru.

2. DEMOGRAPHIC TENDENCIES

According to the Pan-American Health Organization report on the "State of the
Aging and Health in Latin America and the Caribbean, the socio-economic situation of the
elderly adults", presented in January of the 2004, the region has been divided in four sub-
regions. Peru is located in the sub-region of Andean Countries together with Bolivia,
Colombia, Ecuador and Venezuela where the aging index will be duplicated in next two
decades and the rural area will continue being important for elderly adult population.

The components that determine the growth, size and the structure of the populations
are the natality, the mortality and the migration rate. In our country the growth is mainly
consequence of the interaction of these first two demographic factors. The rate of mortality
and natality have diminished in the last 30 years and it is expected they continue
diminishing up to the 2015; starting from this year the mortality will began to increase
while the natality will continue diminishing. The changes in the fecundity in Peru have
been notorious and it is expected that the global rate of fecundity diminishes up to 2.1
children per woman for the 2025. Chart 2.1

Chart 2.1 Peru: Natality, mortality and fecundity rates, 1970 - 2025

Year Natality Global Mortality
Rate ( per mil)
Fecundity Rate Rate
1970 42.35 (children per women) ( per mil)

1980 35.64 6.30 14.01
5.01 9.83
1985 32.49 4.36 8.31
3.90 7.27
1990 30.42 3.45 6.68
3.02 6.29
1995 27.7 2.72 6.07
2.48 5.99
2000 24.52 2.29 6.00
2.15 6.06
2005 22.18 2.10 6.36

2010 20.38

2015 18.84

2020 17.29

2025 16.48

Source: INEI

In the Chart 2.1, can be observed an increase of the longevity; that it is measured by
means of life expectancy at birth that has increased from 53.47 years in 1970 to 70.4 years
for the present year, 2004. (chart 2.2)

Chart 2.2 Peru: Life expectancy at birth, 1970 – 2025

Year Life expectancy at birth ( by years)

1970 – 1975 Total Men Women
1980 – 1985 55,52 53,88 57,25
1985 – 1990 61,55 59,46 63,75
1990 – 1995 64,37 62,08 66,77
1995 – 2000 66,74 64,40 69,20
2000 – 2005 68,32 65,91 70,85
2005 – 2010 69,82 67,34 72,42
2010 – 2015 71,23 68,68 73,90
2015 – 2020 72,53 69,93 75,27
2020 – 2025 73,75 71,08 76,55
Source: INEI 74,87 72,14 77,73

The rate of the population's growth is defined as the relationship between the annual
surplus of the births and the deaths of the population, measured in the period of observation
and it is expressed in percentage (chart 2.3).

Chart 2.3 Peru: Evolution of the population's growth rate, for five year period, 1980 - 2025.

1980 - 1985 - 1990 - 1995 - 2000 - 2005 - 2010 - 2015 - 2020 -
1985 1990 1995 2000 2005 2010 2015 2020 2025

2,41 2,19 1,85 1,7 1,5 1,4 1,31 1,19 1,04

Source: INEI

Between the years 1970 and 2004, the group with ages of 50 or more years
increased their participation. The projections for the year 2025 indicate that the population
of elderly women would reach, 13.7% and the elderly men, 11.53% (Chart 2.4)

Chart 2. 4 Peru: Structure of the population according to age and gender (% 1970 - 2025)

Total 1970 1990 2004 2025
0 - 14 years
13192677 21753328 27546574 35725458
% 5805842 8313015 9013296 8606711

15 - 50 years 44.01 38.21 32.72 24.09
5927997 10815052 14531002 19030660
%
44.93 49.72 52.75 53.27
50 - 60 years 727904 1307885 1923141 3659460

% 5.52 6.01 6.98 10.24
730934 1317376 2079135 4428627
60 +
5.54 6.06 7.55 12.40
%
6648691 10944495 13852228 17879352
Men 2949225 4222387 4585173 4391704
Total
0 - 14 years 44.36 38.58 33.10 24.56
2998457 5458566 7330314 9615530
%
45.10 49.88 52.92 53.78
15 - 49 years 358957 647925 955095 1811267

% 5.40 5.92 6.89 10.13
342052 615617 981646 2060851
50 - 59 years
5.14 5.62 7.09 11.53
%
6543986 10808833 13694346 17846106
60 + 2856617 4090628 4428123 4215007

% 43.65 37.84 32.34 23.62
2929540 5356486 7200688 9415130
Women
Total 44.77 49.56 52.58 52.76
368947 659960 968046 1848193
0 - 14 years
5.64 6.11 7.07 10.35
% 388882 701759 1097489 2367776

15 - 49 years 5.94 6.49 8.01 13.27

%

50 - 59 years

%

60 +

%
Source: INEI

If the changes are analyzed inside the group of elderly adults; it can be observed that
among 1970 and 2025 the group of 75 years old or more presented a sustained increase
inside the group of elderly adults. (Chart 2.5)

Chart 2.5 Peru: Structures of the population elderly than 50 years by five-year age groups,
1970 – 2025

50 - 54 years 1970 1990 2000 2010 2025
55 - 59 years
60 - 64 years 26,79% 27,18% 26,38% 26,68% 24,39%
65 - 69 years 23,11% 22,64% 21,27% 21,66% 20,86%
70 - 74 years 18,78% 17,61% 17,60% 16,78% 17,51%
75 - 79 years 13,71% 13,07% 13,76% 12,78% 13,60%
80 years o + 9,64% 9,20% 9,65% 9,66% 10,08%
5,32% 6,09% 6,14% 6,61% 6,78%
Source: INEI 2,65% 4,21% 5,20% 5,83% 6,78%

100,00% 100,00% 100,00% 100,00% 100,00%

In the graph 2.1 is the population elder than 50 years current percentage distribution.

Graph 2.1. Peru: Structure of the population elder than 50 years by decade age groups, 2004

5,43% 48,05%

16,18% 50-59

30,34% 60-69

70-79

80 or +
years

Source: INEI

When analyzing the structure changes of the population elder than 50 years between
1970 and 2025 for each gender; the women elder than 80 years increased their participation
in the group from 2.93% in 1970 to 7.68% this year, while the men increased in smaller
proportion, from 2.34% to 5.79%. (Chart 2.6)

Chart 2.6 Peru: Structure of the population elder than 50 years for each gender, according
to five-year groups of age (%, 1970 - 2025)

Men 1970 1990 2000 2010 2025
50 - 54 years
55 - 59 years 27.65 28.11 27.38 27.47 25.34
60 - 64 years 23.56 23.18 21.69 22.14 21.45
65 - 69 years 18.83 17.74 17.45 17.00 17.78
70 - 74 years 13.45 12.89 13.58 12.74 13.53
75 - 79 years 9.21 8.83 9.47 9.41 9.77
80 years o + 4.96 5.63 5.84 6.18 6.34
2.34 3.62 4.60 5.05 5.79

Total 100.00 100.00 100.00 100.00 100.00

Women 25.98 26.32 25.63 25.94 23.52
50 - 54 years 22.70 22.14 20.81 21.22 20.32
55 - 59 years 18.75 17.50 17.40 16.58 17.25
60 - 64 years 13.95 13.23 13.84 12.82 13.67
65 - 69 years 10.03 9.55 9.93 9.89 10.36
70 - 74 years 5.66 6.51 6.51 6.99 7.20
75 - 79 years 2.93 4.75 5.88 6.56 7.68
80 years o + 100.00 100.00 100.00 100.00 100.00
Total
Source: INEI

During the last five decades, the Peruvian society has been marked by a clear
tendency to the urbanization, expressed in the population territory redistribution. The
migratory flows are evidenced, through a quick growth of the population of the urban areas,
as well as of a slow growth and a relative loss of population of the rural areas. The changes
in the Peruvian population's composition between 1940 and 1993 are significant. Of a
population for the most part rural in 1940 (65%) it passes to a mainly urban population in
1972 (60%), increasing their participation in 1993 to 70% and according to estimates for
the 2004 will arrive to 72.48%.

The urban population has grown much more quickly that the rural one. The rates of
growth of the first one in the periods 1940-61 and 1981-93 were respectively of 3.7% and
2.8%. While the rural one in the same periods grew 1.3% and 0.9% respectively. It is
appreciated in the last period a relative descent of the speed of the urbanization. From 1940
to 1993, the urban population has grown 6 times, while the national population almost 3
times, and the rural one hardly in 0.6.

