HOME CARE NEEDS AMONG ELDERLY IN DISTRICT 12, HO CHI
MINH CITY
Abstract
Background: Home care need for elderly is now increasing all over the world.
However, this type of service is still under development in Vietnam. Additionally,
few Vietnamese studies investigated home care needs in a comprehensive approach.
Objective: The aim of the study was to identify five aspects of home care needs
among elderly, including ADLs, IADLs, psychological, health care and health
information needs,and related factors.
Methods: A cross-sectional study was carried out to answer the research
phenomena during 12 July to 12 November, 2015. Three hundred and nine of
29,930older adults living in the district 12 of Ho Chi Minh City were randomly
chosen and completed interviews with astructured questionnaire, including five subscales. The validity was tested by content validity and Cronbach’s alpha levels for
internal consistent reliabilities were from 0.75 to 0.87.
Results: Female was predominant (58.9%) in this study. Nearly half of study
population (47.9%) participants aged from 60 to 69 and 33.66% aged from 70 to 79.
Almost elderly lived with relatives in their house (94.5%). The mean score of ADLs
was 5.72 ± 1.07 (0-6) and 5.16 ± 2.33 (0-8) for IADLs.The mean Affect Balance
score was 6.23 ± 0.31 (0-10).Only 17.48% had home health care needs, whereas there
were 88.67% participants had needs of information about health care issues. Factors
that had strong association with home care needs included age, gender, allowance,
living arrangement and number of comorbidities (p< 0.05).
Conclusion: The results showed that elderly in district 12 had low ADLs, low
psychological needs, low health care needs, but high health information needs and
IADLs needs. The study also contributed to literature about factors those had potential
impacts on home care needs in elderly population. These factors included age, gender,
allowance, living arrangement and number of comorbidities.
Introduction
Old age is often characterized as a period of susceptibility of chronic illnesses ,
psychological problems , declining physical functioning , restricted cognitive
abilities , and lack of health information . Generally, most of the elderly have to cope

with non-contagious and chronic diseases such as joint degradation, cardiac problems
and blood pressure, prostate, and urination disorders . Additionally, life course
changes, such as retirement and bereavement, may lead to a loss of social roles and
limit participation in social activities and those in turn result in psychological impacts
on elders such as depression, anxiety, loneliness and social isolation . Studies on
changes in functional ability showed that elderly experiences inevitably decreases
upon individuals’ ability to carry out basic activities of daily living (ADLs) including
bathing, dressing, using the toilet, transferring from bed to chair, and feeding oneself .


In addition to decrease in ADLs, older people may also have limitations on
instrumental activities of daily diving (IADLs) that includes such activities as the
ability to prepare meals, take medications properly, go grocery shopping, do
housework, and manage money . Currently, many studies suggested that the need for
information about health become more prevalent at older age and elderly are often the
subgroups of population who have lack of health information, especially as epidemics
or health risks arise . Since proven to be associated with reduced independence ,
functional disabilities and other disadvantages among elderly could be used to
evaluate the needs for formal and informal community and home care . On the other
words, there are four main types of home care needs among elderly including home
health care needs, ADLs/IADLs needs or home help needs, psychological needs and
health information needs .
Although confirmed as essential requirements, home-care needs among elderly
are often neglected or unmet. A survey in Canada showed that 33% to 67% of seniors
with ADL or IADL needs did not receive any form of home care in preceding year .
Also, other studies from many countries also revealed that the prevalence of at least
one unmet ADL or IADL need has been estimated at between one-fifth and one-half,
depending on the samplecharacteristics, the definition of unmet needs, and which
ADL/IADL are considered .
Unmet home-care needs are not only cause consequences for frail elders but also

the health-care system . A previous study had concluded that the consequences of
inadequate help could impede management of chronic health conditions among older
population, and may compromise seniors’ ability to maintain a safe and reasonable
quality of community living . Desai et al. in his study reported that nearly half of
participants with unmet needs experienced one or more negative consequences such
as not being able to eat when hungry and experiencing a burn or scald when bathing,
and that negative consequences had the potential to seriously threaten the health and
safety of those with unmet needs. Current studies also reported that unmet ADL needs
were associated with many negative health-related events such as having pressure
ulcers and contractures, losing weight, falling, incontinence, depression, and death .
As for the health-care system, unmet ADL needs were also associated with increases
in the number of physician visits, emergency-department visits, nursing-home
placement, and hospitalizations .
Vietnam also follows the aging trend as other countries in the world . In 1979,
there were 3.71 million men and women aged 60 and above, representing 6.9% of the
total population, and in 1989 the total of elderly people was of 4.64 million,
accounting for 7.2% of the total population. By the year of 2006, there were over 7.8
millions of the elderly, yielding a proportion of 9.2% . According to the statistics from
the 2008 Vietnam Household Living Standard Survey, the total of elderly people was
estimated to be of 9.47 million, accounting for 11% of the total population. By the


