Abstract Background: Home care need for elderly is now increasing all over the world. However, this type of service is still under development in Vietnam. Additionally, few Vietnamese studies investigated home care needs in a comprehensive approach. Objective: The aim of the study was to identify five aspects of home care needs among elderly, including ADLs, IADLs, psychological, health care and health information needs,and related factors.
HOME CARE NEEDS AMONG ELDERLY IN DISTRICT 12, HO CHI MINH CITY Abstract Background: Home care need for elderly is now increasing all over the world However, this type of service is still under development in Vietnam Additionally, few Vietnamese studies investigated home care needs in a comprehensive approach Objective: The aim of the study was to identify five aspects of home care needs among elderly, including ADLs, IADLs, psychological, health care and health information needs,and related factors Methods: A cross-sectional study was carried out to answer the research phenomena during 12 July to 12 November, 2015 Three hundred and nine of 29,930older adults living in the district 12 of Ho Chi Minh City were randomly chosen and completed interviews with astructured questionnaire, including five subscales The validity was tested by content validity and Cronbach’s alpha levels for internal consistent reliabilities were from 0.75 to 0.87 Results: Female was predominant (58.9%) in this study Nearly half of study population (47.9%) participants aged from 60 to 69 and 33.66% aged from 70 to 79 Almost elderly lived with relatives in their house (94.5%) The mean score of ADLs was 5.72 ± 1.07 (0-6) and 5.16 ± 2.33 (0-8) for IADLs.The mean Affect Balance score was 6.23 ± 0.31 (0-10).Only 17.48% had home health care needs, whereas there were 88.67% participants had needs of information about health care issues Factors that had strong association with home care needs included age, gender, allowance, living arrangement and number of comorbidities (p< 0.05) Conclusion: The results showed that elderly in district 12 had low ADLs, low psychological needs, low health care needs, but high health information needs and IADLs needs The study also contributed to literature about factors those had potential impacts on home care needs in elderly population These factors included age, gender, allowance, living arrangement and number of comorbidities Introduction Old age is often characterized as a period of susceptibility of chronic illnesses , psychological problems , declining physical functioning , restricted cognitive abilities , and lack of health information Generally, most of the elderly have to cope with non-contagious and chronic diseases such as joint degradation, cardiac problems and blood pressure, prostate, and urination disorders Additionally, life course changes, such as retirement and bereavement, may lead to a loss of social roles and limit participation in social activities and those in turn result in psychological impacts on elders such as depression, anxiety, loneliness and social isolation Studies on changes in functional ability showed that elderly experiences inevitably decreases upon individuals’ ability to carry out basic activities of daily living (ADLs) including bathing, dressing, using the toilet, transferring from bed to chair, and feeding oneself In addition to decrease in ADLs, older people may also have limitations on instrumental activities of daily diving (IADLs) that includes such activities as the ability to prepare meals, take medications properly, go grocery shopping, housework, and manage money Currently, many studies suggested that the need for information about health become more prevalent at older age and elderly are often the subgroups of population who have lack of health information, especially as epidemics or health risks arise Since proven to be associated with reduced independence , functional disabilities and other disadvantages among elderly could be used to evaluate the needs for formal and informal community and home care On the other words, there are four main types of home care needs among elderly including home health care needs, ADLs/IADLs needs or home help needs, psychological needs and health information needs Although confirmed as essential requirements, home-care needs among elderly are often neglected or unmet A survey in Canada showed that 33% to 67% of seniors with ADL or IADL needs did not receive any form of home care in preceding year Also, other studies from many countries also revealed that the prevalence of at least one unmet ADL or IADL need has been estimated at between one-fifth and one-half, depending on the samplecharacteristics, the definition of unmet needs, and which