... ICP/HEE/OOl ENGLISH ONLY
J
REPORT ON THE INTERCOUNTRY WORKSHOP ON HEALTH OF THE ELDERLY
Convened by the
REGIONAL OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANIZATION Fukuoka, Japan 22 - 27 October 1984
Not for resale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines January 1985
r
Note The views expressed in this report are those of the participants in the Workshop and do not necessarily reflect the policies of the Organization
This report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for Governments of Member States in the Region and for those who participatned in the Intercountry Workshop on the Health of the Elderly, which was held in Fukuoka, Japan, from 22 to 27 October 1984.
CONTENTS
1.
INTRODUCTION OBJECTIVES
.......................................................................................................... . .......................................................................................................... .
1
2.
3
3.
WORKSHOP PROCEEDINGS 3 .. 1 Organizaton
.......................................................................................... • • • • •• • • • • •• • • . . . • • • • • • • • • • • • • • • • • • • • . • • • • • . . .................................................................. '"......................
5 5
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
3.2 3.3
Project review Other projects
5 7
4.
RECOMMENDATIONS 4.1 4.2 4.3
.................................................................................................... .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... ..
7
General conclusions and recommendations regarding policy, prograuunes and training 7
General conclusions and recommendations for research Specific recommendations for the current c rOI!! a-country survey
••.••••
9 10
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .. ..
ANNEX 1 - SOME KEY FINDINGS ANNEX 2 - OPENING REMARKS BY THE REGIONAL DIRECTOR ANNEX 3 - AGENDA
11
19
........................................................................
21
ANNEX 4 - LIST OF PARTICIPANTS, TEMPORARY ADVISERS, CONSULTANTS, OBSERVERS AND SECRETARIAT ••••••••••••.••• ANNEX 5 - RESEARCH PROTOCOL ANNEX 6 - MINIMUM DATA SET
25 31 83
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1.
INTRODUCTION
Health care of the elderly is increasingly recognized as a main priority for development in the Western Pacific Region of the World Health Organization. A Working Group on Health Care of the Elderly. which first met in Manila on 18-24 August 1981, identified "insufficiency of data available on the needs. demands and problems of this age group as well as the inadequacy of skills and knowledge in providing for their health and social care •••• ".1 Since that time. the World Assembly on Aging has been held under United Nations auspices in Vienna in July/August 1982. The Vienna Plan of Action. which was subsequently adopted by the United Nations General Assembly, called attention to the importance of increasing international cooperation and regional cooperation. In particular. emphasis was given to intercountry activities in order to promote cooperative research. as well as the exchange of information and expertise among interested countries at regional level. It has now been widely accepted that, given demographic projections and changing socio-economic features. together with increasing urbanization. modernization and pressures on traditional values. the aging population in the developing countries of the world will represent a major challenge to health care policy-makers and providers in the coming decades. That these factors are evidently at work in the Western Pacific Region is set down in detail in the Research Protocol for the Health of the Elderly Project (Annex 3). The relative number and proportion of the elderly in most countries of the Western Pacific is still small so that the impact of population aging on social and health services is only now beginning to be evident. As this sector of the population grows rapidly in absolute and proportional terms during the next few decades, the impact will increasingly be felt and. because of its relative needs, it can be expected to be out of proportion to the actual increase in the aging population itself. The opportunity thus exists in the Region to anticipate future needs and, on the basis of concrete data. to develop appropriate policies and programmes to effectively meet the challenge within the context of the World Health Organization's overriding goal of health for all by the year 2000. A study of the health and social aspects of aging, sponsored by the World Health Organization Regional Office for the Western Pacific, was begun in response to these objectives in cooperation with the Governments of Malaysia, the Republic of Korea. the Philippines and Fiji. The study is being conducted in two parts. The first is to examine data which are already available in accordance with a standard format. The second is to collect information and population data which are not currently available through the use of a survey instrument andindepth case studies. A full description of the research design. instruments. survey methodology and timetable is given in Annex 2. The project has proceeded in accordance with the original timetable established in October 1983. The Intercountry Workshop on the Health of the Elderly was held at the Sun Palace. Fukuoka, Japan. from 22 to 24 October 1984 to coincide with the completion of the fieldwork and the initial analysis of the results for both parts of the study for Malaysia, the Republic of Korea and the Philippines. The workshop also coincided with the commencement of fieldwork for Fiji. l"Working Group on Health Care of the Elderly" Manila, Philippines, 18 - 24 August 1981. WHO/WPRO, Manila, Philippines. December 1981.
- 2 The workshop was attended by 15 participants, 3 WHO temporary advisers, 2 consultants, 4 observers and a WHO secretariat of 2, comprising
the Regional Nutrition Adviser (Operational Office) and the Manager, Global Programme on Health of the Elderly. Present at the meeting were participants, observers and advisers from Australia, China, Fiji, Hong Kong, Indonesia, Japan, Malaysia, New Zealand, the Philippines, the Republic of Korea, and Singapore. Following the WHO workshop, the participants were then actively involved in additional workshops and a symposium, which were collaboratively sponsored and organized by the WHO Regional Office for the Western Pacific, the International Association of Gerontology/Asia Oceania Region and the Japan Geriatric Society. The six-day programme was as follows: Monday, 22 OctoberWednesday, 24 October Thursday, 25 OctoberFriday, 26 October WHO Intercountry Workshop on the Health of the Elderly International Workshop and seminar: Workshop I - Population based studies of aging Workshop II - Dementia in the developing world Symposium on Aging
Saturday, 27 October
In his address to the WHO Intercountry Workshop on the Health of the Elderly, Dr Hiroshi Nakajima, Regional Director of the WHO Regional Office for the Western Pacific said that the examination of the health of the elderly in the Region was in accordance with the plan of action accepted by the United Nations following the World Assembly on Aging held in Vienna in 1982. He emphasized that basic research, cooperation and exchange of information on the health of the elderly would significantly contribute to the WHO objective of health for all by the year 2000. The issue was of particular importance in the Western Pacific Region because of improved control of infectious diseases, changes in traditional values, family structure and lack of information generally in the developing countries. He stressed the value on this particular occasion of the joint meeting with the International Association of Gerontology/Asia Oceania Region and the Japan Geriatric Society in contributing to the sharing of expertise and information. The address is annexed in full. Throughout the three days, the workshop focused on the questions of future action in research, policy formulation, programme development and professional and community education. The preliminary data provided to the meeting formed a basis on which to build a framework for further activities and gave some rationale for the establishment of policy directions, priorities and future planning at regional and national levels. It became evident that, while substantial further analysis of the available data is justified and more indepth consideration should be given to key policy issues, the future main thrusts of action should be country-based and emphasis must be given to nationally and locally focused action plans.
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Annex 6 contains a timetable for the project detailing: progress to date the completion of the present intercountry study in 1985 development of policy guidelines in 1985 development of individual country action plans in 1985/86 further development of the study 2.
OBJECTIVES
Objectives were established and agreed for both the study itself and the three-day intercountry workshop. The study objectives were formulated in the light of the demographic, socio-economic and cultural changes expected in the Region. It was recognized that there would be an increasing need to provide data on aging to assist in policy formulation, planning, priority rating and resource allocation. Particular consideration should be given to the level of expertise and resources available within the Region. Thus the study was undertaken with the following specific objectives in mind: (1) to increase awareness among researchers and policy-makers of the issues associated with an aging population; (2) to provide a pilot cross-sectional study using largely quantifiable techniques to gain experience in undertaking such research in an Asian setting; (3) to generate provisional and indicative quantifiable information on which to base objectives for more intensive and specific investigationsj
(4) to move towards the alternate achievement of a comprehensive data base on aging for the Western Pacific Region of WHO; and finally, (5) to provide some information which will be relevant in the formulation of policies and provision of programmes to meet the needs of the aging population. The specific objectives set down for the three-day intercountry workshop as such were: In connection with the cross-national study on social and health aspects of aging, undertaken in Fiji, Malaysia, the Philippines and the Republic of Korea, to: (1) formulate recommendations for gathering ongoing data within countries and for the Region by reviewing background data collected from existing sources; (2) develop a framework for translating the survey results into proposals for a plan of action on the basis of the preliminary results of the survey on a national and cross-national level; (3) make recommendations on plans for future research activities on the aging, particularly proposals for indepth studies which arise out of the preliminary results of the present study;
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(4) discuss the implications of the research results for the development of national policies and guidelines on health care of the aging, within the context of primary hea1h care and organization of health services for health for all by the year 2000. The overriding objective of both the study and the workshop was to achieve some concrete recommendations which would govern future action in the area of health care of the elderly. In this respect and in order to establish a process for formulating action plans, the workshop adopted the following general framework for setting out the relationship of survey information to policy and programme development. Table 1 Relationship of Survey to Policy and Programme Development Questionnaire Mental status Issue
Policy Promotion of mental health of the aging Minimum income
Programme
Prevalence of dementia and depression Poverty
Counse 11 ing and community mental health care Financial supplementation or assistance
Economic resources
Health
Relationship of heal th and aging Re lationship of utilization and aging Relationship of lifestyle and health Relationship of disability and aging
Health care of the aging Health planning for the aged Prevention
Provis ion of primary heat1h care
utilization of health services Lifestyle
Provision of comprehensive
heal th services Health education and promotion Provision of aids and community assistance
Disabilities
Minimization of handicap
Activities of daily living Transport Housing Mobility and aging Housing problems and aging Family and community
Access Housing
Provision of transport Alternative acco1lBllodation provisions
Social resources
Family and conununity
and family support
Family support services
roles and aging
responsibility
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3. 3.1 Organization
WORKSHOP PROCEEDINGS
Dr Hajime Orimo, Japan, was elected Chairman for the meeting. The individual participants are listed in Annex 3. The following Rapporteurs were appointed for the meeting as a whole: Professor Paul C. Y. Chen, Malaysia Professor John Campbell, New Zealand Dr Hal Kendig, Australia (Observer/Rapporteur) The workshop followed the agenda given on Annex 4. Participants were divided for small group discussion into three working groups: physical health and medical service mental health social aspects. Each group was asked to review a section of the research protocol/questionnaire and survey results in terms of the following: (1) (2) (3) (4) implications for policy, programmes and training; cross-country variation: suggestions for further analysis; improvements in study methodology and questionnaire design.
The group discussions were recorded in detail in the Rapporteurs' reports. The reports will contribute significantly to the completion of the project and the development of the survey instrument. The workshop activity, small group sessions and plenary meetings were characterized by active participation and involvement of all of the participants, and the degree of interaction achieved between all involved in the meeting was seen itself as a most worthwhile outcome of the exercise. 3.2 Project review
The consultants reported progress in the implementation of the project in the four-country study. In addition, the approach to preliminary analysis was described and the initial results and tabulations were discussed. Principal investigators for each of the countries reported on their experience. The results of the review of existing data sources for Malaysia, the Republic of Korea and the Philippines were reported. This consisted of an exhaustive analysis of routine data collections, national surveys and one-off data collections and studies, which were reviewed in terms of the timeliness, specificity and appropriateness of data collections. In general, a paucity of specific data relating to aging beyond that gathered in routine census collections was identified. The main gaps in data collections and specification of the agreed minimum data set on the aging population are given in Annex 6.
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The survey had been successfully implemented in the field in Malaysia, Republic of Korea and the Philippines, and would shortly be applied to a sample of the aging population in Fiji. Completed questionnaires were analysed as follows: Country Malaysia Republic of Korea Philippines Number of analysed Questionnaires
1001 977 827
Results had been processed on schedule in Adelaide and draft-weighted (for age, sex, ethnicity where appropriate and urban/rural distribution) tables were presented for discussion. 1 In general the principal investigators had not experienced any major difficulties in implementing the study. While formal validation and reliability testing had not been undertaken in the field, the Principal Investigators' meeting held previously had thoroughly explored the face validity of individual items and questions had been scrutinized carefully for cultural bias. 2 The field experience of the questionnaire in test-runs had been generally positive. Detailed recommendations for alterations to the questionnaire, particularly in the area of financial resources, were noted. 3 Response rates were generally reported as being very high with more refusals being experienced in the urban higher-class areas, but even in these instances response rates of better than 85% were noted. The detailed results required further close study and more indepth analysis. A broad review, however, revealed generally a reassuring consistency in results generally. Overall the impression was of a reasonably physically and mentally agile aging population with a very high proportion of the respondents residing in households of two or more generations. Lifestyle factors, particularly smoking and drinking behaviour, revealed some interesting cross-country variations for further
problems such as visual impairment could be identified as specific issues for further consideration. More detailed and indepth review of both country results and intercountry comparisons is planned for the final report and the workshop provided valuable pointers for an approach to analysing the data available.
l"Preliminary Survey Results, Health and Social Aspects of Aging. Republic of Korea, Malaysia, Philippines." Prepared for the WHO Intercountry Workshop on the Health of the Elderly" Fukuoka, Japan, October 1984. Z"Report - Principal Investigators' Meeting for the Health Care of the Elderly Project", 14-16 December 1983, WHO/WPRO, Manila, Philippines. 3Reports by the rapporteurs of th e three working groups at the WHO Intercountry Workshop on the Health of the Elderly, Fukuoka, Japan, October 1984, as detailed in Section 3 "Workshop Proceedings".
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3.3
Other projects
A broad review of current and planned project activities throughout the countries represented at the meeting was undertaken on a round-table basis. A range of studies extending over such projects as reviews of mental health services for the elderly, definition of physiological reference values, surveys of dementis, risk factor studies, studies of housing needs for extended families, socio-economic surveys of the aging population, labour force involvement, etc. etc. were reported upon briefly. This emphasized the need for some effective means of monitoring current activities in aging research throughout the Region. Dr Macfadyen made reference to activities of the Global Programme including the availability of a microcomputer graphics programme for data display and a proposed International Course on Epidemiology of Aging to be held in London during September 1985. In addition, some key WHO reports were now available which were relevant to the topic. 1 4. RECOMMENDATIONS
4.1
GENERAL CONCLUSIONS AND RECOMMENDATIONS REGARDING FUTURE POLICIES, PROGRAMMES AND TRAINING The workshop participants concluded: that the WHO Regional Office for the Western Pacific, in collaboration with countries of the Region, should initiate the process of developing policy guidelines on aging which could be di~cussed and possibly adopted at the next regional WHO meeting.
4.1.1
4.1.2
In formulating guidelines the workshop participants believe: (i) that special consideration must be given to the consequences of demographic transition in terms of the particular needs of the aging population as identified in studies and the importance of promoting and maintaining the health of the aging population; (ii) that use should be made of available survey data at national and cross-national levels to formulate in more detail the development of specific policies, programmes and training requirements.
4.1.3
The participants considered: (i) that the range of policies, programmes and tra1n1ng requirements which emerge will require reconceptualization of key aspects of health care delivery, especially primary health care, to focus on the special needs of the aging, and that this reconceptualization will need to reach well beyond health care delivery to encompass such areas as economic development,
employment, productivity, housing, education and exploration of the positive contributions of the aging to the community and society generally; l"The uses of epidemiology in the study of the elderly." Report of a WHO Scientific Group on the Epidemiology of the Aging, Technical Report Series 706, WHO, Geneva, 1984.
. ~"
- 8 (ii) that the programme implications which then evolve may well
not require expensive new resources but may represent a reorientation of priorities and programme directions to reflect
the identified special needs of the aging. 4.1.4 The participants directed specific attention to the following; (i) The family as the principal source of support for the aging. Note was however taken of the increasing pressures on families and especially on female children so that adequate emphasis needs to be given to appropriate mechanisms for providing family as well as community support. This may require some direct support to be provided to carers rather than necessarily being directed to the needs of the aging individuals themselves (e.g. respite care). (ii) The manner in which preliminary survey results highlighted the areas requiring development of specific recommendations such as set out in the foregoing. Broad areas of programme reconceptualization included, by way of example, such approaches as:
challenging the misconceptiDn that the aged are mDre handicapped than indeed they actually are; reviewing and improving the availability Df needed health aids; fDcusing mental health training towards depression and dementia as key prDblems assDciated with aging; and exploring the effectiveness of health promotiDn strategies directed to improving the health behaviour Df the aging population. 4.1.5 The participants considered action should now be taken to; (i) consolidate and analyse in detail the results of the WHO Cross-Country Study in order to provide a data base on which to mount national workshops on health of the elderly to be held in 1985/1986 with WHO support in each of the countries participating in the study with a view to developing specific policy and programme prDposals taking account of the demography, level of develDpment, resources and specific needs of each individual country;
(ii) review ongoing data collections available in each country including census, morbidity collectiDns, national household survey exercises, population surveys, etc. in terms of the
appropriateness and timeliness of these activities in relation to defining community needs, manpower requirements and health care resource requirements;
(iii) comprehensively review at national level the provision of primary health care in the light of the anticipated aging of the population generally. Having regard to the patterns of morbidity and association of physical, mental and social factDrs in the health of the elderly, the appropriateness, utilization and accessibility of existing services should be examined. Programme
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priorities and current organization of services should then be appraised in terms of the need to accommodate the special needs of the elderly and their families in the future; (iv) improve the degree to which positive attitudes and appropriate knowledge and skills are achieved in health professional training in relation to the elderly. In this respect the data base which will be provided through the WHO-sponsored regional cross-country study and other available sources of data should be utilized to provide the necessary information required for a full understanding of the experience of aging in the unique economic, social and cultural settings of the Region. The resource document on curriculum development, developed at a cross-country interregional WHO meeting in Singapore in 1981 (as updated), could also be a useful resource in this area; (v) utilize the information obtained from the study to promote through the media channels a wider understanding of the key issues associated with aging through public education. 4.2. 4.2.1 GENERAL CONCLUSIONS AND RECOMMENDATIONS FOR RESEARCH The participants made the following recommendations: (i) The differentiation between impairment, disability and handicap provides a useful framework for conceptualizing the principal applications of epidemiological and social research. (ii) Priorities given by individual countries depend upon the availability of resources and expertise. Thus, all countries should at least undertake research such as that described in the WHO-sponsored cross-country study aimed at providing data on prevalence, particularly of handicaps and associated social support networks. Such population-based studies will provide basic data relevant to programme development. (iii) Those countries in the Region with sufficient resources should undertake more sophisticated etiological and epidemiological studies directed to elucidation of causes, risk factors and specific incidence of disease in the aging population. Both quantitative research and qualitative information to establish a more complete picture of the context of identified problems should be undertaken. Such research should draw on the valuable contrasts in social,'economic and cultural environments which exist within the Region and fieldwork should then be designed to include several countries. Where resources are appropriate, the nature of the issues is such that longitudinal studies will be of particular value. (iv) The WHO Regional Office for the Western Pacific should move to create a register of current research on aging for appropriate distribution thruoughout the Region to encourage collaboration and cross-country transfer of skills, knowledge and experience. This register should be achieved in the first instance by surveying the countries throughout the Region to obtain up-to-date information on current activities. The information could then be regularly
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updated at least every three years. Particular note was taken of the impressive range of biological research currently under way in the Region into dementia, and the potential value of developing a pool of information concerning risk factors, which are currently being explored in a relatively disjointed fashion, was also stressed.