year 2020, Vietnam is expected to have more than 12 million older persons and the
proportion of older population is estimated to be 26.1% by 2050 .
Despite of great efforts of the government, health care accessibility of
Vietnamese older adults is still inequitable between rural and urban areas. For most of
older persons with financial limitations living in rural areas, they visit commune
health stations as their first-choice in seeking health care since these health stations
are close to their home and provide free health care activities through the national
health insurance program . On the contrast, hospitals were found to be convenient for

the elderly with better economical status living in urban areas although they may have
to pay out-of-pocket for health care services . Either living in rural or urban settings
however the elderly receive inadequate health care, both in quantity and quality, from
formal health care system .
As recommended by many international organizations , home care may be a
good solution to meet the health care needs of older populations, not only in
developed countries but also in developing countries including Vietnam. This type of
care service however is still at the dawn of the establishment in Vietnam. Recently,
with the permission of the People Committee of Ha Noi only two private clinics
providing home care services for older patients had been found . In other provinces,
home care service is still a new concept although several studies showed a huge home
care needs among older adults .
In Ho Chi Minh, the Health Services has been implemented family doctor offices
since 2009 . The main aims of family doctors are to provide essential care at home for
patients or persons who need care at home. Apart from family doctor system, private
home care services are also available in Ho Chi Minh city. The services are provided
by professional nurses who work for hospitals or commune health stations. They do
home care activities as an extra-work out of their working days. To date there are no
available data about how many nurses have been doing home care activities and what
kinds of home care they have been delivering. Also, the family doctors system has
been still working, but no reports about its effectiveness have been documented so far.
It is believed from health authorities of Ho Chi Minh city that there are
significant but unexplored home care needs among older people and the existing
home care services could not meet the needs of this population. However, there are
not any studies or surveys conducted up to now to answer this question. Therefore, an
initial study on home care needs among elderly is necessary. The findings of the study
is expectd to give a clear picture about to which extent the home care needs of older
people and what services that healthcare facilities can provide to this special group of
population.
Material and Methods

A cross-sectional design wasconducted from July 12 to August 12, 2015 at
district 12 of Ho Chi Minh city. The district 12 of Ho Chi Minh city included 11


communes. According to the People’s Committee of District 12, there were 29,930
elderly (60 and over) living in the district 12 in 2014 . With the acception from the
People’s Committee, the researcher had the list of all elderly in the whole district. The
researcher assigned each elderly an ID number from 1 to 29,930. The single random
sampling technique was applied to select the sample for this study. A random number
table was used to choose 384 numbers within the range from 1 to 29,930. From the
list of chosen numbers, the investigator collected lists of chosen elderly in each
commune. For instance, there might be 100 chosen numbers those corespondent to
100 elderly living in the commune A; therefore, the data collectors made 100
interviews in the commune A.
After having the lists of selected elderly in each commune, the investigator
contacted with the local health authorities to hold free physical examinations for
selected elderly at the health commune stations. Five interviewers collected the data.
During physical examinations, elderly took regular examinations such as blood
pressure, height and weight measurements. Then interviewers clearly explained the
purposes and ethical protections of the current study. After the elder persons agreeing
to participate, the interviewers invited them and had 10-15 minutes interviews in a
quiet and seperate site.
As the data collection finished, a total of 384 observations were collected.
However, 74 elderly did not complete two third of the questionnaire; therefore they
were excluded from the study. Thus, only 309 elderly were recruited in this study.
Research Instruments
The questionnaire used in the study was designed based on previous studies . The
questionnaire included six sections as follow:
Demographic information: This part consisted of items related socio-economic
characteristics including age, gender, income, living arrangement, smoking habit,