The evolution of the population's structure elder than 50 years, in rural environment
as in the urban one is in the chart 2.6. In 1970, it is observed that almost 2/5 of the elder
than 50 years population lived in the rural environment; in the 90s less than a 1/3 of this
group lived in the rural areas. For the 2025, is expected that only a 1/4 of elder than 50
years population will live in rural areas.

Chart 2.6. Peru: Structure of the population elder than 50 years Urban vs. Rural, 1970 –
2025

Total 1970 % Rural % 1990 % Rural %
50 a 59 years Urban 58.06 5533466 41.94 Urban 68.75 6798228 31.25
60 a 69 years 7659211 56.08 319717 43.92 14955100 68.54 31.46
70 a 79 years 54.95 213584 45.05 67.13 411420 32.87
80 years or + 408187 53.92 100589 46.08 896465 67.10 264759 32.90
260479 52.95 47.05 540693 69.04 132097 30.96
117683 18159 269405 34190
20440 76242

Total 2004 % Rural % 2025 % Rural %
50 a 59 years Urban 72.48 7580394 27.52 Urban 75.12 8887245 24.88
60 a 69 years 19966180 77.27 437082 22.73 26838213 80.32 19.68
70 a 79 years 1486059 74.50 309680 25.50 2939151 81.86 720309 18.14
80 years or + 74.15 167322 25.85 2059905 81.52 456399 18.48
Source: INEI 904713 79.86 20.14 1112086 82.03 252040 17.97
480071 43777 98514
173572 449683

In Chart 2.7 is the regional distribution of the Peruvian population and the
percentage of elder than 60 years in each one of them.

Chart 2.7 Peru: Elderly Adult’s total population, by regions, 2004

Total pop of Elderly Adult

Regions Total 60 years or Population % 60 population
Population
Amazonas more years or more distribution
Ancash 436073
1139083 24637 5.65% 1.18%
Apurímac 478315 93966 8.25% 4.52%
Arequipa 1126636 31114 6.50% 1.50%
Ayacucho 571563 96021 8.52% 4.62%
Cajamarca 1532878 41017 7.18% 1.97%
811874 95086 6.20% 4.57%
Callao 1237802 74207 9.14% 3.57%
Cusco 459988 82620 6.67% 3.97%
Huancavelica 833640 27513 5.98% 1.32%
Huánuco 709556 48541 5.82% 2.33%
1274781 57539 8.11% 2.77%
lca 89590 7.03% 4.31%
Junín 1550796
La Libertad 123938 7.99% 5.96%
1141228
Lambayeque 8011820 86545 7.58% 4.16%
Lima 931444 739089 9.22% 35.55%
Loreto 104891 44137 4.74% 2.12%
163757
Madre de Dios 277475 3213 3.06% 0.15%
Moquegua 1685972
Pasco 1297103 12933 7.90% 0.62%
Piura 14780 5.33% 0.71%
Puno 777694 108437 6.43% 5.22%
309765 93697 7.22% 4.51%
San Martín 211089
Tacna 39864 5.13% 1.92%
Tumbes 18495 5.97% 0.89%
11112 5.26% 0.53%

Ucayali 464399 21045 4.53% 1.01%
27546574 2079135 7.55% 100.00%
Total
Source: INEI

It is prominent the elderly adult population concentration in certain regions of the
country that doesn't always present the highest percentages of elderly adult population's
total distribution.

It can also be observed in the previous chart that the regions with more proportion
of elderly adult population are located in the coast, where the biggest urban centers in the
country are also located. This was expected since these regions offer to the population more
labour options as well as an easiest access to education services, culture, health, and
recreation. This in turn generates conflicts of coexistence, overalls in Lima. Lastly the
unequal regional development drives to political-social and economic conflicts when
concentrating financial resources on some few regions.

3. GENERAL CONSIDERATIONS FOR THE POPULATION OF 50 YEARS OLD OR
MORE

According to the United Nations Development Program (UNDP) the indicators of
life quality in Peru are as the one as the average of Latin America that is to say below the
developed countries. According to the index of human development, that is measured in
three basic dimensions (hope of life, educational level and income) the Peru is a country of
intermediate development, being located in the 13th place in the Latin American context
and 82nd at world level.

3.1 WORK

3.1.1 Occupation, unemployment and inactivity rates

According to the National Home Survey (ENAHO 99), only the 37.46% of the
elderly adults was economically active (EA) in the urban area; 52.07% of them were males
and 24.41% females. This difference are explained in function of the social factors
prevalent decades ago, in which the feminine presence was important at home, and at the
same time and by this excuse her participation inside the productive activity was restricted.

Chart 3.1 Peru: Elderly adult population, by gender, activity condition, Urban Area at
National Level (1999)

Activity Total Men Female
559,348 625,778
Population 1,185,126 291,267 152,738
273,574 151,62
EA 444,004 37.46% 17,693 52,07% 1,118 24,41%
268,081 93,93% 473,04 99,27%
Employed 425,193 95.76% 6,07% 0,73%
47,93% 75,59%
Unemployed 18,811 4.24%

NON EA 741,122 62.54%

Source INEI- ENAHO 1999-III Trimestre

3.1.2 Underemployment and Unemployment

ENAHO 1999 also find that at Urban Peru level, the 44.7% of the population elder
than 55 years was under-employed. Chart 3.2

Chart 3.2 Urban Peru, Underemployment by age groups: 1999

Age Under-
employment
Total Rate
14 - 24 years
24 - 44 years 43.40%
45 - 54 years 52.50%
55 or more years 39.50%
Source: INEI 39.10%
44.70%

In Peru the unemployment had increased in all age groups. Among the elderly adult
population this could be due aspects that are related with the labour offer like: health
problems, lack of qualification, or with the labour demand: lack of opportunities, age
discrimination. The unemployed population of this age could probably be looking for a job
due an subsistence objective, mainly if he/she doesn't have access to a social security
pension, own rents or family support.

For the year of 1997, 7.6% of the males and 4.3% of the females elder than 55 years
were unemployed. The males of this age group present the highest unemployment rate,
after the youths between 14 and 24 years. Due the lack of information, to be able to analyze
the evolution of the unemployment, it is necessary to restrict the analysis to Lima City. In
1990, while the unemployment only affected 3.1% of the economically active elder than 65
years population; in 1993 reached the maximum level of 9.9% and diminished lightly in
1997 remaining at 8.84%.

Lima City: Unemployment rate evolution, by age group

14-19 1986-1998 19.42
20-34
35-49 20.2
50-65
20.0 65-+
10.0
13.0 11.6 11.1 13.1 9.76 8.84
0.0 9.8 9.2 9.9 8.1 8.0 9.0 6.64

7.3 6.1 3.8

2.9 5.1 6.16
2.5 2.6
3.4 3.1

1986 1990 1993 1995 1997

If the differences are analyzed by gender, it is observed that contrarily to what
happens in other age groups, the elder males had the highest unemployment rates. This
could be probably because the women elder than 65 years are more dedicated to home tasks
or offering family support to their sons or daughters and they are not looking for an
employment actively (This means they are part of the non economically active population).

The working men elder than 50 years, had a high increment in the unemployment
rate. It rose from 3% for the period 1986-1990 to 7.7% for the period 1994-1997.

In the chart 3.3 can be observed more recent statistics about the characteristics of
the economically active population at Lima City.