4.3. 4.3.1
SPECIFIC RECOMMENDATION FOR THE CURRENT CROSS-COUNTRY SURVEY Participants advised: (i) that further research should now be pursued based upon the WHO-sponsored cross-country study. The research protocol and survey instruments should be refined and improved along the specific lines recommended by the small groups during this intercountry workshop. 1 The objective should be to achieve a culturally transferable "core package", which can then be used in future surveys throughout the Region. This core set of instruments should be formally tested for reliability and validity in this regional setting to assist further application in the field. (ii) that further studies should then be promoted throughout the Region with the primary aim of establishing prevalences using standardized methodology as a means of assisting in the development of scientifically supported policy formulation and programmes.
lReports by the rapporteurs of the three working groups at the WHO Intercountry Workshop on the health of the Elderly, Fukuoka, Japan, October 1984, as detailed in Section 3 "Workshop Proceedings".
- 11 ANNEX 1 SOME KEY FINDINGS The work groups highlighted some key findings which indicate, as examples only, the nature of issues, policies and programmes which are likely to be developed once the anlaysis of the project results has been completed. The examples developed so far highlight the extent to which a broad range of issues of relevance to the whole community have impact on the health and perceptions of health of the elderly, and in particular on the extent to which they cope with disabilities. The initial results indicate that the most appropriate action for many of the key issues is a reconceptualization of existing policies and programmes. 1. Economic Resources (a) Issue
A concept of economic well-being broader than income and assets owned is more relevant. Many aging people live with or nesr their families and are dependent on the families' economic wealth. Nevertheless, the elderly sometimes contribute labour, child care and assets to the family. The numbers of elderly living with their children are: Malaysia Republic of Korea Philippines (b) Policy 72% 77% 76%
The family should be seen as the economic unit in many but not all cases. Employment status of children and the degree of unity of the family should be taken into consideration in developing programmes. (c) Programmes
Programmes could support maintenance of exchange, between the aging person and other members of the family, to strengthen the family unit. Programmes also could support stimulation to geneal economic activity in the community. 2. Work (a) Issue
About one-quarter of the aging contribute in a work sense. However, the changing structure of the labour force to a greater proportion being employed can threaten the ability of persons of post-retirement age to contribute.
- 12 Annex 1 Works full- or part-time Republic of Malaysia % Korea
Philippines %
%
Male Female Urban Rural Overall
34 11
14 27 22
45 19 14 54 31
35 14 24 25 24
Also the majority of elderly do not feel that they are consulted by the community. (b) Policy
Develop new programmes to respond to changes in the structure of the labour force and to promote the economic and social contribution of the elderly to the community, at a rate which they find desirable, to strengthen the social and economic base of the elderly. (c) Programmes
Programmes could include informal and formal re-education of the aging of retiring age. 3. Literacy Illi terate, includinll blind Republic of Malaysia % Korea
Philippines %
%
Male Female Total (a) Issue
27 79 54
57 80 68
35 46 40
Illiteracy i. greater in rural areas and among the 70+ age group. (b) Policy
Develop all health and welfare policies and programmes in such a manner as not to be dependent on the literacy of the recipient. (c)
Prollrammes
Existing programmes in all areas could be affected through the use of pictorial material etc. and through the involvement of other literate members of the family and community.
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Annex 1 4.
Housing (a) Issue
Survey data indicate housing may present difficulties for the aging in the Republic of Korea. Issues include residents' perception of the house, and availability of fresh water and cooking facilities. (b) Policy
Review the availability of housing and the suitability of housing for the elderly. Establish the extent, if any, to which housing is inappropriate and, if so, how the elderly are affected.
Final programmes could be based on local communities' or families' involvement in upgrading housing for the elderly. 5.
Utilization of services (a)
Issue
Differential rstes for utilization of services between areas are indicated in the survey data. Utilization of services Republic of Korea %
Malaysia %
Philippines %
Doesn't feel healthy Illness affects activities of daily living Saw doctor at least once Saw nurse at least once Saw pharmacist at least once Saw HW at least once Sick one or more day. Needs more medical care Took prescribed medicine Took over-counter medicine
27 26 41 1 1 5
50 43 20 1 27 7 19 48 25 44
17 66 28 14 1 1 9 16 58 42
7 9 47 27
The results suggest that polypharmacy could be a problem and that there are specific groups in need of additional services. There is also a suggestion that there exists a group who are financially deprived and who require more treatment. (b) Policy Review the causes for the recorded poor perceived health in Korea.
- 14 Annex 1 (c) Programmes
Progranunes could be based on building a greater reliance on doctors rather than on pharmacists. 6. Activities of Daily Living (ADL) Activities of daily living Republic of Korea % 7 8 5
Malaysia %
Philippines %
Travel Shopping Handle money Get to we in time No help available (a) Issue
2 6 3
3 S
1 3
4 14
22 22
4
The same five factors were highest rating, out of eleven factors, in each of the three countries. Apart from getting to the we in time, ADL factors relating to activities within the home did not generally rate beyond 1-2%. (b) Policy
Policy and programme outcomes regarding ADL issues will depend upon further analysis of the data, concentrating on the availability of support from the family and the local community. 7. Heal th Aids Specific health problems Republic of Korea %
Malaysia %
Philippines %
Foot problem restricting act1v1ty Hearing problems Sight problems Evidence of cataract Dental prosthesis Difficulty chewing
7 16 68 57 37 48
15 20 33 12 39 62
3 26 81
20 3S 3S
- 15 Annex 1 Eyesight and use of glas8es Republic of Korea %
Malaysia %
Philippines % 61 18
Glasses used Glasses needed (a) Policy
44 7
44 3
Investigate causative factors for high prevalence of sight problems recorded in the Philippines. (b) Progr8lllDes
Final prograames could be centred round: (1) increased provision of glasses; (2) reduction in the eyesight risk factors in the cOllDDUnity 8.
Lifest;ile Heavy smoker (15 or more fer da;i) Republic of Korea %
Malaysia %
Phi lippines % 18 7 13
Male Female Overall (a) Policy
21 3
12
51 20 35
Discourage smoking.
Educate ca.munity on risks of smoking. 9. Mental Status (a) Issue
There is a low prevalence of psychotic disorders. The prevalence of dementia and depression is higher but the greater majority show normal cognitive functions. The Korean data shows poorer cognitive function and greater depression.
- 16 Annex 1 Cognitive score on 15 items Republic of Korea %
Malaysia No correct
Philippines % 0
responses 0-
%
3 7
4 -
8 - 11 12 - 15
2 4 23 71
3 14 31 52
1 12 87
(b)
Policy
In the mental health area, place a greater emphasis on supporting demented and depressed persons in the community rather than on psychotic disorders. (c) PrograDD1les
Modify training programmes for health care workers, service-providers and the general community. 10 Social resources and family support (a) Issues Living conditions of the elderly are influenced strongly by family circumstances. The extent to which family can cope with providing support is important. Family planning is reducing family size and affecting families' ability to provide support. The exchange of contributions between the elderly and the family and community can be unnecessarily unbalanced. The value of the contribution from the aged i. not always recognised. (b) Policy
Enhance and promote opportunities for the aging to contribute. Provide recognition of the contribution of the aging. Provide support for the carers (family and community) where appropriate, rather than directly for the elderly person. 11. Overall Situation (a) Issue
With the exception of sight and hearing problems, prevalance of specific health complaints is low. In particular the elderly are quite mentally agile and reasonably physically agile.
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Annex 1 (b) Policy Promote the elderly as a group who have the potential to contribu te to the family and community. Investigate means of reducing the level of sight and hearing handicaps. SUIIlIIIary The brief analysis given above indicates the types of results which a detailed analysis of the study data will produce.
- 19 ANNEX 2 OPENING REMARKS BY THE REGIONAL DIRECTOR TO THE WHO INTERCOUNTRY WORKSHOP ON HEALTH OF THE ELDERLY PROJECT HELD IN FUKUOKA, JAPAN, ON 22-27 OCTOBER 1984 Ladies and Gentlemen, It gives me great pleasure to say a few words to you on the second day of this Intercountry Workshop on Health of the Elederly which is being held to review the results of the WHO-sponsored national collaborative studies on social and health aspects of aging in Malaysia, the Republic of Korea, and the Philippines. The Vienna Plan of Action, which was accepted by the United Nations General Assembly, following the World Assembly on aging held in July and August of 1982 in Vienna, specifically referred to the need for basic research and especially for programmes of cooperation and exchange of skills and knowledge at regional level. The studies which are being reported at this workshop are fully consistent with these important obejctives. As you know, only sixteen years remain between now and the end of this century, for us to achieve the World Health Organization's goal of health for all by the year 2000, and it is essential that the special needs of the aging population should not be overlooked during this critical period. As I remarked in December last year at the Principal Investigators' Meeting for the project in Manila, the programme for the care of the elderly is receiving an increasing share of attention, both at national level and within international organizations like WHO. As the problems of communicable diseases have come under increasing control in most parts of the world, the expectation of life has increased not only in developed countries but also in developing countries. The proportion of the aged is thus growing in the majority of countries, and this changed population structure will become more definite in the years to come. In addition, the traditional joint family structure and the ancient cultural pattern under which the younder generation were duty bound to care for their elders are gradually changing and more and more aged persons are being left to look after themselves. As a consequence of these factors, the problems of the aged will need to receive priority attention. Although there is a reasonable amount of data available on the situation in the developed countries throughout the world, this is not the case in the developing countries, and, in order to decide on programmes for the welfare of the aged, it is essential to have a clearer picture of the nature and extent of their problems. This has led us to support national studies on the social and health aspects of aging in Malaysia, the Republic of Korea, the Philippines and subsequently, Fiji. The presence at this meeting of participants from China, Hong Kong, Japan, and Singapore - countries or areas which were not
involved in the initial survey - is most important as it is our hope that this type of work will be extended throughout the Region to eventually provide a valuable and comprebensive regional and national data base on the health and social aspects of aging in the Western Pacific.
- 20 -
Annex 2
I understand that today you will be reviewing the survey results in depth while tomorrow you will undertake the important task of formulating recommendations for future action. This meeting is also very significant as it will continue throughout the week in a collaborative exercise with the International Association of Gerontology, Asia Oceania Region and the Japanese Geriatric Society. I am also very pleased to note that Dr David Macfadyen, the Manager of the Global Programme on Health of the Elderly, is also participating in the meeting. I wish to extend my special thanks to our Japanese hosts and particularly to Professor Kenzo Tanaka, President of the Kyushu University and his esteemed colleagues. I must also thank the consultants for this project: Professor Gary Andrews, who has been the principal consultant involved and - for the assistance in the study MR Cam Rungie and Mr Adrian Easterman, who is responsible for the statistical analysis. I would also like to acknowledge the admirable work that has been undertaken under the direction of the Principal Investigators in the participating countries, with the support of their National Advisory Groups. I will conclude these remarks by wishing all of you a pleasant stay in Fukuoka and a most fruitful meeting. I look forward with keen interest to learning of the outcome of your discussions which will be vitally important in determining the future support of WHO for this most important Regional Project. Thank you.
- 21 ANNEX 3 WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE
IIfGIOMAL OFfICE fOil THE WESTE"N PACIFIC BU"EAU "'GroNA\. DU PACIfiQUE OCCIDENTAL
INTERCOUNTRY WORKSHOP FOR HEALTH CARE OF THE ELDERLY PROJECT Fukuoka, Japan 22-27 October 1984 AGENDA Monday, 22 October 8:30
\/PR/HEE 84.1 3 September 1984
Welcome Address Dr N. V. K. Nair, WHO Regional Adviser in Nutritioll Opening Remarks Professor Gary Andrews, WHO Consultant Election of Chairperson and Rapporteurs
9:00 9:15
COFFEE BREAK Working Session - Participating Country Reports Republic of Korea Malaysia Philippines Fiji
11:45
Reports on Current Activities in Other Countries China Hong Kong Japan Singapore
12:30 13:30 14:00 15:00 15:30
LUNCH Working Session - Statistical Report Mr Adrian Easterman, WHO Te~orary Adviser Small Group Discussion - Cross National Comparisons COFF8E BREAK Working Session - Framework for Policy and Programme Recommendations Plenary Discussion
17:00
Adjourment
- 22 -
Annex .3.. WPR/HEE/84.1 Tuesday, 13 October 9:00
Address by Dr Hiroshi Nakajima Regional Director, WBO/WPRO Review of First Day Dr David Macfadyen Manager, Global Programme, REE/EURO
9:30 9:45
COFFEE BREAK Working Session - Review of Survey Results Demographic Information Economic Resources
Housing 12:30 13:30 LUNCH Working Session - Review of Survey Results Health - Physical and Mental Activities of Daily Living 15:00 15:30
COFFEE BREAK Working Session - Review of Survey Results Social Resources Assessment
17:00
Adjourraent
Wednesday, 24 October 8:30 Review Session Professor Gary Andrews and Mr Cam Run3ie - WHO Consultants
9:00
Small Groups - Reco_endations for Ongoing Dsta Collection of National and Regional Levels COFFEE BREAK Working Session - Plenary Small Group Reports
10:00 10: 15
- 23/24 Annex 3 WPR/HEE/84.1
10:30
Small Groups - Recommendations for Policy Formulation and Programmes Primary Health Care Specialist Training and Programmes Community Support Programmes Institutional Care
12:00 12:30 14:00
Working Session - Plenary Small Group Reports LUNCH Working Session - Future Research Directions Research Implications for Other Countries Japan China Singapore Hong Kong
15:00
Working session - Longitudinal Studies Advantages Feasibility Recommendations
15:30 16:00 17:00 17:30
COFFEE BREAK Working Session - Format for Final Report and Recommendations Working Session - Proposals for Further Action Adjourment
- 25 -
ANNEX 4 W 0 R.L D HEll. L T H ORGANIZATION ORGANISATION MOHDIALE DE LA SAHTtil
REGIONAL O'''CE '0" THE WESTEIIN 'ACI'IC 8UII.EAU II(GIONAL DU 'AClflQUE OCCIDENTAL
WHO INTERCOUNTRY WORKSHOP ON THE HEALTH OF THE ELDERLY Fukuoka, Japan 22'to 27 October 1984 INFORMATION BULLETIN NO. 2
WPR/HEE / IB 12 30 September 1984 ENGLISH ONLY
LIST OF PARTICIPANTS, TEMPORARY ADVISERS, CONSULTANTS, OBSERVERS AND SECRETARIAT 1. AUSTRALIA PARTICIPANTS
Dr G.A. Broe * Senior Neurologist Lidcombe Hospital Lidcombe, N.S.W. Dr Zhang Lin Deputy Chief Physician of Medicine Deputy Director of Institute of Geriatrics Beijing Hospital Beijing Dr Wang Xinde* Director Department of Neurology Beijing Hospital Beijing
CHINA
FIJI
Dr Nii-K P1ange School of Social and Economic Development University of the South Pacific Suva Dr V. Rigamoto Assistant Director for Social Welfare c/o Social Welfare Department Box 2127 P.O. Government Building Suva
iii
Particlpant funded
..
~i
EURO.
- - 26 -
Annex 4 WPRtHEE/IB/2 HONG KONG Dr Ng Yau Yung Consultant Geriatrician, Geriatric Unit Princess Margaret Hospital Hon. Lecturer in Geriatric Medicine University of Hong Kong c/o Medical and Health Department Sungsing Plaza Hipen Avenue Causeway Bay Dr Katsumanto Setyonegoro c/o World Health House Indraprastha Estate Mahatma Gandhi Road New Delhi - 110002 Dr Hajime Orimo Associate Professor Tokyo University Medical School IJunkyoku !okyo Professor Paul C.Y. Chen Department of Social and Preventive Medicine University of Malaya Kuala Lumpur 22-11 Dr Nur Afizah bt. Mohd. Noor Physician General Hospital Kelang, Selangor PHILIPPINES Dr Jane Baltazar Associat-e Professor Institute of Public Health University of the Philippines Pedro Gil Street, Ermita Manila Dr June P. Lopez Psychiatric-Research Consultant Phil ippine Mental Heal th Association 11 Eas t Avenue Diliman Quezon City
INDO:;ESIA
JIIPA.>;
MALAYSIA
- 27 -
Annex 4 ~;PR/HEE /
IB / 2
REPUBLIC OF KOREA
Dr Jong Huh School of Public Health Seoul National University Seoul Dr Seon Ja Rhee School of Public Health Seoul National University Seoul
SINGAPORE
Dr Ling Sing Lin Registrar •.. Ministry of Health HQ 09-00 Cuppage Centre 55 Cuppage Road
2.
TEMPORARY
ADVISERS
Dr John Campbell Senior Lecturer in Medicine Otago University Dunedin New Zealand Mr Adrian Easterman Medical Statistician South Australian Health Commission P.O. Box 1313 Adelaide 5001 South Australia Dr Kiyotaro KOlido Pro.fessor and Chairman Department of Public Health Hokkaido University School. of Mediciae Kita-ku, Sapporo Japan
-
28 -
Annex 4 WPR/HEE/IB/2
3.
CONSULTANTS
Dr Cary Andrews Chail~an and Chief Executive Officer Health Commission of South Australia Westpac Building 52 Pirie St. Adelaide SA 5000 Australia
Kr Cam Rungie
Social Researcher 25 Hutt St. Adelaide, SA 5000 Australia
4.
