Long-Term Care Needs in the Context of Poverty and Population Aging: the Case of Older Persons in Myanmar

Myanmar is one of the poorest and least healthy countries in Southeast Asia. As elsewhere in the region, population aging is occurring. Yet the government welfare and health systems have done little to address the long-term care (LTC) needs of the increasing number of older persons thus leaving families to cope on their own. Our study, based on the 2012 Myanmar Aging Survey, documents the LTC needs of persons aged 60 and older and how they are met within the context of the family. Nearly 40% of persons in their early 60s and 90% of those 80 and older reported at least one physical difficulty. Spouses and children constitute the mainstay of the financial and instrumental support of elderly including those with LTC needs. Nearly two-thirds of older persons reported receiving assistance with daily living activities. More than three quarters coreside with children, a living arrangement that in turn is strongly associated with receiving regular assistance in daily living. Daughters represent almost half and spouses, primarily wives, one-fourth of primary caregivers. Unmet need for care as well as inadequate care decline almost linearly with increased household wealth. Thus elderly in the poorest households are most likely to experience gaps in LTC. Given mounting concerns regarding health disparities among Myanmar’s population, this pattern of inequality clearly needs to be recognized and addressed. This needs attention now rather than later given that reduced family size and increased migration pose additional challenges for family caregiving of frail elderly in the coming decades.     

Health care for older persons: a country profile-Korea

The Korean healthcare system is faced with a crisis caused by rapidly changing social values tending toward westernization, increasing insurance benefit requests for elder health care, financial instability of the National Health Insurance (NHI) program, and a lack of social infrastructure for the elderly. The demand for health care for the elderly has increased markedly, because of a rapidly aging population, growing female participation in the labor market, elevated expectations for health care, and a change in the pattern of medical conditions in the elderly from acute illness to chronic disability. NHI lacks the finances to meet the benefit request for long-term care (LTC). Only 0.39% of the elderly can be accommodated in LTC beds. Consequently, the chronically disabled elderly overflow to acute care beds in general hospitals, which places an undue burden on the already strained NHI system in terms of longer stays and higher cost of treatment in hospitals compared with care specific to the elderly in LTC facilities. It is clear that the Korean healthcare system does not have the facilities to meet such challenges and is in a state of disorder. Korea has failed to predict and prepare for population needs before they arise, including financing and the development of appropriate care models, particularly concerning the adequate provision of LTC. This paper advocates the necessity of international discussion of the prospects for developing health care for aging populations and encourages the sharing of differing national experiences concerning care for the elderly.     

The Effects of Dementia and Long-Term Care Services on the Deterioration of Care-needs Levels of the Elderly in Japan

To investigate the associations between dementia, the use of long-term care (LTC) services, and the deterioration of care-needs levels of elderly persons in Japan.Using a retrospective cohort study, we analyzed 50,268 insurance beneficiaries aged 65 years and older who had utilized LTC services between 2010 and 2011 in Kyoto prefecture, Japan. Logistic regression analyses were used to identify predictors of care-needs level deterioration.Dementia, facility care services, the male sex, older age, and lower baseline care-needs levels were associated with care-needs level deterioration. The disparity between odds ratios of home care services, dementia diagnoses, and facility care services on care-needs level deterioration diminished with increasing baseline care-needs levels. The other risk factors of care-needs level deterioration showed stronger associations as care-needs levels and age increased.The effects of baseline care-needs levels and dementia should be considered when developing LTC policies.     

Evolution of the needs of older persons

Most countries in the world experienced a major increase in life expectancy during the 20th century and a resulting aging of their populations. Further gains in life expectancy are uncertain, particularly in developed countries already characterized by a high longevity, and little is known concerning the health state of future generations of the elderly. But there is no doubt that further population aging will produce larger numbers of older persons both in developed and developing countries. As the prevalence of most chronic diseases is high in old age, population needs change rapidly in health care systems still organized essentially to provide acute care to children and young adults. Old age is heterogeneous, but a large proportion of older persons is affected by multiple chronic diseases, resulting in a wide range of needs. Health systems will have to adapt to this new situation while still providing appropriate responses to acute diseases affecting all ages. Although future needs are difficult to quantify, their nature is already apparent. Providing for these needs will require a major investment in manpower, a diversification of services delivered by health care systems, changes in the training of health professionals and extensive research to define effective treatments for elderly patients with multiple co-morbidities.     

