274277883 p16 23 prevalence of dementia among elderly and health care needs

ORIGINAL RESEARCH Prevalence of dementia among the elderly and health care needs for people living with dementiain an urban community of central Vietnam Doan Vuong Diem Khanh1*, Vo Van Thang1, Ho Dung1, Tran BinhThang1, Hoang DinhTuyen2, Hoang Dinh Hue2, Le Dinh Duong2 ABSTRACT Introduction: Dementia is one of the major causes of disability and dependency among older people There is little research on the prevalence of dementia, its related factors and health care needs for people living with dementia in Vietnam Aims: The aims of this study are: (i) to examine the prevalence of dementia, its related factors among people aged 65 years and abovein Hue City of Vietnam, (ii) examine the needs of health care for dementia patients Methods: 905 people aged 65 years and aboveliving in Hue City in central Vietnam were interviewed and examined MMSE test (Mini Mental State Examination) was used as a screening instrument for dementia Diagnosis of dementia was undertaken using ICD-10 research criteria Results: Overall prevalence estimates for dementia was 9.4% Age, medical history of stroke, physical activities and entertaining activities were significantly associated with dementia The most common health care needs for people living with dementia were medication (76.5%), receiving consultation regarding how to care for people with dementia (75.3%), having support and professional advice on how to deal with mental and behavioral disorders (63.5%) Conclusion: In this population, probable dementia is common Comprehensive care delivery for people living with dementia is urgently needed in Vietnam Keywords: Dementia, prevalence, related factors, health care needs, Vietnam Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy Faculty of Public Health, Hue University of Medicine and Pharmacy * Corresponding author: Doan Vuong Diem Khanh, Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy (Hue UMP), 06 Ngo Quyen Street, Hue city, ThuaThien Hue province, Vietnam Fax: 00-84-984118-925 Website: http://iccchr-hue.org.vn/ Email: diemkhanh1972@gmail.com 16 Vietnam Journal of Public Health - www.vjph.org 2015 Vol Iss Doan Vuong Diem Khanh et al INTRODUCTION elderly above 60 years old3 Life expectancy of human beings has been increasing worldwide In Vietnam, people aged 60 years and over occupy 10.2% of population, whereas the percentage of people aged 65 years and over is 7.1%1 Vietnam is now in the period of aging population The time for Vietnamese population to change from aging population into the aged population is predicted to be much shorter than many other nations1 A study on the prevalence of dementia in a rural area of Vietnam (Ba Vi district) conducted in 2005 among 5,712 adults aged 60 years and over in 2006 found that the prevalence of dementia was 4.6% among this population4 This prevalence of dementia increases with age Prevalence of dementia among persons aged 65 years and over was 5.8%, among those aged 60-64 was 0.8%, aged 70-74: 3.8%, aged 75-79: 5.9%, aged 80-84: 8.5% and among those aged above 85 was 16.4% Prevalence of dementia reduced among the group of the elderly with higher education: This prevalence was 9.7% among group of elderly who just knew how to read and write, among group of primary school was 2.4%, group of secondary school and above was 1.8%4 Challenges of aging population issue, including access to health care for the elderly, have been especially paid attention by many countries in general and Vietnam in particular Dementia is among the leading causes of disability and death among the elderly2 It not only affects seriously the patient’s quality of life but also physical, psychological and socioeconomic impact on caregivers, family members and society2 Worldwide, there are approximately 35.6 million people living with dementia and 7.7 million new cases every year Most of researches worldwide recognize that prevalence of dementia increases remarkably with increasing age The prevalence of dementia is approximately 1% among people aged 60-64, 5-10% among people aged 65 and over, and up to 30-50% among people aged 85 and over2 This study tries to examine the prevalence of dementia, its associated risk factors and determine the needs of health care for patients living with dementia in Hue city, Vietnam The study will provide importance evidence regarding the burden of this syndrome, the related factors and the extent to which people living with dementia is in needs of health care This will help policy makers to design practical strategies and activities to improve mental health care and quality of life for thousands of people in central Vietnam Up to now, there are very few studies in Vietnam regarding epidemiological aspects of dementia as well as the needs of health care for people living with dementia in Vietnam A large study among 8,965 persons in an urban community in the north of Vietnam (Thai Nguyen city) in the year 2000 revealed that prevalence of dementia was 0.64% of the general population and 7.9% among the A cross sectional study was carried out in Hue city, central Vietnam between June and August 2014 Multi-stage cluster sampling method was used Stage 1: quarters in Hue city were randomly selected Stage 2: from each quarter, sub-administrative units were randomly selected Stage 3: From 30 sub-administrative 2015 Vol Iss Vietnam Journal of Public Health - www.vjph.org METHODS 17 Doan Vuong Diem Khanh et al units selected, a total of 905 individuals aged 65 and above, who were permanent residents, were randomly selected (based on the list of the elderly provided by the local commune health centers) A response rate of 98.7% was obtained Data collection was undertaken using face to face interview at participants’ households with the assistant of family members when necessary Diagnosis of dementia was undertaken using a two phase process The first phase was the screening one for dementia using MMSE test (Mini Mental Status Examination) MMSE has been used widely in Vietnam and internationally It is a brief 30-point questionnaire test The total score ranges between 0-30 A total of 878 persons among 905 undertook MMSE test Individuals who had a total score of MMSE < 24 (MMSE positive) were recruited to enter the second phase to diagnose dementia by using ICD-10 criteria5 280 persons did diagnostic test (253 persons with MMSE< 24 plus 27 persons not did MMSE) Individuals who could not undertake MMSE for any reasons were also examined for diagnosis of dementia (impairment of visual or hearing capacity) logistic regression model to examine simultaneously factors associated with dementia while controlling for the effects of other factors ETHICAL APPROVAL The study was approved by the Research committee of Hue University of Medicine and Pharmacy RESULTS The sociodemographic characteristics of the participants were presented in Table There are a majority of participants being females (64.6%) and a high percentage of them was Table Socio demographic chararteristics of the sample Data analysis was undertaken using SPSS.16 Descriptive statistics were used for presenting prevalence of dementia and demographic characteristics distribution of the study sample Simple regression was undertaken for exploring associated factors of dementia (including age, sex, religion, occupation, education level, perceived household economic situation, family history of dementia, living situation, history of hypertension, heart disease, stroke, diabetes, blood lipid disorder, Parkinson; habits of smoking, drinking, physical and entertainment activity) Factors statistically associated with dementia were then entered into the multiple 18 Vietnam Journal of Public Health - www.vjph.org 2015 Vol Iss Doan Vuong Diem Khanh et al widowed (39.9%) Most participants were Buddhism (67.3%) Regarding education level, nearly 20% were illiterate, 21.3% knew how to read and write and 24.2% attended primary school 29.1% of participants’s main occupation (during lifetime) were farmers; 60.4% perceived their family economic situation as moderate There were 9.1% of the elderly in this sample currently living alone PREVALENCE OF DEMENTIA AND ASSOCIATED FACTORS Our results revealed that prevalence of MMSE positive (MMSE < 24) was 28.8% Prevalence of dementia and 95% CI are reported in Table The overall prevalence estimates for dementia was 9.4% (12% in women and 4.7% in men) This ranged from 0.5% among people aged 65-69 years to 37.7% among those aged 90 years and above Mean values for age of onset and total years living with dementia were 76.6 years (SD=17.8) and years (SD=15.0) respectively (results not shown in the tables) Simple logistic regression revealed that age, sex, marital status, occupation, education level, living situation, medical history of stroke, habits of physical activities and habit of entertainment activities were statistically associated with dementia (p