among the elderly in Thuy Bieu Ward, Hue City, Vietnam

(1)

1. Ñaët vaán ñeà

Tieâu chaûy vaø nhieãm khuaån hoâ haáp caáp ôû treû em laø hai beänh coù tyû leä maéc vaø töû vong cao nhaát ôû nhöõng nöôùc ñang phaùt trieån. ÔÛ nöôùc ta, 80% töû vong do tieâu chaûy xaûy ra ôû treû em döôùi 2 tuoåi, bình quaân 1 treû döôùi 5 tuoåi moãi naêm maéc töø 0,8-2,2 ñôït tieâu chaûy, öôùc tính haøng naêm coù 1100 tröôøng hôïp töû vong [6], [5].

Veà NKHH, trung bình moãi naêm moät ñöùa treû maéc 4-9 laàn, tyû leä töû vong do NKHH chieám 1/3 (30-35%) so vôùi töû vong chung [1], [4]. Tyû leä maéc vaø töû vong cuûa hai beänh naøy raát cao nhöng hoaøn toaøn coù theå haïn cheá baèng caùch chuû ñoäng phoøng traùnh taùc nhaân gaây beänh vaø xöû lí kòp thôøi khi bò beänh. Ñeå phoøng choáng beänh, ngöôøi daân noùi chung vaø ngöôøi chaêm soùc treû noùi rieâng phaûi coù kieán thöùc ñaày ñuû veà phoøng beänh vaø caùch xöû lyù khi treû bò maéc beänh ñeå giaûm tyû leä maéc vaø töû vong.

Chính vì lyù do ñoù, chuùng toâi thöïc hieän nghieân cöùu:

“Kieán thöùc cuûa caùc baø meï coù con döôùi 5 tuoåi veà phoøng choáng tieâu chaûy vaø nhieãm khuaån hoâ haáp caáp tính ôû treû em taïi moät soá vuøng/mieàn Vieät Nam”, vôùi muïc tieâu moâ taû kieán thöùc cuûa caùc baø meï coù con döôùi 5 tuoåi veà phoøng choáng tieâu chaûy vaø nhieãm khuaån hoâ haáp ôû treû em taïi moät soá vuøng/mieàn Vieät Nam

naêm 2014. Töø ñoù coù theå ñöa ra moät soá khuyeán nghò phuø hôïp vaøo coâng taùc truyeàn thoâng phoøng choáng caùc beänh nhieãm khuaån cho treû em trong giai ñoaïn hieän nay.

2. Phöông phaùp nghieân cöùu

2.1. Ñòa ñieåm vaø thôøi gian nghieân cöùu

Nghieân cöùu ñöôïc thöïc hieän vaøo naêm 2014 taïi 3 tænh: Hoøa Bình, Haø Tónh vaø Kieân Giang, ñaïi dieän cho 3 mieàn Baéc, Trung, Nam cuûa Vieät Nam.

2.2. Ñoái töôïng nghieân cöùu Caùc baø meï coù con döôùi 5 tuoåi.

Tieâu chuaån löïa choïn: Laø caùc baø meï coù con döôùi 5 tuoåi, coù tinh thaàn minh maãn, töï nguyeän, hôïp taùc traû lôøi phoûng vaán.

Tieâu chuaån loaïi tröø: Tinh thaàn khoâng minh maãn hoaëc khoâng coù maët taïi hoä gia ñình trong thôøi gian nghieân cöùu hoaëc khoâng töï nguyeän, hôïp taùc trong quaù mothers being able to detect some severe signs of diarrhea and ARI was low. Only 6.6% of mothers recognized wrinkled skin signs (14.4 % in urban and 2.1% in rural region, respectively); 11 % of mothers recognized signs of dyspnea (25.9 % in urban and 1.5% in mountainous region). Mothers’

knowledge about prevention of diarrhea and ARI in urban was better than that of mothers in rural and mountain regions.

Keywords: Diarrhea, acute respiratory infections, knowledge, under 5-year-old child.