Chart 3.3 Economically Active Population in Lima City: Employment, Underemployment
and Unemployment levels, 2002

Unemployment Underemployment Proper employment

EA population 9,72% 41,91% 48,37%

Men 50,58% 34,79%
34,94% 59,30%
14 - 24 years 14,63% 31,91% 61,54%
34,43% 55,47%
25 - 44years 5,76%
51,03% 30,92%
45 - 54 years 6,55% 44,61% 44,63%
46,09% 46,88%
55 or + years 10,10% 59,79% 32,20%

Females

14 - 24 years 18,05%

25 - 44 years 10,76%

45 - 54 years 7,03%

55 or +years 8,01%

Source: INEI - ENAHO 2002

3.1.3 Characteristics of the elderly adult's occupation categories and work place

In the year of 1996, the age group from 25 to 44 years was the most prevalent in
most of all the occupational categories. The adults elder than 55 years represented 10.5% of
the economically active urban population, having a significant participation among the
groups of the independent workers and of employees or bosses. Chart 3.4

Chart 3.4 Peru: The Economically Active Population distribution and by age groups, 1996

Occupational Age groups( by years )
Category
14 - 24 25 - 44 45 - 54 55 or + Total
Hard-Worker 100
Employed 34.0 46 12.7 7.3 100
Independent worker 100
22.5 59.5 12.8 5.2

11 52.1 20.2 16.7

Professional 12.8 49.2 21.7 16.3 100
Non professional 16.7 100
Boss 11 52.2 20.1 17.9 100
Family worker non paid
Home 5.7 54.7 21.7 8.3 100
Others 4.8 100
Total 50.3 32.2 9.2 4.2 100
Fuente: ENAHO 1996 10.5 100
55.8 31.6 7.8

55.3 27.6 12.9

23.4 50.8 15.3

However, inside the group of adults elder than 55 years, most of them were independent
workers, employees and hard-workers. Chart 3.5

Chart 3.5 Peru: Urban population elder than 55 years distribution by occupational category,
1996

Occupational 55 or + (%)
Population
Category
Hard-Worker 13.7
Employed 14.1
Independent worker 54.3
1.6
Professional 52.7
Non professional 9.7
Boss
Family work non paid 5.6
Home 1.8
Others 0.1
NEP 0.7
100.0
Total
Source: ENAHO 1996

For 1996, the age group that worked more in the agricultural area was the one of 55
years or more, while the youths worked more in commercial locals or shops. Chart 3.6

Chart 3.6 Peru: Population's distribution by age groups and by work place, 1996

Work place Age groups ( by years )

Commercial local or shop 14 - 24 25 - 44 45 - 54 55 or more Total
At home 26.5 100
On the street (a fixed place) 15.9 53.7 13.6 6.2 100
On the street (a mobile place) 21.3 100
Transport vehicle 22.9 47.9 18.4 17.8 100
22.1 100
52.8 15.9 10

53 14.1 10.0

53 14.9 10.0

Clients home 17 54.1 16.2 12.7 100
Marketplace 22.1 48.5 14.7 14.7 100
Agricultural area 18.4 37.9 17.3 26.4 100
Others 30.3 43.3 17.9 8.5 100
Total 22.9 51.4 15.1 10.6 100

Source: ENAHO 1966

Among the group of elder than 55 years, most of them worked in commercial locals
and shops, at home and in the agricultural area. Chart 3.7

Chart 3.7 Peru: The 55 year-old urban busy population's percentage distribution and but for
age groups, according to work place, 1996

Occupational 55 or + (%)

Category Population
Commercial locals or shops 26.9
At home 25.6
On the street (fixed place) 6.1
On the street(mobile place) 8.4
Transport vehicule 6.6
Clients home 6.3
Marketplace 4.2
Agricultural area 14.3
Others 1.6
Total 100.0
Source: ENAHO 1996

3.1.4 Characteristics of the none economically active population

It is considered none economically active population the one that is not working or
isn’t looking for employment actively. The reasons for this "inactivity" are multiple, but the
most important are: waiting the beginning of a work, home tasks, being retired or
pensioner, to be sick or disabled.

In Lima City for the year 2002, the main causes of inactivity were home tasks (also
the first cause among women) and being retired or pensioner (first cause among men).
Although illness or inability were not the most important causes of inactivity, the elderly
adult group is the age group that suffers more of these causes in comparison to other
groups. Chart 3.8

Chart 3.8 Lima City: None economically active elder than 55 years population distribution,
2002

Waiting for beginning of work % Total Total Men Women
Home Tasks 0,76% 4318 77,86% 22,14%
46,33% 263335 8,42% 91,58%
Being retired or pensioner 39,57% 224913 57,52% 42,48%
Illness or disability 12,14% 68981 42,29% 57,71%
Others 1,20% 6826 73,33% 26,67%

Source: ENAHO 2002

The elderly adult population's situation in regard to the labour activity, it is limited,
due to the scarce possibilities with which they count to stay active inside the labour
environment. Also at certain age they are pressed to leave the labour status to augment the
lines of the pensioners.

This situation can generate inside this group, anxiety states, frustrations and social
area retirement, factors that impact directly in the deterioration of health.

Also, staying subject to a fixed pension that is insufficient in most of the cases,
exercises pressure inside this group to attempt their re-insertion in the labour activity, being
in some cases, staying active after arriving to the retirement age a viable perspective.

3.2 SOURCES OF INCOME

3.2.1 The contributions according to sources of labor revenues

Given the scarce existent information of this topic at national level, we should
restrict the analysis to Lima City. During the 1986-1998 period, the elder than 65 years
population's monthly income has been only lower than the one perceived by the
population's group between 35 and 64 years. Chart 3.9

Chart 3.9 Lima City: Monthly labour income by age group (In soles of June of 1994)

Age 1986-1989* 1992 1997 1998

14 - 18 years 225.50 211.77 193.05 191.55

19 - 34 years 580.03 406.65 514.02 564.97

35 - 49 years 842.81 573.38 663.41 802.52

50 - 64 years 909.30 568.81 657.38 682.46

65 or + years 621.11 469.28 340.50 300.91

All ages total 686.91 475.07 557.32 640.24

Source: Elaboración propia en base a las Encuestas de Hogares del Ministerio de

Trabajo y el INEI.

The group of people elder than 65 years received revenues below the average during
this whole period, increasing the difference notably starting from 1997; on the other hand
the group of 50 to 65 years, having been the first one in terms of perceived revenues, was
seen in second place starting from 1992.

According to the information of the National Home Survey (ENAHO) of the year
2002, the employed population of Lima city elder than 55 years perceived more incomes
that the ones of 14 to 24 years and that of 25 to 44 years. This pattern doesn't repeat in other
coastal cities; this way for example in Ica, the 55 year-old population is the age group that
perceives the highest incomes, while in Tacna this group only had higher incomes than one
of 14 to 24 years; similar pattern to the one presented in the cities of the sierra (mountain)
and the forest. Chart 3.10

Chart 3.10 Metropolitan Lima and other cities: monthly labour according to age group,
2002 (in soles of the 2002)

Coast Sierra (Mountain) Forest

Lima Ica Tacna Ayacucho Huanuco Huaraz Tarapoto

14 to 24 years 495,65 358,71 408,51 338,18 271,09 263,66 341,97

25 to 44 years 985,33 674,27 639,99 681,77 649,36 714,00 717,79

45 to 54 years 1353,91 856,42 608,07 746,87 716,81 743,00 867,79

55 years or more 1157,93 874,70 462,79 497,18 577,00 470,00 512,44

Source: Elaboración propia en base a las Encuestas de Hogares del Ministerio de Trabajo y el INEI.

In Lima City, for all the age groups, the males perceive more income that the
females. This difference that is minimum in the group of 14 to 24 years increases
progressively with the age, being observed that in the 55 or more years-old group the men
almost triplicate the incomes of the women. In other cities the difference of income for this
group is similar or smaller than the one registered in Lima, but always favouring the group
of the males. Chart 3.11

Chart 3.11 Lima City: Labour monthly income according to age group and gender, 2002 (in
Soles of the 2002)

Men Women
493,3
14 to 24 years 497,5 756,5
868,6
25 to 44 years 1159,8 508,5

45 to 54 years 1716,6

55 or more years 1482,6

Source: ENAHO, October 2002

Although a great percentage of the elderly adult’s counts with a family, mainly sons
or daughters that can most of times offer their economic support; it is one of the main
concerns of people that have passed the first half of their existence, to assure some form of
income.

However, the back of a small capital, the own housing, the investment carried out in
the education of the sons and daughters that is translated then like family help; don't always
attenuate the lacks that elder people can suffer.

3.2.2 Pensions and jubilation

Aging in Peru also means an economic deterioration, since the pensions have not
increased together with the economic inflation and is a fact that the pensioner cannot
exclusively live only with his/her pension. Most of the elderly adults appeal to the support
of their families, but that help cannot be constant in a context where the general population
income is low and with so much unemployment and poverty.

Also the labour market, hardly accepts the 60 or more years old population's
participation, being more negative for the elderly adult feminine population, many times
with the excuse that they are retired people.

