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Sasidharan A, Ambatipudi S. A community-based cross-sectional survey of orthostatic hypotension among elderly from south India. Indian Heart J 2022; 74:478-483. [PMID: 36403667 PMCID: PMC9773280 DOI: 10.1016/j.ihj.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. METHODS A community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. RESULTS The prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR = 1.97 [95%CI = 1.05, 3.72]). Increase in number of co-morbidities (ORadj = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (ORadj = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (ORadj = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (ORadj = 4.81 [95%CI = 1.57, 14.77]), hypertension (ORadj = 4.97 [95%CI = 1.01, 24.46]) and cognitive impairment (ORadj = 5.01 [95%CI = 1.40, 18.51]) were at a higher odds of having OH. CONCLUSIONS OH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.
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Affiliation(s)
- Akhil Sasidharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Thiruvananthapuram, 695011, India,Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, 600077, India
| | - Srikant Ambatipudi
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Thiruvananthapuram, 695011, India,Corresponding author. Achutha Menon Centre for Health Science Studies. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical college, Thiruvanathapuram, 695011, India.
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2
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Prince MJ, Acosta D, Guerra M, Huang Y, Jacob KS, Jimenez-Velazquez IZ, Jotheeswaran AT, Llibre Rodriguez JJ, Salas A, Sosa AL, Acosta I, Mayston R, Liu Z, Llibre-Guerra JJ, Prina AM, Valhuerdi A. Intrinsic capacity and its associations with incident dependence and mortality in 10/66 Dementia Research Group studies in Latin America, India, and China: A population-based cohort study. PLoS Med 2021; 18:e1003097. [PMID: 34520466 PMCID: PMC8439485 DOI: 10.1371/journal.pmed.1003097] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has reframed health and healthcare for older people around achieving the goal of healthy ageing. The recent WHO Integrated Care for Older People (ICOPE) guidelines focus on maintaining intrinsic capacity, i.e., addressing declines in neuromusculoskeletal, vitality, sensory, cognitive, psychological, and continence domains, aiming to prevent or delay the onset of dependence. The target group with 1 or more declines in intrinsic capacity (DICs) is broad, and implementation may be challenging in less-resourced settings. We aimed to inform planning by assessing intrinsic capacity prevalence, by characterising the target group, and by validating the general approach-testing hypotheses that DIC was consistently associated with higher risks of incident dependence and death. METHODS AND FINDINGS We conducted population-based cohort studies (baseline, 2003-2007) in urban sites in Cuba, Dominican Republic, Puerto Rico, and Venezuela, and rural and urban sites in Peru, Mexico, India, and China. Door-knocking identified eligible participants, aged 65 years and over and normally resident in each geographically defined catchment area. Sociodemographic, behaviour and lifestyle, health, and healthcare utilisation and cost questionnaires, and physical assessments were administered to all participants, with incident dependence and mortality ascertained 3 to 5 years later (2008-2010). In 12 sites in 8 countries, 17,031 participants were surveyed at baseline. Overall mean age was 74.2 years, range of means by site 71.3-76.3 years; 62.4% were female, range 53.4%-67.3%. At baseline, only 30% retained full capacity across all domains. The proportion retaining capacity fell sharply with increasing age, and declines affecting multiple domains were more common. Poverty, morbidity (particularly dementia, depression, and stroke), and disability were concentrated among those with DIC, although only 10% were frail, and a further 9% had needs for care. Hypertension and lifestyle risk factors for chronic disease, and healthcare utilisation and costs, were more evenly distributed in the population. In total, 15,901 participants were included in the mortality cohort (2,602 deaths/53,911 person-years of follow-up), and 12,939 participants in the dependence cohort (1,896 incident cases/38,320 person-years). One or more DICs strongly and independently predicted incident dependence (pooled adjusted subhazard ratio 1.91, 95% CI 1.69-2.17) and death (pooled adjusted hazard ratio 1.66, 95% CI 1.49-1.85). Relative risks were higher for those who were frail, but were also substantially elevated for the much larger sub-groups yet to become frail. Mortality was mainly concentrated in the frail and dependent sub-groups. The main limitations were potential for DIC exposure misclassification and attrition bias. CONCLUSIONS In this study we observed a high prevalence of DICs, particularly in older age groups. Those affected had substantially increased risks of dependence and death. Most needs for care arose in those with DIC yet to become frail. Our findings provide some support for the strategy of optimising intrinsic capacity in pursuit of healthy ageing. Implementation at scale requires community-based screening and assessment, and a stepped-care intervention approach, with redefined roles for community healthcare workers and efforts to engage, train, and support them in these tasks. ICOPE might be usefully integrated into community programmes for detecting and case managing chronic diseases including hypertension and diabetes.