Five-year changes of social activity and incident long-term care needs among depressed older adults: A 15-year follow up

ObjectivesTo examine the effects of changes in individual/multiple social activities between 65 and 70 years of age on incident long-term care (LTC) needs between 70 and 80 in older adults with depressive symptoms.MethodsParticipants were recruited from the New Integrated Suburban Seniority Investigation Project, an ongoing prospective cohort study. A total of 525 older adults with depressive symptoms were included. The validated 15-item Geriatric Depression Scale was used to assess depressive symptoms. A self-report questionnaire was used to measure social activities (social-related, learning, and personal). LTC needs was defined according to Japan's Long-term Care Insurance System. A competing risk model and a Laplace regression model were used to estimate the hazard ratios of LTC needs incidence and the 25th percentile difference in LTC-needs-free survival time and their 95% confidence intervals.ResultsOut of 4314 person-years of mild LTC needs, 108 individuals developed it. Participants who increased their frequency of learning activities have a lower risk of developing mild LTC needs. Increasing the frequency could also prolong LTC-needs-free survival time by approximately 2.61 years. Out of 4535 person-years for severe LTC needs, 54 individuals developed it. Participants with a continuous regular frequency of learning activities had a lower risk of developing severe LTC needs. However, the association between this frequency and LTC-needs-free survival time for severe LTC needs was insignificant in the multivariable models.ConclusionsIncreased frequency of learning activities reduced the risk of LTC needs among older adults with depressive symptoms and prolonged their LTC-needs-free survival time.     

The WHO programme on health of the elderly

The aging of population is a world-wide phenomenon bearing important policy implications for both developing and developed nations. The health programme for the elderly in the years 1990 to 1995 will focus on approaches leading to the well-being of aged persons. This might be achieved by reducing their functional dependency due to the deterioration of their health, social and economic status. This objective will be realized through the following approaches: --support to Member States in the formulation and implementation of policies promoting the well-being of the elderly; --data collection and information dissemination important to decision making, service planning and policy formulation; --cooperation with national programmes in organising comprehensive care systems for the elderly including training components; --promotion of research directed towards the well-being of the elderly; --development or adaptation, when applicable, of technologies appropriate for the elderly in developing countries; --encouragement of multilateral international collaboration for the well-being of the elderly.     

Factors related to satisfaction with long-term care services among low-income Korean elderly adults: A national cross-sectional survey

BackgroundWith the growing demand for long-term care (LTC) services, it is increasingly important to explore experience with care. This study examined care satisfaction in a nursing home and at home among low-income elders in South Korea.MethodsThis cross-sectional study was conducted with 246 elderly recipients of welfare benefits using a proportional stratified sampling method. Two self-reported versions of a questionnaire developed for users of nursing home care and homecare were used.ResultsThose at home reported higher care satisfaction than those in nursing homes did. Both users of nursing home care and homecare were less satisfied with the food served. Users of nursing homes had comparatively less satisfaction regarding the daily activities available to them and less autonomy concerning their care decisions. Factors that influenced satisfaction with nursing home care and homecare were the quality of caregivers, care facilities, and physical wellbeing.ConclusionsAn approach focused on improving the quality of the care facilities and caregivers could help enhance care satisfaction among low-income Korean elders receiving LTC.     

Long-term care of the aging population with intellectual and developmental disabilities

The aging population with intellectual and developmental disabilities (I/DD) deserves appropriate health care and social support. This population poses unique medical and social challenges to the multidisciplinary team that provides care. In the past, long-term care (LTC) facilities played an essential role in the livelihood of this population. The likelihood that the geriatric LTC system must prepare for adequately caring for this population is high. This article conveys the need to prepare for the inclusion of the growing aging population with I/DD into long-term care with the general elderly population in the near future.     

Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs

ABSTRACT

Objectives: Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers.

Methods: This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities.

Results: Results suggested that LTC staff struggle with how to be sensitive to LGBT residents’ needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show “favoritism” or “special treatment,” which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression.

Conclusions: LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.     