The pensions constitute one of the first means to consider, when assuring a source
of income. However the establishment of social politics guided to give the benefits of the
jubilation without having the necessary sustenance, has determined an imbalance,
overloading the national systems of pensions; making the pensions insufficient for the
elderly adult’s necessities.

At the present time, Peru is in a transition stage between an allotment system
administered by the State and a system of individual capitalization of private property
(AFPs). The number of pensioners outside the economically active population has
increased from 67,700 in 1972 to 97,599 in 1981 and to 312,000 in 1993. Lima
concentrates approximately half of these people.

There is a significant increase of the minimum age of retirement in 1995. The
jubilation age in women was increased in ten years, from 55 to 65 years, and in the case of
men, increased from 60 to 65 years.

In the year 2002, 41.66% of the adult's elder than 65 years (pension beneficiaries for
jubilation) were affiliated to a pensions system. The 97% of this last group were affiliated

to the National System of Pensions (SNP) and the rest to Private pensions systems. Chart
3.12

Chart 3.12 Peru: Adults elder than 65 years, according to pension system affiliation
condition: 2002

Affiliation condition 2002
Non affiliated 58.33%
Affiliated 41.67%

National Pensions System 97.72%
Private Pensions System 2.28%
Source: INEI y ONP

A. National Pensions System

The number of affiliated pensioners to the national pensions system and other
entities whose pensioner population is administered by the Office of Previsional
Normalization (State System) can be found in chart 3.13.

Chart 3.13 Pensioner population administered by the Office of Previsional Normalization,
2002

Funds Pensioner population

Pensions National system - SNP 383737
Education ministry - MINEDU 145044
Workers Work accidents Insurance 11964
Acquired Rights Funds - FODASA 2460
Electricity Enterprise of Lima - ELECTROLIMA
Others 1125
Total 1987
Source: Oficina de Normalización Previsional (ONP) 546317

In Lima, the group of pensioners presents strong differences between men and
women. For the year 2002, 30.2% of men elder than 65 years were retired or financiers,
while only 19.38% of women of this age group perceived this rent type.

The jubilation income varies according to the legislative ordinance to which the
pensioners are under. At the moment the jubilation incomes are determined by the Law
Ordinances 19990 and 20530. The last one is no longer valid for new insured and its
restructuring is under evaluation.

Chart 3.14 Peru: Jubilation Incomes of the Population 60 or more years old, 2003

Region Average income in soles according to law

Amazonas D.L 19990 D.L 20530
Ancash
Apurímac 411.9 896.08
Arequipa
466.16 78.93
Ayacucho
Cajamarca 474.5 1006.30

Callao 585.76 1191.27
Cusco
Huancavelica 447.09 385.55
Huánuco
423.14 904.53
lca
Junín 549.85 527.36

419.09 No Dete.

485.19 1014.75

502.29 773.19

556.76 529.10

565.90 793.7

La Libertad 524.72 649.67

Lambayeque 501.57 859.77
Lima 422.44 345.49
Loreto 394.45 No Dete.

Madre de Dios 625.72 141.96

Moquegua 624.01 No Dete.
Pasco 423.40 548.33
Piura 534.05 No Dete.
Puno 456.29 683.83

San Martín 404.97 521.68

Tacna 548.98 529.70

Tumbes 412.83 1021.79

Ucayali 426.80 843.35

Source: ONP (oficina nacional de pensiones) al año 2003

B. Pensions Private System

Aside to the previous state system, the Peru has also private models of attention and
social security, in the form of Pensions Fund Administrators (AFP's). These systems are
flexible and are applied in other countries of the world. In our country this system is
institutionalized in 1995. At the moment in the Peru four AFP's works: HORIZONTE,
PROFUTURO, INTEGRA and UNION VIDA, among all had a total of 2 millions 551
thousand 503 affiliated workers for the 2001. The number of affiliated elder than 50 years
can be observed in the Chart 3.15.

Chart 3.15 Affiliation to the Pensions Private System, according to age group at
December 31, 2002

Age Groups AFP Affiliated number

From 50 to 65 years 253138

More than 65 years 11567

Total 264705

Source: Superintendencia de Administradoras Privadas de Fondos de Pensiones

3.2.3 Levels of Poverty

According to ENAHO 2001, the population in a situation of poverty reached 49.8%
of the total population of the country; and 19.5% lived in extreme poverty. The elderly
adults that live in a state of poverty were 41.7%, a little less than the national average;
however this number is still alarming. Chart 3.16

Chart 3.16 Peru: Population of 60 or more years old according to condition of poverty,
2001

Poverty Poverty Non

Extreme Non extreme Poverty

National total 49.80% 19.50% 30.30% 50.20%

Elderly adults 41.70% 17.50% 24.20% 58.30%

60 to 69 years 41.66% 17.58% 24.08% 58.34%

70 to 79 years 41.50% 16.74% 24.76% 58.50%

80 or more 42.50% 19.30% 23.20% 57.50%

Source: Condición de vida en el Perú evolución, ENAHO 1997 - 2001

3.3 GRADE OF INSTRUCTION

3.3.1 Illiteracy for age and for residence area

According to the National Home Survey (ENAHO) of the 2001; the illiteracy at
national level was of 12.1%. Adults of 60 or more years old have a rate of illiteracy of
35.4%; this is the highest rate between all the age groups. From this age group 29.3% of
illiterates are men and 70.7% are women, being most of them from the rural environment
(57.9%).

According to the census of 1993 the regions that present the highest rates of
illiteracy are Apurimac (73.9%), Ayacucho (69.2%), Cusco (61.3%), Huancavelica
(68.9%), Puno (63.9%), Pasco (52.8), Cajamarca (56.6%) and Huánuco (52.5%). These
regions concentrate 46.6% of the total of illiterate elder than 60 years. These regions also
maintain an important presence of rural population; this would evidence deficiencies as
much in covering as in educational quality in this area.

3.3.2 Average of years of study

The average of years of study reached by the population of 60 and more years,
according to data taken from ENAHO 2001, is of 4.0 years, very below the national
average that reaches 7.7 years. The year of studies average is superior in the urban area that
in the rural one (5.3 vs. 1.3). The masculine population reached an average of 4.9 years of
studies while the feminine population only achieved an average of 3.2 years.

3.3.3 Reached instruction level

The instruction level reached according to projections of the 2003 is shown In the
Chart 3.17

3.17 Peru: Reached Instruction levels, 2003 n %
705438 34.99%
3.17 0.45%
9073 42.73%
Instruction level reached 861486 13.24%
Non Level 266933 2.44%
49193
Kindergarten 4.48%
Elementary school 90322
1.67%
High school 33669 100.00%
Superior non University 2016114

University
Non specified

Total

Spurce: INEI

For 1999, only 15.9% of the elderly adult men had achieved university education,
while only 5.2% of the women of the same age group had achieved the same level. The
gender inequity has marked the differentiated access of men and women to a superior
education, this fact also determines the different participation from both genders in the
labour market and in the decisions making.

3.4 HOUSING AND COMFORT

In 1997, the 87.7% of people elder than 60 years inhabited a house of their own and
10% had additional properties to the housing that they inhabited. In the rural area of the
country, 92.2% had their own housing and 76.3% agricultural properties. Although this
population's had the security of having housing where to inhabit, there are evidences of
situations in which other members of the family make use of the property that belongs to
their parents or grandparents.

The housings of the elderly adults are in a precarious situation. According to the
ENAHO 1998, 48% of the housings inhabited by this age group only have public net
hygienic services. Equally, 25% of these housings don’t have services of water and 33% it
doesn't have electricity.

Also, only 18.8% of the elderly adult population have phone service. 10% only has
car for its particular use, 67.6% possesses television and only 35.4% have a refrigerator.