marital status, former jobs, and comorbidities.
Assessment of ADL needs: in this part, The Katz ADL with six items was used
to evaluate ADL needs of respondents. Six basic activities were evaluated including
eating, dressing, bathing, transferring between the bed and a chair, using the toilet,
and controlling bladder and bowel functions. For each item respondents were asked to
state whether they could perform the activity independtly and easily, independently
but with difficulty (1 point) or whether they are often depent on others or always
depend on others (0 point). If the total score is of 6, respondents could perform
activity independently, whereas if the score of 0 they are dependable too much. To
assess ADLs needs of participants, a three-scale point question including urgently
needed, needed but can wait, and not need was used. With high reliability and validity
tested by studies (construct validity of 0.74 to 0.88 and reliability coefficient of 0.94) ,
the tool was used extensively as a flag signaling functional capabilities of older adults
in clinical and home environments .


Assessment of IADL needs: The Lawton Instrumental Activities of Daily Living
Scale (IADL) was used to assess IADLs of participants . There are eight items from A
to H measuring the ability of elderly in doing eight instrumental activities including
telephoning, shopping, food preparation, housekeeping, laundering, use of
transportation, use of medicine, and financial behavior. The Lawton IADL scale can
be scored in several ways, the most common method is to rate each item either
dichotomously (0 = less able, 1 = more able) or trichotomously (1 = unable, 2 = needs
assistance, 3 = independent) and sum the eight responses. The higher the score, the
greater the person's abilities are. Women are scored on all 8 areas of function, but, for
men, the areas of food preparation, housekeeping, laundering are excluded. Clients
are scored according to their highest level of functioning in that category. A summary
score ranges from 0 (low function, dependent) to 8 (high function, independent) for
women, and 0 through 5 for men. To assess IADLs needs of participants, a three-scale
point question including urgently needed, needed but can wait, and not need was used.

The inter-rater reliability of this scale was established at 0.85. To assess IADLs needs
of participants, a four-scale point question including need urgently, need but can wait,
not sure and not need was used.
Assessment of psychological needs: in this study psychological needs were
assessed by using Affect Balance Scale (ABS) . The scale was made up of two
components: the positive affect and the negative affect component. Each component
has 5 items. The scale asked participants if, in the past few weeks, they had felt
certain emotions. The participant answered “Yes” or “No” to each question. For
positive affects, participants receivedone point for every “Yes” they said. For negative
affects, participants received one point for every “Yes” they said. The Affect Balance
Scale score was computed by subtracting Negative Affect Scale scores from Positive
Affect Scale scores and adding a constant of five to avoid negative scores. Scores
ranged from 0 (lowest affect balance) to 10 (highest affect balance).
Assessment health care needs: generally, therewere three indicators used to
assess health care needs among elderly. They were occurence of comorbidities, selfreported health and experience of home care use. Self-reported health is a subjective
indicators since it is affected by many factors such as age, gender, and health
conditions; therefore it was not chosen as a measure of health care needs in the
present study. Since the study population was elderly, so their memory in experience
of home care use might have bias; thus experience of home care use was also not the
proper indicator to assess home health care needs in this study. As a result, the
occurence of comorbidities was chosen as the measure of home health care needs.
Additionally, a question: Do you want to be cared by health-care professionals at
home?” was asked to explore the needs of home health care of participants. For
respondents having home health care needs, a open-closed question was asked to gain
information about what types of health care services that respondents want to be


provided. In the study, six types of health care services were listed including : (1)
doctor care including home visits to diagnose and treat the illnesses; (2) rehabilitation;
(3) nursing care including ostomy care, intravenous therapy, administering

medication, monitoring the general health of the patient, pain control, and other health
supports; physical, occupational, and/or speech therapy; (4) nutritional support
including dietary assessments and guidance to support the treatment plan; (5)
laboratory testing including certain laboratory tests, such as blood and urine tests; and
(6) transportation providing transportation to patients who require transportation to
and from a medical facility for treatment or physical exams. In other countries,
pharmaceutical services including medicine and medical equipment delivery may be
available; however, this type of service is considered illegal and prohibited in
Vietnam. Therefore excluding the pharmaceutical services out of the list of health
care services was understandable in the study.
Assessment of health information: Since the health information of elderly was
diverse, there were no standard tools those could measure perfectly health information
needs of elderly. Instead, a open-closed question about types of health information
that respodents desire to know was considered resonably. Four main topics of health
information was mentioned by the interviewers including information about chronic
diseases, drug use, disease preventive measures, and pain control. Other types of
health information was also documented.
Five nurses working in General Hospital District 12 were chosen as interviewers
in this study. Prior to data collection a two-day training course was established to
instruct interviewers how to perform data collection and skills of data mining. During
the training, the five interviewers interviewed five elder persons in the General
Hospital to evaluate their inter-rater. The acceptable inter-rater reliability was 0.81
indicating a high reliability of the questionnaire. Chosen participants were categorized
into communes so that the data collection was more convenient and saving time. The
data collection lasted from July 12 to August 12, 2015. During the data collection, the
researcher worked as the supervisor to monitor, gave advices and supports for
interviewers.
After data collection, all records was entered and coded in SPSS version 16. All
variables were tested whether any coding error exists. If wrong coding exists, the
principal investigator reviewed the records and corrected the worng coding. To

