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Zhai S, Zhang Z, Zhang R, Peng Y, Zhang J, Zhang Y, Jin Q, Zhou J, Chen J. Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing. BMC Public Health 2024; 24:1657. [PMID: 38907192 PMCID: PMC11191137 DOI: 10.1186/s12889-024-18878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.
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Affiliation(s)
- Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Zhiying Zhang
- Outpatient Office, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China.
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yiyao Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, No.26, Huangcun West Street, Daxing District, Beijing, 102600, China
| | - Jiaojiao Zhou
- Fengtai District Xiluoyuan Community Health Service Centre, Beijing, 100077, China
| | - Jingjing Chen
- Huairou District Liulimiao Community Health Service Centre, Beijing, 101499, China
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Singh VJ, Roy V, Singhal S, Daga M. Pharmacoeconomics of medicines used for geriatric individuals in a tertiary care hospital in Delhi. Indian J Med Res 2024; 159:143-152. [PMID: 38577855 PMCID: PMC11050745 DOI: 10.4103/ijmr.ijmr_2507_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND OBJECTIVES Expenditure on healthcare is a major concern in the geriatric age group. The current study was carried out to assess the expenditure patterns on medicines utilized in geriatric inpatients. METHODS An observational study was conducted on 1000 geriatric inpatients, aged ≥60 yr, admitted to the medicine unit. Data were collected regarding demographic characteristics, prescribed medicines, expenditure incurred on medicines, appropriateness of medicines prescribed and adverse drug reactions (ADRs). Appropriateness of the prescribed medicines was determined using the American Geriatrics Society 2015 Updated Beers Criteria. RESULTS Geriatric inpatients comprised 41.3 per cent of the total individuals admitted in the ward during the study period. A total of 8366 medicines were prescribed in 127 formulations. The total expenditure on prescribed medicines was INR 1,087,175 with a per capita expenditure of INR 1087.17. Parenteral medicines accounted for 91 per cent of the expenditure on medicines. Maximum expenditure (70%) was incurred on 11.9 per cent of the medicines prescribed. The per capita expenditure was significantly higher in individuals with comorbidities (P=0.03) and those who had a longer duration of hospital stay (P<0.0001). About 28.1 per cent prescriptions were inappropriate. ADRs (140) were observed in 139 (13.9%) inpatients. Individuals with inappropriate medicines prescriptions and ADRs had a longer duration of hospital stay and more number of medicines prescribed. INTERPRETATION CONCLUSIONS Comorbidities, prolonged hospitalization, polypharmacy, inappropriate medicines and parenteral medicines being prescribed contribute to increased expenditure on medicines in geriatric inpatients. In view of the rising number of geriatric inpatients, there is a need to frame a drug policy for them along with surveillance of expenditure on prescribed medicines. This needs to be treated as a priority.
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Affiliation(s)
- Vikram Jit Singh
- Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
| | - Vandana Roy
- Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
| | - Shubha Singhal
- Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - M.K. Daga
- Department of Medicine, Maulana Azad Medical College & Associated Hospitals, New Delhi, India
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Isac C, Lee P. Transitional care for older adults with chronic illness: A qualitative inquiry. Int J Older People Nurs 2024; 19:e12599. [PMID: 38268312 DOI: 10.1111/opn.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 11/07/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Improved public health strategies and medical advancements have expanded older adults' survival after acute insults from chronic diseases. The resultant increase in disability and care requirements among older adults is significant. However, transitional care interventions to support the efficient transition from acute care settings to home are primitive in developing countries like India. OBJECTIVE This qualitative survey aimed to estimate the transitional care requirements of older adults with chronic illness discharged from acute care facilities. METHODS Descriptive phenomenological approach was utilised for this qualitative study. The older adult-family caregiver dyads fulfilling the inclusion criteria were interviewed until the achievement of information saturation. The transcribed narratives between the researcher, older adults and their caregivers were thematically analysed. Consolidated Criteria for Reporting Qualitative Research (COREQ) served as the framework for reporting this research. RESULTS Thirteen older adult-caregiver dyads participated in the semi-structured interview, which yielded six themes. Older adults have a hidden self with characteristics ranging between a continuum of 'insistence' to 'giving up'. Caregiver attributes identified from this inquiry were exhaustion, engagement and empowerment. The remaining four themes which constitute the framework for the 'transitional care progression' model include 'complications are mature when identified among older adults', 'medication knowledge is proportionate with its compliance', 'ignorance of supportive care increases caregiver burden' and 'deficient follow-up practices compromise health'. CONCLUSIONS Transitional care for older adults with chronic illness is premature in developing countries. However, the needs of older adults with chronic disease and their caregivers evolved from the present study align with global perspectives. Themes generated from the current qualitative interview, blended with evidence-based interventions, yielded the transitional care progression model, which serves as the only available framework for implementing transitional care in the region. IMPLICATIONS FOR PRACTICE Future research to establish the feasibility and validity of the 'transitional care progression model' is forecasted. The model requires inclusion within the healthcare curriculum. Professional nurses prepared to implement coordinated transitional care pathways are recommended.
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Affiliation(s)
- Chandrani Isac
- Faculty of Health, Education, Medicine & Social Work, School of Nursing & Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - Premila Lee
- College of Nursing, Christian Medical College, Vellore, India
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Lieber J, Banjara SK, Mallinson PAC, Mahajan H, Bhogadi S, Addanki S, Birk N, Song W, Shah AS, Kurmi O, Iyer G, Kamalakannan S, Kishore Galla R, Sadanand S, Dasi T, Kulkarni B, Kinra S. Burden, determinants, consequences and care of multimorbidity in rural and urbanising Telangana, India: protocol for a mixed-methods study within the APCAPS cohort. BMJ Open 2023; 13:e073897. [PMID: 38011977 PMCID: PMC10685937 DOI: 10.1136/bmjopen-2023-073897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The epidemiological and demographic transitions are leading to a rising burden of multimorbidity (co-occurrence of two or more chronic conditions) worldwide. Evidence on the burden, determinants, consequences and care of multimorbidity in rural and urbanising India is limited, partly due to a lack of longitudinal and objectively measured data on chronic health conditions. We will conduct a mixed-methods study nested in the prospective Andhra Pradesh Children and Parents' Study (APCAPS) cohort to develop a data resource for understanding the epidemiology of multimorbidity in rural and urbanising India and developing interventions to improve the prevention and care of multimorbidity. METHODS AND ANALYSIS We aim to recruit 2100 APCAPS cohort members aged 45+ who have clinical and lifestyle data collected during a previous cohort follow-up (2010-2012). We will screen for locally prevalent non-communicable, infectious and mental health conditions, alongside cognitive impairments, disabilities and frailty, using a combination of self-reported clinical diagnosis, symptom-based questionnaires, physical examinations and biochemical assays. We will conduct in-depth interviews with people with varying multimorbidity clusters, their informal carers and local healthcare providers. Deidentified data will be made available to external researchers. ETHICS AND DISSEMINATION The study has received approval from the ethics committees of the National Institute of Nutrition and Indian Institute of Public Health Hyderabad, India and the London School of Hygiene and Tropical Medicine, UK. Meta-data and data collection instruments will be published on the APCAPS website alongside details of existing APCAPS data and the data access process (www.lshtm.ac.uk/research/centres-projects-groups/apcaps).
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Affiliation(s)
- Judith Lieber
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Hemant Mahajan
- National Institute of Nutrition, Hyderabad, Telangana, India
| | | | | | - Nick Birk
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Wenbo Song
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
- Nagasaki University, Nagasaki, Japan
| | - Anoop Sv Shah
- Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Om Kurmi
- Coventry University, Coventry, UK
| | - Gowri Iyer
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Shilpa Sadanand
- Indian Institute of Public Health Hyderabad, Hyderabad, India
| | - Teena Dasi
- National Institute of Nutrition, Hyderabad, Telangana, India
| | - Bharati Kulkarni
- National Institute of Nutrition, Hyderabad, Telangana, India
- Indian Council of Medical Research, New Delhi, India
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Bogam RR, Chavan VM, Rani CU. Awareness and utilization of social welfare schemes among elderly villagers of Mahabubnagar rural region in Telangana State of India - An interventional study approach. J Family Med Prim Care 2023; 12:2058-2063. [PMID: 38024904 PMCID: PMC10657053 DOI: 10.4103/jfmpc.jfmpc_753_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Demographic transition enhanced the proportion of geriatric population in India. Senior citizens experience progressive economic dependency for their daily survival. The Government of India provides economic assistance through social welfare schemes. However, inadequate awareness of schemes is the key reason for its low utilization. The present study was implemented to evaluate knowledge and utilization of social welfare schemes and also to assess the effect of educational intervention on awareness of elderly persons about welfare schemes. Materials and Methods A community-based interventional study carried out from July to December 2022. A structured 'TIV intervention' comprised of 'Training module', 'Interactive sessions' and 'Village Health Meeting' was administered on 839 elderly persons in one of the rural blocks of Mahabubnagar district of Telangana State of India. Community health workers were actively involved in sensitization sessions. Pre- and postintervention questionnaires were completed through face-to-face interview with participants by trained social workers. The statistical analysis was performed using SPSS Version 20 Software. Results There was a statistically significant improvement in awareness levels and utilization of social welfare schemes due to TIV intervention (P < 0.001, SD = 3.01vs 1.21). The awareness of schemes was significantly greater among males, literates, socioeconomic scale of classes 1 and 2 and with age group of 60-70 years. Conclusions Simple, cost-effective intervention can make significant gain in awareness and utilization levels of social welfare schemes among elderly population. 'Traditional Village Meetings' can be used as a potential opportunity to sensitize community members about social welfare schemes.
