Self-assessed health among Thai elderly

Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia

BACKGROUND

Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics.

METHODS

The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index.

RESULTS

The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820-15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (-0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education.

CONCLUSION

These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.

Self-Reported Health Inequalities among Older Adults in Saudi Arabia

Considering the rising life expectancy, the growing population of older adults poses challenges in providing adequate healthcare services. Self-reported health is an important indicator of overall health, predicting morbidity and mortality. This study investigated self-reported health inequalities among older adults in Saudi Arabia and the underlying factors contributing to establishing such inequalities. The study utilized data from the 2018 Saudi Family Health Survey, focusing on 2023 respondents aged ≥60 years with complete data. Univariate, bivariate, and multivariate logistic regression analyses were employed to explore socio-economic factors linked to health inequalities. Additionally, concentration curves and indices were used to assess the magnitude of health inequalities among older adults. The findings indicate a higher prevalence of self-reported poor health among respondents aged ≥70 years and those with chronic diseases. Age, education, income level, marital status, and insurance coverage were other factors significantly linked to reporting poor health. Inequality analysis revealed a concentration of poor health among less educated individuals (concentration index = -0.261, p < 0.01). Both income- and education-based indices highlighted a concentration of poor health among men with lower income and education levels. Addressing healthcare inequalities among older adults requires targeted policy efforts, focusing on those aged ≥70, unmarried individuals, those without insurance coverage, those with chronic illnesses, and those with lower education levels. Targeted interventions for these groups can address their unique healthcare needs and promote equitable health outcomes.

Social networks as a protective factor for worsened self-perceived health status related to self-perceived changes in loneliness and health conditions in adults aged 50+ during the COVID-19 outbreak

The coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading millions of people to change their lifestyles, especially older individuals who are the most at-risk population. Social isolation, the main preventive action to slow the pandemic's spread, reduced and drastically limited social connections, increasing older individuals' loneliness and stress, and worsening their health. We examined the connection between self-perceived changes in loneliness, the existence and type of social contact (face-to-face/electronic), and health conditions on self-perceived changes in health status during the outbreak, analyzing 51,778 individuals aged 50 plus from the Survey of Health, Ageing and Retirement in Europe (SHARE) database Wave 8 beta (June-August 2020). We found that the odds for worsened self-perceived health status were 249% higher among individuals who reported increased loneliness compared to the non-increase group and were lower in individuals with face-to-face contact (31%) or electronic contact (54%) during the outbreak. In addition, the odds for worsened self-perceived health status were higher for individuals with hypertension (17%), cancer (19%), chronic lung disease (25%), heart problems (27%), and other illnesses (32%). Based on the results obtained, electronic contact has shown a stronger connection as a protective factor for worsened self-perceived health since the outbreak compared to face-to-face interactions. Thus, adopting a policy that encourages the usage of electronic communications could reduce the burden on the healthcare system, particularly during pandemics, while improving patient health outcomes and minimizing pandemic-related health risks. This approach is especially important for older individuals, for whom any departure from home can cause an additional risk of exposure to the virus.

Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults

BACKGROUND

Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults.

METHODS

Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease).

RESULTS

Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease.

CONCLUSIONS

The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.

Gender differences in the association between perceived income sufficiency and self-rated health among older adults: A population-based study in India

This study explores whether gender differences in self-rated health can be attributed to socioeconomic status and self-perceived income sufficiency in particular. We used data from the Building a Knowledge Base on Population Ageing in India (BKPAI-2011) and carried out the descriptive and bivariate analysis along with a chi-square test to explore the significance of possible associations between explanatory and outcome variables in the study. Also, sex-stratified multiple logistic regression models were employed to fulfill the study objectives. The results show that a higher percentage of older women (58.4%) reported their health as fair/poor than older men (52%). Older women reported poor self-rated health than older men with similar self-perceived income sufficiency (OR: 2.04; p < .001 vs. OR: 1.56; p < .010). All the health indicators such as suffering from higher number of chronic conditions (AOR: 3.70; p < .001 vs. AOR: 2.73; p < .001) and disability (AOR: 3.79; p < .001 vs. AOR: 3.33; p < .001) increased odds of rating of poor health among older women than men, except having two plus difficulty in activities of daily living (ADL), which was positively associated with reporting poor health among men than women (OR: 4.03; p < .001 vs. OR: 2.36; p < .001). The study highlights the gender differences in self-rating of health associated with subjective income status and other socioeconomic and health-related variables that are important while framing social policies for the Indian graying population.