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Affiliation(s)
- Martin J. Prince
- King’s Global Health Institute, King’s College London, London, United Kingdom
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daisy Acosta
- Geriatric Section, Internal Medicine Department, Universidad Nacional Pedro Henríquez Ureña, Santo Domingo, Dominican Republic
| | - Mariella Guerra
- Psychogeriatric Unit, National Institute of Mental Health “Honorio Delgado Hideyo Noguchi”, Lima, Peru
- Centro de la Memoria y Desordenes Relacionados, Lima, Peru
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - K. S. Jacob
- Christian Medical College and Hospital, Vellore, India
| | - Ivonne Z. Jimenez-Velazquez
- Geriatrics Program, Internal Medicine Department, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | | | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Caracas, Venezuela
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Ana Luisa Sosa
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico
| | - Isaac Acosta
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico
| | - Rosie Mayston
- King’s Global Health Institute, King’s College London, London, United Kingdom
- Department of Global Health and Social Medicine, King’s College London, London, United Kingdom
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | | | - A. Matthew Prina
- King’s Global Health Institute, King’s College London, London, United Kingdom
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Falgas-Bague I, Ramos Z, Del Cueto P, Kim E, Zhen-Duan J, Wong YJ, Chieng CK, Frontera W, Alegría M. Adaptation of an Evidence-Based Intervention for Disability Prevention, Implemented by Community Health Workers Serving Ethnic Minority Elders. Am J Geriatr Psychiatry 2021; 29:260-269. [PMID: 32855041 PMCID: PMC7855421 DOI: 10.1016/j.jagp.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Changing demographics have created substantial unmet needs for mental health and physical disability services for immigrant and racial/ethnic minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHWs) who speak the same language and share the culture of these elders. Yet, implementation of interventions offered by CHWs requires adaptations of content and delivery, ideally under clinical supervision. OBJECTIVE To culturally adapt two evidence-based interventions, offered in community settings, to address mental health and physical disability prevention for diverse minority elders. METHODS We followed the Castro-Barrera stepped model for cultural adaptation of two evidence-based interventions into one combined program of disability management and prevention delivered by CHWs. We used feedback from key stakeholders, including four clinical supervisors, 16 CHWs, 17 exercise trainers, and 153 participants, collected at three time points to further adapt the intervention to a diverse population of elders. RESULTS Adaptations for administration by CHWs/exercise trainers included: systematization of supervision process, increased flexibility in sessions offered per participants' needs, inclusion of self-care content, modification of materials to better reflect elders' daily life experiences, and greater focus on patient engagement in care. Areas for additional adaptation included enhancing examples with culturally relevant metaphors, incorporating visual aids, and training CHWs in the importance of building trust. CONCLUSION This study identifies key aspects of the cultural adaptation process that facilitates broader cultural sensitivity of service delivery by CHWs to diverse elders in community settings.
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Affiliation(s)
- Irene Falgas-Bague
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA.
| | - Zorangeli Ramos
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Paola Del Cueto
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Emily Kim
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - Yankau Josephine Wong
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ching-King Chieng
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Walter Frontera
- Departments of Physical Medicine, Rehabilitation and Sports Medicine and Physiology and Biophysics, University of Puerto Rico, Río Piedras, Puerto Rico
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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Thiyagarajan JA, Araujo de Carvalho I, Peña-Rosas JP, Chadha S, Mariotti SP, Dua T, Albanese E, Bruyère O, Cesari M, Dangour A, Dias A, Guerra M, Keeffe J, Kerse N, Khan QUA, Liu CJ, Murthy GVS, Ndegwa SN, Reginster JY, Robledo LMFG, Tremblay K, Woo J, Prince M, Beard JR. Redesigning care for older people to preserve physical and mental capacity: WHO guidelines on community-level interventions in integrated care. PLoS Med 2019; 16:e1002948. [PMID: 31626651 PMCID: PMC6799894 DOI: 10.1371/journal.pmed.1002948] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.
