ITlNGIIMI&NGflUNCUBI
Khao sat m6t s6 hanh vi srfc khoe cua ngifoTi cao tu^i tinh Khanh Hoa
TnAAig T a n M i n h (*)
Dua tren dieu tra mgi mdu ngdu nhien 2.170 ngUdi cao tudi (NCT) trong lodn tinh Khdnh Hoa tien hdnh cudi ndm 2008 tren ca sd m^t bdng cdu hoi phdng vdn. ti le hiit thudc Id c^a NCT tinh Khdnh Hoa Id tren 50% vd udng ruou bia Id tren 40%, chd yeu d nam gidi. Ti le tdp the due ciia NCT Id khdng cao vdi hinh thdc tap chu yeu Id di bd Ti li NCT thudng xuyen tim hieu ve siic khoe cdn thdp (30%), trong khi cd 10% NCT tu ghi nhdn Id khong bao gid tim hieu ve link vUc sde khoe. Phuang tien truyen thong chu yi'u de tim hieu sde khoe cua NCT Id cdc phuang tien truyen thong dai chung.
Trgm y teca sd ddng vai tro quan trong trong viec lUa chon nai khdm chita benh ban ddu cua NCT.
Titkhda: Ngudi cao tudi, hdnh vi sde khoe, tram y te, khdm chda binh ban ddu.
A Survey on the Elderly health behaviors in Khanh Hoa province
Truong T a n M i n h (*)
Based on a randomized sample of 2,170 Elderly people living in Khanh Hoa province, a survey conducted by the end of 2008 shows that the percentage of current smokers is above 50% and alcohol use is around 40% with male predominance. The percentage ofthe elderly involved in doing physical exercises is not high with jogging as the main activity. Those who have regular interest in getting information on health account for a low percentage (30%) while 10% ofthe elderly admit that they are never interested in health information. The mass media turns out to be the principal means for getting health information. The commune health centers play an important role in selecting options for primary health care services among elderly people.
Key works: Elderly people, health behaviors, commune health center, primary health care.
Tdc gia
(•) TS. Trtfdng Tan Minh - Giim ddc Sd Y tc Khanh H6a, Chii tich Hgi Y te Cong cong Khinh H6a Dien thogi: 0913461387. E.mail: bstruong [email protected]
T a p chi Y te C d n g cdng, 7.2010, Sd 15 (15) 11
|T0'NGQUAN&N6mENeitU|
l . D a t vifn di
Ngffdi cao radi (NCT) n g a y cang ehiem ti ip c a o Irong epng ddng. Thdng k e cua td chffc L i e n H d p Qudc (UN) eho ihay ti Ie N C T tff 8% ndm 1950 da gia tdng ddn 11 % n a m 2007 va ffdc tinh se gia tang den 2 2 % so vdi dan s d the gidi vao n a m 2050[1 ].
T a i Viet Nam, tinh d e n eudi ndm 2007, nffde ta cd tren 8 tripu N C T , chidm khoang 9,6% d a n sd, c a o hdn li 16 irung binh eua cac qudc gia vung Ddng Nam A [ 2 ] . Thdng k e tiif n d m 1979 d e n 20O6, ti le NCT so vdi dan s d d d Idng tff 6,9% ddn 9,2%. Ty Ie giffa NCT so vdi sd ire e m (trf 14 m d i trd xudng) la 16,6% vao n a m 1979; 18,4% vdo n a m 1989 va 24,2% vao n a m 1999. Dtf bdo, ty le nay se la 2 7 , 3 % vao n a m 2009 vk 12,2% vao n a m 2014[3]. Nhff vay, vide nghien effu n h a n thtfe va h a n h vi sffc k h d e cua NCT la nhffng bffdc di can thiel gdp phan bao vd va nang cao srfc k h o e , k e o dai tudi thp eho N C T .
2. Phffdng p h a p n g h i d n cii'u 2.1. Doi ttidng nghien cdu
T o a n bd NCT (trf 60 mdi trd len) dang sinh sd'ng lai tinh Khanh Hda tai Ihdi d i e m nghien effu (thang 11-12/2008).
