Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing.

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

Gender differences in estimated excess mortality during the COVID-19 pandemic in Thailand.

BACKGROUND: There is a limited body of research specifically examining gender inequality in excess mortality and its variations across age groups and geographical locations during the COVID-19 pandemic. This study aims to fill this gap by analyzing the patterns of gender inequality in excess all-cause mortality in Thailand during the COVID-19 pandemic. METHODS: Data pertaining to all-cause deaths and population between January 1, 2010, and December 31, 2021, were obtained from Thailand's Bureau of Registration Administration. A seasonal autoregressive integrated moving average (SARIMA) technique was used to estimate excess mortality during the pandemic between January 2020 to December 2021. Gender differential excess mortality was measured as the difference in age-standardized mortality rates between men and women. RESULTS: Our SARIMA-based estimate of all-cause mortality in Thailand during the COVID-19 pandemic amounted to 1,032,921 deaths, with COVID-19-related fatalities surpassing official figures by 1.64 times. The analysis revealed fluctuating patterns of excess and deficit in all-cause mortality rates across different phases of the pandemic, as well as among various age groups and regions. In 2020, the most pronounced gender disparity in excess all-cause mortality emerged in April, with 4.28 additional female deaths per 100,000, whereas in 2021, the peak gender gap transpired in August, with 7.52 more male deaths per 100,000. Individuals in the 80 + age group exhibited the largest gender gap for most of the observed period. Gender differences in excess mortality were uniform across regions and over the period observed. Bangkok showed the highest gender disparity during the peak of the fourth wave, with 24.18 more male deaths per 100,000. CONCLUSION: The findings indicate an overall presence of gender inequality in excess mortality during the COVID-19 pandemic in Thailand, observed across age groups and regions. These findings highlight the need for further attention to be paid to gender disparities in mortality and call for targeted interventions to address these disparities.

Measuring effects of height on the autonomic nervous system in middle-aged adolescents using the very low frequency band of heart rate variability.

Previous studies have revealed the association between falling accidents and stress, measured via heart rate variability (HRV). However, none have studied this association using the very low frequency (VLF) band of HRV in adolescent populations. This study aimed to fill this gap by recruiting 90 adolescents to perform a light physical task at varying heights. Heart rates were used to calculate short-term HRV. The results showed a positive correlation between VLF bands and parasympathetic indices and a negative correlation with sympathetic indices, demonstrating the balancing effects of the autonomic modulation associated with height. The lowest VLF bands were obtained as 79.25 ms2 at 10 m (p < 0.001) and 62.87 ms2 at 9 m (p < 0.001) for the experienced and non-experienced male groups, respectively, and 28.09 ms2 at 6 m (p = 0.001) for the female group. The results also suggested the need for a relatively lower height restriction for female adolescents than for males.Practitioner summary: Increased working heights can cause stress, which leads to falling accidents. The very low frequency band was shown to be associated with parasympathetic and sympathetic indices. Furthermore, the results suggested that the height limit necessary for providing a safe working environment may be lower for female adolescents than for males.Abbreviations: HRV: heart rate variability; VLF: very low frequency; ms2: absolute power; ANS: autonomic nervous system; PNS: parasympathetic nervous system; SNS: sympathetic nervous system; RR: intervals between two successive peaks of R waves; RMSSD: root mean square of successive RR interval differences; SD1: Poincaré plot index of standard deviation 1; SD2: Poincaré plot index of standard deviation 2; HF: high frequency; LF: low frequency; BMI: body mass index; ECG: electrocardiography; HR: heart rate; FFT: fast Fourier transformation; IQR: interquartile range; r: non-parametric partial correlation coefficient; η2: eta-squared; EM: experienced males; NM: non-experienced males; NF: non-experienced females; EEG: electroencephalogram.

Smoking and Drinking Behaviors among Older Adults: A Comparative Analysis of Three Southeast Asian Countries.