OBSERVERS
Professor Grimley Evans Department of Medicine (Geriatrics) New Castle General Hospital New Castle-on-Tyne England Mrs Ruth Ina11 Secretary Asia/Oceania Region International Association of Gerontology Science Centre 35 Clarence Stpet Sydney, NSW Australia Dr Hal Kendig Director Family and the Aging Project School of Social Sciences Australian National University Canberra, A.C.T. 2600 Australia
- 29/30 -
Annex 4 WPR/HEE/IB/2
5.
SECRETARIAT
Dr N.V.K. Nair (Operational Officer) Regional Nutrition Adviser WHO Regional Office for the Western Pacific Manila, Philippines Dr D.M. Macfadyen Global Manager Health of the Elderly WHO Regional Office for Europe 8, Scherfigsvej DK - 2100 Copenhagen 0
Denmark
- 31 -
ANNEX 5
25th October, 1983 ENGlISH OMl V
• RESEARCH PROTOCOL 8y
Professor Gary R. Andrews 1 WHO Consultant and Ca. M. Rungle 2 SenIor Research AssIstant
nt1e of Project locatIon PartIcIpatIng AgencIes
Health Care of the Elderly MalaysIa, RepublIc of Korea and Phlltpplnes GovernMent of MalaysIa GovernMent of the RepublIc of Korea GovernMent of the PhIlIppInes GovernMent of F1Jt World Health OrganIzatIon JSIF and General Funds
Source of funds
1 ChaIrman and ChIef ExecutIve OffIcer, South AustralIan Health CQMllsslon ·PO 80x 1303, AdelaIde, S.A. 5001. ClInIcal Professor of CGllUnlty MedIcIne, Fltnders UnIversIty of South AustralIa and the AdelaIde Unlvers Hy. 2 SocIal Researcher, 2S Hutt Street, AdelaIde, South AustralIa, 5000.
- 32 Annex 5 ( i )
I I
CONTENTS Pave SUMARY 1. 2. 3. INTRODUCTION BACKGROUND TO PROJECT AN OVERVIEW OF THE RESEARCH PROJECT 3.1 Terms of Reference 3.2 strategy 3.3 SpecHlc ObjectIves BasIc DemographIc Data - Present and Projected 3.3.1 3.3.2 MortalIty and MorbIdIty 3.3.3 Soclo-economlc Factors SocIal IndIcators 3.3.4 Facl11t les 3.3.5 NutrItIon (Western and TradItIonal Food) 3.3.6 PhysIcal Health Status 3.3.1 Mental Health Status 3.3.8 ActIvItIes of Dally LIvIng 3.3.9 3.3.10 AttItudInal and Cultural Framework 3.4 FInal Report METHODOLOGY 4.1 Study Fra..work 4.2 DescrIptIve and Background InformatIon 4.3 The Survey 4.4 FIeld Research Resources 4.5 Survey SiMPle SIze 4.6 Method of Sagpllng 4 4
I I
( III) I I
1
1
r
!!
5
6 6
. II
,
II II
6 b
II
1
7 7 1
7
8 8
"
8 8 8 9 9
4.
10 10 10
- 33 -
Annex 5 ( l\)
CONTENTS (Cont.) Page ;.
. SURVEY INSTRUMENT 5.1 Soclo-economlc factors 5.1.1 SocIal Support 5.1./ EconomIc 5.1.3 OccupatIon 5.1.4 HousIng 5.1.5 LIteracy 5.2 facilItIes 5.3 Nutrlt Ion 5.4 PhysIcal Health Status 5.S Mental Health 5.6 ActIvItIes of Dally LIvIng 5.7 IntervIewer SelectIon, TraInIng and MonItorIng CASE HISTORIES ANALYSIS Of RESULTS
11
12 12 13 14
14
15
15 16
16 11
17
n 18 18 19
6.
7.
REfERENCES A - THE STUDY TIMETABLE APPEND1~ 8 - THE SURVEY Of EXISTING DATA INSTRUMENTS APPENDIX C - THE QUESTIONNAIRE ~PPENDIX
- 34 -
Annex 5
(III)
HEALTH CARE Of THE ELDERLY PROJECT
SUM!tAIIY I '
The WHOIWPRO Is sponsoring a study of the health and socIal aspects of agIng In cooperation with the GovernMents of Malaysia, the RepublIc of Korea, the PhIlIppInes and FIjI. . The fIrst phase of the project has now been coapleted and Included contracting national counterparts, IdentificatIon Qf Issues and resources and the developnlent of a general framework ('lr the study. The study Is being conducted In two parts. The flr~t part will ex•• lne data whIch Is already available In accordance wlttl a standard fOl'lllllt and wIll seek to IdentIfy gaps In InformatIon collectIon whIch exist at present. The second will seek to collect InformatIon and data which Is not currently avaIlable. It Is proposed that this be done through a survey. The data to be collected will be related to specified Issues and It Is proposed that It be analysed In such a way as to demonstrate releyance for policy formulation and programme develOpMent. The survey saMPle size will be 800-1000 subjects randomly selected fraa specified districts which are themselves reasonably representative In soclo-economlc and ethnic terms of the countrIes as a whole. 80th urban and rural districts will be Included. Appropriate saMPling will be critIcal to the survey. The survey questIonnaire (Appendix C) Is attached as Is the format for collection of existing data (Appendix B).
- 35 -
1.
Annex 5
1.
INTRODUCTION ThIs protocol presents the agreed approach for data,co11ectlon and fIeld work of the WHO sponsored 'Health Care of the Elderly· research project. The project Is InItIally beIng undertaken In MalaysIa, RepublIc of Korea, the PhIlIppInes and FIJI under the auspIces of the governments of those four countrIes and the WHO. The project wIll Include both a collatIon of statIstIcs currently avaIlable wIthIn the partIcIpatIng countrIes In an agreed for.at and the results of a survey to be conducted of a sa.,le of agIng people and theIr I~dlate fa.l1les In each of the selected countrIes, The protocol Includes: background InforMatIon a project overvIew study objectIves detaIls of 5a~le sIze and selectIon survey InstrUient revIew draft questIonnaIre and a bIbliography The results wIll be analysed centrally and c~nted upon by the partIcIpatIng agencIes In each of the countrIes and cross-natIonal comparIsons wIll be .ade. The project conmenced In early 1983. The fIeld work wIll be undertaken In mId 1984 wIth a vIew to prelImInary results beIng avaIlable In October 1984 and a fInal report In early 1985.
2.
BACKGROIJIID TO PROJECT In the developed world agIng has been an accepted area of specIfIc Interest In research and polIcy formulatIon for SoGe tIme. ThIs has not been 50 In the less developed parts of the world. The UN demographIc fIgures show that the agIng populatIon In the less developed natIons of the world Is now nu.erlcally as large as the total aged populatIon for the rest of the world and Is growIng faster. Thus by the year 2000 those aged &5 and over will have Incraased by 100 millIon In the developIng world ca.pared to 35 .,lllon In the ROre developed (Table 1).
- 36 Annex 5 2.
:TABLE 1 World Population Projections Year Total Population (Millions) Populat ion 1i5 " 1i5
Developing Countries 1980 2000 Developed Countr \e~ 1980 2000 1131 1212 129 11. 4 3284
129 229
3.9 4.7
4297
Iii 7
13.2
SOURCE: UN Age and Sex Composition by Population by Country 191i0-2000 New York, 1979 The Western Pacific Region of WHO is made up largely of countries which are developing. The demographic profIle of the region w\ll be characterised by rapid growth, Increased urbanisation, declining fertility and Increased life expectancy at birth. The two factors of dramatic decrease In birth and death rates can be expected to result In significant aging of the population. The increase In aging population described above can be expected because of Increasing prevalence of physical and mental morbidity to result in increasing need for health and social services. While old age Is not necessarily a time of III health, disability and mi~ery, a variety of chronic disorders occur much more frequently among the dged than among younger people. At the same time, It Is recognised that development, urbanisation, IndustrialIsation dnd te[hnologlc~l ch~nge (all of which are being experienced In developing (ountries) have significant Impact upon the lifestyle and wellbeing ,A th~ ,\ling members of the population. There h some evidence that. t.he pattl":" of fdmlly structure (and in particular the predominance of the mu1t'generatlonal household) Is changing so that th", aged will t><?''.Ime inore dependent upon hl'dlth dnd .',,: Id' ,erY\ces proyloecl by Ijovernmenl>.
-
37 -
Annex 5
3.
The relat\ve number and proport\on of the elderly \n most countr\es of the Western Pac\f\c Is stIll smell so that \ts \~act on sot\al and health servIces \s now only beg\nn\ng to be ev\dent. As th\s sector of the populat\on grows rapIdly \n absolute and proport\onal terMs durIng the next few decades, the \mpact w\ll however be \ncreas\ngly felt and because of the\r relat\ve needs, \t tan be expected to be out of proport\on to the actual \ncrease \n the ag\ng populat\on \n these respects . Four countr\es were chosen to be stud\ed \n the f\rst \nstance: Malays\a, Phll\pp\nes, the Republ\c of Korea and F\j\. The demographIc project\ons for the populat\on 60 and over \n each of the four countr\e~ Is shown \n Table 2.
TABLE 2 ApIng PODu1.t\pn NUMber Ind Percentage
Country Year 60 Y!Ars+ 1111 l1\on 1919
KOREA 2000 19BO
MALAYSIA 1990
PHILIPPINES 1915 2000
fiJI
" 65 Yelrs+ m\ 11 ton
2.2 5.9
5.2 9.B
0.1 5.1
0.9 4.B
2.0 4.1
5.2 1.3
1.4
" 10 Y!lrs+ m\1110n
3.7
3.3 6.3
0.4 3.2
0.6 3.1
1.2 2.9
3.4 4.1
"
O.B 2.1
1.9
3.6 n.a.
0.3 1.9 .103
0.3 loB .093
0.1 1.7 .107
1.9 2.7
n.a. 62 YeArs+ work\ng age group (15-59)
SOURCE:
Report of a Reg\onal Survey of the AgIng (Blngkok, ESCAP, 1981) (Olta supplIed by countrIes)
- 38 -
Annex 5
4.
In the lIght of the demographic, soclo-economlc and cultural changes whIch are expected In the relllon, there Is an IncreasIng need for research to provIde data on agIng to assist In polIcy formulatIon, plannIng, prIorIty settIng and resource allocatIon. Because of the close Interelatlonshlps whIch exIst In the agIng populatIon between physIcal, mental and socIal aspects of health, all three aspects should be InvestIgated In an Integrated approach. ThIs present study, then, Is beIng undertaken: (1)
to Increase awareness among researchers and polIcy .akers of the Issues a~sllclated wah an agIng populatIon; to provIde a pIlot cross-sectIonal study usIng largely quantIfIable Lech~lques to gaIn experIence In undertakIng such research i;) an AsIan settIng; to generate pruilslonal and IndIcatIve quantIfIable InformatIon on whIch to base objectIves for more IntensIve and specIfIc Inve$~igatlons; to move towards the alternate achIevement of a comprehensIve data base on agIng for the Western PacIfIc RegIon of WHO;
(2)
(3)
(4)
and f I na 11 y (5)
to provIde some InformatIon whIch will be relevant In the formulatIon of policies and provIsIon of programmes to meet the needs of the' dyIng populatIon.
These alms are consIstent wIth the recommendatIons made at the UnIted NatIons World Assembly on AgIng held In VIenna, AustrIa, July/August 1982. The VIenna Plan of ActIon whIch was subsequently accepted by the UN General Assembly addressed the need for the basIc research and especially for prograll11lt'S of cooperatIon and exchange of skIlls and knowledge at re910r'iJ 1 level. 3.
AN
OVERVIEW Of THE
RE~E~RCH
PROJECI
3.1 TerMS of Reference
The terms of reference for thIs research project are as follows. "In collabordL1on with the approprIate persons at the MInIstry of Health and \Iith indIvIduals of other MInIstrIes and non-Governmental Organisations as desIgnated by the Health MInistry: (a) to develop a format for socIologIcal/health studIes ""'(' ,,",derly In the PhIlippInes, Republic of Korea, MalaysIa, and FIjI; ~8' aI5CU~S plans for 1I1IPlementlng health care "Lrvic .. " for the elderly as part of c_nlty n~ajth servIces In these countrIes; and
(I»
t,·,
(c)
to submit
il
report on cOlllPletlon of the asslgn_nt."
- 39 -
5.
Annex 5
3.2 strategy The proposed study Is basIcally descrIptIve In nature. No hypotheses have been formulated as such. The vIew Is, however, taken that InformatIon on the health and socIal characterIstIcs of the agIng populatIon, theIr attItudes and utIlIsatIon of current servIces dnd certaIn InforlUtlon to be obtaIned from their ImmedIate famIly (where approprIate) are relevant to a formulatIon of theIr needs and therefore useful In the processes of plannIng of programmes dnd formulatIon of polIcIes on agIng. Thus. the data collected can be related to the underlyIng Issues whIch are beIng explored and the polley and prograMMe ImplIcatIons as 5et out In the followIng scha.e. (Table 3) TABLE 3
RelatIonshIp. of Survey to PolIcy and Progr.., DevelOJ!ll!nt QuestIonnaIre Mental status Issue Prevalence of DeRlentla and DepressIon Poverty Pol\cy PrOlllOtlon of Menta 1 Hea lth of the AgIng "'nlmum Income Health Care of the AgIng Health PlannIng for the Aged PreventIon Progra_ Counsell\ng and COIftUnlty Mental Hea lth Care fInancIal Suppl_ntatlon or AssIstance ProvIsIon of Prllllillry Health Care ProvIsIon of COIIIPrehens lYe Hea lth Serv Ices Health EducatIon and PromotIon ProvIsIon of AIds and COIII1IUnHy Ass lstance ProvIsIon of Transport AlternatIve Acc~datlon
Economll Resources Health
RelatIonshIp of Health and AgIng RelatIonshIp of ut III sat Ion and AgIng RelatIonshIp of LIfestyle dnd Health RelatIonshIp of Dlsabl l\ty and AgIng "oblllty and AgIng HousIng Problems and AgIng family and Connunlty Roles and AgIng
ut Illsatlon of Llfestyle
Hea lth Servl ces
DIsabIlitIes ActIvitIes of Dally LIvIng Transport HousIng
"' nImhat I on of HandIcap
Access HousIng
ProvisIons family and C~nlty
SocIal ResourceS and family Support
Respons Ibll Ity
falllly Support ServIces
- 40 -
Annex 5
b.
3.3
SpecIfIc ObjectIves The study was seen as havIng specIfic objectIves of provIdIng data where practIcal and approprIate as specIfied below. To a large extent the specIfIc objectIves fall Into two categorIes. The fIrst category Includes that data whIch can be collected through examInatIon of exIstIng sources. Generally the objectIves 3.3.1 to 3.3.4 fall Into thIs group. The second category covers data whIch Is more lIkely to be avaIlable only through fIeld research. Generally thIs coyers the remaInIng objectlyes and It Is proposed that a survey be used to collect that data. It should, however, be understood that the two categorIes may not be mutually eXf1usl~e.
3.3.1
Saslc DemographIc Data - Present and Projected (1) (2) (3) (4) (5) Number and proportIon of dged; over 55, oyer &5, 75 and over 85. Sex ratios. SocIetal age dependency ratIo. PopulatIon dIstrIbutIons/urban - rural/mIgratIon patterns - Internal and external. StatIstIcs as above for present and prOjected to years 2000 and 2025. OY~r
3.3.2 Mortality and Morbldlu i. 1 )
LIfe expectancy. Age specIfIc death rate. Causes of death. MorbIdIty/hospItal statIstIcs/communIty morbIdity.
(2)
( 3) (4 )
3.3.3
Soclo-economlc factors (1) (2)
MarItal status. Family sIze. Family relatIonshIps. Support relatIonshIps In t 1I1II!s of good health and In tImes of bad health. Accommodation and lIvIng arrang_nts . Income and occupatIon. Extent and type of valued roles.
(3) (4)
(5 )
(6) (1)
- 41 -
Annex 5 1.
3.3.4
Social Indicators ( 1)
Proportion of aged In hospital. ProportIon of aged In other InstitutIonal sett Ings. ProportIon of aged receivIng other welfare or health servIces. Proportion of aged rece"'lng pensIon, provident funds, etc.
( 2) (3)
(4)
3.3.5
facll \tIes (l) (2)
AvaIlabIlity of access and use of facIlities relevant to health and a healthy lifestyle. On specific health services - the use of health workers, nurses, doctors, clinical attendants, hospitalIsation. Use of traditional medicine.
(3) (4)
Use of medIcations. Use of voluntary community services and facilIties.
3.3.&
NutritIon (Western and TraditIonal Food) (1)
Availability of level. Eating habits.
d
dIet that Is suffIcient nutrItional
(2) (3)
Changes In eating habits and level of nutrItIon.
3.3.1
PhYsical Health status (l) (2)
General health status. Symptoms. Disability, handicap and ImpairMent. Health habits; smoking, drinking, exercIse. Dental status.
(3) (4) (5)
3.3.8 Mental Health Status (1) (2) (3) Cognitive functIon. Mood. Symptomatology.
I
I
-
4.~
-
Annex 5 ---3.J.9
8.
ActIvItIes of Dally LIvIng (1) ( 2)
Mobl1lty. EatIng and DrInkIng washing. Tol let Ing. Reneatlon.
( 3) (4)
(5)
3.3.10 AttItudInal & Cultural Framework (I)
RelIgIous attItudes dnd practIces (where approprIate). Attitudes to agIng. AttItudes to death.
(2) (3) 3.4 FInal Report
This pro.ject Is prImarily an exploratory exercIse. It Is beIng undertaken to IdentIfy those areas which might well be the subject of further examInatIon In relatIon to the development and Implementlon of health care services for the aging as a part of communIty health servIces. It Is Intended that the report on thIs project wIll hIghlIght those areas In which the qualIty of lIfe and, In partIcular, the health of the agIng, can be enhanced through a better understandIng of theIr cIrCUMstances and through the possIble development of polIcIes which lead to changes In attItudes and the behavIour within the community or to the provisIon of selvlces or facIlItIes. Gore (1983), Brody (1983), WHO (1980), Kadlr (1982), Kalache (1983) and RegIonal Office for the West Pacific WHO (1981) cite the need for such research. To fully address all the Issues In the above lIst of specifIc objectIves It would requIre resources beyond those avaIlable for thIs project. Consequently, the project wIll concentrate more on those'areas where there Is SOle IndIcatIon of generatIng results whIch wIll subsequently enhance the lIfestyles and the cIrcumstances of the agIng. 4. METNOOOl06Y
4.1
StudY Framework It Is proposed that the data collectIon and fIeld work for the study may be undertaken In two parts. The fIrst part wIll exa.'ne data whIch already largely Is avaIlable from present data collectIon sources, although the extent, depth and accuracy of the Information will be varIable. The second wIll seek to collect through a survey that InformatIon and data whIch Is not otherwIse currently avaIlable.
