Comme dans la plupart des pays francophones d’Afrique Subsaharienne, la question du vieillissement ou la situation des personnes âgées ne sont pas encore d’actualité au Niger, principalement à cause de la jeunesse de sa population d’une part et d’un intérêt plus porté sur les enfants, les adolescents et les mères d’autre part. Pourtant le Niger fait face à une crise économique sans précédent qui peut avoir des conséquences néfastes sur les conditions de vie des personnes âgées. D’un côté, selon la coutume, la personne âgée (généralement grand parent) s’occupe principalement des petits enfants (orphelins ou non) qui lui sont confiés par leurs parents vivant dans la même localité ou ailleurs, ou qui sont décédés. De l’autre, l’absence d’un jeune adulte dans un ménage où vit au moins une personne âgée est considérée comme un phénomène social préoccupant dans les pays à forte prévalence de VIH/SIDA. Le Niger fait partie des pays où la proportion des personnes âgées vivant avec des petits enfants en l’absence de leurs parents adultes est la plus élevée. Cependant, malgré une forte mortalité adulte, l’absence de données fiables ne permet pas de le classer parmi les pays à forte mortalité adulte due au VIH/SIDA. La raison de cette situation est donc à chercher dans les différences individuelles et communautaires. Jusqu’au début des années 1990, la plupart des études sur les personnes âgées réalisées en Afrique Subsaharienne étaient basées sur les études qualitatives, tandis que les plus récentes sont faites à partir des données des recensements ou enquêtes sociodémoraphiques et économiques. Les conditions de vie des personnes âgées et les conséquences de la pauvreté et du VIH/SIDA sur celles-ci sont les principaux thèmes jusque-là couverts à l’aide des données existantes. Mais, il manque encore de données longitudinales essentielles à l’analyse de certains aspects du cycle de vie des personnes âgées. L’étude n’étant pas sociologique, c’est à l’aide de données démographiques quantitatives, plus précisément le recensement général de la population, que nous tenterons d’expliquer le phénomène sur une base exploratoire. L’analyse au niveau individuel a été faite à l’aide de la régression logistique sous STATA, tandis qu’au niveau contextuel, nous avons utilisé l’analyse multiniveau à l’aide du logiciel HLM (version 6.0). Les résultats indiquent que la vie en l’absence d’un jeune adulte et dans un ménage à génération coupée dépendent principalement du statut sociodémographique de la personne âgée au Niger. Par exemple, il ressort que le mariage avantage l’homme âgé, tandis que le veuvage l’isole plus que la femme âgée. Au niveau contextuel, ce sont les facteurs socioéconomiques qui influencent les conditions de vie des personnes âgées. L’étude montre, en effet, que le degré d’urbanisation d’une commune augmente le risque d’isolement d’une personne âgée qui y réside, alors que le niveau de pauvreté le réduit. Toutefois, nos résultats sont à prendre avec prudence parce qu’en premier lieu il n’existe pas d’études références sur le sujet tant au Niger que dans la sous-région d’Afrique francophone sahélienne. Ensuite, parce que le phénomène étudié pourrait être mesuré de plusieurs manières en fonction du contexte et des données disponibles, et que l’analyse approfondie des effets du statut matrimonial nécessiterait une plus grande connaissance du phénomène chez les personnes âgées. Enfin, compte tenu de la faible prévalence du VIH/SIDA au Niger, les principaux facteurs explicatifs de la vie dans un ménage à génération coupée (aussi bien pour les personnes âgées que pour les enfants) pourraient être le confiage des enfants ou la mortalité adulte due aux autres causes telles que le paludisme, la tuberculose et les maladies infectieuses. Toutefois, l’absence d’informations relatives à ces aspects dans les données utilisées n’a pas permis de les intégrer dans notre étude. Ainsi, compte tenu de la difficulté d’appréhender les contours du phénomène, les futurs programmes en faveur des personnes âgées au Niger et en Afrique Subsaharienne francophone doivent se baser sur des études concrètes relatives aux dimensions sociale et économique du phénomène. Mots clés : Niger - personnes âgées - conditions de vie - mode de vie - cohabitation intergénérationnelle - études comparatives - absence d’un jeune adulte - ménage à génération coupée - Afrique. / Niger, like many other countries in Francophone Sub-Saharan Africa, has a young population and the living arrangements of older people are not high on the list of priority issues for politicians and researchers. However, Niger is one of the poorest countries in Sub-Saharan Africa and the ongoing economic crisis there can have adverse impacts on the welfare and alter the living arrangements of both old and young people. In many African societies like Niger, grandparents traditionally take care of grandchildren, and older people living in households with no younger adult present is not an unusual situation. At present, the living arrangements of the older population and orphans has attracted considerable attention especially in high HIV/AIDS prevalence countries where many younger adults have died. While HIV/AIDS is not yet a major problem in Niger, the proportion of older people who live with grandchildren in the absence of the middle generation (called the “skipped generation”) is nonetheless high – roughly the same level as that observed in some high HIV/AIDS prevalence countries in Africa. Many studies on older people in Sub-Saharan Africa were done in the 1990s, using qualitative approaches or cross-sectional survey data (appropriate longitudinal data generally lacking in Africa). The main topics examined by these studies have tended to be the living arrangements of older people in high HIV/AIDS contexts, and the poverty consequences of those living arrangements. In this study, we use quantitative data to examine the living arrangements of older people in Niger, focusing both on individual and contextual covariates. Census data provide our main source of data, and the large number of observations available allows us to examine a relatively large number of covariates and situations. Logistic regressions estimated with STATA are used to study individual determinants, and HLM (6.0 version) software is used for the multilevel (contextual) analysis. With respect to the determinants of living with no (younger) adult or in a skipped generation household, the results show that socio-demographic status of older people is the most important variable for explaining the large sex differences in living arrangements. Interestingly, married women are more likely to live in such a household, while after the death of a spouse, men instead appear to be disadvantaged. At the contextual level, the results show that the socioeconomic characteristics are the most important factors. Specifically, the risk of living without a younger adult or in a skipped generation household is explained is larger in more urban areas, and smaller in communities that are relatively more impoverished. Insofar as this is the first study to examine the issue in this part of Africa – the Francophone Sahel – no comparative results from nearby countries exist and the generality of our findings have yet to be confirmed. The living arrangements of older people can be measured in various ways, differing by context and availability of data, and a more detailed analysis, for example, of the effects of marital status requires a deep understanding of marriage among older people in the Nigeran context. Given the low prevalence of HIV/AIDS in Niger, the likely causes of the high prevalence of households in which older people live without the presence of a younger adult or in a skipped generation are high levels of adult mortality from other causes and child fostering practices. Unfortunately, information on these factors is largely missing from our data, making it impossible to directly examine their importance. Finally, given the difficulties of studying these issues with existing data, evidence-based policy and programs targeting the elderly must pay more attention to social and economic dimensions, often requiring the fielding of surveys targeting the elderly. Key words: Niger - Older people - living arrangements of older people – intergenerational living arrangement - comparative studies-living with no adult - skipped generation- Africa.

Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations.  The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services.   Conclusions                                                                                         There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups.  Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services. / Aging and Living Conditions Program / Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec