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Health for community dwelling older people: trends, inequalities, needs and care in rural Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. (Elderly Health Research)
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care.

Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people.

Methods

An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census.

Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis.

Results

Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations. 

The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions.

Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care.

Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services.

 

Conclusions                                                                                        

There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups. 

Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations.

The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2011. , 72 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1437
Keyword [en]
older people, elderly health, health status, life expectancy, health-related quality of life, EQ-5D, mobility, self-care, usual activities, pain, discomfort, anxiety, depression, activity of daily living, basic ADL, instrumental ADL, intellectual ADL, non-communicable diseases, need of care, health service, model of care, mobile team, day care centre, nursing centre, inequalities, cost of care, socioeconomic, education, marital status, living arrangement, household head, working status, living area, wealth quintile, poverty line, community, cohort study, household survey, focus group discussion, qualitative research, rural, Vietnam, developing country, Asia
Keyword [vi]
người cao tuổi, y tế, thực trạng sức khỏe, hy vọng sống, chất lượng cuộc sống, EQ-5D, đi lại, tự chăm sóc, hoạt động thường xuyên, đau, khó chịu, lo lắng, trầm cảm, hoạt động hàng ngày, bệnh không lây nhiễm, nhu cầu chăm sóc, dịch vụ y tế, mô hình chăm sóc, đội lưu động, trung tâm chăm sóc ban ngày, trung tâm dưỡng lão, bất bình đẳng, chi phí chăm sóc, kinh tế xã hội, giáo dục, hôn nhân, sắp xếp cuộc sống, chủ hộ, tình trạng làm việc, khu vực sống, ngũ phân thịnh vượng, chuẩn nghèo, cộng đồng, nghiên cứu theo dõi dọc, điều tra hộ gia đình, thảo luận nhóm tập trung, nghiên cứu định tính, nông thôn, Việt Nam, nước đang phát triển, châu Á
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-47467ISBN: 978-91-7459-257-3 (print)OAI: oai:DiVA.org:umu-47467DiVA: diva2:442441
Public defence
2011-10-14, Aulan, Vårdvetarhuset, Umeå University, Umeå, 13:00 (English)
Opponent
Supervisors
Projects
Aging and Living Conditions ProgramVietnam-Sweden Collaborative Program in Health, SIDA/Sarec
Available from: 2011-09-22 Created: 2011-09-21 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Remaining life expectancy among older people in a rural area of Vietnam: trends and socioeconomic inequalities during a period of multiple transitions
Open this publication in new window or tab >>Remaining life expectancy among older people in a rural area of Vietnam: trends and socioeconomic inequalities during a period of multiple transitions
Show others...
2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, no 1, 471- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Better understanding of the trends and disparities in health at old age in terms of life expectancy will help to provide appropriate responses to the growing needs of health and social care for the older population in the context of limited resources. As a result of rapid economic, demographic and epidemiological changes, the number of people aged 60 and over in Vietnam is increasing rapidly, from 6.7% in 1979 to 9.2% in 2006. Life expectancy at birth has increased but not much are known about changes in old ages. This study assesses the trends and socioeconomic inequalities in RLE at age 60 in a rural area in an effort to highlight this vulnerable group and to anticipate their future health and social needs.

METHODS: An abridged life table adjusted for small area data was used to estimate cohort life expectancies at old age and the corresponding 95% confidence intervals from longitudinal data collected by FilaBavi DSS during 1999-2006, which covered 7,668 people at age 60+ with 43,272 person-years, out of a total of 64,053 people with 388,278 person-years. Differences in life expectancy were examined according to socioeconomic factors, including socio-demographic characteristics, wealth, poverty and living arrangements.

RESULTS: Life expectancies at age 60 have increased by approximately one year from the period 1999-2002 to 2003-2006. The increases are observed in both sexes, but are significant among females and relate to improvements among those who belong to the middle and upper household wealth quintiles. However, life expectancy tends to decrease in the most vulnerable groups. There is a wide gap in life expectancy according to poverty status and living arrangements, and the gap by poverty status has widened over the study period. The gender gap in life expectancy is consistent across all socioeconomic groups and tends to be wider amongst the more disadvantaged population.

CONCLUSIONS: There is a trend of increasing life expectancy among older people in rural areas of Vietnam. Inequalities in life expectancy exist between socioeconomic groups, especially between different poverty levels and also patterns of living arrangements. These inequalities should be addressed by appropriate social and health policies with stronger targeting of the poorest and most disadvantaged groups.

Place, publisher, year, edition, pages
BioMed Central, 2009
Keyword
older people, elderly health, health status, life expectancy, socioeconomic, gender, education, marital status, living arrangement, household head, working status, living area, wealth quintile, poverty line, community, cohort study, rural, Vietnam, developing country, Asia, người cao tuổi, y tế, thực trạng sức khỏe, hy vọng sống, giới, kinh tế xã hội, giáo dục, hôn nhân, sắp x
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-30577 (URN)10.1186/1471-2458-9-471 (DOI)20017933 (PubMedID)
Projects
Aging and Living conditions ProgramVietnam-Sweden Collaborative Program in Health, SIDA/Sarec
Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved
2. Health-related quality of life, and its determinants, among older people in rural Vietnam
Open this publication in new window or tab >>Health-related quality of life, and its determinants, among older people in rural Vietnam
2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, 549- p.Article in journal (Refereed) Published
Abstract [en]

Background

The proportion of people in Vietnam aged 60 and above has increased rapidly in recent decades. However, there is a lack of evidence, particularly in rural settings, on their health-related quality of life (HRQoL) within the context of socioeconomic changes and health-sector reform in the country. This study assesses the level and determinants of HRQoL in a rural district in order to provide evidence for designing and implementing appropriate health policies.

