Older Thai Research Articles

85 Exploring the Feasibility of the Adapted Lifestyle - Integrated Functional Exercise (ALIFE) Programme to Prevent Falls among Older Adults in Thailand

Abstract Background Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population. Method To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted. Results Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested. Conclusion The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.

Ergonomic Recommendation of Suitable Toilet Seat Height for Older Thai People

Objective: This study aimed to determine the main factors affecting older people as they rise from a toilet seat and to identify the suitable toilet seat height for this population.Material and Methods: Data from 342 older people both male and female aged 60 years and older were used to design a mock-up toilet with a specified seat width according to the 95th percentile of hip breadth. The data of lower leg length were used to design toilet seat height levels in the second phase in another 30 older participants at 100.0%, 110.0% and 120.0% of an individual’s lower leg length (LLL). Rectus femoris and gluteus maximus muscle activity, time taken while rising, pressure under the thighs and satisfaction of the older participants were compared across three toilet seat height levels; using the repeated analysis measurements of variance. These three potential factors were then analyzed together with the prioritized factor indicated by the specialists using the Analytic Hierarchy Process.Results: Rectus femoris muscle activity, time taken while rising, and satisfaction of the older participants in rising from toilet seat heights 100.0, 110.0 and 120.0% LLL were significantly different (p-value<0.05).Conclusion: It was found that the suitable toilet seat height level for older people for industrial ergonomic purposes was at 110.0% LLL, which was also equivalent to the 95th percentile of male and female LLL.

Predisposing and enabling factors associated with public denture service utilization among older Thai people: a cross-sectional population-based study

BackgroundsTooth loss is one of the major oral health problems among older Thai people. However, there is the existence of socioeconomic-related inequalities in dental service utilization, especially denture service. The aim of this study was to assess the determinants associated with inequalities in denture service utilization among older Thai people using the Andersen Behavioural model.MethodThis cross-sectional study involved secondary data analysis of the 2014 survey of older Thai people (N = 38,695). The dependent variable was a public denture service utilization over the past 5 years. Determinants were classified as predisposing and enabling factors. Predisposing variables included age, sex, education, economic condition and dependency status. Enabling variables included working status, health behaviours, health care utilization experience and social/community support. Data were analysed by using bivariate and multivariable analyses at α = 0.05. For bivariate analysis, chi-square test was used to determine the association between dependent and each independent variable. Then, all variables were incorporated into a multivariable binary logistic regression.ResultsThe odds of denture service utilization were significantly higher for individuals who were older, female, and had a higher educational level and health-promoting behaviors. A positive dose-response relationship was demonstrated between denture service utilization and increased quartile of household assets.ConclusionsPredisposing variables had a greater impact than enabling variables in denture service utilization among older Thai people. Despite free public denture service, socioeconomic-related inequalities persist. The government needs to reduce socioeconomic disparities to improve denture treatment inequality.

Exploring caregivers' perspectives on improving care for older people at the end of life in Thailand

Older people in Thailand receive general medical and social care at the end of life, and many rarely access palliative services. In light of this, improving the quality of care for the ageing population relies on addressing the needs of family caregivers, who provide the majority of care in a home setting. Understanding caregivers' perspectives when caring for a friend or relative will help to improve the quality of care that they provide. To explore caregivers' perspectives on improving care for older people in Thailand in the palliative stage. A qualitative study using in-depth interviews and observation of 10 older people in the palliative stage and their caregivers was undertaken. Data were analysed using content analysis. Data analysis revealed three themes: caregivers cared to repay the older person's previous kindness, caregivers cared and changed their caregiving behaviour to minimise the older person's perception of being abandoned or being a burden, and to follow Thai ancestral traditions, so that the older person could die peacefully. This study provides specific instructions for those who provide care for older Thai people in the palliative stage. Finding ways to address caregivers' perspectives on improving care quality could enhance the experience of care recipients.

Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation.

The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF). This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥ 65years) patients with NVAF. Among the 3218 participants that were enrolled, 61.0% were aged older than 65years. Mean HRQoL was lower in older than in younger patients (0.72 ± 0.26 vs. 0.84 ± 0.20; p < 0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p = 0.006) and taking warfarin (p = 0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p < 0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p < 0.001). Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.

