Regional and Gender Differences in Years with and without Mobility Limitation in the Older Population of Thailand.

OBJECTIVES: To examine gender and regional differences in health expectancies based on the measure of mobility. METHODS: Health expectancies by gender and region were computed by Sullivan's method from the fourth Thai National Health Examination Survey (2009). A total of 9,210 older persons aged 60 years and older were included. Mobility limitation was defined as self-reporting of ability to perform only with assistances/aids at least one of: walking at least 400 metres; or going up or down a flight of 10 stairs. Severe limitation was defined as complete inability to do at least one of these two functions, even with assistances or aids. RESULTS: At age 60, females compared to males, spent significantly fewer years without mobility limitation (male-female = 3.2 years) and more years with any limitation (female-male = 6.7 years) and with severe limitation (female-male = 3.2 years). For both genders, years lived with severe limitation were remarkably constant across age. Significant regional inequalities in years lived without and with limitation were evident, with a consistent pattern by gender in years free of mobility limitation (Central ranked the best and the North East ranked the worst). Finally, both males and females in the South had the longest life expectancy and the most years of life with severe mobility limitation. CONCLUSION: This study identifies inequalities in years without and with mobility limitations with important policy implication.

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

OBJECTIVES: To 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. METHODS: Health 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). RESULTS: The 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. CONCLUSION: This 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.

Physical therapy workforce shortage for aging and aged societies in Thailand.

According to demographic changes, the size of the aging population has rapidly increased. Thailand has been facing the "aging society" since 2005 and the "aged society" has been projected to appear by the year 2025. Increased life expectancy is associated with health problems and risks, specifically chronic diseases and disability. Aging and aged societies and related specific conditions as stroke require the provision of services from health professionals. The shortage of the physical therapy workforce in Thailand has been reported. This study investigated the size of physical therapy workforce required for the approaching aging society of Thailand and estimated the number of needed physical therapists, specifically regarding stroke condition. Evidently, the issue of the physical therapy workforce to serve aging and aged societies in Thailand requires advocating and careful arranging.

Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children.

Nutrition is an important factor in mental development and, as a consequence, in cognitive performance. Malnutrition is reflected in children's weight, height and BMI curves. The present cross-sectional study aimed to evaluate the association between anthropometric indices and cognitive performance in 6746 school-aged children (aged 6-12 years) of four Southeast Asian countries: Indonesia; Malaysia; Thailand; Vietnam. Cognitive performance (non-verbal intelligence quotient (IQ)) was measured using Raven's Progressive Matrices test or Test of Non-Verbal Intelligence, third edition (TONI-3). Height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ) and BMI-for-age z-scores (BAZ) were used as anthropometric nutritional status indices. Data were weighted using age, sex and urban/rural weight factors to resemble the total primary school-aged population per country. Overall, 21% of the children in the four countries were underweight and 19% were stunted. Children with low WAZ were 3·5 times more likely to have a non-verbal IQ < 89 (OR 3·53 and 95% CI 3·52, 3·54). The chance of having a non-verbal IQ < 89 was also doubled with low BAZ and HAZ. In contrast, except for severe obesity, the relationship between high BAZ and IQ was less clear and differed per country. The odds of having non-verbal IQ levels < 89 also increased with severe obesity. In conclusion, undernourishment and non-verbal IQ are significantly associated in 6-12-year-old children. Effective strategies to improve nutrition in preschoolers and school-aged children can have a pronounced effect on cognition and, in the longer term, help in positively contributing to individual and national development.

Perspectives on healthy aging among Thai elderly: a qualitative study.

In this qualitative study, we provide an in-depth understanding of the views of healthy aging among Thai elderly and explore the ways that contribute to healthy aging. Data were collected using focus groups and in-depth interviews in four selected provinces of Thailand, and were analyzed using content analysis. The results revealed that Thai elderly described being healthy as the result of multiple components involving physical, mental, and social well-being. Healthy aging was viewed as an absence of serious diseases, having functional independence, a positive psycho-emotional outlook, and making a social contribution. The factors considered to contribute to healthy aging included activities promoting physical and psychological health, as well as active engagement in social activities. Understanding how the elderly define healthy aging and identifying the most important components and factors that contribute to being healthy provides insight into possible policy implications and interventions to promote health and well-being among Thai elderly.

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.