- 43 -
9.
Annex 5
4.2 DescrIptIve and Background InfoM!ltlon It Is proposed that local workIng groups In each country revIew the currently avaIlable InformatIon In accordance wIth the specHlc objectIves. The groups, It 15 Intended, will Identify gaps In the InformatIon currently available. and wHh the assIstance of the consultant, wIll make recOImendatlons for l~roveMent of ongoIng data collectIons relevant to the socIal and hea lth aspects of agIng. . 4.3 The Survey The objectIves for the study call for specIfIc data and cross correlatIons on a range of Issues. As dIscussed below, MUch of the data requIred Is of a nature whIch can be collected by traIned but stIll relatIvely unskIlled IntervIewers usIng structured ano valIdated questIonnaIres and survey InstrUMents. Survey Instruments usIng self-reportIng technIques requIre verlflcat'o~ and valIdatIon to ensure that they are accurate predIctors of the health sItuatIon of the respondent. (8rody, 1983). Thus It Is argued that an IntervIew survey methodology Is approprIate for the study. However. not all the specIfIc objectIves can be covered by valIdated survey Instru.ents. For example, the objectIves on nutrItIon cannot be achIeved. less for.. ' data collectIon technIques wIll be adopted, by necessIty In SOMe areas of the objectIves. Other areas wIll have to be excluded from the study. WhIle few, If any, Instru.ents have been valIdated In the three countrIes to be Included In the study, there are valuable Instruments that have been valIdated In the developed world. See Jenlcek et. a1. (1919). Fl11enbaum (1982), presents a detaIled revIew of several Instruments and In partIcular CARE (ComprehensIve Assessment and Referral EvaluatIon, Gurland et. a1. 1977-1978); MAl (PhIladelphIa GerIatrIc Centre MultIlevel Assessment Instrument, lawton, Moss, Flntcourler & Kleban, 1982); and OARS (Older AmerIcans Resources and Serlces Multldl ..nslonal FunctIonal Assessment QuestIonnaIre. Duke OARS, 1978). Selected parts of these Instruments have been adopted In the questIonnaIre for thIs research. As the questIonnaIre wIll be translated verbally and culturally every attempt has been made not to use those sectIons less lIkely to ,,'ntaln valIdIty through such a process. Mental health InstrUMents such as the General Health QuestIonnaIre, Golberg (1972), are examples of relatIvely culture bound Instruments whIch most certatn1y wIll requtre new scoring procedures when translated to another language and culture. Si.,1arly the ·Rlnl-Menta1 state· Fo1steln and Folsteln (1975) Is related to educatIon or age and Is not well suIted to respondents wIth restrIcted education. (Anthony et. a1., 1982).
- 44 ------.
Annex 5
10.
4.4
FIeld Research Resources The resources avaIlable for the project are limIted. The projec< wIll use a carefully chosen selection of those most r~levant fran the full range of survey Instruments avallable. The firMl questIonnaIre wIll aIm to produce the most useful results for the reSources ivallable. further, the capacIty of aging respondents to understand and answer detailed questIons, the cu1tlJr~l1y bounded nature of some InstrUMents and the resources r~qulred to train IntervIewers who wIll be one person ~d not a gerIatrIc assessment unit are all factors contrlbutlng to the adoptIon (lo' questionnaIre whIch would be relatIvely short In cOMpa~ ison to what Is ottterwise possible In studies of tMs natufl~o 'Dentoll 1983).
4.S Survey Sa!Q1e SIze SamplIng theory would IndIcate that a sample of at least 200 1 required In each sub-group to be considered In the analysiS of the results. The resources for the survey are likely to allow a sample of at least 800 In each of the three countries to be Included. ThIs wIll allow comparIsons of major but not mInor sub-groups In the populatIons. Current lIterature hIghlIghts the dIfferent plIght of the rural and urban agIng. (T'Ae-Hyson, 1982; RepublIc of Korea, 1982). Thus a quota sample of 400 rural and 400 urban respondents would be of value. The lIterature al~o hIghlIghts mIgratIon and In partIcular the move to the cItIes and the growth of the landless rural populatIon. (Meegama. 1982). 0', a total sample of 800 the nUMber of respondents In the~e categories may be below 200 and detaIled comparatIve COl1l11l!nts or. each of these sub-groups without aggregatIng the results from a' three countrIes may not be possIble from the data. 0
4.& Method of SamplIng Sample sIzes of 800 respondents per country are of value provIded the sample Is selected on a correctly random basIs. All surveys, but In partIcular those wIth smaller sample sIzes requ"e careh,' attentIon to sampling. (HurSh-Cesar and Roy. 1976). Where complete samplIng frames are not avaIlable some compromise \s often necessary to avoId the excessIve use of resources. (Lutz, 1981 and 1982). Data on population dIstribution Is avaIlable fOI some areas but not all. (Eng, 1982b). The defInItIon of the agIng populatIon varies. The offIcial definitIons of agIng are reported by Hoshlno (1981), to be KorE: no defInItIon, MalaysIa &0 and over, and PhIlIppines &~ and oy~, RetIrement age~ are reported to be 55-&0 years In Malaysia anti Korea and 65 In PhIlippInes. In thIs survey the sample will b~ drawn from those 60 years and over. (Kadlr, 1982). No convenIent, readIly accessible sampling frame for those over ., In the populatIon Is avaIlable. A truly natIonal representath,_ sample Is beyond the avaIlable resources at thIs stage.
- 45 -
11.
Annex 5 -
-----
Each of the countrIes wIll IdentIfy dIstrIcts whIch on the basIs of census data are reasontbly representatIve of the country as d whole In demographIc and soclo-econOMlc tenas. The selectIon of dIstrIcts wIll be made from both urban and rural settIngs. The selected dIstrIcts whIch wIll have total populatIons of up to 1 mIllIon. The smallest deMOgraphIcally defIned areas, (e.g. In MalaysIa the EnUMeratIon Blocks of the census) are then IdentIfIed and a nuMber of these wIll be randomly selected frOM wIthIn the chosen DIstrIct. It Is then prOpOsed, where feasIble, eIther to systematIcally IdentIfy all of those over 60 wIthIn each area and to use that Inforllliltlon to provIde a slllPHng frallle from whIch to randomly select the requIred nWibers, or to con.ence at a randOM pelnt wIthIn the area and collect the requIred numbers on a quota basIs. It Is envIsIoned that In each of the three countries there will be a saMple of 800-1000 respondents 60 years and over lIvIng outs'd~ of InstItutions. The laportance of the InstItutIonalIsed elderly populatIon Is acknowledged but theIr proportIon In the countrIes under consIderatIon Is small and they should be the subject of d separate study. The sample wIll be se'ected to provIde approxImately equal nUMbers of urban and rural subjects. Close attentIon wIll be given to obtaInIng a saaple whIch Is duly randOll and representatIve. 5. SURVEY INSTRUMENT The specIfIc objectIves can be dIvIded Into the followIng four groups: (1)
data whIch Is to be consIdered In part A of the study and not be Included In the survey; data whIch can be easIly collected In the survey; data requIres some subtlety If It Is to be collected vIa a survey and for whIch approprIate survey Instruments exIst; data requIrIng s~ subtlety If It Is to be COllected vIa a survey and for whIch an approprIate Instrument does not exist.
( 2) (3)
(4)
- 46 -
Annex 5
12. Soclo-economlc Factors 5.1.1 SocIal Support The ·soc\al" posItIon of the agIng In AsIa Is seen to be changIng. SubstantIal dIffIcultIes are reported to be arIsIng from the loss by the agIng of the tradItIonal rank and valued role as cultural leaders and teacher by Bakar (1982), Eng (1981), Kal (1982), T'Ae~Hyon (1982), RepublIc of Korea (1982) and SocIal Research Centre (1982). Whll~ the cultural background of AsIa Is vastly dIfferent thh appears sImIlar to the modern western trend saId to result from the removal of valued socIal roles. The aged are reported to be losIng theIr Important roles because they ~annot cope wIth new urban technology and change by Eng (1982), and mIgratIon of the young. (Eng, 1981). The extent of the devaluatIon, In AsIa, Is not known. The famIly bond and the valuIng of the aged Is stIll to be found In AsIa. (Wee 1981). For Instance reports that In SIngapore there Is substantIal evIdence that the aged perform valued roles, although In a modern urgan envIronment In provIdIng housIng, chIld care and a central hub for the famIly. Donald et. al. (1978), IdentIfIes four areas crItIcal to socIal partlclpatlons:- famIly and home - socIal (e.g. frIendshIp) - communIty Involvement (e.g. partIcIpatIon In organlscltlons) - work (or major role actIvIty If unemployed In the tradItIonal sense) FIllenbaum (1982) dIscusses the Important to health as demonstrated by Kahn and AntonuccI (1979), of a confIdante. ThIs reflects the fIndIng that the number of people known or the frequency of contact does not ensure greater ~atlsfactlon, better health, or better copIng wIth old age. Rather It Is the qualIty of socIal support and the presence of a confIdante whIch relate to personal well-beIng and to physIcal health status. ThIs Is measured through questIons such as: "Do you have someone you can trust and confide In?" and "Do you fInd yourself feelIng lonely?" The lIterature on agIng In AsIa refers less to the absence of close frIends and relatIves. PossIbly, wIth the exceptIon of those effected by mIgratIons or unusual famIly structures the frequency of a lack of a confIdante may be small. ThIs Is not to suggest that a confIdante Is any less Important.
5.1
- 47 -
13.
Annex .'i
The recent WHO-supported survey of agIng In 11 countrIes, HeIkkInen (1982). reported on a range of socIal factor\ relevant to the w@lfare of the agIng. These Include: actIve Meftbershlp of clubs. assocIatIons or socIetIes nunber of socIal occasIons In whIch partIcIpated durIng proceedIng 12 .anths:famIly gatherIng relIgIous servIces foreIgn tourism number of cultural actIvItIes In whIch partIcIpated durIng preceedlng 12 months IncludIng theatre. fIlms concerts. art eKhlbltlons, lIbrary outIngs and sport< compet It Ions. These factors are not frequently IdentIfIed In the lIterature on agIng In the AsIan settIng. MembershIp of clubs, however, may be of laportance as deMOnstrated In a survey carrIed out In Korea. (Jae-Kan, 1982) and Korean SenIor CItIzens AssocIatIon, 1982). AddItIonal factors whIch should be Included In thIs AsIan study are:- number of vIsItors - tImes spent alone - contact wIth neIghbours - feelIngs of lonelIness - lIfe satIsfactIon 5.1.2 [conOlll c The lIterature heavIly underlInes the economIc plIght of the agIng In AsIa and In partIcular the Inadequacy of the Income Is crItIcal but also of SOMe complexIty. Both tasks are probably beyond the resources of thIs study. RudImentary as It may be the survey may have to be restrIcted to collectIng Infonl8tlon on type and cost of provIsIon of acco.lOdatlon, the provIsIon of flnancla' support or Items such as food frO!! famIly and frIends, t~e exlstance of pensIons etc. and eMPloy.ent. nett Income, assIstance to other Meftbers of the household such as 'Bantuan Capa' sch... In Malaya. and the frequency of beggIng. (Eng, 1982). The partIcIpatIng agencIes In each country may well be able to provIde general Inca.e statIstIcs for COMParIsons, IncludIng the avaIlabIlIty of pensIons and the effects of InflatIon.
- 48 -
'4. Annex 5
5.1.3 OccupatIon In addItIon to establIshIng frequency of valued roles the questIonnaIre should also establIsh the frquency of employment. In some communItIes the agIng retIre at S5 years of age such as In MalaysIa (Eng, 1982c), whIle In others they never retIre. Unemployment and retIrement should be differentIated. (Eng, 1981; Jae-Kan, 1982). RetIrement exacerbates the low Income sItuatIon. (Sakar, 1982). Spouses occupatIons should also be recorded as a growIng number of women, In MalaysIa, at least, are workIng. (Eng, 1981 and 1982c). 5., .4
Hou..liru!. .hlle the number of generatIons lIvIng In one household Is a crItIcal part of both support networks for the agIng and changIng domestIc dnd famIly structures, less Importance appears to be placed In the lIterature on problems of accommodatIon and the qualIty of dwellIngs. Eng (1982) reports on dIffIcultIes for the agIng whose famIlIes have mIgrated. He also comments on the need for research Into housIng. Western studIes frequently InvestIgate housIng In detaIl. ThIs survey should at least establIsh ownershIp, general style - house etc. - and the cost of housIng to the agIng person. In addItIon, comparIson of the housIng wIth the neIghbourhood as seen separately by the IntervIewer and the respondent wIll be recorded. The accuracy of such an approach cannot presently be valIdated. FInally consIderatIon should also be gIven to usIng a sImple classIfIcatIon on prIvate dwellIngs; the same as classIfIcatIons used In census questIonnaIres. ThIs classIfIcatIon should be dIscussed wIth local research groups. WhIle thIs study does not Include Hong Kong It Is worthwhIle notIng the dIffIcultIes there. (Hong Kong Government, 1977). HousIng Is a problem for a proportIon of the elderly who do not qualIfy for publIc housIng under exIstIng polIcIes. These are essentIally those elderly In one and two person households. AccordIng to the 1976 bl-census, 30,000 such old people were estl .. ted to be lIvIng In sub-standard housIng, IrrespectIve of Income. Types of housIng Included: (a) accommodatIon In temporary structures and In non-resIdentIal quarters (such as squatter or roof-top huts, lIvIng quarters In IndustrIal buIldIngs etc.) whIch are not suItable for habitatIon; accommodatIon Is In self-contaIned flats where facIlItIes such as the kItchen, toIlet, or even water supply are not avaIlable wIthIn the flat;
(b)
- 49 -
15.
Annex 5
(c) (d)
a hIgh degree of sharIng, when three or more households share the sa~ flat: overcrowdIng when nett lIvIng area per person (I.e. excludIng kItchen and toIlet etc. (Is less than the mInImum standard of accomMOdatIon In publIc housIng I.e. 35 sq. ft. per person: dIffIcult access, such as aCComMOdatIon In the upper storeys of a buildIng where there I s no 11ft. hIgh rent (In relatIon to IncOMe): the reluctance of SONe landlords to rent accommodatIon (espeCIally cubIcles or bedspace) to old people, partIcularly old persons lIvIng alone.
(e) (f) (g)
Many of these problems also confront the non-elderly populatIon, but they are more lIkely to prove Intractable to the elderly owIng to theIr generaly InfIrmIty, reduced mobIlIty and reduced IncONe upon retlrellent. VarIatIons between countrIes, regIons and cultures In attItudes and expectatIons towards hOUSIng hIghlIght the need for subtelty In selectIng the Instrument for thIs study and In developIng Its cultural and lInguIstIc translatIons. The contrIbutIon of local partIcIpatIng groups wIll be paramount In developIng relevant questIons for the survey. Just one exalPle Is the varlaton In defecatIon habIts. QuestIons such as "Do you have a wat~, closet?" and "00 you share the water closet wIth other households?" are of less relevance where water closets ar~ not usually avaIlable or expected for most menDers of a communIty. SImIlarly, questIons on hOUSIng nust reflect dIfferent values In relatIon to sharIng acconnodatlon wIth relatIves and other attItudInal and cultural varIatIons. 5.1.5 LIteracY Eng (1981) has suggested that an Improvement In lIteracy has Increased longevIty. A sImple lIteracy test would b~ of value In the survey.
The critIcal Issues for the agIng In AsIa centre round the role ",f the agIng, role of the falilly, poverty and prImary care. Wester,' studIes show that recall of the use of facIlItIes can be so low that survey ~thodology should be used wIth care, and should concentrate on recent usage.
- 50 Annex 5
lb, The 1151
mIght Include:he<llth workers nu(~es
doctor
~
outpatIent InpatIent, length of stay traditIonal medIcInes tr.'lilt'cnal practItIoners ocher medlclnes ho,plta's hUM' h~lps
hosplt<lls
v0 I un ta ry comun lty servl ces d,:ot ish
Glvelt that att Hudes towards the agIng usIng Sllch servIces, questlonnahp> on need and availabIlity will be of doubtful value. How the agIng person travels to and pays for the servIce wIll be of importance. 5.3
NutrItion WhIle dIet is <l critIcal Issue there Is not a realIstIc and suItable means for evaluatIng the nutrItIonal content of respondents' Jiet5. Even a sIngle Informed observatIon by Intervlewer~ would be of only lImIted valued. Important as It Is, nutrItIon wIll be covered only brIefly In the survey. GIven the cultural varl<ltlons. neIther the respondents appearance nor theIr coments about (perceIved) dlff\cultles In gettIng food can be taken as a true IndIcator of nutrItIon/malnutrItIon, although both wIll be covered In the survey. QuestIons regardIng changes In dIet dnd changes In the dIffIculty In gettIng food wIll gIve so.c IndIcation but may be the result of the effects of cultural, economIc or domestIc changes.
5.4
Physlca]. Health Status Fl11enbaum sIghts several approaches to assessment of physIcal health IncludIng:" (a)
selt
a~sessment
of overall health;
(b) (e)
"ymptoms list; Inqu1ry Into Illness, conditIons and use level of actIvIty; UH'
of
lledlcatlort;
(d) Ie)
of medIcal servIces.
All fIve approaches will be used.
- 51 -
17.
