Common Health problems and Satisfaction of Health Services among Elderly in Nepal

quantitative descriptive cross-sectional study


INTRODUCTION
Living longer lives, most individuals may expect to live into their sixties and beyond.The world's population of people aged 60 and more is predicted to reach 2 billion by 2050 than previous.Today, 125 million individuals are 80 years of age or older.By 2050, there will be nearly as many increasing trends (120 million) in China, and 434 million in the rest of the globe.By 2050, lowand middle-income nations will live 80% of all elderly people.The rate of aging of the global population is likewise rapidly growing.Similarly, France had a 10% to 20% increase in the proportion of the older population. 1 Every country globally is seeing an increase in the number and proportion of elderly persons in its population.Aging stands on the brink of becoming a highly impactful societal transformation in the twenty-first century, influencing almost every sector, encompassing labor and financial markets, the demand for goods and services like housing, transportation, social

NMJ I VOL 06 I NO. 02 I ISSUE 12 I Jul-Dec, 2023
Common Health Problem and Satisfaction of Health Services among Elderly in Nepal... protection, and even family structures. 2milarly in Nepal, the total aging population is 2.5 million (2,521,000) which is almost 8.7% of the country's total population.The magnitude of aging people is predicted to two-fold to 18.6% in 2050 with 6.5 million (6, 568000) people aged up to 60 years. 3Projections of the population for urban and rural areas are increasing day by day, life expectancy people is increasing day by day and the estimated male is 69.8 years and female be 73.8   4 The aim of this paper was to identify the common health problems of aging people of Koshi Province and to insight into the satisfaction of health services among aging people.
In Nepal, most elderly people have at least one or more than one chronic health problems.However, a recent study suggested that only more than threefourths of the elderly people had visited health facilities.Merely more than four-fifths of the elderly were satisfied with their health state. 5

METHODS
Study Design: A quantitative descriptive crosssectional study was conducted to assess the factors affecting the utilization of health services among the elderly of Koshi Province.Koshi Province is in the easternmost part of Nepal.It is divided into 14 districts and districts are subdivided into municipalities (urban and rural).It has one metropolitan city, two submetropolitan cities, 46 municipalities, and 88 rural municipalities.The population of Province 1 is 4834943 which comprises 18% of the total population of Nepal and the population of the elderly in this province is 393031 among them 196513 are male and 196518 are female. 4mpling Procedure: For this study, a multistage sampling technique was used for the selection of the setting.At first, a total of 4 districts (Jhapa, Morang, Ilam, and Dhankuta) were selected among the 14 districts following the quota sampling (for the inclusion of both the hilly and Terai regions).Among four, two districts were selected from the Hilly region and two districts were from the Terai region.In the 2 nd stage, two municipalities (one urban and one rural) were selected from each district via a simple random sampling method.A total of eight municipalities were recruited.One ward (administrative division of a city) from each municipality was selected randomly by lottery method from those assigned municipalities considering the samples (i.e. 45 from each ward) needed.This final selection of individuals was based on the purposive sampling technique.To make the sample more representative, the chosen ward was visited, a bottle was turned in the center direction, and the first household in the direction indicated by the bottle was selected.The sample was then repeated on each alternate house until the target sample size was met.If there was more than one old person in a dwelling, the sample was picked randomly using a lottery system.If there are no seniors in the selected family, the data was collected from the neighboring household according to sample requirements.
Sample size: n= z 2 pq/d 2 =323; Total sample size =356 (including 10% non-response rate) Sample Size was calculated at 95% confidence interval and 80% power taking the 70% prevalence of utilization of health care services in a study done in Pokhara Lekhnath Municipality, Nepal. 6The total calculated sample size is 356 but taken 357.Purposive sampling was done to obtain a representative sample.
Inclusion criteria: The study included individuals aged 60 years and older who expressed a willingness to participate.However, those with diagnosed mental health issues receiving medication and individuals with severe illnesses requiring emergency care were excluded from the study.
Instrumentation: A semi-structured interview schedule was developed by researchers based on the objectives of the study.The questionnaire was divided into three parts.Semi-structured interview-based questionnaires were designed as such to collect information regarding socio-demographic personal and other factors.A structured questionnaire was adopted by the researcher as per the Study of Global Aging and Adult Health (SAGE)'s questions on "Health Care Utilization". 7The questionnaire was divided into three parts.Part I: It consisted of questionnaires related to socio-demographic and psycho-social factors of the elderly.The researchers developed this after the literature review.Part II consisted of questionnaires related to the present health problems of the elderly.The researchers developed this after the literature review.Part III consisted of questionnaires related to the utilization of health services by the elderly.It was a structured questionnaire that was adopted by the researcher as per the Study of Global Aging and Adult Health (SAGE)'s questions on "Health Care Utilization".The tool was originally developed in English, then translated into Nepali, and subsequently backtranslated into English.To ensure its appropriateness, a pretest was conducted among 10% (36) of older adults in a specific ward of Biratnagar Metropolitan City.Notably, this particular ward was designated for exclusion during the random selection of settings.After the pretest, any essential revisions to the tool were implemented.Verbal and written permissions were obtained from the Ward chairman of selected areas prior to carrying out the data collection procedure.Written informed consent was obtained from each participant before the interview.The confidentiality of their information was censured by coding the interviews.Precautions were taken in every step of the study to safeguard the rights and welfare of the participants throughout and after the study.Data Collection Procedure: Data was collected through face-to-face interviews using a structured interview schedule from November 29 to January 2021 by visiting every door-to-door step of each household.The nature and objective of the study were communicated to each participant.Before doing the face-to-face interview, informed consent (both verbal and written) was obtained.Each participant had 15-20 minutes to complete a faceto-face interview.Face-to-face interviews were done individually with each respondent to reduce data contamination.The collected data was reviewed for completeness and edited on the same day to avoid recollection bias and assure the study's quality and accuracy.
Data Analysis Plan: At the end of the interview, the questionnaire was quickly assessed for completeness and accuracy.The collected data was then edited, classified, coded, and then entered into Microsoft Excel, and exported to the statistical package for Social Sciences (SPSS) version 20 for analysis.Descriptive statistics (frequency, percentage, mean, standard deviation, and range) were used to describe the independent (socio-demographic and psycho-social) and dependent (utilization of health services by the elderly).

