Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization

Older people's challenges accessing health services in central Nepal: a qualitative study using the domain of access framework

BACKGROUND

Low- and middle-income countries face rapid population aging. However, the health system has remained largely unprepared to deliver health services to an aging population. As the population is rapidly aging in Nepal, their challenges and experience should be the focus for health care providers to address these issues. There is a paucity of evidence on barriers and facilitators to accessing health care services among older people in Nepal. The aim of this study was to investigate the challenges that older people experience while accessing health services in central Nepal.

METHODS

This qualitative study was conducted between April and June 2023. In-depth interviews were conducted among older people of a municipality in central Nepal, which were analysed thematically using a deductive-inductive approach based on the theory of access.

RESULTS

Hypertension and diabetes were the most common health problems among the participants. The affordability of health services was a major issue, although there is a health insurance scheme and a major focus on universal health coverage from the Government of Nepal. Other issues included poor acceptability, poor communication between older people and health staff, and poor accommodation due to a lack of elderly-friendly services, including long wait times in the clinic. Living with family was a major facilitator of access to health care services and was interrelated with multiple domains of access.

CONCLUSIONS

This study identified barriers to accessing health care services for older adults in Nepal. We found that the affordability of health services, poor acceptability, poor communication between older people and doctors, and a lack of elderly-friendly services are the key challenges experienced by older people. Older people felt that these barriers were easier to overcome when they had family support. Therefore, for those living with their children, family support was reported as the major facilitator.

Health Service Utilization and Its Determinants among Senior Citizens in the Semiurban Area of Western Nepal: A Cross-Sectional Study

Background

Senior citizens are usually infected by multiple chronic conditions and other health problems. Health needs and demand for healthcare services increase with age. However, healthcare services and facilities and their utilization are limited, particularly in developing countries.

Aims

To identify the utilization of health services among senior citizens and their contributing factors.

Methods

A cross-sectional analytic study was conducted among 293 senior citizens of the Kushma municipality, Nepal, from June to December 2019. A structured questionnaire was used as a data collection tool using a multistage sampling technique. Face-to-face interviews were conducted to collect data on the interview schedule. Reliability and validity were maintained by applying different strategies and carefully developing tools, pretesting, double entry, and validation. Data entry, management, and analysis were performed using Epi Data and SPSS software. Research ethics were maintained. Descriptive and inferential statistical tests were performed to infer the findings.

Results

Study participants had a mean age (±SD) of 70.08 (±7.6) years and had various preexisting chronic diseases such as hypertension (46%), gastritis (41.9%), arthritis (34.3%), and asthma (28.7%). Only eight out of ten senior citizens had used health services in the past year. Factors such as age, ethnicity, residency, household income, family support, the presence of chronic diseases, and being under medication were found to have statistically significant associations with the utilization of health services among senior citizens with a p value less than 0.05 and 95% confidence interval.

Conclusions

A remarkable proportion of older people reported using health services in the last year. However, a substantial proportion did not utilize health services that require further interventions to enable them. Efforts are required to promote the health and well-being of Nepal's growing elderly population, including potential enhancements to rural healthcare infrastructure by policymakers.