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Affiliation(s)
| | | | - Juan Pablo Peña-Rosas
- Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Shelly Chadha
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Silvio Paolo Mariotti
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Emiliano Albanese
- World Health Organization Collaborating Center for Research and Training in Mental Health, University of Geneva, Geneva, Switzerland
| | - Olivier Bruyère
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Alan Dangour
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Mariella Guerra
- Institute of Memory, Depression and Related Disorders, Lima, Peru
| | - Jill Keeffe
- World Health Organization Collaborating Centre for Prevention of Blindness, LV Prasad Eye Institute, Hyderabad, India
| | | | | | - Chiung-ju Liu
- Indiana University, Indianapolis, Indiana, United States of America
| | - Gudlavalleti V. S. Murthy
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Indian Institute of Public Health, Hyderabad, Madhapur, India
| | | | - Jean-Yves Reginster
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
| | | | - Kelly Tremblay
- University of Washington, Seattle, United States of America
| | - Jean Woo
- The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Prince
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - John R. Beard
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
- ARC Centre of Excellence on Population Ageing Research, University of New South Wales, Sydney, New South Wales, Australia
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Bhutta MF, Bu X, de Muñoz PC, Garg S, Kong K. Training for hearing care providers. Bull World Health Organ 2019; 97:691-698. [PMID: 31656334 PMCID: PMC6796672 DOI: 10.2471/blt.18.224659] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Abstract
The lack of an appropriately trained global hearing-care workforce is recognized as a barrier to developing and implementing services to treat ear and hearing disorders. In this article we examine some of the published literature on the current global workforce for ear and hearing care. We outline the status of both the primary-care workforce, including community health workers, and specialist services, including audiologists, ear, nose and throat specialists, speech and language therapists, and teachers of the deaf. We discuss models of training health workers in ear and hearing care, including the role of task-sharing and the challenges of training in low and middle-income countries. We structure the article by the components of ear and hearing care that may be delivered in isolation or in integrated models of care: primary care assessment and intervention; screening; hearing tests; hearing rehabilitation; middle-ear surgery; deaf services; and cochlear implant programmes. We highlight important knowledge gaps and areas for future research and reporting.
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Affiliation(s)
- Mahmood F Bhutta
- Department of Ear, Nose and Throat, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, England
| | - Xingkuan Bu
- Jiangsu Ear and Hearing Centre, Jiangsu Province Hospital, Nanjing, China
| | | | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Kelvin Kong
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Bao J, Chua KC, Prina M, Prince M. Multimorbidity and care dependence in older adults: a longitudinal analysis of findings from the 10/66 study. BMC Public Health 2019; 19:585. [PMID: 31096943 PMCID: PMC6524243 DOI: 10.1186/s12889-019-6961-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 05/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In an ageing world facing an epidemic of chronic diseases, there is great interest in the burden of multimorbidity on individuals and caregivers, yet no studies have examined the longitudinal association between multimorbidity and care dependence in low and middle income countries. Mental and cognitive disorders are associated with dependence but little is known about their role in the pathway to dependence in the context of multimorbidity. This study aims to determine (1) the association of multimorbidity with the onset of care dependence in older adults, accounting for mortality and controlling for sociodemographic factors, and (2) the independent effects of physical multimorbidity, mental and cognitive disorders. METHODS A population-based cohort study of people aged 65 years and older in six countries in Latin America, and China. Data on chronic conditions and sociodemographic factors were collected at baseline. Multimorbidity was ascertained as a count of up to 15 mental, cognitive and physical health conditions. Dependence was ascertained through informant interviews at baseline and follow-up. We used competing risk regression to assess the association between multimorbidity and the onset of care dependence, acknowledging the possibility of dependence-free death. We also assessed the independent effects of physical multimorbidity and depression, anxiety and dementia individually. RESULTS 12,965 participants, with no needs for care at baseline, were followed up for a median of 3.0-4.9 years. Each unit increase in multimorbidity count increased the cumulative risk of dependence by 20% in the fully adjusted model. Age was the only variable to confound this relationship. Physical multimorbidity was associated with only a modest increased risk of care dependence. Dementia, depression and anxiety were independently associated with incident care dependence at every level of physical multimorbidity, and depression and anxiety attenuated the effect of physical multimorbidity. CONCLUSION Multimorbidity consistently predicts care dependence with little variation between countries. Physical multimorbidity imparts a lower risk than multimorbidity with mental and cognitive disorders included. Mental and cognitive disorders independently increase the risk of care dependence. Comprehensive and holistic assessment of disorders of body, brain and mind can help to identify older people at high risk of care dependence.
