Dementia and Dependency vs. Proxy Indicators of the Active Ageing Index in Indonesia

Dementia prevalence is increasing worldwide and developing countries are expected to carry the highest burden of this. Dementia has high care needs and no current effective long-term treatment. However, factors associated with active ageing (e.g., longer employment; participation in society; independent, healthy and secure living; and enabling environments to allow people to remain psychosocially and physically active) could help maintain independence in older people for longer. We investigated proxy indicators of the Active Ageing Index (AAI), which were offset against dementia and dependency (assessed by Instrumental Activities of Daily Living or IADL) in multi-ethnic urban (Jakarta) and rural (Sumedang and Borobudur) health care districts on Java, Indonesia. Dementia was assessed using validated cognitive dementia screening tests, the IADL and carer reports. Dementia and dependency prevalence showed large interregional differences and were highest in rural Borobudur. Dementia and dependency were associated with an older age, lower education (for dementia), worse physical health (for dependency) and not engaging in psychosocial activities, such as attending community events, reading (for dementia) and sport activities (for dependency). By supporting active ageing activities in Puskesmas (primary health care centers) and improving access to medical care, rural areas could possibly reduce dementia and dependency risk. Our follow-up study planned in 2021 should illustrate whether recent relevant policies have rendered success in these areas. Using active ageing indicators could focus policies to support regions with targeted interventions to compress care needs in older people.

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Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas

Innovation in Aging ◽

10.1093/geroni/igaa057.177 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 54-54

Author(s):

Robin McAtee ◽

Leah Tobey ◽

Corey Hayes ◽

Laura Spradley ◽

Sajni Kumpuris

Keyword(s):

Older Adults ◽

Pain Management ◽

Rural Areas ◽

Term Treatment ◽

Lessons Learned ◽

Opioid Use ◽

Farm Bureau ◽

Department Of Health ◽

Long Term Treatment ◽

Agricultural Areas

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

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Evaluating a Model of Service Integration for Older People with Complex Health Needs

Evaluation Journal of Australasia ◽

10.1177/1035719x05004001-206 ◽

2005 ◽

Vol 4 (1-2) ◽

pp. 34-41 ◽

Cited By ~ 2

Author(s):

Steve Bird ◽

William Kurowski ◽

Gillian Dickman

Keyword(s):

Health Care ◽

Older People ◽

Service Integration ◽

Evaluation Process ◽

Target Population ◽

Multiple Chronic Conditions ◽

Health Care Needs ◽

Care Needs ◽

Community Based ◽

Quantitative And Qualitative Methods

Background Older people with multiple chronic conditions and complex health care needs require a comprehensive, accessible and well-coordinated system of services. To address this growing problem, a consortium of acute and community-based health care organisations implemented a ‘Patients First’ model of service integration for the target population. The project evaluation utilised a combination of quantitative and qualitative methods in an action research framework. Findings The evaluation process not only demonstrated the benefits of the project to patients and the health care system, but also contributed to the identification of pivotal components in the model, aspects requiring attention and consequently their refinement. It was also a vehicle for the development of a sense of ownership amongst staff and has evolved into an integral part of the model.

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Assessment of older people in the community: lessons from Britain’s ‘75-and-over checks’

Reviews in Clinical Gerontology ◽

10.1017/s0959259899009430 ◽

1999 ◽

Vol 9 (4) ◽

pp. 305-316 ◽

Cited By ~ 9

Author(s):

Steve Iliffe ◽

Mari Gould ◽

Paul Wallace

Keyword(s):

Health Care ◽

Older People ◽

General Practitioners ◽

Unmet Need ◽

Health Assessment ◽

Health Care Needs ◽

Care Needs ◽

Contractual Obligation ◽

Assessment Programme ◽

The World

Research carried out in the 1950s and early 1960s indicated that there was considerable unmet need amongst older people in Britain. This work prompted research into ways of meeting the health care needs of older people, a task made more important by the aging of the population at the end of this century. This focus resulted in the introduction in 1990 of a nationwide health assessment programme for older people, as a contractual obligation for general practitioners. The programme, the first in the world, remains in force but is widely ignored. This paper describes:

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Drug control: a prerequisite for health

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1980.0085 ◽

1980 ◽

Vol 209 (1174) ◽

pp. 159-163

Keyword(s):

Health Care ◽

Rural Areas ◽

Third World ◽

Health Care Expenditure ◽

World Health ◽

Health Care Needs ◽

Care Needs ◽

Pharmaceutical Manufacturers ◽

Health Organization ◽

Limited List

The purchase of drugs employs an increasingly large part of the health budget of many Third World countries. Like health care expenditure as a whole, drug spending is heavily biased in favour of urban hospitals, often for expensive proprietary drugs that offer little benefit over cheaper preparations. As a result, because limited funds are available, vaccines and drugs for prevention and primary care are sometimes unavailable, especially in rural areas. The World Health Organization and many individual countries have responded to the problem of drug costs by creating a limited list of drugs considered essential for health care needs. Other methods of curtailing spending on drugs have included tendering for supplies and the establishment of plants to manufacture and formulate drugs. Controls of this type meet enormous resistance from doctors and pharmaceutical manufacturers, but are vital for the implementation of policies for appropriate health care.

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Determinants of Health Care-Seeking Delay among Tuberculosis Patients in Rural Area of Central China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15091998 ◽

2018 ◽

Vol 15 (9) ◽

pp. 1998 ◽

Cited By ~ 2

Author(s):

Yeqing Tong ◽

Xuhua Guan ◽

Shuangyi Hou ◽

Li Cai ◽

Yadong Huang ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Rural Areas ◽

Hubei Province ◽

Central China ◽

Health Care Seeking ◽

Care Seeking ◽

Mycobacterium Tuberculosis Infection ◽

Tuberculosis Patients ◽

Targeted Interventions

Background The prevalence of tuberculosis (TB) in low and middle-income countries is a significant public health and social concern. TB is a common infectious disease caused by the Mycobacterium tuberculosis infection, which has a widespread infection rate. Health care-seeking delay maybe one of the most important neglected risk factors for the spread of TB. Objectives The aim of this study was to understand the situation of health care-seeking delay among rural tuberculosis patients in Hubei Province, and explore its risk factors. Methods A total of 1408 rural tuberculosis patients were surveyed using a standard structured questionnaire in three cities of Hubei Province during the past two years. Results For the 1408cases of pulmonary tuberculosis, 39.70% of them were health care-seeking delayed. Logistic regressions indicate that the Han nationality, farming careers, the over 45 min walk to the township’s hospital, and awareness of the national TB free treatment policy, were significantly associated with higher odds of a delay in care seeking. Conclusions The prevalence of health care-seeking delay among tuberculosis patients was high in rural areas. It is essential to take comprehensive targeted interventions to reduce care-seeking delay.

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Supporting older military veterans in the rural US

Quality in Ageing and Older Adults ◽

10.1108/qaoa-04-2018-0017 ◽

2018 ◽

Vol 19 (4) ◽

pp. 286-297

Author(s):

Bret Hicken ◽

Kimber Parry

Keyword(s):

Health Care ◽

Rural Areas ◽

Access To Health Care ◽

Veterans Health ◽

Health Administration ◽

Care Needs ◽

Content Type ◽

Access To Health ◽

The Us

Purpose The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas. Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans. Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas. Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

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Healthcare utilization and quality among survivors of adolescent and young adult cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.21 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 21-21

Author(s):

Anne C. Kirchhoff ◽

Sapna Kaul ◽

Mark Fluchel ◽

Christopher F Parmeter ◽

Holly Lynn Spraker

Keyword(s):

