Disability and Quality of Life of Community-Dwelling Older People

With the increase of life expectancy, more Malaysian will live to old ages. The rapid ageing of the population is leading to an increasing number of disabled older people as disability is associated with increasing age. The study on the prevalence, risk factors for disability and consequences of disability on quality of life is important in the face of the prevailing ageing population. This study assessed disability prevalence and determined factors that predict disability and quality of life among the older people who lived in the community. In this study, Verbrugge and Jette’s model of disablement process has been used as a conceptual frame of reference. Data from the Mental Health and Quality of Life of Older Malaysians Survey (MHQoLOM) were used in this study, which was a national survey conducted from 2003 through 2005 that employed a cross-sectional design. A multi-stage proportional stratified sample of 2980 older persons living in the community in Malaysia, ranging in age from 60 to 104 years were interviewed in the respondent’s home. Statistical procedures for the analyses included descriptive statistics, univariate logistic regression and multivariate logistic regression. The prevalence of disability in at least one of the activities of daily living (ADL) and instrumental activities of daily living (IADL) items was 22.8 percent. Higher prevalence of disability was observed in older women (31%) compared to older men (14.5%). The predictors for disability in men were age, ethnicity, marital status, self-rated health, heart disease, eye disorder and functional limitation. While age, ethnicity, marital status, smoking, self-rated health, respiratory disorders and functional limitation predicted disability in women. Increasing age, being of the other ethnicity compared with the Malay for men and being of Indian ethnicity compared to the Malay for women, being unmarried, poor self-rated health and functional limitations increased the risk of disability in both men and women. The predictors of perceived good quality of life for men were ethnicity, education, income, urban/rural residence, physical activity and self-rated health. Among women, ethnicity, self-rated health and functional limitation predicted perceived good quality of life. Being of Indian and Chinese ethnicity compared to the Malay were associated with reduced perceived good quality of life for both men and women, while being of Bumiputera and other ethnicity compared to the Malay increased the odds of perceived good quality of life among men. Very poor self-rated health compared to excellent self-rated health was associated with lower perceived good quality of life in both men and women. These findings confirmed the independent contribution of risk factors, medical conditions or disease, and functional limitation in the disablement process. The examination of perceived quality of life in relation to the disablement process indicated that risk factors and functional limitation contributed to lower perceived good quality of life. The findings of the study will be relevant for program development to improve functional abilities and to minimize risk factors by early intervention, improve or maintain the quality of life of older people and to promote the use of appropriate health and social resources. Moreover, policy makers and service providers could effectively focus on those factors that are crucial in maintaining functional ability and quality of life of the older Malaysians

Sinhalese Version of the Global Physical Activity Questionnaire for Community-Dwelling Older Adults: Reliability and Validity

Background: A reliable and valid measurement of physical activity (PA) is vital for PA surveillance activities in community settings and for evaluating PA intervention programs targeted at older adults. This study assessed the reliability and validity of a Sinhalese version of the Global Physical Activity Questionnaire-version 2 (GPAQv2) adapted for community-dwelling older adults (aged 60+) in Sri Lanka. Methods: Cross-cultural adaptation and an assessment of content validity of the GPAQv2 were done. Indirect criterion validity (n = 210) and test-retest reliability (n = 40) of the tool were assessed. Content validity index, Spearman rank correlation coefficients and intra-class correlation coefficient (ICC) were calculated, and Bland– Altman plots were drawn. Results: The content validity index of the questionnaire was 0.82, an acceptable value. The 3600 turn test (r = –0.258, p= 0.03), and timed up-and-go test (r = –0.197, p= 0.02) were negatively correlated, whereas total balance (r= 0.241, P= 0.00), single leg stance (r= 0.206, p= 0.01), and instrumental activities of daily living score (IADL) (r= 0.244, p= 0.00) were positively correlated with the GPAQv2 scores of PA, confirming the indirect criterion validity of the Sinhalese version of the GPAQv2. The tool demonstrated favorable test-retest reliability (ICC = 0.713). The mean difference between the test and retest total PA scores was –302.6 MET/week, a slight overestimation of PA in the retest. Conclusions: The Sinhalese version of the GPAQv2 demonstrates acceptable reliability and validity. It is suitable for use in PA measures among community-dwelling older adults in Sri Lank

