Dissetation Title
An oral examination was held for the dissertation submitted by Ysohino Ryuji, a Ph.D student in TMGH, and it was decided that his doctoral degree would be accepted.
Background:
Along with the population ageing by increasing the life expectancy, the higher prevalence of having disability among the elderly people aged 60 and above compared with the people below aged 60 have been more apparent, and their growing care needs for elderly individuals with disabilities have emerged as a significant worldwide concern, particularly in Sub-Saharan Africa (SSA). While family members provide most of the care informally, this approach falls short of addressing the needs and associated issues in SSA. Inadequate care for disabled elderly people can result in negative outcomes, including higher chances of hospitalization, readmission, mental distress, and mortality. The Activity of Daily Living (ADL) assessment serves as a reliable indicator of health status and is commonly used to identify disabilities in older adults. Previous study conducted in several developing countries has shown the range of care needs for elderly individuals with various ADL impairments. However, no such study has been carried out in Kenya to date.
Objective:
The main objective of this study is to clarify the unmet needs among the elderly people with the ADL impairment in Kwale County Kenya.
Methods:
The study employed a mixed-methods study, cross-sectional design in Kwale County, where the HDSS is operated by Nagasaki University and KEMRI. The Katz index and Lawton scale were used to assess the prevalence of ADL/IADL impairment. To investigate the relationship between ADL/IADL impairment and associated factors, logistic regression analysis was conducted. Subsequently, qualitative in-depth interviews were carried out to explore the unmet care requirements of older individuals with ADL limitations.
Result:
The study found that 11.8% of older adults experienced impairment in at least one ADL. A significant association was observed between ADL impairment and several factors: advanced age (individuals with ADL impairment averaged 75.72 years, while those without averaged 68.27 years), multiple chronic conditions (those with ADL impairment had a mean of 2.51 diseases, compared to 1.72 for those without), urinary issues, hypertension, mental health problems, and stroke. Higher education levels were associated with a lower likelihood of ADL impairment. Qualitative in-depth interviews revealed six key areas of unmet care needs for elderly individuals with ADL impairment: (1) lack of mutual assistance in the community, (2) insufficient public assistance by the government, (3) unmet needs for appropriate medical treatment and accessibility, (4) vulnerable environmental situation for the elderly’s household, (5) care environment and network (including informal care and family dynamics) (6) mental health care needs to address loneliness and depression.
Conclusion:
This study revealed the prevalence of ADL/IADL impairment among the elderly population in Kwale county, Kenya. It aligns with findings from other rural areas in SSA countries, although the percentage of affected elderly population remains relatively small. The study identified several unmet care needs for older adults, including enhanced social protection programs, access to geriatric medicine, and improved living conditions. The study clarified that family structure impacts caregiving dynamics, with various strategies employed to address the challenges of caring for elderly individuals with ADL/IADL impairments in rural Kenya. Despite the low prevalence of ADL/IADL impairment among the elderly, the research findings highlight the importance of further exploring current unmet care needs and the diverse challenges faced by older adults in rural Kenya.