Studies on the two major health-risk behaviors of smoking tobacco and drinking alcohol among older populations, particularly in Southeast Asia, are limited. This paper provides comparative analyses of the prevalences and correlates of smoking tobacco and drinking alcohol among older people in Myanmar, Vietnam, and Thailand, using data from the latest available national aging surveys in the three countries. The analyses were conducted within a multivariate framework. Gender-specific results show that smoking tobacco and drinking alcohol are more common among older men than women in all three countries. However, the prevalence of smoking and drinking among men declines at older ages. The multivariate analyses reveal that a higher level of education has a significant negative association with smoking and drinking in all three settings, but the magnitude and the direction of associations vary considerably between countries and genders. Area of residence is correlated with smoking among men in all three countries, whereas co-residential arrangements with spouse, children, or both significantly reduce alcohol consumption among men in Myanmar and among men and women in Thailand. In all three settings a significant complementary relationship between smoking and drinking is observed. From a policy perspective this implies that a successful reduction in smoking could be achieved through anti-drinking campaigns and vice versa.

Intergenerational living arrangements in Myanmar and Thailand: a comparative analysis.

The present study compares living arrangements and related intergenerational support in Myanmar and Thailand based on recent national surveys of older persons in both countries and prior surveys in Thailand. The countries share relatively similar cultural contexts but differ radically in economic development. Substantially higher percentages of older persons in Myanmar currently coreside with their children and are considerably more likely to have non-coresident children living in the same locality. They are also less likely to live with a spouse and to have children living at a substantial distance. Older persons in Myanmar are much less likely to have phone contact with children living away and less likely to receive visits. Thai elders are considerably more likely to provide custodial care to grandchildren with absent parents and to live in skip generation households. Older Thais are also considerably more likely to receive substantial remittances from non-coresident children. The living arrangements of older age Thais in the past, however, more closely resembles the current situation in Myanmar. It appears that current differences are largely attributable to the more advanced Thai economic development through its associated impacts on migration, fertility and mortality. Contrasting political situations and government priorities also likely play a role. The results provide insights into the implications of development for older persons and suggest that if the recent course of political transformation and opening to the global economy continues in Myanmar, living arrangements there may well follow the trends in Thailand over past decades.

Poverty, noncommunicable diseases, and perceived health risks among older adults during the COVID-19 pandemic in urban Thailand.

The COVID-19 pandemic has had negative impacts on vulnerable populations worldwide. This study aimed to examine the association between the health worries of urban older people in Thailand and covariates related to income and non-income poverty, noncommunicable diseases (NCDs), and metabolic risk factors (MRFs). The study utilized the 2021 Survey on Housing and Support Services for Poor Older Adults, which sampled lower-income urban adults aged at least 55 years from five national regions. Bivariate analyses were performed to determine the relationships of NCDs and MRFs with the covariates. Then, binary logistic regression was used to analyze outcomes of perceived health risks including becoming infected with COVID-19, declining health status, and being unable to access health care. Higher educational attainment and income levels were observed to be negatively correlated with worse health status and the inability to access health care. Subjective household crowding consistently had a positive association with the three health concerns. Having MRFs was related only to concerns about health status and access to health care during the pandemic. Welfare and health policies need to improve their responsiveness to the needs of the older population, especially for protection from socioeconomic shocks such as those seen with the current pandemic.

Postural Changes on Heart Rate Variability among Older Population: A Preliminary Study.

OBJECTIVE: This study aims to investigate an association between body postures and autonomic nervous system (ANS) responses through analysis of short-term heart rate variability (HRV) data obtained through electrocardiography. METHODS: Forty older individuals were recruited to form the sample. HRV measurements were taken in three positions-sitting, supine, and standing-and compared. RESULTS: Results demonstrated statistically significant differences in the HRV parameters used to examine the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS), specifically in the measurements obtained from the sitting position and the supine position (P < 0.001 for PNS and P = 0.011 for SNS). The differences in these parameters were, however, negligible between the sitting and the standing positions. Moreover, the ANS responses obtained in the sitting position were strongly and positively correlated with those in the standing position (r = 0.854 for PNS and r = 0.794 for SNS). These results suggested that the PNS and SNS parameters obtained while sitting were likely to be affected by orthostatic hypotension in much the same way as those in the standing position, as compared to the supine position. CONCLUSIONS: As such, sitting may not be the best position for older individuals in the assessment of their autonomic responses, whereas the supine position is recommended as the baseline posture in the old-age population. These findings are useful for future research in clinical settings that require accuracy in the ANS responses as determined by the HRV measurements.

Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand.

OBJECTIVE: The COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects of the pandemic. This study aimed to explore the psychological well-being of older people, which is important especially in an ageing society categorised as low income or middle income due to the limits of economic and healthcare resources. SETTING: The impact of COVID-19 on older persons in Thailand, an online survey, taken across nine provinces within the five regions of the country. PARTICIPANTS: Information was collected from 1230 adults aged at least 60 years old.If an older person was illiterate, unable to access the internet or had a disability preventing them from responding to the survey, an intermediary residing in the community conducted the survey interview. PRIMARY AND SECONDARY OUTCOME MEASURES: The analysis focused on the worries of older adults and the factors associated with psychological distress experienced during the pandemic using logistic regression analysis. RESULTS: The majority of people aged at least 60 years old experienced psychological distress during COVID-19. Employment loss (OR 1.08, 95% CI 0.78 to 1.38), inadequate income (OR 1.77, 95% CI 1.28 to 2.44) and debt incursion (OR 2.74, 95% CI 1.57 to 4.80) were detrimental to psychological well-being. The negative changes in the perception of their health status (OR 1.92, 95% CI 1.23 to 2.99) and decreased life satisfaction (OR 1.49, 95% CI 0.45 to 1.87) also weighed on older Thais. The protective factors for psychological well-being were residing in rural areas (OR 0.46, 95% CI 0.35 to 0.61) and being married (OR 0.75, 95% CI 0.55 to 1.01). CONCLUSION: Observing the concerns of the older population is important for introducing policies that can alleviate their precarious financial and health statuses.

Education and grip strength among older Thai adults: A mediation analysis on health-related behaviours.

Abstract. BACKGROUND: Previous studies have investigated the effect of differential educational attainment at younger ages on health disparities among older adults, but how such an effect can be attenuated remains understudied. This study examines the mediating effects of four health-related behaviours, namely smoking, alcohol drinking, healthy eating, and physical activity, on the relationship between older adults' education and grip strength. METHODS: The study used data from 7,064 individuals aged 60 years and older who participated in the 2009 National Health Examination Survey of Thailand. To examine the relationships among education, health behaviours, and grip strength, multivariate regressions were performed following Baron and Kenny's approach. Generalized Structural Equation Modelling (SEM) was utilized to quantify the mediating effects. RESULTS: All else being equal, education is positively associated with stronger grip for both genders. The mediation analyses demonstrate that health-related behaviour plays an important role in the relationship between education and grip strength; however, the extent to which it mediates the effect of education varies with the type of health behaviour and between genders. Not smoking and engaging in physical activity can partly explain the relationship between education and grip strength in older men. Meanwhile, the consumption of fruits and vegetables and participation in regular physical activity significantly mediate the effect of education on grip strength in older women. CONCLUSION: Our study reaffirms the importance of educational opportunity in earlier life and recommends health-related behavioural modifications to improve health status in low-educated older adults.

Variation of Autonomic Nervous System Function by Age and Gender in Thai Ischemic Stroke Patients.

BACKGROUND: Ischemic stroke is one of the major causes of disability and mortality. Its effects on the autonomic nervous system (ANS) through nonlinear heart rate variability (HRV) and pulse transit time (PTT) have not been well explored among Thai patients. OBJECTIVE: This study aims to demonstrate the association between ANS and ischemic stroke through nonlinear HRV and PTT. METHODS: In total, 111 patients were enrolled in the study and their short-term HRV and PTT data were collected. RESULTS: Parasympathetic tone was higher in elderly patients (≥60 years). The elderly patients had a higher SD1 but lower SD2 and SD2/SD1 than the younger patients, and a similar pattern was found in the female patients compared to the male patients. These findings were supported by the results of the Poincaré plots. Older and female patients had circular plots and approximately round plots, respectively. Moreover, the parasympathetic nervous system (PNS) response was moderate and positively associated with SD1 (r = 0.47, p < 0.001) and PTT (r = 0.29, p = 0.002), and negatively associated with SD2 and SD2/SD1 (r = -0.47, p < 0.001), after controlling for age and sex. CONCLUSIONS: The PNS response was predominant in older and female patients whereas the sympathetic response was lower than in the younger and male patients, which reflected certain characteristics of ANS response to ischemic stroke. Moreover, nonlinear parameters of SD1, SD2, SD2/SD1, and Poincaré plots including PTT are useful and recommended in investigating ANS, particularly in PNS, among ischemic stroke patients.

