Dr Paul Kowal

Dr Paul Kowal

Conjoint Senior Lecturer

School of Medicine and Public Health

Career Summary

Biography

My early career focused on clinical geriatric care, shifting to clinical research, then public health, gerontology & epidemiology of ageing, before moving to my current areas of foci on global health and health system responses to demographic and epidemiologic shifts.

I continue to pursue a better understanding of national, regional and international adult health and well-being, and health care utilization, by addressing data gaps through coordinating primary data collection and fostering numerous research collaborations. obal health & health systems. 

Currently Conjoint Senior Lecturer/Research Fellow in University of Newcastle's Research Centre for Generational Health and Ageing, PI of WHO's multi-country SAGE & Senior Research Adviser at CMU-RIHES. Ongoing consultancies with numerous organizations.
ORCID orcid.org/0000-0002-6314-8753. 
Scopus ID: 55800049400. 

Researchgate: www.researchgate.net/profile/Paul_Kowal2


Qualifications

  • Doctor of Pharmacy, University of Washington
  • Bachelor of Science (Pharmacy), University of Wisconsin - USA
  • Graduate Certificate in Geriatric Pharm Prac &Educ, University of Washington
  • Master of Science, University of Minnesota - USA

Keywords

  • Ageing
  • global health
  • health system strengthening research

Languages

  • English (Mother)

Fields of Research

Code Description Percentage
160807 Sociological Methodology and Research Methods 25
111799 Public Health and Health Services not elsewhere classified 50
160399 Demography not elsewhere classified 25

Professional Experience

Academic appointment

Dates Title Organisation / Department
1/10/2017 -  Senior Research Advisor

I have an appointment in CMU-RIHES as Senior Research Advisor, while also retaining my other affiliations and roles - including at the University of Newcastle Priority Research Centre for Generational Health and Ageing - and applying for consultancies on a competitive basis.

Chiang Mai University
Research Institute for Health Sciences
Thailand
6/01/2008 -  Conjoint Senior Lecturer/Research Fellow

I worked for a number of years as a Research Fellow in RCGHA before moving to Conjoint status - and have continued to work with Prof Julie Byles and her team on a number of domestic, regional and international projects on ageing and health. 

University of Newcastle - Faculty of Health and Medicine, School of Medicine and Public Health
Australia

Professional appointment

Dates Title Organisation / Department
1/01/1999 -  Principal Investigator

I am a Principal Investigator of the multi-country longitudinal Study on global AGEing and adult health (SAGE), with my colleague Somnath Chatterji, and coordinator of the multiple sub-studies that this includes.

World Health Organization
Switzerland

Awards

Research Award

Year Award
2016 Network for International Longitudinal Studies on Ageing (NILSA).
Umea University
Edit

Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Chapter (2 outputs)

Year Citation Altmetrics Link
2013 Gorrindo T, Chatterji S, Kowal P, Epstein Z, Weinstein M, 'A cross-country comparison of sociodemographic correlates of depression in the WHO study of global aging and adult health (SAGE)', Applied Demography and Public Health 45-60 (2013)

© Springer Science+Business Media Dordrecht 2013. Depressive disorders are the leading cause of the burden of disease in both middle- and high-income countries (Mathers et al. 200... [more]

© Springer Science+Business Media Dordrecht 2013. Depressive disorders are the leading cause of the burden of disease in both middle- and high-income countries (Mathers et al. 2008). With the exception of the African region ¿ where infectious and diarrheal diseases continue to dominate ¿ depressive disorders rank among the top ten causes of disease burden in all WHO regions; globally, they are projected to be the single most important cause in 2030. Alleviating the personal suffering and reducing the economic costs and consequences of this group of disorders is a growing concern and focus for intervention. Relative to physical conditions, psychiatric disorders have been shown to be more disabling and less likely to be treated in some parts of the world (Suliman et al. 2010).

DOI 10.1007/978-94-007-6140-7_4
2006 Velkoff VA, Kowal P, 'Aging in Sub-Saharan Africa: The Changing Demography of the Region', Aging in Sub-Saharan Africa: Recommendations for Further Research, The National Academies Press, Wahington, United States of America 55-91 (2006) [B1]
Citations Scopus - 14

Journal article (115 outputs)

Year Citation Altmetrics Link
2018 Charlton KE, Ware LJ, Baumgartner J, Cockeran M, Schutte AE, Naidoo N, Kowal P, 'Iodine Status Assessment in South African Adults According to Spot Urinary Iodine Concentrations, Prediction Equations, and Measured 24-h Iodine Excretion.', Nutrients, 10 (2018)
DOI 10.3390/nu10060736
2018 Goldman EA, Eick GN, Compton D, Kowal P, Snodgrass JJ, Eisenberg DTA, Sterner KN, 'Evaluating minimally invasive sample collection methods for telomere length measurement', AMERICAN JOURNAL OF HUMAN BIOLOGY, 30 (2018)
DOI 10.1002/ajhb.23062
2018 Werfalli M, Kassanjee R, Kalula S, Kowal P, Phaswana-Mafuya N, Levitt NS, 'Diabetes in South African older adults: prevalence and impact on quality of life and functional disability¿as assessed using SAGE Wave 1 data', Global Health Action, 11 1-11 (2018) [C1]
DOI 10.1080/16549716.2018.1449924
2018 Ralston M, Schatz E, Naidoo N, Kowal P, 'Including Older Adults in Development Goals: Is Subjective Wellbeing the Answer? A Case Study of Older South Africans', Journal of Development Studies, 54 702-718 (2018) [C1]
DOI 10.1080/00220388.2017.1311406
2017 Brennan-Olsen SL, Cook S, Leech MT, Bowe SJ, Kowal P, Naidoo N, et al., 'Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: Analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) Wave 1', BMC Musculoskeletal Disorders, 18 1-12 (2017) [C1]
DOI 10.1186/s12891-017-1624-z
Citations Scopus - 1
2017 Awoke MA, Negin J, Moller J, Farell P, Yawson AE, Biritwum RB, Kowal P, 'Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana', Global Health Action, 10 1-11 (2017) [C1]
DOI 10.1080/16549716.2017.1301723
Citations Scopus - 1
2017 Menyanu E, Charlton KE, Ware LJ, Russell J, Biritwum R, Kowal P, 'Salt use behaviours of ghanaians and south africans: A comparative study of knowledge, attitudes and practices', Nutrients, 9 1-13 (2017) [C1]
DOI 10.3390/nu9090939
2017 Mugisha JO, Schatz EJ, Negin J, Mwaniki P, Kowal P, Seeley J, 'Timing of Most Recent Health Care Visit by Older People Living with and Without HIV: Findings from the SAGE Well-Being of Older People Study in Uganda', International Journal of Aging and Human Development, 85 18-32 (2017) [C1]

© The Author(s) 2016. The objective of this article is to document factors associated with the recency of health-care service utilization by people aged 50 years and over living w... [more]

© The Author(s) 2016. The objective of this article is to document factors associated with the recency of health-care service utilization by people aged 50 years and over living with and without HIV in Uganda. A survey was conducted with 510 Ugandans aged 50 and older, living with and without HIV. The survey included information on sociodemographic characteristics, health state, self-reported chronic conditions, and timing of most recent visit to a health-care facility (time since last visit [TSLV]). We use ordinal logistic regression to identify independent factors associated TSLV. Independent factors associated with TSLV ( > 6 months) include age, OR = 2.40 [95% CI 1.08-5.37] for those aged 80 years and above, urban respondents, OR = 0.6 [95%CI 0.38-0.94] , HIV-positive respondents, OR = 0.33 [95%CI 0.18-0.59], and better health. To understand the meaning of these finding, further investigation should examine (a) h ow best to define and measure older persons' health-care service needs and (b) older persons' decision-making processes around the timing of their access to health-care facilities.

DOI 10.1177/0091415016680071
2017 Schrock JM, McClure HH, Snodgrass JJ, Liebert MA, Charlton KE, Arokiasamy P, et al., 'Food insecurity partially mediates associations between social disadvantage and body composition among older adults in india: Results from the study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF HUMAN BIOLOGY, 29 (2017) [C1]
DOI 10.1002/ajhb.23033
Citations Scopus - 1
2017 Eick GN, Kowal P, Barrett T, Thiele EA, Snodgrass JJ, 'Enzyme-Linked Immunoassay-Based Quantitative Measurement of Apolipoprotein B (ApoB) in Dried Blood Spots, a Biomarker of Cardiovascular Disease Risk', Biodemography and Social Biology, 63 116-130 (2017) [C1]

© 2017 Society for Biodemography and Social Biology. Apolipoprotein B (ApoB) is a strong predictor of cardiovascular disease, which remains the leading cause of mortality in both ... [more]

© 2017 Society for Biodemography and Social Biology. Apolipoprotein B (ApoB) is a strong predictor of cardiovascular disease, which remains the leading cause of mortality in both higher and lower income countries. Here, we adapted an enzyme-linked immunosorbent assay (ELISA) development kit for quantitative determination of ApoB levels in serum and plasma for use with dried blood spots (DBS). After confirming the dilution linearity of the assay for DBS, we measured ApoB in 208 venous DBS samples. Then, using Passing-Bablok regression analysis and Spearman rank correlation analysis, we evaluated the correspondence in ApoB values between matched plasma and finger-pri ck DBS samples from 40 individuals who had ApoB values spanning the range of ApoB values observed in the 208 vDBS samples. We also evaluated assay precision and recovery, the effects of hematocrit, number of freeze-thaw cycles, and different storage temperatures on ApoB levels in DBS. There was a strong, significant correlation between plasma and DBS ApoB levels with little bias. Assay precision and recovery were within the range recommended by the U.S. government¿s industry guidelines for bioanalytical assay validation. The assay was not affected by the DBS matrix or physiological hematocrit levels. This DBS-based ELISA assay will facilitate population-scale assessment of cardiovascular risk in previously unexplored populations.