An actIvIty IndIcator (d) wIll be used, see 5.~ and use of servIces wIll be used as an IndIcatIon of Issues relatIng to ImpaIrment, dIsabIlIty and handIcap. To dIfferentIate between the three, as has been attempted elsewhere. (WHO Kozarevlc, 1983), would place unnecessary de.ands on IntervIewers, respondents and resources though some IndIcatIon wIll be provIded In the analysis of the survey results. The quest lonna I re should record habits, Le·. s!lOk I ng, dr Ink Ing and exercIse. SImilar questIons to a prevIous WHO study wIll be used. (HeIkkInen et. al., 1982). There wIll be a general self-assessment of overall health. Where the s~lf assess.ent Is of poor health, questIons wIll record the type and length of the III health, I.e. accIdent, Injury, dIsease, acute, chronIc. FInally there will be a questIon on the use of medIcatIon. where used and the type of medIcatIon. On the questIons on type of Illness and type of MedIcatIon It Is lIkely that open ended questIons would be deSIrable wIth general probIng to establIsh the overall nature of III health and the general type of medIcatIon. The respondents actual cOMIents would be recorded to gIven an IndIcatIon of theIr perceptIons. 5.5 Mental Health Mental condItIon and status features heavIly In research In the developed world partIcularly In relatIon to assessIng the need for InstItutIonal care. (Grauer and 8lrnbom. 1915). A short mental functIonIng questionnaIre would be !lOst approprIate In thIs survey. Such questIonnaIres, however, can easIly be culture bound and are of less value wIthout standardIsatIon. WhIle there are several suItable questIonnaIres for the developed world, 'one sIngle questIonnaIre suItable for all 3 countrIes under revIew Is not known. (Eng, 1982b). Thus It wIll be necessary to !IOdlfy an Instrument used In the developed world. 5.~
ActivItIes of Dal,y LIvIng 80th the OARS and the Katz et. al. (19~3). Instruments of physIcal and Instrumental activItIes of dally lIvIng show good relIabIlIty and theIr language and cultural translatIons should not be diffIcult. Eng (1982) suggests that the agIng face dIffIcultIes In access to transport, largely due to IncOMe. ThIs area should also be consIdered for the study. FlexIbIlIty wIll be requIred wIth questIons relatIng to telephones In some areas.
5.1
IntervIewer SelectIon. TraInIng and MonItorIng It Is envIsaged that 800 IntervIews wIll take In the vIcInIty of IntervIewIng weeks. ThIs could be 10 IntervIewers workIng ~ weeks or ~ ~ntervlewers workIng 10 weeks each etc. ~O
IntervIewers should have SOle prevIous \ntervlew\ng experIence. They need not have un\verslty degrees but evIdence of good scholast\c abIlIty Is des\rable.
- 52 18. Annex 5
TrainIng will be essentIal. This Is likely to take 1 to 2 weeks. Regular monItorIng and QualIty control of the IntervIewers will also he essentIal. So too wnl be a check by re-IntervltIWlng a small 5ample of respondents usIng a short Questionnaire. 6. CASE HISTORIES
In addItion to the InformatIon collected from available sources and the survey, It Is proposed that In each country a serIes of approxl.ately 15 detached case histories wIll be prepared. The subject.s for case hlstor\es 10/111 be selected accordIng to agreed crIteria from the sur,'!;, respondents dnd the historIes will be recorded In a standard format. MaterIal from case historIes will be most Important In Interpretatlo" of cross c~lture survey data. 1. ANALYSIS
or RESULTS
It Is envIsaged that the open ended QuestIons would be analysed and cullated fIrst by each work group. Then the results for all 4 countrIes would be joIntly computer analysed. The IndivIdual results for each country will be sent back to the work groups for comnent before flndl documentation.
I,
- 53 -
19.
Annex 5
REFERENCES ANDREWS. G, Assignment Report: Health Care of the Elderly, 16 February - 8 March 1983, WHO. ANTHONY, J.e., LeRESCHE, L., NIAZ, U.. VON KORFF, M.R., FOLSTEIN, M.F. Limits of the 'Mini-Mental State' as a screening test.for Cementia and Del~rium among Hospital Patients, Psychological Medicine, 1982, 12, 397-408, Great Britain. BAKAR, D.N.L.B.D.H.A., CREE, K.L. Prospects of population Aging in Malaysia, Prepared specifically for:- International Symposium on an Aging SOCiety: Strategies for 21st Century Japan, Tokyo, Japan 24th - 27th Novembe',' 1982, BRODY, ,T
.1'..
Reseuch Priorities in the Ep1ciemioloqy of Aging, Scientl.iic Group on Epidemiology of Aging, Geneva, 11-17 January 1983, WHO.
DENTON, C.F. The Oesiqn of Health and Social Surveys of the Elderly, Scient' he Group on the Epidemioloqy of Aging, Geneva, 11-1: January 1983, WHO. ~DD,
C.
Proceedings of the 2nd Regional Congress of the International ASSOC~atLon of Gerontology Asia/Oceania Region, Singapore 22-25 January 1982, International Association of Gerontology ASia/Oceania Region. et. a1. Soc,al health. In: Conceptualization and !1easurernent of Health for Adults ,n the Health Insurance Study, Santa Mo~ica, Rand Corporation, 1978; Vol. 4. Hul tidimensional Functional Assessment: The OARS Methodology, 2nd .. d. Durham, Centre for the Study v[ ;""i.r.'l ""d n=o3" Dc,'clc?"'''n~. Duke University, 1978. th the assistance of MASTERS, G. The Evaluation or Geriatric Assessment Services in Young and'Albury, Progress Report No.1, May 1982, D.;;partment of COllonunity Medicine of sydney Westmead Centre. ."\NDREWS, G. The Evaluation of Geriatric Assessment Services in Young "nd Albury, Progress Report No.2: 1 May - 31 December 1982, Mercy Hospitals Evaluation Project, December 1982, Department of CommunLty Medicine Westmead Centre. '" i
D(,NAr.D, CA,
~1J~;.c;
OARS.
';~.l.!':N,
J.,
SL:'F.fl, J.,
0)1,:', Ci'.
"acilitles to Meet the Needs of the Aged, !'resented ,at the Seminar on "7'le Elderly and Society" on Saturday 12th June 1982 at Auditorium Sultan
Ahmad Shah, RISDA Building, Ampang Road, Kuala Lumpur, (1982a). EN':;, C.K. Populat,on Aging in Developing Countries: A Spatio-Teillporal Case Study cf Peninsular Malaysia, 1957-1970, Asian Profile, June 1982, Vol. la, 1;0. 3, 11982b). Socia-Economic I(llplication$ of Population Aging in a Developing Country:
::~l:"",
C.K.
The Malaysian Case, appro" date or publ. 1982, (1982c). ::~k; Ie. ~.
The Elderly in ?eninsular Malaysia A Neglected Group? Some SocioEconomic Imolication, Occasional Paper No. 5, Presented at Seminar on "Integrati!19 Population with Development", Kuantan, Paqang 9-11 November 1981, University of Malaya.
CrLLENBA<iM,
S. S, 'rhe Wellteing of the Elderly-Approaches to mul tidirnensional Asse,;sment, Centre for t.he Study of Aging and Human Development, :luke I
Uni.versity
1982.
- 54 -
20. Annex 5
FOLSTEIN,
til. P .,
F()J,:--'~r:IN,
',:. E.
_'~~ini-l~ntal
s:.ate"
A Pract.i.ci~l_~~_UIO~~£
Crddin9.__ Ll'...~ ~o'!?~t.ive State of Patients !:ur the Cli.n~~, 1975, Vol. l~, t1p. 13Y-198, Pergamon Press, Great Britain.
GOLBERG, D.?, In,;tltute of Psychiatry, Maudsley Monographs ~21, Trk Dc'ecL.,.'·' or PSyc:ill.J.trl<; LInes!'> by Questiooiiire. A Techniqu,= for the Ident.!.tlcafion of Non P5ycili.:J.tric P!.;ych~atrjc Illness, Oxford University Pres~. ')-'i '30RE, M. S. lnformatwn Needs for Plunning Health servifes for r.he Elderl.l"..'. Scie:-ltific Group on the Epidemiology of A9ing, Geneva, 11-17 Ja,Uld.ry 1983, WHO. '.HAUER, H., BIRNBOM, F. A Geriatric Functional Rating Scale to Determine elk ~ced for Il"'stitutional Care. J. of American Geriatrics So..:~ety, ..... , [lui 472-.i76, 1975.
GURLAND, B. et. al. The Mind and Mood of Aging: Mental Health Problems of thf. Community E1C1erly in New York and London, New York, Naworth Press. l'li," !lEJK1G;<EN, E .. WATERS, W.E., BRZEZINSKI, Z.J. (eC1s.) Aging: An International ?rof He, P':e 1 irninary Findings of a WHO-supported Medico-social survey conducted in Countries, April 1982, HFA 2000.
1"
HONe. KONG GllVERNMENT. h(,[:!(INS, J. ?rincl.pCll
Services for the Compon~Ilt
Elder~,
Hong Kong Government
i"rint~r
l~n
Analysis of Four Health Indicators dnd Construc'tl.on Epidemiol<:>~,
,)f .1 Global Health Index in the Aged, American Journal of F}79.
IJ(
<.iIlI~I(;,
S. Report cf il Regional .Survey of the Aging, Technical Meet~ng on i·.(J~nCJ for th0 ;'. .:iian and pacific Region, 27-30 January 1981 Bangkok. EconomH:' and SQc·i.al Commission for Asia and the Pacific.
Illli<Sn-CSSAR, -.;., ROY, P. (eds.) :;T.::h::i'7r::d::....cW"-o:::;:r-:l"'d:.....:S"urv:=-:... :::.l.y"'sc.::_.;S;u:;rv;.:.:;e.y....;R:;e:.;s;:;e::;a:;r:;::c"h:.....:i:.:n:-Developing Nations, 1976, Macmillan Company of India Limited. I/\E-KAN, P. 'rhe Present st.a.tus of the Aged and Countermeasures., Korea Journal.,
~:orcan
N.:l.t:.i.ona 1 conunission for Unesco, April 1982, vol. 22 f No.4.
JENICEl<, M., CLEROUX, R., LAMOUREUX, N. Principal Component Malysioo of Four Healtb IndicJtors and Construction of a Global Health Index in the A,l"d, Americ"" Journ"l of Epidemiology, Vol. 110, No. :I, 1979. K..:UJIR, N.!". 'rhe Role of the Aged in National Development, Seminar on the !\gt!d and Society Sponsored by the Ministry of Welfare 12 June 1982 - 13 June 1982. Rr~se(1 rc.:h an<'l Plal":ning ui vision Ministry c f Ulbou;r and Manpower, Malaysia.
,',,:c, :.. \'.
commu~tJ:>
Efforts to Strengthen the Bonds of the Elderlv in the Family and ~he Seminar on the .1\ge:d and the Society Sponsored by Ministry "f ~Y,:·lf..I.1.·'::: :~erv~ces ~..ai(jyS1.a 12 June 1982 - 13 June 1982, t-tinistry Ot Weliare S~rvic~s.
K..r\H:"-i,
:\.L., [.\NTONUCCI, T.e::. Convoys ·Over the Life Course: Attachment, Roles i":~ Suci<ll S'upport. In: Baltes, 8.S. and Brim, D.G. Jr., ed. Life-S?drj
develuprnent ana behaviour. ~·.;\:~A~~HE,
New York, Academic Press, 1980, Vol. 3
;:...
Research Priorities in the Epidemiology of Aging, Scientific Group tn0
on
t::pidt:!rniolugy of Aging, Geneva, 11-17 January 1983,
~oJHO.
21.
- 55 Annex 5
KATZ, S., FORD, A.B., MOSKOWITZ, R.W, JACKSON, B.A.& JAFFE, M.W. Studies of Illness in the Aged. A Standardised Measure of ' Biological and Psychologic"l Function. Journal of the Americ~n Medical Association, September 1963, 185 (~2), 914-919. Ki::>lIlilTAN, P., KELUARQ.., P. PERAl<, J.D. Health and Fa:nily Planning Survey if>
Johor and PeraK, 1982. KO~~
SENIOR CITIZENS' ASSOCIATION, THE. Association, Julj' 1982.
h
Profile
o~
the Korean
Se~ior
Citizens'
KOZAREVIC, D. The Design of Health and social Surveys of the Elderly, Scientkfic Group on the Epidemiology of Aging, Geneva,. 11-17 January 1983, 1'1110. LAlfi'()N, M,P., MOSS, M., FULCOMER, M., KLEBAN, M.H. A Research and Service OrJ.ented Multilevel Assessment Instrument, Journal of GerontolO'jl),, 1982, Vul..J7, No. l, 91-99. LU'fZ, I~.
Planning and Organising a Health Survey,
A Guide for H€:altil Workers,
1981, International Epidemiological Association.
LUTZ, Ii.
Sampling: HOW to Select People, Households, Places to Study Communkty. Eealth, A Guide for Health Workers, 1982, International Epidemiological [\ssoc ia t ion.
~£EGAMA,
S.A.
Aging in Developing Countries, 1982, Geneva, WHO.
PROJECT WORKING GROUP. Research Protocol: The Evaluation of Geriatric Assessment Services in Young and AlbUry, March 1982, Department of Community Medicine, The University of Sydney Westmead Centre. REGIONlu. OFFICE FOR THE WESTERN PACIFIC OF THE WORLD HEALTH ORGANISATION. Workbg Group on Hed.lth Care of the Elderly, 18-24 August 1981, Regional Office tor the Western Pacific ot the World Health Organisation. i<EPUBLIC OF KOREA. National Report: on Aging, 1982 .
.';(''CIJ,L RESEARCH CENTRE.
The Elderly of As~a, Asian Regional CO/lference on .r.ctive Aging, Social Resarch Centre, University of Santo Tomas, Manila, 1982.
'!"
,;E-HYON, K. Family Services for the Aged in Korean Society, Korea Journal, April 1982. Th" Dynamics of Family Lif" in Singapore, Proceedings of Second Regional ~'?.!!.5_~~,
,<IE::, ;;.
Sing:tporc, :!2-25 J ..lnu-ary 19B3.
Princ+pltas of N(?nnalisation in Hu.--nan Se+vic~s and evaluation manuals, Natkonal InstL~ute on Mental Retardat10n (Canada) through Leonard Crainford, Toronto. Library of Congress Card 1;0. 7295107. :'iC-,I'':''2 ,'ERTILITY SURIi'EY, June 1982, Publications Office Intel'national Statistical ;-,O:,?£NSaER(-:., tol.
lnstitutute. ~·j(JP~D
HEALTE ORGANISATION. Health Care of the Elderly, Report on the Technical Group on Services and Systems of Care for the Elderly, 2-4 October :~80, Hels1nki.
Annex 5
- 56 -
APPENDIX A
FINALISe: PI<OTOCOL. FINALISE OUESTIONAIRc. PIlODUCE CODING
-'r'
INal/ I'!)~e;: --I
,
·-r
-I
-r-' -·....,:..--f--i---·~t--;---+---~-·
W _-
_.\
er .... El(lsrlNC;; ~TA
INSTRUCTION5. NDARO ~M"T OF
.. _ .......:..-.......,......._...;. __-+___ . L __ f>I<ODUCE mAINING MPoJNUO.\..1 f---l---Io ,
_·t···-··+,
I
-
.~-.-
I -.-.!
·1
+.__..,.. ' ·--·-···
--1----4--;.-- r--· J
0E'eGN
~Pl.E
~LD w;eT QUe5TIONAIQE INTE-J:.'VIEWEQS. OI!;L..e:ci AND TQ"'IN X ~--I---I-
FIELD 5Uk've:yX
Of'" ANALYOIS
PRELlI'vllNARY DESIGN
QUE.STIONAIRE:S
FINAL CODING OF
f.)'I.TA REVIEW AND ENTRY OA..TA EDlT/VF-PlFlC'ATION /c~r.
---_.-4 .•.
MTA BASE CPEATION PRELIM. C)A.TA .AAl-'LYSI8 DESCRIPT.
-.•.
-~
STAre. ANALYSI5
:.....-..1--
·_-·--'-··---i--·;----··!---4---;..·---+······I--·· '·0 _.---:1[. PETAll.ED COJNTRY REPORlS
PRIN::I~L
x MALAYSIA AND PHILIPPINES RFPlJ6l.\C Of I<UI?EA.
INVE.STIC-A1OR5. MEE:TIN3.
-
57 -
Annex 5
- "Al'PEND I X B
-----
DDSc)J JANUARY, 1984
"HEALTH CARE OF THE ELDERLY· PROJECT A survey of the Soc1al and Health Aspects of Aging 1n MalaysIa, RepublIc of Korea and the Phlllpp1nes F1eld Work - Part I Data CollectIons from ExIstIng SOurces
CoordInatIon Contact PoInt
Prof. G.R. Andrews WHO Consultant C/- S.A. Health Co.Ilsslon GPO Box 1313, AdelaIde SOUTH AUSTRALIA. 5001 Government of MalaysIa GovernMent of the RepublIc of Korea GovernMent of FIJI Governnent of the PhIlIppInes World Health OrganIsatIon
PartIcIpating Agencies
- 58 -
Annex 5
1.
The Project The WHO sponsored research project "Health Care of the Elderly" Is documented In the "Research Protocol", G.R. Andrews and C.M. Rungle, 25th October, 1983. The Project Is Initially being undertaken In MalaysIa, Republic of Korea, the Philippines, and FIJI
2.
Study Framework ThIs document specifies the types of data to be collected from existing sources In each country. This data collection Is part 1 of the field work for the Research Project. Part 2 Is a survey of random samples of the aging populations In each country. The two parts of the field work can be undertaken concurrently.
3.
ClaSSifications of Data The types of data to be collected are specified below, and Is In the Master Information Sheet. Unless otherwise stated, data Is sought for the aging population, which, for the project, has been defined to be 60 years of age and older, and data Is sought for the whole population for Use In COMparisons.
4.
Detail Information Sheet A detail Information sheet has been prepared to Identify the speclf'c characteristics of any data which Is available. Where a group of classIfications of data Is available from the one source and where the same analysis Is undertaken on each classification, one Information sheet can be used to describe the Whole group. Otherwise, It will be necessary to use one or more InformatIon sheets for each data classification and each source.
5.
Procedure The Master Information Sheet Is to be completed by the Prlnlcpal Investlgator(s) or their agents and returned as Indicated. Please Indicate on the Master Information Sheet which data Is available and for each category avaIlable ensure that a detail 'nformatlon sheet 's completed, e.g. for populatIon, Income, accommodation, hospital morbIdity, self-assessment, health, etc. etc. The Detail Infonaatlon Sheet has been designed so that It can be forwarded by the Principal Investigator directly to the appropriate agency for COMPletion.