2.2. Thie't ke nghien ctiu Srf dung ihiel k d nghien ciJu eat ngang.
2.3. Phuang phdp chQn mdu
Chpn m l u theo phffdng p h a p m a u chiim (cluster sampling). Ta'l ea cde huyen, ihi xa, ihanh p h d trong linh deu dffde chpn. Sau do, ehpn c u m 30 xa theo phffdng phdp mdu thudn tien (coovenient sampling) theo cdch sau: M d i huyen chon 1 ihi Iran (dai dien eho khu vffe tlii tff, trung t a m eua h u y e n ) . Cdc xa khac dffde ehpn n g a u nhien (Iheo bdng s d n g l u nhidn sau khi ddnh sdthrf iff cdc xa dffde xdp theo thrf tff trf B a c xud'ng N a m , iff T a y sang Ddng) theo 3 khu viJc: mien nui, ndng ihdn (ddng bang) va ven bien, h a i d a o . R i e n g 2 h u y e n m i e n n d i (Khdnh Sdn va Khdnh Vinh) chon cae xa eon Iai theo b a n g so'ngau nhien, khong ehia theo khu vffe sinh thai. Thi xa C a m R a n h va thanh p h d Nha Trang ehon 3 xd vung npi thi, 3 xa theo khu vffe.
Huydn Ninh Hda, ngoai thi Iran chpn 2 xa mien nui, 2 xa vung ndng thon vd 1 xd ven bien, hai d a o . H u y e n Van Nmh, do la h u y e n v e n bien n e n khdog ehpn viing sinh thdi m i e n nui, cM chon thi trS^n, ddng bdng vd ven bidn.
2.4. Cd mau
Cd m l u dffde xdc dinh drfa tren gia dinh v e ti le h i e n e o vi cdc h a n h vi hrft ihudc Id, u d n g rffdu vk t a p the due d N C T . D o khdng cd ti 16 nghien cffu ndo trffde dd tai tinh Khdnh H d a ddi vdi N C T , vd de td'i da c 5 m l u , chon ti 16 n d y b a n g 5 0 % . Cong thffc tinh cd m l u trong n g h i e n effu cat ngang nay nhff sau:
Pi^~P)
Z (1-^)
T r o n g do:
n = cd tndu nghien ciiu p: Tlii mdc benh. Ckgnp = 0,5.
q =l-p = 0.5
'^(!-a/2) = 1,96, tuang dng vdi dg ti d = D6 chinh xdc. Chgn d = 0,03 n tinh todn duac = 1.067 ngUdi
Vl day la phffdng p h a p c h p n m a n chiim cho nen c i n d i l u ehinh cd m i u b a n g h e s d ihidt k d (DE:
design effect). Trong trffdng h d p n a y chpn DE = 2.
D o dd ed m l u can ihidt Id 1.067 * 2 = 2.134 ngffdi.
Dff phdng 5 % cdc trffdng h d p khdng dieu tra dffde do c a c n g u y e n nhdn khde nhau, cd mau can thiet dffde chon la:
n = 2.134 + (0,05*2.134) = 2.240 ngudi.
2.5. Thu thqp soliiu
M p t bang eau h o i dffde ihidl k d n h a m tim hieu mdt s d h a n h vi sffc k h o e c d a N C T b a o g d m hrft thudc l a , u d n g rffdu bia va lap the due. D d n g thSi b a n g can hdi efing t h a m d o n h a n thffc cua NCT vd sffc k h o e va nhu eau c h d m sde sffc k h o e cua hp. Cac bidn sd n h a m t h a m d o y kidn chu quan cua NCT dffde thidt kdchiJ ydu dffa v a o thang do L i k e n . Cdc sd lidu sau ddy dffde thu t h a p :
- Cdc clu sd've d a n s d h p c : T u d i , gidi, ddn lpc.
- N h a n thrfc vd m d t s d h a n h vi srfc k h d e ciia N C T , trong dd chd trpng 3 h a n h vi: htil thudc Id, udng rffdu vd tdp t h e d u e .
- T i m hidu v e n h a n thrfc vd nhu e l u c h d m sde sffc k h d e .
2.6. PhUdngphdp phdn tich sdliiu N h a p sdlidu bang p h i n m e m EpiData 3 . 1 . Phdn tich so'lidu b i n g phdn m e m Stata 10.0.
12 T a p chi Y te Cdng cpng, 7.2010, Sd 15 (15)
ITfNGaBAN&NGHIlNCliUI
3. Kg't qua va nghi§n cihi
3.1. MQt sodqc diem chinh cua doi tUtfng nghien cdu
Cd ldng cdng 2.170 ngffdi cao tudi dffde khao sdt theo each chpn mlu neu iren. Dau ndm 2008, huyen Cam Ldm dffde thanh lap tren cd sd taeh thi xd Cam Ranh va 2 xa thude huydn Di^n Khdnh. Day chi la srf phan bd lai, khdng anh hffdng de'n npi dung vd phffdng phdp oghien effu. Do do, kd't qua se dffde tiinh bay va thdng ke Iheo ddn vi hanh chinh mdi.
Ddc diem sdlipu nen dffde trinh bay tai Bang 1.
Bdng 1. Phdn boNCT theo dia phUOng, gidi tinh, nhom tuoi, ddn IQC vd hon nhdn
ISOi dnng
Dia phiAlDg:
- Nha Tiang - Cam Ranh - Van Ninh - Ninh H6a - K h a n h Vinh - Dien Khinh - Cam Lfim - Khanh Sdn Gldl dnh:
- N a m - N i r Nh6m m6i:
- T i r 60-69 tu^i - T i r 70-79 m^i -Tflr 80-89 luoi -TO" 90-99 moi - >=100 tu^i Dan l6e'
- K i n h - Raglai - T ' l i n - K h i c V^/chong - C6n song - Da rafft
S d ' l t f ^ g (n=2.170)
533 201 303 468 39 355 249 22
849 1321
885 866 367 50 2
2.095 64
1
!0
1 255 905
l i l f %
24,6 9.3 13.9 21.6 1.8 16,4 11,5 1.0
39.1 60.9
40,8 39,9 16,9 2.3 0.1
96.5 2.9 0.1 OJ
58,1 41,9
mdi dffdi 80. Khdng ed sff khac bipt ve nhdm mdi giffa oam vd off (x2 = 1,98. p = 0,74). Gio mpt nffa cdc trffdng hdp la da gda bua hoac vd da qua ddi.
3.2. Ve hdnh vi sde khoe
Cdc hanh vi sffc khde dffde khao sdi trong nghien cffu nay bao gdm hut Ibudc la, udog rffdu bia va tdp the due. Kdt qua khao sat cho tha'y tai Baog 2
Hut thud'e Id va udng rffdu bia chi phd bidn d nam. irong dd cd qud nrfa nam gidi hrft thude id, gin 50% cd ndng rffdu bia. Ti Ie tap the due cua ca 2 gidi khdng cao lam, irong do nam ehie'm hdn 60%. Ti le hut Ihud'c Id d NCT nam la mot ri Id kha cao.
Tai thdl diem dieu tra, vdi phffdng phap chpn mlu ngau nhien he thdng phdn lang Id phffdng phap gidp cho mlu chpn mang tinh dai dipn cho quan the nghien effu, da cho tha'y nff nhieu hdn nam, phan dnh phan nao iudi Ihp ciia nff cao hdn eiia nam. Phan tich theo nhdm mdi cho ihd'y Uen 80% d trong dd
Bdng 2. Hdnh
m n h Tl site khie
Hilt Oiudc \i U&ignl?!) Tip Ih^ dvc
VI sde khoe cua NCT theo gidi
NB S^llA^g 49/1 321 lS/1319 627/1317
T I l ¥ » 3,7 1.*
47,6 N>m S»lU9DE 435/849 361/849 512/849
T ! l $ « 51,2 424 603
3.2.1. Ve hiit thudc la
Ve sddid'u thude hiit hdng ngay, khao sat eho tha'y ed 437 nam gidi tra Idi eau hoi ndy (trong khi cdu hoi ed hay khdng hrft thudc Id ehi cd 435 ngffdi tra ldi ed). Trong sd ndy khdng cd trffdng hdp nao hiit tff tren 30 didu moi ngay. Cd 63,8% hiit dffdi 10 did'u/ngay, 34,6% hiit iff 10 - 20 dieu/ngdy vd chi ed 1,7% (7 trffdng hdp) hiil tren 20 - 30 didu/ngdy.