Self-rated health among older adults in India: Gender specific findings from National Sample Survey

INTRODUCTION

The self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting.

MATERIALS AND METHODS

We used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults.

RESULTS

The overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange.

CONCLUSIONS

Supporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

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 and Associated Factors among Community-Dwelling Thai Older Adults in Northern Thailand: The Relationship between History of Fall and Geriatric Depression

BACKGROUND

Globally, population aging is happening more quickly than in the past, and Thailand ranks the world's number three among the rapidly aging countries. Age-related decline in physical and mental health would impact depression among older adults. We aimed to determine the depression among the community-dwelling Thai older adults in Chiang Mai, Thailand.

METHODS

The baseline data, collected by door-to-door household visits of an intervention arm from a cluster randomized controlled trial (Community-Integrated Intermediary Care (CIIC): TCTR20190412004), were included in this cross-sectional study. Descriptive analysis and binary logistic regression were applied.

RESULTS

The mean age was 69.31 ± 7.10 years and 23.8% of study participants were older than 75 years. The Thai geriatric depression scale showed 6.5% had depression. Adjusted risk factors for depression were older age, being single, drinking alcohol daily, having diabetes, having experience of a fall last year, self-rated health as neutral, poor/very poor, and moderate/severe dependency by ADL scoring.

CONCLUSION

Our findings highlighted the potentially modifiable risk factors in addition to the common predictors affecting depression among community-dwelling older adults. Fall prevention programs and public health interventions to prevent diabetes are recommended. Furthermore, self-rated health and Barthel's ADL scoring would be simple tools to predict risk factors for geriatric depression.

Impacts of mistreatment on the psychological and physical health of older adults living in sheltered homes

OBJECTIVES

To assess the impact of the mistreatment on psychological and physical health among older adults living in sheltered homes.

METHODS

This cross-sectional study included 446 older adults living in 43 sheltered homes. The psychological effects questions screened for suicidal ideation, depression, anxiety, and sleep problems. The physical health effects questions assessed perceived physical health status and healthcare resource utilization.

RESULTS

All subtypes of mistreatment of older adults were associated with increased prevalence rates of anxiety symptoms, depressive symptoms, and sleep problems. Perceived poor physical health is common among older mistreated adults; it was self-reported by 74% who experienced physical mistreatment and 49% who experienced other types of mistreatment. Increased healthcare utilization was higher among older adults who experienced mistreatment.

DISCUSSION

Mistreatment of older adults living in sheltered homes is associated with negative impacts on physical and psychological health, as well as increased healthcare utilization compared to those who are not mistreated.

Determinants of self-rated health among an older Tibetan population in a Chinese plateau area: analysis based on the conceptual framework for determinants of health

BACKGROUND

Self-rated health (SRH) has been frequently used in population health surveys. However, most of these studies only focus on specific factors that might directly affect SRH, so only partial or confounding information about the determinants of SRH is potentially obtained. Conducted in an older Tibetan population in a Chinese plateau area, the aim of our study is to assess interrelationships between various factors affecting SRH based on the conceptual framework for determinants of health.

METHODS

Between May 2018 and September 2019, 2707 Tibetans aged 50 years or older were recruited as part of the China Multi-Ethnic Cohort Study (CMEC) from the Chengguan District of Lhasa city in Tibet. The information included SRH and variables based on the conceptual framework for determinants of health (i.e., socioeconomic status, health behaviors, physical health, mental health, and chronic diseases). Structural equation modeling (SEM) was used to estimate the direct and indirect effects of multiple factors in the conceptual framework.