ADL/IADL are considered Unmet home-care needs are not only cause consequences for frail elders but also the health-care system A previous study had concluded that the consequences of inadequate help could impede management of chronic health conditions among older population, and may compromise seniors’ ability to maintain a safe and reasonable quality of community living Desai et al in his study reported that nearly half of participants with unmet needs experienced one or more negative consequences such as not being able to eat when hungry and experiencing a burn or scald when bathing, and that negative consequences had the potential to seriously threaten the health and safety of those with unmet needs Current studies also reported that unmet ADL needs were associated with many negative health-related events such as having pressure ulcers and contractures, losing weight, falling, incontinence, depression, and death As for the health-care system, unmet ADL needs were also associated with increases in the number of physician visits, emergency-department visits, nursing-home placement, and hospitalizations Vietnam also follows the aging trend as other countries in the world In 1979, there were 3.71 million men and women aged 60 and above, representing 6.9% of the total population, and in 1989 the total of elderly people was of 4.64 million, accounting for 7.2% of the total population By the year of 2006, there were over 7.8 millions of the elderly, yielding a proportion of 9.2% According to the statistics from the 2008 Vietnam Household Living Standard Survey, the total of elderly people was estimated to be of 9.47 million, accounting for 11% of the total population By the year 2020, Vietnam is expected to have more than 12 million older persons and the proportion of older population is estimated to be 26.1% by 2050 Despite of great efforts of the government, health care accessibility of Vietnamese older adults is still inequitable between rural and urban areas For most of older persons with financial limitations living in rural areas, they visit commune health stations as their first-choice in seeking health care since these health stations are close to their home and provide free health care activities through the national health insurance program On the contrast, hospitals were found to be convenient for the elderly with better economical status living in urban areas although they may have to pay out-of-pocket for health care services Either living in rural or urban settings however the elderly receive inadequate health care, both in quantity and quality, from formal health care system As recommended by many international organizations , home care may be a good solution to meet the health care needs of older populations, not only in developed countries but also in developing countries including Vietnam This type of care service however is still at the dawn of the establishment in Vietnam Recently, with the permission of the People Committee of Ha Noi only two private clinics providing home care services for older patients had been found In other provinces, home care service is still a new concept although several studies showed a huge home care needs among older adults In Ho Chi Minh, the Health Services has been implemented family doctor offices since 2009 The main aims of family doctors are to provide essential care at home for patients or persons who need care at home Apart from family doctor system, private home care services are also available in Ho Chi Minh city The services are provided by professional nurses who work for hospitals or commune health stations They home care activities as an extra-work out of their working days To date there are no available data about how many nurses have been doing home care activities and what kinds of home care they have been delivering Also, the family doctors system has been still working, but no reports about its effectiveness have been documented so far It is believed from health authorities of Ho Chi Minh city that there are significant but unexplored home care needs among older people and the existing home care services could not meet the needs of this population However, there are not any studies or surveys conducted up to now to answer this question Therefore, an initial study on home care needs among elderly is necessary The findings of the study is expectd to give a clear picture about to which extent the home care needs of older people and what services that healthcare facilities can provide to this special group of population Material and Methods A cross-sectional design wasconducted from July 12 to August 12, 2015 at district 12 of Ho Chi Minh city The district 12 of Ho Chi Minh city included 11 