Frailty index to predict all-cause mortality in Thai community-dwelling older population: A result from a National Health Examination Survey cohort

BackgroundFrailty is a clinical state of increased vulnerability from aging-associated decline. We aimed to determine if a Thai Frailty Index predicted all-cause mortality in community-dwelling older Thais when accounting for age, gender and socioeconomic status. MethodsData of 8195 subjects aged 60 years and over from the Fourth Thai National Health Examination Survey were used to create the Thai Frailty Index by calculating the ratio of accumulated deficits using a cut-off point of 0.25 to define frailty. The associations were explored using Cox proportional hazard models. ResultsThe mean age of participants was 69.2 years (SD 6.8). The prevalence of frailty was 22.1%. The Thai Frailty Index significantly predicted mortality (hazard ratio = 2.34, 95% CI 2.10–2.61, p < 0.001). The association between frailty and mortality was stronger in males (hazard ratio = 2.71, 95% CI 2.33–3.16). Higher wealth status had a protective effect among non-frail older adults but not among frail ones. ConclusionsIn community-dwelling older Thai adults, the Thai Frailty Index demonstrated a high prevalence of frailty and predicted mortality. Frail older Thai adults did not earn the protective effect of reducing mortality with higher socioeconomic status. Maintaining health rather than accumulating wealth may be better for a longer healthier life for older people in middle income countries.

Moving on from adversity: an understanding of resilience in rural Thai older people

ABSTRACTObjective: This study explored the concept of resilience in rural Thai older people.Method: The study was exploratory and descriptive in design. Ethnographic fieldwork was undertaken in four rural Thai communities. Non-participant observation (340 h) and 35 semi-structured interviews with older people enabled the collection of qualitative data. Nvivo 10 was used to collate and organise the qualitative data. Data analysis was conducted thematically.Results: One major core theme and five qualitative sub-themes emerged from the data related to the theoretical construct of rural Thai elders’ resilience. The subthemes of the core theme ‘moving on’ include: (1) keep doing a job and earning a living; (2) having Jai-Yai to fight for life; (3) accepting a situation (Plong and Taam-Jai); (4) expressing difficulty; and (5) connecting with people, beliefs and customs.Conclusion: The concept of ‘moving on’ provides a subcultural viewpoint of older rural Thai people in the face of adversity in their everyday lives. Previous conceptions of resilience and older people focus on it being bouncing back from adversity. Bouncing back implies a setback, whereas ‘moving on’ found in this study is the process of continuous movement forward and getting on with one's life despite difficulties.

Older Thai Peoples’ Perceptions and Experiences of Major Depression

BACKGROUND: Depressive disorders are common mental health problems and may be disabling among the general older population. Although older people have significant symptoms of depression, the symptoms are likely to be underreported. The condition often co-exist along with somatic ill and has often been unrecognized. The aim of the study was to explore and understand the perceptions and experiences of older Thai people diagnosed with major depressive disorder.METHODS: A qualitative inductive research design was used and latent content analysis was utilized. The data were collected through face-to-face, in-depth interviews. Fourteen older people diagnosed with major depressive disorder were selected for participant using purposive sampling. FINDINGS: Older Thai peoples’ perceptions and experiences of depression were abstracted into two themes. First theme was leading a life in detachment, which included three subthemes: living with meaninglessness, holding distress with one’s self, and feeling judged by surrounded people. The second theme was inconvenience of approaching mental health treatment, which included two subthemes: sensing an unapproachable health care service, and lacking knowledge about clinical depression.CONCLUSION: Older Thai peoples’ perceptions and experiences of major depression were affected with high level suspected existential loneliness that might even be worse in a collect oriented society as in the Thai context. Further, it seem hard to approach the mental health care. The central reason for this is interpreted as lack of mental health literacy, and in this case, specifically, knowledge on depression. Future studies should focus on relatives’ experiences of living with an older family member that suffered from major depression, and on the state of mental health literacy in the rural Thai population.