RESULTS

Among all participants, 5.54% rated their health excellent, 51.16% very good, 33.58% good, 9.12% fairly poor and 0.59% poor. Physical health (β = - 0.23, P <  0.001), health behaviors (β = - 0.44, P <  0.001), socioeconomic status (β = - 0.29, P <  0.001), chronic diseases (β = - 0.32, P <  0.001) and gender (β = 0.19, P <  0.001) were directly associated with SRH. Socioeconomic status, physical health and gender affected SRH both directly and indirectly. In addition, there are potential complete mediator effects in which age and mental health affect SRH through mediators, such as physical health, health behaviors and chronic diseases.

CONCLUSIONS

The findings suggested that interventions targeting behavioral changes, health and chronic disease management should be attached to improve SRH among older populations in plateau areas without ignoring gender and socioeconomic disparities.

Self reported health status and its determinants among elderly widows in Puducherry, India

Background:

Materials and Methods:

Results:

Conclusion:

Self-rated health and general procrastination in nurses: a cross-sectional study

Introduction

nurses are responsible for taking care of the health of the general public. Nurses´ own health is among the important factors affecting the quality of patient care. Self-Rated Health (SRH) is one of the indicators used extensively in health research for the assessment of the health status of individuals. The present study was conducted to evaluate self-rated health and its relationship with general procrastination in nurses.

Methods

the present cross-sectional study was conducted in 2019 on 305 Iranian nurses selected by stratified random sampling. The relationship of self-rated health with procrastination was determined using an ordinal logistic regression analysis after adjustments for personal and occupational factors.

Results

self-rated health was poor/bad in 11.3% of the nurses, fair in 23.7%, good in 34.3% and excellent in 30.7%. After adjustments for personal and occupational factors, a significant relationship was observed between procrastination and self-rated health (OR=0.95; 95%CI 0.92, 0.98).

Conclusion

the results showed an unfavorable health status in nurses. Given the significant relationship between procrastination and poor self-rated health in nurses, it is essential to consider this relationship for improving nurses´ health.

Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece

It is well known that self-perceived health (SPH), even if it is a subjective health indicator, is significantly associated with objective health and quality of life (QoL) in the general population. Whether it can be considered an indicator of cognitive functioning and quality of life in the elderly is still an open issue. This study used a data-driven approach to investigate the interrelationship among SPH, non-communicable diseases (NCDs), QoL, and cognitive functioning to answer this question. The study sample included information about 12,831 people living in Italy, Spain, and Greece, extracted from the Survey on Health, Aging, and Retirement in Europe, in the year 2015. The additive Bayesian networks methodology was used to identify the best directed acyclic graphs (DAG) for SPH, QoL, and NCDs. Results were given as posterior estimates of generalized linear models (GLM) coefficients, with 95% credibility intervals. Good SPH was associated with a decreasing number of chronic diseases in Italy (coeff = −0.52, 95%CI: [−0.59, −0.44]), Spain (coeff = −0.53, 95%CI: [−0.60, −0.46]) and Greece (coeff = −0.57, 95%CI: [−0.64, −0.50]). Age and Body Mass Index were determinants of NCDs in all countries. QoL of elderly was associated with SPH in Italy (coeff = 0.12, 95%CI: [0.10, 0.14]), Spain (coeff = 0.16, 95%CI: [0.15, 0.18]), and Greece (coeff = 0.18, 95%CI: [0.16, 0.20]). The number of NCDs was higher for people who were not employed in Spain (coeff = 0.45, 95%CI: [0.37, 0.53]) and was decreasing for a unitary increase in years of education in Greece (coeff = −0.12, 95%CI: [−0.14, −0.09]). As a general rule, the framework of the interrelationship among NCDs, SPH, and QoL was similar for Italy, Spain, and Greece. The connections found among indicators could be proposed to identify strategies for health promotion and healthy aging among people aged 50 and above, which are viable in general and at a country level. Reinforcing strategies targeted at some health indicators could have relevant effects on other related indicators.