Effect of the living environment on falls among the elderly in Thailand.

The household environment influences the health of the elderly. We studied home hazards and living arrangements and their association with falls among the elderly in Thailand. The data were obtained from a national survey among the elderly in Thailand conducted by the National Statistical Office in 2007. The survey asked about a history of falls, the household environment and possible risk factors for falls. The survey was conducted in 26,689 subjects aged > or = 60 years. The factors associated with a chance of falls were: a slippery floor in the first storey of the house (OR 1.39; 95% CI 1.21-1.59, p = 0.000), a slippery floor in the bathroom or toilet (OR 1.32; 95% CI 1.16-1.49, p = 0.000) and bathroom or toilet located outside the house (OR 1.23; 95%CI 1.12-1.35, p = 0.000). Elderly people who lived with spouse had a 32% lower chance (OR 0.68; 95%CI 0.59-0.78, p = 0.000) of experiencing a fall than those who lived alone in the house.

Mechanisms by which social support networks influence healthy aging among Thai community-dwelling elderly.

OBJECTIVE: To examine the relationships among family, friendship networks and supports, health-promoting behaviors, and healthy aging. METHOD: A sample of 469 Thai elderly persons was recruited using multistage random sampling. A structural equation model based on Berkman's conceptual model was performed. RESULTS: Family networks did not directly influence health-promoting behaviors but rather had an indirect effect through family support. Friendship networks had both a significant direct effect on the elderly health-promoting behaviors and an indirect effect via friendship support. Interestingly, friendships had both direct and indirect influences on family support to the elderly. Health-promoting behaviors had a powerful influence on healthy aging and play a significant role in mediating the relationship between family and friendship supports and healthy aging. DISCUSSION: Findings demonstrate the importance of family and friendship roles on health-promoting behaviors and healthy aging. Intervention programs should be designed to include a collaborative approach involving family members and friends.

Labor force participation in later life: evidence from a cross-sectional study in Thailand.

BACKGROUND: The labor force participation rate is an important indicator of the state of the labor market and a major input into the economy's potential for creating goods and services. The objectives of this paper are to examine the prevalence of labor force participation among older people in Thailand and to investigate the factors affecting this participation. METHODS: The data for this study were drawn from the '2007 Survey of Older Persons' in Thailand. Bivariate analysis was used to identify the factors associated with labor force participation. The variables were further examined using multivariate analysis in order to identify the significant predictors of the likelihood of older people participating in the labor force, after controlling for other variables. RESULTS: Overall, 30,427 elderly people aged 60 or above were interviewed. More than a third (35%) of all respondents had participated in the labor force during the seven days preceding the survey. Respondents who were female (OR=0.56), those who were older (OR=0.47 for 70-79 and 0.21 for 80+ years), those who were widowed/divorced (OR=0.85), those who were living with their children (OR=0.69), those whose family income was relatively low, and those who worked in government sectors (OR=0.33) were less likely to participate in the labor force than were their counterparts. On the other hand, those who lived in urban areas (OR=1.2), those who had a low level of education (OR, secondary level 1.8, primary 2.4, and no schooling 2.5), those who were the head of the household (OR=1.9), and those who were in debt (OR=2.3) were more likely be involved in the labor force than their comparison groups. Furthermore, respondents who experienced greater difficulty in daily living, those who suffered from more chronic diseases, and those who assessed their health as poor were less likely to participate in the labor force than their counterparts. CONCLUSION: Labor force participation in their advanced years is not uncommon among the Thai elderly. The results suggest that improving the health status of the elderly is necessary in order to encourage their employment. By doing so, the country can fulfill the labor shortage and further improve the economic condition of the nation. The results of this study also suggest that for policies encouraging employment among older persons to succeed, special focus on the rural elderly is necessary.

Self-assessed health among Thai elderly.