describe each variable, mean and standard deviation to summary quantitative
variables were applied and frequency and proportion to summary qualitative variables
were applied. To analyze the relationship between background profile and the needs
of participants Chi Square, t-test or ANOVA test were applied to test the significant
asssociations. The p-value of 0.05 was used as statistical significance.
Results
There were 309 participants enrolled in the study. As shown in table 5.1, female


was predominant (58.9%), 47.9% participants aged from 60 to 69 and 33.66% aged
from 70 to 79. Most of participants got married (72.81%) and 22.34% were widowed.
Almost elderly lived with relatives in their house (94.5%). Among of those, 76.71%
lived with more than two other people in the same house.
More than seventy percent (72.17%) participants did not have monthly
allowance. Among those who had allowance (74/309), 90.54% had less than 5 million
Vietnamese dong. Regard to former works, housewives or unemployed participants
occupied 26.88%, followed by workers (24.91%). Businessmen and farmer also
accounted for 21.68%.
Among comorbidities, arthritis, high blood pressure and heart diseases were
three of the most common diseases (56.3%, 47.9% and 46.6%, respectively).
Regarding number of comorbidities, 45.63% had more than two diseases and 34.3%
had 2 diseases.More than half of participants (55.34%) were smoking at the time of
interview, while 31.72% never smoked before. Only 24.60% participants had falls in
the last 3 years.

Table 1. Demographic profile of participants (n=309)
Characteristics

n


%

n

%

Male
127 41.10
Yes
Female
182 58.90
No
Age [mean(range)]68.67 (60-87)
Amount of allowance
(n=74)
60-69
148 47.90
≤ 5 million VND
70-79
104 33.66
> 5 million VND
≥ 80
57
18.45 Former work
Marital status
Housewives/
unemployed
Married
225 72.81
Workers

Widowed
69
22.34
Businessmen
Divorced/separated 15
4.85
Farmer
Officers
Family size (n=292)
Number of comorbidities
2 persons
68
23.29
No comorbidities
> 2 persons
224 76.71
1 disease

86
223

27.83
72.17

67
7

90.54
9.46


83

26.88

77
67
67
15

24.91
21.68
21.68
4.85

5
57

1.62
18.45

Co-morbid diseases
Arthritis
174
High
blood 148
pressure
Heart diseases
144

2 diseases

56.31
> 2 diseases
47.9 Smoking

106
141

34.30
45.63

46.6

40

12.94

Gender

Characteristics
Allowance

Used to smoke


Characteristics

n

%


Characteristics

Osteoporosis
Gastric diseases
Cataract
Diabetes
Respiratory
diseases
Cancer

91
73
46
45
32

29.45
Smoke up to now
23.62
Never smoke
14.89 Living arrangement
14.56
Living alone
10.36
Living with others

3

0.97


n

%

171
98

55.34
31.72

17
292

5.50
94.50

Generally, most of participants received one point for each of daily living
activities. As a result, the total mean ADL score of participants was 5.72 ± 1.07
(range from 0 to 6). It meant that participants had high independence in daily
activities. The percentages of participants who did not need helps from outsiders for
ADL activities were very high (> 89%).Dressing and toileting had lowest needs
(2.6%), while bathing had highest needs (10%). Transferring and continence had the
least urgently needs, while bathing had the most urgently needs. Participants needed
helps of toileting but can wait at least (1.0%), while transferring was also needed but
can wait the most.
Table 2. ADL scores and ADLs needs among participants (n=309).
Levels for needs
ADL items

Independent(1)


Dependent(0)

