Một đề tài mới lạ về nhu cầu chăm sóc sức khỏe của người cao tuổi tại nhà. Đề tài sử dụng các bộ công cụ ADL và IADL để đánh giá nhu cầu chăm sóc sức khỏe tại nhà của người cao tuổi. Kết quả nghiên cứu cho thấy: 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.
Abstract Background: Home care need for elderly is now increasing all over the world However, this type of service is still in development in Vietnam Additionally, few Vietnamese studies investigated home care needs in a comprehensive approach Objective: The aim of the study was to indentify home care need and related factors among elderly in terms of five aspects including ADLs needs, IADLs need, psychological needs, health care needs and health information needs Methods: A cross-sectional study was carried out at General Hospital District 12 from 12 July to 12 November, 2015 A sample of 309 older adults was collected and took part in interviews with a structured questionnaire The significance of the results was assessed by t-test, ANOVA test and Chi-Square test at p-value of 0.05 using SPSS version 16 Results: There were 309 participants enrolled in the study 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 i 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 ii Acknowledgement I would like to send my special thanks to Professor Chiung-Man Wu, my supervisor, who had spent lots of time and patience to instruct me to carry out this thesis Without her, I could not complete my studying In addition, I would like to thank all professors at Nursing Department in Meiho University had provided useful and precious advices to me I also acknowledged helpful supports by officers in Post-graduate Office in Nguyen Tat Thanh University Another thank was sent to The Director Board of General Hospital District 12, who facilitated me to access and interview all participants in the study I also would like to thank all participants for their help in providing valuable information Finally, I would like to tell that I love my family due to their endless supports from the beginning to the end of my studying iii Contents Pages Abstract iii Acknowledgement iii List of tables iii List of Figures iii Chapter 1: Introduction 1.1 Statement of the Problem 1.2 Problem: Background and Significance 1.3 Aim of this research 1.4 Research questions 1.5 Chapter summary .3 Chapter 2: Literature Review 2.1 Introduction 2.2 Aged population worldwide .3 2.3 The aging population in Vietnam .3 2.4 Home care 2.5 Home care needs Chapter 3: Conceptual Framework iv 3.1 The study framework 3.2 Definitions of terms Chapter 4: Material and Methods 4.1 Study Design 4.2 Sampling and Setting .3 4.3 Research Instruments .3 4.4 Research Progress 4.5 Data Analysis 4.6 Ethical Consideration .3 Chapter Results 5.1 Demographic profile of participants 5.2 Home care needs 5.3 The relationships between home care needs and demographic profile of participants Chapter Discussion 6.1 Discussing the significance results of findings 6.2 The principal research findings 6.3 Contributions and implications 6.4 Limitations .3 6.5 Recommendations for further research v 6.6 Conclusion References Appendix 1: The questionnaire Appendix 2: Informed consent vi List of tables Page Table 4.1 The results of reliability analysis of ADLs, IADLs and ABS Table 5.1 Demographic profile of participants Table 5.2 History of comorbidities and smoking habit Error! Bookmark not defined Table 5.3 ADL scores and ADLs needs among participants Table 5.4 IADL needs among participants Table 5.5 Psychological needs among participants Table 5.6 Health care needs among participants Table 5.7 Health information needs among participants 3 Table 5.8 Relationship between ADL score and demographic profile of participants Table 5.9 Relationship between ADL score and history of comorbidities and smoking habit among participants Table 5.10 Relationship between IADL score and demographic profile of participants Table 5.11 Relationship between IADL score and history of comorbidities and health behavior of participants Table 5.12 Relationship between affect balance score and demographic profile vii of participants Table 5.13 Relationship between affect balance score and history of comorbidities and health behavior of participants Table 5.14 Relationship between health care needs and demographic profile of participants Table 5.15 Relationship between health care needs and history of comorbidities and smoking habit of participants Table 5.16 Relationship between health information needs and demographic profile of participants Table 5.17 Relationship between health information needs and history of comorbidities and smoking habit of participants viii List of Figures Page Firgure 3.1 The study framework with relevant concepts ix Chapter 1: Introduction 1.1 Statement of the Problem Population aging is now an increasing trend in a large part of the world In most developed countries, the population has been ageing for many decades, while in developing countries population ageing has taken place relatively recently The number of people who turn 60 each year worldwide is nearly 58 million, equivalent to almost two persons every second In 2012, people aged 60 or over represent almost 11.5 per cent of total global population of billion It is estimated that the proportion is projected to nearly double to 22 per cent by 2050 By 2050, for the first time there will be more older people than children under 15 In 2000, there were already more people aged 60 or over than children under 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 interview, while 31.72% never smoked before Few Vietnamese studies focused on smoking rate among elderly Instead, rate of smoking among adolescents and adults was investigated in many studies These studies showed that there are now 47.4% of young people aged over 15 smoking in over the country and total number of smokers in the country is rising up to 15 million (18.75% of total population) Young smokers continue their smoking habit as they grow older and along with adult smokers they make the proportion of smokers who are adults and older adults