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Affiliation(s)
- Jianan Bao
- Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Kia-Chong Chua
- Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew Prina
- Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Martin Prince
- Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Spoorenberg SL, Reijneveld SA, Uittenbroek RJ, Kremer HP, Wynia K. Health-Related Problems and Changes After 1 Year as Assessed With the Geriatric ICF Core Set (GeriatrICS) in Community-Living Older Adults Who Are Frail Receiving Person-Centered and Integrated Care From Embrace. Arch Phys Med Rehabil 2019; 100:2334-2345. [PMID: 30986412 DOI: 10.1016/j.apmr.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/31/2018] [Accepted: 02/13/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the prevalence, severity, and change in health-related problems in a sample of older adults who received individual care and support from Embrace, for the whole sample, per subgroup based on complexity of care needs and frailty, and for those who had at baseline a health-related problem. DESIGN A pretest-posttest study with assessments at baseline and after 12 months. SETTING Community. PARTICIPANTS Older adults aged 75 years and older (N=136) who are frail (n=56) or who have complex care needs (n=80). INTERVENTION Participants received care and support by Embrace, a person-centered and integrated care service for community-living older adults supporting them to age in place. A multidisciplinary team provided care and support, with intensity depending on the older adults' risk profile. MAIN OUTCOME MEASURE Health-related problems as perceived by older adults and measured with the Geriatric International Classification of Functioning, Disability and Health Core Set. RESULTS Health-related problems were related to 6 coherent clusters: (1) Mental Functions; (2) Physical Health; (3) Mobility; (4) Personal Care; (5) Nutrition; and (6) Support. The most prevalent and most severe problems at baseline were related to Mental Functions and Mobility. Changes in the prevalence of problems after 12 months varied. Severity scores decreased or remained stable, except for Mobility items which showed a varying changing pattern in participants with complex care needs. Prevalence and severity of problems for those with a problem at baseline decreased after 12 months. Frail participants with a problem had higher baseline severity scores than those with complex care needs experiencing a problem, but differences in changes between individuals who are frail and those with complex care needs were small. CONCLUSIONS The results are encouraging and may indicate that individual, person-centered and integrated care and support from Embrace offers a route to counteracting the decline in physical, cognitive and social functioning associated with aging.
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Affiliation(s)
- Sophie L Spoorenberg
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Sijmen A Reijneveld
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Ronald J Uittenbroek
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen
| | - Hubertus P Kremer
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Klaske Wynia
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen; University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands.
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O'Donovan J, Verkerk M, Winters N, Chadha S, Bhutta MF. The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature. BMJ Glob Health 2019; 4:e001141. [PMID: 30899572 PMCID: PMC6407559 DOI: 10.1136/bmjgh-2018-001141] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Community health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs. Methods We performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature. Results We identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss. Conclusion CHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.
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Affiliation(s)
- James O'Donovan
- Department of Education, University of Oxford, Oxford, UK.,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Misha Verkerk
- Department of Otolaryngology, King's College Hospital NHS Foundation Trust, London, UK
| | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
| | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
| | - Mahmood F Bhutta
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Prina AM, Mayston R, Wu YT, Prince M. A review of the 10/66 dementia research group. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1-10. [PMID: 30467589 PMCID: PMC6336743 DOI: 10.1007/s00127-018-1626-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this review we discuss how the study of dementia epidemiology in Low- and Middle-Income Countries (LMICs) has changed in the last 20 years, and specifically to review the evidence created by the 10/66 Dementia Research Group (DRG) and discuss future directions for research. METHODS We identified and collated all the papers related to the 10/66 Dementia Research Group, including papers from groups who adopted the 10/66 methodology, that have been published in peer-reviewed journals. RESULTS Over 200 papers including data from Africa, Asia, Europe and Latin America and the Caribbean were identified by this review. Many of the findings revolved around the epidemiology of dementia, mental health and non-communicable diseases, including the cross-cultural development and validation of measurement tools of cognition and functioning, need for care, care arrangements and mental health. Social ageing, care dependence and caregiver interventions were also topics that the group had published on. DISCUSSION A body of evidence has been generated that has challenged the view, prevalent when the group started, that dementia is comparatively rare in LMICs. The experience of the 10/66 DRG has shown that descriptive epidemiological research can be important and impactful, where few data exist. Monitoring population trends in the prevalence and incidence of dementia may be our best chance to confirm hypotheses regarding modifiable risk factors of dementia.