Urgently
needed

Needed but
can wait

Not needed

n

%

n

%

n

%

n

%

n

%


Bathing
Dressing
Toileting

289
288
292

93.5
93.2
94.5

2.9
1.0
1.6

22
5
3

7.1
1.6
1.0

278
301
301

90.0

97.4
97.4

299

96.8

6.5
6.8
5.5
3.2

9
3
5

Transferring

20
21
17
10

0

0.0

25

8.1


284

91.9

Continence
Feeding

301
298

97.4
96.4

8
11

2.6
3.6

0
2

0.0
0.6

24
7

7.7

2.3

285
300

92.3
97.1

Among instrumental daily living activities, housekeeping was the most
independent activities (90.7%), while shopping was the least independent activity
(61.2%). The total mean IADL score of participants was 5.16 ± 2.33 (range from 0 to
8). Unlike IADLs score, a large portion of participants (> 51%) have high needs for
all IADL activities. Participants had the most urgently needs on using telephone
(21.7%), while handling finances was the least urgently needs(12.9%).

Table 3. IADL scores and IADLs needs among participants
(n=309)
IADL items

Independent Dependent
(1)
(0)

Level for needs
Urgently
needed

Needed but
can wait


Not needed


Use Telephone
Shopping
Food preparation
Housekeeping
Laundry
Mode of Transportation
Responsibility for
Own Medications
Ability to Handle
Finances

n

%

n

%

n

%

n

%


n

%

247
189
121
165

79.9
61.2
66.5
90.7

62
120
61
17

20.1
38.8
33.5
9.3

67
46
52
46

21.7

14.9
16.8
14.9

31
114
108
108

10.0
36.9
35.0
34.9

211
149
149
155

68.3
48.2
48.2
50.2

150
245

82.4
79.3


32
64

17.6
20.7

46
46

14.9
14.9

108
68

34.9
22.2

155
195

50.2
36.9

231

74.7

78


25.2

46

14.9

56

18.1

207

67.0

247

79.9

62

20.1

40

12.9

130

42.1


139

45.0

The mean of Affect Balance score was 6.23 ± 0.31 (range from 0 to 10). For
positive affects, the mean scores was 2.12 ± 0.21 (range from 0 to 5) (Table5.4). Only
62 (20.06%) participants felt particularly excited or interested in something and 83
(26.86%) felt pleased about having accomplished something. Other positive affects
were poorly perceived by elderly. For negative affects, the mean score was 3.67 ±
0.54 (range from 0 to 5). A large part of participants felt bored and very lonely
(50.48% and 30.10%). Other negative affects were relatively low perceived by
participants.
Table 4. Psychological needs among participants (n=309)
Yes

Affect items

Feeling particularly excited or interested in something
Proud because someone complimented you on
something you had done
Pleased about having accomplished something
On top of the world
That things were going your way
Positive effect score (Mean ± SD[range])
Feel so restless that you couldn't sit long in a chair
Very lonely or remote from other people
Feel bored
Depressed or very unhappy
Upset because someone criticized you
Negative effect score (Mean ± SD[range])


No

n

%

n

%

62

20.06

247

79.94

29

9.38

280

90.62

83
10


26.86
3.23

226
299

73.14
96.77

22

7.12
287
2.12 ± 0.21 (0-5)
14.89
263
30.10
216
50.48
153
7.44
286
9.71
279
3.67 ± 0.54 (0-5)

46
93
156
23

30

92.88
85.11
69.90
49.52
92.56
90.29


Yes

Affect items
n

No

%
n
6.23 ± 0.31 (0-10)

The Affect Balance Score (Mean ± SD[range])

%

Among participants, only54persons(17.48%) had home health care needs. The
most needed health care service from participants was transportation to hospital 48
persons (88.89%), followed by monitoring the general health 32 persons (59.26%)
and doctor’s visits for diagnosis and treat illnesses 52.7 persons (52.70%).
Table 5. Health care needs among participants (n=309)

Health care

Frequency

Want to be cared by health-care professionals at home
Yes

%

54

17.48

255

82.52

Transportation to hospital for treatment illnesses

48

88.89

Monitoring the general health of the patient

32

59.26

Doctor visits for diagnosis and treat the illnesses


29

52.70

Pain control
Nursing at home
Dietary assessments
Dietary guidance

21
13
10
10

38.89
24.07
18.52
18.52

Acupuncture
Rehabilitation

9
6

16.67
11.11

Intravenous therapy

Blood sampling
Urine sampling
Administering medication

4
3
3
1

7.4
5.56
5.56
1.85

No
Kinds of healthcare services want to be delivered (n=54)