communes According to the People’s Committee of District 12, there were 29,930 elderly (60 and over) living in the district 12 in 2014 With the acception from the People’s Committee, the researcher had the list of all elderly in the whole district The researcher assigned each elderly an ID number from to 29,930 The single random sampling technique was applied to select the sample for this study A random number table was used to choose 384 numbers within the range from to 29,930 From the list of chosen numbers, the investigator collected lists of chosen elderly in each commune For instance, there might be 100 chosen numbers those corespondent to 100 elderly living in the commune A; therefore, the data collectors made 100 interviews in the commune A After having the lists of selected elderly in each commune, the investigator contacted with the local health authorities to hold free physical examinations for selected elderly at the health commune stations Five interviewers collected the data During physical examinations, elderly took regular examinations such as blood pressure, height and weight measurements Then interviewers clearly explained the purposes and ethical protections of the current study After the elder persons agreeing to participate, the interviewers invited them and had 10-15 minutes interviews in a quiet and seperate site As the data collection finished, a total of 384 observations were collected However, 74 elderly did not complete two third of the questionnaire; therefore they were excluded from the study Thus, only 309 elderly were recruited in this study Research Instruments The questionnaire used in the study was designed based on previous studies The questionnaire included six sections as follow: Demographic information: This part consisted of items related socio-economic characteristics including age, gender, income, living arrangement, smoking habit, marital status, former jobs, and comorbidities Assessment of ADL needs: in this part, The Katz ADL with six items was used to evaluate ADL needs of respondents Six basic activities were evaluated including eating, dressing, bathing, transferring between the bed and a chair, using the toilet, and controlling bladder and bowel functions For each item respondents were asked to state whether they could perform the activity independtly and easily, independently but with difficulty (1 point) or whether they are often depent on others or always depend on others (0 point) If the total score is of 6, respondents could perform activity independently, whereas if the score of they are dependable too much To assess ADLs needs of participants, a three-scale point question including urgently needed, needed but can wait, and not need was used With high reliability and validity tested by studies (construct validity of 0.74 to 0.88 and reliability coefficient of 0.94) , the tool was used extensively as a flag signaling functional capabilities of older adults in clinical and home environments Assessment of IADL needs: The Lawton Instrumental Activities of Daily Living Scale (IADL) was used to assess IADLs of participants There are eight items from A to H measuring the ability of elderly in doing eight instrumental activities including telephoning, shopping, food preparation, housekeeping, laundering, use of transportation, use of medicine, and financial behavior The Lawton IADL scale can be scored in several ways, the most common method is to rate each item either dichotomously (0 = less able, = more able) or trichotomously (1 = unable, = needs assistance, = independent) and sum the eight responses The higher the score, the greater the person's abilities are Women are scored on all areas of function, but, for men, the areas of food preparation, housekeeping, laundering are excluded Clients are scored according to their highest level of functioning in that category A summary score ranges from (low function, dependent) to (high function, independent) for women, and through for men To assess IADLs needs of participants, a three-scale point question including urgently needed, needed but can wait, and not need was used The inter-rater reliability of this scale was established at 0.85 To assess IADLs needs of participants, a four-scale point question including need urgently, need but can wait, not sure and not need was used Assessment of psychological needs: in this study psychological needs were assessed by using Affect Balance Scale (ABS) The scale was made up of two components: the positive affect and the negative affect component Each component has items The scale asked participants if, in the past few weeks, they had felt certain emotions The participant answered “Yes” or “No” to each question For positive