Abstract
Coronavirus - 19 outbreak situation is a significant problem affecting population globally in all dimensions. Older people are a vulnerable group due to age- related decline and a weakened immune system; these led older persons prone to have chronic conditions known as non-communicable diseases that require continuing care. The main aims of this study were to 1) examine changes in health dimensions including physical activity, physical frailty, social frailty, life-space mobility, depressive symptoms, and quality of life among older persons with non-communicable diseases prior to the COVID-19 pandemic (the first wave), during the pandemic (3 months before and during the current wave), and new normal (last week), and to inform health policy recommendations.
This longitudinal study was composed of two phases: the first was to test the psychometric property of the 4 translated measures including the Rapid Assessment of Physical Activity: RAPA, the Frail Scale, Social Frailty Index, and the Life- Space Mobility Assessment Questionnaire: UAB LSA. The second phase was designed to investigate health dimensions in older persons. The sample was older persons with non-communicable diseases who met the inclusion criteria were selected by convenience sampling from 5 regions including the Northeast (Roi-Et), North (Phrae), Central (Samut Prakan), South (Surat Thani), and East (Prachin Buri). The multi-stage sampling was used to select the settings. One hundred and fifty participants were recruited to participate in the first phase of the study and 2,000 participants were enrolled to the phase 2. Data were corrected from June to November 2021 by trained research assistants. The participants responded to study tools including 1) the Demographic and Health Questionnaire 2) the Rapid Assessment of Physical Activity: RAPA, 3) the Frail Scale , 4) the Social Frailty Index, 5) the Life-Space Mobility Assessment Questionnaire: UAB LSA), 6) the Thai Geriatric Depression Scale- 15: GDS-15, and 7) the EQ-5D-5L. Mplus was employed to analyze data for the content validity index, confirmatory factor analysis, and reliability of Cronbach’s alpha coefficient and Kappa coefficient of the first phase. Regarding the second phase, one-way ANOVA, Kruskal-Wallis H test, and path analysis were used for data analysis with the Mplus program. A significant level was set at p < .05.
Results revealed that a total of 2,000 participants aged rang 60 – 89 years with a mean age of 65.13 years (SD = 4.62 years). Most of the participants were females (63.7%) and had top-five chronic conditions including diabetes (62.45%), hypertension (37.5%), dyslipidemia (18.6%), knee pain (12.5%), and cardiovascular diseases (6.8%), respectively. For the psychometric property testing of four measurements, all measures were acceptable for validity and reliability. Regarding changes in health dimensions in the older participants during the COVID-19 pandemic, findings indicated that the prevalence of low level of physical activity, physical frailty, social frailty, life-space mobility limitation, and depressive symptoms were 94.65-95.65%, 2.3 – 3.2%, 42.00-47.05%, 29.95 – 36.20%, and 4.85 – 5.45, respectively. The quality of life assessed by participant perceptions of their health state and their satisfaction with health state showed that older participants perceived their health and were satisfied with their health state when facing the COVID-19 outbreak. The older participants showed downward trends in decreasing satisfaction; the other health dimensions were quite stable, but there was a significant difference among participants living areas Results from a path analysis indicated that physical frailty was the strongest direct power on quality of life (DE = -.39) following by depressive symptoms (DE = -.219), and life-space mobility (DE = .116), respectively at the time of COVID-19 first outbreak. When considering a total effect of dependent variables on quality of life, physical frailty, depressive symptoms, and life-space mobility were also strongly influent on the quality of life (TE = -.464, TE = -.219, and TE = .116, respectively).
The main conclusion that can be drawn from this study is an essential finding to a better understanding and raise awareness of health dimension trajectory among older persons with non-communicable diseases during the COVID-19 outbreak. Monitoring and managing changes in health dimensions, particularly physical frailty, depressive symptoms, and life-space mobility, which impact the quality of life, is suggested to promote active aging and maintain a good quality of life in this population, specifically living areas.