There were 274 persons(88.67%) participants had needs of information about
health care issues. Of those, 221 persons(80.66%) needed information about diseases
preventive measures, followed by information about chronic diseases and drug usage
(66.42% and 56.57%, respectively).
Table 6. Health information needs among participants (n=309)
Health information
Frequency
Percent (%)
Needs of information about health care issues
Yes

274


88.67


Health information

Frequency
35

Percent (%)
11.33

Diseases preventive measures

221

80.66

Chronic diseases

182

66.42

Drug usage

155

56.57

Pain control


126

45.99

No
Kinds of health information (n=274)

The relationships between home care needs and demographic profile of
participants
Age was the factor having significant associations with ADL needs among
participants (p < 0.001). Older elderlyhad lower scores of ADLs than younger ones.
In other word, older elderly had lower independent in ADLs than younger ones. Other
demographical factors did not have associations with ADL needs (p> 0.05).


Table 7. Relationship between ADL score and demographic profile of

participants (n=309)
Characteristics

ADL
score
Mean ±
SD

p

Gender
Male

Female
Age
60-69
70-79
≥ 80

Widowed
Divorced
Living
arrangement
Alone
With others
Smoking
Used to smoke
Still smoking
Never smoke

ADL
score
Mean ±
SD

p

Allowance
5.77 ±
0.07

Yes
0.47


5.68 ±
0.08
5.86 ±
0.70
5.81 ±
0.69
5.15 ±
1.93

No
Former work
Housewives
<
0.001

Workers
Businessmen

Marital status
Married

Characteristics

Farmer
5.66 ±
2.46
5.58 ±
1.21
5.91 ±

0.52

Officers
0,67

Number of
comorbidities
No comorbidities
1 disease

6.00 ±
0.00
5.70 ±
0.06
5.6 ± 1.03
5.81 ±
0.89
5.60 ±
1.33

0.26

2 diseases
> 2 diseases

0.22

5.90 ±
0.07


0.054

5.64 ±
0.07
6.00 ±
0.00
5.70 ±
0.06
5.44 ±
0.05
5.16 ±
0.01
5.14 ±
0.08

0.39

5.8 ± 0.44
5.78 ±
0.79
5.79 ±
0.95
5.63 ±
1.25

0.63


Age, gender, and allowance had significant associations with IADL needs
among participants (p< 0.001). Female elderly had higher independent on IADLs than

male counterparts (p< 0.001). Older elderly had less independent on IADLs than
younger ones (p< 0.001). Elderly with no allowance had higher independent on
IADLs than elderly with allowance (p< 0.001). Other factors did not have
associations with IADL needs (p> 0.05).
Table 8. Relationship between IADL score and demographic profile of participants
(n=309)
Characteristics

IADL
score
Mean ±
SD

p

Gender
4.03 ±
0.12

Female

5.95 ±
0.18

70-79
≥ 80
Marital status
Married
Widowed
Divorced/

separated
Living
arrangement
Living alone
Living with
others
Smoking
Used to smoke

IADL
score
Mean ± SD

p

Yes

5.12 ± 0.13

<
0.001

No

5.76 ± 0.44

Allowance

Male


Age
60-69

Characteristics

6.06 ±
2.05
4.86 ±
2.10
3.35 ±
2.27
4.26 ±
2.89
4.65 ±
2.54
5.84 ±
1.95

5.56 ±
2.03
5.23 ±
1.90

<
0.001

<
0.001

0.33


0.27

0.08
4.15 ±

Former work
Housewives/
unemployed
Workers

4.62 ± 0.50
5.12 ± 0.45

Businessmen

5.93 ± 0.19

Farmer
Officers

4.86 ± 0.16
5.12 ± 0.13

Number of
comorbidities
No comorbidities

0.06


6.2 ± 1.64

1 disease

5.38 ± 2.61

2 diseases

5.07 ± 2.17

> 2 diseases

5.09 ± 2.37

0.48


Characteristics

Smoke up to now
Never smoke

IADL
score
Mean ±
SD
2.41
5.29 ±
2.08
5.33 ±

2.63

p

Characteristics

IADL
score
Mean ± SD

p

Only living arrangement had strong association with affect balance score in
which participants who lived with others had higher score than elderly living alone
(6.01 ± 0.10 versus 4.23 ± 0.43) (p< 0.001). Other factors did not have any
associations with affect balance score (p> 0.005).
Table 9. Relationship between affect balance score and demographic

profile of participants (n=309)
Characteristics

ABS
Mean ± SD

p

Gender

Characteristics


ABS
Mean ± SD

Allowance

Male

5.11 ± 0.23

Female
Age
60-69

5.34 ± 0.19

0.43

6.06 ± 0.05
0.08

70-79
≥ 80
Marital status
Married
Widowed

5.96 ± 0.16
5.35 ± 0.12

Divorced/

separated
Living
arrangement
Living alone
Living with
others
Smoking
Used to smoke
Smoke up to now