Gender analysis of nurses' attitude towards care of the elderly with dementia in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria

This study assessed nurses' knowledge and attitudes by gender toward the care of elderly patients with dementia and explored gender differences in attitudes and associated factors in Obafemi Awolowo University Teaching Hospital, Ile-Ife. The study adopted a sequential explanatory mixed method design to obtain data from 100 nurses selected through a multistage sampling technique. Data analysis was done at univariate, bivariate, and multivariate levels with a significance at P < .05. Findings revealed that a majority of the nurses have good knowledge and attitudes toward the care of elderly patients with dementia. Previous experience in a specialized unit (Odd = 2.879, CI = 0.013-8.287, P = .047) was the main predictor for the nurses' attitude.

Decomposing gender inequality in functional disability among older people in Vietnam

OBJECTIVES

This study compared functional disability in older men and women, and examined the extent to which social determinants contribute to the difference in functional disability between Vietnamese older men and women.

METHODS

A nationally representative sample of persons aged 60 and older in Vietnam, taken from the 2011 Vietnam Aging Survey, was analyzed (N = 2,693, consisting of 1,622 women and 1,071 men). Ordinary least squares regression (OLS) was used to identify factors associated with functional disability in men and women, while Oaxaca-Blinder decomposition for linear models was applied to examine how much of gender inequality in functional disability was attributed by the distribution of the social determinants.

RESULTS

The OLS results showed that functional disability score for women was significantly higher than that for men, and that men and women shared similarity in factors associated with functional disability (e.g., age, educational level, employment status, and perceived sufficiency of income). The decomposition results showed that the distribution of the social determinants explained about 54 per cent of gender inequality in functional disability; among the determinants, age, employment status, and educational level were the major drivers. Approximately 46 per cent of the inequality was explained by unobserved factors.

CONCLUSION

The findings of this study highlight the need for policy to mitigate the social determinants (e.g., education and employment) that contribute to gender inequality in functional disability.

Eliciting Preferences for Health Insurance in Iran Using Discrete Choice Experiment Analysis

BACKGROUND

The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016.

METHODS

A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models.

RESULTS

The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P<.001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P=.485) disutility (OR=0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P<.001) the highest for the private hospitals' benefits (OR=2.82) followed by public hospitals' benefits (OR=2.02) and outpatient benefits (OR=1.75), and the premium revealed statistically significant (P<.001) disutility (OR=0.96).

CONCLUSION

Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals' utility from the insurance benefits packages.

Impact of social disadvantages in the presence of diabetes at old age

Background

Social disadvantages that start during childhood and continue into the later stages in life may be linked to the presence of diabetes during adulthood. Objective. To analyze whether the presence of social disadvantages in childhood and in the present affects the presence of diabetes in older adults.

Methods

The present study was based on longitudinal data from the third and fourth Mexican Health and Aging Study (MHAS) waves (2012 and 2015). Data on diabetes diagnosis, past (e.g. “no shoes during childhood”) and present (e.g. self-perception of economic status) social disparities, and other covariables were analyzed.

Results

From 8,848 older adults, 21.5% (n = 1903) were classified as prevalent cases (PG), 5.2% (n = 459) as incident cases (IG) and 77.4% (n = 6,486) were free of disease (NDG). The predictor variable “no shoes during childhood” was statistically significant in the model incident versus no diabetes group. Hypertension and body mass index (BMI) were the most relevant covariates as they were statistically significant in the three groups (PG, IG and NDG).

Conclusions

Not having shoes during childhood, an indicator of social disadvantages, is associated with the incidence and prevalence of diabetes in older adults. This suggests that social disadvantages can be a determinant for the presence of chronic diseases in adulthood.

A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

Subjective health and quality of life among elderly people living with chronic multimorbidity and difficulty in activities of daily living in rural South Africa

Background: South Africa has been experiencing a growing proportion of elderly population with rapid increases in the burden of non-communicable diseases (NCDs) characteristic of population aging. Rural areas in South Africa represent a far smaller fraction of the population, however, share a relatively higher burden of NCDs. In the current literature, there is limited evidence on rural studies in the context of chronic diseases and activities of daily living (ADLs) among the elderly population (60 years and above) in South Africa.