3.2.2. Ve udng ruou bia
Tin sudt udng rffdu bia irong nam gidi dffde ihd'ng ke trong Bang 3 (Trong sd 361 nam ghi nhan cd udng rffdu bia ihi chi ed 360 ngffdi cd eho bidt iao sual udog rffdu bia cua ban Ihan). Tan suat nay dffde Bang 3. Tan sudt uo'ng riMu bia theo nhdm tuoi
Tin sui'l
m„.,>,
ThtftlDg nong
Thinh ihoang
fikhi
RS'iilkhi
T6D° C^Dg
NfaUmlu^i 6069t
9 ( 4 j * ]
IS (9,1%)
122 (61,6S)
35 (I7.7»)
14 (7,1 » i
19S 70-79 [
10 (8.1 fr)
11 (8,9%)
66 (53,7%)
27 (22.0*)
9 (7.3%)
123
~ 80-89 1 17 (18.4»)
3 (7.9%)
21 I55J*)
5 (13,l»)
2 5.3%)
38
#901 0
0
1 1100%)
0
0
1 C^ng
26 (7,2%)
32 (8,9% 1
210 (S8J%)
67 (18.6%)
25 17,0%)
360
Tap chl Y t§' C6ng cong, 7.2010, So 15 (15) 13
|T6'HGQUfiN&NGHilNCUU|
phdn chia theo nhdm mdi vd dffde thd hien dffdi dang mdl bidn ihff Iff iheo 5 gid tri dffdi dang ihang do Likerl nhtf sau: Hdng ngay, thtfdng udng nhrfog khdng phai hang ngay, thinh dioang, it khi udng, rd't it khi udng. Cdu hdi dffpe hdi de ddi tffdng iff ddnh gia. Bang 3 cho tha'y ehie'm hlu hdt la cdc trffdng hdp cd udng rffdu bia nhffhg chi d tin sud't "ihinh thoang" (58,3%) hodc "it khi" (18,6%). Srf khae biet giffa cdc nhdm tudi Id khdng cd y nghla thd'ng k6 (x2
= ll,9786,p = 0,39,Fisher's exact).
3.2 3. Ve tap thi due
Thdng k6 ve tdp the due cho tha'y ti Ip nay chung cho ea 2 gidi Id 52,6%. Trong sdnhffng ngffdi tap Ihe due dffde hdi ve tin sud't tap, cd 1.136 ngffdi tra ldi cdu hdi ndy vdi ke^t qua phan theo nhdm ludi cho thl^y li Ip ldp the due hang ngay va thffdng xuyen cao hdn bin (51,3% vd 16,8%) va tffdng do'i ddng deu giffa edc nhdm ludi. Sff khdc bi$t nay la cd y nghia ihd'ng ke vdi x2 = 24,935, p = 0,015.
Hlnh thffc ldp the due phd bidn la di bp (69,8%) va tap thd due Ihdng ihffdng (20,1%). The due dffdng sinh chi chid'm 8%.
Bdng 4. Tan sudt t4p thedifc theo nhom tuoi
Bdng 5. Tim hieu vi tinh vifc sde khoe cua NCT
I I . - Uiag ngiy
ThifSng xuytu Thhb ihoing
ttkhi Ri'ibUu Tdng eOng
N b i m n A 60-691
266 (51,1*)
97 (18.7%)
142 (27.3%) (U%) 5 (1.0%)
520 70-791
235 (51,2%)
73 (15.9%)
125 (27.2%)
19 (4,2*)
7 (1,5%)
459 80-891
77 (53,8%)
20 (14,0%)
36 (25,2%)
9 (6.3%)
1 (0.7%)
143
#90i S (3S,7%)
1 n,2%)
5 (35,7%)
3 (21,4%)
0 14
CtDg 583 (51,3%)
191 (16,8%)
30S 117,1%)
41 (3.6%)
13 (1,2%)
1136
Mi!c dO t i m h i ^ u K h 5 n g b a o gid H i e m khi Thinh thoang Thiiflng xuyfin Rg't fttrdng xuyfin C p n g
SS^lrf^ig 215 3 4 2 921 5 9 8 7 8 2.154
T l l ? % 9,9 15,9 42,8 27,8 3,6
la'y mlu sd chung la 2.170 ngffdi cao tudi trong mdu thi ti Ip tim hidu qua truyen hinh Id cao nhit (75,7%), sau dd id tff cdn bp y td.