RESULTS
Table 1 shows that more than two-thirds (70.3%) of the respondents were young old age whereas 6.4% of the respondents were old-old age.More than half (47%) of the respondents were female.Likewise, less than half of the respondents were illiterate whereas 2% of the elderly were bachelors and above.Less than half (48.1%) of the respondents were Brahmin/ Chhetri whereas only 1.7% were Muslim.Similarly, three-fourths (77.5%) of the respondents were Hindus whereas 1.1% of the respondents were Christian.and care.More than half (52.7%) of the respondents agreed that good privacy was maintained during a discussion with doctors.In terms of maintaining privacy according to patients' needs, Dr. more than half (54.9%) of the respondents agreed.In terms of maintaining the confidentiality of information, more than half (52.4%) of the respondents agreed.In terms of a problem contact with a doctor and happy to service, more than half (54.7%) of the respondents agreed to good.In terms of problem occurs, less than half (49.3%) %) of the respondents agreed to good.In an evaluation of the cleanliness of health facilities, more than half (53.5%) of the respondents agreed.In an evaluation of cleanliness, fresh air, and accommodation of health facilities more than half (53.5%) of the respondents agreed.

DISCUSSION
This study assessed the factors affecting the utilization of health services among the elderly of Koshi Province.This study finding revealed that the mean age of respondents was 70.89±8.35and more than half (52.9%) of respondents were female whereas a similar finding by Safstrom et al 8 argued that patient's mean age was 82.5 (±6.8), as well as 49%, were women.The study shows that less than half (43.69%) of the respondents were illiterate and nearly three fourth (74.5%) of respondents were married and 19.6% of respondents were widows whereas contract findings revealed that a study 9 argued that only 28.7% had received no formal education and 75.8% were married, 21.6% were widowed and.This might be the differences in socio-demographic variables and settings.A similar finding shows that the mean age is 70.2 ± 8.0 for the elderly and had reported by a variety of preexisting circumstances for example hypertension (37.7%), gastritis (28.4%), asthma (25.4%), and arthritis (23.4%) reported in the past one year. 6is study finding showed that more than half (52.5%) of the respondents' monthly income was Rs. 4000-9000 and less than half (82.4%) of the respondents were hypertensive, and less than one-fourth (21.8%) of the respondents were diabetes, contradicting finding show that a study conducted among 2000 elderly in claims that the health services 11 used by pension income level 1000-2000 RMB, source of income, poor self-reported health status, sensation disorders, feeling lonely and/or nervous, poor satisfaction with life, limitation to activities of daily living (ADLs), health status changing for the worse, and having a chronic disease like heart disease, cataracts, cerebrovascular disease, and gastroenteritis were particularly more likely to use outpatient health services.This might be differences in the socio-demographic characteristics of respondents and the setting of the study.