Health Policy Recommendations
The findings of this study highlighted that the policy response to COVID-19 seems beneficial for transmission control, but health problems that require long-term care have significantly increased, particularly in older adults. The COVID-19 restriction policy may generate poor health outcomes—decreased physical activity or daily mobility, increased risk of developing physical frailty, social frailty, and depression—resulting in poor quality of life, increased healthcare needs, and costs of care for older adults.
Based on the research findings and in-depth interview, the essence of policy recommendations for government organizations and other partners in line with complex care needs in older adults, for enhancing elder care quality and improving specific management either during the pandemic situation or at other events are as follows:
1. Monitoring older people's health with specific assessment tools for this population is highly recommended. The Ministry of Public Health should initiate monitoring older people's health policy with specific assessment tools to healthcare personnel. Applying specific assessment tools—the Frail Scale, the Social Frailty Index, and the Life-Space Mobility Assessment Questionnaire—are essential in early identifying health problems and tracking health status changes in older adults, which is beneficial for gaining information to enhance both preventive policy announcement and effective continuing care.
2. Safe areas in the community or senior’s hours allowance older people is recommended for promoting health, social interaction, and quality of life. The Ministry of Interior, Ministry of Social Development and Human Security, Provincial Administrative Organization, Subdistrict Administrative Organization, Hospitals or Primary care settings, community resources, or others should provide additional support for promoting physical activity and daily life and social interaction in older adults during controlling pandemic policy. Establishing a zoning permit for older people in the communities or local temples is essential in maintaining health and socialization within local contexts. Moreover, creating senior hours (early morning or evening) for older people for grocery shopping, religious rituals, and exercises is significant for maintaining bodily function, spiritual well-being, and quality of life.
3. Visualized health information focusing on caring for older persons or vulnerable population is imperative for enhancing healthy practice and providing easy-to-access care during the pandemic. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should provide visualized practical information for an older person regarding health practice, transmission prevention, vaccination, and resources. All valid health information should be available for access via broadcasting on television or media outlets, local announcement, and posting at communities or local temples, which is indispensable for improving the confidence of individual self-care, family members, village health volunteers (VHVs), and caregivers (CGs) further to strengthening easy-to-access care.
4. Precise, up-to-date, professionals’ health information focusing on an older person is imperative for enhancing the confidence and competence of healthcare teams. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should provide precise practical information for an older person regarding health practice, transmission prevention, resources, referrals, and others to the frontline health personnel. The reliable real-time health information should be available for access via authorized websites/official line applications, targeting media outlets, and posting at communities or primary care settings, which is indispensable for enhancing better care and improving the confidence and competence of healthcare teams both professional and non-professional personnel.
5. Providing transportation support for managing healthcare services is more crucial than using telemedicine/telehealth to maintain health and enhance proactive care equity, particularly in rural contexts. Older people require regular health assessment, but mostly may not be affordable for using smartphones to access high technological care. The Ministry of Public Health, local administrative organizations, hospitals, primary care units, and other local authorities should provide effective transpiration—mobile geriatric clinic by geriatric nurse practitioners, medical distribution by VHVs, and safety vanpooling for in-hospital services or medical appointments by local authorities—to promote health equity and quality of care.
6. Geological tracking or location mapping is highly encouraged to provide better care and full precision support for vulnerable older adults, particularly those with long-term care needs, bedridden, continuous ambulatory peritoneal dialysis (CAPD), or living alone/with no family support. The Ministry of Public Health, the Ministry of Information and Communication Technology, and other related organizations should integrate tracking location technology to communicate with healthcare teams in providing effective, timely care as needed in each geographical area. Remarkably, further research is required to better understand technology acceptance and barriers for monitoring healthcare needs in older adults living in rural areas.
7. Trained and educated non-professional healthcare personnel is highly recommended for better care and preventing the burden of health personnel shortage during the pandemic. The Ministry of Public Health, the Ministry of Higher Education, Science, Research and Innovation, School of Nursing, and other related organizations should provide short course training or specific education support to non-professional healthcare personnel—volunteers, family members, teachers, and caregivers (CGs)—for enhancing efficient care collaboration during the pandemic. Moreover, blending folk wisdom or local community beliefs with scientific knowledge may improve holistic care covering multidimensional of health in older adults.