Attitudes toward and willingness to work with older people among undergraduate nursing students in a public university in Sri Lanka: A cross sectional study

Background:With the increased number of older people globally, caring for older people has become a challenge for many countries. Nurses have a pivotal role in providing quality care for older people and care is affected by their attitudes. The preparation of nurses to deliver quality care needs to be instilled during their studying in the Schools of Nursing. Objective: To examine the attitudes of nursing students toward and theirwillingness toworkwith older people in Sri Lanka. Methodology: A purposive sample of 98 first to fourth year undergraduate nursing students in the Department of Nursing, University of Peradeniya completed a self-administered questionnaire consisting of socio-demographic variables, Kogan's Attitudes toward Older People Scale, and questions related to willingness to work with older people. Results: Fifty percent of the respondents (n=49) held slightly positive attitudes toward older people while 45% (n= 44) held slightly negative attitudes. About one-third of the respondents (29.9%, n =29) selected the elderly group as the least preferred group for their future career from the categorized seven age groups. Only 5.1% (n = 5) of the respondents ranked the elderly group as the first preferred group. There was a significant difference in attitudes between students who lived with older people and students who did not live with older people (t = 2.565, p = .012). There was a positive relationship between attitudes and preference for working with older people (r = .342, p = .001). Conclusion: Nursing students havemoderately positive attitudes toward older people; however, they show little interest in working with older people. Living with older people develops positive attitudes of young people toward older people. Attitudes are related to the selection in area of specialty in nursing. Nursing curricula need to include Gerontological Nursing as a major area

Physical Activity of Urban-Dwelling Older People in Sri Lanka

There is a paucity of information on physical activity behaviour of older adults in Sri Lanka. This study determined the physical activity status of urban-dwelling older adults in a district in the country. A cross sectional survey of 880 subjects (aged 60+ years) was conducted using the Global Physical Activity Questionnaire. The prevalence rates of physically inactive, sufficiently active and highly active were 21.5%, 78.5% and 52.7% respectively. Women were more active than men (Women, 80.9% versus men, 75.5%, p < 0.05). Activity at work accounted for the highest portion of physical activity as reported by the participants [Median = 2400 MET/Week, 95% CI: 240, 4800] followed by active transport [Median =120 MET/Week, 95% CI: 0, 560] and leisure-time activity [Median = 0 MET/Week, 95% CI: 0, 270]. Factors contributing for extensively engaging activity at work need further investigations and older adults should be encouraged to do leisure-time physical activities

Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka : an application of Anderson’s model of health service utilization

Background: Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka. Methods: A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and sociodemographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression. Results: Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level. Conclusions: Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and afordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories

Enrollment and attendance to Cardiac Rehabilitation after Percutaneous Coronary Intervention in Sarawak : A Prospective Study

Abstract: Background: Cardiac rehabilitation is vital for cardiac patients, especially after the percutaneous coronary intervention as it is proven to reduce recurrent cardiac event and death. The ongoing CR participations of the patients in Sarawak after percutaneous coronary intervention have not been explored. Purpose: To examine the enrollment and attendance to cardiac rehabilitation among patients who have underwent percutaneous coronary intervention in Sarawak. Methods: A prospective study was conducted. Data on baseline characteristics, diagnosis, smoking status, and referrals received for CR were collected for selected subjects prior to hospital discharge. Their attendances to CR programme were followed up at two months after hospital discharge. Independent sample Ttest was used to analyse the continuous data and Chi square test was conducted for categorical data to identify the differences in characteristics between patients who was enrolled for CR and those who was not. Results: Three hundred and eighty patients were recruited in this study. Among these patients, 141 patients (37.11%) were referred to CR. Only 58 patients (15.3%) completed all the eight sessions of the CR programme, 276 patients (72.6%) did not turn up and 46 patients (12.1%) dropped out before completing all the sessions. Patients who were enrolled in CR were more likely to be men (p=0.001), Malay (p=0.000), having travel time of less than 1 hour from home to hospital (p=0.000), and able to drive (p=0.009). Conclusions/ Implications for Practice: The enrollment and attendance rate of CR in Sarawak is low. Men, Malay, staying near to the hospital, and being a driver were more likely to be referred to CR. Further study on this is needed as CR is proven to benefit the patients