A secondary analysis of atypical presentations of older patients with infection in the emergency department of a tertiary care hospital in Thailand

Abstract Background Classic symptoms of illness are often absent in older adults, delaying diagnosis and management, and resulting in unfavorable outcomes. Objectives To determine the prevalence of atypical presentations by older Thai adults with infections in the emergency department (ED) of a tertiary care hospital, and to identify factors associated with atypical presentations in such patients. Methods We performed a secondary analysis of a retrospective cohort observational study of atypical presentations of patients aged ≥65 years in the ED using a subset of data first reported in the Archives of Gerontology and Geriatrics in 2015; 62:97-102. Results The prevalence of atypical presentations was 35% of those with infectious diseases (64 of 183 cases). Pneumonia was the most common (30%). We identified 4 associated risk factors: complicated urinary tract infection (UTI) (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.75,11. 78; P = 0.002), cancer (OR 2.64; 95% CI 1.07, 6.53; P = 0.04), dementia (OR 6.66; 95% CI 1.47, 30.11; P = 0.01), and pulse rate &gt;90 beats/min (OR 2.06; 95% CI 1.01, 4.22; P = 0.04). Infective diarrhea was protective (OR 0.27; 95% CI 0.09, 0.8; P = 0.02). Conclusions Atypical presentations of infectious diseases by older Thai patients in the ED accounted for about one third of those with infectious disease. Associated risk factors were complicated UTI, cancer, dementia, and increased pulse rate. Older patients with these factors who have uncertain diagnoses should be considered for hospitalization because the absence of classic symptoms does not exclude life-threatening infections.

Testing a Model of Sodium Reduction in Hypertensive Older Thai Adults

ABSTRACTHypertensive older adults will benefit if there is a clear understanding of the factors related to sodium reduction. That would raise awareness of the causes, consequently reducing many health risks, lowering health care costs, and diminishing economic and social burden from high blood pressure. This study explored predictors of urinary sodium excretion. A cross-sectional, correlational study was conducted in 312 hypertensive older Thai adults. Questionnaires related to knowledge, self-care agency, self-care behavior of sodium reduction, and 24-hour urinary sodium analyses were used, followed by the application of structural equation modeling and the Analysis of Moment Structures program. Self-care agency, knowledge, self-care behavior, rural/urban location, and education accounted for 61% of urinary sodium excretion. Self-care agency, knowledge, and self-care behavior were the main predictors in the urinary sodium excretion model. This study suggests establishing supportive educative sodium reduction-related programs that improve knowledge and enhance self-care agency, as well as a comparison of the changes of sodium reduction self-care behavior and urinary sodium excretion over time after the intervention.

The Role of Communication Perceptions in the Mental Health of Older Adults: Views From Thailand and the United States

ABSTRACTThis study examines age ingroup and outgroup communication perceptions of older Thai and American adults to assess whether communication perceptions of self and others are associated with mental health outcomes such as personal self-esteem, collective self-esteem, and life satisfaction. Results suggest that more accommodation by same-age older others leads to greater personal self-esteem, greater group esteem, and greater life satisfaction, while more nonaccommodation by younger others leads to less life satisfaction for the Thais and Americans. More overaccommodation by younger others was found to lead to less personal self-esteem and less life satisfaction for the sample as a whole. Discriminant loadings show life satisfaction was the most important variable in distinguishing between the prototypical older Thai and American respondent. The overall profile shows the typical Thai older adult participants as perceiving members of their own age ingroup as communicatively avoidant and overaccommodating while also experiencing lower collective self-esteem and life satisfaction. Typical older Americans tended to be associated with higher collective self-esteem and life satisfaction.

Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis

This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.

Estimate of Impact on the Oral Health-Related Quality of Life of Older Thai People by the Provision of Dentures through the Royal Project

Purpose. To estimate the impact of the provision of dentures to Thai older people by the Royal Project on their oral health-related quality of life. Methods. A purposive cross-sectional study of a sample of 812 subjects was conducted. The Oral Impacts on Daily Performances (OIDP) measure was used to assess the oral health-related quality of life. Results. Four groups of older people with different tooth types were studied. 216 (26.6%) had natural teeth (NT). 189 (23.3%) had natural and replaced teeth (NRT). 167 (20.6%) had below the minimum number of teeth but had no dentures (Edent) and 240 were edentate with complete dentures provided by the Royal Project (ECD) (29.6%). Overall, 36.5% had at least one oral impact. Eating was the most affected oral impact. When compared to the group with natural teeth (NT), the Edent group was significantly more likely to report having impacts on eating OR = 6.5 (3.9–10.9), speaking clearly OR = 43.7 (12.7–15.07), emotional stability OR = 16.5 (6.0–45.6), and social contacts OR = 4.6 (2.2–9.5) (p < 0.001). Conclusion. Those who are edentulous are much more likely to have an oral impact on their daily performances than those provided dentures. Provision of dentures may lead to improvement of considerable oral impacts.