Sff kdt hdp nhieu phffdng tipn khdc nhau ciing dffde ngffdi eao mdi srf dung trong viec lim hidu sffc khoe. Qua dd, ti Ip kdt hdp giffa tivi va cdn bp y id chid'm ti Ip cao nhl^t: 27,9%. Ti6'p theo Id sff dung dong thdi tivi va truyen ihanh cdng epng (hinh thffc phd bidn nhai 8 Khdnh Hda hipn nay): 18,2%. Tiep theo la vffa sff dung radio, vrfa srf dung tivi: 15,3%.
Sd ngtfdi ghi nhdn srf diing ddng thdi li'l el cdc phffdng ti6n tren la 26 ngtfdi, chiem li le 1,2%.
Bdng 6. Cdc phuang tiin ditim hiiu vetinh vifc sde khoe cua NCT
PhiTtfng ti$n S^ch bSo Tivi Radio Tniyen thdnh cong cong Cdn be y le' TSrOiyle^
Khac
T ^ n s u S i 371 1.642 366 445 817 130 13
T\\^%
17,1 75,7 16.9 20,5 37.6 6,0 0,6
3.3. Nhdn thdc, hiiu bii't vd thUc hdnh sde khoe ciia NCT
3.3.1. Tim hieu ve chdm soc siic khoe Cd 2.154 ngffdi Ira ldi eau hdi ve mffe dd thffdng xuyen lim hieu ve Hnh vffe chdm soc srfc khoe. K6't qua cho ihay ehi ed ehffa ddn 1/3 sd ngffdi eao luoi thffdng xuyen tim hieu ve ITnh vtfc cham sde srfe khoe. Gin iO% sd ngffdi dffde hdi da khdng bao gid tim hieu ve Hnh vffe nay.
Thdng k6 vd cde phffdng lien cung cap Ihdng tin chdm sde sffc khde cho thay cdc phffdng lipn Ihdng tin nay deu dffde srf dung vdi tin sua't khd cao. Ne'u
3.3.2. Thdi do va nhu cdu khdm chda benh Khi dffde hoi ndu dffde iff Irfa chon ndi kham chffa benh cho ban thdn, kdl qua tham dd cho Iha'y ehie'm ri 16 eao nh£t vin la Iffa ehpn tram y idxa. Ti le bpnh vien huydn vd tinh khdng khdc nhau Idn (25,4% va 27%). Kdl qua da cho Ihd'y llm quan Irpng cua y td cd sd trong viec cham sde sffc khoe eho NCT.
Tim hieu vi ly do chpn lffa ndi khdm chffa bdnh
nay, ihdng ke cho Ihdy ly do phd bidn nhd't de lffa
ehpn ndi kham benh Id ydu id dia ly (55,9%) ihuan
tien cho vipc khdm benh. Vai trd ciia y id cd sd lai
14 Tap chi Y te Cdng cdng, 7.2010, Sd 15 (15)
ITONeWNiNBHIEKCOUl
Bdng 7. Lua chgn nai KCB cua NCT Ndi kham chl7a benh
Tram Y te'xa PKKV BV huyen BVtinh Khac Cong
Tan suat 650
85 551 585 294 2.165
Tile's.
30,0 3,9 25.4 27,0 13,6
mpt Ian nffa dffde k h a n g djnh. Y e u id tidp tiieo la trang thiet bi va thudc m e n tai cd sd k h a m chffa bdnh (42,8%).
