EXPLORING THE NEEDS OF OLDER PEOPLE WHO ARE SEEKING PRIMARY HEALTH CARE

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Domenic Andrews
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Sciences, University of Aveiro, Portugal MARIA PIEDADE BRANDÃO, School of Health Sciences, University

1 International Istanbul Initiative on Ageing -Istanbul, Turkey, October 4-6, 2013 ANA FILIPA ALMEIDA, Department of Health Sciences, University of Aveiro, Portugal CÉLIA FREITAS, School of Health Sciences, University of Aveiro, Portugal MARIA PIEDADE BRANDÃO, School of Health Sciences, University of Aveiro, Portugal EXPLORING THE NEEDS OF OLDER PEOPLE WHO ARE SEEKING PRIMARY HEALTH CARE

2 BACKGROUND The increase in life expectancy observed in the world, has resulted in a steep rise of older population. Increased longevity transfers new challenges to health, which justify the consumption of health care for the older people. (Al-Mandhari et al, 2013) This reality may represent a need to change public and health policies. Promoting Active Aging and Health Education may bet to face it the longevity challenges. (World Health Organization, 2005; 2012)

3 BACKGROUND Factors like living alone and have poor self-perception of health may influence the seek for Primary Health Care (PHC). (Louvison et al., 2008; Quintal, Lourenço, & Ferreira, 2012) In Portugal the rate use of PHC is higher in people aged 65 years or more: Rate Use Youth Health 0 18 years 53.1% Adult Health years 50.5% years 65.8% 65 years 79.0% Source: Ministry of Health, Portugal (2006)

4 PROBLEM The health care professionals questioned the use of health services by the older people 1. Do the older people seek PHC because of health issues? 2. Is loneliness and isolation related with this use? Thus: Are isolation and loneliness reasons why older people seek the PHC?

5 OBJECTIVES To explore the motives and needs of older people who seek the PHC in Portugal Determine if the isolation or loneliness, questioned by health professionals, are motives for seeking the PHC by older people

6 METHODS Design: Descriptive-exploratory qualitative study Context: Health Care Center located in a rural community of the central coastal region of Portugal. Participants: 14 users of PHC ( 65 anos) 6 staff of PHC Data collection: Research from the Informatics System of Health Units (SINUS) Participant and non-participant observation in the waiting room Semi-structured interviews Data analysis: Content analysis and documentary analysis

7 RESULTS Participants characterization Female: 8 (57,1%) Male: 6 (42,9%) Married: 9 (64,3%) Widows: 5 (42,9%) Users Age mean: 73,1 (± 6,9) Just enough income: 10 (71,4%) Major expenses on medication: 13 (92,9%) Staff Administrative worker: 1 Medical Auxiliary: 1 Doctors: 2 Nurses:2 Age mean: 54,5 (± 7,3) Average years of service at the Health Center: 20,2 (11,9)

RESULTS Data from Informatics System of Health Units Table 1 - Number of consultations by age in 2011 25000 19904 20000 15292 15392 15000 13196 10000 9135 9555 5000 0 19-44 45 64 65 Nurse contacts

8 RESULTS Data from Informatics System of Health Units Table 1 - Number of consultations by age in Nurse contacts Medical consultations Linear (Nurse contacts) Linear (Medical consultations) Table 2 Older people consultations in the years 2011 and 2012 Consultations (elder users) Doctor presence No doctor presence Total Fonte: Informatics System of Health Centers

9 RESULTS Older people PHC users: All perform instrumental activities (housework) and agricultural work except for one (due to functional disability) Live alone (n=4/14) Few relations with neighbors, family and friends (n=6/14) Few leisure activities due to: Functional disability (n=9/14) Few transportation (n=1/14) Other motives (e.g. lack of time) (n=4/14)

RESULTS Reasons why the older people seek the PHC: Reported by the users Reported by the staff Participants 78% 100% 12 10 64% Participants 6 8 6 4 2 14% 5 4

10 RESULTS Reasons why the older people seek the PHC: Reported by the users Reported by the staff Participants 78% 100% % Participants % % 33% 0 Prescription and acute and/or chronic diseases Disease prevention Proximity to home 0 Clinical reasons Health information loneliness/isolation

11 DISCUSSION The literature supports our results This finding is congruent with previous findings that disease and perception of poor health are two strong predictors of care seeking behavior. (Dall Agnol, Lima, & Ramos, 2009; Maniecka-Bryla, Gajewska, Burzyńska, & Bryla, 2013) And: The World Health Organization refers the importance of promoting social contact networks for the older people for example through community services, family caregivers and help the neighborhood. (World Health Organization, 2005)

12 CONCLUSIONS Main findings The results seem to contradict the initially idea reported by health professionals: the seek for PHC may be related to loneliness and isolation; The results suggest that the reasons for older people to seek the PHC are not due to isolation or loneliness but mainly because their health needs and health concerns;

13 CONCLUSIONS Some considerations Faced with an aging population the basic PHC services in Portugal should include the evaluation of older people s needs; By maintaining proximity of populations, the PHC are a useful resource to identify old people needs and implement community programs that can act on them; Besides the results, the staff from the PHC recognizes problems like isolation and loneliness in the older people PHC users; Further investigation is required in order to check if the country s financial situation may have affect our results.

14 REFERENCES Carret, M. L., Fassa, A. G., & Kawachi, I. (2007). Demand for emergency health service: factors associated with inappropriate use. BMC Health Services Research, 7(1), 131. Dall Agnol, C. M., Lima, M. A. D. S., & Ramos, D. D. (2009). Fatores que interferem no acesso de usuários a um ambulatório básico de saúde. Rev. Eletr. Enf., 11(3), Retirado de Maniecka-Bryla, I., Gajewska, O., Burzyńska, M., & Bryla, M. (2013). Factors associated with self-rated health (SRH) of a University of the Third Age (U3A) class participants. Archives of Gerontology and Geriatrics. World Health Organization. (2005). Active ageing: a policy framework. World Health Organization. (2012). Policies and priority interventions for healthy aging. Health Ministery. (2006). Estatística do Movimento Assistencial dos Centos de Saúde em Lisboa: IGIF Instituto de Gestão Informática e Financeira da Saúde.

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