Taùc giaû:

1. Vieän ñaøo taïo Y hoïc döï phoøng vaø Y teá coâng coäng, tröôøng Ñaïi hoïc Y Haø Noäi Email: [email protected]

2. Cuïc phoøng choáng HIV/AIDS – Boä Y teá Email: [email protected]

3. CNYTCC4 naêm hoïc 2015-2016, Vieän ñaøo taïo Y hoïc döï phoøng vaø Y teá coâng coäng, tröôøng Ñaïi hoïc Y Haø Noäi Email: [email protected], [email protected]

4. Boä Y teá

Email: [email protected], [email protected]

Taùc giaû:

4. Boä Y teá

Using home health care services: situation and demands among the elderly in Thuy Bieu Ward, Hue City, Vietnam

Nguyen Thi Dang Thu; Tran Van Vui; Nguyen Van Hung

Abstract

Introduction: Parallel with the aging population and increasing illness and disability, the need for home health care services has been growing rapidly among the elderly in Vietnam. The aims of this study were to determine the situation and demands of using home health care services and its associated factors among the elderly living in Thuy Bieu Ward, Hue City.

Methods: A descriptive cross-sectional study was conducted on 425 elderly persons in 2018. Data were collected by using a structured questionnaire. Information of using home health care services situation and demands (proportions, cost, types, and quality assessments) among the elderly were calculated. Multiple logistic regression analysis was performed to measure the correlates of using home health care services.

Results: The actual prevalence of those who had been using home health care services was 3.1%

while their demands for these services were 28.7%. Multivariate logistic regression analysis indicated that physical disability (p<0.001, 95%CI: 3.6-48.3), marital status (p=0.03, 95%CI:

0.3-0.9), affordability (p=0.003, 95%CI: 0.02-0.5), acute (p=0.023, 95%CI: 1.1-4.5) and chronic illness (p=0.004, 95%CI: 1.1-2.7), and history of using (p=0.002, 95%CI: 2.6-60.7) were found to be significantly associated with need of seeking home health care services.

Conclusions: The actual prevalence of seeking home health care services among the elderly was low whereas their demands for these services were critically high. The health system should improve this kind of service to meet the demand of the elderly on health care at their home.

Keywords: home health care services, the elderly, home health care situation, health care demands, Hue City,

1. Background

Population aging and the rapid increase in the percentage of elderly people is a global phenomenon resulting from decreasing fertility and increasing life expectancy

¹

. In 1950, 205 million people worldwide were aged 60 and over. By 2012, the number of elderly people has increased to nearly 810 million. It is estimated

that the number will reach 1 billion in nearly

10 years and in 2050 will double to 2 billion

²

.

The global burden of acute infectious diseases

and non-communicable diseases associated

with population aging can cause temporary or

permanent functional disabilities and diminish

quality of life. A recent review of the World

Health Organization (2015) warns that health

systems around the world were inadequate to

(2)

Taùc giaû:

4. Boä Y teá

meet the needs of older people

³

. This would be a major challenge for the health care delivery system due to the increased costs of health care and long-term care

⁴

. It was also a challenge for the community and government to find alternative care strategies to meet the specific demands of the elderly and their families

⁵

. However, many countries have gained achievements in providing home health care for the elderly. In the US, the Center for Health Care and Services estimated that 8,090 home-based health care facilities in the United States provide health care services for more than 2.4 million elderly and disabled people annually

⁶

. In the UK, United Kingdom Homecare Association provides 2.79 million hours taking care of approximately 166,000 elderly people every week

⁷

.

In Vietnam, during the period 1979-2009, the total population increased 1.6 times higher, in which the elderly increased 2.12 times higher.

Compared with other countries in the world, the aging speed of Vietnam is quite high.

Specifically, the number of years that made the proportion of people aged 65 and over in Vietnam increase from 7% to 14% of the total population is smaller than many countries:

France after 115 years; America after 69 years, Japan and China after 26 years, while Vietnam after only 20 years

⁸

. On the other hand, the elderly also suffer from diseases caused by lifestyle changes under the influence of socio- economic changes in the process of economic growth and development. Vietnamese elderly also have a high demand of using home health care services. The study of Phuong T.L.

Dang (2009) shows that 53.8% of the elderly had demanded home health care

⁹

; while this

percentage in Tu N. Ngoc (2005-2007) was very high with 97.9%

¹⁰

.

