Risk Factors for Six Types of Disability among the Older People in Thailand in 2002, 2007, and 2011

Sex differences in the risk factors of disability among community-dwelling older adults with hypertension: Longitudinal results from the Health, Aging, and Retirement in Thailand study (HART)

Background

Hypertension poses a serious health problem among Thai older adults which could subsequently lead to disability. However, little to no research has been conducted to understand modifiable risk factors of disability among community-dwelling older adults with hypertension in Thailand. In addition, sex is an important social determinant of health, but its role in disability among older adults with hypertension is less clear.

Objectives

This study focused on community-dwelling older adults with hypertension in Thailand and investigated predictors of disability and examined sex differences in the risk factors that were associated with disability in this population.

Methods

Longitudinal data were from the Health, Aging, and Retirement in Thailand (HART) survey (2015-2017; N = 916). The outcome variable was difficulty with the activity of daily living at follow-up. Potential risk factors included sociodemographic information, health behaviors/health status, and disability at baseline. Descriptive analysis and logistic regression analysis were employed to analyze the data.

Results

Most of the participants were female and between aged 60 and 69 years old. Being in an older age group (OR = 1.78, 95% CI: 1.07-2.97, p < 0.05), having more chronic conditions (OR = 1.38, 95% CI: 1.10-1.73, p < 0.01), experiencing obesity (OR = 2.02, 95% CI: 1.11-3.69, p < 0.05), and having disability at baseline (OR = 2.42, 95% CI: 1.09-5.37, p < 0.05) significantly predicted disability at 2 year follow-up among community-dwelling Thai older adults with hypertension. The effects of these risk factors on disability at follow-up did not differ by sex. However, different risk factors of disability were observed across sexes.

Conclusion

The situations of disability among older adults with hypertension in Thailand are likely to aggravate due to the rapid aging of the population. Our analysis provided useful information regarding significant predictors of disability and sex-specific risk factors of disability. Tailored promotion and prevention programs should be readily available to prevent disability among community-dwelling older adults with hypertension in Thailand.

Bidirectional association between functional disability and multimorbidity among middle-aged and older adults in Thailand

Objectives

The purpose of this study was to assess the bidirectional association between multimorbidity (MM) and functional disability among middle-aged and older adults in a longitudinal study in Thailand.

Methods

We analyzed longitudinal data of participants aged 45 years and older from two consecutive waves (in 2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART). Functional disability was assessed with a 4-item activity of daily living (ADL) scale. Logistic regression analysis was conducted to assess the association between baseline functional disability and incident MM (≥2), and baseline morbidity and incident functional disability.

Results

The results indicate that a total of 1,716 individuals without morbidity at baseline and 3,529 without functional disability at baseline were included. At follow-up, 16.7 and 20.0% of functional disability cases and 7.1 and 3.6% of nonfunctional disability cases developed 2 morbidities and 3 or more morbidities, respectively, and 6.6% of MM cases and 4.0% of non-MM cases developed a functional disability. In the final logistic regression model adjusted for education, income, age, marital status, sex, smoking tobacco, body mass index (BMI), alcohol use, physical activity, and social engagement, functional disability at baseline was positively associated with incident MM (≥2) (adjusted odds ratio [aOR]: 2.58, 95% CI: 1.42-4.72), and MM (≥3) at baseline was positively associated with incident functional disability (aOR: 1.97, 95% CI: 1.13-3.43).

Conclusion

Multimorbidity and functional disability were bidirectionally associated.

Depression, Disability, and Cognitive Impairment Among Elders With Medical Illnesses Attending Follow-Up Clinics at a Tertiary Care Hospital in Northern Sri Lanka

INTRODUCTION

The rising proportion of the elderly is increasingly affected by non-communicable diseases. Despite an abundance of literature suggesting that elders with medical conditions are more vulnerable to depression, disability, and cognitive impairment, these tend to go unnoticed and unaddressed. This study describes the prevalence and correlates of depression, disability, and cognitive impairment among elders with medical illnesses attending follow-up clinics in a tertiary care hospital in northern Sri Lanka.