DOI 10.1080/19485565.2017.1283582
2017 Cabello M, Miret M, Caballero FF, Chatterji S, Naidoo N, Kowal P, et al., 'The role of unhealthy lifestyles in the incidence and persistence of depression: A longitudinal general population study in four emerging countries', Globalization and Health, 13 1-8 (2017) [C1]
DOI 10.1186/s12992-017-0237-5
Co-authors Catherine Deste
2017 Lin H, Guo Y, Kowal P, Airhihenbuwa CO, Di Q, Zheng Y, et al., 'Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries', British Journal of Psychiatry, 211 157-162 (2017) [C1]

© The Royal College of Psychiatrists 2017. Background: Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countri... [more]

© The Royal College of Psychiatrists 2017. Background: Little is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries. Aims: To investigate the effects of exposure to ambient fine particulate matter pollution (PM 2.5 ) and smoking and their combined (interactive) effects on depression. Method: Multilevel logistic regression analysis of baseline data of a prospective cohort study (n=41 785). The 3-year average concentrations of PM 2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression. Results: The odds ratio (OR) for depression was 1.09 (95% Cl 1.01-1.17) per 10µg/m 3 increase in ambient PM 2.5 , and the association remained after adjusting for potential confounding factors (adjusted OR=1.10, 95% CI 1.02-1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM 2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model. Conclusions: Our study suggests that exposure to ambient PM 2.5 may increase the risk of depression, and smoking may enhance this effect.

DOI 10.1192/bjp.bp.117.202325
Citations Scopus - 2Web of Science - 1
2017 Ware LJ, Charlton K, Schutte AE, Cockeran M, Naidoo N, Kowal P, 'Associations between dietary salt, potassium and blood pressure in South African adults: WHO SAGE Wave 2 Salt & Tobacco', Nutrition, Metabolism and Cardiovascular Diseases, 27 784-791 (2017) [C1]
DOI 10.1016/j.numecd.2017.06.017
2017 Negin J, Randell M, Raban MZ, Nyirenda M, Kalula S, Madurai L, Kowal P, 'Health expenditure and catastrophic spending among older adults living with HIV', Global Public Health, 12 1282-1296 (2017) [C1]

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased ris... [more]

© 2016 Informa UK Limited, trading as Taylor & Francis Group. Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health utilisation and expenditure among HIV-positive and HIV-negative adults over 50. Methods: Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents. Results: HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p =.03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8; p < .001) and respondents from rural settings (OR 2.9; p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care. Conclusions: These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services¿which can inform South Africa¿s development of a national health insurance scheme.

DOI 10.1080/17441692.2016.1173717
2017 Arokiasamy P, Uttamacharya, Kowal P, Capistrant BD, Gildner TE, Thiele E, et al., 'Chronic noncommunicable diseases in 6 low- and middle-income countries: Findings from wave 1 of the world health organization's Study on Global Ageing and Adult Health (SAGE)', American Journal of Epidemiology, 185 414-428 (2017) [C1]

© The Author 2017. In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, ... [more]

© The Author 2017. In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged =50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: Angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

DOI 10.1093/aje/kww125
Citations Scopus - 11Web of Science - 9
Co-authors Julie Byles
2017 Lambert SD, Bowe SJ, Livingston PM, Heckel L, Cook S, Kowal P, Orellana L, 'Impact of informal caregiving on older adults' physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO's Study on global AGEing and adult health (SAGE).', BMJ open, 7 e017236 (2017)
DOI 10.1136/bmjopen-2017-017236
2017 Gomez-Olive FX, Schröders J, Aboderin I, Byass P, Chatterji S, Davies JI, et al., 'Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration.', BMJ global health, 2 e000508 (2017)
DOI 10.1136/bmjgh-2017-000508
2017 Lin H, Guo Y, Di Q, Zheng Y, Kowal P, Xiao J, et al., 'Ambient PM

© 2017 American Heart Association, Inc. Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM 2.5 ) has been linked to increased stroke. Few studi... [more]

© 2017 American Heart Association, Inc. Background and Purpose - Short-term exposure to ambient fine particulate pollution (PM 2.5 ) has been linked to increased stroke. Few studies, however, have examined the effects of long-term exposure. Methods - A total of 45 625 participants were interviewed and included in this study, the participants came from the Study on Global Ageing and Adult Health, a prospective cohort in 6 low- and middle-income countries. Ambient PM 2.5 levels were estimated for participants' communities using satellite data. A multilevel logistic regression model was used to examine the association between long-term PM 2.5 exposure and stroke. Potential effect modification by physical activity and consumption of fruit and vegetables was assessed. Results - The odds of stroke were 1.13 (95% confidence interval, 1.04-1.22) for each 10 µg/m 3 increase in PM 2.5 . This effect remained after adjustment for confounding factors including age, sex, smoking, and indoor air pollution (adjusted odds ratio=1.12; 95% confidence interval, 1.04-1.21). Further stratified analyses suggested that participants with higher levels of physical activity had greater odds of stroke, whereas those with higher consumption of fruit and vegetables had lower odds of stroke. These effects remained robust in sensitivity analyses. We further estimated that 6.55% (95% confidence interval, 1.97%-12.01%) of the stroke cases could be attributable to ambient PM 2.5 in the study population. Conclusions - This study suggests that ambient PM 2.5 may increase the risk of stroke and may be responsible for the astounding stroke burden in low- and middle-income countries. In addition, greater physical activity may enhance, whereas greater consumption of fruit and vegetables may mitigate the effect.

DOI 10.1161/STROKEAHA.116.015739
Citations Scopus - 16Web of Science - 10
2017 Murphy A, Kowal P, Albertini M, Rechel B, Chatterji S, Hanson K, 'Family transfers and long-term care: An analysis of the WHO Study on global AGEing and adult health (SAGE)', Journal of the Economics of Ageing, (2017)

© 2017 The Authors. Background: Populations globally are ageing, resulting in increased need for long-term care. Where social welfare systems are insufficient, these costs may fal... [more]

© 2017 The Authors. Background: Populations globally are ageing, resulting in increased need for long-term care. Where social welfare systems are insufficient, these costs may fall to other family members. We set out to estimate the association between long-term care needs and family transfers in selected low- and middle- income countries. Methods: We used data from the World Health Organization's Study on global AGEing and adult health (SAGE). Using regression, we analysed the relationship between long-term care needs in older households and i) odds of receiving net positive transfers from family outside the household and ii) the amount of transfer received, controlling for relevant socio-demographic characteristics. Results: The proportion of household members requiring long-term care was significantly associated with receiving net positive transfers in China (OR: 1.76; p = 0.023), Ghana (OR: 2.79; p = 0.073), Russia (OR: 3.50; p. < . 0.001). There was a statistically significant association with amount of transfer received only in Mexico (B: 541.62; p = 0.010). Conclusion: In selected LMICs, receiving family transfers is common among older households, and associated with requiring long-term care. Further research is needed to better understand drivers of observed associations and identify ways in which financial protection of older adults' long-term care needs can be improved.

DOI 10.1016/j.jeoa.2017.08.003
2016 Mugisha JO, Schatz EJ, Randell M, Kuteesa M, Kowal P, Negin J, Seeley J, 'Chronic disease, risk factors and disability in adults aged 50 and above living with and without HIV: findings from the Wellbeing of Older People Study in Uganda.', Global health action, 9 31098 (2016) [C1]
DOI 10.3402/gha.v9.31098
Citations Scopus - 7Web of Science - 9
2016 Wu F, Guo Y, Zheng Y, Ma W, Kowal P, Chatterji S, Wang L, 'Social-Economic Status and Cognitive Performance among Chinese Aged 50 Years and Older', PLOS ONE, 11 (2016) [C1]
DOI 10.1371/journal.pone.0166986
Citations Scopus - 3Web of Science - 2
2016 Charlton K, Ware LJ, Menyanu E, Biritwum RB, Naidoo N, Pieterse C, et al., 'Leveraging ongoing research to evaluate the health impacts of South Africa's salt reduction strategy: a prospective nested cohort within the WHO-SAGE multicountry, longitudinal study', BMJ OPEN, 6 (2016)
DOI 10.1136/bmjopen-2016-013316
Citations Scopus - 4Web of Science - 4
2016 Barrett TM, Liebert MA, Schrock JM, Cepon-Robins TJ, Mathur A, Agarwal H, et al., 'Physical function and activity among older adults in Jodhpur, India', Annals of Human Biology, 43 488-491 (2016) [C1]

© 2015 Informa UK Limited, trading as Taylor &amp; Francis Group. Background: Physical activity impacts the ageing process; yet, few studies have examined relationships among ph... [more]

© 2015 Informa UK Limited, trading as Taylor & Francis Group. Background: Physical activity impacts the ageing process; yet, few studies have examined relationships among physical activity, functional abilities and health among older adults in non-Western settings. Aim: This study tests for associations among measures of physical activity, function and self-report health conditions among 200 older adults (49--50 years old) in Jodhpur, Rajasthan, India. Methods: Seven consecutive days of accelerometry data were used in measures of physical activity (Total Daily Energy Expenditure [TDEE], Physical Activity Level [PAL] , Daily Average Activity Count [AC] and Activity Energy Expenditure [AEE] ). Measures of physical function included grip strength, timed walk and daily average sit time. Participants reported if they had been diagnosed with diabetes, hypertension, arthritis and/or depression. Results: All four measures of physical activity were positively associated with grip strength (p = 0.05). AC was negatively associated with timed walk (p = 0.05), and both AC and AEE were negatively associated with daily average sit time (p = 0.05). Women who reported diagnosis of hypertension had lower PAL and AC (p = 0.05). Conclusion: This study provides further evidence for a positive relationship between physical activity and functional ability among older adults and between physical activity and cardiovascular health among women in India.

DOI 10.3109/03014460.2015.1103901
2016 Arokiasamy P, Uttamacharya, Kowal P, Chatterji S, 'Age and Socioeconomic Gradients of Health of Indian Adults: An Assessment of Self-Reported and Biological Measures of Health', Journal of Cross-Cultural Gerontology, 31 193-211 (2016) [C1]

© 2016, Springer Science+Business Media New York. This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults f... [more]

© 2016, Springer Science+Business Media New York. This paper describes overall socioeconomic gradients and the age patterns of socioeconomic gradients of health of Indian adults for multiple health indicators encompassing the multiple aspects of health. Cross-sectional data on 11,230 Indians aged 18¿years and older from the WHO-SAGE India Wave 1, 2007 were analyzed. Multivariate logit models were estimated to examine effects of socioeconomic status (education and household wealth) and age on four health domains: self-rated health, self-reported functioning, chronic diseases, and biological health measures. Results show that socioeconomic status (SES) was negatively associated with prevalence of each health measure but with considerable heterogeneity across age groups. Results for hypertension and COPD were inconclusive. SES effects are significant while adjusting for background characteristics and health risk factors. The ag e patterns of SES gradient of health depict divergence with age, however, no conclusive age pattern emerged for biological markers. Overall, results in this paper dispelled the conclusion of negative SES-health association found in some previous Indian studies and reinforced the hypothesis of positive association of SES with health for Indian adults. Higher prevalence of negative health outcomes and SES disparities of health outcomes among older age-groups highlight need for inclusive and focused health care interventions for older adults across socioeconomic spectrum.