affects, participants receivedone point for every “Yes” they said For negative affects, participants received one point for every “Yes” they said The Affect Balance Scale score was computed by subtracting Negative Affect Scale scores from Positive Affect Scale scores and adding a constant of five to avoid negative scores Scores ranged from (lowest affect balance) to 10 (highest affect balance) Assessment health care needs: generally, therewere three indicators used to assess health care needs among elderly They were occurence of comorbidities, selfreported health and experience of home care use Self-reported health is a subjective indicators since it is affected by many factors such as age, gender, and health conditions; therefore it was not chosen as a measure of health care needs in the present study Since the study population was elderly, so their memory in experience of home care use might have bias; thus experience of home care use was also not the proper indicator to assess home health care needs in this study As a result, the occurence of comorbidities was chosen as the measure of home health care needs Additionally, a question: Do you want to be cared by health-care professionals at home?” was asked to explore the needs of home health care of participants For respondents having home health care needs, a open-closed question was asked to gain information about what types of health care services that respondents want to be provided In the study, six types of health care services were listed including : (1) doctor care including home visits to diagnose and treat the illnesses; (2) rehabilitation; (3) nursing care including ostomy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health supports; physical, occupational, and/or speech therapy; (4) nutritional support including dietary assessments and guidance to support the treatment plan; (5) laboratory testing including certain laboratory tests, such as blood and urine tests; and (6) transportation providing transportation to patients who require transportation to and from a medical facility for treatment or physical exams In other countries, pharmaceutical services including medicine and medical equipment delivery may be available; however, this type of service is considered illegal and prohibited in Vietnam Therefore excluding the pharmaceutical services out of the list of health care services was understandable in the study Assessment of health information: Since the health information of elderly was diverse, there were no standard tools those could measure perfectly health information needs of elderly Instead, a open-closed question about types of health information that respodents desire to know was considered resonably Four main topics of health information was mentioned by the interviewers including information about chronic diseases, drug use, disease preventive measures, and pain control Other types of health information was also documented Five nurses working in General Hospital District 12 were chosen as interviewers in this study Prior to data collection a two-day training course was established to instruct interviewers how to perform data collection and skills of data mining During the training, the five interviewers interviewed five elder persons in the General Hospital to evaluate their inter-rater The acceptable inter-rater reliability was 0.81 indicating a high reliability of the questionnaire Chosen participants were categorized into communes so that the data collection was more convenient and saving time The data collection lasted from July 12 to August 12, 2015 During the data collection, the researcher worked as the supervisor to monitor, gave advices and supports for interviewers After data collection, all records was entered and coded in SPSS version 16 All variables were tested whether any coding error exists If wrong coding exists, the principal investigator reviewed the records and corrected the worng coding To describe each variable, mean and standard deviation to summary quantitative variables were applied and frequency and proportion to summary qualitative variables were applied To analyze the relationship between background profile and the needs of participants Chi Square, t-test or ANOVA test were applied to test the significant asssociations The p-value of 0.05 was used as statistical significance Results There were 309 participants enrolled in the study As shown in table 5.1, female was predominant (58.9%), 47.9% participants aged from 60 to 69 and 33.66% aged from 70 to 79 Most of participants got married (72.81%) and 22.34% were widowed Almost elderly lived with relatives in their house (94.5%) Among of those, 76.71% lived with more than two other people in the