In Thua Thien Hue Province, a study in Huong Thuy District shows that 71.83% of the elderly had health care demands (Vy T.Tran, 2008)

¹¹

. While the proportion of the elderly who need health care services is gradually increasing, medical providers and facilities have not met the requirements. 61.5% of the elderly living in Phu Nhuan Ward, Hue City supposed that waiting time and red tape led them to assess that the quality of treatment in hospital was not good

¹²

. Therefore, older people’s health care programs and services in Vietnam should not be limited to treatment for acute illness in health facilities but need a long- term care program. Long-term care would be the comprehensive care that helps the elderly get the best physical and mental health, especially long-term care at home. Furthermore, their needs for health care services should be assessed, and strategies and policies for improving their health should be developed. However, to our best knowledge, very few publications can be found available in the literature that discusses this issue. Hence, we conducted a study to examine the situation, demands and correlates of using home health care services among the elderly in Thuy Bieu District, Hue City in 2018. This research will provide scientific evidence that can help governments and medical providers have a general view of the needs of home health care for the elderly.

2. Methods

2.1. Study design

This was a cross-sectional study

(3)

Taùc giaû:

4. Boä Y teá

Taùc giaû:

4. Boä Y teá

2.2. Research subjects

The research subjects were the elderly (60 years old and above) living in Thuy Bieu Ward, Hue City, Vietnam.

Inclusion criteria

The elderly who have been living in the research area for at least 12 months.

Exclusion criteria

The elderly who have been living in the research area for fewer than 12 months.

The elderly who were unable to communicate;

and those who refused to participate in the study

Data collection was conducted from February 2018 to April 2018.

2.3. Sample size and sampling

The sample size was calculated by using the formula to estimate population ratios

at least one type of home health care services within the past 3 months such as health check- up, treatment, rehabilitation, etc.

The demands were estimated by asking the study participants about the desires (yes/no) in the future that they wanted to use services.

2.4.2. The independent variables

The socio-economic status of the study subjects was estimated by assessing age (60- 69, 70-79, ≥80), gender (Male, Female), marital status (married, single, widow), living situation (partners or descendants, relatives, alone), distance from home to the nearest health facility (average, min, max), household economic status (poor, near-poor, normal), income (average, min, max), health status (acute disease, chronic disease, disability).

People provided health care when the elderly needed (relatives, neighbors, health workers, themselves), reasons for using (acute illness, exacerbation of chronic illness, chronic illness, disability), using time (days), cost (average, min, max), satisfaction assessment (5-point Likert scale), affordable cost (average, min, max), had used home health care services (yes, no).

2.5. Data collection

Data were collected through personal interviews conducted by experienced interviewers. The interviewers included 06 sixth-year students of Hue University of Medicine and Pharmacy who were trained for 2 days. The interviewers approached the elderly to screen them for study eligibility and informed consent process that included participant’s rights, the risks and the benefits of participation, and then the elderly With,

(Success rate from a previous evaluation is not available, so use p=0.5)

Sample size . Add 10% of the sample, then . In fact, this research recruited 425 participants.

2.4. Measurements

2.4.1. The dependent variables

The prevalence and demands of using home health care among the elderly were measured.

The prevalence was identified if the study

participants reported that they experienced

(4)

Taùc giaû:

4. Boä Y teá

completed a face-to-face interview.

2.3. Data analysis and statistical methods

Both descriptive and analytical statistics were carried out using SPSS 16.0 software.

- Descriptive statistics: Prevalence and demands (%) of using home health care services (mean, median, min, max and SD) among the study participants were calculated.

- Analytical statistics: Step 1, using the Chi- square Test with confidence interval 95%

to examine the associations. Step 2, with variables having p<0.2, multivariate logistic regression modelling was applied to predict the association between the prevalence and demands of using home health care services and its associated factors (David W. Hosmer and Standly Lemeshow, 2000)

¹³

. A significance level of p<0.05 was used.

2.4. Ethical consideration

This study was approved by the Ethical council of Hue University of Medicine and Pharmacy and issued Decision No. 1924/QD-YD dated August 30, 2017, on the assignment of the thesis for major of General Medicine, Dentistry, Preventive Medicine, Traditional Medicine, Pharmacology, Nursing, Public Health, the academic year of 2017-2018.