3.3.3. Lua chon phuang phdp dieu tri Khao sat ve ltfa chpn phffdng phdp dieu iri b a n g Tdy y hay D d n g y, kdt qua cho tha'y chi cd 5 , 1 % N C T lffa chpn phffdng phdp D d n g y nhtf Id phtfdng phdp KCB duy nha't cho minh. Tuy nhien, cd 3 2 , 5 % N C T Iffa ehpn phffdng phdp Ddng T a y Y ke'i h(?p.
Vai trd cua Tdy Y la khd Idn trong viec KCB eho N C T ( 6 1 , 7 % ) .
4. B a n l u ^ n
Nghidn effu cua chrfng Idi cho Ihd'y ty 16 N C T hrft Ihud'c Id khd cao (51,2%). T a i Hdng Kong, ti le n a m hut thudc Id ehi vdo khoang hdn 2 0 % [ 4 ] . Ti 16 hiit thudc Id ciia N C T Khdnh H d a la kha cao. Md'i nguy hai eua hut thudc la lai mpt Ian nffa d\X(ic dffa ra Irong n g h i e n crfu tai Hdng Kdng cho thay ri le m a c lao hdng n a m dd'i vdi nhrfng ngffdi dang hut Ihud'c, da tffng hut thud'e (ex-smokers) va khdng bao
gid hut ihudc i l n Iffdl la 7 3 5 , 4 2 7 vk 174 tren 100.000 ngffdi[4].
T i 16 udng rffdu, bia qua i3ieu tra n a y Id 4 2 , 5 % 6 n a m va ra't it d nff. So sdnh vdi mdl nghien effu tai mpl hat d N e w York (My) cho tha'y ri le u d n g rtfi?u d N C T tff 60 - 94 mdi Id 6 2 % , trong do d mrfc dp ndng (heavy drinking) la 1 3 % (3 n a m vd 2 % d nff[5].
T h e o bao cdo v l tinh hinh benh idt vd tff vong hang m l o eiia Hoa Ky ( M M W R ) , ti 16 tdp the due thffdog xuyen cua N C T tren 65 tudi cua My la 4 4 , 5 % Irong ndm 2005, c a o hdn d ngffdi da irang (52,3%) va thap nha't d c a e chung tdc khae (irong dd ed ngffdi chau A ) : 45,7%[6]. Nhff vay, ri !p tap the due thffdog xuydn eua N C T tai nghien crfu nay Id kha thdp.
Chung Idi d e nghi: Tdng effdng cdc hoat dong phdng chd'ng tac hai thude Id (md Hdi Y te cdng cpng rinh IChdoh Hda daog ine'o khai) trong epng ddng NCT, tnrdc mat d thanh phd'Nha Trang, huyen Ninh Hda vd thi xa C a m Ranh.
T o chffc e a c chtfdng trinh gido due srfc k h o e eho N C T thdng qua sinh hoat eiia Hpi N C T , trffde m a t thi didm tai thanh p h d Nha Trang, ddng thdi danh gid hieu qua ciia chffdng trinh d d nhan rpng md hinh. Chii trong cac hoat ddng phdng ehdng tdc hai Ihud'c Id, I(?i ich eua vipc ren luy6n than the, c h e dd dinh dffdng eho N C T .
Nen cd nhffng nghien cffu sau hdn ve anh hffdng Clia hiit thud'e Id (bao gdm ea nhiing ngtfdi da bo thudc la), udng rffdu, va l a p the due ddi vdi sffc khde NCT, d a e biet la lien quan den bdnh ly tim mach, hd hap, ung thff, rd'i loan chuydn hda, rdi loan h a n h vi...
Tai li^u Iham khao
1. UN. World Population Ageing 1950 - 2050 (2001).
2. UN. World Population Ageing 1950 - 2050. (2001).
3. UN. World Population Ageing 1950 - 2050. (2001).
4. UN. World Populauon Ageing 1950 - 2050. (2001).
5. UN. World Population Ageing 1950 - 2050. (2001).
6. UN. World Population Ageing 1950 - 2050. (2001).
T a p chi Y td C d n g cdng, 7.2010, Sd 15 (15) 15