same house More than seventy percent (72.17%) participants did not have monthly allowance Among those who had allowance (74/309), 90.54% had less than million Vietnamese dong Regard to former works, housewives or unemployed participants occupied 26.88%, followed by workers (24.91%) Businessmen and farmer also accounted for 21.68% Among comorbidities, arthritis, high blood pressure and heart diseases were three of the most common diseases (56.3%, 47.9% and 46.6%, respectively) Regarding number of comorbidities, 45.63% had more than two diseases and 34.3% had diseases.More than half of participants (55.34%) were smoking at the time of interview, while 31.72% never smoked before Only 24.60% participants had falls in the last years Table Demographic profile of participants (n=309) Characteristics n % n % Male 127 41.10 Yes Female 182 58.90 No Age [mean(range)]68.67 (60-87) Amount of allowance (n=74) 60-69 148 47.90 ≤ million VND 70-79 104 33.66 > million VND ≥ 80 57 18.45 Former work Marital status Housewives/ unemployed Married 225 72.81 Workers Widowed 69 22.34 Businessmen Divorced/separated 15 4.85 Farmer Officers Family size (n=292) Number of comorbidities persons 68 23.29 No comorbidities > persons 224 76.71 disease 86 223 27.83 72.17 67 90.54 9.46 83 26.88 77 67 67 15 24.91 21.68 21.68 4.85 57 1.62 18.45 Co-morbid diseases Arthritis 174 High blood 148 pressure Heart diseases 144 diseases 56.31 > diseases 47.9 Smoking 106 141 34.30 45.63 46.6 40 12.94 Gender Characteristics Allowance Used to smoke Characteristics n % Characteristics Osteoporosis Gastric diseases Cataract Diabetes Respiratory diseases Cancer 91 73 46 45 32 29.45 Smoke up to now 23.62 Never smoke 14.89 Living arrangement 14.56 Living alone 10.36 Living with others 0.97 n % 171 98 55.34 31.72 17 292 5.50 94.50 Generally, most of participants received one point for each of daily living activities As a result, the total mean ADL score of participants was 5.72 ± 1.07 (range from to 6) It meant that participants had high independence in daily activities The percentages of participants who did not need helps from outsiders for ADL activities were very high (> 89%).Dressing and toileting had lowest needs (2.6%), while bathing had highest needs (10%) Transferring and continence had the least urgently needs, while bathing had the most urgently needs Participants needed helps of toileting but can wait at least (1.0%), while transferring was also needed but can wait the most Table ADL scores and ADLs needs among participants (n=309) Levels for needs ADL items Independent(1) Dependent(0) Urgently needed Needed but can wait Not needed n % n % n % n % n % Bathing Dressing Toileting 289 288 292 93.5 93.2 94.5 2.9 1.0 1.6 22 7.1 1.6 1.0 278 301 301 90.0 97.4 97.4 299 96.8 6.5 6.8 5.5 3.2 Transferring 20 21 17 10 0.0 25 8.1 284 91.9 Continence Feeding 301 298 97.4 96.4 11 2.6 3.6 0.0 0.6 24 7.7 2.3 285 300 92.3 97.1 Among instrumental daily living activities, housekeeping was the most independent activities (90.7%), while shopping was the least independent activity (61.2%) The total mean IADL score of participants was 5.16 ± 2.33 (range from to 8) Unlike IADLs score, a large portion of participants (> 51%) have high needs for all IADL activities Participants had the most urgently needs on using telephone (21.7%), while handling finances was the least urgently needs(12.9%) Table IADL scores and IADLs needs among participants (n=309) IADL items Independent Dependent (1) (0) Level for needs Urgently needed Needed but can wait Not needed Use Telephone Shopping Food preparation Housekeeping Laundry Mode of Transportation Responsibility for Own Medications Ability to Handle Finances n % n % n % n % n % 247 189 121 165 79.9 61.2 66.5 90.7 62 120 61 17 20.1 38.8 33.5 9.3 67 46 52 46 21.7 14.9 16.8 14.9 31 114 108 108 10.0 36.9 35.0 34.9 211 149 149 155 68.3 48.2 48.2 50.2 150 245 82.4 79.3 32 64 17.6 20.7 46 46 14.9 14.9 108 68 34.9 22.2 155 195 50.2 36.9 231 74.7 78 25.2 46 14.9 56 18.1 207 67.0 247 79.9 62 20.1 40 12.9 130 42.1 139 45.0 The mean of Affect Balance score was 6.23 ± 0.31 (range from to 10) For positive affects, the mean scores was 2.12 ± 0.21 (range from to 5) (Table5.4) Only 62 (20.06%) participants felt particularly excited or interested in something and 83 (26.86%) felt pleased about having accomplished something Other positive affects were poorly perceived by elderly For negative affects, the mean score was 3.67 ± 0.54 (range from to 5) A large part of participants felt bored and very lonely (50.48% and 30.10%) Other negative affects were relatively low perceived by participants Table Psychological needs among participants (n=309) Yes Affect items Feeling particularly excited or interested in