Extent of aging across education and income subgroups in Thailand: Application of a characteristic-based age approach.

AIM: This study aimed to identify differences in physical performance across various socioeconomic groups within an older population and to convert those differences into a common metric to facilitate comparisons of aging speed across socioeconomic subgroups. METHODS: We employed data from the 2009 National Health Examination Survey of Thailand. Physical performance was assessed using three health characteristics: grip strength, as a measure of upper body strength; walking speed, as a measure of lower body strength; and a combined measure of grip strength and walking speed, to capture the strength of the whole body. Education level and income were used to distinguish socioeconomic subpopulations. We followed a characteristic-based age approach to transform these population characteristics, which were measured in different units, into a common and comparable aging metric, referred to as α - age. RESULTS: Physical aging trajectories varied by sex and socioeconomic status. Some education, particularly secondary or higher education levels, was significantly associated with greater physical strength in older age for both men and women, whereas higher income was significantly associated with physical strength only for men. Across the three health characteristics, having a primary education slowed age-related declines by up to 6.3 years among men and 2.8 years among women, whereas being in a higher income group slowed age-related declines by 8.2 years among men and up to 4.9 years among women. CONCLUSIONS: This study adds new evidence from a developing Asian country regarding the difference in aging speeds across subpopulations associated with different levels of education and income.

Rural-urban gaps in health care utilization among older Thais: The role of family support.

This study examined rural-urban differences in health visits among older Thais utilizing Andersen's model. Data were drawn from the 2011 Survey of Older Persons in Thailand of adults 50 years and older (N = 56,435). Logistic regression models examine individuals' predisposing, enabling, and health need factors for explaining older adults' health care use. Approximately 50% of older adults sought health care but urban dwellers were more likely than rural dwellers to seek health care (54.8% vs. 49.7%). Predisposing factors and health needs narrow the rural-urban gap while enabling factors widened the gap in health visits. The receipt of financial support from children presented a significant moderating effect in the rural-urban divide of health care use. Despite Thailand's universal access to health care, geographic inequity in health care utilization withstands. Findings suggest investments in education, income security, social participation, and healthy lifestyle promotion can improve health care utilization. Furthermore, results suggest a need for continued investigation of the role of family support in bridging the rural-urban divide in the health of older Thais.

Associations of Grip Strength and Change in Grip Strength With All-Cause and Cardiovascular Mortality in a European Older Population.

OBJECTIVE: (1) To examine the associations between 3 measures of grip strength: static grip strength, change in grip strength, and the combination of grip strength and its change, with all-cause and cardiovascular mortality, and (2) to determine which measure is the most powerful predictor of all-cause and cardiovascular mortality among the European older population. METHOD: Data come from the first 4 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). A Cox proportional hazard model and a competing risk regression model were used to assess the associations. To determine the best predictor, Akaike information criterion was applied. RESULTS: Grip strength and the combination of grip strength and its change were associated with all-cause and cardiovascular mortality. Change in grip strength was correlated with only all-cause mortality. Among the 3 measures, the static measure of grip strength was the best predictor of cardiovascular mortality whereas the combined measure is that of all-cause mortality. DISCUSSION: Grip strength is a significant indicator of all-cause and cardiovascular mortality. The combination of grip strength and its change can be used to increase the accuracy for prediction of all-cause mortality among older persons.

Preparations for Old Age and Well-Being in Later Life in Thailand: Gender Matters?