Long-term care grade and mortality in Korean nursing home residents

Background and aimTo evaluate the association between long-term care (LTC) grade and mortality in Korean nursing home residents and to determine whether there are any associations between mortality and other clinical indices.MethodsA retrospective observational study was done with four hundred and fifty-five elderly newly admitted residents of eight nursing homes in Korean Nursing Home Networks from July 2008 to April 2010 measuring age, sex, admission day, long-term care grade, co-morbid diseases, physical and emotional status, discharge day, discharge outcome (death, transfer to hospital, transfer to other nursing home, others), and causes of death.ResultsThe average age of the subjects was 81. Sixty-three (13.8%) died during the follow-up period. Compared to LTC grade 3, mortality of grade 1 and 2 were about six times and four times higher, respectively. And, two items of ability to perform daily living (eating and exercising, dressing and washing) had statistically significant associations with mortality.ConclusionEffective management of nursing home residents via providing a personalized medical approach according to long-term care grade is needed, including, for example, developing a more accurate survival indicator system or end of life care for LTC grade 1, and mental health or physical rehabilitation for LTC grade 3.     

Ageing in Indonesia – Health Status and Challenges for the Future

Ageing and problems concerning the aged were until recently the domain of developed countries, but they are now becoming an increasing and alarming reality in developing and underdeveloped countries such as Indonesia. Families and even the nation are facing many challenges relating to support for the elderly. This is because in the past developing policies, and caring for, the elderly were not major priorities of Government as the elderly represented a small percentage of Indonesia’s population. One of the challenges impacting on the provision of care for the elderly is the lack of health service programs for the elderly who are living in their own homes. Health personnel shortages including community health nurses have been identified as a significant contributor to this health service problem. This paper will initially consider Indonesia’s geography as a nation comprising many islands. It will then discuss the impact of a changing population profile and present an overview and critique of the current level of health services provided to promote wellbeing for the elderly.     

Who will become my co-residents? The role of attractiveness of institutional care in the changing demand for long-term care institutions

BackgroundIn several OECD countries the percentage of people over 80 in LTC institutions has been declining for more than a decade, despite population ageing. The standard model to explain healthcare utilization, the Andersen model, cannot explain this trend. We extend the Andersen model by including proxies for the relative attractiveness of community living compared to institutional care. Using longitudinal data on long-term care use in the Netherlands from 1996 to 2012, we examine to what extent a decline in institutional care is associated with changes in perceived attractiveness of institutional LTC care compared to community living.MethodsWith a Blinder–Oaxaca decomposition regression, we decomposed the difference in admission to LTC institutions between the period 1996–1999 and 2009–2012 into a part that accounts for differences in predictors of the Andersen model and an “unexplained” part, and investigate whether the perceived attractiveness of institutional care reduces the size of the unexplained part.ResultsWe find that factors related to the perceived attractiveness of institutional care compared to community living explains 12.8% of the unexplained negative time trend in admission rates over the total period (1996–2012), and 19.1–19.2% over shorter time frames.DiscussionOur results show that changes in the perceived attractiveness of institutional LTC may explain part of the decline in demand for institutional care. Our findings imply that policies to encourage community living may have a self-reinforcing effect.     

Aging and Caregiving in the Republic of Palau

Aging has been an important population trend of the twentieth century, with most elderly people living in developing countries. Little has been published on the healthcare needs of elderly in the Pacific Islands. The Pacific Islands Geriatric Education Center, at the University of Hawaii, has a mission to promote training in geriatric education in the Pacific Islands to improve healthcare to the elderly. The aim of this project was to develop and test a family caregiver training program for Palau and was achieved in two phases: (1) assessing needs by interviewing key informants and surveying elders and (2) evaluating the caregiver training program that was designed based on findings from the assessment. The Ecological Systems Theory provided the theoretical framework for this study. The needs assessment identified training and education of family caregivers as a top priority, with the Palauan culture of family caring for seniors presently threatened by caregiver burnout. Nearly all of the long-term care in Palau is provided by families, and elders have high prevalence of geriatric syndromes. A family caregiver train-the-trainer workshop was subsequently conducted in February 2011. Forty-four trainers, including 12 from other Pacific Islands, attended the workshop. To assess changes in knowledge and confidence to teach, we compared scores on pre- and post-questionnaires using paired t tests. The train-the-trainer workshop resulted in significantly improved self-assessed competence and confidence to teach in all geriatric syndromes, including dealing with difficult behaviors, gait and transfer training, caregiver stress relief, and resources for caregivers (p?<?0.0001). This successful intervention identified geriatric care needs in Palau and successfully trained family caregivers to meet these needs, and may be used as a model for similar interventions in other Pacific Islands.     

