Exploration of Multidimensional Poverty and Dementia in Adults older than 50 years old in South Africa

Background: Multidimensional poverty is associated with chronic health conditions. However, limited research exists investigating the association between multidimensional poverty and dementia on a population level in low-and middle-income countries (LMICs). Method: This study was conducted in Soweto between 11 November 2019 and 28 February 2020. Participants included older adults above 50 years old. Data analysis was concluded in August 2021. We calculated a measure of multidimensional poverty that includes seven dimensions and eleven indicators. Assessing Dementia 8 (AD8) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to measure dementia. Differences in level and depth of poverty between adults with no dementia and those with a score above the threshold for either AD8 or RUDAS, or for both AD8/RUDAS, and for comparing gender, age group and marital status were examined. Correlation analyses to assess overlap of dimensions of deprivation were carried out. Association between dementia and multidimensional poverty were investigated using multivariate regression model. Result: Among 227 participants living in Soweto, South Africa, 151 adults were identified with dementia by the AD8 (66.5%), 64 by the RUDAS (28.2%) and 50 by both AD8 and RUDAS (22.0%). More men (32.1%) had no dementia compared to women (24.7%); and 20% of adults with dementia compared to 9.7% of those without dementia were found to be poor on four dimensions or more. The difference in multidimensional poverty index for k = 3 was 77.1% and 67.3% between adults with and without dementia. Education, health and employment were the main contributors of poverty. Multidimensional poverty was strongly associated with dementia as measured by AD8/RUDAS (adjusted OR 2.31, 95% CI 1.08-4.95), with higher odds for older female (OR 2.03, 95% CI 1.00-4.12) or those living in large households (OR 1.27, 95% CI 1.05-1.53). Conclusion: This study found that the prevalence and depth of poverty is higher among older adults with dementia. A lack of education, poor health and unemployment are major dimensions of poverty which was associated with higher risk of dementia. These findings suggest that early improvement in social determinants of health through targeted structural policies may prevent dementia later in life.