4. HEALTH INDICATORS OF THE ELDERLY ADULT POPULATION

4.1 MORTALITY

For the year 1966 the mortality gross rate was 15.6 per thousand habitants; the main
causes of death were the transmittable diseases. Almost 60.07% of all the deaths happened
to those younger than 15 years of age. (Chart 4.1)

Chart 4.1 Peru: Registered deaths by age groups and causes, 1966

Death causes

Population Transmittable Tumours Cardio Perinatal death External Others Total
diseases vascular
diseases causes causes

0 to 14 years 5062504 61411 689 288 24820 2573 17520 107241
9556 2650 1600 0 492 7507 21865
15 to 49 years 5101919 2587 1992 1231 0 4729 2917 13456
9407 6289 8332 0 1181 35941
50 to 59 years 667095 11620 11451 8975 10732 178503
82961 24820 38676
60 or more years 635707

11467225
Source: OPS/OMS - MINSA

The elder adults represented 5.54% of the peruvian population's for the year 1966,
this group had 20.13% of the deaths happened in that year; however their mortality gross
rate was of 56.54 per thousand habitants elder than 60 years. The main causes of mortality
for this age group were the transmittable diseases with 26.17%, followed by the
cardiovascular system diseases with 23.18%.

The mortality gross rate for the year 2000 was 6.15 per thousand habitants for the
general population; while for the elder adult population was 39.49 per thousand habitants.
This age group had 46.41% of the deaths happened in that year. The main cause of
mortality for the elderly adult group were the cardio-vascular diseases with 25.87%,
followed by tumours with 23.30% and in third place the transmittable diseases with 18.84%
(Chart 4.2).

Chart 4.2 Peru: Registered deaths by age and causes, 2000

Death causes

Population Transmittable Tumours Cardio Perinatal death External Others Total
diseases Vascular causes Causes
diseases

0 to 14 years 8567257 11292 1307 985 10721 5723 11458 41486
5022 2911 0 7288 7301 28632
15 to 49 years 13572989 6110 4067 2541 0 1531 4409 14517
17078 18967 0 2560 20892 73308
50 to 59 years 1664975 1969 27474 25404 10721 17102 44060 157943

60 or more years 1856469 13811

25661690 33182

Source: OPS/OMS - MINSA

There is a major change of the patterns of mortality from year 1966 to 2000; the
most significant changes are the reduction of mortality for transmittable diseases in the
general population as in the elder adult one. Chart 4.3

Chart 4.3 Peru: Indexes of mortality in elderly adult and general populations, 1966-2000

Transmittable Tumours Cardio Perinatal External Others Total
diseases Vascular death causes Causes
diseases 56.54
15.57
1966 >= 60 years 14.80 9.89 13.11 0.00 1.86 16.88 39.49
General Pop. 7.23 1.01 1.00 2.16 0.78 3.37 6.15
0.00 1.38 11.25
2000 >= 60 years 7.44 9.20 10.22 0.42 0.67 1.72
General Pop 1.29 1.07 0.99

Mortality rate per 1000 habitants
Source: OPS/OMS - MINSA

4.2 MAIN DEATH CAUSES

For 1986, the transmittable diseases and certain infections originated in the perinatal
period occupied the first places among the mortality causes; also by this year some
degenerative chronic illnesses were characteristic as main causes of death, most of all in the
aging population. The acute respiratory infections occupied the first place among the
causes of death in the general population; they were followed by the intestinal infectious
diseases and tuberculosis.

For the year 2000, the acute respiratory infections were still the first cause of
mortality for the general population. The other main causes belonged to a constellation of
damages corresponding to diverse stages of the life cycle, including the stroke and the
ischemic heart diseases on one side, and the intestinal infectious diseases, the perinatal
respiratory affections and nutritional deficiencies for another. Chart 4.4

Chart 4.4 General population’s main causes of mortality in Peru, 2000 (List 6/61 OPS
-CIE 10)

Mortality causes Mortality rate
Acute respiratory infections 70.36
Stroke 26.60
Ischemic heart diseases 24.16
Urinary system diseases (chronic renal insufficiency and others non specified) 23.20
Cirrhosis and others chronic liver diseases 21.36
Perinatal respiratory affections 21.05
Others accidents 19.51
Stomach malignant tumour 18.48
Septicaemia, except neonatal 17.48
Congenital malformations, deformities and cromosomal anomalies 17.01
Tuberculosis 15.83
Nutritional deficiencies y nutritional anaemia 15.74

Terrestrial vehicle accidents 15.01
13.72
Cardiac insufficiency 13.39

Diabetes mellitus
Mortality rate per 100000 habitants
Source: OPS/OMS Ministerio de salud

In the group of adults elder than 50 years the acute respiratory infections still are the
main cause of mortality, followed by the stroke, ischemic heart disease and the urinary
system diseases; however cancer and chronic illnesses as the diabetes mellitus have more
importance today than past ages. Chart 4.5

Chart 4.5 Peru: Adults elder than 50 years main causes of mortality, 2000 year (List
6/61 OPS -CIE 10)

Mortality Causes Mortality
Rate
Acute Respiratory Infections
Stroke 294.96
Ischemic heart diseases 163.23
Urinary system diseases (chronic renal insufficiency and others non specified) 159.39
Cirrhosis and others chronic liver diseases 127.53
Stomach malignant tumour 120.8
Diabetes mellitus 115.86
Cardiac Insufficiency 88.96
Hypertensive diseases 85.96
Septicaemia 85.79
Thraquea, bronchus and lung malignant tumours 62.62
Tuberculosis 54.84
Malignant Prostate tumour 53.25
Nutritional Deficiencies and Nutritional Anaemia 45.75
Chronic respiratory tract diseases 45.63
Mortality rate per 100000 habitants 41.57

Source: OPS/OMS Ministerio de salud

In Peru, like in other countries, the tumours have been acquiring more importance as
morbidity and mortality causes in the last decades. While the mortality gross rate has
decreased in the country, the mortality rate for this group of illnesses has stayed without
significant changes; this situation has increased their relative importance as mortality cause.
The neoplasic illnesses represented 17.5% of the elderly adults mortality causes in 1966,
while for the year 2000 were 23.29%.

The stomach malignant tumour is and has been from the second half of the 20th century
the main type of malignant neoplasia among the peruvian population. The bronchus’s and
lung tumours have displaced the malignant tumour of other parts of the uterus. Chart 4.6

Chart 4.6 Peru: Mortality Main Causes for Tumours, 2000

Main causes of mortality for tumors Mortality rate

Stomach malignant tumour 19.27
Lung and bronchus malignant tumours 8.50
Liver and biliary tract malignant tumours 7.38
Prostate malignant tumour 7.18
Uterus Neck malignant tumour 6.46
Breast malignant tumour 5.33
Non Hodgkin Lymphoma or other non specified type 4.15
Colon malignant tumour 3.85
Uterus malignant tumour; non specified part 3.50
Pancreas malignant tumour 3.32
Brain malignant tumour 3.01
Kidney malignant 1.58
Mortality Rate per 100000 habitants

Source: OPS/OMS Ministerio de salud

There is not an important difference between the mortality rate by tumours in men and
women, but there are significant differences among the neoplasia types that affect these two
population groups. Charts 4.7 and 4.8

Chart 4.7 Peruvian male elder than 50 years mortality rate for tumours, 2000

Mortality main causes Mortality rate
Stomach malignant tumour 2174
Prostate malignant tumour 1748
Lung and bronchus malignant tumour 1132
Liver and biliary tract malignant tumour 655
Non Hodgkin Linfoma of non specified type 403
Colon malignant tumour 367
Pancreas malignant tumour 358
Kidney malignant tumour, except from renal pelvis 220

Esophagus malignant tumour 201
193
Brain malignant tumour 192
177
Bladder malignant tumour
Multiple Myeloma and plasmatic cells tumours

Mortality rate per 100000 habitants
Source: OPS/OMS Ministerio de salud

Chart 4.8 Peruvian female elder than 50 years mortality rate for tumours, 2000

Mortality main causes Mortality rate
Stomach malignant tumour 2010
Uterus Cervix malignant tumour 1020
Breast malignant tumour 921
Liver and biliary tract malignant tumour 817
Lung and bronchus malignant tumours 732
Uterus malignant tumour, non specified parts 648
Colon malignant tumours 468
Pancreas malignant tumours 395
Biliary tract malign tumour of others non specified parts 325
Ovary malignant tumour 319
Non specified Hodgkin Lymphoma and of other parts 303
Gallbladder malignant tumour 292
Mortality rate per 100000 habitantes