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Affiliation(s)
- Rahul Ramesh Bogam
- Community Medicine Specialist Trainer, Community Medicine Residency Programme, Primary Health Care Corporation, Doha, Qatar
| | - Vishwajeet Manohar Chavan
- Professor, Department of Community Medicine, Malla Reddy Medical College for Women, Hyderabad, India
| | - C Usha Rani
- Professor and Head, Department of Community Medicine, Government Medical College, Mahabubnagar, Telangana, India
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Jamwal S, Golechha M, Bohra T. Examining the determinants of health and long-term care for older adults in India through a socio-ecological model - A qualitative assessment. J Family Med Prim Care 2023; 12:1615-1620. [PMID: 37767432 PMCID: PMC10521837 DOI: 10.4103/jfmpc.jfmpc_813_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/07/2022] [Accepted: 05/22/2023] [Indexed: 09/29/2023] Open
Abstract
Background Ageing is associated with multiple long-term health problems and requires medication management, support with activities of daily living, and attention to psychological needs. This study aimed at exploring the enablers and barriers and psychosocial determinants of long-term care. Methods A qualitative study, using semi-structured interviews and thematic analysis, was carried out from February to June 2018. One-on-one in-depth interviews were carried out with 28 participants, including care recipients (n = 12), caregivers (n = 12), and primary-care physicians (n = 4) at the Community Health Centre in the state of Jammu and Kashmir of India. Results Attention from family members, leisure activities, faith in the healthcare provider, and a positive attitude towards life were found to be enablers of long-term care. Resource constraints and alienation from the community were barriers. Incorporating the psychosocial needs of care recipients and problems faced by family caregivers is essential in providing good quality care to individuals with chronic illness. Conclusion The lack of a targeted, nationwide policy has resulted in considerable variability in long-term care services across the country. There is an urgent need to make long-term care an integral part of the Indian health system utilizing a holistic framework to address the health needs of older adults and implementing it through an equitable community-based comprehensive primary health and community-based model.
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Affiliation(s)
- Sonalika Jamwal
- Health Systems and Health Policy, Indian Institute of Public Health-Gandhinagar, Gujarat, India
| | - Mahaveer Golechha
- Health Systems and Health Policy, Indian Institute of Public Health-Gandhinagar, Gujarat, India
| | - Tasneem Bohra
- Health Systems and Health Policy, Indian Institute of Public Health-Gandhinagar, Gujarat, India
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Samra T, Jain K, Kaushal V, Bhatia N, Patel S, Naveen Naik B, Chouhan DK, Dhillon MS, Singh A. The Outcome of Surgically Treated Proximal Femur Fractures Managed by Ortho-anesthetic Geriatric Care Pathway: A Prospective Observational Study with 2-Year Follow-Up. Indian J Orthop 2023; 57:957-966. [PMID: 37214365 PMCID: PMC10192487 DOI: 10.1007/s43465-023-00880-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Background Evaluation of the ortho-anesthetic geriatric care pathway for patients with proximal femur fracture in a tertiary care referral center was done by reporting the peri-operative morbidity and mortality. Clinical and demographic predictors of mortality were also identified in this cohort. Material and Methods This prospective observational study was conducted between August 2017 and November 2018. Demographic, anesthetic and surgical characteristics were recorded. Telephonic post-discharge follow-up was done for a period of 2 years. Factors predicting mortality were estimated using multivariate logistic regression. Results The cohort was characterized by frailty, high ASA physical status, NYHA class and Charlson co-morbidity index. The delay in presentation to hospital and subsequent surgical fixation was 7 (1-8) and 8 (5-13) days, respectively. The 30, 60, 90-day, 1-year and 2-year mortality was 13.6%, 21.8%, 25.45%, 36.5% and 44%, respectively. Intra-operative blood transfusion was a predictor of 30-day mortality (OR 9.2, 95% CI 1.02-83.17; p = 0.048). Pre-operative respiratory dysfunction predicted 60-day (OR 11.245, 95% CI 1.38-91.58; p = 0.024) and 90-day (OR 11.654, 95% CI 1.91-71.1; p = 0.008) mortality. Post-operative morbidity was reported in 31 (28.1%) patients; incidence of pneumonia (n = 9), sepsis (n = 8), MI (n = 6), PTE (n = 5) and ARF (n = 3) were 8.18%, 7.27%, 5.45%, 4.54% and 2.72%, respectively. Conclusion Existing pathway facilitated surgical fixation with median delay of 8 days which should be shortened to 48 h. High mortality in our cohort needs to be decreased by preventing admission delays and aggressively managing co-morbidities. Acceptable benchmark goals for pre-operative optimization of lung disease and decrease in intra-operative blood transfusion need to be incorporated in existing care pathway.