something Proud because someone complimented you on something you had done Pleased about having accomplished something On top of the world That things were going your way Positive effect score (Mean ± SD[range]) Feel so restless that you couldn't sit long in a chair Very lonely or remote from other people Feel bored Depressed or very unhappy Upset because someone criticized you Negative effect score (Mean ± SD[range]) No n % n % 62 20.06 247 79.94 29 9.38 280 90.62 83 10 26.86 3.23 226 299 73.14 96.77 22 7.12 287 2.12 ± 0.21 (0-5) 14.89 263 30.10 216 50.48 153 7.44 286 9.71 279 3.67 ± 0.54 (0-5) 46 93 156 23 30 92.88 85.11 69.90 49.52 92.56 90.29 Yes Affect items n No % n 6.23 ± 0.31 (0-10) The Affect Balance Score (Mean ± SD[range]) % Among participants, only54persons(17.48%) had home health care needs The most needed health care service from participants was transportation to hospital 48 persons (88.89%), followed by monitoring the general health 32 persons (59.26%) and doctor’s visits for diagnosis and treat illnesses 52.7 persons (52.70%) Table Health care needs among participants (n=309) Health care Frequency Want to be cared by health-care professionals at home Yes % 54 17.48 255 82.52 Transportation to hospital for treatment illnesses 48 88.89 Monitoring the general health of the patient 32 59.26 Doctor visits for diagnosis and treat the illnesses 29 52.70 Pain control Nursing at home Dietary assessments Dietary guidance 21 13 10 10 38.89 24.07 18.52 18.52 Acupuncture Rehabilitation 16.67 11.11 Intravenous therapy Blood sampling Urine sampling Administering medication 3 7.4 5.56 5.56 1.85 No Kinds of healthcare services want to be delivered (n=54) There were 274 persons(88.67%) participants had needs of information about health care issues Of those, 221 persons(80.66%) needed information about diseases preventive measures, followed by information about chronic diseases and drug usage (66.42% and 56.57%, respectively) Table Health information needs among participants (n=309) Health information Frequency Percent (%) Needs of information about health care issues Yes 274 88.67 Health information Frequency 35 Percent (%) 11.33 Diseases preventive measures 221 80.66 Chronic diseases 182 66.42 Drug usage 155 56.57 Pain control 126 45.99 No Kinds of health information (n=274) The relationships between home care needs and demographic profile of participants Age was the factor having significant associations with ADL needs among participants (p < 0.001) Older elderlyhad lower scores of ADLs than younger ones In other word, older elderly had lower independent in ADLs than younger ones Other demographical factors did not have associations with ADL needs (p> 0.05) Table Relationship between ADL score and demographic profile of participants (n=309) Characteristics ADL score Mean ± SD p Gender Male Female Age 60-69 70-79 ≥ 80 Widowed Divorced Living arrangement Alone With others Smoking Used to smoke Still smoking Never smoke ADL score Mean ± SD p Allowance 5.77 ± 0.07 Yes 0.47 5.68 ± 0.08 5.86 ± 0.70 5.81 ± 0.69 5.15 ± 1.93 No Former work Housewives < 0.001 Workers Businessmen Marital status Married Characteristics Farmer 5.66 ± 2.46 5.58 ± 1.21 5.91 ± 0.52 Officers 0,67 Number of comorbidities No comorbidities disease 6.00 ± 0.00 5.70 ± 0.06 5.6 ± 1.03 5.81 ± 0.89 5.60 ± 1.33 0.26 diseases > diseases 0.22 5.90 ± 0.07 0.054 5.64 ± 0.07 6.00 ± 0.00 5.70 ± 0.06 5.44 ± 0.05 5.16 ± 0.01 5.14 ± 0.08 0.39 5.8 ± 0.44 5.78 ± 0.79 5.79 ± 0.95 5.63 ± 1.25 0.63 Age, gender, and allowance had significant associations with IADL needs among participants (p< 0.001) Female elderly had higher independent on IADLs than male counterparts (p< 0.001) Older elderly had less independent on IADLs than younger ones (p< 0.001) Elderly with no allowance had higher independent on IADLs than elderly with allowance (p< 0.001) Other factors did not have associations with IADL needs (p> 0.05) Table Relationship between IADL score and demographic profile of participants (n=309) Characteristics IADL score Mean ± SD p Gender 4.03 ± 0.12 Female 5.95 ± 0.18 70-79 ≥ 80 Marital status Married Widowed Divorced/ separated Living arrangement Living alone Living with others Smoking Used to smoke IADL score Mean ± SD p Yes 5.12 ± 0.13 < 0.001 No 5.76 ± 0.44 Allowance Male Age 60-69 Characteristics 6.06 ± 2.05 4.86 ± 2.10 3.35 ± 2.27 4.26 ± 2.89 4.65 ± 2.54 5.84 ± 1.95 5.56 ± 2.03 5.23 ± 1.90 < 0.001 < 0.001 0.33 0.27 0.08 4.15 ± Former work Housewives/ unemployed Workers 4.62 ± 0.50 5.12 ± 0.45 Businessmen 5.93 ± 0.19 Farmer Officers 4.86 ± 0.16 5.12 ± 0.13 Number of comorbidities No comorbidities 0.06 6.2 ± 1.64 disease 5.38 ± 2.61 diseases 5.07 ± 2.17 > diseases 5.09 ± 2.37 0.48 Characteristics Smoke up