DOI 10.1007/s10823-016-9283-3
Citations Scopus - 3Web of Science - 3
2016 Kumar K, Shukla A, Singh A, Ram F, Kowal P, 'Association between wealth and health among older adults in rural China and India', Journal of the Economics of Ageing, 7 43-52 (2016) [C1]

© 2016 Elsevier B.V. Declining mortality and fertility has resulted in an increase in the size of older adult (60+) populations worldwide, often characterized by limited economic ... [more]

© 2016 Elsevier B.V. Declining mortality and fertility has resulted in an increase in the size of older adult (60+) populations worldwide, often characterized by limited economic resources, poor health status and challenges with accessing health facilities, thereby increasing their vulnerability to various poor health outcomes. Using data from the World Health Organization's Study on global AGEing and adult health (WHO SAGE), economic differentials in health-related ailments were examined among rural dwelling older adults in China and India. Employing a disability framework, the associations between wealth status and four health outcomes, active disease, physical impairment, functional limitation and disability, were tested. Older adults from the three wealthiest quintiles (richest, richer and middle) were less likely to report the four health outcomes than the poorest one. Economic inequalities were largest for functional impairment and disability. Age advancement had a significant impact on each of the health outcomes. Equitable old age security schemes providing physical, social and economic support to this population, particularly to the economically disadvantageous groups in rural areas, are needed to ensure healthy aging in rural China and India.

DOI 10.1016/j.jeoa.2016.02.002
Citations Scopus - 3Web of Science - 3
2016 Dent E, Kowal P, Hoogendijk EO, 'Frailty measurement in research and clinical practice: A review', European Journal of Internal Medicine, 31 3-10 (2016) [C1]

© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. One of the leading causes of morbidity and premature mortality in older people is ... [more]

© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. One of the leading causes of morbidity and premature mortality in older people is frailty. Frailty occurs when multiple physiological systems decline, to the extent that an individual's cellular repair mechanisms cannot maintain system homeostasis. This review gives an overview of the definitions and measurement of frailty in research and clinical practice, including: Fried's frailty phenotype; Rockwood and Mitnitski's Frailty Index (FI); the Study of Osteoporotic Fractures (SOF) Index; Edmonton Frailty Scale (EFS); the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) Index; Clinical Frailty Scale (CFS); the Multidimensional Prognostic Index (MPI); Tilburg Frailty Indicator (TFI); PRISMA-7; Groningen Frailty Indicator (GFI), Sherbrooke Postal Questionnaire (SPQ); the Gérontopôle Frailty Screening Tool (GFST) and the Kihon Checklist (KCL), among others. We summarise the main strengths and limitations of existing frailty measurements, and examine how well these measurements operationalise frailty according to Clegg's guidelines for frailty classification - that is: their accuracy in identifying frailty; their basis on biological causative theory; and their ability to reliably predict patient outcomes and response to potential therapies.

DOI 10.1016/j.ejim.2016.03.007
Citations Scopus - 69Web of Science - 64
2016 Biritwum RB, Minicuci N, Yawson AE, Theou O, Mensah GP, Naidoo N, et al., 'Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa', Maturitas, 91 8-18 (2016) [C1]

© 2016 Elsevier Ireland Ltd. All rights reserved. Background The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and... [more]

© 2016 Elsevier Ireland Ltd. All rights reserved. Background The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. Methods Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. Results This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. Conclusions Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.

DOI 10.1016/j.maturitas.2016.05.012
Citations Scopus - 7Web of Science - 7
Co-authors Julie Byles
2016 Hosseinpoor AR, Bergen N, Kostanjsek N, Kowal P, Officer A, Chatterji S, 'Socio-demographic patterns of disability among older adult populations of low-income and middle-income countries: results from World Health Survey', International Journal of Public Health, 61 337-345 (2016) [C1]

© 2015, The Author(s). Objective: Our objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distrib... [more]

© 2015, The Author(s). Objective: Our objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distribution of disability. Methods: World Health Survey data included 53,447 adults aged 50 or older from 43 low- and middle-income countries. Disability was a binary classification, based on a composite score derived from self-reported functional difficulties. Socio-demographic variables included sex, age, marital status, area of residence, education level, and household economic status. A multivariate Poisson regression model with robust variance was used to assess associations between disability and socio-demographic variables. Results: Overall, 33.3¿% (95¿% CI 32.2¿34.4¿%) of older adults reported disability. Disability was 1.5 times more common in females, and was positively associated with increasing age. Divorced/separated/widowed respondents reported higher disability rates in all but one study country, and education and wealth levels were inversely associated with disability rates. Urban residence tended to be advantageous over rural. Country-level datasets showed disparate patterns. Conclusions: Effective approaches aimed at disability prevention and improved disability management are warranted, including the inclusion of equity considerations in monitoring and evaluation activities.

DOI 10.1007/s00038-015-0742-3
Citations Scopus - 3Web of Science - 4
2016 Snodgrass JJ, Liebert MA, Cepon-Robins TJ, Barrett TM, Mathur A, Chatterji S, Kowal P, 'Accelerometer-measured physical activity among older adults in urban India: Results of a study on global AGEing and adult health substudy', American Journal of Human Biology, 28 412-420 (2016) [C1]

© 2016 Wiley Periodicals, Inc. Objectives: Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology ha... [more]

© 2016 Wiley Periodicals, Inc. Objectives: Accelerometry provides researchers with a powerful tool to measure physical activity in population-based studies, yet this technology has been underutilized in cross-cultural studies of older adults. The present study was conducted among older adults in an urban setting in India with the following three objectives: (1) to compare average activity levels obtained through different durations of monitoring (1, 3, and 7 days); (2) to document differences in physical activity patterns by sex and age and (3) to evaluate links between measures of physical activity and anthropometrics, as well as between activity parameters and measures of household size, work status, and social cohesion. Methods: The present study uses data from a physical activity substudy of the World Health Organization's Study on global AGEing and adult health (SAGE-PA). This study of 200 older adults (49-90 years old; 72 males, 128 females) in urban India combines 7 continuous days of ActiGraph GT3X accelerometry with anthropometric and sociodemographic data. Results: Results reveal overall low activity levels, with significantly lower activity energy expenditure (AEE) among females (P < 0.05). No significant differences were documented in activity level by monitoring duration. Age was negatively correlated with AEE in men (P < 0.01) and women (P < 0.001). AEE was positively correlated with BMI in men (P < 0.01) and women (P < 0.05). Finally, women who were more socially integrated had greater AEE (P < 0.01). Conclusions: This study illustrates the utility of accelerometry for quantifying activity levels in aging populations in non-Western nations.

DOI 10.1002/ajhb.22803
Citations Scopus - 1Web of Science - 1
2016 Miu J, Negin J, Salinas-Rodriguez A, Manrique-Espinoza B, Sosa-Ortiz AL, Cumming R, Kowal P, 'Factors associated with cognitive function in older adults in Mexico', Global Health Action, 9 (2016) [C1]

� 2016 Jenny Miu et al. Background: As populations age, cognitive decline and dementia pose significant burdens for societies and health care systems, including low- and middle-... [more]

� 2016 Jenny Miu et al. Background: As populations age, cognitive decline and dementia pose significant burdens for societies and health care systems, including low- and middle-income countries such as Mexico. Minor age-related declines in cognitive function appear to represent a stable but heterogeneous phase in the continuum between normal cognitive ageing and dementia. Loss of cognitive function has impacts at societal and individual levels and understanding the risk factors can help provide a framework for health policies and interventions to target at-risk groups. Design: A cohort of older Mexican adults (50+) from the World Health Organization's Study on global AGEing and adult health (WHO SAGE) was used to examine cognitive function, including a total of 2315 respondents, with 325 respondents aged 80 years and older. Cognition was objectively evaluated using verbal recall, verbal fluency, forward digit span and backward digit span, with differences in an overall cognitive score assessed against sociodemographic variables, and associated factors using linear regression. Results: The most significant predictors of poorer cognitive function were found to be older age (ß=-13.88), rural living (ß=-2.25), low income (ß=-8.28), self-reported severe or extreme memory difficulties (ß=-6.62), and difficulty with two or more activities of daily living (ß=-2.02). Conclusions: These findings can inform public health initiatives to address cognitive impairment in ageing populations in Mexico and other middle-income countries.

DOI 10.3402/gha.v9.30747
Citations Scopus - 2Web of Science - 1
2016 Gildner TE, Liebert MA, Capistrant BD, D'Este C, Snodgrass JJ, Kowal P, 'Perceived Income Adequacy and Well-being Among Older Adults in Six Low- and Middle-Income Countries.', J Gerontol B Psychol Sci Soc Sci, (2016)
DOI 10.1093/geronb/gbw145
Co-authors Catherine Deste
2016 Eick G, Urlacher SS, McDade TW, Kowal P, Snodgrass JJ, 'Validation of an Optimized ELISA for Quantitative Assessment of Epstein-Barr Virus Antibodies from Dried Blood Spots', Biodemography and Social Biology, 62 222-233 (2016) [C1]

© 2016 Society for Biodemography and Social Biology. Our objective was to validate a commercially available ELISA to measure antibody titers against Epstein-Barr virus (EBV) in dr... [more]

© 2016 Society for Biodemography and Social Biology. Our objective was to validate a commercially available ELISA to measure antibody titers against Epstein-Barr virus (EBV) in dried blood spots (DBS) to replace a previously validated assay for DBS that is no longer available. We evaluated the precision, reliability, and stability of the assay for the measurement of EBV antibodies in matched plasma, fingerprick DBS, and venous blood DBS samples from 208 individuals. Effects of hematocrit and DBS sample matrix on EBV antibody determination were also investigated, and the cutoff for seropositivity in DBS was determined. A conversion equation was derived to enable comparison of results generated using this method with the former DBS method. There was a high correlation between plasma and DBS EBV antibody titers (R 2 ¿=¿0.93) with very little bias (-0.07 based on Bland-Altman analysis). The assay showed good linearity and did not appear to be affected by the DBS matrix, and physiological hematocrit levels had no effect on assay performance. There was reasonable agreement between DBS EBV titer estimates obtained using this assay and the previously validated assay (R 2 ¿=¿0.72). The commercially available ELISA assay for EBV antibody titers that we validated for use with DBS will facilitate continued investigation of EBV antibody titers in DBS.