Annex
I)
OOS9J ·WHO HEALTH CARE OF THE ELDERLY· PROJECT ~URVEY OF EXISTING DATA SOURCES Master InformatIon Sheet INSTRUCTIONS:Please IndIcate whIch data Is avaIlable for (1) whole of populatIon and (2) populatIon 60 years and above T1ck approprIate colum In each case N/A = not applIcable
DATA CLASSIFICATION whole nonn. i~60 vrs ves no ives no NIA CENSUS DATA
I i ,
A populatIon Age dIstributIon Sex distrIbutIon Aged dependency ratIo family sIze MarHal status Number of people per dwellIng Household relatIonshIp Urban - rural PopulatIon dIstrIbutIon
I !
I
I Income, amount Income sources OccupatIon EducatIonal attaInment I !
I
I , I
C HousIng Type of accoanodatlon (InstItutIonal, etc.) Type of dwellIng SIze of dwellIng Bath and toIlet facIlItIes HeatIng facIlItIes OWnershIp of dwellIng
o "'gratlon Intercountry Intracountry Rural urban Age of cOlll1lUnH I es .'
- 60 -
Annex :,
wIIo le I ooon. I~&D vrs yes no Ives no NIA
I
E ECONOfilIC Gross natIonal product per capIta Labour force partIcIpatIon Income dIstrIbutIon Poverty levels Tax levels Total health expendIture (publIc and prIvate) PublIc health expendIture PhysIcIans • HospItal • NursIng home • Dental • TradItIonal .edlclnes expendIture Sources of fInancIng .edlcal servIces FInancIng by type of .edlcal servIce F SOCIAL SECURITY. PENSIONS AND PROVISION OF SOCIAL ACCOMMODATION SocIal SecurIty benefIts , • benefIcIarIes • • expendIture ProportIon of agIng populatIon receIvIng pensIon, provIdent funds, etc. ProportIon of agIng populatIon receIvIng socIal securIty health benefIts ProportIon of agIng In specIal housIng (publIc) ProportIon of agIng In old peoples homes or hostels ProportIon of agIng In long-term InstItutIons ProportIon of agIng In hospItals G MORTALITY Life expectancy Age specIfIc death rates Cause of death SuIcIde rate H MORBIDITY HospItal morbIdIty CommunIty morbIdIty General health status ChronIc condItIons Symptoms DisabIlitIes RestrIctIons In actIvItIes of dally lIvIng MobIlIty restrIctIons Dental health Mental Health
,
,
, ,
i
I
I I
I :
i
I i
, ,
i
I I
, ,
, , : I
I I
i I
- 61 -
Annex 5
wIIole DODn_ yes no
-~ &0 lyes no
rs NIA
I
PHYSICAL HEALTH HABITS SmokIng DrInkIng ExercIse
,
J
i •
! I, , I ,
, , , --,
J
HEALTH MANPOWER PhysIcians PhysIcians by place of care PhysIcIans by specIalty RegIstered nurses Health Care WOrkers other health professIonals TradItIonal practItIoners
I!
,
~--r-~ I i:, , I I
I
I
I
, I
I! ,-,
i ,
K HEALTH FACILITIES HospItals Hosplta 1 beds NursIng homes (long ten. nursIng care) NursIng home beds Hostels (long term accoanodatlon for fraIl persons) Spec\al 1I0us Ing Home health servlces(comnunlty health) ClInIc servIces (hospItal) ClInIc servIces (non-hospItal) Dental servIces
, I
J I
I I I
I --
L HEALTH SERVICES UTILISATION Hospital dIscharges HospItal bed days NursIng home dIscharges NursIng home bed days Drug utIlIsatIon (prescrIptIons) ClInIc attendances M HEALTH BENEFITS Free medIcal servIces Free hospItalIsatIon NatIonal health Insurance NatIonal prescrIptIon sche.e Denture schetle Glasses schetle AIds for dIsabled sclle.e
,
I --
r-- -- -~--
--
--1-- i
-
6~
-
Annex 5
whole DODn. ~&O rs yeS no ·yes no NIA
N SOCIOECONOMIC AND ATTITUDINAL SURVEY DATA In tImes of good and bad hea lth Support relatIonshIps - In tImes of good and bad health Shared responsIbIlIty for housIng Extent and type of valued roles RelIgIous attItudes and practIces AttItudes to agIng • • death Self-assessment of health FamIly relatIonshIps -
I
,
o NUTRITION EatIng habIts NutrItIon levels Ava\1ab\1 Ity of dIet of suffIcIent nutrItIonal level Changes In eatIng habIts and levels of nutritIon
Note:
Please complete the above •.. ster InformatIon sheet" and return together wIth "detaIled InformatIon sheets" In all cases wh.r. data Is avaIlable. DetaIled InforMatIon Sheets have been provIded for forwardIng to agencIes wIIere approprIate. You should cOMplet. the return address requIrements and deadlIne as applIcable.
To be returned to: Professor G.R. Andrews Health CommIssIon of South AustralIa GPO Box 1313 AdelaIde. S.A. 5001 AUSTRALIA marked ·Personal &ConfIdentIal".
- 63 -
Annex 5
'WHO HEALTH CARE OF THE ELDERLY' PROJECT SURVEYOr EXISTING DATA SOURCE~ DetaIl InformatIon Sheet
ThIs "DetaIl InformatIon Sheet" relates to a survey of exIstIng data sources for the WHO cross-natIonal study of the socIal and health aspects of agIng. Please complete all questIons as fully as possIble. If posslbl~, please attach examples of the avaIlable data, e.g. copIes of reports, computer prIntouts etc. Please return the completed sheet by ............... . Thank you very much for your cooperatIon.
SIgned Date Please IndIcate: I would lIke to receIve a copy of the Project Report when It Is completed YES NO
- 64 -
Annex 5
DETAIL INfORMATION $HEET 1. Class\f\cat\on(s) of data (e.g. hosp\tal morbIdIty data II \ncone)
..................................................................................... 2.
Who collected the data, \.e. wh'ch agency etc? (e.g: "\n'stry of H.alth, Bureau of Census & stat'st,cs, Depart..nt of Labour & Industry)
.................................................................................................................... 3.
How was the data collected? (e.g. surveyor census or rout'ne collect'on as part of ad.'n'strat've procedures) Census Household survey Rout'ne collect\on/ad.'n\strat\ve records ·One off· survey Case records (or case stud\es) Other, please speclfy
4.
Is the data ava\lable for the whole populat\on?
B analys\s)
Yes No
If no, wh\ch sub-group does \t apply to? (e.g. publlc hospltal patlents only, or urban reglons only, etc.)
.................................................................................................................. 5.1 Is the prlmary data avallable for secondary analysls? (l.e. for further
B 5.2 If
Yes No \t
yes, ln what fom(s) \s
ava\1able?
A publlshed report An unpubl\shed r.port Computer pr'ntout Computer readable for.s such as .agnet\c records (tape or dlsc) etc. for conputer use Questlonna\res Case notes Other, please speclfy
..............................................................................
- 1,5 -
Annex 5
5.3 ts the data avaIlable In aggregate fOnMS whIch could be used for secondary analysIs?
B 5.4 If yes, In what forms?
Yes
No
A publ'shed report An unpublIshed report Computer prIntout Computer readible fonlS such as magnetIc records (tape or dIsc) etc. for computer use Other, please specIfy
6.
How Is the data broken down? By:
,.
Age groups
If tes, please spe~Ify age groups used (eg >-.55 , )&5, )10, >_60 etc)
B
Yes
No
· ................................................. . 2. Sex
B B
Yes
No
Yes
No
If yes, please specIfy groups coyered Indlyldua"y) (e.g. Malay. ChInese. IndochInese etc.)
· ................................................... . 1. How often '5 the data collected?
cont'nuously Regularly (specIfy frequency: eYery 5 years) Irregularly (11kely to be repeated frGl tIM to tIme) "One off" (un11kely to be repeated) 8. When was data last collected? (e.g. 1981 or 1918-7')
· .................................................. .
- 66 -
Annex 5
9.
Are projectIons avaIlable? (e.g. 2000, 2025)
If so, for whit y.ars Yelrs ....•......
B 10. rr~
Yes No
where Is the data avaIlable? Agency (e.g. Bureau of Census &stat'st,cs) NIIIIe :
........................................................
contact (e.g. "'ss Wont) MIlle:
....................................................
ntle: Address:
....................................................
- 67 1
Annex 5
Slll.ECT III. lEAlTH CME OF TI£
ElliE' FllQCi
aJiJllIIY: •.••.•.....................•......••••.•..•..••••••...•......•..•...•......
2.
DISTlIICl.
UlCM.ITY. ••
......................................................................... . IU&:R OF VISITS
IECIIIID OF VISITeS)
DAlEes) TOTAL TIllE TMDI rill INlERYJEW
INlERYIEIIED BY. Sll'ERYISOlh
1. IIDMCS.
N_ Subject ••••.••.•••••....•••••••••••••••••••••••.•••••••••••••••.••••••••••••••
Addr... . .....•.•...................................................................
I.
N_ Infor...... t ......•..•.•••.•.....••.•••••••.••••••••••••••••••••••••••••••••••••
l!. . ~.
Relationship of InforMant to Subject .••••••••.•••••.•••••••••••.•••••.••••••••.••. tnfor-.nt or other persons pre8ent during MUch of interview with subject? Yes 1
No
2 1 2 J 4 ~
1'. Typo of Housing
Detsched house Shop or terrace house Semi-detached houBe Shanty house Group dwelling - Multistorey flats, apartment - Special aged housing Boarding house or hotel Other
6 7
B
- 68 Annex 5 2
IIOIIIGRN'HIC 1. Sex of Subject:
Male
rellaIe
I
2 I l j
2.8
Are you married?
Never married Married Widowed Divorted No answer
""ot appropriate '.8 How many people normally live here ..,ith you?
4 X y
None One Two Three Four Five
a I
2 j
4 5
S"
6 7 8 9 y
Seven
Eight or more Institution No answer Not appropriate 4.8 Who live. here wHh you? [CH!:C1( "YES" OR "NO" FOR EACH No one Husband or wi fe
,
or
THE FOLLOWING]
Yes I I I I I I I I I I I I I
No No answer X 2 X 2 2 2
Not appropr18te y y y
Grandchildren Daughter Son Children-in-Iaw
Parents Grandparents Brothers and sisters Other relatives [DOES NOT INCLUOE IN-LAWS COVERED IN TH!: ABOVE CATEGORIES] Friends Non-related paid" helper ['INCLUOES FREE ROOM] Others [SPECIFY]
2 2 2 2 2 2 2 2
X X X X X X X X X X X
V y
Y Y Y V
Y Y Y Y
1 1 I
2 2 2 2
X X
Y
X
Y Y 7 7 8 B 9+ 9+ X X
5.8
Now I would like to know how many living children and including adopted children you have: 0 I 2 3 456 Children Sisters or brothers 0 1 2 3 4 5 6 How many Ilving sisters or brothers have you? Race of subject
y
Y
6.8 7.
Chineae Eurasien European Indian Korean Malaysian Philippino
1 2 5 6 7 8 X
Other No answer Not appropriate
Y 1
8.8
What rehgion are you?
None Buddhist/Taoist Christian Huo1110 Confuci.-. Hindu
2 3 4
5 6 7 X
Other No BOawer
Not appropriate Year 9.8.a. b. When were you born? How old are you?
Y
e.
[FOR THE INTERVIEWER] Are 9.a and b reliable
Yes No No answer
1
2 X
Not Ipproprlate I f NO - Estimate age
Y
- 69 3
Annex 5
0.8 rOf how Many years did you attend school? 11.1 Old you Uf~rtake
studies beyond high school or secondary school?
Ves ~o
1
No answer Not appropriate
X Y
lW I'd like to ask you 90me questions about YQur work situation. 12.8 Are you presently: [CHECK "YES" OR "NOIt FOR EACH OF THE FOLLOWING)
Yes I 1 I
Working full-time Working pert-time Retired Retired on disability Not eMPloyed and seeking work 8. [IF RETIRED AS!( e.) How long ago did vou stop working?
1 1
No 2 2 2 2 2
No anewer X X X X X
Not appropriate V Y Y
Y Y
11.8 What kind of work have you done most of your life?
Professional proprietor White collar Skilled labour Armed service (excluding Officers) etc, Unskilled labour (domestic) Houeewife Other No answer
• "
,
Never elllPloyed Not appropr iate
6 7
8 X Y
>4.8
[IF NOT IN MAIN OCCUPATION NOW) [MAIN REASON ONLV) Old you leave your main occupation [SPEClrV] because of:
Age/Reached retirement III health/Invalidity Redundancy/Retrenchaent Better occupation? Couldn't find appropriate work?
l
2 ,
Never eMPloyed? Other reMonl?
4 5 6 7
Not relevant No .,awer Not appropriate
8 X Y
.8 Does your husband/wife work or did he/she ever work? [QUESTION APPLIES ONLY TO SPOUSE TO WHOM MARRIED THE LONGEST) Ye. 1 No 2 Never married J No answer X
Not appropriate [IF "YES· ASK a.) 8. Whet kind of work did or does he/she do most of his/her life? Professional proprietor White collar Skilled labour Armed services Unak i lIed 1 abour Other No answer Not applicable
Y 1 2 )
4 5 6 X
Y
16.A Do you think people your age ahould be allowed to work if they wi.h?
V.. No No answer
I
2
X
Not appropriate 17.8 What is your .,in source of income? [CODE MAIN SOURCE ONLY] Eoploy.ont or work? Penoion? Provident Fund/Superonnultion? Dependence on family including spouse? SOCial welfare car,? Friend./c...unity Other? No answer
Y 1
2
J 4 5 6 7 X y
Nat appropriate .8 In addition to your main source of income, do you receive other money regularly? Yea No No answer Not appropriate
Y
2 X
1
- 70 -
Annex 5 19.8 00 you receive anv oth~r
4
forms of support?
[If "YES" J Froe whom?
Not appropriate 00 not have enough for bole requireMenta?
No .newer
Yee No
1 2
Y 1
X
2O.A
Thinking about your money situltion, would you say you:
Have juet enough to get 810no on?, or Are you cOfifortlble? No ......1'
2 J X Y
Not appropriate and ••penH. of this house?
21.1 00 you (and your husband/wHe) pay all the coata . . . . . of the coota. or none of the coote of the (rent/.. rtgego) AI 1 the coet. 5... of the coot. Nons of the coot. 1
No anewer
Not appropriate
X Y 1 2
2 ,
I. Who owns th11 houae/dwelling/building in which you live?
Subject Spa_
Subject end spou.e SubJect and other Sons Oaughters Sons and daughters Other relative Governlll!lnt
, 4 ~
6 7
Charitable institution Other No an.wer Not appropriate
A B
x
Y
ZZ.I How ....ch inc... do you (and your huabond/wifo) have • year? [SHOW AIIIUAl INCOME AN> CIRCLE THE LETTER WHICH IDENTIfiES EITHER YEARLY OR HDNTHlY INCOME CATEGORy] [Multiple choice answers to be idvised by countries] IDL,"
Now I would like to ook you .ooe que.tion. about your health.
23.A How do you feel about your pre..nt health; do you feel quite healthy?
Y•• No No Wlawer No .....r
1
2 X
X
Not _ropriate
V
2•• A How would you evaluate your pre••nt heelth; is it:
Very good? fairly good? A •• r . ? fairly bad? Bad? No.r Not rapr iate
• V
, 1 2
1 2
~.A
If you COIIIPlre your health with that of other persons you know of your
own -ve, ia your own he.lth.
Bettor? About the lior..? Cannot ••y? No_r Not appropriate
._1 , X
• V X
~.I Have you had .... accident, injury or long t.,. ill.... or long tor" he.Ittl probl.....let. .Nect• .,UviU.. daily lIving, including work? V.. No No_r Not appropd_
or
2
1
V
[IF "YES") which di.e .... inJury or acCident .ffect. your daily activitio. lncludino .ork? [FOR E'I£RV Dt5£& IT IS OESIIUlBLE TO fiND OUT THE NAME OR. If THIS IS NOT POSSIBLE. THE MAIN SYMPTOM.) I .........................•....•..................••••...................•••.......•...................•..••
2 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• 3 ........................................................................................................... . 4 ••••••••••••••••.•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ~
...........................................................................................................
6 •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••.•••••••••••••••••.•••••••••••
- 71 5
Annex 5
.1 Do you have any other diseases, injuries or accidents which do not affect your daily activities, including work? JR EVERY DISEASE IT IS DESIRABLE TO FINO OUT THE NAME OR, IF THIS IS NOT POSSiBlE, THE MAIN SYMPTOMS.] 1. .•••••.....•..............................................................••....•.•••.......•..•...••..... 2 ••• " ••••••.•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••.. J ••••••••••••••.••••••....•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••.•••••...••••.•.••••• 4 ......................................................................................................................................... .
5 ............................................................................................................................................................... . 6 ••••••••••••••••••••••••••••••••••••••••••••••••••••.•••••••••••••••••••••••••••••••••••••••••••.••••••...•
•• About how .... y ti• • during the lut praltl_?
one IIIOI'Ith have you consulted the following o:ategori •• of penon. for health
Doctor
Nurse PhanI8Cist Traditional health worker Priest ~~
1--1--1
-I
•• Ouring the 118t one MOnth how many daye were you 80 lick that you were unable to carryon your U8U81 activitl" ,uch 8S going to work or working around the house? No. of Dey.
~..
How _eny daye in the last one month were you in
8
hoapitel for physical health probleaa? No. of Dey •
III III 1 2 X V
. 1 How -.nr probl_?
~.
in the last one month were you in a [nursing home, or reh8bilitation centre] for physical health No. of Day•
•1 00 you f.el that you need medical care or tr.atatent beyond what you are receiving at this tiM? Y •• No No answer [IF Y'S ASK •• AM> b.]
Not appropriate
a. b.
What prabl.. do you need treatMent for? Why e.. )'011 not get the traatlll8nt?
.................................................. Can't afford Can I t get
there
1 2 )
Not available Other [SPECIFY] .•..••..•.•••••.....••••........•..