This study finding revealed that most (90.7%) of the respondents visited (utilized) health service facilities whereas only (9.5%) did not utilize health facilities.More than three fourths (78.9%) of the respondents were visited a government hospital or health facility whereas only 5.6% of the respondents were visited a private hospital which contradicts the finding revealed that about one-third (76.5%) of respondents reported physical health issues, 14.6% claimed some physical handicap, and 52.6% indicated a mental health issue.Gender disparities in marital status, literacy, living arrangements, pensions, physical health issues, and mental health problems were found to be significant (p < 0.01) 10 Likewise, another contradicting finding 11 by argued that most aged patients used public health services when they needed medical care (70.4%).Similarly, another study argued contradicting findings 12 that nearly seventyfive (74.5%) in the past three months, including 59.4% from general practitioners, 18.4% from nursing staff, and 16.5% from specialists.39.2% had laboratory tests conducted, and 24.9% had radiographic examinations, 2.4% were emergency visits, and 2.9% were hospitalizations.Likewise, other contradicting findings revealed that half of the patients had not visited any health care institution in the month preceding their hospitalization, and 79% went to the emergency department without a referral.One-third felt unsafe after being admitted to the hospital and had no idea who to talk with or contact in the case of worsening or difficulties. 8esent study findings revealed that more than three fourths (78.9%) of the respondents visited government hospitals or health facilities whereas only 5.6% of the respondents visited private hospitals.Furthermore, contradicting findings revealed that those living in rural regions with university education used public primary care more frequently, but richer people used private practitioners more frequently. 13

CONCLUSIONS
Over two thirds of the participants were elderly individuals.The majority of those surveyed were female.Likewise, less than half of the respondents were illiterate, on the other hand, Muslims made up the minority among the respondents, with less than half being Brahmin/Chhetri.In a similar vein, Hindus made up three quarters of the respondents.
The study found that diabetes, hypertension, heart disease, eye, dental, and anxiety disorders were the most prevalent health issues among the elderly.The majority of senior citizens went to (used) healthcare facilities.Less than ten percent of respondents visited Ethical Consideration: Ethical clearance was obtained from the Institutional Review Committee (IRC) of Tribhuvan University Institute of Medicine (TU, IoM) Maharajgunj and Ref.No (68(C-11) E 2 078/079).
Common Health Problem and Satisfaction of Health Services among Elderly in Nepal...

Table 2
Common Health Problem and Satisfaction of Health Services among Elderly in Nepal...
NMJ I VOL 06 I NO.02 I ISSUE 12 I Jul-Dec, 2023

Table 2 :
Place Resident, Income & occupation of the Respondents n=357

Table 3
revealed that less than half (44.0%) of the respondents were hypertensive.Less than one-fourth (21.8%) of the respondents were diabetes.Less than one-fifth (18.2%) of the respondents were having difficulty breathing.Nearly eleventh percent (10.6%) of the respondents had arthritis.Ten percent (10.1%) of the respondents had eye problems whereas only 5.9% of respondent's problems had heart disease.

Table 3 :
Common Health problems of elderly (n=357)

Table 4 :
Common Health Problems of Elderly Living in Urban and Rural Areas (n=357)

Table 5
Common Health Problem and Satisfaction of Health Services among Elderly in Nepal...

Table 5 :
Patient Satisfaction on Utilization of Health Service (n=357) Common Health Problem and Satisfaction of Health Services among Elderly in Nepal...

Table 6
illustrated that more than half (57.4%) of the elderly people were neutral (satisfactory satisfied) whereas less than one-thirds (33.9%) of the elderly were unsatisfied only for care provided by doctors, nurses and overall care and hospital facility.Likewise, less than one-tenth (8.7%) of the elderly were highly satisfaction.

Table 6 :
Level of Satisfaction of elderly on health care facilities n=357