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Affiliation(s)
- Tanvir Samra
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Vivek Kaushal
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Nidhi Bhatia
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Sandeep Patel
- Department of Orthopedics, PGIMER, Sector 12, Chandigarh, 160012 India
| | - B. Naveen Naik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | | | | | - Ajay Singh
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Patil DS, Bailey A, George S, Hyde M, Ashok L. Unpacking the role of transport inequalities among older adults for accessing healthcare in Bengaluru, India. Glob Public Health 2023; 18:2274438. [PMID: 37902071 DOI: 10.1080/17441692.2023.2274438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes.
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Affiliation(s)
- Divya Sussana Patil
- Transdisciplinary Centre for Qualitative Methods, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ajay Bailey
- Transdisciplinary Centre for Qualitative Methods, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Sobin George
- Centre for Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
| | - Martin Hyde
- Department of Management, School of Business, University of Leicester, Leicester, UK
| | - Lena Ashok
- MSW Program, Department of Global Health, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Vaishnav LM, Joshi SH, Joshi AU, Mehendale AM. The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India. Ann Geriatr Med Res 2022; 26:183-195. [PMID: 36039665 PMCID: PMC9535372 DOI: 10.4235/agmr.22.0062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aging care is critical. Projections for 2020 indicate that India’s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program’s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program’s achievements and challenges.
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Affiliation(s)
- Lokesh Mukut Vaishnav
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Shiv Hiren Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
| | - Abhishek Upendra Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
- Corresponding Author: Shiv Hiren Joshi, MD Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), 442001, India E-mail:
| | - Ashok Madhukar Mehendale
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), India
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Mahadzir MDA, Quek KF, Ramadas A. Comprehending Nutrition and Lifestyle Behaviors of People with Metabolic Syndrome: A Focus Group Study. Healthcare (Basel) 2022; 10:1653. [PMID: 36141266 PMCID: PMC9498472 DOI: 10.3390/healthcare10091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Demographically and socio-culturally appropriate care is critical for empowering people with metabolic syndrome (MetS) to self-manage their condition. This focus group study aimed to explore the understanding of nutrition and lifestyle behaviors (NLBs) of Malaysians with MetS. Adults with MetS (N = 21) participated in four focus groups at a university's research clinic in Malaysia. A thematic framework analysis approach was applied to the focus group data using an initial coding framework developed from the Health Belief Model. Six main themes were identified on perceived motivations, barriers, and threats toward healthy NLBs. Motivations to adopt healthy NLBs were body image, personal experience of adverse complications, and family and social support. The perception that healthcare is a business model, the idea that changes in NLBs are difficult and expensive, and cultural influence on food intake were identified as barriers to healthy NLBs. Inadequate knowledge of MetS was identified as a subtheme in this study. Health education and health promotion activities that aim to modify the NLBs of people with MetS should consider the community's perception of motivation and barriers to change. Addressing these aspects in the development of programs can potentially increase program adoption and adherence, ensuring the success of community-based lifestyle interventions.
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Affiliation(s)
| | | | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Malaysia
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Santoyo-Sánchez G, Merino-Soto C, Flores-Hernández S, Pelcastre-Villafuerte BE, Reyes-Morales H. Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610102. [PMID: 36011737 PMCID: PMC9407808 DOI: 10.3390/ijerph191610102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 05/20/2023]
Abstract
The objective of this work was to validate the content of a scale formulated in Spanish for older adults in Mexico, with the aim of comprehensively measuring the access of this population group to outpatient primary-care services. To this end, we carried out a methodological content-validity study in four stages: (1) construction of the scale; (2) evaluation of item legibility; (3) quantitative content evaluation by two groups of judges selected by convenience: participant-judges including older adults with adequate reading comprehension, surveyed in person (n = 23), and expert-judges comprised of researchers specialized in the fields of health services, psychometrics and aging, surveyed online (n = 7); and (4) collection of qualitative feedback from several of the participant-judges (older adults, n = 4). The content was validated both by sequentially examining the level of consensus in the responses of both groups of judges, using the Tastle and Wierman method, and by calculating Aiken's Validity Coefficient with a 90% confidence interval. The scale contained 65 items pertaining to 10 dimensions of two major constructs: accessibility (n = 39) and personal abilities (n = 26). Five items were eliminated in accordance with the minimum-consensus criterion (0.5). This is the first psychometric scale to be developed in Mexico with the view of integrating the characteristics of health-care services and the abilities of the older adults in a single questionnaire designed to measure the access of this population group to outpatient primary-care services.