Health Care ◽

Young Adult ◽

Health Care Quality ◽

Comparison Group ◽

Care Quality ◽

Health Care Use ◽

Medical Expenditure ◽

Adolescent And Young Adult ◽

Care Needs ◽

Targeted Interventions

21 Background: To evaluate perceived health care quality among a national sample of survivors of adolescent and young adult (AYA) cancer relative to individuals from the general population. Methods: Using the Medical Expenditure Panel Surveys from 2008-2012, we identified 1,163 survivors diagnosed with cancer ages 15-39 who were at least five years from diagnosis and currently ages of 20-64. A comparison group with no history of cancer was created via propensity score matching on sex, age at study, race/ethnicity, census-region, and survey year. Participants with one or more health care visit in the past 12 months were asked to rate health care quality from all providers (0 = worst to 10 = best), which we categorized as low (0-4), moderate (5-7) and high (8-10). Among survivors, we identified factors such insurance and health status associated with health care quality using ordinal logistic regression. Results: Mean time since diagnosis was 18.3 years. A total of 18% of survivors of AYA cancer reported no health care visits in the previous 12 months compared to 25% of the comparison group (p < 0.001). Survivors rated their health care quality lower than the comparison group (low/moderate: 30.8% vs. 22.5%, respectively, p = 0.003). Among survivors, those who were publicly insured (odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.97, p = 0.04) and uninsured (OR = 0.25, 95% CI: 0.13-0.48, p < 0.001) were more likely to provide lower health care quality ratings than privately insured survivors. Survivors in fair/poor health also reported poorer quality compared to those in excellent/very good/good health (OR = 0.43, 95% CI, p < 0.001). Conclusions: Survivors of AYA cancer reported greater health care use and poorer health care quality compared to individuals without cancer. Our results call for targeted interventions to meet AYA cancer survivors’ health care needs and expectations.

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Profile of the Current Psychiatrist Workforce in South Africa: Establishing a Baseline for Human Resource Planning and Strategy

Health Policy and Planning ◽

10.1093/heapol/czab144 ◽

2021 ◽

Author(s):

Bernard Janse van Rensburg ◽

Carla Kotzé ◽

Karis Moxley ◽

Ugasvaree Subramaney ◽

Zukiswa Zingela ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Health Care ◽

Mental Health Care ◽

Rural Areas ◽

Urban Areas ◽

Resource Planning ◽

Data Repository ◽

Care Needs ◽

South African Society

Abstract The WHO Global Health Observatory Data Repository reports South Africa with 1.52 psychiatrists/100 000 of the population among other countries in Africa with 0.01 psychiatrists/100 000 (Chad, Burundi and Niger) to more than 30/100 000 for some countries in Europe. The overall situation, while being cognizant that mental health care is not only provided by specialist psychiatrists and that the current treatment gap may have to be addressed by strategies such as appropriate task sharing, suggests that there are actually too few psychiatrists to meet the country’s mental health care needs. To address the need to develop a strategy to increase the local specialist training and examination capacity, a situational review of currently practicing psychiatrists was undertaken by the [BLINDED] and the [BLINDED], using the South African Society of Psychiatrists (SASOP) membership database. The number, distribution and attributes of practicing psychiatrists were compared with international figures on the ratio of psychiatrists/100 000 population. In April 2019 there were 850 qualified psychiatrists actively practicing in the country and based on the national population figure of 55.6 million people (2016 Census), the psychiatrists/100 000 ratio was 1.53. This indicates no improvement between 2016 to 2019. From the SASOP database, we determined that about 80% of psychiatrists are working in the private sector - a much higher proportion than is usually quoted. As the vast majority of psychiatrists are practicing in urban areas in two provinces, Gauteng (n=350) and Western Cape (n=292), the ratio of psychiatrists/100 000 in these areas is relatively higher, at 2.6 and 5.0 respectively. Whereas rural areas in South Africa are largely without specialist mental health expertise, at a rate of 0.03/100 000 population. This investigation provides a discipline-specific situational review of the attributes and distribution of the current workforce of specialists in the country.

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