Barriers to timely treatment-seeking in patients with acute myocardial infarction in Malaysia: a qualitative study

Background: Persisting delay in seeking treatment among Acute Myocardial Infarction (AMI) patients was reported in Malaysia despite intensified efforts in educating the public on symptoms of AMI and the importance of seeking prompt treatment. Studies outside Malaysia have shown that patients’ personal thoughts during symptom onset could contribute to the delay. The purpose of this study is to explore the barriers of AMI patients prior to the decision of seeking treatment in Malaysia. Methods: A qualitative descriptive research approach was chosen. Individual in-depth interviews were conducted among 18 patients with AMI. Data were analysed using thematic analysis. Recordings were transcribed and coded, codes were subsequently organized into categories. The stages of coding and identifying categories were repeated before themes were identified. Results: Three meaningful themes with nine sub-themes that may have influenced the delayed decision to seek treatment were identified. Some themes identified were culturally bound. Conclusions: The findings of this study give insights on barriers prior to the decision of seeking treatment when patients were experiencing AMI. Findings indicates that interventions targeted at increasing knowledge about AMI symptoms and correct actions using an informative approach at the current practice may not be adequate to reduce patient delay. The findings of this study could provide basis for the development of interventions that are culturally relevant to the Malaysians setting to promote behavioural change in the population and reduce pre-hospital delay

Nursing procedures in special areas

This handbook is a manual on clinical procedures commonly carried out in the hospital settings. It serves as a reference for nursing students during their clinical placement in specialised areas

Translation, Adaptation, and Validation of the Malay Version of the Cardiac Rehabilitation Barriers Scale

Background: The rate of cardiac rehabilitation attendance at the Sarawak Heart Centre was identified as very low, and the reason has not been investigated. A scale is needed to identify barriers to participation in cardiac rehabilitation among patients with heart disease in Sarawak, Malaysia. Purpose: The purposes of this study were to translate, adapt, and evaluate the Malay-language version of the Cardiac Rehabilitation Barriers Scale (CRBS) and to measure the psychometric properties of the Malay-version CRBS to justify its use in Sarawak. Methods: A forward and back-translation method was used. Content validity was assessed by three experts. Psychometric testing was conducted on a sample of 283 patients who were eligible to participate in cardiac rehabilitation. A construct validity test was performed using factor analysis. Cronbach's alpha was used to examine the internal consistency. The test–retest reliability was calculated using the intraclass correlation coefficient on 22 participants. Independent-samples t test and analysis of variance were conducted to assess the criterion validity. Mean scores for total barriers of the scale and each individual factor were compared among the different patient characteristics. Results: The Malay-version CRBS showed an item level of content validity index of 1.00 for all of the items after improvements were made based on the experts' suggestions. The factor analysis, using principal component analysis with direct oblimin rotation, extracted four factors that differed from the original study. These four factors explained 52.50% of the cumulative percentage of variance. The Cronbach's alphas ranged from .74 to .81 for the obtained factors. Test–retest reliability was established using the intraclass correlation coefficient value of .78. Criterion validity was supported using the significant differences in the mean score for total barriers among educational level, driving distance, travel time to the hospital, and cardiac rehabilitation attendance. Conclusions/ Implications for Practice: This study found the Malay-version CRBS to be a valid and reliable instrument. It may be used with inpatients to identify barriers to participation in cardiac rehabilitation to promote rehabilitation attendance and improve patient care. KEY WORDS: translation, adaptation, psychometric testing, Cardiac Rehabilitation Barrier Scale, Malay