5.26 ± 1.89

5.43 ± 0.13
5.25 ± 0.70

4.23 ± 0.43
6.01 ± 0.10

0.23

<
0.001

0.49
5.15 ± 0.41
5.01 ± 0.66

Yes
No
Former work

Housewives/
unemployed
Workers
Businessmen
Farmer
Officers
Number of
comorbidities
No comorbidities

5.93 ± 0.19

p

0.0
9

6.00 ± 0.01
5.52 ± 0.45
5.11 ± 0.12
5.35 ± 0.21
5.24 ± 0.23
5.13 ± 0.11

0.1
4

5.28 ± 0.23

1 disease


5.11 ± 0.17

2 diseases
> 2 diseases

5.54 ± 0.11
5.09 ± 2.37

0.2
1


Characteristics
Never smoke

ABS
Mean ± SD
4.12 ± 0.63

p

Characteristics

ABS
Mean ± SD

Only allowance had strong association with health care needs in which
participants had their own allowance had higher health care needs than elderly who
did not their own allowance (27.91% versus 13.45%) (p< 0.003). Other factors did not

have any associations with health care needs (p> 0.05).
Table 10. Relationship between health care needs and demographic

profile of participants (n=309)
Characteristics

Health
care
needs n
(%)

p

Gender
Male
Female
Age
60-69
70-79
≥ 80

Widowed
Divorced/
separated
Living
arrangement
Living alone
Living with
others


Health
care
needs n
(%)

p

Allowance
24
(18.90)

Yes
0.58

30
(16.48)
21
(14.19)
19
(18.27)
14
(24.56)

No

0.28

Former work
Housewives/
unemployed

Workers
Businessmen

Marital status
Married

Characteristics

Farmer
51
(22.67)
14
(20.28)
2 (13.33)

4 (23.53)
50
(17.12)

Officers
0,17

0.49

Number of
comorbidities
No comorbidities

24
(27.91)

30
(13.45)
25
(30.12)
13
(16.88)
15
(22.39)
17
(25.37)
3 (20.00)

0.29

0 (0.00)

1 disease

8 (14.04)

2 diseases

24
(22.64)
22
(15.60)

> 2 diseases

0.003


0.28

p


Characteristics

Health
care
needs n
(%)

Smoking
Used to smoke
6 (15.00)
Smoke up to now 37
(21.64)
Never smoke
11
(11.22)

p

Characteristics

Health
care
needs n
(%)


p

0.08

Only number of comorbidities had strong association with health information
needs among participants in which patients with more comorbidities had higher needs
compared to participants who did not have comorbidities (p=0.03). Other factors
related to demographic profile had no associations with health care information needs
among participants (p> 0.05).
Table 11. Relationship between health information needs and demographic profile of
participants (n=309)
Characteristics

Health
informatio
n needs n
(%)

p

Gender

Characteristics

Health
informatio
n needs n
(%)


p

Allowance

Male

112 (88.19)

0.58

Yes

77 (89.53)

Female
Age
60-69

162 (89.01)

197 (88.34)

70-79
≥ 80
Marital status
Married
Widowed

92 (88.46)
47 (82.46)


Divorced/
separated
Living
arrangement
Living alone
Living with

14 (93.33)

No
Former work
Housewives/
0.21 unemployed
Workers
Businessmen
Farmer
Officers
Number of
0.17
comorbidities
No comorbidities
0.39

1 disease

7 (12.28)

2 diseases
> 2 diseases


21 (19.81)
7 (4.96)

135 (91.22)

202 (89.77)
63 (91.30)

14 (82.35)
260 (89.04)

0.76

75 (90.36)
68 (88.31)
56 (83.58)
63 (94.03)
13 (86.67)

0.89

0.28
0 (0.00)


