Abstract
The Development of primary healthcare model for the elderly in new normal society is a challenge for the country to prepare for the hyper-aged society in the next 9 years. Innovative design of healthcare and nursing care to access health services by reducing the country's resource constraints and changing the emerging disease situation will help provide the elderly in the communities with well-being of health status and quality of life. This research aims to: 1) Study the situation of the problem, the needs of the elderly, the factors influencing the health status and quality of life among the elderly living in community; 2) Develop models of care and innovations for primary and geriatric care in the new normal society; 3) Evaluate the outcome of adopting innovative primary and gerontological care in community for the new normal society, using research and development to synthesize policy proposals for public health reform for primary care and elderly care in the new normal society. Quantitative and qualitative data were collected through random sampling from four health districts. 1-2 provinces per health districts and 16 setting to achieve differences in context and culture of elderly care. The samples were 800 elderly people, family caregivers, care managers and volunteer caregivers. Health care providers included doctors, public health officers, and health care workers, physical therapists, Thai traditional medicine practitioners, policymakers or health service advocates such as: the Provincial Public Health Office, Provincial Administrative Organizations, Tambon Administrative Organizations, the Provincial Office of Social Development and Human Security. Data were collected using six sets of questionnaires for the elderly. four sets of questionnaires for family caregivers of the elderly, three sets for care manager, three sets for volunteer caregivers, one set for public health officers and in-depth interviews. Focus group discussions were conducted to use data to design care innovations and geriatric healthcare treatments with evaluation of the outcomes of implementing the care innovations in four pilot areas in 16 health districts. The study found the majority of the elderly to be females, with a mean age of 78.54 years, primary educations, requirement for mobility aids such as walking canes for the most party, followed by wheelchairs and eyeglasses, respectively. More than half had 1-2 chronic diseases, the most frequent being cardiovascular diseases. The most common health problems were difficulty moving and urinary incontinence and the elderly were primarily assisted by family caregivers. The mean time spent in assistance and care for bedridden elderly was 22.90 hours per week. The homebound group received care for 23.31 hours per week and the social group received care for 19.18 hours per week. The activities with which the family caregivers of the elderly needed assistance as to provide the most support to the elderly by preparing food, followed by feeding, buying food or making smoothies, cleaning up after excretion from urinary and fecal incontinence. The nature of health services and the process of caring for the elderly found care managers to be the main leaders in home visits to the elderly at a mean of once a month. The elderly was visited at home by volunteer caregivers (mean=58.94%) at a mean of 1-2 times a month. According to the findings on the problems and needs of the elderly, the home visits conducted by the volunteer caregivers were no different from the public health volunteer caregivers of the elderly, usual care visiting, talking, encouraging and giving advice. The family caregivers of the elderly wanted to have knowledge and skills to properly care for the elderly. The care managers were overwhelmed with their workloads. Thus, an integrated care plan for the elderly covering all dimensions of chronic dependency and chronic disease is needed without increasing the workload of routine tasks. Furthermore, local administrative organizations need an environmental assessment tool that can quickly coordinate assistance for the elderly. The factors influencing the quality of life of the elderly include frailty, health literacy of elderly, health literacy of family caregivers, and environmental management, which can be predicted quality of life at 54.7%. (R2 = .547, p < .001). The development of innovative care models for gerontological nursing and medical care consist of the following: 1) Guidelines in caring for the elderly with chronic diseases and dependencies on 13 guidelines; 2) Implementation of the 13 guidelines; establishment of a Network Community Action Plan (N-CAP) for use in information systems for communication and care of the elderly through the use of "Awuso.net" for the elderly among healthcare professionals and elderly people, families and non-professional volunteers; 3) Elderly Care Knowledge Video Series with 18 videos; the results of the 12-month trial of care innovation in the pilot area with 521 elderly people, N-CAP's top five most frequently used issues were caring for the elderly with dependency, environmental management, hypertension, osteoarthritis, and diabetes mellitus in the community. The results of using N-CAP showed a statistically significant increase in the mean quality of life scores among the elderly (t=11.234 p<0.001). (pretest=42.25±8.89 points, posttest=46.01±8.62 points). Mean score for the performance of the activities of daily living increased with statistical significance (t=7.398 p<0.001) (pretest=8.92±5.44 points, posttest=10.54±5.75 points). Mean health literacy score increased with statistical significance (t=12.016 p<0.001) (pretest=10.19±4.99 points; posttest=12.39±4.08 points). Mean frailty score decreased with statistical significance (t=8.954 p<0.001) (pretest=7.47±3.27 points, posttest=6.17±3.16 points). The users were very satisfied. (Mean±SD=4.03±0.88) The factors influencing the quality of life that increased after implementing the Awuso.net innovation included improved environmental management (ß=0.44, p<.000), number of times N-CAP was used (ß=-0.324, p<.000), number of assignments given by a care manager nurse per week (ß=0.192, p<.000), number of home visits by volunteer caregivers per week (minutes) (ß=0.162, p<.000), changes in ADL performance scores (ß=0.162, p<.000), changes in vulnerability scores (ß=-0.162, p<.000) and changes in health literacy scores. (ß=0.162, p<.000), respectively. Together, the above factors were able to co-predict the ADL performance of the elderly in the community at 54.4% (R2=.544, p<.000). Therefore, use of the Awuso.net should be expanded to other areas to be more extensive and comprehensive to ensure that the elderly have access to standardized medical care. The innovation is safe and produces clear health outcomes, reduces the working hours of nurses, care managers and volunteer caregivers. Thus, the elderly does not have to come to the hospital unnecessarily, thereby resulting in good quality of care and cost-effectiveness with quality of elderly health services in communities.