to now Never smoke IADL score Mean ± SD 2.41 5.29 ± 2.08 5.33 ± 2.63 p Characteristics IADL score Mean ± SD p Only living arrangement had strong association with affect balance score in which participants who lived with others had higher score than elderly living alone (6.01 ± 0.10 versus 4.23 ± 0.43) (p< 0.001) Other factors did not have any associations with affect balance score (p> 0.005) Table Relationship between affect balance score and demographic profile of participants (n=309) Characteristics ABS Mean ± SD p Gender Characteristics ABS Mean ± SD Allowance Male 5.11 ± 0.23 Female Age 60-69 5.34 ± 0.19 0.43 6.06 ± 0.05 0.08 70-79 ≥ 80 Marital status Married Widowed 5.96 ± 0.16 5.35 ± 0.12 Divorced/ separated Living arrangement Living alone Living with others Smoking Used to smoke Smoke up to now 5.26 ± 1.89 5.43 ± 0.13 5.25 ± 0.70 4.23 ± 0.43 6.01 ± 0.10 0.23 < 0.001 0.49 5.15 ± 0.41 5.01 ± 0.66 Yes No Former work Housewives/ unemployed Workers Businessmen Farmer Officers Number of comorbidities No comorbidities 5.93 ± 0.19 p 0.0 6.00 ± 0.01 5.52 ± 0.45 5.11 ± 0.12 5.35 ± 0.21 5.24 ± 0.23 5.13 ± 0.11 0.1 5.28 ± 0.23 disease 5.11 ± 0.17 diseases > diseases 5.54 ± 0.11 5.09 ± 2.37 0.2 Characteristics Never smoke ABS Mean ± SD 4.12 ± 0.63 p Characteristics ABS Mean ± SD Only allowance had strong association with health care needs in which participants had their own allowance had higher health care needs than elderly who did not their own allowance (27.91% versus 13.45%) (p< 0.003) Other factors did not have any associations with health care needs (p> 0.05) Table 10 Relationship between health care needs and demographic profile of participants (n=309) Characteristics Health care needs n (%) p Gender Male Female Age 60-69 70-79 ≥ 80 Widowed Divorced/ separated Living arrangement Living alone Living with others Health care needs n (%) p Allowance 24 (18.90) Yes 0.58 30 (16.48) 21 (14.19) 19 (18.27) 14 (24.56) No 0.28 Former work Housewives/ unemployed Workers Businessmen Marital status Married Characteristics Farmer 51 (22.67) 14 (20.28) (13.33) (23.53) 50 (17.12) Officers 0,17 0.49 Number of comorbidities No comorbidities 24 (27.91) 30 (13.45) 25 (30.12) 13 (16.88) 15 (22.39) 17 (25.37) (20.00) 0.29 (0.00) disease (14.04) diseases 24 (22.64) 22 (15.60) > diseases 0.003 0.28 p Characteristics Health care needs n (%) Smoking Used to smoke (15.00) Smoke up to now 37 (21.64) Never smoke 11 (11.22) p Characteristics Health care needs n (%) p 0.08 Only number of comorbidities had strong association with health information needs among participants in which patients with more comorbidities had higher needs compared to participants who did not have comorbidities (p=0.03) Other factors related to demographic profile had no associations with health care information needs among participants (p> 0.05) Table 11 Relationship between health information needs and demographic profile of participants (n=309) Characteristics Health informatio n needs n (%) p Gender Characteristics Health informatio n needs n (%) p Allowance Male 112 (88.19) 0.58 Yes 77 (89.53) Female Age 60-69 162 (89.01) 197 (88.34) 70-79 ≥ 80 Marital status Married Widowed 92 (88.46) 47 (82.46) Divorced/ separated Living arrangement Living alone Living with 14 (93.33) No Former work Housewives/ 0.21 unemployed Workers Businessmen Farmer Officers Number of 0.17 comorbidities No comorbidities 0.39 disease (12.28) diseases > diseases 21 (19.81) (4.96) 135 (91.22) 202 (89.77) 63 (91.30) 14 (82.35) 260 (89.04) 0.76 75 (90.36) 68 (88.31) 56 (83.58) 63 (94.03) 13 (86.67) 0.89 0.28 (0.00) Characteristics Health informatio n needs n (%) others Smoking Used to smoke 35 (87.50) Smoke up to 145 (84.80) now Never smoke 94 (95.92) p Characteristics Health informatio n needs n (%) 0.06 In this study, five aspects of home care needs were evaluated including ADLs needs, IADLs need, psychological needs, health care needs and health information needs Some key findings could be drawn from the results as followed: Firstly, elderly in district 12 did not have much ADLs and IADLs limitation Among IADLs, transportation, handling finances, shopping and food preparation were four activities those elderly need more help in implementation than other activities Those findings were in consistent with few studies on health care needs among elderly in Vietnam Secondly, elderly took part in the present study also had relative high affect balance, so they may not need psychological supports However, the resulted also noted that they often engaged loneliness and boring during their daily life and those could lead to psychological problems such as depression and anxiety if they could not be solved Thirdly, although elderly in the study