BACKGROUND: The ageing of the population is rapidly progressing in Thailand. Self-assessed health status can provide a holistic view of the health of the elderly. This study aims to identify the determinants of self-assessed health among older Thai people. METHODS: The data for this study were drawn from a national survey of older persons conducted in 2007. Stratified two-stage random sampling was used for data collection. The analysis was restricted to the population aged 60 and above. The study used univariate, bivariate, and multivariate analysis procedures to analyze the data. Bivariate analysis was used to identify the factors associated with self assessment of health status. After controlling for other variables, the variables were further examined using multivariate analysis (binary logistic regression) in order to identify the significant predictors of the likelihood of reporting poor health. RESULTS: Overall, 30,427 elderly people were interviewed in this study. More than half of the sampled respondents (53%) were aged 60-69 years and about one out of seven (13%) were aged 80 years or above. About three in five respondents (56%) reported that their health was either fair or very bad/bad. Logistic regression analysis found that age, education, marital status, working status, income, functional status, number of chronic diseases, and number of psychosocial symptoms are significant predictors in determining health status. Respondents who faced more difficulty in daily life were more likely to rate their health as poor compared to those who faced less such difficulty. For instance, respondents who could not perform 3 or more activities of daily living (ADLs) were 3.3 times more likely to assess their health as poor compared to those who could perform all the ADLs. Similarly, respondents who had 1, 2, or 3 or more chronic diseases were 1.8 times, 2.4 times, and 3.7 times, respectively, more likely to report their health as poor compared to those who had no chronic disease at all. Moreover, respondents who had 1-2, 3-4, or 5 or more psychosocial symptoms in the previous months were 1.6 times, 2.2 times, and 2.7 times, respectively, more likely to report poor health compared to those who did not have any psychosocial symptoms during the same period. CONCLUSION: Self-assessed poor health is not uncommon among older people in Thailand. No single factor accounts for the self-assessed poor health. The study has found that chronic disease, functional status, and psychosocial symptoms are the strongest determinants of self-assessed poor health of elderly people living in Thailand. Therefore, health-related programs should focus on all the factors identified in this paper to improve the overall well-being of the ageing population of Thailand.

Correlates of unintended pregnancy among currently pregnant married women in Nepal.

BACKGROUND: Women living in every country, irrespective of its development status, have been facing the problem of unintended pregnancy. Unintended pregnancy is an important public health issue in both developing and developed countries because of its negative association with the social and health outcomes for both mothers and children. This study aims to determine the prevalence and the factors influencing unintended pregnancy among currently pregnant married women in Nepal. METHODS: This paper reports on data drawn from Nepal Demographic and Health Survey (NDHS) which is a nationally representative survey. The analysis is restricted to currently pregnant married women at the time of survey. Association between unintended pregnancy and the explanatory variables was assessed in bivariate analysis using Chi-square tests. Logistic regression was used to assess the net effect of several independent variables on unintended pregnancy. RESULTS: More than two-fifth of the currently pregnant women (41%) reported that their current pregnancy was unintended. The results indicate that age of women, age at first marriage, ideal number of children, religion, exposure to radio and knowledge of family planning methods were key predictors of unintended pregnancy. Experience of unintended pregnancy augments with women's age (odds ratio, 1.11). Similarly, increase in the women's age at first marriage reduces the likelihood of unintended pregnancy (odds ratio, 0.93). Those who were exposed to the radio were less likely (odds ratio, 0.63) to have unintended pregnancy compared to those who were not. Furthermore, those women who had higher level of knowledge about family planning methods were less likely to experience unintended pregnancy (odds ratio, 0.60) compared to those having lower level of knowledge. CONCLUSION: One of the important factors contributing to high level of maternal and infant mortality is unintended pregnancy. Programs should aim to reduce unintended pregnancy by focusing on all these identified factors so that infant and maternal mortality and morbidity as well as the need for abortion are decreased and the overall well-being of the family is maintained and enhanced.

Family relations and health-promoting behavior among older people in Nan Province.

OBJECTIVE: To examine the relationships by which family networks and support influence the health-promoting behaviors among the older persons. MATERIAL AND METHOD: The present study was a cross-sectional survey of 469 elders aged 60 years and over living in a community in Nan Province. Samples were selected by multi-stage random sampling. Data were collected by interviewing from May to July 2007. A structural equation modeling (SEM) with the LISREL program version 8.72 was used for analysis after the effects of socio-demographic factors were controlled RESULTS: Family networks did not have direct influence on the elderly health-promoting behavior but had indirect influence through support and sense of well-being. Family support had a prominent influence on elderly sense of well-being, then facilitating health-promoting behavior Elderly sense of well-being had strong association with health-promoting behavior. CONCLUSION: Family support programs to facilitate the good interrelationship within the family should be encouraged and promoted to enhance elderly psychological well-being and health-promoting behaviors subsequently.