DOI 10.1080/19485565.2016.1169396
Citations Scopus - 2Web of Science - 2
2016 Olson B, Gribble B, Dias J, Curryer C, Vo K, Kowal P, Byles J, 'Cervical cancer screening programs and guidelines in low- and middle-income countries.', Int J Gynaecol Obstet, 134 239-246 (2016) [C1]
DOI 10.1016/j.ijgo.2016.03.011
Citations Scopus - 10Web of Science - 10
Co-authors Julie Byles, Cassie Curryer Uon
2015 Hewlett SA, Calys-Tagoe BNL, Yawson AE, Dako-Gyeke P, Nakua E, Folson G, et al., 'Prevalence and geographic distribution of edentulism among older Ghanaians', Journal of Public Health Dentistry, 75 74-83 (2015) [C1]

© 2014 American Association of Public Health Dentistry. Objectives Edentulism has important health implications for aging individuals and is used as an indicator of the oral healt... [more]

© 2014 American Association of Public Health Dentistry. Objectives Edentulism has important health implications for aging individuals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase; however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country. Methods Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Results The overall prevalence was 2.8%, varying by sex (men had lower rates; OR = 0.67, 95% CI = 0.47-0.97); by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%); by education levels (rates were higher among those with no formal education; OR = 1.626, 95% CI = 1.111-2.380); and by marital status (those living without a partner had higher rates; OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism. Conclusion Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning.

DOI 10.1111/jphd.12075
Citations Scopus - 2Web of Science - 2
2015 Kumar K, Singh A, Kumar S, Ram F, Singh A, Ram U, et al., 'Erratum: Socio-economic differentials in impoverishment effects of out-of-pocket health expenditure in China and India: Evidence from WHO SAGE (PLoS ONE (2015) 10:8 (e0135051) (DOI:10.1371/journal.pone.0135051))', PLoS ONE, 10 (2015)
DOI 10.1371/journal.pone.0138499
2015 Arokiasamy P, Uttamacharya U, Jain K, Biritwum RB, Yawson AE, Wu F, et al., 'The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: What does the study on global ageing and adult health (SAGE) reveal?', BMC Medicine, 13 (2015) [C1]

© 2015 Arokiasamy et al. Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to o... [more]

© 2015 Arokiasamy et al. Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs. Methods: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries. Results: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases. Conclusions: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.

DOI 10.1186/s12916-015-0402-8
Citations Scopus - 38Web of Science - 39
2015 Verghese J, Kowal P, Bennett DA, 'Author response', Neurology, 85 389 (2015)
DOI 10.1212/01.wnl.0000470376.04336.ea
2015 Kowal P, 'Chronic Medical Disease and Cognitive Aging: Toward a Healthy Body and Brain.', AMERICAN JOURNAL OF HUMAN BIOLOGY, 27 883-884 (2015) [C3]
DOI 10.1002/ajhb.22788
2015 Bloom DE, Chatterji S, Kowal P, Lloyd-Sherlock P, Mckee M, Rechel B, et al., 'Macroeconomic implications of population ageing and selected policy responses', LANCET, 385 649-657 (2015) [C1]
DOI 10.1016/S0140-6736(14)61464-1
Citations Scopus - 71Web of Science - 56
2015 Kowal P, Charlton K, 'Joint effect of mid- and late-life blood pressure on the brain: the AGES-Reykjavik Study.', Neurology, 84 329 (2015) [C3]
DOI 10.1212/01.wnl.0000460552.36620.a9
2015 Kowal P, Arokiasamy P, Afshar S, Pati S, Snodgrass JJ, 'Multimorbidity: health care that counts "past one" for 1.2 billion older adults', LANCET, 385 2252-2253 (2015) [C3]
DOI 10.1016/S0140-6736(15)61062-5
Citations Scopus - 1Web of Science - 3
2015 Kowal P, Afshar S, 'Health and the indian caste system', The Lancet, 385 415-416 (2015) [C3]
DOI 10.1016/S0140-6736(15)60147-7
Citations Scopus - 1Web of Science - 2
2015 Brinda EM, Kowal P, Attermann J, Enemark U, 'Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: The WHO study on global AGEing and adult health (SAGE)', Journal of Epidemiology and Community Health, 69 489-494 (2015) [C1]

Background: Healthcare financing through out-ofpocket payments and inequities in healthcare utilisation are common in low and middle income countries (LMICs). Given the dearth of ... [more]

Background: Healthcare financing through out-ofpocket payments and inequities in healthcare utilisation are common in low and middle income countries (LMICs). Given the dearth of pertinent studies on these issues among older people in LMICs, we investigated the determinants of health service use, out-of-pocket and catastrophic health expenditures among older people in one LMIC, India. Methods: We accessed data from a nationally representative, multistage sample of 2414 people aged 65 years and older from the WHO's Study on global Ageing and adult health in India. Sociodemographic characteristics, health profiles, health service utilisation and out-of-pocket health expenditure were assessed using standard instruments. Multivariate zero-inflated negative binomial regression models were used to evaluate the determinants of health service visits. Multivariate Heckman sample selection regression models were used to assess the determinants of out-of-pocket and catastrophic health expenditures. Results: Out-of-pocket health expenditures were higher among participants with disability and lower income. Diabetes, hypertension, chronic pulmonary disease, heart disease and tuberculosis increased the number of health visits and out-of-pocket health expenditures. The prevalence of catastrophic health expenditure among older people in India was 7% (95% CI 6% to 8%). Older men and individuals with chronic diseases were at higher risk of catastrophic health expenditure, while access to health insurance lowered the risk. Conclusions: Reducing out-of-pocket health expenditure among older people is an important public health issue, in which social as well as medical determinants should be prioritised. Enhanced public health sector performance and provision of publicly funded insurance may protect against catastrophic health expenses and healthcare inequities in India.

DOI 10.1136/jech-2014-204960
Citations Scopus - 12Web of Science - 13
2015 Kowal P, 'A Life Course Approach to Healthy Ageing', AMERICAN JOURNAL OF HUMAN BIOLOGY, 27 441-442 (2015) [C3]
DOI 10.1002/ajhb.22722
2015 Rivas-Marino G, Negin J, Salinas-Rodríguez A, Manrique-Espinoza B, Sterner KN, Snodgrass J, Kowal P, 'Prevalence of overweight and obesity in older Mexican adults and its association with physical activity and related factors: An analysis of the study on global ageing and adult health', American Journal of Human Biology, 27 326-333 (2015) [C1]

© 2014 Wiley Periodicals, Inc. Objectives: The obesity epidemic in Mexico is increasing and represents a considerable public health challenge. The population aged 50 years and old... [more]

© 2014 Wiley Periodicals, Inc. Objectives: The obesity epidemic in Mexico is increasing and represents a considerable public health challenge. The population aged 50 years and older is also increasing and is not exempt from the obesity rise. We aimed to determine the current prevalence of Body Mass Index (BMI) categories in a sample of Mexicans aged 50 years and older and to test the associations of BMI with physical activity categories and related factors. Methods: Data from 2,032 individuals aged 50 years and older who participated in SAGE Wave 1 (2009-2010) were analyzed. Representativeness of the sample was obtained by using weighted data. Descriptive statistics, chi square tests, simple regression analysis, and multiple regression analysis were performed in relation to BMI, self-reported physical activity categories, and several variables, including demographic characteristics and selected risk factors for non-communicable diseases. Results: Among older adults, 0.6% was found to be underweight, 21.4% normal weight, 49.4% overweight, and 28.7% obese. It was also found that practicing vigorous intensity physical activity (-1.32) and being 80 years or older (-2.73) were significantly associated (P < 0.05) with a lower mean BMI (28.3). In contrast, being in the lowest income quintile (1.35), and living in urban areas (0.86) were significantly associ ated with a higher mean BMI. Conclusions: The study results contribute to the current understanding of obesity etiology in Mexico, and moreover confirm that overweight and obesity are current public health problems that must be addressed in specific subgroups of older adults. Am. J. Hum. Biol. 27:326-333, 2015.

DOI 10.1002/ajhb.22642
Citations Scopus - 5Web of Science - 5
2015 Mugisha JO, Schatz E, Seeley J, Kowal P, 'Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda', African Journal of AIDS Research, 14 159-167 (2015) [C1]

© 2015 NISC (Pty) Ltd. The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected i... [more]

© 2015 NISC (Pty) Ltd. The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health/personal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.

DOI 10.2989/16085906.2015.1040805
Citations Scopus - 1Web of Science - 2
2015 Kumar K, Singh A, Kumar S, Ram F, Singh A, Ram U, et al., 'Socio-Economic Differentials in Impoverishment Effects of Out-of-Pocket Health Expenditure in China and India: Evidence from WHO SAGE', PLOS ONE, 10 (2015) [C1]
DOI 10.1371/journal.pone.0135051
Citations Scopus - 11Web of Science - 8
2015 Hewlett SA, Yawson AE, Calys-Tagoe BNL, Naidoo N, Martey P, Chatterji S, et al., 'Edentulism and quality of life among older Ghanaian adults', BMC Oral Health, 15 (2015) [C1]

© Hewlett et al.; licensee BioMed Central. Background: Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed ... [more]

© Hewlett et al.; licensee BioMed Central. Background: Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults. Methods: Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult's aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question "How would you rate your overall quality of life?". To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman's correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate. Results: Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure. Conclusion: Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it.

DOI 10.1186/s12903-015-0034-6
Citations Scopus - 7Web of Science - 6
2015 Afshar S, Roderick PJ, Kowal P, Dimitrov BD, Hill AG, 'Multimorbidity and the inequalities of global ageing: A cross-sectional study of 28 countries using the World Health Surveys', BMC Public Health, 15 (2015) [C1]

© 2015 Afshar et al. Background: Multimorbidity defined as the &quot;the coexistence of two or more chronic diseases&quot; in one individual, is increasing in prevalence globally.... [more]

© 2015 Afshar et al. Background: Multimorbidity defined as the "the coexistence of two or more chronic diseases" in one individual, is increasing in prevalence globally. The aim of this study is to compare the prevalence of multimorbidity across low and middle-income countries (LMICs), and to investigate patterns by age and education, as a proxy for socio-economic status (SES). Methods: Chronic disease data from 28 countries of the World Health Survey (2003) were extracted and inter-country socio-economic differences were examined by gross domestic product (GDP). Regression analyses were applied to examine associations of education with multimorbidity by region adjusted for age and sex distributions. Results: The mean world standardized multimorbidity prevalence for LMICs was 7.8 % (95 % CI, 7.79 % - 7.83 %). In all countries, multimorbidity increased significantly with age. A positive but non-linear relationship was found between country GDP and multimorbidity prevalence. Trend analyses of multimorbidity by education suggest that there are intergenerational differences, with a more inverse education gradient for younger adults compared to older adults. Highe r education was significantly associated with a decreased risk of multimorbidity in the all-region analyses. Conclusions: Multimorbidity is a global phenomenon, not just affecting older adults in HICs. Policy makers worldwide need to address these health inequalities, and support the complex service needs of a growing multimorbid population.