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Affiliation(s)
- A Matthew Prina
- Institute of Psychiatry, Psychology & Neuroscience, Department of Health Service, King's College London, London, UK.
| | - Rosie Mayston
- Institute of Psychiatry, Psychology & Neuroscience, Department of Health Service, King's College London, London, UK
| | - Yu-Tzu Wu
- Institute of Psychiatry, Psychology & Neuroscience, Department of Health Service, King's College London, London, UK
| | - Martin Prince
- Institute of Psychiatry, Psychology & Neuroscience, Department of Health Service, King's College London, London, UK
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10
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Llibre Rodriguez JJ, Prina AM, Acosta D, Guerra M, Huang Y, Jacob K, Jimenez-Velasquez IZ, Salas A, Sosa AL, Williams JD, Jotheeswaran A, Acosta I, Liu Z, Prince MJ. The Prevalence and Correlates of Frailty in Urban and Rural Populations in Latin America, China, and India: A 10/66 Population-Based Survey. J Am Med Dir Assoc 2018; 19:287-295.e4. [DOI: 10.1016/j.jamda.2017.09.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/24/2017] [Accepted: 09/30/2017] [Indexed: 11/17/2022]
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Ayuso RMF, Velázquez JMM, Ayuso DF, Torre-Montero JCDL. Validation to Spanish of the Caring Assessment Tool (CAT-V). Rev Lat Am Enfermagem 2017; 25:e2965. [PMID: 29069268 PMCID: PMC5676299 DOI: 10.1590/1518-8345.0920.2965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/23/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE to translate and validate to Spanish the Caring Assessment Scale tool, CAT-V, by Joanne Duffy, within the framework of Jean Watson; as a secondary objective, it is proposed to evaluate its psychometric properties. There are tools designed to measure the patient's perception of provided cares, including CAT-V, the subject of our interest, in a way that it can be used in Spanish-speaking patients. METHODS to meet the objectives, it was performed sequential translation and retro-translation of the scale to be validated, through a standardized procedure. The final version of that scale was validated in a sample of 349 patients from four public and two private hospitals in Madrid, Spain. RESULTS The instrument was translated and validated with high internal consistency (Cronbach's alpha .953). The subsequent factor analysis revealed a three-factor structure, not coincident with the data from the US population. CONCLUSION it is considered that the translation of CAT-V is a suitable instrument to be used in the evaluation of patient care in Ibero-american health centers whose language is Spanish.
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Affiliation(s)
- Rosa María Fernández Ayuso
- 1PhD, Professor, San Juan de Dios University School of Nursing and Physical Therapy, Universidad Pontificia Comillas, Madrid, Spain
| | - Juan Manuel Morillo Velázquez
- PhD, Associate Professor, San Juan de Dios University School of Nursing and Physical Therapy, Universidad Pontificia Comillas, Madrid, Spain
| | - David Fernández Ayuso
- PhD, Adjunct Professor, San Juan de Dios University School of Nursing and Physical Therapy, Universidad Pontificia Comillas, Madrid, Spain
| | - Julio César de la Torre-Montero
- PhD, Adjunct Professor, San Juan de Dios University School of Nursing and Physical Therapy, Universidad Pontificia Comillas, Madrid, Spain
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Mayston R, Lloyd-Sherlock P, Gallardo S, Wang H, Huang Y, Montes de Oca V, Ezeah P, Guerra M, Sosa AL, Liu Z, Uwakwe R, Guerchet MM, Prince M. A journey without maps-Understanding the costs of caring for dependent older people in Nigeria, China, Mexico and Peru. PLoS One 2017; 12:e0182360. [PMID: 28787029 PMCID: PMC5546609 DOI: 10.1371/journal.pone.0182360] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/17/2017] [Indexed: 12/03/2022] Open
Abstract
PURPOSE OF THE STUDY Populations in Latin America, Asia and sub-Saharan Africa are rapidly ageing. The extent to which traditional systems of family support and security can manage the care of increased numbers of older people with chronic health problems is unclear. Our aim was to explore the social and economic effects of caring for an older dependent person, including insight into pathways to economic vulnerability. DESIGN & METHODS We carried out a series of household case studies across urban and rural sites in Peru, Mexico, China and Nigeria (n = 24), as part of a cross-sectional study, nested within the 10/66 Dementia Research Group cohort. Case studies consisted of in-depth narrative style interviews (n = 60) with multiple family members, including the older dependent person. RESULTS Governments were largely uninvolved in the care and support of older dependent people, leaving families to negotiate a 'journey without maps'. Women were de facto caregivers but the traditional role of female relative as caregiver was beginning to be contested. Household composition was flexible and responsive to changing needs of multiple generations but family finances were stretched. IMPLICATIONS Governments are lagging behind sociodemographic and social change. There is an urgent need for policy frameworks to support and supplement inputs from families. These should include community-based and residential care services, disability benefits and carers allowances. Further enhancement of health insurance schemes and scale-up of social pensions are an important component of bolstering the security of dependent older people and supporting their continued social and economic participation.