Palliative care for the geriatric patient in Europe

Background

Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize geriatric palliative care in Europe.

Objective

The goal of the current study was to map the existing palliative care structures for geriatric patients, the available policies, legislation, and associations in geriatric palliative medicine in different countries of Europe.

Methods

A questionnaire was sent to Geriatric and Palliative Medicine Societies of European countries through contact persons. The areas of interest were (1) availability of services for the management of geriatric patients by using vignette patients (advanced cancer, severe cardiac disease, and severe dementia), (2) policies, legislation of palliative care, and (3) associations involved in geriatric palliative medicine.

Results

Out of 21 countries contacted, 19 participated. Palliative care units and home care palliative consultation teams are available in most countries. In contrast, palliative care in long-term care facilities and in geriatric wards is less developed. A disparity was found between the available services and those most appropriate to take care of the three cases described in the vignettes, especially for the patient dying from non-malignant diseases. The survey also demonstrated that caregivers are not well prepared to care for the elderly palliative patient at home or in nursing homes.

Conclusion

One of the challenges for the years to come will be to develop palliative care structures adapted to the needs of the elderly in Europe, but also to improve the education of health professionals in this field.     

Do-not-resuscitate practice,guidelines and policies in long-term care in Ontario: results of a survey

We used a survey to determine the prevalence of do-not-resuscitate (DNR) guidelines and protocols, and opinions related to cardiopulmonary resuscitation (CPR) in facilities that provide long-term care (LTC) in Ontario. Questionnaires completed by 357 of 474 facilities providing LTC, revealed that most have written DNR policies. Over half inform residents about the policy on admission, and a third later on, with most indicating DNR status on the chart. Over half the institutions can provide CPR, mostly basic cardiac life support. Most institutions rely on emergency ambulance services to treat cardiac arrests. In the absence of a DNR order, almost half will perform CPR, and a quarter have a protocol to deal with this circumstance. Most respondents indicated that staff, families and residents would welcome a protocol to deal with absent DNR orders in cardiac arrests. Most believe that staff, families and residents would welcome DNR as the basic policy, with CPR as the exception. There is a high awareness in facilities that provide LTC of the limits of CPR in the elderly. Without specific legislation, most facilities have policies and protocols, but there are inconsistencies across Ontario.     

Training Unemployed Women for Adult Day Care in İzmir,Turkey: A Program Evaluation

The proportion of older people in Turkey is increasing steadily with a subsequent growth of long-term care (LTC) needs. There is a scarcity of formal care provisions for residential and particularly nonresidential settings. Thus, formal caregiving is not meeting LTC needs nor attracting workers as a labor option. The authors examine the hypothesis that LTC may offer work opportunities for women unfamiliar with caregiving as an occupation, and also examine the need and acceptance of different types of LTC beyond residential care. The authors evaluate an innovative project introducing these two elements to 76 women in ?zmir, Turkey, using an analysis framework that incorporates factors related to applications and progression; management assessment; trainees’ self-assessment reflecting on their views on aging; and older people’s perception of the experience and its impact on their well-being. Trainees reported a major positive shift in their attitudes toward working in LTC and toward the aging process. Users reported discovering a new dimension to care, which directly affected their quality of life. Overall, this community-based initiative appeared effective in enhancing the awareness of the concept of adult day centers providing a social model of care, and appears promising in addressing the growing need for formal LTC in Turkey.     

Intention to Use Long-Term Care Facilities: Differences beween Korean Pre-elderly and Korean Baby-boomers

With the rapidly increasing number of older adults, dealing with long-term care (LTC) needs becomes an emerging issue in South Korea. This study aims to examine factors affecting the intention to use longtermcare facilities with two groups of young-old adults: (1) Korean pre-elderly (KPE) and (2) Korean babyboomers (KBB). Guided by Andersen’s behavioral model of health service use and prior research, predisposing characters, enabling resources, need factors, availabilities of informal care and self-care activities were used as predictors. In the final analyses, 803 KPE and 966 KBB were included. The results of logistic regression analyses showed different findings in two groups. Age, education, spouse's physicalhealth, and self-care activities for relationship with family and friends are significantly associated with intention to use LTC facilities among KPE. However, income, physical health of respondents, and relationship satisfaction with children are significantly related to intention of use LTC facilities in the group of KBB. This study suggests different LTC needs between KPE and KBB. Health care professionals and policy makers need to consider such differences to provide quality LTC care for them.