Purpose: In this regard, we undertook the present study with the objective of examining the demographic, behavioral, and socioeconomic predictors of subjective health, depression, and quality of life among elderly men and women living in the rural areas (n=2,627).

Methods: Data for this study were collected from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Main explanatory variables were self-reported NCDs and difficulties in ADLs. The predictors of subjective health, depression, and quality of life were assessed using multivariable regression methods.

Results: We found that the proportion of participants who reported good health, not having depression, and good quality of life was respectively 44.7%, 81.3%, and 63%. Women in the oldest age group (80+ years) were significantly less likely to report good health (OR=0.577, 95% CI=0.420, 0.793) and quality of life (OR=0.709, 95% CI=0.539, 0.933) compared with those in the youngest group. Having more than one chronic condition and ADL difficulties significantly lowered the odds of good health, having no depression, and quality of life among men and women.

Conclusion: The present findings suggest the involvement of sociodemographic factors in health and quality of life outcomes among elderly South Africans, and call for enhanced efforts to address these health limiting conditions such as ADLs and chronic multimorbidity.

The distribution and correlates of self-rated health in elderly Chinese: the China Kadoorie Biobank study

BACKGROUND

Self-rated health (SRH) have been widely used as a valid indicator of health status at the population and individual level. We aimed to investigate the distribution and correlates of global SRH and age-comparative SRH in elderly Chinese.

METHODS

Survey of 57,693 men and 67,089 women aged 60 years and above was conducted in five rural (Gansu, Sichuan, Hunan, Henan, Zhejiang) and five urban areas (Heilongjiang, Shandong, Jiangsu, Guangxi, Hainan) in China between 2004 and 2008. Logistic regression models were used to calculate the relations of different factors with global SRH and age-comparative SRH.

RESULTS

Among the participants, 38.33% reported their global SRH as good or excellent while 61.67% as fair or poor, and 17.70% reported better age-comparative SRH while 17.99% as worse. In the multivariate model, compared to women, men tended to report a good global SRH and better age-comparative SRH, urban residents tend to report good global SRH and better age-comparative SRH. The socioeconomic and health behavior factors that were associated with good global SRH and better age-comparative SRH (with varying strengths of association) included: high educational level, high household income, house ownership, quitting smoking by own choices, occasional and current alcohol drinking, overweight, and high physical activity level. The factors that were associated with poor global SRH and worse age-comparative SRH included: quitting smoking by illness, former drinking, underweight, and weight lost ≥2.5 kg in the previous year.

CONCLUSIONS

We found a moderate level of good global SRH and a low level of better age-comparative SRH among elderly Chinese. We identified a number of demographic, socioeconomic and health behavior factors that were related to SRH measures. Our study emphasizes the importance of incorporating both global and age-comparative SRH measures in future studies, and considering gender inequalities and urban/rural disparity, as well as socioeconomic status and health behaviors as important modifiers of health.

Effect of acute respiratory illness on short-term frailty status of older adults in Nakhon Phanom, Thailand-June 2015 to June 2016: A prospective matched cohort study

Background

Frailty is associated with increased risk of mortality and decline in functional status among older adults. Older adults are at increased risk of severe disease from acute respiratory illness (ARIs), but ARI effects on frailty status among older adults are not well understood. We evaluated how ARIs affect short‐term frailty status among community‐dwelling adults aged ≥65 years in Nakhon Phanom, Thailand.

Methods

During May 2015 to May 2017, older adults were contacted weekly to identify ARIs as part of a community‐based longitudinal cohort study. Each participant's frailty status was assessed at baseline and every 6 months using the Vulnerable Elders Survey‐13 (VES‐13). We selected cohort participants with an ARI and compared them with a sample of participants without an ARI matched on age, sex, influenza vaccination status, and most recent VES‐13 score. For these matched cohort members, an additional VES‐13 was recorded at 3‐4 weeks after the ARI episode date.

Results

Of 3220 cohort study participants, 114 participants with an ARI and 111 comparison participants without an ARI were selected for the matched cohort; three comparison participants were matched to two ARI cases. We found no statistically significant difference between ARI and non‐ARI participants in modified VES‐13 score 3‐4 weeks post‐episode (cases = 0.90, controls = 0.63, P = 0.07). Only two ARI episodes required hospitalization.

