Elderly care in Nepal: Are existing health and community support systems enough

The Impact of Accessibility of Community Elderly Care Services on Quality of Life of the Elderly

Background/Objectives: With the gradual increase in population aging and the prevalence of the empty nest, community elderly care services have become an effective service model for responding to population aging because they can alleviate the decline in family care function and meet the needs of elderly homecare patients. This paper aims to identify the influence mechanism of the accessibility of community elderly care services on the quality of life of the elderly. Methods: This paper surveyed a total of 949 elderly people and adopted the interview questionnaire survey method, and it used ordered logistic regression to analyze the impact of accessibility on the quality of life of the elderly. Results: The study finds that approachability, availability, acceptability, and accommodation affect the living environment satisfaction of the elderly. Accessibility affects environmental satisfaction by influencing the service utilization frequency, and accessibility affects the psychological health and environmental satisfaction of the elderly by influencing service utilization satisfaction. Conclusions: The improvement of accessibility can increase service utilization and, thus, improve the welfare of the elderly. So, the government should improve the accessibility of community elderly care services.

Exploring the pathways between depression, anxiety, stress, and quality of life on life satisfaction: a path analysis approach

BACKGROUND

Life satisfaction, one promising health asset, is associated with reduced risk of several chronic diseases and mortality. Mental health conditions and quality of life (QoL) are important aspects of well-being in late life and are significantly associated with life satisfaction. Despite the complex interrelationships between mental health, QoL and life satisfaction, the current literature has evaluated the simple association between them and failed to consider the complex pathways among these variables, especially among the older population. Hence, this study explores the pathways between mental health conditions (depression, anxiety, and stress), QoL and life satisfaction among older adults in eastern Nepal.

METHODS

This cross-sectional study was conducted in eastern Nepal via face-to-face interviews with 847 older adults selected by multi-stage cluster sampling. The 5-item Satisfaction with Life Scale and 13-item Older People's QoL scale assessed life satisfaction and QoL, respectively. The 21-item Depression, Anxiety and Stress scale measured mental health conditions. The relationship between QoL, depression, anxiety, and stress with life satisfaction was first evaluated using linear regression, subsequently by path analysis.

RESULTS

The mean (± SD) life satisfaction and QoL score were 19.7 (± 5.3) and 42.9 (± 7.1), respectively. More than one-fifth of the participants had moderate to severe depression (30%), anxiety (34%), and stress (20%). In adjusted regression analysis, QoL was positively associated (β: 0.44; 95% CI: 0.40 to 0.48) with life satisfaction, whereas depression, anxiety, and stress were inversely associated. In the path analysis, the relationship between depression and stress with life satisfaction was mediated by QoL. Depression was indirectly related to life satisfaction (mediated by QoL, β = -0.25), whereas stress was both directly (β = -0.11) and indirectly (mediated by QoL, β = -0.08) related to life satisfaction.

CONCLUSIONS

Given the high mental health burden among the older Nepali population and its potential impact on life satisfaction and QoL, routine screening for mental health should be encouraged in clinical practice. Additionally, community-based interventions and mental health promotion programs should be launched at regional and local levels.

Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study

INTRODUCTION

Quality of life (QoL) is a subjective measure reflecting individuals' evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal.

METHODS

This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People's Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression.

RESULTS

Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04-0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11-0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03-0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30-4.04) and unstable residence (OR = 6.25, CI: 2.03-19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL.

CONCLUSION

Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood's ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.

Availability and Affordability of Essential Palliative Care Medicines in Nepal: A Cross-Sectional Study

CONTEXT

The government of Nepal adopted the 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by the International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list.

OBJECTIVES

To evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability, and affordability in Nepal.

METHODS

A cross-sectional descriptive study of the availability of EPCMs in Nepal, and their inclusion in the national essential medicines list, government health insurance medicines list, government fixed rate medicines list, and free medicines list. Affordability was assessed using the World Health Organization Daily-Define-Dose and the Nepal Government-defined minimum daily wage.

RESULTS

A total of 27 of 33 (82%) of the IAHPC-EPCMs and 41 of 60 (68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18%, and 10% of IAHPC-EPCMs were available cost-free via district hospitals, primary healthcare centers, and health posts, respectively. The government had not included opioids on both free and fixed price lists. A total of 24 of 33 (73%) IAHPC-EPCMs were available on the Government Health Insurance Medicines List. A total of 19 of 41 (46%) available EPCMs were affordable.

CONCLUSION

Many EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with the government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.

Addressing the Critical Gap: Ensuring Urgent Access to Palliative Care Services with Essential Medications in Nepal

Palliative care is essential for life-threatening illnesses. However, Nepal still faces significant challenges in accessing primary palliative care services, including required medications, particularly in rural areas. This commentary highlights the need for policies and guidelines to ensure equitable access to palliative care with medicines. While limited studies in Nepal confirmed the demand, challenges persist in rural areas with deficient access to quality healthcare. This article discusses the existing efforts and noteworthy initiatives implemented by healthcare institutions. However, these efforts are currently limited in scale. We recommend including essential palliative care medicines in government healthcare policies, establishing training programs for healthcare professionals, and developing comprehensive policies with detailed field research work to meet the growing demand. Addressing these issues will significantly improve the quality of life for palliative care patients in Nepal.

Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan

OBJECTIVE

This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan.

METHODOLOGY

This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023).

RESULTS

Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place.