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Affiliation(s)
- Gerardo Santoyo-Sánchez
- School of Public Health of Mexico, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - César Merino-Soto
- Psychology Research Institute, San Martin de Porres University, Avenue Tomás Marsano 232, Lima 34, Peru
| | - Sergio Flores-Hernández
- Center for Evaluation and Surveys, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - Blanca Estela Pelcastre-Villafuerte
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
- Correspondence: ; Tel.: +52-(777)-329-3028
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Gandham A, Scott D, Bonham MP, Kulkarni B, Kinra S, Ebeling PR, Zengin A. Sex Differences in Bone Health Among Indian Older Adults with Obesity, Sarcopenia, and Sarcopenic Obesity. Calcif Tissue Int 2022; 111:152-161. [PMID: 35507092 PMCID: PMC9300534 DOI: 10.1007/s00223-022-00981-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
Age-related changes in fat and lean mass contribute to bone health, but these associations may be influenced by sex and ethnicity. This study investigated sex-specific associations of obesity and sarcopenia with bone mineral density (BMD) and bone mineral apparent density (BMAD) among Indian older adults. 1057 adults aged ≥ 50 years were included. Dual-energy X-ray absorptiometry (DXA) measured BMD at the hip, spine and whole-body, and BMAD was calculated as BMD/√bone area. Obesity was defined by body fat percentage (cut points; > 25% for men and > 35% for women), and sarcopenia was defined using the revised Asian Working Group for Sarcopenia classification with low hand grip strength (< 28 kg for men and < 18 kg for women) and appendicular lean mass index (< 7.0 kg/m2 for men and < 5.4 kg/m2 for women). Participants were classified into four groups: controls (no obesity or sarcopenia), obesity, sarcopenia, or sarcopenic obesity. Linear regression (β-coefficients and 95%CI) analyses were performed with adjustments for age, smoking status, protein intake, and socioeconomic status. Prevalence of sarcopenia (37%) and sarcopenic obesity (6%) were higher in men than women (17% and 4%, respectively). Compared with controls, men with obesity had lower whole-body BMD and BMAD, but women with obesity had higher hip and spine BMD and BMAD (all p < 0.05). Men, but not women, with sarcopenic obesity, had lower hip and whole-body BMD and BMAD (all p < 0.05) than controls. Men with sarcopenia had lower BMD and BMAD at the hip only, whereas women had lower BMD at all three sites and had lower BMAD at the hip and spine (all p < 0.05), compared with controls. Obesity, sarcopenia, and sarcopenic obesity have sex-specific associations with BMD and BMAD in Indian older adults. With the aging population in India, it is important to understand how body composition contributes to poor bone health among older adults.
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Affiliation(s)
- Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
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Marmamula S, Kumbham TR, Shidhaye R, Modepalli SB, Barrenkala NR, Yellapragada R, Keeffe J. Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Sci Rep 2022; 12:11779. [PMID: 35821044 PMCID: PMC9276822 DOI: 10.1038/s41598-022-15943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
We report prevalence and risk factors for multimorbidity and multi-disability among elderly people in residential care in the Hyderabad region in South India. In total, 1182 elderly (aged ≥ 60) participants were examined in 41 homes for the aged centres. Detailed interviews were conducted by trained personnel to collect personal and demographic information. A questionnaire was used to assess the history of non-communicable diseases and Washington Disability Questionnaire (WDQ) was administered to assess disabilities. The mean age of the participants was 75.0 years (SD 8.8 years; range: 60-108 years), 35.4% were men, 20.3% had no formal education, 60.7% had school education and 19% had higher education. The prevalence of multimorbidity was 37.6% (95% CI: 34.8-40.4). Prevalence of multi-disability was 23.6% (95% CI: 21.2-26.3; n = 270). In total, 857 (72.5%) participants reported using at least one medication for NCDs. Over a third of the elderly in residential care had multimorbidity, and a quarter of them had multi-disability. A holistic health care system that comprises health and wellness coupled with rehabilitation to address disabilities is needed to achieve healthy aging in elderly in homes for the aged in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India.
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.
- Department of Biotechnology, Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Jill Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, 500034, India
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The Mediating Effect of Healthcare Utilization on Livelihood Empowerment against Poverty (LEAP) and Health Security of Older Adults in Ghana: A Case Study on the Ga-West Municipality in Accra, Ghana. Healthcare (Basel) 2022; 10:healthcare10020370. [PMID: 35206984 PMCID: PMC8872544 DOI: 10.3390/healthcare10020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
The concept of health security has aroused several interpretations because of theoretical technique indifferences or academic methodology. The focus has been on human security, old age health security (OAHS), whereas there remain issues of low healthcare utilization by older people from rural Ghana while there are social assistance programs. The study aimed at investigating the mediating effect of healthcare utilization on Livelihood Empowerment against Poverty (LEAP) and old age health security OAHS. With purposive sampling technique, participants were selected to participate in the study with standardized quantitative questionnaire to measure the variables involved in the study and a regression technique to analyze the data. The result of the mediation analysis showed a partial mediation between LEAP and Healthcare Utilization (HU) was found to have bridged the gap between the LEAP and OAHS. The LEAP policy also caused an increase in Health Utilization and, subsequently, an increase in old age health security (OAHS). The study is essential to help the National Health Insurance Authority NHIA in restructuring health care premiums to incite utilization of health facilities by the aged.