Source: OPS/OMS Ministerio de salud

Although the mortality profile shows the differences between men and women; there
are also differences between the different levels of poverty. In the less poor population (Y-
I) the diabetes mellitus and the lung and bronchus malignant tumours acquire higher
importance like main cause of death. Of another side, in the poorest stratum (Y-V) acquire
higher importance, the nutrition deficiencies, the appendicitis and intestinal obstruction.
Chart 4.9

Chart 4.9 Peru: Elder Adults Mortality Main Causes for Socioeconomic level, 1997

Order Mortality causes MR Estrata V MR
Estrata I 376.8 Respiratory acute infections 895.4
1 Respiratory acute infections 239.3 Ischemic Heart disease 546.6
2 Ischemic heart diseases 218.5 Urinary tract diseases 401.1
3 200.5 Stomach malignant tumour 311.8
4 Stroke 304.9
5 Circulatory Lung diseases Stroke 274.2
6 165.7 257.4
7 Urinary tract diseases 150.7 Nutrition deficiencies 251.6
8 Digestive tract diseases 149.8 Intestinal Obstruction and 190.9
Stomach malignant tumour 179.4
Appendicitis
Diabetes Mellitus 114 Cirrhosis

9 Cirrhosis 106.4 Septicaemia

10 Lung malignant tumour 100.8 Hypertensive diseases

Mortality rate per 100000
Source: Cálculos por OPS a partir de los certificados de defunción, 1996 – 1998

The social security health system counts with more recent statistical information of
intra-hospital deaths; In the year 2003, the main death causes of EsSalud adults elder than
65 were the low respiratory tract infections (12.68%), followed by the hypertensive
diseases with 9.48% and stroke with 5.57%. Chart 4.10

Chart 4.10 Peru: Adults elder than 65 years main causes of intra-hospital mortality, EsSalud
2003

Death causes 65 or + 75 or
Low respiratory tract infections years +years
Hypertensive diseases 1137 12.68% 921 15.78%
Stroke 850 9.48% 550 9.42%
Diabetes mellitus 500 5.58% 352 6.03%
Cirrhosis 480 5.35% 283 4.85%
328 3.66% 153 2.62%

Chronic Obstructive Lung Disease 263 2.93% 205 3.51%

Nephritis, nephrosis 256 2.85% 125 2.14%

Stomach malignant tumour 253 2.82% 131 2.24%

Accidents 238 2.65% 165 2.83%

Ischemic heart diseases 235 2.62% 151 2.59%

Trachea, bronchus’s and lung malignant tumour 229 2.55% 122 2.09%

Other causes 4200 46.83% 2679 45.90%

Total 8969 100.00% 5837 100.00%

Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud

Although the main cause of death for those elder than 65 years that assisted to
Social Security Services are the low respiratory tract infections, as a group the transmittable
diseases occupy the third place (17.2%) in this age group, behind the cardiovascular
illnesses (21.34%) and the malignant tumours (20.5%). Chart 4.11

Chart 4.11 Peru: Social Security Adults elder than 65 years old, Mortality Main Causes by
groups of diseases, 2003

65 or + years %

Cardiovascular diseases 1914 21.34%
Malignant Tumours
Transmittable diseases 1839 20.50%
Digestive System diseases
Respiratory diseases 1542 17.20%
Genital-urinary diseases
Others 793 8.84%
Total
780 8.70%

436 4.86%

1665 18.56%

8969 100.00%

Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud

4.3 HEALTHY LIFE EXPECTANCY

A highest life expectancy doesn't necessarily mean that it lapses in a good health
state. The high frequency of functional limitations in the elderly adult population
deteriorates their quality of life; this makes indispensable to invest the maximum effort in
decreasing the morbidity and their disability. It is clear that the life expectancy is not
enough as a good health indicator, it is necessary to have an indicator that allows to plan
that proportion of life expectancy that corresponds at the time lived with disability.

In the WHO reports about the year 2001 World Health, the calculation of a healthy
life expectancy is included as an indicator of health level reached by the populations.

The healthy life expectancy at birth is equivalent to the numbers of years in
complete health that a newly born wait to live based on the current levels of bad health and
mortality in his/her country.
v

The measure of the time spent in bad health is based on a combination of the
estimates made for different health states by age and sex made by the study of various
diseases. The estimates for the peruvian population are in the chart 4.12

Chart 4.12 Peru: Healthy life expectancy, 2001

Total Men Women Healthy years Healthy life
population lost at birth expectancy lost
(percentage)

When born When born At 60 years When born At 60 years Men women men women

61 59.6 12.7 62.4 14.4 7.9 9.6 11.70% 13.30%

Source: Informe sobre salud del mundo 2001, OMS

4. 4 SECONDARY AND THIRD CARE

At Health Ministry institutions a defined geriatrics attention is almost not existent;
some few hospitals have geriatrics services whose functions are limited to the outpatient
practice and the answer of the inter-consults of the specialty. The geriatric patient that
requires hospitalization passes to internal medicine services. It is considered that the 30% to
40% of the beds of these services are occupied by this group of patients.

About rehabilitation, most of hospitals of the Health Ministry have this type of
service. There are rehabilitation centers that offer attention to the general population,
including the elderly adult population; the most important of these centers is the Peruvian
National Institute of Rehabilitation. In the year 1999 assisted 1743 elderly adults, the
67.1% were women. Chart 4.13

Chart 4.13 Elderly Adult Population with problems of the locomotive apparatus, consult
and attentions in the National Institute of Rehabilitation, 1999

Gender Number ofr Attentions Number of Consults

Total N% N%
Men
Women 1743 100% 4493 100%
Source: INEI
573 32.90% 1385 30.80%

1170 67.10% 3108 69.20%

On the other hand, the Social Security (EsSalud) and the health services of the
Army Forces have been creating diverse geriatrics assistance levels with the purpose of
satisfying the necessities of their users, they have Domiciliary Attention Programs; as well
as Geriatrics Attention Units, Outpatient consults, Day Hospital and Acute Cases Attention
Units in their hospitals of higher levels.

The Social Security (EsSalud) assistance levels can be seen in the Chart 4.14, some
of these levels are exclusive of the Hospital Guillermo Almenara Irigoyen.

Chart 4.14 Assistance Geriatrics Levels, EsSalud

Assistance level Centros de Salud
Guillermo Almenara Irigoyen Hospital
Acute Hospitalization Unit Assistance Health Center
Hospitalization Unit Guillermo Almenara Irigoyen Hospital
Day Hospital San Isidro Labrador Clinic
Medium care hospitalization unit Level IV Clinic
Long care hospitalization unit Assistance Health Center
Geriatrics outpatient office Assistance Health Center
Health attention program PADOMI
Domiciliary attention program Elderly adult health center
Basic attention unit Assistance Health Center
Complementary medicine
Source: EsSalud

EsSalud and the Armed forces also have rehabilitation services in their main
assistance centers, their programs of domiciliary visits also offer these services. In the chart
4.15 is a report of the activities and resources of the Visits of EsSalud Domiciliary Program
for March, 2004.

Chart 4.15 Social Security (EsSalud), Domiciliary Program Activities and Resources,
March 2004

Activities and resources Visits Consults Continued Number of
(N+R) attentions professionals
Domiciliary program 22970
General Domiciliary Medic Visit 4580 881 20604 122
Specialized Domiciliary Medic Visit 7928 2105 1539 31
Domiciliary Nurse Visit 13484 381 1618 48
Domiciliary Rehabilitation Visit 783 435 3127 69
Domiciliary Psychology Visit 437 267 467 5
Domiciliary Social Service Visit 426 9 5
Source: Padomi

4.5 MORBILITY RATES

Health Ministry Morbidity

The highest causes of morbidity registered by the peruvian health ministry system
are the respiratory system diseases, followed by the osteum muscular and connective tissue
diseases and the nervous and senses system diseases. Chart 4.16

Chart 4.16 Elderly adult population's morbidity diagnosis by programmatic damage,
MINSA 1998

Diagnosis TOTAL MEN WOMEN
PROGRAMMATIC DAMAGE
Respiratory System Diseases 169,904 69,296 100,608
Osteum muscular and connective tissues diseases 136,180 48,236 87,944
Nervous and senses system diseases 83,979 36,072 47,907
Trauma and poisoning 69,923 36,384 33,539
Dysentery and gastroenteritis 66,778 28,072 38,706
Oral cavity diseases 53,838 25,334 28,504
Skin diseases 39,289 17,088 22,201
Mental illnesses 28,133 8,808 19,325
Diabetes mellitus 12,172 3,649 8,523
Cancer 9,805 4,460 5,345