Delirium in critical care: a study of incidence, prevalence, and associated factors in the tertiary care hospital of older Thai adults

Objectives: Delirium is a common condition in older adults which can have devastating outcomes. The studies about delirium in intensive care units (ICU) are relatively rare compared to studies in the non-ICU setting. This study aimed to study the prevalence, incidence, and risk factors of delirium among older Thai adults in ICU.Method: Participants were older patients who were admitted to the ICU of Srinagarind Medical School, KhonKaen, Thailand from May 2013 to August 2014. Baseline characteristics were collected. Delirium was rated by trained clinical researchers using the Confusion Assessment Method for the ICU (CAM-ICU). Demographic data were analyzed using descriptive statistics. Regression analyses were used to analyze the outcomes.Results: Delirium occurred in 44 of 99 patients (44.4%) with an incidence rate of 22.2% (22/99). The prevalence of delirium in mechanically ventilated patients was 62.5% (30/48). The majority of the patients had delirium within five days of ICU admission. Seven independent predisposing factors were identified using bivariate regressions: age, functional status, disease severity, having pneumonia, cognitive impairment, depression, or previous stroke. Numbers of additional drugs, bed changes, physical restraints, sleep deprivation, use of bladder catheters, and patients with mechanical ventilators were independent precipitating factors. For multivariate regressions, previous stroke, multiple bed changes, and physical restraints were the significant factors.Conclusion: The prevalence and incidence of delirium of older adults in the ICU setting in this study was high and comparable to prior studies. There are several significant risk factors associated with delirium which could be modified. These factors should be considered when designing effective preventive strategies of delirium.

Gender differences in health expectancies across the disablement process among older Thais.

ObjectivesTo estimate health expectancies based on measures that more fully cover the stages in the disablement process for the older Thais and examine gender differences in these health expectancies.MethodsHealth expectancies by genders using Sullivan’s method were computed from the fourth Thai National Health Examination Survey conducted in 2009. A total of 9,210 participants aged 60 years and older were included in the analysis. Health measures included chronic diseases; cognitive impairment; depression; disability in instrumental activities of daily living (IADL); and disability in activities of daily living (ADL).ResultsThe average number of years lived with and without morbidity and disability as measured by multiple dimensions of health varied and gender differences were not consistent across measures. At age 60, males could expect to live the most years on average free of depression (18.6 years) and ADL disability (18.6 years) and the least years free of chronic diseases (9.1 years). Females, on the contrary, could expect to live the most years free of ADL disability (21.7 years) and the least years free of IADL disability (8.1 years), and they consistently spent more years with all forms of morbidity and disability. Finally, and for both genders, years lived with cognitive impairment, depression and ADL disability were almost constant with increasing age.ConclusionThis study adds knowledge of gender differences in healthy life expectancy in the older Thai population using a wider spectrum of health which provides useful information to diverse policy audiences.