CONCLUSIONS

This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Elderly Patients at Risk of Malnutrition Presenting to a Tertiary Hospital in Nepal: A Descriptive Cross-sectional Study

INTRODUCTION

The nutritional status of elderly people is crucial for healthy aging, enabling them to maintain productive lives and reduce the progression of chronic diseases. Given that the quality of life tends to decline with age, it becomes particularly crucial for elderly individuals. Therefore, this study was aimed to find out the prevalence of elderly patients at risk of malnutrition in a tertiary hospital.

METHODS

This descriptive cross-sectional study was conducted among 281 elderly patients in a tertiary hospital from 2 January 2023 to 10 February 2023 after obtaining ethical approval. Non-probability purposive sampling technique was used. A face-to-face interview was conducted using a structured interview schedule with the elderly in the absence of their caregiver using a standard Mini-Nutritional Assessment tool for nutritional status, and WHOQOL_OLD quality of life for the elderly to assess the quality of life. Point estimate at 95% Confidence Interval was calculated.

RESULTS

Out of 281 elderly patients enrolled in our study, 164 (58.36%) (52.64-64.16, 95% Confidence Interval) were at risk of malnutrition.

CONCLUSIONS

The study concluded that older people could be at risk of malnutrition, which could impair their quality of life.

The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study

BACKGROUND

Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults.

METHODS

A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health.

RESULTS

Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support.

CONCLUSIONS

Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

Functional Impairment and Depressive Symptoms among Older Adults of Rural Nepal: The Moderating Role of Three Sources of Social Support

OBJECTIVES

This study aimed to determine whether social support from family, friends, and significant others moderated the relationship between functional impairment and depressive symptoms among Nepali older adults living in rural areas.

METHODS

The participants were 147 women (Mage = 66.71, SDage = 5.97) and 153 men (Mage = 67.41, SDage = 6.47) aged 60 years and older who lived in the rural mid-hills of Nepal. They completed the Karnofsky Performance Status Scale, the Multidimensional Scale of Perceived Social Support, and the Geriatric Depression Scale-Short Form.

RESULTS

Only 6.3% participants experienced some degree of functional impairment. Almost half (44.33%) of participants had depressive symptoms. Social support from family and friends, but not significant others, moderated the relationship between functional impairment and depressive symptoms. Social support from family was protective for older adults with moderate to high levels of functional impairment. Social support from friends was protective at no to low levels of functional impairment.

CONCLUSIONS

Interventions aimed at increasing social support from family among Nepali older adults living in rural hilly areas may reduce depressive symptoms, particularly among those with high levels of functional impairment.

CLINICAL IMPLICATIONS

Family support is important to alleviate depressive symptoms among functionally impaired older adults.

High Social Support System among Elderly in a Hilly District: A Descriptive Cross-sectional Study

Introduction

Social support is an important contributing factor that promotes the health of the elderly by providing them with positive experiences, socially satisfying roles, or the ability to cope with stressful situations. The objective of this research study is to ind out the prevalence of a high social support system among the elderly in a Hilly district.

Methods

A descriptive cross-sectional study was conducted among the elderly from a hilly district of Nepal. The ethical approval was taken from Ethical Review Board (Reference number: 3050). Data were collected from 20 May 2019 to August 2019. The elderly aged 60 years and above were the study population. A convenience sampling technique was used. The face-to-face interview was taken by using a structured questionnaire. Point estimate, and 95% Conidence Interval were calculated.

Results

Out of 263 elderly people, 188 (71.48%) (66.02-76.94, 95% Conidence Interval) were provided with high support by their family members, friends, and signiicant others.

Conclusions

The prevalence of high social support among the elderly was found to be higher when compared to similar studies conducted in similar settings.

Keywords

elderly; social support; social support system.

Community support and promoting cognitive function for the elderly

Proper cognitive functions are critical to the life of the elderly. With the rapid aging of the population, community support plays an important role in cognitive functioning. This study examines the association between community support and the level of cognitive functioning in the elderly, and the mediating effect of social participation in the relationship. Based on the panel data of China Longitudinal Healthy Longevity Survey (CLHLS) in 2005, 2008, 2011, 2014, and 2018, people aged 65 and over are selected as the research object (N = 35,479). The panel Logit model is used to analyze the influence of community support on their cognitive functioning. In addition, the stepwise regression and KHB decomposition methods are used to test the influence mechanism of community support on their cognitive function. The benchmark regression results show that there is a significant correlation between community support and cognitive function in the elderly (OR: 1.64, 95% CI: 1.41–1.91, p &lt; 0.01). Daily care (OR: 1.75, 95% CI: 1.33–2.29, p &lt; 0.01) has the strongest impact on the cognitive function of the elderly, followed by health care (OR: 1.70, 95% CI: 1.43–2.01, p &lt; 0.01) and legal support (OR: 1.64, 95% CI: 1.37–1.95, p &lt; 0.01), while psychological care (OR: 1.62, 95% CI: 1.31–2.01, p &lt; 0.01) has the weakest impact on the cognitive function of the elderly. The results of the mediation effect test show that social participation plays a significant intermediary role in the impact of community support on the cognitive function of the elderly (mediation percentage: 16.89%), demonstrating that community support can improve the cognitive function of the elderly by promoting the social participation of the elderly. In classified community support, social participation plays a significant intermediary role in the impact of psychological care on cognition (mediation percentage: 46.10%).