Characteristics

Health
informatio

n needs n
(%)

others
Smoking
Used to smoke 35 (87.50)
Smoke up to 145 (84.80)
now
Never smoke
94 (95.92)

p

Characteristics

Health
informatio
n needs n
(%)

0.06

In this study, five aspects of home care needs were evaluated including
ADLs needs, IADLs need, psychological needs, health care needs and health
information needs. Some key findings could be drawn from the results as followed:
Firstly, elderly in district 12 did not have much ADLs and IADLs
limitation. Among IADLs, transportation, handling finances, shopping and food
preparation were four activities those elderly need more help in implementation than
other activities. Those findings were in consistent with few studies on health care
needs among elderly in Vietnam.

Secondly, elderly took part in the present study also had relative high affect
balance, so they may not need psychological supports. However, the resulted also
noted that they often engaged loneliness and boring during their daily life and those
could lead to psychological problems such as depression and anxiety if they could not
be solved.
Thirdly, although elderly in the study suffered many comorbidities that
indicated they have many health care needs, their home health care needs were very
low. The common reasons were that they have their children take care at home and
that they still have enough health to go to hospital by themselves. Among home health
care services, transportation from home to hospitals and checking examination at
home were two of health care services received concerns from participants. Finally,
there was a huge need of health information among participants. This information
mostly related to prevention measures toward diseases, nature of chronic diseases and
pain control as well.
Among related factors to home health care needs, age seems to have many
associations with home care needs. It both had strong association with ADLs need and
IADLs needs in which older elderly had lower ADLs and IADLs scale than younger
elderly. Other factors including gender, allowance, living arrangement and number of
comorbidities together have impacts on many aspects of home care needs.
It could be said that this was the first study investigating home care needs
among elderly in a holistic manner. Not only ADLs and IADLs needs were assessed

p


in the study but also psychological needs, health care needs and health information
needs of older adults were evaluated. The results showed that elderly in district 12 had
low ADLs need, low psychological needs, low home health care needs, but high
health information needs and IADLs. The study also contributed to literature about
factors those had potential impacts on home care needs in elderly population. These

factors included age, gender, allowance, living arrangement and number of
comorbidities.
The results of the study would be used as baseline information for following
intervention programs:
1. Since a part of elderly had limitations on shopping and food preparation, private
care services could be developed to deliver those services to elderly living in district 12. Such private care services may provide care services from shopping essential supplies and food to food preparation at home for elderly.
2. A chatting service could be developed to provide private communications and information sharing to elderly in district 12. Such services could send their staff to
elder’s home for chatting, taking elderly outside for relaxes or counseling elderly
in psychological matters. If any psychological disorders are discovered by the
staff during their task, those staff may contact with professional health staff working in hospitals or other health facilities to give professional psychotherapy for
older patients.
3. For General Hospital district 12, home health care services should be developed in
a near future. Home health care services should focus on providing transportation
services and physical examination and treatment for elderly at home. Those services may implement as out of hours services or weekend services so that health
care staffs have enough time to deliver the services effectively.
4. Another service that could also be implemented in General Hospital district 12
was health information provision. A hot line phone used as counseling channel in
the hospital and served 24 hours per day is advisable. Health staff who are responsible for health information should be general practitioners who are skillful in
health consultation.
The study had few limitations. Three subscale including ADL Katz tool,
IADL Lawton tool, and Affect Balance Scale were firstly used in this study. Although
ADL and IADLs subscales showed high reliability with Cronbach’ alpha over 0.8,
Affect Balance Scale was merely achieved Cronbach’ alpha of 0.75. It meant that the
ABS may not fit completely with study settings in particular and Vietnamese settings
in general. A study focusing on reliability and validity evaluation of those subscales
therefore is necessary. Another drawback of this study is its cross-sectional design.
All statistical significant associations revealed in this study may not have causal
relations those always have in perspective studies. Finally, since this study did not
evaluated cognitive ability of elderly, participants may have recall bias during their



interviews. Consequently, some data related to demographic profile or ADL and
IADLs self-evaluation may not be precisely and that in turn could lead to bias in
analysis of associations.
From the finding, a clear picture on home health care needs of elderly living in
district 12 had been obtained. Therefore, a study recruiting elderly from different
districts in the city may be conducted in the future. With that study, the author could
make a comparison among districts about home care needs so that recommendations
for health authorities in the city on policies of home care needs may be devoted.