DOI 10.1186/s12889-015-2008-7
Citations Scopus - 23Web of Science - 20
2015 Stewart Williams J, Kowal P, Hestekin H, O'Driscoll T, Peltzer K, Yawson A, et al., 'Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: Results from the WHO Study on global AGEing and adult health (SAGE)', BMC Medicine, 13 (2015) [C1]

© 2015 Stewart Williams et al. In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 ye... [more]

© 2015 Stewart Williams et al. In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly. Methods: Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0). Results: The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (P < 0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P < 0.0001). Conclusions: The findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.

DOI 10.1186/s12916-015-0390-8
Citations Scopus - 27Web of Science - 22
Co-authors Jenny Stewartwilliams
2015 Wu F, Guo Y, Chatterji S, Zheng Y, Naidoo N, Jiang Y, et al., 'Common risk factors for chronic non-communicable diseases among older adults in china, ghana, mexico, india, russia and south africa: The study on global AGEing and adult health (SAGE) wave 1', BMC Public Health, 15 (2015) [C1]

©2015 Wu et al.; licensee BioMed Central. Background: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol ar... [more]

©2015 Wu et al.; licensee BioMed Central. Background: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- And upper-middle income countries. Methods: The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors. Results: The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa. Conclusion: There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

DOI 10.1186/s12889-015-1407-0
Citations Scopus - 30Web of Science - 24
2015 Clausen T, Martinez P, Towers A, Greenfield T, Kowal P, 'Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health.', Substance abuse : research and treatment, 9 125-132 (2015) [C1]
DOI 10.4137/sart.s23549
Citations Scopus - 2Web of Science - 2
2015 Gildner TE, Barrett TM, Liebert MA, Kowal P, Snodgrass JJ, 'Does BMI generated by self-reported height and weight measure up in older adults from middle-income countries? Results from the study on global AGEing and adult health (SAGE).', BMC obesity, 2 44 (2015) [C1]
DOI 10.1186/s40608-015-0074-0
Citations Scopus - 2
2015 Williams JS, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T, et al., 'Risk factors and disability associated with low back pain in older adults in low- and middle-income countries. Results from the WHO study on global AGEing and adult health (SAGE)', PLoS ONE, 10 (2015) [C1]

© 2015 Stewart Williams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution... [more]

© 2015 Stewart Williams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Back pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs. Methods: Standardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability. Results: Prevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p < 0.01). About 8% of respondents reported that they experienced intense back pain in the previous month. Conclusions: Evidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

DOI 10.1371/journal.pone.0127880
Citations Scopus - 25Web of Science - 25
Co-authors Jenny Stewartwilliams
2014 Charlton K, Kowal P, Soriano MM, Williams S, Banks E, Vo K, Byles J, 'Fruit and vegetable intake and body mass index in a large sample of middle-aged australian men and women', Nutrients, 6 2305-2319 (2014) [C1]

Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed ... [more]

Dietary guidelines around the world recommend increased intakes of fruits and non-starchy vegetables for the prevention of chronic diseases and possibly obesity. This study aimed to describe the association between body mass index (BMI) and habitual fruit and vegetable consumption in a large sample of 246,995 Australian adults aged 45 + year who had been recruited for the "45 and Up" cohort study. Fruit and vegetable intake was assessed using validated short questions, while weight and height were self-reported. Multinomial logistic regression was used, by sex, to assess the association between fruit and vegetable intake and BMI. Compared to the referent normal weight category (BMI 18.5 to 24.9), the odds ratio (OR) of being in the highest vegetable intake quartile was 1.09 (95% confidence interval (CI) 1.04-1.14) for overweight women (BMI 25.0-29.9) and 1.18 (95% CI 1.12-1.24) for obese women. The association was in the opposite direction for fruit for overweight (OR 0.85; 95% CI 0.80-0.90) and obese women (OR 0.75; 95% CI 0.69-0.80). Obese and overweight women had higher odds of being in the highest intake quartile for combined fruit and vegetable intake, and were more likely to meet the "2 and 5" target or to have five or more serves of fruit and vegetables per day. In contrast, overweight men were less likely to be in high intake quartiles and less likely to meet recommended target of 5 per day, but there was no consistent relationship between obesity and fruit and vegetable intake. Underweight women and underweight men were less likely to be in the highest intake quartiles or to meet the recommended targets. These data suggest that improving adherence to dietary targets for fruit and vegetables may be a dietary strategy to overcome overweight among men, but that overweight and obese women are already adhering to these targets. The association between fruit and vegetable intake and underweight in adults suggests that improving fruit and vegetables intakes are important for the overall dietary patterns of people in this group. © 2014 by the authors; licensee MDPI, Basel, Switzerland.

DOI 10.3390/nu6062305
Citations Scopus - 16Web of Science - 15
Co-authors Julie Byles
2014 Verghese J, Annweiler C, Ayers E, Barzilai N, Beauchet O, Bennett DA, et al., 'Motoric cognitive risk syndrome Multicountry prevalence and dementia risk', NEUROLOGY, 83 718-726 (2014) [C1]
DOI 10.1212/WNL.0000000000000717
Citations Scopus - 77Web of Science - 76
2014 Charlton K, Webster J, Kowal P, 'To Legislate or Not to Legislate? A Comparison of the UK and South African Approaches to the Development and Implementation of Salt Reduction Programs', NUTRIENTS, 6 3672-3695 (2014)
DOI 10.3390/nu6093672
Citations Scopus - 20Web of Science - 19
2014 Calys-Tagoe BNL, Hewlett SA, Dako-Gyeke P, Yawson AE, Baddoo NA, Seneadza NAH, et al., 'Predictors of subjective well-being among older Ghanaians.', Ghana Med J, 48 178-184 (2014)
Citations Scopus - 2
2014 Gildner TE, Liebert MA, Kowal P, Chatterji S, Snodgrass JJ, 'Sleep Duration, Sleep Quality, and Obesity Risk Among Older Adults from Six Middle-Income Countries: Findings from the Study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF HUMAN BIOLOGY, 26 803-812 (2014)
DOI 10.1002/ajhb.22603
Citations Scopus - 19Web of Science - 17
2014 Martinez P, Lien L, Landheim A, Kowal P, Clausen T, 'Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa', BMC PUBLIC HEALTH, 14 (2014)
DOI 10.1186/1471-2458-14-316
Citations Scopus - 3Web of Science - 4
2014 Gildner TE, Liebert MA, Kowal P, Chatterji S, Snodgrass JJ, 'Associations between Sleep Duration, Sleep Quality, and Cognitive Test Performance among Older Adults from Six Middle Income Countries: Results from the Study on Global Ageing and Adult Health (SAGE)', JOURNAL OF CLINICAL SLEEP MEDICINE, 10 613-621 (2014)
DOI 10.5664/jcsm.3782
Citations Scopus - 34Web of Science - 29
2014 Arokiasamy P, Verma U, Kowal P, 'Untitled', MEDICC REVIEW, 16 5-5 (2014)
2014 Minicuci N, Biritwum RB, Mensah G, Yawson AE, Naidoo N, Chatterji S, Kowal P, 'Sociodemographic and socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana', GLOBAL HEALTH ACTION, 7 (2014)
DOI 10.3402/gha.v7.21292
Citations Scopus - 18Web of Science - 17
2014 Yawson AE, Ackuaku-Dogbe EM, Seneadza NAH, Mensah G, Minicuci N, Naidoo N, et al., 'Self-reported cataracts in older adults in Ghana: sociodemographic and health related factors', BMC PUBLIC HEALTH, 14 (2014)
DOI 10.1186/1471-2458-14-949
Citations Scopus - 5Web of Science - 4
2014 Peltzer K, Stewart Williams JA, Kowal P, Negin J, Snodgrass JJ, Yawson A, et al., 'Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa', Global Health Action, 7 1-9 (2014) [C1]
DOI 10.3402/gha.v7.25314
Citations Scopus - 8Web of Science - 8
Co-authors Jenny Stewartwilliams
2014 Peltzer K, Hewlett S, Yawson AE, Moynihan P, Preet R, Wu F, et al., 'Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 11 11308-11324 (2014)
DOI 10.3390/ijerph111111308
Citations Scopus - 20Web of Science - 16
2014 Kowal P, Towers A, Byles J, 'Ageing across the Tasman Sea: the demographics and health of older adults in Australia and New Zealand.', Aust N Z J Public Health, 38 377-383 (2014) [C1]
DOI 10.1111/1753-6405.12194
Citations Scopus - 3Web of Science - 3
Co-authors Julie Byles
2013 He W, Kowal P, 'HOW ARE THEY DIFFERENT? HEALTH RISK BEHAVIORS OF THE OLDER POPULATIONS IN SAGE COUNTRIES: 2007-2010', GERONTOLOGIST, 53 471-471 (2013)
2013 Capistrant BD, Kowal P, 'Social Epidemiology of Hypertension Stages', HYPERTENSION, 62 E41-E41 (2013)
DOI 10.1161/HYPERTENSIONAHA.113.02356
Citations Scopus - 1Web of Science - 1
2013 Mugisha J, Scholten F, Owilla S, Naidoo N, Seeley J, Chatterji S, et al., 'Caregiving responsibilities and burden among older people by HIV status and other determinants in Uganda', AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 25 1341-1348 (2013)
DOI 10.1080/09540121.2013.765936
Citations Scopus - 9Web of Science - 10
2013 Gildner TE, Liebert MA, Kowal P, Chatterji S, Snodgrass JJ, 'The Study on global AGEing and adult health (SAGE): The effect of self-reported sleep quality and duration on cognitive function among older adults from six middle income countries', AMERICAN JOURNAL OF HUMAN BIOLOGY, 25 258-259 (2013)
2013 Hawkins LM, Snodgrass JJ, Gildner TE, Liebert MA, Kowal P, Chatterji S, 'The Study on global AGEing and adult health (SAGE): Socioeconomic status, urban-rural differences, and sleep in older adults from five middle income countries', AMERICAN JOURNAL OF HUMAN BIOLOGY, 25 259-259 (2013)
2013 McClure HH, Snodgrass JJ, Kowal P, 'Study on global AGEing and adult health (SAGE): Food insecurity in relation to physical, cognitive, and emotional challenges among older adults.', AMERICAN JOURNAL OF HUMAN BIOLOGY, 25 266-267 (2013)
2013 Yawson AE, Baddoo A, Hagan-Seneadza NA, Calys-Tagoe B, Hewlett S, Dako-Gyeke P, et al., 'Tobacco use in older adults in Ghana: sociodemographic characteristics, health risks and subjective wellbeing', BMC PUBLIC HEALTH, 13 (2013)
DOI 10.1186/1471-2458-13-979
Citations Scopus - 11Web of Science - 13
2013 Nyirenda M, Newell M-L, Mugisha J, Mutevedzi PC, Seeley J, Scholten F, Kowal P, 'Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa', GLOBAL HEALTH ACTION, 6 1-11 (2013)
DOI 10.3402/gha.v6i0.19201
Citations Scopus - 18Web of Science - 19
2013 Biritwum RB, Mensah G, Minicuci N, Yawson AE, Naidoo N, Chatterji S, Kowal P, 'Household characteristics for older adults and study background from SAGE Ghana Wave 1', GLOBAL HEALTH ACTION, 6 1-13 (2013)
DOI 10.3402/gha.v6i0.20096
Citations Scopus - 9Web of Science - 8
2013 Luis Ayuso-Mateos J, Miret M, Felix Caballero F, Olaya B, Maria Haro J, Kowal P, Chatterji S, 'Multi-Country Evaluation of Affective Experience: Validation of an Abbreviated Version of the Day Reconstruction Method in Seven Countries', PLOS ONE, 8 (2013) [C1]
DOI 10.1371/journal.pone.0061534
Citations Scopus - 11Web of Science - 11
2013 Wu F, Guo Y, Kowal P, Jiang Y, Yu M, Li X, et al., 'Prevalence of Major Chronic Conditions among Older Chinese Adults: The Study on Global AGEing and Adult Health (SAGE) Wave 1', PLOS ONE, 8 (2013) [C1]
DOI 10.1371/journal.pone.0074176
Citations Scopus - 31Web of Science - 21
2013 Mutevedzi PC, Rodger AJ, Kowal P, Nyirenda M, Newell M-L, 'Decreased Chronic Morbidity but Elevated HIV Associated Cytokine Levels in HIV-Infected Older Adults Receiving HIV Treatment: Benefit of Enhanced Access to Care?', PLOS ONE, 8 (2013) [C1]
DOI 10.1371/journal.pone.0077379
Citations Scopus - 9Web of Science - 9
2013 Harttgen K, Kowal P, Strulik H, Chatterji S, Vollmer S, 'Patterns of Frailty in Older Adults: Comparing Results from Higher and Lower Income Countries Using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE)', PLOS ONE, 8 (2013) [C1]
DOI 10.1371/journal.pone.0075847
Citations Scopus - 36Web of Science - 34
2013 Biritwum RB, Mensah G, Minicuci N, Yawson AE, Naidoo N, Chatterji S, Kowal P, 'Household characteristics for older adults and study background from SAGE Ghana Wave 1.', Glob Health Action, 6 20096 (2013)
DOI 10.3402/gha.v6i0.20096
2013 Nyirenda M, Newell M-L, Mugisha J, Mutevedzi PC, Seeley J, Scholten F, Kowal P, 'Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa.', Glob Health Action, 6 19201 (2013)
DOI 10.3402/gha.v6i0.19201
2012 Kowal PR, Arokiasamy P, Ridaura RL, Yong J, Minicuci N, Chatterji S, 'Hypertension in developing countries', Lancet, 380 1471 (2012) [C3]
Citations Scopus - 10Web of Science - 7
2012 Negin J, Martiniuk A, Cumming RG, Naidoo N, Phaswana-Mafuya N, Madurai L, et al., 'Prevalence of HIV and chronic comorbidities among older adults', AIDS, 26 (2012)