METHODS

This descriptive cross-sectional study was carried out among 122 elders (≥60 years) attending medical clinics at Teaching Hospital Jaffna. Depression, disability, and cognitive impairment were assessed by the 15-item Geriatric Depression Scale, 12-item World Health Organization Disability Assessment Schedule 2.0, and Montreal Cognitive Assessment, respectively. Student's T-Test, ANOVA, and correlation coefficient were used in analyzing data using Statistical Package for Social Sciences 25 (SPSS-v25) (IBM, New York, United States).

RESULTS

The mean age of the participants was 68.3 years (SD=5.70); 58 (47.5%) were males and 64 (52.5%) were females. Prevalence of depression was 44.3% (95% CI=35.5-53.1), while disability was 95.9% (95% CI=92.4-99.4) and cognitive impairment was 80.3% (95% CI=73.2-87.4). Depression was significantly associated with gender (p=0.013), marital status (p=0.019), and living arrangement (p<0.001). Cognitive impairment was significantly associated with education level (p=0.045), and disability was associated with education level (p=0.008) and marital status (p=0.027). Among the study participants, only 12 (9.8%) had previously sought professional help for depression, disability, or cognitive impairment.

CONCLUSION

Depression, disability, and cognitive impairment are common among the elderly attending medical clinics in Teaching Hospital Jaffna, and are, in most cases, unaddressed.

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BACKGROUND

The COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies.

OBJECTIVE

This study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty.

METHODS

We analyzed data from a national survey of US working-age adults (aged 18-64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty.

RESULTS

Adults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing.

CONCLUSIONS

Working-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.

Ability of older adults to recognize cognitive changes and its relationship with mental health: a cross-sectional study

INTRODUCTION

With rising age, the incidence of physical and mental problems increases. Physiological and social changes occur across the lifespan that can affect an individual's health and ability. The present study was aimed to determine older adult's ability to recognize cognitive changes and its relation with mental health status.

MATERIALS AND METHODS

A descriptive correlational design was used to recruit 423 older adults who were referred to health centers in Tabriz, Iran in 2019 to receive primary health care. A systematic random sampling method was used for selecting participants. Data collection tools included a demographic-social questionnaire, General Health Questionnaire for assessing mental health (with 4 subscales) and a questionnaire of ability to recognize cognitive changes (with 8 sub-scales). Data were analyzed using descriptive statistics and inferential statistics.

RESULTS

The mean score of mental health of the older adults was 56.35 (8.40) which shows moderately impaired mental health. The most impaired aspect of mental health detected was the social function dimension 13.20 (2.67). The average of the total ability score was 41.19 (4.78) and the physical strength dimension had the highest average of 9.08 (1.80) and the empowerment obligation dimension had the lowest average of 3.06 (1.08). There was significant relationship between dimensions of depression (r = 0.21, p < 0.001), anxiety (r = 0.1, p = 0.04) and social functioning (r = 0.17), p < 0.001) with the ability to recognize cognitive changes of the older adults.

CONCLUSION

Negative mood states and social functioning were associated with the ability to recognize cognitive changes in this population of older adults. This sample exhibited moderately impaired mental health status and relatively large burdens of untreated affective symptoms. Although causality cannot be determined with this cross-sectional design, use of social programs to keep older adults mentally active, as well as cognitive rehabilitation programs could be tested with longitudinal designs for their impact on cognitive change recognition.

Vision and Hearing Impairments Affecting Activities of Daily Living among Malaysian Older Adults by Gender

Vision and hearing impairments are common among older adults and can cause undesirable health effects. There are limited studies from low- and middle-income countries exploring gender differences between vision and hearing impairment with Activities of Daily Living (ADL) disability. Therefore, this study aimed to investigate gender differences between vision and hearing impairments with ADL disability among older adults in Malaysia. Cross-sectional data from 3977 respondents aged 60 and above from the Malaysian National Health and Morbidity Survey 2018 were used. We used logistic regression analysis to measure associations between vision and hearing impairments with ADL disability, adjusted for covariates. The prevalence of ADL disability was higher among females than males (p < 0.001). The adjusted associations between vision impairment and ADL disability were significant among males (aOR 3.79; 95%CI 2.26, 6.38) and females (aOR 2.66; 95%CI 1.36, 5.21). Similarly, significant adjusted associations were found between hearing impairment and ADL disability among males (aOR 5.76; 95%CI 3.52, 9.40) and females (aOR 3.30; 95%CI 1.17, 9.33). Vision and hearing impairments were significantly associated with ADL disability, with no gender differences identified. Early detection and effective management of vision and hearing impairments are important to prevent ADL disability and improve older adults' level of independence.