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Chatterjee C, Chandra Nayak N, Mahakud J. Magnitude and determinants of inpatient health expenditure among the elderly in India. Int J Health Plann Manage 2021; 37:1402-1420. [PMID: 34970811 DOI: 10.1002/hpm.3410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 01/22/2023] Open
Abstract
As India is experiencing both the epidemiological and demographic transition, the grey population is expected to incur huge expenditure on health care, especially hospitalization expenditure, in the coming decades. The present study, thus, examines the magnitude of different types of inpatient health expenditure (medical, non-medical, total and out-of-pocket expenditure) and factors affecting them among the Indian elderly, using a health expenditure model empirically tested by the World Health Organization. Data were drawn from the 75th Round of the Health Survey conducted by the National Sample Survey Office, Government of India. In addition to basic descriptive statistics, the study employs a two-stage least square and a generalized linear model with log-link and gamma distribution to conduct the econometric analysis. The study finds that higher income, education, and household size, diseases like cancer, treatment involving surgery, poor physical mobility, and the elderly opting for packages involve higher inpatient health spending, while both private and social health insurance tends to reduce the same. So, a thrust on insurance-financed health systems may reduce health spending among the elderly. In this context, the study suggests that a disease-specific policy is required for the elderly along with ensuring state-of-the-art treatment facilities for them in public hospitals for critical ailments.
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Affiliation(s)
- Chandrima Chatterjee
- School of Commerce, Narsee Monjee Institute of Management Studies, Hyderabad, India
| | - Narayan Chandra Nayak
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Jitendra Mahakud
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, Kharagpur, India
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Bajpai J, Ventrapati P, Joshi S, Wadasadawala T, Rath S, Pathak R, Nandhana R, Mohanty S, Chougle Q, Engineer M, Abraham N, Ghosh J, Nair N, Gulia S, Popat P, A P, Sheth T, Desai S, Thakur M, Rangrajan V, Parmar V, Sarin R, Gupta S, Badwe RA. Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India. Breast 2021; 60:177-184. [PMID: 34655887 PMCID: PMC8527043 DOI: 10.1016/j.breast.2021.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Young (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying. METHODS The YBC treated with a curative intent between 2015 and 2016 at our institute were analysed. RESULTS There were 1228 patients with a median age of 36 (12-40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) -III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0-131) months, 5-year overall and disease-free survival was 79.6% (76.8-82.5) and 59.1% (55.8-62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8-90.6), 77.3% (73.4-81.2), 69.7% (52.5-86.9) and disease-free survival was 94% (85.9-100), 65.9% (60.3-71.5), 55% (50.5-59.5), and 29.6% (14-45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6-86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients. CONCLUSION More than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.
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Affiliation(s)
- Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India.
| | - Pradeep Ventrapati
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Shalaka Joshi
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Sushmita Rath
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Ravindra Nandhana
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Samarpita Mohanty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Qurratulain Chougle
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Mitchelle Engineer
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Nissie Abraham
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Nita Nair
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Palak Popat
- Department of Radiology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Patil A
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Tanuja Sheth
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Sangeeta Desai
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Meenakshi Thakur
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Venkatesh Rangrajan
- Department of Surgical Pathology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - Vani Parmar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - R Sarin
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - S Gupta
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
| | - R A Badwe
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India; Homi Bhabha National Institute, India
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Pai RR, Alathur S. Mobile Health Systems Affordability in India: Perspectives of Stakeholders. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211050151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: The purpose of this study were to identify stakeholder perspective for achieving affordable and cost-effective system outcomes and what describes success associated with mHealth systems in India. This study identifies stakeholder views on (a) fundamental conditions for initiating mobile health (mHealth) systems and (b) desirable outcomes regarding affordable and cost-effectiveness of successful mHealth systems. Design/Methodology/Approach: This qualitative study uses existing models of affordability and used an inductive approach to organise emerging codes as per a priori themes. Data were collected from direct observations and 17 in-depth interviews both online and offline involving stakeholder, namely healthcare professionals, technology entrepreneurs and software developers working on health information and mHealth systems. Findings: Findings illustrated people’s need and unwillingness, lack of application infrastructure, ecosystem development, governmental policies, and training and support as factors influencing successful mHealth systems in India. Originality/Value: Earlier studies were less adequate in explaining mHealth systems affordability and cost-effectiveness from the perspective of stakeholder. The current study attempts to provide fundamental conditions and desirable outcomes that are considered to be valuable for developing mHealth systems. This makes healthcare providers with information of what needs to be considered for developing mHealth systems.