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Affiliation(s)
- Rosie Mayston
- Health Service and Population Research Department, King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Peter Lloyd-Sherlock
- School of International Development, University of East Anglia, Norwich, United Kingdom
| | - Sara Gallardo
- Instituto de la Memoria y Desordenes Relacionados, La Molina, Lima, Peru
| | - Hong Wang
- Peking University, Institute of Mental Health, Beijing, China
| | - Yueqin Huang
- Peking University, Institute of Mental Health, Beijing, China
| | - Veronica Montes de Oca
- National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico
| | - Peter Ezeah
- Department of Sociology/Anthropology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Mariella Guerra
- Instituto de la Memoria y Desordenes Relacionados, La Molina, Lima, Peru
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico
| | - Zhaourui Liu
- Peking University, Institute of Mental Health, Beijing, China
| | - Richard Uwakwe
- Department of Sociology/Anthropology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Maëlenn M. Guerchet
- Health Service and Population Research Department, King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Martin Prince
- Health Service and Population Research Department, King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
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Javadi D, Feldhaus I, Mancuso A, Ghaffar A. Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence. Glob Ment Health (Camb) 2017; 4:e14. [PMID: 29230310 PMCID: PMC5719475 DOI: 10.1017/gmh.2017.15] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. METHODS Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. RESULTS Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. CONCLUSIONS There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.
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Affiliation(s)
- D. Javadi
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - I. Feldhaus
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Mancuso
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A. Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
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Jotheeswaran AT, Dias A, Philp I, Patel V, Prince M. Calibrating EASY-Care independence scale to improve accuracy. Age Ageing 2016; 45:890-893. [PMID: 27496925 PMCID: PMC5105821 DOI: 10.1093/ageing/afw106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/06/2016] [Indexed: 11/22/2022] Open
Abstract
Background there is currently limited support for the reliability and validity of the EASY-Care independence scale, with little work carried out in low- or middle-income countries. Therefore, we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Objective we assessed the internal construct validity and hierarchical and classical scaling properties among frail dependent older people in the community. Methods three primary care physicians administered EASY-Care comprehensive geriatric assessment for 150 frail and/or dependent older people in the primary care setting. A Mokken model was applied to investigate hierarchical scaling properties of EASY-Care independence scale, and internal consistency (Cronbach's alpha) of the scale was also examined. Results we found that EASY-Care independence scale is highly internally consistent and is a strong hierarchical scale, hence providing strong evidence for unidimensionality. However, two items in the scale (unable to use telephone and manage finances) had much lower item Loevinger H coefficients than others. Exclusion of these two items improved the overall internal consistency of the scale. Conclusions the strong performance of the EASY-Care independence scale among community-dwelling frail older people is encouraging. This study confirms that EASY-Care independence scale is highly internally consistent and a strong hierarchical scale.
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Affiliation(s)
- A. T. Jotheeswaran
- Indian Institute of Public Health, Hyderabad, Hyderabad, Telangana 500033, India
- Institute of Psychiatry, King's College London, London SE58AF, UK
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Ian Philp
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Vikram Patel
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, UK
- Sangath, Goa, India
| | - Martin Prince
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, and Centre for Global Mental Health, King's College London, London, UK
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