3. Results

3.1. Demographic characteristics

The results show that there were 425 elderly persons with an average age of 72.4 ± 9.4 years.

Among them, the age group of 60-69 accounted for nearly 50%. The percentage of male and female were 42% and 58%, respectively.

Approximately 2/3 of subjects had married, and ¼ of them were widows. More than 50% of the elderly were living with husband/wife and descendants, and about 1/3 of them were living alone or living with relatives. The number of the elderly who suffered from chronic diseases occupied the largest proportion with more than

½ of research subjects.

The average distance from the elderly’s home to the nearest health facilities was 1.65 ± 0.798 km. The percentage of poor and near-poor household economic status was 8.2%. The average income of the elderly per month was 2,760,188 ± 1,749,670 VND (roughly 73.36 ± 77.66 USD).

3.2. The prevalence of using home health care services for the elderly.

The percentage of the elderly in the study using home health care services within the last 3 months was 3.1%. When the elderly needed health care at home, more than 50% received helps from relatives, neighbors; 29.6% of them practiced self-service and just 20% of cases received care from health workers.

Most of the research respondents used health

care services when suffering from acute illness

or exacerbation of chronic diseases (84.6%)

and the majority of health care providers

were doctors (76.9%). Median of days using

homecare services was 3, with minimum of 1

day and maximum of 36 days. Average cost for

using services was 580,769 ± 483,709 VND

(approximately 25$ ± 20.81USD) with a wide

range from 50,000 VND to 1,500,000 VND

(nearly 2.15-64.54 USD).

(5)

Taùc giaû:

4. Boä Y teá

Taùc giaû:

4. Boä Y teá

Figure1. Satisfaction assessment of the elderly who had used healthcare services at home

Figure 1 illustrates that there was a good general assessment with more than 50% users who thought that the quality of home health care services was satisfied or very satisfied.

3.3. The demand for using home health care services among the elderly

The demand for using home health care services

for the elderly was expressed by 27.8% of the elderly in the study. The average cost which the elderly could pay for home health care services every month was about 529,508 VND (roughly 23.28 USD), in particular, the highest cost that the study participants could pay was 4,000,000VND (172.11 USD) and the lowest was 0 VND.

Table 1. Types of home health care services which the elderly expected to use

Features Frequency

(n=122)

Proportion (%)

95% CI Upper

limit

Lower limit

Health check-up 96 78.7 74.8 82.6

Nursing care 36 29.5 25.2 33.9

Treatment 13 10.6 7.8 13.6

Health advice via phone 11 9.0 6.3 11.7

Physiotherapy - Rehabilitation 10 8.2 5.6 10.8

Subclinical Test 6 4.9 2.9 7.0

Psychological counselling via phone 4 3.3 1.6 5.0

Palliative care 4 3.3 1.6 4.5

Emergency transportation 3 2.5 1.0 3.9

(6)

Taùc giaû:

4. Boä Y teá

Table 1 summarizes that the most chosen form of health care services by the elderly was health check-up at home with more than ¾ of choices.

The second type of services was nursing care with nearly 1/3 of the elderly’s choices and emergency transportation was the lowest (with 2.5%).

3.4. Factors associated with the situation and demands using home health care services of the elderly

Table 2.The multivariate logistic regression model determined the factors associated with using home health care services for the elderly

Variables OR

Upper limit

95% CI Lower limit p

Gender Male 0.4 0.1 1.7 0.219

Female 1 - - -

Chronic diseases

Yes 3.0 0.7 11.9 0.121

No 1 - - -

Handicap/

disability

Yes 13.3 3.6 48.3 <0.001

No 1 - - -

Table 2 shows that there was a relationship between the percentage of using home healthcare services for the elderly and the factor of handicapped/limited functionality (p<0.05).