is increasing 6.1.2 Home care needs among participants ADLs needs The results showed that, participants could all six daily activities without partly help or complete support from other individuals such as children or relatives (total ADLs score 5.72 ± 1.07) As a result, they had lower needs of ADLs It was hardly to find Vietnamese studies in which ADL Katz tool was used to evaluate disability of elderly in daily activities; however, few studies demonstrated that ADLs ability of elderly were extremely high Indeed, a study in Can Tho evaluated the self-care ability of elderly in bathing, dressing, caring, housekeeping, transportation, toileting, and shopping and the results showed that 80.24% elderly could these activities themselves without any help from 74 relatives Another study did not evaluate ADLs ability but assessed the ability of movement in daily activities of elderly and the author concluded that 83.7% elderly had normal movement and only 15.9% had little problem with movement Only the study of Hoi et al assessed ADLs of elderly and they found that most of participants had high independence in ADLs activities The finding that the majority of older people have no need of support in specific ADL items may be explained by the fact they are mainly at young-old (61.8% at 60-74 years) and middle-old (29.0% at 75-84 years ages Compared to worldwide studies on elderly, it could be said that Vietnamese elderly had more independence on ADLs activities than western elderly A large survey in US showed that almost a third of people aged 75 to 84 and more than half of those aged 85 or older report functional limitations More than 40 percent of people aged 85 or older had difficulty performing one or more ADLs, compared with 14 percent of those aged 65 to 74 Among ADLs, difficulty with bathing was the most common ADL limitation Other studies in different countries stated that the proportions of basic ADL dysfunction among the community’s elderly population were very low (2-8%), and the elderly were more likely to be dependent in instrumental ADLs than basic ADLs IADLs needs 75 Generally, the total mean IADL score of participants was relative high, yielding a score of 5.16 ± 2.33 According to Hoi et al among rural elderly ADL impairment did not a significant problem, while IADLs and intellectual ADLs impairments became the most frequent problems, and the frequencies increased with age Asked about the needs of IADLs, surprisingly a high proportion of participants reported high needs for all eight aspects of IADLs There were large needs for transportation (63.1%), handling finances (55.01%), food preparation (51.78%), and shopping (51.78%) and medium needs for laundry (49.83%), housekeeping (49.81%), medication (33.01%), using telephone (31.71%) It is understandable why participants had high needs for transportation since they need someone could take them to health facilities for physical examination and diseases treatments Western elderly had lower needs for help in transportation compared to Vietnamese counterparts since western elderly had higher ability of using vehicles The fact that more than half of participants needed helps in handling finances, food preparation and shopping indicated that their needs in those activities were unmet although those activities were performed by their relatives or their children Psychological needs 76 In this study, Affect Balance Scale was used to evaluate psychological needs From Positive and Negative Affects, the affect balance score of participants was 6.23 ± 0.31 It meant that respondents had relative high balance between Positive and Negative Affect No official data about the prevalence of loneliness of elderly in Vietnam reveals to date; however, Vietnamese elderly are now facing more loneliness in their life since their children may have to work far away from home and they spare little time for emotional sharing with their parents A 400 elderly survey conducted in Ho Chi Minh city revealed that two most frequent needs among older adults were needs of living together with other people (77.7%) and needs of priority in health care (76%) Studies have shown that loneliness is linked to depression and lower quality of life and increased vulnerability to both physical and mental health problems of the elderly Thus, although participants in this study had affect balance; there were still a part of them felt loneliness in their life and those could be defined as elderly who had psychological needs Health care needs Asked about the needs of home health care, only 17.48% respondents confirmed their needs The proportion in the study was sunprisingly lower than that in another study conducted in Ha Noi In her study on patients vitied at Ha 77 Noi University of Medicine Hospital, Bui reported that 72.5% patients had health care needs at home From comparation of findings between two studies, it could draw a conclusion that patients or elderly who lived in high income areas may have higher health care needs more than patients or elderly who live in low income areas Among respondents who did not have home health care needs, a question about the reasons why they did not need home health care was asked Most of respondents claimed that they were taken care of by their children at home (23.66%) and that they could go to hospital by themsevles as they got illnesses (57.89%) Other reasons included “do not need home health care right now”, “hospital have sufficient equipments than doctors visit at home”, and “could not be affordable for home health care” Other studies also noted that situation A study in Can Tho showed that as elderly get sick, they still could take care of themsevles (50.42%), while the rest received supported from relatives In a study in rural areas, most of ADL and IADL activities of elderly were supported by their son (70-90%) and their grandchildren (10-20%) The most wanted health care service from participants was transportation to hospital (88.89%), followed by monitoring the general health (59.26%) and doctor’s visits for diagnosis and treat illnesses (52.70%) A study in Ha Noi 