Mycosis 8,557 3,391 5,166
8,418
Helmintiasis 7,757 3,345 5,073
4,168 4,109 3,648
Tuberculosis 2,854
1,265 1,676 2,492
Ischemic Heart Diseases 735 1,077 1,777
Nutrition deficiencies 628 495 770
Typhoid Fever 461
331 300 435
Congenital anomalies 94,550 342 286
Cholera 88,677 304 157
Sexual transmittion diseases 174 157
Virus Hepatitis 35,348 59,202
Other diseases of the circulatory system 33,727 54,950
Other diseases of the gastrointestinal apparatus

Diseases of the genital urinary apparatus 83,624 34,099 49,525

Non defined symptoms and signs 46,265 18,303 27,962
Other parasites 23,933 11,115 12,818
Blood and other haematopoietic organ diseases 17,591 6,055 11,536
Other external causes
Other metabolism and endocrine diseases 10,486 6,109 4,377
Tetanus, Sarampion 9,550 1,744 7,806
11 8 3
TOTAL 1,079,862 439,120 640,742

Source: INEI

The elderly adult outpatient attention causes by illness groups for the year 2002 are
in the Chart 4.17, the first cause of consults were the respiratory system diseases, followed
by the osteum muscular system diseases.

Chart 4.17 Elderly adult outpatient attention causes of attention, MINSA 2002

Group diseases Total Men Women
40.00% 60.00%
Respiratory system diseases 15.14% 37.00% 63.00%
36.00% 64.00%
Osteum muscular diseases 13.50% 37.00% 63.00%
42.30% 57.70%
Circulatory system diseases 8.79% 41.75% 58.25%

Digestive apparatus diseases 7.88%

Genital urinary system diseases 7.70%

Rest of Diseases 46.99%

Source: Oficina de Estadística e Informática - MINSA

Social Security (EsSalud) Morbility

EsSalud registered a total of 4650035 outpatient attentions for the general
populations in the year 2003, of these 33.15% belonged to adults elder than 65 years. The
first morbidity cause was the primary arterial hypertension, followed by the arthrosis and
other dorsopathies. 55,9% of the Primary Hypertension cases belong to this age group.
Chart 4.18

Chart 4.18 EsSalud Outpatient Office Attentions Profile, 2003

65 years General %of cases that affect
or more % Population the population elder
Total than 65 year old

Essential Hypertension (primary) 123387 8,00% 220735 55,90%

Arthrosis 82738 5,37% 167514 49,39%

Other dorsopathies 53681 3,48% 278668 19,26%

Other skin and connective tissues diseases 47977 3,11% 283680 16,91%

Acute pharyngitis and amygdalitis 46729 3,03% 596464 7,83%

Prostatic Hyperplasia 46085 2,99% 75624 60,94%

Diabetes mellitus 44653 2,90% 105083 42,49%

Gastritis y duodenitis 41842 2,71% 200202 20,90%

Glaucoma 39991 2,59% 62690 63,79%

Cataract and other crystalline problems 31915 2,07% 40455 78,89%

Soft tissue problems 31484 2,04% 132922 23,69%

Others 951201 61,70% 2637813 43,28%

Total 1541683 100,00% 4650035 33,15%

Source: Sistemas de Información y vigilancia epidemiológica, Gerencia de prestaciones-EsSalud

EsSalud registered a total of 2699672 attentions in the emergency services in the
year 2003. Of these, 14.62% belonged to adults elder than 65 years. The Primary Arterial
Hypertension was the elderly adult’s first cause of consultation. Chart 4.19

Chart 4.19 EsSalud Emergency Services Attentions Profile, 2003

Essential Hypertension (primary) 65 years General %of cases that affect the
Other trauma or more % Population population elder than 65
Abdominal and pelvic pain 32694 8,28% Total year old
Diarrheic and gastroenteritis of infectious origin 26766 6,78% 66535 49,14%
Acute Pharyngitis and Amygdalitis 22393 5,67% 186823 14,33%
Others dorsopathies 18675 4,73% 150884 14,84%
Asthma 17697 4,48% 144351 12,94%
Acute Bronchitis 14874 3,77% 274656 6,44%
Other urinary system diseases 12638 3,20% 85496 17,40%
Fever of unknown origin 10357 2,62% 121466 10,40%
Other ear and mastoid apophysis diseases 10017 2,54% 82158 12,61%
9176 2,33% 65196 15,36%
7463 1,89% 146605 6,26%
30819 24,22%

Other acute respiratory infectious diseases 6880 1,74% 115606 5,95%

Other 205004 51,95% 1229077 16,68%

Total 394634 100,00% 2699672 14,62%

Source:Sistemas de Información y vigilancia epidemiológica,Gerencia de prestaciones-EsSalud

EsSalud Hospitalization Services registered a total of 352332 users in the year 2003;
of them 20.49% were adults elder than 65 years. Pneumonia was their first cause of
hospitalization, followed by the cholecistitis, cholelitiasis and the prostatic hyperplasia.
Chart 4.20

Chart 4.20 EsSalud Hospitalization Services Attentions Profile, 2003

65 years or General %of cases that affect the
Population population elder than 65
more % Total year old
37,44%
Pneumonia 3669 5,08% 9799 21,57%
70,58%
Cholelitiasis and cholecistitis 3291 4,56% 15254 35,91%
54,36%
Prostatic Hyperplasia 3095 4,29% 4385 68,18%

Other urinary system diseases 2647 3,67% 7371 37,35%
67,74%
Other respiratory system diseases 2070 2,87% 3808 36,88%
48,82%
Septicaemia 2066 2,86% 3030 50,92%
67,61%
Others symptoms, signs y abnormal clinical 59,15%
15,13%
findings 1963 2,72% 5255 20,49%

Cardiac Failure 1953 2,71% 2883

Inguinal Hernia 1911 2,65% 5182

Diabetes mellitus 1836 2,54% 3761

Others digestive apparatus diseases 1716 2,38% 3370

Femur Fracture 1570 2,17% 2322

Others ischemic heart diseases 1542 2,14% 2607

Others 42869 59,38% 283305

Total 72198 100,00% 352332

Source:Sistemas de Información y vigilancia epidemiológica,Gerencia de prestaciones-EsSalud

EsSalud domiciliary attention program (PADOMI), presents as first morbidity cause
essential hypertension (18.97%), followed by osteoarthrosis and urinary tract infections.
Chart 4.21

Chart 4.21 PADOMI Morbility Causes, March - 2003

Causes Number. Of %
attentions
Essential Hypertension (primary)
Generalized Primary Osteoathrosis 5249 18,97%
Urinary tract infections
Parkinson Disease 1048 3,79%
Chronic Gastritis, non specified
634 2,29%

513 1,85%

423 1,53%

Chronic Bronchitis, non specified 361 1,30%
Dementia, non specified 327 1,18%
Stroke Sequels 321 1,16%
Acute Pharyngitis, non specified 304 1,10%
Cardiovascular diseases sequels 275 0,99%
Pressure Ulcers 272 0,98%
Other general controls 6079 21,97%
Others 11867 42,88%
Source EsSalud: Padomi, 2003

4.6 CHRONIC DISABILITY

For the year 2003, 1.3% of the total population had some type of disability, while
the elderly adult population had almost quadrupled the general population's value. Chart
4.22

Chart 4.22 Peru: Disability type distribution. 2003

Total population %of population Blindness Deafness Mutest Mental Mental Invalid Othes
60 to 64 years old 20,90% 14,40% 6,70% Retard Problems 28,00% 7,90%
Elder than 65 years with disability 12,40% 9,80%
1,30%
5,30% 17,10% 32,10% 2,00% 3,10% 5,60% 30,60% 9,60%
23,10%

Source: INEI Censo de población 1993

CONADIS is a public organism of the Woman and Social Development Ministry
that has as function to promote the execution of the law of people with disability, as well as
the establishing of national multisector politics for the people with disability in order to
contribute to their social, economic and cultural integration process. This organism
registered for the year 2003, 2263 elderly adults with some type of disability, the
distribution by gender and type of disability can be seen in the chart 4.23