Table 3.The multivariate logistic regression determined the factors associated with the demands of using home health care services of the elderly

Variables OR

Upper limit

95% CI Lower limit p

Age group

60-69 years 1 - - -

70-79 years 1.7 1.0 3.0 0.068

≥ 80 years 2.1 1.2 3.6 0.06

Marital status

Have partner 1 - - -

Single/

Divorce/

Widowed

0.6 0.3 0.9 0.03

Household income

Poor 0.1 0.02 0.5 0.003

Normal 1 - - -

Acute disease Yes 2.2 1.1 4.5 0.023

No 1 - - -

Chronic disease

Yes 1.7 1.1 2.7 0.004

No 1 - - -

(7)

Taùc giaû:

4. Boä Y teá

Taùc giaû:

4. Boä Y teá

Had Used home health care services

Yes 12.6 2.6 60.7 0.002

No 1 - - -

Table 3 illustrates that there were the relationships between the demands of using home health care for the elderly and marital status, household economy, acute illnesses, chronic diseases and people used home health care services within the last 3 months.

4. Discussion

4.1. Situation and health care demands of the elderly

In our study, the focus of attention was that only 3.1% of the elderly used home health care services within the past 3 months from the time of the study commencement. This percentage was much lower than 31.7% of the elderly who had used at least one type of home health care services in a previous study of Dam T. Hieu

¹⁴

. It was because there were not many health facilities in Hue City providing health care services at home. According to Figure 1, most of the elderly (60.9%) who had used home health care services assessed the quality of these services from good and above levels. Compared to the study of Dam T. Hieu, the elderly in his study who assessed that the quality of services was good and above accounted for 94.7%

¹⁴

. Similarly, the attitude of home health care providers in this study was satisfied by 69.2% elderly people, which was lower than that of Dam T. Hieu’s study with nearly 100% elderly people felt very satisfied.

In terms of cost, 69.2% of this study’s subjects rated it as good or better while 77.9% of the

elderly in Dam T. Hieu’s study thought that it was affordable/cheap.

The proportion of the elderly who had the demand for home health care services was 28.7%. In fact, the model of family doctor in Thua Thien Hue province was a brand new concept receiving inadequate investment, encountering many limitations, and showing low efficiency, so the number of the elderly who have heard about these services was quite low. This proportion was also much lower than 67.3% of older persons in need of such services in the study findings of Dam T.

Hieu

⁷

, and lower than 42.9% of interviewed elderly people having aspirations for home health care in a study conducted by Nguyen T.M.Hien in Cau Giay District, Hanoi

¹⁵

, while a finding from Tran N.Tu’s research performed in Tu Liem District, Hanoi (2005-2007) shows that the demand for elderly health care in the community was very high with 97.9% elderly people want to be provided with healthcare services at home

¹⁰

.

4.2. Factors related to the situation and demands of using home health care services among the elderly

According to multivariate logistic regression analysis results in Table 2, there was a relationship between the prevalence of using home health care services for the elderly and handicap/disability of the elderly (p<0.05).

Specifically, those with handicap/disability had

13.3 times higher of using homecare compared

(8)

Taùc giaû:

4. Boä Y teá

to non-disabled people. In term of demands of using home health care services which were shown in Table 3, marital status also had a statistical relationship with demand of using home health care services of the elderly, for more details, the elderly who were separated/

divorced/widowed generated only 0.6 times of demand in comparison with the married group.

The difference between household economic factor and the demand was statistically significant. Regarding the proportion of poor/

near-poor households needing to use the services, it was only 0.1 times than that of the households with middle-income and above.

The situation of acute and chronic diseases with the demands for using related services was statistically significant (p <0.05). This result is similar to the research findings of Dam T.Hieu, where the elderly who had been treated in health care center within the last 6 months had a demand for using home health care services at 2.69 times higher than that of the non-medical group

¹⁴

. The result was also comparable to the study findings of Nguyen V. Sai that the elderly who had vulnerable physical health tended to get a higher need for medical care

¹⁶

.

There was a correlation between the proportion and demand for using health services of older people. The elderly who have used medical services at home within the past 3 months were 12.6 times more likely to use the services than the non-user groups. This relationship was also found in the research of Dam T. Hieu, where the elderly who used it were 5.63 times more likely to need it compared to the unused group

¹⁴

.

5. Conclusion

In general, compared to other cities that have established the home care system for a long time, home health care services for the elderly in Hue City were not too developed. It is also a challenge for the community and government to find alternative care strategies to meet the specific demands of the elderly and their families. Home health care services need to be planned at the national level and coordinated as packages of care that are tailored and delivered to patients in their own homes. Home health care should be accepted as an integral component of the primary health care service package, and affordable by the community and provide acceptable quality of care.

References