Conclusions

Primarily mild ARIs did not affect short‐term frailty status among community‐dwelling older adults in Thailand. As few cases of severe ARI were detected, the contribution of severe ARI to changes in frailty requires further investigation.

Association between multiple comorbidities and self-rated health status in middle-aged and elderly Chinese: the China Kadoorie Biobank study

Background

Understanding the correlates of self-rated health (SRH) can help public health professionals prioritize health-promotion and disease-prevention interventions. This study aimed to investigate the association between multiple comorbidities and global SRH and age-comparative SRH.

Methods

A total of 512,891 participants aged 30–79 years old were recruited into the China Kadoorie Biobank study from ten regions between 2004 and 2008. Multivariate logistic regression models were used to estimate the odds ratios (ORs) for the associations between comorbidities (including diabetes, hypertension, coronary heart disease, rheumatic heart disease, stroke, tuberculosis, emphysema/bronchitis, asthma, cirrhosis/chronic hepatitis, peptic ulcer, gallbladder disease, kidney disease, fracture, rheumatic arthritis, psychiatric disorders, depressive symptoms, neurasthenia, head injury and cancer) and SRH. Population attributable risks (PARs) were used to estimate the contribution of multiple comorbidities to poor global SRH and worse age-comparative SRH.

Results

After adjusting for covariates, suffering from various diseases increased the chance of reporting a poor global SRH [OR (95% CI) ranged from 1.10 (1.07, 1.13) for fracture to 3.21 (2.68, 3.83) for rheumatic heart disease] and a worse age-comparative SRH [OR (95% CI) ranged from 1.18 (1.13, 1.23) for fracture to 7.56 (6.93, 8.25) for stroke]. From the population perspective, 20.23% of poor global SRH and 45.12% of worse age-comparative SRH could attributed to the cardiometabolic diseases, with hypertension (7.84% for poor global SRH and 13.79% for worse age-comparative SRH), diabetes (4.35% for poor global SRH and 10.71% for worse age-comparative SRH), coronary heart disease (4.44% for poor global SRH and 9.51% for worse age-comparative SRH) and stroke (3.20% for poor global SRH and 10.19% for worse age-comparative SRH) making the largest contribution.

Conclusions

Various diseases were major determinants of global and age-comparative SRH, and cardiometabolic diseases had the strongest impact on both global SRH and age-comparative SRH at the population level. Prevention measures concentrated on these conditions would greatly reduce the total burden of poor SRH and its consequences such as poor quality of life and use of health care services.

Determinants of self-rated health in elderly populations in urban areas in Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey

Background

Ageing imposes extra financial burdens on social and health services in developed countries. Self-rated health (SRH) is considered to be both a reliable measurement of overall health status including morbidity and mortality and an important predictor of hospitalization, functional impairment and greater demand for health-care services in the elderly. Our aim was to identify factors associated with poor SRH in elderly populations and investigate possible differences between urban areas in Slovenia, Lithuania and UK. Data were obtained from population-based surveys from the European Urban Health Indicator System Part 2 project. The stratified representative sample (41% men and 59% women) consisted of a total of 2547 respondents aged ≥65 from the urban areas in the three countries. The prevalence of poor SRH was highest in Lithuanian urban areas. The strongest factors associated with poor SRH were low education [OR (odds ratio) 4.3, 95% CI (confidence interval) 2.5-7.3, P < 0.001], restriction of activities attributable to a chronic disease (OR 2.6, 95% CI 2.2-3.0, P < 0.001), inadequate physical activity (OR 1.7, 95% CI 1.2-2.5, P = 0.007) and poor mental health (OR 1.1, 95% CI 1.1-1.2, P < 0.001). The main factors associated with poor SRH by country included the following: living alone (Slovenia) (OR 2.0, 95% CI 1.1-3.7, P = 0,023), female sex (Lithuania) (OR 2.0, 95% CI 1.0-4.2, P = 0.058) and inadequate physical activity (UK) (OR 2.2, 95% CI 1.3-3.6, P = 0,003). Despite different levels of poor SRH, the factors associated with poor SRH were similar for the urban areas of the three countries. Factors associated with poor SRH in the urban areas could also reflect either cultural differences or specific situations for elderly in that country, which need further research.

