Jeyanthini, Sathasivam (2016) Community dwelling frail older people in an urban setting in Malaysia-prevalence, healthcare utilization and caregiver burden / Jeyanthini Sathasivam. PhD thesis, University of Malaya.
Abstract
With the rising life expectancies and declining fertility rates, Malaysia is moving towards the status of an ageing nation. Frailty increases incrementally with advancing age and these vulnerable older people are prone to dependency and poor health outcomes. These health outcomes contribute to an increased demand for optimum healthcare services and a robust familial support system. Therefore, the purpose of this research was to seek a better understanding on the prevalence of frail older people in Malaysia, factors that are associated with frailty, their patterns of healthcare utilization and the burden of care-giving experienced by their carer’s. Methods: Frailty status was determined using two measurement models; the Frailty Phenotype (FP) and the Frailty Index (FI) on a sample of 1040 community dwelling older people aged 60 and above residing in the district of Johor Bahru. A face to face interview with the older people was conducted to assess the frailty status and their health care utilization patterns. The caregiver that was present was required to self administer the Zarit Burden Interview. Multivariate regression analysis was applied to explore the correlates of frailty. The healthcare utilization pattern was described by frailty status. Ordinal regression models were used to evaluate the association between frailty and caregiver burden. Results: The findings of this study highlighted that although the numbers that were categorized as frail was only (FI: 5.7 percent and FP: 3.0 percent), there are large numbers of pre-frail older people (FI: 67.7 percent and FP: 48.3 percent) residing in the community. The study also found that a past history of fall (p<0.001), abnormal upper (p <0.05) and lower body strength (p<0.001) and poor self rated health (p<0.001) were significant correlates to increasing levels of frailty (p<0.05). The results also showed that 35.0 percent of frail older people had a direct need for outpatient services as compared to 16.1 percent who were pre-frail and 14.2 percent who were robust. There iv were also unmet needs among the frail and prefrail older people which were lack of transportation to access a healthcare facility (82.0 percent of frail older people) and poor perception of the gravity of their illness (43.0 percent of pre-frail older people). The frail older people were hospitalized 2.5 times more than pre-frail and 5.6 times more than robust older people. 45.5 percent and 49.2 percent of carers of frail and pre-frail older people experienced objective burden (worry and concern to provide optimum care) predominantly. The study results also highlighted that the caregivers of frail older people had 4.5 times the odds of experiencing mild to moderate levels of burden than the caregivers of robust older people. Conclusion: This study provides a stepping stone for stakeholders of older people health to prevent or reverse the continuum of frailty by reducing falls and improving the nutritional status of older people in the community. Improving the provision of transport for frail older people to access the health system is warranted. Empowering caregivers with coping strategies and providing social and resources support such as respite care or day-care for the older people are approaches that can be explored to alleviate the caregiver‘s burden. Key words: Frailty, Older people, Caregiver Burden, Healthcare Utilization, Frail Older people
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