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Affiliation(s)
- Rajesh R. Pai
- Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sreejith Alathur
- School of Management, National Institute of Technology Karnataka, Surathkal, Karnataka, India
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Zhi L, Yin P, Ren J, Wei G, Zhou J, Wu J, Shen Q. Running an Internet Hospital in China: Perspective Based on a Case Study. J Med Internet Res 2021; 23:e18307. [PMID: 34342267 PMCID: PMC8485192 DOI: 10.2196/18307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 11/25/2020] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Internet hospitals, as a new forum for doctors to conduct diagnosis and treatment activities based on the internet, are emerging in China and have become integral to the development of the medical field in conjunction with increasing reforms and policies in China's medical and health system. Here, we take the Internet Hospital of the First Affiliated Hospital, Zhejiang University (FAHZU Internet Hospital) as an example to discuss the operations and functional positioning of developing internet hospital medical services in relation to physical hospitals. This viewpoint considers the platform operation, management, and network security of FAHZU Internet Hospital, and summarizes the advantages and limitations in the operation to provide a reference for other areas with interest in developing internet hospitals.
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Affiliation(s)
- Lihua Zhi
- Department of Internet Hospital Office, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Pei Yin
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoqing Wei
- Department of Medical Administration, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Zhou
- Department of Internet Hospital Office, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Wu
- Department of Internet Hospital Office, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Qun Shen
- Department of Internet Hospital Office, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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Transport Poverty with Special Reference to Sustainability: A Systematic Review of the Literature. SUSTAINABILITY 2021. [DOI: 10.3390/su13031451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this work is to analyse the state of the art of scientific research related to transport poverty with special reference to sustainability and to identify new research needs. To this end, a methodology has been used in line with the objective set out, choosing the systematic review of the literature as the most suitable method. The results show that transport poverty is an under-exploited issue and is not well articulated by researchers, and there are great differences between the different areas of knowledge studied. The subjects related to health and medicine have more publications, almost 58%, with the rest distributed among 11 different subjects. Of the works analysed, only 26.69% refer to the topic of sustainability, and therefore this is a branch which is little studied in the literature in this field. Another relevant finding is that all the articles analysed highlight the vulnerability and inequality of the groups affected by transport poverty, with the elderly being the least studied in the research work.
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20
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Davalbhakta S, Sharma S, Gupta S, Agarwal V, Pandey G, Misra DP, Naik BN, Goel A, Gupta L, Agarwal V. Private Health Sector in India-Ready and Willing, Yet Underutilized in the Covid-19 Pandemic: A Cross-Sectional Study. Front Public Health 2020; 8:571419. [PMID: 33194971 PMCID: PMC7643808 DOI: 10.3389/fpubh.2020.571419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The private medical sector is a resource that must be estimated for efficient inclusion into public healthcare during pandemics. Methods: A survey was conducted among private healthcare workers to ascertain their views on the potential resources that can be accessed from the private sector and methods to do the same. Results: There were 213 respondents, 80% of them being doctors. Nearly half (47.4%) felt that the contribution from the private medical sector has been suboptimal. Areas suggested for improved contributions by the private sector related to patient care (71.8%) and provision of equipment (62.4%), with fewer expectations (39.9%) on the research front. Another area of deemed support was maintaining continuity of care for non-COVID patients using virtual consultation services (77.4%), tele-consultation being the preferred option (60%). 58.2% felt that the Government had not involved the private sector adequately; and 45.1% felt they should be part of policy-making. Conclusion: A streamlined pathway to facilitate the private sector to join hands with the public sector for a national cause is the need of the hour. Through our study, we have identified gaps in the current contribution by the private sector and identified areas in which they could contribute, by their own admission.
