The resiliency of noncommunicable diseases services during the public health crisis: a lesson from Bangkok, Thailand.

BACKGROUND: The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. METHODS: Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. RESULTS: The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. CONCLUSION: During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.

QUALITY OF LIFE AND FEAR OF FALLING AMONG AN AGING POPULATION IN SEMI RURAL, THAILAND.

BACKGROUND: Thailand is the country where large numbers of old population are living in rural areas. Multiple factors are influencing the health of old people but falling is the biggest cause affecting their quality of life. This study explores the relationship between the quality of life, and fear of fall among aging people in the semi-rural, Thailand. METHODS: A cross sectional study was conducted on 394 old aged individuals living in Nakornnayok Province. Participants were selected through simple random method (SRM) from village population list. Old people were interviewed by adapting World Health Organization quality of life instrument-older module (WHOQOL-OLD) to access the quality of life. Multiple logistic regression analysis was applied to identify factors associated with QOL. RESULTS: Above half of respondents during this study were female, married, educated with age 70.45 ± 6.99. Majority of aging had low income and were not enrolled for their health check-up at hospitals on regular basis. Over a half of them suffered from chronic diseases, and one third of them were using instrumental aids such as visual glasses, walker support, wheel chair and hearing aids etc. Majority, (70%) of the participants was living in safe houses but (34%) reported fall at least one time in past year. Mean of fear of fall score (FFS) was calculated (26.97 ± 4.31) and mean of FFS during using public transportation was (9.8756 ± 2.19467). Two third of aging population reported the moderate quality of life (QOL). CONCLUSIONS: Study has concluded that the QOL in aging people is related with household safety and confidence to use public transportation.

Factors Influencing Access to Health Services among Chronically Ill Older Adults with Physical Disabilities in the Era of the COVID-19 Outbreak.

Chronically ill older adults with physical disabilities frequently face difficulties in their daily lives and require essential health service access, especially in the COVID-19 context. This study aimed to examine the association between social support, perception of benefits due to disability and access to health services among chronically ill older adults with physical disabilities during this crisis in Thailand. A total of 276 chronically ill older adults with physical disabilities were included in this cross-sectional study. Self-reported questionnaires were assessed through multi-stage random sampling. Correlations between the independent variables and health service access were examined using multiple regression analysis. Of the respondents, 159 were female (59.6%). Most participants perceived benefits (58.8%) and access to health services (56.2%) at good levels, while social support was at a moderate level (47.9%). Stepwise multiple regression analysis showed that social support (ß = 0.351), perception of benefits (ß = 0.257) and age (ß = 0.167) were positively correlated with health service access. The findings are relevant for health care providers and multi-professional teams, who should enhance older adults' social support and perception of benefits to improve their access to health services, particularly among chronically ill older adults with physical disabilities, in the era of COVID-19.

Factors Predicting the Coronavirus Disease 2019 Preventive Behaviors of Older Adults: A Cross-Sectional Study in Bangkok, Thailand.

The coronavirus disease 2019 (COVID-19) pandemic has affected the health behaviors of older adults. Thus, the factors predicting the COVID-19 preventive behaviors of older adults during the COVID-19 outbreak should be examined. Therefore, this study aimed to assess the COVID-19 preventive behaviors of older adults and explore the factors predicting these. A cross-sectional study was performed with 400 older adults who were selected using the cluster sampling technique. The associations of all variables in preventing COVID-19 infection with COVID-19 preventive behaviors were examined using stepwise multiple regression. The study results revealed that 70.8% of the study participants had high levels of COVID-19 preventive behaviors. Among these, self-efficacy in preventing COVID-19 infection (ß = 0.224) showed the highest ability to predict COVID-19 preventive behaviors, followed by COVID-19 response efficacy (ß = 0.171), knowledge about COVID-19 (ß = 0.110), and gender (ß = -0.102). Older adults adopted protective behaviors at the beginning of the COVID-19 pandemic. The predictors of these behaviors should be considered while designing and developing appropriate COVID-19 preventive behavior interventions, aimed at inducing behavioral modifications to reduce further infection with and spread of COVID-19.

Effects of the Older Family Network Program on Improving Quality of Life Among Older Adults in Thailand.