suffered many comorbidities that indicated they have many health care needs, their home health care needs were very low The common reasons were that they have their children take care at home and that they still have enough health to go to hospital by themselves Among home health care services, transportation from home to hospitals and checking examination at home were two of health care services received concerns from participants Finally, there was a huge need of health information among participants This information mostly related to prevention measures toward diseases, nature of chronic diseases and pain control as well Among related factors to home health care needs, age seems to have many associations with home care needs It both had strong association with ADLs need and IADLs needs in which older elderly had lower ADLs and IADLs scale than younger elderly Other factors including gender, allowance, living arrangement and number of comorbidities together have impacts on many aspects of home care needs It could be said that this was the first study investigating home care needs among elderly in a holistic manner Not only ADLs and IADLs needs were assessed p in the study but also psychological needs, health care needs and health information needs of older adults were evaluated The results showed that elderly in district 12 had low ADLs need, low psychological needs, low home health care needs, but high health information needs and IADLs The study also contributed to literature about factors those had potential impacts on home care needs in elderly population These factors included age, gender, allowance, living arrangement and number of comorbidities The results of the study would be used as baseline information for following intervention programs: Since a part of elderly had limitations on shopping and food preparation, private care services could be developed to deliver those services to elderly living in district 12 Such private care services may provide care services from shopping essential supplies and food to food preparation at home for elderly A chatting service could be developed to provide private communications and information sharing to elderly in district 12 Such services could send their staff to elder’s home for chatting, taking elderly outside for relaxes or counseling elderly in psychological matters If any psychological disorders are discovered by the staff during their task, those staff may contact with professional health staff working in hospitals or other health facilities to give professional psychotherapy for older patients For General Hospital district 12, home health care services should be developed in a near future Home health care services should focus on providing transportation services and physical examination and treatment for elderly at home Those services may implement as out of hours services or weekend services so that health care staffs have enough time to deliver the services effectively Another service that could also be implemented in General Hospital district 12 was health information provision A hot line phone used as counseling channel in the hospital and served 24 hours per day is advisable Health staff who are responsible for health information should be general practitioners who are skillful in health consultation The study had few limitations Three subscale including ADL Katz tool, IADL Lawton tool, and Affect Balance Scale were firstly used in this study Although ADL and IADLs subscales showed high reliability with Cronbach’ alpha over 0.8, Affect Balance Scale was merely achieved Cronbach’ alpha of 0.75 It meant that the ABS may not fit completely with study settings in particular and Vietnamese settings in general A study focusing on reliability and validity evaluation of those subscales therefore is necessary Another drawback of this study is its cross-sectional design All statistical significant associations revealed in this study may not have causal relations those always have in perspective studies Finally, since this study did not evaluated cognitive ability of elderly, participants may have recall bias during their interviews Consequently, some data related to demographic profile or ADL and IADLs self-evaluation may not be precisely and that in turn could lead to bias in analysis of associations From the finding, a clear picture on home health care needs of elderly living in district 12 had been obtained Therefore, a study recruiting elderly from different districts in the city may be conducted in the future With that study, the author could make a comparison among districts about home care needs so that recommendations for health authorities in the city on policies of home care needs may be devoted