Data from the 2011 Survey of Older Persons in Thailand examines the association between preparations for old age (financial, health, caregiving, living arrangements, and spiritual) and three measures of well-being: financial satisfaction, life satisfaction, and physical health. The study further explores the role of social stratification and the gendered nature of these relationships. The sample ( N = 10,235) is restricted to adults 60 years and above, who are retired and answered the survey independently. Multivariate logistic regression analyses indicate that different forms of preparation are positively associated with post-retirement well-being for men and women but socioeconomic resources are positively associated with all three well-being outcomes. Furthermore, for women, there are significant negative interaction effects of income and financial preparation on life satisfaction, as well as negative interaction effects of disability and caregiver preparation on self-rated health. Implications for long-term care, socioeconomic inequality, and gender inequality in paid labor are discussed.

Caring for Thai Older Persons With Long-Term Care Needs.

OBJECTIVE: To provide a situation analysis of recent long-term care (LTC) needs among older persons in Thailand. METHOD: The 2014 Survey of Older Persons in Thailand (SOPT) provides data to assess patterns of caregiving, whether care needs are met, and who are main caregivers for older Thais. We examine how types of familial and nonfamilial caregivers are associated with the well-being of older persons. RESULTS: The need for LTC increases sharply with age and is more common among women than men. Spouses and children constitute approximately 90% of main caregivers. The association of a family member as the main caregiver and education or value of assets is quite weak underscoring the general normative prescription for family members to serve as care providers. DISCUSSION: Thailand is experiencing acute population aging but empirical evidence to support LTC needs remains lacking. This analysis helps close the gap.

Social Participation and Disaster Risk Reduction Behaviors in Tsunami Prone Areas.

This paper examines the relationships between social participation and disaster risk reduction actions. A survey of 557 households in tsunami prone areas in Phang Nga, Thailand was conducted following the 2012 Indian Ocean earthquakes. We use a multivariate probit model to jointly estimate the likelihood of undertaking three responses to earthquake and tsunami hazards (namely, (1) following disaster-related news closely, (2) preparing emergency kits and/or having a family emergency plan, and (3) having an intention to migrate) and community participation. We find that those who experienced losses from the 2004 tsunami are more likely to participate in community activities and respond to earthquake hazards. Compared to men, women are more likely to prepare emergency kits and/or have an emergency plan and have a greater intention to migrate. Living in a community with a higher proportion of women with tertiary education increases the probability of engaging in community activities and carrying out disaster risk reduction measures. Individuals who participate in village-based activities are 5.2% more likely to undertake all three risk reduction actions compared to those not engaging in community activities. This implies that encouraging participation in community activities can have positive externalities in disaster mitigation.

How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand.

Living arrangements and family support for older persons have become an increasingly important policy concern in developing and rapidly aging Asia. Formulating a sound elderly care policy for the region will benefit from empirically examining how living arrangements, particularly coresidence, and intergenerational exchanges of financial, instrumental, and emotional support are associated with old-age psychological health. This study analyzes data from nationally representative aging surveys in Myanmar, Vietnam, and Thailand for 2011-2012 to offer a comparative perspective from Southeast Asia where various kinship systems coexist. Results suggest that coresidence with a child of culturally preferred gender significantly improves the emotional health of Vietnamese and Thai elders but with different implications. In Vietnam, living with a married son is more beneficial to parents' psychological wellbeing than living with other children. In Thailand, coresidence regardless of the child's gender improves old-age psychological wellbeing but living with a daughter brings greater benefits than living only with son. Evidence points to the importance of understanding the dominant kinship system that may shape normative filial expectations and gender role expectations within the family. In Vietnam and Thailand, the positive association holds even after intergenerational support is controlled, suggesting that the value of culturally preferred coresidence goes beyond practical functions. In Myanmar, there are almost no significant differences in psychological wellbeing among elderly across various living arrangements, except between coresidence and network living arrangements. For all settings, we do not find evidence in support of network family arrangements as a complete substitute for coresidence in terms of promoting old-age psychological wellbeing after filial support is controlled. Our study highlights important cultural nuances for theorizing the nature of the relationship between living arrangements and old-age psychological health, and presents the important need for more rigorous investigation of the causal links between these two phenomena in future research.