Gender differences in functional disability and self-care among seniors in Bangladesh

BACKGROUND

Disability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults' disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.

METHODS

This research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh's 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group's short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.

RESULTS

Forty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.

CONCLUSIONS

Programs aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Predictors of self-reported health among the elderly in Ghana: a cross sectional study

BACKGROUND

Self-reported health is a widely used measure of health status across individuals. As the ageing population increases, the health of the elderly also becomes of growing concern. The elderly go through life facing social, economic and financial hardships. These hardships are known to affect the health status of people as they age. The purpose of this study is to assess social and health related factors of self-reported health among the elderly in Ghana.

METHODS

A multivariate regression analysis in form of a binary and ordinal logistic regression were used to determine the association between socioeconomic, demographic and health related factors, on self-reported health. The data used for this study was drawn from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) Wave 1.

RESULTS

In total, out of 2613 respondent, 579 (20.1%) rated their health status as poor and 2034 (79.9%) as good. The results showed that the odds of reporting poor health was 2.5 times higher among the old-old compared to the young old. The elderly with one or more than one chronic condition had the odds of 1.6 times and 2 times respectively, of reporting poor health. Engaging in mild to moderate exercise increased the chances of reporting poor health by 1.8 times. The elderly who had never worked in a lifetime were 2 times more likely to report poor health. In the same way, residents of Eastern and Western parts of Ghana were 2 times more likely to report poor health compared to those in the Upper West region. Respondents with functional limitations and disabilities were 3.6 times and 2.4 times respectively, more likely to report poor health. On the other hand, the odds of reporting poor health was 29, 36 and 27% less among respondents in the highest income quintiles, former users of tobacco and those satisfied with certain aspects of life respectively. Also, current alcohol users were 41% less likely to report poor health.

CONCLUSION

The health status of the elderly is to an extent determined by the circumstances in which they are born, grow and live. The findings suggest that addressing social issues faced by individuals in youthful age will go a long way to achieving good health in the future. People with physical limitations and disabilities are most vulnerable to unmet healthcare needs and support system from government, policy makers and family.

Self-perceived health in functionally independent older people: associated factors

Background

Self-perceived health (SPH) is a powerful indicator of the health status of elderly people. This issue has been widely studied in oldest populations considering altogether functionally independent and dependent individuals. The objective of this study was to describe SPH and to identify the main factors that have an impact on SPH in a sample of functionally independent community-dwelling older adults.

Methods

For this cross-sectional study, face-to-face interviews were carried out with non-institutionalized functionally independent older individuals in a northern region of Spain. Participants were asked: “Overall, you would say that your health is excellent, very good, good, fair or poor?”. SPH responses were grouped in two categories: good and poor. Binary logistic regression was used to identify factors associated with poor SPH.

Results

A sample of 634 individuals was studied, of whom 55 % were women. The mean age was 74.8 (SD 6.7) years. About 18 % of the respondents rated their health as poor. In the multivariate model adjusted for age and sex, reported poor health was significantly associated with polypharmacy (≥3 drugs per day) (OR: 5.76, 95 % CI: 3.60–9.18), the presence of sensory impairment (OR: 1.87, 95 % CI: 1.15–3.04), bad sleep quality (OR:1.82, 95 % CI: 1.02–3.28), a bad nutrition pattern (OR: 2.37, 95 % CI: 1.08–5.21), not engaging in cognitively stimulating activities (OR: 4.08, 95 % CI: 1.64–10.20), or group social activities (OR: 2.62, 95 % CI: 1.63–4.23).

Conclusions

The study indicates that several health and social variables are strongly related to SPH in independent community-dwelling older adults. This finding highlights the need for thorough assessment of factors related to SPH in older independent adults, this being essential to develop health-related programmes for promoting active and healthy ageing and to delay the onset of dependence in this population.