No answer Not applicable
4 X V
".1 During the last month have
~ou
taken any medicine or use any Traditional medications?
v•• No No an.wer Not approprioLe
I
2 X y
".1
During the l .. t month have you taken any MOdern medicines or drugs prescibed by a doctor?
Yea No anawer Not appropriate No
I 2 X
y 88
)S.I During the last IIIOnth have you taken any modern Medicines which are not prescribed by 8 doctor, such ~lc.tion8 you Mey buy at a phar~acy or shop? Yel No ~ot
No answer appropriate
1 2 X
Y
.8 >I.B
[IF TAKING ANY MEDICINE] Do you take medicine your.elf or doe • •"""'one help you? [CHECK BELOW] [IF NOT TAKING HEDICINE] If you had to take medicine, could you do it? [CMECK BELOW] (Are you/would you be) coopletely unable to take your own Medicine? No .,swer Not oppl1cable
Without help (in the right doses at the right time) With some help (take medicine if Bomeone prepares it for you and/or reminds you to take it), or
1 2 3 X V
- 7:'. -
Annex 5 ".B
6
Do you use any of the fnllowing aids all or most of the time? [CHED< "'r'ESII OR "1«1" FOR EACH AID]
Yes Cane (including tripod-tip cane) Wilker 1 1
No
Wheelchair leg brace Pace~aker
Bock brace
]f.'
Glasse. Artificial li.t Heering aid Coloat~ equipoent Catheter Other [SPECIFV] .....•.•..••••••••••..•
I
1 I I
1 1
No answer Not appropriate 2 X V 2 X V 2 X V 2 2 2 2 2
G."
2
X
Y
X X
1 1
X X X
Y V Y Y V V Y
I
2
Z
X
X
Il." I-I I-I I-I I-I I-I I-I I-I I-I I-I I-I
,=,
Do you need eny lid. (supportive or prosthetic devices) th.t you currently do not ha.e? No en_r
Ves No
1
Z X
Not appropriate
Y
[rF "VES", ASK
I. and
b.) 1
I. WhIt .ide you you need? [SPECIFV - TICK BOXES NEXT TO Q."] b. Why c..,' t you obtain it? Not available [IF MORE TH~ ONE ASK FOR Too expensive HOST IMPORT~l) Other [SPECIfY)...................................................... No anawer
2 J X
Not appropriate
Y
B 00 you haye have any problems with your feet such 88 bunions, corne, bent toea or lonv t.-naila or v.-iCOlHt \o.ine1 Yes 1
No
2 ~
No an.wer
a.
[IF "YES" ASK •• )
Not oppropri.te V I
Do theee foot problems restrict your activities?
, 41.8 Do you heir what 8
No . .wer
Yes No
2
Not _ropr 18te
V 1
X
person speaking at normal volume is .Iying to you, when you are alone with him or her? Ya. No
With dHficulty No .,...r
2 J
X Not eppropr iate Y 1 2 J 4
A2.A HearIng Test;
Hearing uni~81red Iftlpaired one .ar IMpaired both •• ra
No hearinv No .,swer
X
Not appropr iate
v 1 2 J 4
Sight unimpaired IfllPaired one eye I~aired
Blind a. Evidence of cataract?
both .,e.
No answer ~.A
Yeo No
I 2
Not _roprhte Correctly read
X V
Reading Teet: [LOCAL NEWSPAPER)
Incorrectly reed Unab I. to reod Visual proble.. ~o
, 2 4 X
1
Not appropriate !~.8
IIflswer
y
Do you have a dental prosthesis?
Vos No No an.wer Not approPriate
1 2 X
V I 2 y X
~.B
Do
~ou
hav£> di ffleu1 ty in chewing food?
Yes No
No answer
f\,jot appropr late
- 73 7
Annex 'l Yes With difficulty No Not appropriate 1 2 J
• B Can you walk to ... (SELECT POINT )DOH AWAY]
Y
M:TIYITIES Of DAILY UYIIIG
I'd like to Ilk you about some of the activities afd.ily living, thing. that we .11 noed to do . . . port of our Iy Ii.... I would like to know if you can do these activities without any help at all, or if you need .... help to , thH, or i f you can't do them at all. [BE SURE TO READ ALL ANSWER CHOICES IF AI't'LICABLE IN NEXT 11 III£STIONS TO !ESP\lNDEN T) j~ I
lnet.--t.l MIl
\ 1
[Ir TELEPHONES IOENERAUY AVAILABLE]
Can you use the telephone when one i. available? [PROBE] Without help, including looking up nUMbers and dialing With some help (can answer phone or dial operator in In eMergency, but need a epecial help in getting the number or dialing) Or are you ooopletely UBlble to use the talephone? Never knew how to use telephone No answer
2 I 0 A X
Not appropriate i •
y
Can you get to placoa out of walking diatance ••• Without help (can travel alone on buaes, taxiS, or drive you own car), With some help (need someone to help you or go with you when travelling), or Are you unable to travel unless e~rgency arrangeaents are _&de for 8 specialized vehicle like an .-bulance? No anawer
2 1
0 X
Not appropriate ~
Y 2 J
8
Can you go ahopping for food or clothes [ASSUMING S HAS TRANSPORTATION] .,.
Without help (taking care of all shopping neede youreel', aSSUMing you had trsnsportation), With SOMe help (need someone to go with you on all shopping tripa), Or Ire you completaly unable to do any shopping? No ..swer Not appropriate
o X y
;1.1 [WOMEN ONLY] Cen you prepare your own ...ls ••. Without help (plan snd cook full meals youreelf), With SOBI help (can prepare some thing. but unable to cook full meals youreelf), Or are you completely unable to prepare any ".fa? Dees not cook No anewer Not appropriate ;, 8 Can you handle your
2 A X
o
1
Y 2
own
money •••
Without help (write checks, pay bille, etc.), With some help (manage day-to-day buying but nsed help with managing your checkbook and paying your bills), Or are you ca.pletely unable to handle MOney? No answer Not applicable Cen you eat ••. Without help (able to f.ed yourself completely), With some help (need help with cutting, etc.), Or are you completely unable to feed yourself? No answer
o X
1
Y
2
a X
1
Not appropriate ~
Y 2 1
•
Can you dress and undress yourself •••
Without help (able to pick out clothes, dress and undress youreelf), With s""" help, Or are you coepletely unlble to dre.s Ind undress yourself? No answer Not appropriate ~_t~,
0 X
Y
is ••
Cen you take care of your appearance, for example combing your hair and (for men) shaving •.• With so.e help, Or are you colIPletely uneille to _si"tain your appearance yourself? No .,ewer Not appropriate
2 1 0 X
Y U8e
,
B
Can you walk •••
Without help (except from s cane), With some help frae a person or with the Or are you c""",lately unable to walk? No answer Not appropriate
of 8 walker, or crutchea, etc,
2 I 0 X Y
- 74 Annex 5 )7.8 Can you get in and out of bed ••• Without any help or aids, With some help (either from a person or with the aid of aa.e device), 2
8
Or are you totally dependent on ea.eone e1.8 to lift you?
1 0 l(
No answer
Not appropr iate
y
iI.1 Can you teke a bath or shower '"
Without help With oo.e help (n.ed help in getting 1n ond out of the tub, Dr need opoci.l Or ere you completely unablo to bothe youroelf? No on_r Hot _ropr ilt. )9.1 Do you ever have trouble getting to the toilet on ti•• ? Ho Yes
.tt~t.
on
t~
tub),
2 I 0 X y
2 I
Ha.e Hot
c.t~t.r
[Ir "yES· ASK Q60]
_red Not appropriate
or cololta.y
0 I
X
Y
&0.' 51.1
Wow often do you wet
Of s~il
youfself (either day or niqht)?
Onee or twice
8 ....
Three ti...
8
week or .are
No ..... r Hot appropr iat.
a
1
x Y
Is there aOM:one who helps you with such things as shopping, housework, bething, drnei"9 and getting around?
Yo. No
L
No ...ewer
Not appropri.to
Y
X
[Jr "YEP ASK e. to d.] a. Who il your Major helper? b.
Rellt10nahip [PROII£] Spouee
b I
d
Dau9hter Son
2 )
1 2 )
Child-in-l... Sioter
Brot~r Ot~r rel.tive
Elderly 'riend Ot~r friend ljoighbDur Ot~r poraon in .....".ity P....n 'roo charity group Go• ....-.t porlGO No an_r Not _ropriate c.
5 6 7 8 9
A
4
5 6 7 8 9 A
B
B
o X Y
C
o X
C
y
Who .1.. helps you? ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
N_
d.
Relationohip? [COD[ ABOVE] UYIIIIi .-ITS
rhe next lot of questions concern your living habit. and phyaical activity. It il ioportant that we know thole ror our 'e•• arch. S2.1 Hive you e.er 8MOked regularly, alMOst every day at l ... t for one yelr? VII. No 1 2
No an...r Not appropriete [Ir "Y[S"] ror how many ya.rs? [Ir "NO"] oIcip to qua.tion 6) ~ 00 you amok. regularly now? N_r ••••• y.er. Yea No No .,.wer
Y
X
1
2
X
Not appropriate Y b. [If "NO"] dlily' how
.any years ago did you stop smoking?
Nu.ber •••.• ye.rs
c. [If "YES;] How many Cigarettes, pad . . , cigars, pipefuls
Cigarette. 1 2 )
Cigar. 1 2 J 4 X
Pipefuls I 2 J 4
4 X Y
X Y
(
<
Y
(
-
75 9
Annex 5 Yes No No anewer Not appropriate I 2 X Y
.1 Do'you drink alcohol auch 8a beer, wine, liquor (todi)
[Jr "YES" a.
ASI(
eo to eo)
... .any days 890 did you last have a drink?
b.
He. any ...oer of your
f . . ily
cOMplained about the a.ount you drink?
Y.. No No ..
I
Not appropriate eo
_r
2 X
Y 1 2 X
Do you think you drink too much?
Y.. No No ..
Not appropriate SOCIAl ...8 On how meny days in the past month did you atop to S8y 8
_r
Y
prayers by your•• lf?
On how ..ny days in the past month did you attend with other people? ~ •• ,
religious .aeting or service, or join in prayers
Do you belong to a orouPt regular meeting, club or society other than 8 rellgioue group or meeting? ~
j
No No ...wer
2 X
[lr "YES" ASK eo end bo J
Not appropriate
Y
e. b.
On how .any daye in the past month did you attend the meeting or join in the group? For the ol'qW'IizaUon in which you are most activ., which of the following etatMMtnts beat deacJ6e) yoJr
function.
I am only an inactive ~r and do not participate in activities 1 am a ~r and participate occisionilly in activities I am an active member I am 8 leader ar argeni.er or group No anewer Not appropriate 8018
1 J
2
Q
Y
X
4.8 Do you belong to
group, oeeting or SOCiety for the elderly or the retired? [PROBE)
Ya. For..lly Ve. Infor..lly No No_r Not appropri.te
1 Z J X
Y 68 1 4
8 How orten do you attend f ..ily cere-anies, weddings, funerals or birthday partiel, etc. > Daily < Daily, > Weekly ~JI How often ~o you viait relatiyes or have them visit you? < Weekly, > Monthly < MOnthly, > J Monthly < J Monthly, > 6 Monthly < 6 Monthly, > Once per Y.ar < Once .. r Year No_r Not oppropri.te ,.8 Do you ••• iat in taking care of any grandchildren or other children not including econOMic help? Yel No
67 I
2 J 4
, 2 7
5 6 7 X Y
5 6 X Y
No ..
Not appropriate 3~.
_r
2 X
Y 1 2 X V
Are you consulted or Baked to participate in making decisions for the f ..tly?
~o
anawer Not appropriate
Ve. No
1.8 Are yOlJ consulted rqarding c_ity problna? [PROBE)
Yes Qffi~i811y No unofficially No answer Not appropriate
1 2 X Y
- 76 -
Annex 5 7Z.8
10 Never
About how orten do you go out of thIS (heuse/building) in good weather?
I 2 J 4 6 8
leBa then once • .onth Once a IIOnth
2 or , days Once B
-anth
week
2-4 day. 0 _ 5 days • week Of No 118Mr Not approprilte
100'.
7 B X y
7'.8 How ..ny people do you know well enough to visit with in their homel?
rive or IIIOr8 Three to four One to two None No
I
J 2 0 X V
Not IIIPropriete 7••1 00 you hIve aa.eone you can trust and confide in?
.,wer
Vo. No
I 2 X V
No .,.... r
Not .,rapr i.te
••
[IF "VES· ASK •• ]
Relation,hip [PROBE]
Spou8e OMlghter Child-in-I.. Sieter Brother Other rel.tin Elder I y fr iend Son
I 2 J
" 5 6 0-
Other friend Neighbour
Other porson in . - l t y Person froon cltar it y group e 0 GDver~t pereon No answer
9 A B X Y
Not appropriate
7S.A 00
you
find youreelf f ..ling lonely quite often, SOMetimeS, or aloost never?
Not _ropr ieto 76.A 00 you aee your relatives and friends see them' 88
No enewer
Quits afton Soaeti...a AlltIOlt never
0
1 2 X y
often
88
you went to or are you aa.ewh.t unhappy about hQ. little you ~ often a. wanta to 1 S_et unhappy Ibout ' - l1ttl. 2 No 8n8Wer X Not appropriate V
77.8 18 there ea.eone who would Qive you any help at ell if you were siCk or diSabled, for exa.ple your hu8bend/wife, a ..-ber of your f ..ily, or 8 frie~d? Vaa I Na on. willing ...,d able to help 0 No
Not appropriate [IF "YES· ~5K •• and b.] •• ]s there eomeone who would take care of you as long 8S needed, or only for a short time, or only .a.eone who would help you now and then (for example, taking you to the doctor, or fixing lunch occasionally, etc.)? Soaeone who would take care of Subject indefinitely (8a long as needed) 5a.eone who would take care of Subject for 8 short ti.e (8 few week. to 8ix .anth.) Someone who would help the Subject now and then (taking him to the doctor or fixing lunch, etc.)
.,_r
y
1 2 J
Not appropriate b. Who is this peraon?
No answer
V Spou.. Oaughter Son Child-in-Iaw Sieter Brother Other relatiye Elderly friend Other fr iend Neighbour Other peraon in ~ity Person fro~ charity group GovernMent per.on No anewer
X
1
2 J
• 5 6 7 8 9 A 8 C 0 X
Not appropriate
V
78.1 How long have you been living at your present addreaa?
number of years
III
- 77 11 ...... About how far ew8)' .8. the hOM you lived in before this. Was it:
Annex 5
in this neighbour~ [w.thin a block. or a half a aile) 1, in this city (town) but in 8 different nalQhb-'-" , '2 I in another city (town), or in II10ther proY ince
3 I 4 I
No answer
X I
Not appropriate .... During your childhood did you live in: "'lnly urban area.? "'lnly rural ar...? Both urban end rural ar..e Q80 I 2 ,
YI
Qal I I
I.' az.A
As 8n adult did you li.e in:
2 J X Y
No answer
Not appropriate I11115IIIl How would you rate this (houae/building) a8 8
X
Y
place to live _ would you say it is: Exoallent? GoocI? I
2 3
fair?, or Poor? No anawer
4 X
I
Not appropriate No
Y
.... .,..,.. Do you have convenient access to:
Ye. Clean fresh weter? Toilet faciIit!..? Cooking faciliti.a? Blthing f.ciliti.a? 1 1 I
Not appropr late y V
No 2 2
answer X
X X
1
2 2
Y
X
Y
F SINGLE STOREY BUILOING, CODE Q84 •• and b. BUT DON'T ASK) ~..
•• Which floor do you mainly live on: [CODE THE LOWEST NUMBER)
e'.ement? Ground floorlfir.t floor? Second floor? Third floor? Fourth floor? Fifth floor? Sixth floor? Seventh floor? Eighth floor? Ninth or higher? No answer Not appropriate
0
I
2 , 4 6 7 8
S
9 X I
Y
b. 1. there a lift?
Ye. No Single .torey bu.lding No answer
2 J X ~
Not appropriate
as.A
All things conSidered, how satisfied do you feel with (city/village/town)
8••
place to live? Are you; Very satisfied, J
F81rly satiBfied, or Not very satisfied? No anewet Not appropriate .• A How aafe do you feel in your (house/apartment) at night? Very .afe, rairly •• fe,
2 J K
Y
Not too aa'e, or Not at 8U •• f.? No anewer Not appropriate MEllTM. STA'IE EXMlIIIITlIIII
I 2 J 4 X V
.A 1 would like you to ra..-oar .y n.... [USE CULTURAL NAME)
~~E~~A~~
NANi'UNiiL'CORRECTLy'REPEATEOj""
Can you repeat that? ~8pronunci.tion8
Cannot repeat interviewer's "8MB after three or l.a. repetitions. (Minor No answer, no codllble reply Not ~ropri.te
No error
are allowed)
1 2 y
X
- 78 Annex 5 12
II.A I am going to nome thr.. objecta. After I have said them, remeMber whit th*y Ire because I _ I)Dlft9 t.o uk you. to n... them again in 8 few minutes. "Banana" "T*le" "Money" No Not Could you repeat the three items for ..? Ihcorrect answlr 8PPfopri8te Correct [SCORE rIRST TRIAL] I 2 Y X 8. Banens 2 1 X V b. rele 1 2 X Y c. Honey
!P..
Could you plelee touch your right ear with your left hind?
I
2
X X X
Y V Y
".A What i. this callod? [SHOW PENCil] 91.A Pl .... copy this design.
1 1 1 1 1 1 1 1 I I
2 2 2 2 2 2 2 2 2 2
'LA How, whit .. re the thr .. object. I askod you to re..-r? a. 88" • • 10. c.
reI.
X X
Maney II)'
X X X
Y Y Y Y Y
".A Cen you retl8llber
name? What ie it?
94.A What yo .. i. it (now)? What oonth io it (now)? What day or date of the month is it (now)? 9S.A How would you deecribe where you live to sa.eone elae?
X X X
Y Y Y
9'•• 00 you have difficulty with sloep? Do you find that you ara sleeping too MUch? '7.A Do you reel .ar. tense and worry more than uBual about little things?
