Study Of Needs And Utilization Of Health Services Among Middle To,Highest Aged Old People In Jiading District

ObjectiveThe objective of the current study was to explore the current situation of the middle to, highest aged old people health needs and utilization in Jiading District, and investigated the impacting factors,thus providing relevant policy suggestions to improve the target populationg’s health status.MethodsWith Multi-stage cluster sampling self-designed questionnaire was administered to 1200 middle to, highest aged old people (70 and above 70 years old)for the cross-sectional investigation into the health services needs and utilization and its relative influencing factors.Epidata software package was used to establish quantitative data database, and logic check was set up. EXCEL software was used for sorting data. SPSS 16.0 statistical software and EXCEL2007 were used to descriptive research, χ2test and multi-variable logistic regression was used to explore the factors that may affect health service demand and utilization of the Middle,oldest elderly population.Results1 General conditionsIn this current study,1200 questiongnaires were put out and 1196 questiongnaires were collected in effect.There were 521 males and 675 female in 1196 middle and,oldest-old.the sex ratio is 0.77. the proportion of Middle,oldest elderly population in different age-group as 70-74、75-79、80-84、85-89、90 years and over were 30.18%、33.19%、22.66%、9.87%、4.10% in turn.The proportion of middle to, highest aged old people in Unmarried, widowed or divorced was 35.70%.99.83% of middle to, highest aged old people reported being covered by the medical security system.However,they still reported high financial pressure resulting from the medicao expenses.The survey showed that middle to, highest aged old people reported their relations with family members as follows:excellent(56.1%),fairily well(35.79%),average(7.68%),below average(0.25%).65.54% of the middle and,oldest-old participants reported as having frequent talk with their friends and neighbors.16.81% of the participants reported as taking part in almost all community activities.2 The characteristics of lifestyle and demandThe smoking rate among middle to, highest aged old people was 14.63%,male smoking rate was 32.82%.Female smoking rate was 0.59%. The drinking rate among middle,oldest -old was 12.62%,male drinking rate was 23.80%.the female drinking rate was 1.48%.24.33% of middle to, highest aged old people reported as having taken non procedures for self-care.56.44% of middle to, highest aged old people lived a regular life.36.77% of the middle to, highest aged old people took care of themselves by doing physical exercise.31.77% of middle to, highest aged old people took care of themselves by living on a diet.48.83% of middle to, highest aged old people didn’t have regular physical exercise.83.44% of middle to, highest aged old people reported as taking care of themselves in activities of daily living. The self-care proportion of middle to, highest aged old people in different age-group as 70-74、75-79、80-84、85-89、90 years and over were 94.18%、86.65%、80.07%、59.32%、55.10% respectively.34.62% and 60.12% of middle to, highest aged old people who cannot take care of themselves in activities of daily living asked for assistance from their spouse and children.8.03% of middle to, highest aged old people were living in or in the process of application for nursert homes.The main reasons for application were that they were in need of extensive care (29.17%) and were willing to be there(34.38%).Those who chose not to apply for nuring home listed not having the needs(28.71%),or being able to obtain support from families(34.65%).The acceptable endowment agency fees was among 500-1000 yuan per month.3 Health service needs Over the past year,70.82% of middle to, highest aged old people were diagnosed as having chronic disease in the past year.the 80-84 year- old group has the highest prevalence of the chronic diseases,78.97%.61.73% of middle to, highest aged old people with chronic illness suffered from one kind of chronic diseases;28.44%,two kinds;9.83%,three or more kinds.the top 10 chronic diseases were:hypertension, diabetes, coronary heart disease, cerebral infarction, chronic bronchitis, gallstones, arthritis, cancer, prostatitis and gout in turn. The average chronic disease suffering time was 11.00 years. The average chronic diseases treatment fee was 2277.04 yuan,with the frequency of doctor visit 11.63. Multiple factors analysis found the region,age, applying for or living in the pension agency, having frequent talk with their friends and neighbors and the pressure of the medical expenses were significantly correlated with the prevalence of the chronic diseases.4 Utilization of health ServicesOver the past year,3.09% of middle to, highest aged old people reported having used ambulance service. When middle to, highest aged old people feel unwell,91.30% of them chose to ask their children or relatives for help.37.37% of middle to, highest aged old people reported having experience of not seeking medical assistance in times of sickness.The main reason for not seeking medical assistance were that the diseases were perceived as not serious and elders purchasing medicines with the intent of handling themselves.58.19% of middle to, highest aged old people prefer to see a doctor in the community health service centers:28.18%, Community Health Service Station; 13.13%,hospital.the main reasons for choosing where to ibtain medical assistance were the short distance, low price and good quality.The hospitalization rate of middle to, highest aged old people is 4.72%,The average hospitalization time was 55.13 days; medical expense,10283.04 yuan.49% of the hospitalization preferred to live in District hospotals; 18%,municipal hospitals; 13.5%,family beds; 12%,Community Health Service centers. Multiple factors analysis found the Area, applying for or living in the pension agency, economic status, doing physical exercise and the pressure of the medical expenses were significantly correlated with the hospitalization rates.Conclusion1.With the increase of age,the ration of males versus females increased with single female of 75 years old and above getting bigger.the percentage of the oldest-old of middle to, highest aged old people increased,therefore making the health service for the old-elder more important.2.More male elders drank alcohol or smoked cigarettes.In addition,almost half of the elders rarely engaged in any form of physical excrcise,making the self-care capabilities drop dramatically as they aged. It is thus of great significance for relevant agencies to attend to this issue. Spouses and children were identified as those who took care of the elders and it has been very urgent that elders have others resources to turn to.3. Almost all the participants reported as having medical insurance. However, about ten percentage of elders felt that they were under great financial pressure. It was evident that elders reported as having a less active social lives.4. Participants reported having limited resources to turn to in time of sickness,and the social agencies to provide assistance to elders in this regard were urgently needed. Elders were often suffered from chronic disease of many kinds,such as hypertension, diabetes, coronary heart disease and cerebral infarction. Several factors might account for the chronic disease among elders including area,age,living status, applying for or living in the pension agency,talking with frends or neighbors,financial pressure.5. High proportion of elders reported taking medical measures to take care of themselves in time of sickness. It was of great significance for relevant agencies to consider providing convenient medical service to elders the Community health service centers and health service station can be identified as places where elders can turn to for help,whereas hospitals could serve as aplace of hospitalization. The hospitalization rate could be impacted by four factors including area, applying for or living in the pension agency,financial status,and pressure felt for medical expenses.Recommendations1.Relevant agencies should pay attention to research studies about single female elders and medical service for oldest-old in general. In addition, convenient medical services should be provided for elders accordingly.2. More proactive measures should be taken to propose healthy living styles for male elders (such as stopping using alcohol and cigarettes), to explore different forms of physical exrcises that suit elders’ physical needs,and to increase the proportion of the middle and,oldest-old who engage in physical exercise. In addition, measures should be taken to help establish a fairly complete system to take care of daily lives of middle to, highest aged old people, instead of having them to rely heavily on spouse and adult children.3. Measures should be taken to provide financially beneficial package to elders and to explore effective ways for elders to have an active social life.4. The medical saaistance system should be established and further improved. The health education should be enhanced so that the prevention of various chronic diseases such as hypertension, diabetes, coronary heart disease and cerebral infarction diseases.5. The relevant medical agencies such as Community health service centers and community health service stations should put efforts to assist in middle to, highest aged old people doctoral visiting,disease treatment,and rehabitaliza,and the quality of district hospital, community health service centers and the community health service stations should be improved.