78 showed that general examnination at home was the most wanted services chosen by patients (22.3%), followed by treatment at home (15.8%) and nursing at home (15.7%) Health information needs There were a huge needs of health information was explored in this study Almost participants (88.67%) confirmed that they needed health information provision Studies showed that the need for health information seems to become more prevalent at an older age Health emerged as the most important information topic in Williamson's study of elderly Australians Changes in one's own health situation have also given rise to an increased need for information according to numerous studies Furthermore, when epidemics or health risks are much noticed, elderly often feel that they not receive sufficient information 5.2.3 The relationships between home care needs and demographic profile of participants ADLs needs and related factors 79 Age was the factor having significant associations with ADL needs among participants (p < 0.001) As age increased the ADL score reduced A study showed that the proportion of people who are independent in basic ADLs drops from 97.6% among those over 64 years of age, to 86.7% among those above 84 years The proportion decreased significantly with each increment in ten-year age interval Younger age groups, literacy, married status, living alone, position as household head, working until old age, smaller household size, living in the highlands or lowlands, and belonging to better wealth quintiles are indicators of having fewer ADLs that are completely dependent on caregiver support IADLs needs and related factors The results showed that male elderly had lower IADLs score than female counterparts (4.03 ± 0.12 versus 5.95 ± 0.18) Younger elderly had higher IADLs score than older elderly (60-69 years: 6.06 ± 2.05; 70-79: 4.86 ± 2.10; and ≥ 80: 3.35 ± 2.27) Finally, elderly who had allowance got higher IADL score than elderly who did not have allowance (5.93 ± 0.19 versus 4.86 ± 0.16) Contrary to this study’s finding, studies showed that men have higher indices for basic and instrumental ADLs while women only have a higher intellectual ADL index This might be due to characteristics associated with patrilineality and patrilocality which still strongly influence rural areas, and the 80 fact that literacy is lower among women The first aspect may increase the emotional expectation among men of help with basic and instrumental ADLs Lower literacy among women might lead to a greater need for help with intellectual ADLs Psychological needs and related factors Only living arrangement had strong association with affect balance score in which participants who lived with others had higher score than elderly who live alone It meant that elderly living with others may have lower needs of psychological supports than elderly living alone As elderly live alone, they have more time of thinking about their loneliness, so they may have more negative affect than positive affect and that may lead to psychological problems such as depression and anxiety Health care needs and related factors The results showed that allowance played an imortant role of choosing health care services at home among elderly Participants who had their own allowance had higher needs than participants who did not have allowance This finding is consistent with other studies A study in Ha Noi showed that affordability of patients had high impacts on health care needs at home Hoi et 81 al found that financial problems were one of significant obstacles that prevent elderly access to health care services Health information needs and related factors Participants who had more co-morbid diseases had more health information needs than participants who had less co-morbid diseases It was obviously that elderly who had more co-morbid diseases had higher needs of information since they want to gain more knowledge and information about their diseases they suffered so that they could prevent or manage them more effectively To participants who had lower education, they have less chance of accessing to health information sources such as books, television, internet; so their needs of health information was relative low Such elderly should be the main target for health promotion programs in the community 6.2 The principal research findings 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 82 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 83 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 6.3 Contributions and implications 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 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 84 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 85 who are responsible for health information should be general practitioners who are skillful in health consultation 6.4 Limitations 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 6.5 Recommendations for further research From the finding, a clear picture on home health care needs of elderly living 86 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 between districts about home care needs so that recommendations for health authorities in the city on policies of home care needs may be devoted 6.6 Conclusion 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 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, low psychological needs, low home health care needs, but high health information needs and IADLs need 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 87 References ... home care needs in District 12, Ho Chi Minh city To achieve the aim, two objectives were proposed as following: To identify the home care needs of elderly in District 12 on the basis of five facets... disability (20.3%) and hearing disability (12. 5%) Quang Nam was the province having the most disabled people (61%), while the proportion of disabled people in Ho Chi Minh city was merely 22% Among 18... Relationship between IADL score and history of comorbidities and health behavior of participants Table 5 .12 Relationship between affect balance score and demographic profile vii of participants Table 5.13