BACKGROUND: The evidence of promoting family members' health care for older adults by applying family networks and theory of planned behavior will lead to mental health and lower the quality of life among older adults in rural community in Thailand is unclear. OBJECTIVE: The study aimed to assess the effects of health promotion among older adults using an aging family network program to reduce depression and improve quality of life (QOL) among older adults. PATIENTS AND METHODS: This quasi-experimental study was enrolled on one hundred and ten older adults and their family members. Fifty-five older adult participants joined the health promoting program using family member involvement. This program trained them to change health behaviors such as eating healthy food, exercising, emotion management and disability preventive activities to reduce dementia, stroke and falls. The program was conducted in a rural community for 12 months. A comparison group program conducted usual health promoting activities by health personnel. They evaluated quality of life (QOL) using WHOQOL-OLD measurement, and 30-item geriatric depression scale before implementing interventions and after interventions at 9th and 12th months. Data were analyzed using general linear mixed model analysis. RESULTS: After the intervention, social support and perception of health care from family members were significantly improved at the 9th month. At the 12th month, overall QOL, sensory ability, social participation, intimacy, social support, and perception of health care from family members significantly improved. Depression was also reduced at the 12th month. CONCLUSION: These findings demonstrated that health promotion using family members improved QOL and reduced depression long term. Policymakers should implement programs to improve QOL among older adults. They need to improve the involvement of family members when conducting health promotion among older adults and support funding due to conduct on weekends or in the evening.

Health Literacy among Older Adults during COVID-19 Pandemic: A Cross-Sectional Study in an Urban Community in Thailand.

BACKGROUND: This study assessed health literacy (HL) and its associated factors among older adults during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included older adults in urban communities in Thailand. We randomly selected a total of 421 older adults and performed multiple logistic regression analyses. RESULTS: The average age of the respondents was 70.0±7.1 years. Most respondents were female, married, had a low education level (primary school or lower), were unemployed, and had sufficient income. We observed nonproficient and proficient HL levels in 56.1% and 43.9% of respondents, respectively. The factors influencing HL included attending healthcare services at a tertiary hospital, good accessibility to COVID-19 prevention materials and health information, and provision of a high level of social support from neighbors and health personnel. CONCLUSION: The results of our study provide important information on the outcome of accessibility and social support among older adults in an urban community during the COVID-19 pandemic. In addition, access to health services, prevention equipment, and information was important for people at risk of HL and helped promote good behaviors.

Factors Associated with Good COVID-19 Preventive Behaviors Among Older Adults in Urban Communities in Thailand.

INTRODUCTION/OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has affected mobility and mortality entire age, especially older adults. The COVID-19 preventive behaviors among older adults during the pandemic should be determined. To our knowledge, little is known about the preventive behavior during the COVID-19 pandemic among older adults living in urban areas in Thailand and the factors predicted to their behavior. Hence, the present study aimed to assess COVID-19 preventive behaviors among older adults and to identify the associated factors. METHODS: This cross-sectional study included 421 participants aged ≥60 years. Data were analyzed using descriptive statistics, binary and multiple logistic regression analysis. RESULTS: We found that 321 (72.6%) of the participants had good COVID-19 preventive behaviors. Moreover, 83.4% of the participants had good family support and 58.2% had easy access to health information. Only sufficient income (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.04-2.97), easy access to health services (OR: 3.66, 95% CI: 1.42-9.45) and protective material (OR: 1.98, 95% CI: 1.14-3.45), and good family support (OR: 2.05, 95% CI: 1.10-3.82) were associated with good COVID-19 preventive behaviors. In contrast, health literacy, access to health information, and neighbor and health personnel support were not associated with COVID-19 preventive behaviors. CONCLUSION: Based on the present results, interdisciplinary healthcare teams should consider social support, and access to healthcare when developing interventions for encouraging and promoting health outcomes in order to improve physical and psychological COVID-19 preventive behaviors, particularly among elderly people living in urban communities during the COVID-19 pandemic.

Influence of Socioeconomic Factors on Daily Life Activities and Quality of Life of Thai Elderly.

BACKGROUND: The increasing number of older people is a significant issue in Thailand, resulted in growing demands of health and social welfare services. The study aim was to explore the influence of socioeconomic factors on activities of daily living and quality of life of Thai seniors. DESIGN AND METHODS: Using randomised cluster sampling, one province was sampled from each of the Central, North, Northeast and South regions, then one subdistrict sampled in each province, and a household survey used to identify the sample of 1678 seniors aged 60 years and over. The Mann-Whitney U-test and binary logistic regression were used to compare and determine the association of socioeconomic variables on quality of life and activities of daily living. RESULTS: The findings showed that sociodemographic and socioeconomic factors were significantly related to functional capacity of daily living. Education levels were strongly associated with daily life activities, with 3.55 adjusted ORs for respondents with secondary school education. Gender was important, with females comprising 61% of dependent respondents but only 47% of independent respondents. Seniors with low incomes were more likely to be anxious in the past, present and future and less likely to accept death in the late stage, with 1.40 Adjusted ORs (95%CI: 1.02-1.92), and 0.72 (95%CI: 0.53-0.98), respectively. However, they were more likely to engage in social activities. CONCLUSIONS: While socioeconomic factors strongly indicated the functional capacity to live independently, a good quality of life also required other factors leading to happiness and life satisfaction.