Objectives: Limited evidence is available on HIV, aging and comorbidities in sub-Saharan Africa. This article describes the prevalence of HIV and chronic comorbidities among those... [more]

Objectives: Limited evidence is available on HIV, aging and comorbidities in sub-Saharan Africa. This article describes the prevalence of HIV and chronic comorbidities among those aged 50 years and older in South Africa using nationally representative data. Design: The WHO's Study of global AGEing and adult health (SAGE) was conducted in South Africa in 2007-2008. SAGE includes nationally representative cohorts of persons aged 50 years and older, with comparison samples of those aged 18-49 years, which aims to study health and its determinants. Methods: Logistic and linear regression models were applied to data from respondents aged 50 years and older to determine associations between age, sex and HIV status and various outcome variables including prevalence of seven chronic conditions. Results: HIV prevalence among adults aged 50 and older in South Africa was 6.4% and was particularly elevated among Africans, women aged 50-59 and those living in rural areas. Rates of chronic disease were higher among all older adults compared with those aged 18-49. Of those aged 50 years and older, 29.6% had two or more of the seven chronic conditions compared with 8.8% of those aged 18-49 years (P < 0.0001). When controlling for age and sex among those aged 50 and older, BMI was lower among HIV-infected older adults aged 50 and older (27.5 kg/m) than in HIV-uninfected individuals of the same age (30.6) (P < 0.0001). Grip strength among HIV-infected older adults was significantly (P=0.004) weaker than among similarly-aged HIV-uninfected individuals. Conclusion: HIV-infected older adults in South Africa have high rates of chronic disease and weakness. Studies are required to examine HIV diagnostics and treatment instigation rates among older adults to ensure equity of access to quality care, as the number and percentage of older adults living with HIV is likely to increase. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

DOI 10.1097/QAD.0b013e3283558459
Citations Scopus - 45
2012 Negin J, Martiniuk A, Cumming RG, Naidoo N, Phaswana-Mafuya N, Madurai L, et al., 'Prevalence of HIV and chronic comorbidities among older adults', AIDS, 26 S55-S63 (2012) [C1]
2012 Kowal PR, Chatterji S, Naidoo N, Biritwum R, Fan W, Ridaura RL, et al., 'Data resource profile: The World Health Organization Study on global AGEing and adult health (SAGE)', International Journal of Epidemiology, 41 1639-1649 (2012) [C2]
Citations Scopus - 203Web of Science - 199
Co-authors Catherine Deste
2012 Nyirenda M, Chatterji S, Falkingham J, Mutevedzi P, Hosegood V, Evandrou M, et al., 'An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa', BMC Public Health, 12 259-272 (2012) [C1]
Citations Scopus - 27Web of Science - 25
2012 Hosseinpoor AR, Stewart Williams JA, Jann B, Kowal PR, Officer A, Posarac A, Chatterji S, 'Social determinants of sex differences in disability among older adults: A multi-country decomposition analysis using the World Health Survey', International Journal for Equity in Health, 11 (2012) [C1]
DOI 10.1186/1475-9276-11-52
Citations Scopus - 26Web of Science - 27
Co-authors Jenny Stewartwilliams
2012 Miret M, Caballero FF, Mathur A, Naidoo N, Kowal PR, Ayuso-Mateos JL, Chatterji S, 'Validation of a measure of subjective well-being: An abbreviated version of the day reconstruction method', PLOS One, 7 (2012) [C1]
DOI 10.1371/journal.pone.0043887
Citations Scopus - 16Web of Science - 15
2012 Hosseinpoor AR, Stewart Williams JA, Amin A, Araujo De Carvalho I, Beard J, Boerma T, et al., 'Social determinants of self-reported health in women and men: Understanding the role of gender in population health', PloS One, 7 (2012) [C1]
DOI 10.1371/journal.pone.0034799
Citations Scopus - 42Web of Science - 31
Co-authors Jenny Stewartwilliams
2011 Parkinson L, Dolja-Gore X, Gibson RE, Doran E, Notley L, Stewart Williams JA, et al., 'An observational study of the discrediting of COX-2 NSAIDs in Australia: Vioxx or class effect?', BMC Public Health, 11 892 (2011) [C1]
Citations Scopus - 2Web of Science - 1
Co-authors Jenny Stewartwilliams, Julie Byles, Xenia Doljagore, L Parkinson
2011 Kowal PR, Gibson RE, Wutzke S, Smith K, Cotter P, Strivens E, et al., 'Roundtable discussion: Data on ageing Aboriginal and Torres Strait Islander populations', World Medical and Health Policy, 3 1-11 (2011) [C3]
DOI 10.2202/1948-4682.1181
Citations Scopus - 1
2011 Scholten F, Mugisha J, Seeley J, Kinyanda E, Nakubukwa S, Kowal P, et al., 'Health and functional status among older people with HIV/AIDS in Uganda', BMC PUBLIC HEALTH, 11 (2011)
DOI 10.1186/1471-2458-11-886
Citations Scopus - 39Web of Science - 32
2011 Kowal P, Hosseinpoor AR, Chatterji S, 'Untitled', MEDICC REVIEW, 13 5-5 (2011)
2011 Kowal P, Williams SR, Chatterji S, 'Challenge of ageing populations: Ageing alongside and outside EU borders', BMJ (Online), 343 (2011)
DOI 10.1136/bmj.d4885
Citations Scopus - 2
2010 Kowal PR, Kahn K, Ng N, Naidoo N, Abdullah S, Bawah A, et al., 'Ageing and adult health status in eight lower-income countries: The INDEPTH WHO-SAGE collaboration', Global Health Action, 3 11-22 (2010) [C1]
DOI 10.3402/gha.v3i0.5302
Citations Scopus - 66Web of Science - 54
2010 Ng N, Kowal PR, Kahn K, Naidoo N, Abdullah S, Bawah A, et al., 'Health inequalities among older men and women in Africa and Asia: Evidence from eight health and demographic surveillance system sites in the INDEPTH WHO-SAGE study', Global Health Action, 3 96-107 (2010) [C1]
DOI 10.3402/gha.v3i0.5420
Citations Web of Science - 17
2010 Blain H, Robine JM, Michel JP, Rose T, Baeyens JP, Fitzner R, et al., 'The necessity to expand the vaccination program throughout life impact of an effective vaccination on aging population', Revue de Geriatrie, 35 161-165 (2010)

Childhood immunisation is a standard and recognised critical element of preventive care around the world. Despite strong evidence for the efficacy of immunization against influenz... [more]

Childhood immunisation is a standard and recognised critical element of preventive care around the world. Despite strong evidence for the efficacy of immunization against influenza, pneumococcal disease and other vaccine preventable diseases (VPD), there is a gap between recommendations for vaccination among older persons and actual vaccination rates in Europe. Older Europeans are not well vaccinated and therefore not well protected against these VPD. Identifying and developing strategies for overcoming barriers to vaccination is therefore an important health policy goal for Europe. In this brief, we summarize the evidence about policies and practices that promote the use of vaccination from all over the world and identify actions that policy makers should take to improve rates of vaccination and promote healthy ageing.We articulate four broad policy goals and identify specific actions required to realize them. The four policy goals are: - Promote life course vaccination to promote healthy ageing by limiting the burden of illness linked to vaccine-preventable infectious disease; - Improve the vaccination rate among health care professionals (HCP) and empower their critical role as vaccination providers; - Expand opportunities for patients to receive vaccination; - Develop patient knowledge and improve attitudes and beliefs; Each of these goals, along with a list of recommended policy actions, are summarised in one table available at the end of this Policy Brief. The potential economic, social, cultural and health benefits of these changes are enormous, but to translate 'what we know' into effective policy, policy makers must use evidence from the literature, including the evidence we summarise here, to define precise and realistic objectives regarding expected vaccination coverage. It is also crucial to develop implementation plans that include providing appropriate information to patients and to HCP in charge of vaccination; monitor vaccination coverage with appropriate tools and assess the results; and continuously readapt policies and programmes based on new evidence. © La Revue de Gériatrie.