Methods

In 2007, 2,873 people aged 60+ living in 2,240 households randomly selected from the FilaBavi demographic surveillance site (DSS) were interviewed using a generic EQ-5D questionnaire to assess their HRQoL. Socioeconomic characteristics of the people and their households were extracted from the DSS's re-census that year, and the EQ-5D index was calculated based on the time trade-off tariff. Multilevel-multivariate linear regression analysis was performed to measure the affect of socioeconomic factors on HRQoL.

Results

The EQ-5D index at old age was found to be 0.876 (95%CI: 0.870-0.882). Age between 60-69 or 70-79 years, position as household head, working until old age, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on the deterioration of HRQoL at older ages, mainly due to reduction in physical rather than mental functions. Educational disparity in HRQoL is low, and exists mostly between basic and higher levels of education. Being a household head and working at old age are advantageous for attaining better quality of life in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical utilities. Long-term living conditions more likely affect HRQoL than short-term economic conditions.

Conclusions

HRQoL at old age is at a high level, and varies substantially according to socioeconomic factors. Its determinants should be addressed in social and health policies designed to improve health of older people, especially among the most vulnerable groups.

Place, publisher, year, edition, pages
BioMed Central, 2010
Keyword
older people, elderly health, health status, health-related quality of life, EQ-5D, mobility, self-care, usual activities, pain, discomfort, anxiety, depression, inequalities, socioeconomic, gender, education, marital status, living arrangement, household head, working status, living area, wealth quintile, poverty line, community, household survey, rural, Vietnam, developing country, Asia, người cao tuổi, y tế, thực trạng sức khỏe, chất lượng cuộc sống, EQ-5D, đi lại, tự chăm sóc, hoạt động thường xuyên, đau, khó chịu, lo lắng, trầm cảm, bất bình đẳng, kinh tế xã hội, giới, giáo dục, hôn nhân, sắp xếp cuộc sống, chủ hộ, tình trạng làm việc, khu vực sống, ngũ phân thịnh vượng, chuẩn nghèo, cộng đồng, điều tra hộ gia đình, nông thôn, Việt Nam, nước đang phát triển, châu Á
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-38493 (URN)10.1186/1471-2458-10-549 (DOI)000282240200001 ()20831822 (PubMedID)
Projects
Aging and Living conditions ProgramVietnam-Sweden Collaborative Program in Health, SIDA/Sarec
Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2017-12-11Bibliographically approved
3. Elderly care in daily living in rural Vietnam: Need and its socioeconomic determinants
Open this publication in new window or tab >>Elderly care in daily living in rural Vietnam: Need and its socioeconomic determinants
2011 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, no 11, 81- p.Article in journal (Refereed) Published
Abstract [en]

Background

The proportion of older people is increasing rapidly in Vietnam. The majority of the elderly live in rural areas. Their health status is generally improving but this is less pronounced among the most vulnerable groups. The movement of young people for employment and the impact of other socioeconomic changes leave more elderly on their own and with less family support. This study aims to assess the daily care needs and their socioeconomic determinants among older people in a rural setting.

Methods

In 2007, people aged 60 years and older, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance System (DSS). They were interviewed using structured questionnaires to assess needed support in activities of daily living (ADLs). Individuals were interviewed about the presence of chronic illnesses that had been diagnosed by a physician. Participant socioeconomic characteristics were extracted from the FilaBavi repeat census. The repeat census used a repeat of the same survey methods and questions as the original FilaBavi DSS. Distributions of study participants by socioeconomic group, supports needed, levels of support received, types of caregivers, and the ADL index were described. Multivariate analyses were performed to identify socioeconomic determinants of the ADL index.

Results

The majority of older people do not need of support for each specific ADL item. Dependence in instrumental or intellectual ADLs was more common than for basic ADLs. People who need total help were less common than those who need some help in most ADLs. Over three-fifths of those who need help receive enough support in all ADL dimensions. Children and grandchildren are the main caregivers. Age group, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, poverty status, and chronic illnesses were determinants of daily care needs in old age.

Conclusions

Although majority of older people who needed help received enough support in daily care, the need of care is more demanded in disadvantaged groups. Future community-based, long-term elderly care should focus on instrumental and intellectual ADLs among the general population of older people, and on basic ADLs among those with chronic illnesses. Socioeconomic determinants of care needs should be addressed in future interventions.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-47474 (URN)10.1186/1471-2318-11-81 (DOI)
Available from: 2011-09-21 Created: 2011-09-21 Last updated: 2017-12-08Bibliographically approved
4. Willingness to use and pay for options of care for community dwelling older people in rural Vietnam
Open this publication in new window or tab >>Willingness to use and pay for options of care for community dwelling older people in rural Vietnam
Show others...
2012 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, 36- p.Article in journal (Refereed) Published
Abstract [en]

Background: The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam.

Methods: In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level.

Results: Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services.

Conclusions: Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

Place, publisher, year, edition, pages
BioMed Central, 2012
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-47475 (URN)10.1186/1472-6963-12-36 (DOI)
Available from: 2011-09-21 Created: 2011-09-21 Last updated: 2017-12-08Bibliographically approved

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