Lifestyle, chronic diseases and self-rated health among Malaysian adults: results from the 2011 National Health and Morbidity Survey (NHMS)

BACKGROUND

Self-rated health (SRH) has been demonstrated as a valid and appropriate predictor of incident mortality and chronic morbidity. Associations between lifestyle, chronic diseases, and SRH have been reported by various population studies but few have included data from developing countries. The aim of this study was to determine the prevalence of poor SRH in Malaysia and its association with lifestyle factors and chronic diseases among Malaysian adults.

METHODS

This study was based on 18,184 adults aged 18 and above who participated in the 2011 National Health and Morbidity Survey (NHMS). The NHMS was a cross-sectional survey (two-stage stratified sample) designed to collect health information on a nationally representative sample of the Malaysian adult population. Data were obtained via face-to-face interviews using validated questionnaires. Two categories were used to measure SRH: "good" (very good and good) and "poor" (moderate, not good and very bad). The association of lifestyle factors and chronic diseases with poor SRH was examined using univariate and multivariate logistic regression.

RESULTS

Approximately one-fifth of the Malaysian adult population (20.1 %) rated their health as poor (men: 18.4 % and women: 21.7 %). Prevalence increases with age from 16.2 % (aged 18-29) to 32.0 % (aged ≥60). In the multivariate logistic regression analysis, lifestyle factors associated with poor SRH included: underweight (OR = 1.29; 95 % CI: 1.05-1.57), physical inactivity (OR = 1.25; 95 % CI: 1.11-1.39), former smoker (OR = 1.38; 95 % CI: 1.12-1.70), former drinker (OR = 1.27; 95 % CI: 1.01-1.62), and current drinker (OR = 1.35; 95 % CI: 1.08-1.68). Chronic diseases associated with poor SRH included: asthma (OR = 1.66; 95 % CI: 1.36-2.03), arthritis (OR = 1.87; 95 % CI: 1.52-2.29), hypertension (OR = 1.39; 95 % CI: 1.18-1.64), hypercholesterolemia (OR = 1.43; 95 % CI: 1.18-1.74), and heart disease (OR = 1.85; 95 % CI: 1.43-2.39).

CONCLUSIONS

This study indicates that several unhealthy lifestyle behaviours and chronic diseases are significantly associated with poor SRH among Malaysian adults. Effective public health strategies are needed to promote healthy lifestyles, and disease prevention interventions should be enhanced at the community level to improve overall health.

Healthcare use and voluntary health insurance after retirement in Thailand

BACKGROUND

The dramatic changes occurring in the age structure of the Thai population make providing healthcare services for the elderly a major challenge for decision makers. Because the number of the elderly will be increasing, together with the number of retired workers, under the Social Health Insurance (SHI) scheme, there will be the unmet needs for healthcare use after retirement. The SHI scheme does not cover workers after retirement unless they could use free healthcare for the elderly. In addition, the government budget is tight regarding the support of universal healthcare and long-term care services for all of the elderly. Therefore, the government could support retired workers who have the ability to pay by facilitating voluntary health insurance.

OBJECTIVE

The main objectives of the present study are to analyze the characteristics of workers that need health insurance after retirement and to identify the factors explaining healthcare use to offer healthcare services to meet the workers' needs and expectations.

METHODS

Four hundred insured workers under the Social Health Insurance (SHI) Scheme in Thailand were interviewed using a structured questionnaire. The Anderson-Newman model of healthcare use is the conceptual framework used in this study to understand the factors that explain healthcare use patterns of workers. Multiple regressions are employed extensively to evaluate the variables that predict healthcare use.

RESULTS

According to the survey, a person that purchases voluntary health insurance is likely to be female, have a higher personal income, and healthy. The characteristics related to healthcare use were poor health status, a high personal income, and peeople afflicted by chronic illness.

CONCLUSIONS

There is a gap between healthcare service use and the demand for voluntary health insurance. People that have a high income are more likely to purchase voluntary health insurance, while people in worse health and afflicted by chronic illness may have greater difficulty purchasing voluntary health insurance because they face higher premiums or are denied coverage by insurers.