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Affiliation(s)
- Samira Davalbhakta
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Shefali Gupta
- Department of Microbiology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mulana, India
| | | | - Gaurav Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Bijaya Nanda Naik
- Department of Community Medicine, NAMO Medical Education and Research Institute, Silvassa, India
| | - Ashish Goel
- Department of Medicine, University College of Medical Sciences, New Delhi, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Aggarwal V, Sashindran VK, Dudeja P. Health-care needs and morbidity profile of the elderly veterans and their dependents staying in an urban area:A cross-sectional study. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Vancampfort D, Lara E, Smith L, Rosenbaum S, Firth J, Stubbs B, Hallgren M, Koyanagi A. Physical activity and loneliness among adults aged 50 years or older in six low- and middle-income countries. Int J Geriatr Psychiatry 2019; 34:1855-1864. [PMID: 31435958 PMCID: PMC6854283 DOI: 10.1002/gps.5202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/10/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Loneliness is widespread and associated with deleterious outcomes in middle-aged and older age people in low- and middle-income countries (LMICs). Physical activity is one potential psychosocial strategy with the potential to reduce loneliness in this population. Thus, the aim of this study was to explore associations between physical activity (PA) and loneliness in middle-aged and older people from six LMICs. MATERIALS AND METHODS Data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. Self-reported data on loneliness and PA (as assessed by the Global Physical Activity Questionnaire) were collected. Participants were dichotomized into those who do and do not meet the international recommendation of 150 minutes of moderate to vigorous PA per week. Associations between loneliness and PA were examined using logistic regressions. RESULTS Among 34 129 individuals aged 50 years or older, the prevalence of loneliness was higher among those not meeting the PA guidelines in all countries, although this difference was not significant in Mexico and South Africa. After full adjustment, not meeting PA guidelines was positively associated with loneliness in the meta-analysis based on country-wise estimates, with a moderate level of between-country heterogeneity being observed (OR = 1.31; 95% CI, 1.07-1.61; I2 = 48.7%). At an individual country level, statistical significance was only reached in Ghana (OR = 1.89; 95% CI = 1.44-2.49). DISCUSSION Our data suggest that physical inactivity and loneliness commonly co-occur in adults aged 50 years or older in LMICs overall but that this association differs by country. Longitudinal studies are required to confirm these findings and investigate potential mechanisms that may inform future interventions.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Elvira Lara
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ai Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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23
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Agyemang-Duah W, Peprah C, Peprah P. Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana. BMC Public Health 2019; 19:1185. [PMID: 31462254 PMCID: PMC6714403 DOI: 10.1186/s12889-019-7437-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. METHODS Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. RESULTS Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). CONCLUSIONS Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Peprah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Prince Peprah
- Natural and Built Environment, Sheffield Hallam University, Sheffield, UK
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24
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Wee LE, Tsang TYY, Yi H, Toh SA, Lee GL, Yee J, Lee S, Oen K, Koh GCH. Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060967. [PMID: 30889851 PMCID: PMC6466029 DOI: 10.3390/ijerph16060967] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/08/2023]
Abstract
In Singapore, a densely urbanised Asian city state, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. We were interested in exploring social-environmental factors that are associated with loneliness among elderly residents of public rental housing in Singapore. We surveyed residents aged ≥60 in two Singapore public housing precincts in 2016. Loneliness was measured using a three-item scale. Sociodemographic information was obtained via standardised questionnaires. We used chi-square to identify associations between loneliness and sociodemographic characteristics, as well as neighbourhood perceptions (safety, convenience and the physical environment), on univariate analysis; and logistic regression for multivariate analysis. The response rate was 62.1% (528/800). On multivariate analysis, staying in a rental flat block was independently associated with loneliness (adjusted odds ratio, aOR = 2.10, 95% confidence interval (CI) = 1.32⁻3.36), as was staying in a poorer physical environment (aOR = 1.92, 95% CI = 1.15⁻3.22). Although needy Singapore residents share the same built environment as more well-to-do neighbours, differences in the impact of loneliness do exist.
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Affiliation(s)
- Liang En Wee
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore.
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.
| | | | - Huso Yi
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Sue Anne Toh
- Regional Health System Planning and Development, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Geok Ling Lee
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore 119077, Singapore.
| | - Jaime Yee
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Shannon Lee
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Kellynn Oen
- Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore 119228, Singapore.
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore 119228, Singapore.
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25
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Goswami AK, Ramadass S, Kalaivani M, Nongkynrih B, Kant S, Gupta SK. Awareness and utilization of social welfare schemes by elderly persons residing in an urban resettlement colony of Delhi. J Family Med Prim Care 2019; 8:960-965. [PMID: 31041233 PMCID: PMC6482716 DOI: 10.4103/jfmpc.jfmpc_28_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Demographic transition increased the proportion of elderly in India. Elderly persons experience increased economic dependency for their day-to-day existence. The Government of India provides monetary benefit through social welfare schemes. Health outcomes of the elderly improve when they are economically independent. We aimed to assess the awareness and utilization of social welfare schemes among elderly persons in an urban resettlement colony of Delhi. Materials and Methods: This was a community-based cross-sectional study conducted from February to May 2018. Two specially recruited interviewers administered the self-developed semi-structured interview schedule. It consisted of sociodemographic data, awareness, and utilization of various schemes. Results: A total of 931 [416 (37.4%) males and 515 (55.3%) females] participants completed the interview. Of the total, 809 (86.9%) participants were aware of at least one social welfare scheme. Participants utilizing any of the social welfare schemes were 393 (42.2%). Females utilized the social welfare schemes almost twice as compared to males (AOR = 1.7, 95% CI: 1.1–2.6). Participants aged 75 years and above had four times higher utilization of social welfare schemes compared to 60–64 years age group (AOR = 3.9, 95% CI: 2.4–6.4). Conclusion: Although the awareness of social welfare schemes among elderly persons was good, their utilization has scope for significant improvement. Focus is needed on elderly males and among the younger elderly persons.
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Affiliation(s)
- Anil Kumar Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Ramadass
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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