Disability among Palestinian elderly in the occupied Palestinian territory (oPt): prevalence and associated factors

BACKGROUND

Disability poses an important challenge to countries all over the world since it affects more than 15% of the global population. The disability prevalence is higher in developing countries compared to developed ones. Disability has negative consequences on health, wellbeing, and quality of life. The goal of this study is to assess the prevalence of disability and to determine some of its associated factors among Palestinian elderly in the occupied Palestinian territory (oPt), a country marked by a chronic lack of political, economic, and social stability which affect various aspects of the population's life.

METHODS

We used data from the Palestinian Central Bureau of Statistics (PCBS) disability survey conducted in 2011 using a nationally representative sample of the Palestinians living in the West Bank (WB) and Gaza Strip (GS). Data were collected using a standardized questionnaire developed and adopted by the World Health Organization (WHO) and the Washington Group (WG) for Disability Statistics, adapted to satisfy the Palestinian context.

RESULTS

Overall, 31.2% of the Palestinian elderly 60 years and above reported one or more type of disability. Binary logistic regression with disability as the dependent variable showed that older people [OR = 2.88, 95% CI: 2.31-3.60], women [OR = 1.65, 95% CI: 1.33-2.04], illiterate people [OR = 2.37, 95% CI: 1.83-3.06], people reporting small family sizes with 1 to 2 members [OR = 1.69, 95% CI: 1.34-2.14], people who reported that they were not working at the time of the survey [OR = 4.59, 95% CI: 3.13-6.73], and Palestinian refugees [OR = 1.22, 95% CI: 1.04-1.42] were more likely to have a disability. However, residents of the Centre of WB were less likely to have disability compared to residents of the GS [OR = 0.46, 95% CI: 0.37-0.58].

CONCLUSIONS

The study found a high prevalence of disability among Palestinian elderly, as has been reported by the majority of studies performed in developing countries. However, results indicate that demographic and socioeconomic differences among the disabled should be taken into special consideration in setting policies and practices to improve the health and wellbeing of the disabled.

Perspectives and experiences of Thai adults using wheelchairs regarding barriers of access to dental services: a mixed methods study

PURPOSE

To explore the perspectives and experiences of Thai wheelchair users regarding barriers of access to dental services and report potential solutions in terms of customer satisfaction.

PARTICIPANTS AND METHODS

We conducted a 2-phase cross-sectional study with quantitative and qualitative components at a community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. In quantitative phase, participants were interviewed using a structured questionnaire that consisted of 1) questions on demographic characteristics and 2) adapted questions that were based on the modified Penchansky and Thomas dimensions of access. Enter method of binary logistic regression analysis was used. Regarding qualitative phase, focus group discussions were conducted using the themes of a semi-structured discussion guide. Thematic analysis was used.

RESULTS

A total of 156 wheelchair users participated in the quantitative phase. Most study participants had not attended dental care services in the previous year (78.2%). Multivariate analysis found a statistically significant association that indicated that participants who had education level ≤primary education were 3.5 times more likely to had not attended a dental appointment in the previous year (P=0.003). In the qualitative phase, 33 participants were included in 3 focus groups (each comprising 11 participants), they were wheelchair users with education >primary, who did not go to see a dentist in the previous 12 months. Findings of the 3 focus groups suggest generally negative views about Thai dental services for all dimensions of access.

CONCLUSION

This study reflects the unheard voices of wheelchair users and provides rigorous evidence in Thai context that difficulties of access to dental services persist. Policy makers and oral health professionals in oral health system should be alerted to the explicit barriers reported, such that equitable and equal dental services for disabled individuals can be developed.