No ve. Na .,.....r
IX 0 I X Y
Not appropriate V No No_r Not """ropr iat. Yoo
9I.A Have you lost intereat in doing thing! you usually cared about or enjoyed?
No Yo. No .....r
0 I X
Not appropriate
Y
".A Have you ever felt so sid or depreB8ed you thought of
~ittin9
suicide?
No No answer
0
Ve.
I Y 0 1 X X
Not .ppropriate Yo.
lID•• Do you f .. l Ured all tho till87
No
No answer
Not appropriate
Y l
101 •• Do you forget where you left things more than you used to, or forget the n.... of close friends or relative.? No Yo. ~o an.wer Not appropriate
1 X
Y
18I.A Since you rac.... the age of 60, have you e"et had the experience of hearing things that other people could not? No 0 Yea I
No an...r Not oppropriate
Y
X
10).A Slnco yOU reached tho ago of 60, hive you ever had tho uperience or ..oing thinge that other peopla could not? No 0 Yo. 1 Ho_r
X
Not oppropriate
V 0 X Y
la..A 00 you ever belie"e that people are watching you, or .pying on you, or plott!ng 8g11n8t you? No
No entWer Not .ppropriato
Ve.
I
lOS.A po you ever feel that special
",Sag8S
are being sent to you on the TV or
r~io?
No Ve.
0
No _war Not appropriate
X Y
1
- 79 13
Annex 5
1*
II!
LESTIONS TO BE ASKED Of AN INfORMANT BASED ON HIS KNOWLEDGE Of THE SUII.ECT) llf THE SUII.ECT IS tJlRELIABLE THESE QUESTIONS IIIST BE ASKED Of AN INfORMANT) [IF THE SUII.ECT IS RELIABLE, THE QLESTIONS MUST BE ASKED IF AN INfORMANT IS AVAILABLE]
SOCIM. IESIIIR'£S
116. How well does •••••••••.••.•••• [SUII.ECT] get along with hia/her f . .ily and friondo: Very well fairly well [HAS S8M[ CONFLICT OR TROUBLE WITH THEM] Poorly [HAS CONSIDERABLE TROUBlE OR CONfLICT WITH THEM] No .-aswar
3
2 I X
Not appropriate
V
7.
8 • ..,le hie/her
Is thare aW one who would (or is) help ............. [SUII.ECT] at .11 if ha/ahe ware eiel< or disabled, for huIbInd or wife, a MeMber of the f ..ily or • friend? Vea, or already rleeiv•• help I No o No anewer X y Not _ropriata
[If "I" ASK .. and b.l a. 18 there (thil) someone who would (IS) take(ing) care of hi_/her 8S long 88 needed, or only for a short tiMe, or only SOMeone who would (is) help(in~) now and then (for example, taking him/her to the doctor, fixing lunell, etc.)? SOMeone who would take care of Subject indefinitely (eo long as needed) 1 Someone who would take care of Subject 8 short ti.e (. fe. week. to six MOnths) 2 Soneone who would heip him now and then (taking him to the doctor or fi_ing lunch, etc.) 3 ~ ~5~r X
Not appropriate b. Who ie thie person?
~
Nilfle •••••••••••••.••••.••••••••••••••••••••••••••••••••••••••.••••••••••••••••.•..•
Relationship ECONIIIIC RfSQIIlCES
••
In your opinion are ........•..... 's [SUB.I:CT'Sj needs for the following basic necessities being well .. t, or Not Ire thay not being ..ot? No Well met Barely met Not met anawer approprllte V rood 3 I X 2 V 3 1 X Housing 2 Y 1 Clothing 3 2 X Y I X Medical care 3 2 V 3 I X SII811 luxuries 2
MEIITM. I£lILTH '.. Does ............ [SUII.ECT] show good, COIIIIIIOn aenae in aaking jud_ntl and decisions?
Vee No No ana.... r
1 0 )(
Not approprlate ~.
Y I 0 X
18 ••••••••••••••• [SUBJECT] able to handle (cope with) ..ajor probl..e which occur in hie/her life? Ve. No No anewer Not IPproprilte
Y
!11.
Have
ever noticed any ch8Age for the worle in hie/her personality, auch .. the way ha/.he bahave. ~o oocia 1y or otherwi ..? Vea occ.lionaUy Ve. orten No ."...r ~ot _opr18t.
TOU
o I
2 X Y
11.
Does he/ahe aometi ... get involved in embarrassing situations in public because of hie/her behaviour? No 0
Yee occ8sional1) Ves aften No anewer Not appropriate 11'. Has he/she become more irritele of angry? No No .......r Not -.:tPrapriate
1 2 X Y D 1
V..
Ye, occ •• ionally
ortan
2 X Y
- 80 -
Annex 5 Llt. Does
14
he/she have difficulty knowing where he/she i8, or recognizing you?
No difficulty Sllght difficulty Greot dt fficulty No Wlawet
o 1 2 X Y
Not _raprtote lIS.
Does he/ahe hIve difficulty remembering when he/ehe last saw you, or
~hlt
happened the day before? No dHficulty SliVht dirficulty Greet difficulty
o I
No anewer
2 X Y
Not eppropriate
l16.
When opeaking, does he/she have difficulty finding the right word or use wrong words?
No Yea occasionally Vae orten No .,ewer Not opproprtoto No Yea acc_ionall)' Yea often No anawer Not opprapr tete
0 I
2 X Y
117. Doeo he/Ihe have difficulty with his/her sloep?
0 I
2 X Y
UI.
Do you think he/_ is depr....d?
No occasionally Ve. orten Y••
0 I
No anawer
2 X Y
Not appropriate
119.
How would you rate ..••••.....•.• [SUBJECT'S] health at the present
ti~
- excellent, good, fair, or poor?
Excell.nt Good reir Poor No anawer Not appropriate
) 2 I
0
X Y
120.
Haw ouch dO •••.••••..•.••. [SUBJECT'S] heslth trouble. stand in the way of his/her doing the thingo he/she ..nt. to do - not at all, 8 little (aOMe) , or 8 great deal? Not at all J A little (.OIIIe) 2 A great deal 0 No anewer X Not appropriate Y INI~
,
ENT
THE REMAINING QUESTIONS ARE TO BE ANSWERED BY THE INTERVIEWER IMMEDIATELY ArTER LEAVING THE INTERVIEW SITE] l2' factual infor.ation obtained frOll:
Subject Relative Other [SPECIFY] .•••..•..•••.•••.••••.••••••••••••••••.••••...••.•••.•••••••.••••••••••••••••••••••••• Not appropriate 122.
1
2 Y J
Fectuel questiona (obtained fro. Subj.ct and/or infor..nt) are:
Caopletely reliable 1 Reliable in ooet it... 2 R.l~lo on only a f$w ite.. J Completely unreliable 4 Not appropriate Y Completely reliable Reliable on oo.t ito.a Reliable on only • raw i t _ Completely unr.liable Not obtained Not opproprilte 1 2 J 4
IU.
SUbjecti •• que.tion. (obtained from Subjact only) are:
[IF S ANSliER e.)
S Y
e. Why didn't the Subject onawer the Subjective questions? [BE SPECIrIC]
·........................... , ....................................................................... . ·..................................................................................................... ·....................................................................................................
- 81 15
••
Which of the following best describe. the a.ailability of help for the Subject if he(Bhe) were slck or diHbled? At leaet one porson could and would t ... care of the Subject indefinitely (ae long ao needed) At lo.. t one poreon could end would toke care of the Subject for 8 .hort tWo (I week. to 6 _tho) Help .... ld only b. o.oilll>le oow and then for such thing. as t .. ing hi.(her) to the doctor, fixing lunch etc. No help at all (eKcopt possibly ... rgoncy help) would be •• 8i111>1. Not ~riote
'ew
1 7
J 4
Y
5. Which of the following beat describea the Subject"
.ocial reloUon.hips?
Elf_I&&IIIIIC 'f9'M!'fli
Very .atisfactory, extenaive Fairly satiafactory, adequate Un.otl.factory, of poor quality, few Not _ropriate i~?
1 Z 3 Y
126.
In your opinlon which of the fo11 .... ing beat _cribea the Subject's
.-pIs Satisfactory lnwMqo,.ta Totally inodeqUlto No incOMe at all Not appropriate 7. In .your opinion does the Subject have any financial reserves? V .. t hall rellttrY88
_.t
1 2 j
4
,
v
Not _roprilta
No, ho8 (little or) no ro •• r.el
o y
1
s.
no _t?
In your opinion which of the fo11 ....1ng sta_to beat deacribe. the extent to which the SubJect' a ...... are
rood, hou.ing, clothing, and ..dieel needs are Net; Subject cannot .fford ...11 luxuries Either food or housing, or clothing, or ..dical needs are """"'t. Subjo.ct cannot afford s ... l1 luxurie' Two or ..re booic n.od. (housing, food, clothing, oediCll carol Ire UM.et; Subject connot ofFDrd 8Mll luxuriea Not _ropr iate PllYSlCAI. " IDI.,"
Food, housing, clothing, Ind medical needs are _t; Subject can afford ...11 luxuriea
J 2 j
• V
Ia the Subject either oxtremely overweight, or molnourished end ,,"oilted?
V •• , ..lnouri.hed or ...ei.ted No .......r
V .. , .ext..-.l.,
No, neither
o......1g11t
0 1
2 X
Not appropriete IIDITAI. 1£JI.1M
Y
o. Is it your iopreaaionlhat tho Subject .hows
good, c _
.en_
in _i09 judgooento end deciaiona? No ..ewer
No
V..
1 '( Y 1 0
Not appropriate ••1. Is it your iop .... ian that the Subj.ct ia able to hindI. (cope with) Major prob~·which
occur in hia/her I1f.? No No_r Not appropri.t.
V.a
0 X
y
IIIISIIIG
·Z.
Standard of latrine/toilet:
nu-.ing W.tar-oeolOd Pit ayat.. None
1 2 3 4
Other (Spoc1fy)................... ............... . Not appropriate No enMMr I). OpiniQft. of hygiene in the halDe/accon.odation
5 X V 1 2 3 Y 1
Good Sufficient Inoufficlont Not appropriate Good Sufficient Insufficient Not appropriate
•• Opinion of hygiene of tho person: (clothe., hoir, handa)
) Y
Z
- 82 -
Annex 5 l)S~
16
Place of interview:
Nor ... l _ Special houaif1C.iJ
I y
Institution Not Ipprapri.to 116. Area of residence: lJrb..
2 J
Suboourb.. Rur.l Not _ropr lou SllCIAl II£SOI"IES RATING SCAI.£
I 2 J Y
In. [RATE THE CURIIENT SOCIAL RESOURCES Of THE PERSON BEING EVAlUATED ALONG Ttl: SIX-POINT SCALE PRESENTEQ BELOW. CIRCLE THE OIl: NlM!(R WHICH BEST DESCRIBES THE PERSON'S PRESENT CIRCUMSTANCES. SOCIAl RESOURCES QUESTIONS ARE NlM!(RS]
£xcelJ.nt
eoci~ 1 lOW 066. I ....
would t8k. care of hilt{her) indefinitely.
Social relationships are very ••tiefying and extensive; at le •• t one person 1
Social relationships afe fartly satisfying and adequate and at 1eut one per.on would tlke cere of hi.(her) indefinitely. or Social reletionahipe are ~ery satisfying and extensive; and only short ter~ help is available Mildly 8ICially ~red. Soclal relationships are unsatisfactory, or poor quality, few; but at le.at one peraon would take care of him(her) indefinitely. or Social relationships are fairly satisfactory, adequate; and only short term help is available Social relationehips are unsatisfactory, or poor Quality, few; and only short term clre is available. or Social relationships are at least adequate or satisfactory; but help w~uld only be av.iIeble now and the~ ~1, ~all, ~. SOCial relationships are un.atisfactory, of poor quality, fa_; and help ~ould only be 8vaillble now and then. or Social relationships are at least satisfactory or adequate; but help is not even available now and then Totally eocially ~~. SOCial relationships are unsatisfactory, or poor quality, few; and help is not even a••U.t>le now and then. Not .pprapr iah Ealauc 1I£SOIarr5 RATING SCAI.£
IiDDd .acla1
2 J
4 ~
6 Y
HI. [RATE THE CURRENT ECONOMIC RESOURCES OF THE PERSON BEING EVAlUATED ALONG THE SIX-POINT SCALE PRESENTED BELOW. CIRCLE THE OIl: NIJ4BER WHICH BEST DESCRIBES THE PERSON'S PRESENT CIRClJ4STANCES. ECONOMIC QUESTIONS ARE NIJIIERS •• ] [~ic ~ are e.callent. Income is a.pls; Subject has reserves. ~c rna Ire. . . . . . .i.rectory. Income is ample; Subject has no reserves or Income is adequate; Subject has reserves. 2 ~c 1 uaa are -'Idly ~. Inco~ is adequate; Subject has no reserves or IncOMe is aa.ewhat inadequate; Subject has no resefves. 3 E 'e 1 ....... __ retel, ~. InCOlfe is ao.awhat inadequate; Subject hae no reaerves. 4 ~c 1 .... E1t . . . . .1y ~a Income is totally inadequate; Subject lIIay or lIIay not have reaarv.. S E~c • eua are a..pletely ~red. Subject i8 destitute, COMpletely without income or reaerves. 6 Not _raprhte Y PllYSICAl HEALTH RATlIIG SCAlE 1)9. [RATE THE CURR(NT PHYSICAL F.... CTIONING OF THE PERSON BEING EVAlUATED ALONG THE SIX-POINT SCALE PRESENTED BELOW. CIRClC THE OIl: NUIflE:R WHICH BEST DESCRIBES THE ptRSON'S PRESENT F....CTIONING. PHYSICAL HEALTH QUESTIONS ARE NUMBERS ••• ] In ....llent phJaical ~th. Engages in vigorou. phy.ical actiVity, either regularly or .t lea.t frOM ti.. to tillll! In good Ph¥eiaal heelth. No significant illnesses or disabilities. Only routine medical care such 88 annual check ups required. 2 .~y "'.'eally ~~ Has only minor il1ne8ses and/or disabilities which might benefit from ..dical treat..nt or corrective measurea. 3 rlltelr ...,.,.1ca11, ~nd. HIla one or IIOre disea.ea or disabilities which are either apainful or which require 8ubetWtUal ...~::Iic.l treatfDeflt. 1& s.werely phyala.lly ~. Ha. one or MOre illne8s•• or disabilities which are either severely painful or life thre.tening, or which require extensive ..dica1 treatment. ~ Tet8l1, ~cal1y ~. Confined to bed and requiring rull time ~dic8l assistance or nursing care to .aintain vital bodily functions. 6 NDt apprapr iatl Y " S
POfU'Un RAHIIG SCAI.£ FUI ACTIVITIES Of DAILY LInt«: 140. [RATE THE CURRENT PERFORMANCE OF THE PERSON BEING EVALUATED ON THE SIX-POINT SCALE PRESENTED BELOW. CIRCLE THE ONE NlJ4BER WHICH BEST DESCRIBES THE PERSON'S PRESENT PERfORMANCE. ACTIVITIES or DAllY lIVING QUESTIONS ARE NlMIERS ] [ ...lllnt ADl CIPIClty. Cln perform all of the Activiti •• of Dsily Living without aSSistance end with ••••• 1 IDod ADl DlplClty. Can perform all of the Activitie. of Daily Living without essi.tonce. 2 Raldly ~red ADl DlplCity. Con perform all but one to three of the ActiYitie. of Doily Livin;. SOMe help is required .ith one to three, but not necessarily every day. Can get through any 81ng18 day without help. Is able to prepare his own lleals. J Nldar.tel, ~red ADl copoclty. Regularly require •••• istance with .t le.st four Activities of D.ily Living but is able to get through any single day without help. Or regularly requires help with mesl preparation. Q s.o.r.ly '-Paired ADl c.,.clty. Need. help e.ch day but not neces.srily throughout the day or night with Many
...
Aetivities of Daily living. ~ ADl ~ty. Needs help throughout the d.y .nd/or night to carry out the Activit1e. or Daily Living. Not appropr i ate of the
5'
OIIplately
6 V
, I
- 83 -
ANNEX 6
MINIMUM DATA SET
POPULATION
Age Distribution Sex Distribution Population Distribution
MORBIDITY
Community Morbidity
*
Restrictions in activities of daily living
I, ,
PHYSICAL HEALTH HABITS
Smoking Drinking Exercise
Ii, I,
HEALTH MANPOWER
Distribution of Physicians Distribution of Physicians by place of care Distribution of Physicians by speciality Distribution of Registered Nurses Distribution of Health Care Uorkers Distribution of other heal th professionals Distribution of traditional praci tioners
- 84 -
Annex 6
II" 11 '
"
HEALTH FACILITIES
Distribution of Hospitals Distribution of Hospital Beds Distribution of Nursing Homes (Long term nursing care) Distribution of Nursing Home Beds Distribution of hostels (long term accommodation for frail persons) Distribution of special housing Distribution of home health services (community health) Distribution of Clinic Services (hospital) Distribution of Clinic Services (non-hospital) Distribution of Dental Services
,
II
11
HEALTH SERVICES UTILIZATION**
Hospital discharges Hsopital bed days Nursing home discharges Nursing home bed days Drug utlization (prescriptions) Clinic attendances
NUTRITION
Eating habits Nutrition levels Availability of diet sufficient nutritional level Changes in eating habits and levels of nutrition
Note:
*
Possibly one of the most valuable descriptors but very difficult, even unrealistic to obtain. Weak data but readily available.
**
- 85 Annex
6
1984 J F M A M J
J
A SOli
1985 JUL 8S. D J F M A M J JUN 86
FINl'.LISE QUESTIONNAIRE SURVEY EXISTING DATA FIELD TEST
QUESTIONNAIRE
FIELD SURVEY
PRELDltNARY ANALYSl;S DESCRIPTIVE STATISTICAL ANALYSIS
COUNTRY tiOlUCSROPS!
DEV. OF ACTION PLANS EXTENSION OF STUDY DEVELOPMENT OF POLICY GUIDELIRES
INTBRCOIlNTRY IIOJtMIIOP
PRESENTATIOli OF STUDY
ro
REGIcmAL RESEAllCH COteilit_ MALAYSIA REPUBLIC OF kOIIEA
PHILIPPINES
FIJI
I
I