Strategies for Successful Ageing Living Alone

The purpose of this qualitative study, conducted in Thailand, was to identify strategies for older adults to live alone happily, with dignity, security, and independence. Purposive sampling techniques were used to recruit participants from 12 provinces throughout Thailand. The sample included three groups: older Thai people living alone (n = 1,087), clinician who working with Thai older adults (n = 149), and administrators working in aged care and support services in Thailand (n = 83). Data were collected using structured interview guides. Content analysis was used to identify and develop the study findings. Most of the older Thai people living alone were single, widowed or divorced with few wanting to remain living alone. The large majority of participants needed government assistance to manage their activities of daily living including access to health and public services. Participants wanted aged care and support services to assist with their living arrangements, organise community activities, and provide home visits. Moreover, they wanted their families to visit them and provide financial support and care for them when they were ill. These older adults experienced living alone positively and negatively. Some participants felt proud, dignified, and independent. Other participants felt that living alone resulted in poorer health status, particularly emotional problems, especially for those who were not living alone by choice. These participants reported feeling lonely, bored, irritated, sad, and sorrowful. This group of older Thai adults had limited interaction with their families and the wider community. From this study, four strategies were identified to assist older Thai adults to live alone happily, safely and with a sense of dignity, security, and value. These strategies are: ensuring individual choice, maintaining family support, developing community value, and advocating for over-arching government policy support of aged care. A high number of older adults live alone in Thailand and this presents a big challenge for both these individuals and the community in which they live. If this important group in Thai society is to live alone happily and successfully, it needs to be additional assistance to ensure they are supported by families, communities, and government departments.

Knowledge Sharing and Management via Online Social Networks: A Prototype for Older People in Thailand

Knowledge sharing via online social networks may not just be for younger people or people who are still working. This study shows that a prototype of an online social network for older people in Thailand can be of importance for people at this age. The study used qualitative research methods to investigate attitudes of older Thai people who live in the capital city and its surrounding towards social networks and knowledge sharing. This particular online social network prototype was designed, developed and tested by researchers then by experts before conducting the experimental tests with the real sample groups of older people. The researchers conducted the second experimental tests as a follow up study. From the results of UAT (User Acceptance Test) it can be implied that this online social network successfully met the needs of older Thai people in this area. 

Psychometric Properties of the Dietary Salt Reduction Self-Care Behavior Scale.

Valid, reliable, and culturally-specific scales to measure salt reduction self-care behavior in older adults are needed. The purpose of this study was to develop the Dietary Salt Reduction Self-Care Behavior Scale (DSR-SCB) for use in hypertensive older adults with Orem's self-care deficit theory as a base. Exploratory factor analysis, Rasch modeling, and reliability were performed on data from 242 older Thai adults. Nine items loaded on one factor (factor loadings = 0.63 to 0.79) and accounted for 52.28% of the variance (Eigenvalue = 4.71). The Kaiser-Meyer-Olkin method of sampling adequacy was 0.89, and the Bartlett's test showed significance (χ2 (df =36) = 916.48, p < 0.0001). Infit and outfit mean squares ranged from 0.81 to 1.25, while infit and outfit standardized mean squares were located at ±2. Cronbach's alpha was 0.88. The 9-item DSR-SCB is a short and reliable scale.

Osteoporosis Knowledge, Health Beliefs, and Preventive Behavior: A Comparison Between Younger and Older Women Living in a Rural Area

Osteoporosis is widely recognized as one of the major health problems in postmenopausal and older women. Raising awareness about osteoporosis is an important step in examining how much people know about the disease and their attitudes toward preventive behaviors. The aims of the present study were to examine the differences in osteoporosis knowledge, health beliefs, and preventive behaviors between younger and older Thai women, and to examine the relationship between their osteoporosis knowledge, health beliefs, and preventative behaviors. An understanding of these variables measured in younger and older women is essential for the development and delivery of effective age-tailored intervention programs.

The relationships among family, friends, and psychological well-being for Thai elderly

Objectives: The extent to which family and friends contribute to psychological well-being (PWB) may be subject to cultural variability. This study examines the mechanisms by which relationships with family and friends contribute to PWB among Thai elders. Method: Interviews were conducted with 469 men and women aged 60 and older in Nan Province, Thailand. The data were analyzed using structural equation modeling, controlling for age, gender, education, income, marital status, and health status. Results: Family and friendship networks have a significant direct effect on family and friendship support. However, family and friendship networks do not have a significant direct effect on PWB, but rather an indirect effect via social support. Similarly, friendship support mediates the relationship between friendship networks and family support. Both family support and friendship support are significantly related to PWB but family support is the stronger predictor. Conclusion: Using an adapting theoretical framework developed by Berkman, Glass, Brissette, & Seeman (2000) allows researchers to map the various pathways by which relationships with family and friends may contribute to PWB among older Thai adults.