Chart 4.23 CONADIS: Registered Elderly Adults distribution according to disability type.
2003

Population Behaviour Communication Self-care Locomotion Body Dexterity Situation

Registered l 248 313 205
89 96 86
Men 1693 44 186 180 517 337 409 291

Women 570 13 74 53 159

Total 2263 57 260 233 676

Source: Gerencia de Sistemas, Identificación y estadística – CONADIS

4.7 FUNCTIONAL CAPACITY; basic activities of daily life (ADLs)

Few peruvian works evaluate the activities related to the daily life in the
community. Recently Varela and collaborators carried out a national hospitalary study that
evaluates this indicator as part of a integral geriatric assessment. This study found that 53%
of the elderly adults were independent two weeks before their hospitalization ( 0 score in
the scale of Katz), 30% were partial dependent (score between 1 at 5) and 17% were
dependent total ( 6 score in the scale of Katz). Graph 4.1

Graph 4.1 Functionality in patients two weeks before their hospitalization, 2003

Functionality by KATZ

17% Autonomy

53% Partial
Dependence
30%
n = 400 Total
Dependence

Source: Valoración Geriátrica Integral en Adultos Mayores Hospitalizados a Nivel Nacional, 2003; Diagnostico Vol
43, Num 2, Marzo-Abril 2004

Another important work was the Trujillo county Elderly Adults Profile carried out
by Leiton, Villanueva, and collaborators among the years 1999 and 2000; the study had a
sample of 681 elderly adults and the instrument for gathering information was a survey
elaborated by the PAHO/WHO (1990) adapted to the Peruvian reality. It evaluates
economic characteristic, health risks and problems; among them the levels of independence
to carry out activities of daily life.

According to the results of this study, the elderly adults present levels of
independence in basic activities of the daily life of 82% for men and 76.4% for women.
Also found that in this population there is a decrease in independence as the age increase.
However, the dependence in the men began at 85 years, while in women started at 75 years.
Chart 4.24

Chart 4.24 Trujillo, Basic Activities of the Daily Life by age and gender, 1999 -2000

60 - 74 years 75 - 79 years 80 - 84 years 85 or + years

Men 0.00% 0.00% 0.00% 16.70%

Women 0.00% 8.00% 3.00% 14.00%

Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000

Besides the previous studies, there are other smaller studies in hospitalized patients,
national health clinics and localized communities; most of these studies used as instrument
the Katz Test . Chart 4.25

Chart 4.25 Elderly Adults Functionality Studies, Peru

Year Researcher Place N Age group Origin Results
1990 Chu, M Lima 913 + 65 years Outpatient with 50% Lima were independent
1998 Sandoval, L Cusco 168 + 60 years Social Insurance 25% Cusco were independent
168 + 60 years Outpatient and 77.3% Outpatient independent
Varela, L Lima 130 + 60 years Hospitalized 59.5% Hospitalizes independent
60 + 60 years Outpatient and 22.4% ADLs dependent
1999 Hardy,G Lima Hospitalized 40.3% ADLs dependent
Hospitalized 77% functional dependence
2000 Varela, P Lima
Sillicani, A Lima Outpatient and 13.4% Outpatient dependent
Hospitalized 50% Hospitalized dependent
2000 Villar, D Higher levels of dependence in the
Varela, L Elderly adult club asylums patients
Asylums
2001 Ruiz, W Lima 100 + 60 years Health campaign 40% functional dependence

2002 Lisigurski,M Barranca 90 + 60 years
Varela, L

4.8 INSTRUMENTAL ACTIVITIES OF THE DAILY LIFE

In Peru there are only a few studies about the instrumental activities of the daily life.
In the elderly adult’s profile of Trujillo county, the levels of independence in instrumental
activities of the daily life are also found in a high frequency, although in smaller proportion
than the dependence levels in basic activities. Chart 4.26

Chart 4.26 Trujillo, Instrumental Daily Life Activities by age and gender, 1999 - 2000

60 - 64 years 65 - 74 years 75 – 79 years 80 - 84 years 85 or + years
33.00%
Men 0.00% 0.00% 8.00% 3.00% 53.00%

Women 0.00% 4.00% 4.00% 23.00%

Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000

4.9 RISK FACTORS FOR NON TRANSMISIBLES CHRONIC ILLNESSES

Although a few national studies about risk factors for chronic illnesses exist for the
general population, few make emphasis in the elderly adult population and generally take
this age group like part of the one of all the adults.

Noxious habits

Smoking

According to the Pan American Health Organization the smoking prevalence in
Peru in the population between 12 and 50 years is 41.5% for males and 15.7% for women.
According to the 2002 Lima City Epidemiology Study of the National Institute of Mental
Health Hideyo Noguchi, the life prevalence of tobacco use is 69.5% (84.1% males and
56.2% women) and the annual prevalence of tobacco dependence is 1.9% (3.3% males and
0.5% women) for the general population.

According to the national survey of prevention and use of drugs of 1999, the
tobacco dependence in the age group between 17 and 40 years was 9.3% to 10.4%, and
3.9% for the adults among 60 to 64 years. This study doesn't make reference to the
population elder than 65 years but it is considered that the prevalence should be smaller
than the one of the last group. The results can be observed in the Chart 4.27

Chart 4.27 Peru: Tobacco Dependence, Contradrogas, 1999

12 to 13 14 to 16 17 to 19 20 to 40 41 to 59 60 to 64
1.60% 9.30% 10.40% 6.20% 3.90%
Total 0.80% 2.30% 16.60% 15.90% 9.10% 5.60%
0.90% 2.80% 5.80% 4.20% 2.90%
Men 0.30%

Women 1.40%

Source. Contradrogas, 1999

Alcoholism

In Peru, it is considered that the percentage of alcoholism is higher than 10% in the
adult population, especially in the males and in the rural area. According to Contradrogas,
in Peru the age group with more alcoholic dependence is the one between 20 to 40 years,
however the groups among 41 to 64 years present an important prevalence, in males
mostly. Chart 4.28

Chart 4.28 Peru: Alcohol Dependence, Contradrogas, 1999

Total 12 to 13 14 to 16 17 to 19 20 to 40 41 to 59 60 to 64
Men 1.00% 3.00% 11.50% 13.50% 7.30% 7.20%
Women 1.60% 4.30% 19.00% 21.60% 12.50% 18.80%
0.00% 1.60% 4.70% 7.00% 3.50% 0.00%

Source. Contradrogas, 1999

Other noxious habits

In the Trujillo County Elderly Adult profile a 56.2% of the elderly adult population
consumed coffee, a 44.9% fat and 20.6% salt; it is also appreciated that although this
consumption is high in the elderly adults, it becomes smaller as the age increases. Chart
4.27

Chart 4.27 Trujillo, Presence of noxious habits: coffee, fat and salt in the elderly adult by
age and gender, 1999 - 2000

60 - 64 years 65 - 69 years 70 - 74 years 75 - 79 years 80- 84 years 85 + years

Coffe 53.00% 47.00% 45.00% 39.00% 19.00% 36.00%

Fat 50.00% 45.00% 41.00% 48.00% 37.00% 37.00%

Salt 23.40% 17.00% 25.00% 21.00% 17.00% 12.00%

Source: Perfil del adulto mayor en la provincia de Trujillo, 1999-2000

Physical Activity

According to Seclen-Palacin and Jacobi study, that was based on the information of
the National Home Survey of the year 1997. Only 11.6% of the population elder than 18
years old had physical activity in a daily or inter-daily frequency, a higher proportion was
found in men that in women; 53.7% of the population didn't practice sports. The age group
that practiced more regular sport activities (daily or inter-daily) was the one of men
between 50 to 55 years (20%) and for women the group of 40 to 45 years (18%).

The 11.4% of those interviewed was 60 or more years old, of this group only 13.5%
of the males had regular sport activity and 47.7% didn't practice any sport, while in the
group of women 6.6% had a daily or inter-daily physical activity and a 61.4% didn't
practice any sport. Chart 4.28

Chart 4.28 Frequency of Regular Sport Activities in the urban population, by age group and
gender. Peru 1997

Frecuency Age groups (years) >=60 Total
Daily 15 - 19 20 - 29 30 -44 45-49 % 8,20
% % %%
Men ( n = 21798) 9,90
7,00 5,60 9,20 10,70