2009 Kowal P, Chatterji S, 'Valuing health directly WHO values health directly', BRITISH MEDICAL JOURNAL, 339 (2009)
DOI 10.1136/bmj.b3503
2009 Clausen T, Rossow I, Naidoo N, Kowal P, 'Diverse alcohol drinking patterns in 20 African countries', ADDICTION, 104 1147-1154 (2009)
DOI 10.1111/j.1360-0443.2009.02559.x
Citations Scopus - 42Web of Science - 33
2009 Mataria A, Giacaman R, Stefanini A, Naidoo N, Kowal P, Chatterji S, 'The quality of life of Palestinians living in chronic conflict: assessment and determinants', European Journal of Health Economics, 10 93-101 (2009)
DOI 10.1007/s10198-008-0106-5
Citations Scopus - 27Web of Science - 25
2009 Andreotti A, Minicuci N, Kowal P, Chatterji S, 'Multidimensional Profiles of Health Status: An Application of the Grade of Membership Model to the World Health Survey', PLOS ONE, 4 (2009)
DOI 10.1371/journal.pone.0004426
Citations Scopus - 9Web of Science - 5
2008 Ninness BM, 'Editor', International Journal of Adaptive Control and Signal Processing, (2008) [C2]
Co-authors Brett Ninness
2008 Kowal P, 'China and India's challenges: the other end of the spectrum', LANCET, 372 1459-1459 (2008)
DOI 10.1016/S0140-6736(08)61611-6
Citations Scopus - 2Web of Science - 2
2008 Chatterji S, Kowal P, Mathers C, Naidoo N, Smith JP, Suzman R, Kowal P, 'The Health of Ageing Populations in China and India', Health Affairs, 27 1052-1063 (2008) [C1]
DOI 10.1377/hlthaff.27.4.1052
Citations Scopus - 91Web of Science - 74
2006 O'Connell MB, Frye RF, Matzke GR, St Peter JV, Willhite LA, Welch MR, et al., 'Effect of Conjugated Equine Estrogens on Oxidative Metabolism in Middle-aged and Elderly Postmenopausal Women', Journal of Clinical Pharmacology, 46 1299-1307 (2006) [C1]
DOI 10.1177/0091270006292249
Citations Scopus - 9
2006 Ferreira M, Kowal P, 'A Minimum Data Set on Ageing and Older Persons in Sub-Saharan Africa: Process and Outcome', African Population Studies, 21 19-36 (2006) [C1]
Citations Scopus - 7
2003 Kowal PR, Lopez AD, 'Child survival.', Lancet, 362 915 (2003)
Citations Scopus - 3
2003 Velkoff V, Kowal P, 'Aging in Africa: Demographic dimensions', GERONTOLOGIST, 43 414-414 (2003)
2003 Kowal PR, Lopez AD, 'Child survival', LANCET, 362 915-915 (2003)
DOI 10.1016/S0140-6736(03)14308-5
Citations Scopus - 1Web of Science - 4
2002 Kowal PR, Dowd JE, Aboderin IAG, Madzingira N, 'Data for older adult populations in sub-Saharan Africa', LANCET, 360 91-91 (2002)
DOI 10.1016/S0140-6736(02)09353-4
Citations Scopus - 1Web of Science - 1
2000 O'Connell MB, Kowal PR, Allivato CJ, Repka TL, 'Evaluation of warfarin initiation regimens in elderly inpatients', Pharmacotherapy, 20 923-930 (2000)

Study Objective. To compare initial warfarin doses of 5 mg or below and doses above 5 mg in hospitalized elderly, Design. Retrospective review of charts identified from computeriz... [more]

Study Objective. To compare initial warfarin doses of 5 mg or below and doses above 5 mg in hospitalized elderly, Design. Retrospective review of charts identified from computerized pharmacy records. Setting. County teaching hospital. Patients. Inpatients aged 65 years or older receiving at least three warfarin doses. Intervention. We measured the time to first international normalized ratio(INR) of 2.0 or greater, bleeding complications, number of warfarin doses held, and vitamin K use. Measurements and Main Results. The average initial low dose (33 patients) was 4.8 ± 0.8 mg and the average initial high dose (40 patients) was 9.0 ± 1.2 mg. The mean time to first INR of 2.0 or greater was similar, 3.4 and 3.0 days, respectively (p=0.38). The low-dose group had fewer bleeds (7 vs 13, p=0.28) and doses held (11 vs 18 patients, p=0.27, 30 vs 50 doses). Four patients in each group received vitamin K (p=0.8). Forty-four percent of patients with an INR of 4 or above and 48% of patients who had a dose held were on a long-term drug or had a new drug added that could cause a major drug interaction with warfarin. Conclusion. In this pilot study, hospitalized elderly who received a low versus high initial dose of warfarin achieved therapeutic INRs in a similar time and had lower but not significantly different safety outcomes.

DOI 10.1592/phco.20.11.923.35260
Citations Scopus - 25
1994 Zimmerman MH, Kowal PR, 'The pharmacist's role in pain management', Journal of Pharmaceutical Care in Pain &amp; Symptom Control, 2 23-37 (1994)

Pharmacists now are able to contribute far more to pain management than in the past, through drug therapy monitoring, patient and staff education, and other means, To improve pati... [more]

Pharmacists now are able to contribute far more to pain management than in the past, through drug therapy monitoring, patient and staff education, and other means, To improve patient care, pharmacists can become better informed on pain management through programs of the American Pain Society and state cancer pain initiatives. Standards to monitor quality of care have been developed by the American Pain Society. Guidelines to assist in choices of drug therapy have been published the American Pain Society, the Department of Health and Human Services Agency for Health Care Policy and Research and by several state cancer pain initiatives. A practical approach for pharmacists to become more involved in gathering information about pain patients through chart reviews, interviewing patients, and selecting appropriate medications and routes specific to patients¿ needs is presented. To optimally impact patient care outcomes, it is mandatory for pharmacists to become familiar with the pharmacokinetics and pharmacodynamics of medications used to treat pain. Pharmacists practicing on orga-. nized health care settings can have a significant impact on pain management by becoming involved with reviewing the Quality Assurance Standards for pain treatment. These pharmacists¿ unique accessibility to patients, physicians, and the process, places them in an excellent position to have an impact on improving the treatment of pain. © 1994, Informa UK Ltd. All rights reserved.

DOI 10.1300/J088v02n02_04
Small J, Aldwin C, Kowal P, Chatterji S, Pruchno R, 'Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach.', Gerontologist,
DOI 10.1093/geront/gnx159
Minicuci N, Naidoo N, Chatterji S, Kowal P, 'Data Resource Profile: Cross-national and cross-study sociodemographic and health-related harmonized domains from SAGE plus ELSA, HRS and SHARE (SAGE+, Wave 1).', Int J Epidemiol, 45 1403-1403j [C1]
DOI 10.1093/ije/dyw181
Show 112 more journal articles

Conference (26 outputs)

Year Citation Altmetrics Link
2017 Eick G, Cepon-Robins T, Devlin M, Kowal P, Sugiyama L, Snodgrass JJ, 'Expanding the methodological toolkit for dried blood spot samples in human biology and health research: Best practices and preliminary results for interleukin-10 (IL-10)', AMERICAN JOURNAL OF HUMAN BIOLOGY (2017)
2017 Gildner TE, Kowal P, Snodgrass JJ, 'Healthy heart, healthy mind: Testing crosscultural associations between cardiovascular health and cognitive performance in the study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF HUMAN BIOLOGY (2017)
2017 Dent E, Hoogendijk E, Kowal P, 'Measurement of frailty in clinical practice and population health surveys', AUSTRALASIAN JOURNAL ON AGEING (2017)
2016 Goldman EA, Eick G, Compton D, Kowal P, Snodgrass JJ, Eisenberg DTA, Sterner KN, 'Evaluating minimally invasive methods of telomere length measurement: A sub-study of the WHO Study on Global AGEing and Adult Health (SAGE)', AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Atlanta, GA (2016)
2016 Schrock JM, Liebert MA, Kowal P, Snodgrass J, 'Sociodemographic and lifestyle factors associated with lung function in five countries', AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Atlanta, GA (2016)
2016 Eick GN, Urlacher SS, Fording TE, Kowal PR, Sugiyama LS, Snodgrass JJ, 'What a drop can really do: methodological challenges of integrating dried blood spot samples into human biology research.', AMERICAN JOURNAL OF HUMAN BIOLOGY (2016)
2016 Gildner TE, Liebert MA, Kowal P, Snodgrass JJ, 'Study on global AGEing and adult health (SAGE): Cross-cultural associations between cognitive function and diminished physical performance among older adults.', AMERICAN JOURNAL OF HUMAN BIOLOGY (2016)
2016 Schrock JM, Liebert MA, Kowal P, Snodgrass JJ, 'Study on global AGEing and adult health (SAGE): The social stratification of frailty among older adults in India.', AMERICAN JOURNAL OF HUMAN BIOLOGY (2016)
2016 Sheridan J, Towers A, Minicuci N, Kowal P, Newcombe D, 'HOW MUCH IS HOW MUCH? MEASUREMENT OF ALCOHOL CONSUMPTION IN LONGITUDINAL STUDIES OF AGEING', DRUG AND ALCOHOL REVIEW (2016)
2016 Small J, Aldwin C, Kowal P, 'CONTEXTUAL DETERMINANTS OF CAREGIVER WELL-BEING IN KWA-ZULA NATAL SOUTH AFRICA', GERONTOLOGIST (2016)
2016 Gonzales E, Liu Y, Roberto K, Kowal P, 'SOCIAL DETERMINANTS OF HEALTH, HEALTH DISPARITIES, AND PRODUCTIVE AGING: FINDINGS FROM CHINA', GERONTOLOGIST (2016)
2015 Gildner TE, Liebert MA, Kowal P, Snodgrass JJ, 'Is employment status cross-culturally associated with cognitive function among older adults: Results from the Study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, St Louis, MO (2015) [E3]
2015 Liebert MA, Gildner TE, Kowal P, Chatterji S, Snodgrass JJ, 'Associations between socioeconomic status and obesity in low- and middle-income countries: Results from the Study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, St Louis, MO (2015) [E3]
2015 Barrett TM, Liebert MA, Kowal P, Snodgrass JJ, 'Study on global AGEing and adult health (SAGE): links among measures of perceived control, happiness, and blood pressure', AMERICAN JOURNAL OF HUMAN BIOLOGY (2015) [E3]
2015 Brigham R, Gildner TE, Liebert MA, Kowal P, Snodgrass JJ, 'Study on global AGEing and adult health (SAGE): the effects of social cohesion and personal relationships on depression diagnosis among older adults in India', AMERICAN JOURNAL OF HUMAN BIOLOGY (2015) [E3]
2015 Schrock JM, McClure HH, Kowal P, Naidoo N, Snodgrass JJ, 'Food insecurity and underweight/overweight among older adults in India: results from the Study on global AGEing and adult health (SAGE)', AMERICAN JOURNAL OF HUMAN BIOLOGY (2015) [E3]
2015 Snodgrass JJ, Liebert MA, Gildner TE, Kowal P, 'Study on global AGEing and adult health (SAGE): the role of income on depression diagnosis among older adults in six middle-income countries', AMERICAN JOURNAL OF HUMAN BIOLOGY (2015) [E3]
2015 Capistrant BD, Ghosh S, Friedemann-Sanchez G, Kowal P, Mathur A, 'CULTURE AND CAREGIVING FOR OLDER ADULTS IN INDIA: A QUALITATIVE STUDY', GERONTOLOGIST (2015)
2015 Ghosh S, Capistrant BD, Friedemann-Sanchez G, Kowal P, Mathur A, 'DEMOGRAPHIC SHIFTS, FAMILY STRUCTURE, AND ELDER CARE IN INDIA: HOW ARE INDIAN FAMILIES NAVIGATING NEW TERRAIN?', GERONTOLOGIST (2015)
2014 Capistrant BD, Ghosh S, Friedemann-Sanchez G, Kowal P, 'IN WHAT CONTEXTS DO NEW ELDER CARE DEMANDS EMERGE IN INDIA?', GERONTOLOGIST (2014)
2014 Gildner T, Liebert MA, Kowal P, Chatterji S, Snodgrass J, 'STUDY ON GLOBAL AGEING AND ADULT HEALTH (SAGE): ASSOCIATIONS BETWEEN INCOME ADEQUACY AND WELL-BEING', GERONTOLOGIST (2014)
2014 Gildner TE, Liebert MA, Kowal P, Snodgrass JJ, 'The Study on global AGEing and adult health (SAGE): The effect of sleep quality and duration on obesity levels among older adults from six middle income countries.', AMERICAN JOURNAL OF HUMAN BIOLOGY (2014)
2014 Olson WJ, Liebert MA, Gildner TE, Kowal P, Snodgrass JJ, 'The Study on global AGEing and adult health (SAGE): Depression and body composition among aging populations', AMERICAN JOURNAL OF HUMAN BIOLOGY (2014)
2014 Snodgrass JJ, Liebert MA, Cepon-Robins TJ, Mathur A, Kowal P, Chatterji S, 'The Study on global AGEing and adult health (SAGE): Objectively measured physical activity among older adults in urban India.', AMERICAN JOURNAL OF HUMAN BIOLOGY (2014)
2013 Liebert MA, Snodgrass JJ, Cepon-Robins TJ, Gildner TE, Mathur A, Williams SR, et al., 'The relationship between clinical markers of frailty and measured physical activity using accelerometers: Results of a SAGE sub-study among older adults in India.', AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Knoxville, TN (2013)
2000 O'Connell MB, Kowal PR, 'Evaluation of warfarin initiation regimens in elderly inpatients', PHARMACOTHERAPY, CHICAGO, ILLINOIS (2000)
DOI 10.1592/phco.20.11.923.35260
Citations Web of Science - 23
Show 23 more conferences

Other (1 outputs)

Year Citation Altmetrics Link
2015 Byles J, D'Este C, Kowal P, Curryer C, Thomas L, Yates A, et al., 'Gender and Ageing. Background Paper** Contribution to The World Report on Ageing and Health: a policy framework for healthy ageing.', The World Report on Ageing and Health: a policy framework for healthy ageing. Geneva: World Health Organisation (WHO) (2015)
Co-authors Catherine Deste, Cassie Curryer Uon, Julie Byles

Report (2 outputs)

Year Citation Altmetrics Link
2014 Byles JE, Curryer CA, Edwards N, Weaver N, D'Este C, Hall J, Kowal P, 'The health of older people in selected countries of the Western Pacific Region', World Health Organisation, 54 (2014) [R1]
Co-authors Natasha Weaver, Catherine Deste, John Hall, Cassie Curryer Uon, Julie Byles
2012 Wan H, Muenchrath MM, Kowal P, 'Shades of Gray: A cross country study of health and well-being of the older populations in SAGE countries', National Institute on Aging (NIA) (2012) [R1]
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Grants and Funding

Summary

Number of grants 6
Total funding $1,660,994

Click on a grant title below to expand the full details for that specific grant.


20181 grants / $236,310

Beyond successful ageing: Longevity & healthy ageing among Australian women$236,310

Funding body: ARC (Australian Research Council)

Funding body ARC (Australian Research Council)
Project Team Professor Julie Byles, Professor Deb Loxton, Dr Lucy Leigh, Doctor Liz Holliday, Professor John Beard, Doctor Paul Kowal, Professor Carol Jagger
Scheme Discovery Projects
Role Investigator
Funding Start 2018
Funding Finish 2019
GNo G1700222
Type Of Funding Aust Competitive - Commonwealth
Category 1CS
UON Y

20151 grants / $19,684

Updating the Directory of Research on Ageing in Africa$19,684

Funding body: United Nations Department of Economic and Social Affairs

Funding body United Nations Department of Economic and Social Affairs
Project Team Professor Julie Byles, Doctor Paul Kowal, Associate Professor John Hall, Doctor Masuma Khanam
Scheme Research Grant
Role Investigator
Funding Start 2015
Funding Finish 2015
GNo G1501160
Type Of Funding International - Competitive
Category 3IFA
UON Y

20131 grants / $940,000

Reducing hypertension in sub-Saharan Africa through salt reduction strategies$940,000

To monitor the effectiveness of salt reduction legislation on blood pressure in the South African population.  Ghana was included for a comparison population.  Also capturing tobacco use data using GATS methods.

Funding body: Bloomberg Philanthropies

Funding body Bloomberg Philanthropies
Project Team

Karen Charlton, SAGE teams in Ghana and South Africa, colleagues at North West University

Scheme Don't know what this is.
Role Lead
Funding Start 2013
Funding Finish 2018
GNo
Type Of Funding C3220 - International Philanthropy
Category 3220
UON N

20121 grants / $47,010

Comparative Study on Health of Older Persons in Selected Countries in the Western Pacific Region$47,010

Funding body: World Health Organisation

Funding body World Health Organisation
Project Team Professor Julie Byles, Associate Professor John Hall, Conjoint Professor Cate d'Este, Doctor Paul Kowal, Professor Hal Kendig, Dr Joel Negin, Dr Nawi Ng
Scheme Research Grant
Role Investigator
Funding Start 2012
Funding Finish 2012
GNo G1201053
Type Of Funding International - Non Competitive
Category 3IFB
UON Y

20111 grants / $386,000

Harmonizing health outcomes and determinants across longitudinal studies on aging.$386,000

The major goal of this project is to harmonize the data sets from selected longitudinal studies of aging in order to allow cross study analysis of issues of interest. The project will deliver a harmonized data set with all metadata as per international standards. This included data from two waves each from WHO SAGE, US HRS, ELSA, SHARE, and one wave of LASI and CHARLS.

Funding body: United States National Institute on Aging

Funding body United States National Institute on Aging
Project Team

Somnath Chatterji, Nadia Minicuci, Nirmala Naidoo

Scheme R21
Role Lead
Funding Start 2011
Funding Finish 2013
GNo
Type Of Funding International - Competitive
Category 3IFA
UON N

20091 grants / $31,990

Uptake and impact of new Medicare Benefits Schedule Items - Psychologists and Other Allied Mental Health Professionals$31,990

Funding body: Australian Rotary Health

Funding body Australian Rotary Health
Project Team Professor Julie Byles, Professor Deb Loxton, Conjoint Associate Professor Lynne Parkinson, Mr Richard Gibson, Doctor Jenny Stewart Williams, Doctor Paul Kowal
Scheme Mental Health Research Grant
Role Investigator
Funding Start 2009
Funding Finish 2009
GNo G0189463
Type Of Funding Aust Competitive - Non Commonwealth
Category 1NS
UON Y
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Research Supervision

Number of supervisions

Completed0
Current3

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD Health of older adults in Ghana
co-supervising PhD student
Health, Priority Research Centre for Generational Health and Ageing (RCGHA), The University of Newcastle, NSW. Co-Supervisor
2017 PhD Multi-Morbidity and Disability Among the Older Adults in Bangladesh: Implications for Redesigning Healthcare Policies
Multi-Morbidity and Disability Among the Older Adults in Bangladesh: Implications for Redesigning Healthcare Policies
Health, Priority Research Centre for Generational Health and Ageing (RCGHA), The University of Newcastle, NSW. Co-Supervisor
2015 PhD International obesity and SES: Relative vs Absolute
Co-supervising PhD student
Health, The University of Newcastle, NSW Co-Supervisor
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Dr Paul Kowal

Position

Conjoint Senior Lecturer
School of Medicine and Public Health
Faculty of Health and Medicine

Contact Details

Email paul.kowal@newcastle.edu.au
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