The aim of this study was to assess the unmet health care needs among elderly residing in urban areas (Itahari and Dharan) of Sunsari district.
This was a Community Based Cross Sectional Study within a period of one year from September 2017 to August 2018 in selected wards (administrative divisions of a city) of Itahari and Dharan two sub-metropolitian cities of Sunsari district. People of Age 60 years and above willing to participate in the study were included in the study and those with diagnosed mental health problems under medication, severely ill who needed emergency care were excluded from the study. Sample Size was calculated at 95% confidence interval and 85% power taking the 26.2% prevalence of unmet health care needs in people suffering with hypertension from study done in Bhaktapur District. (11) The total calculated sample size was 530.
Systematic proportionate random sampling was done to obtain the representative sample. The proportion was based on total population of metropolitian and population in each selected ward. Wards are the small administrative divisions of districts. Eight wards were selected from each sub-metropolitian randomly using lottery method. Selected ward was visited and bottle was rotated at the middle junction and first household was chosen in the direction that bottle pointed. Then every 3rd house was taken for the study until the desired sample size was fulfilled. In case sample criteria, didn’t meet in the selected household the adjacent household with sample criteria was taken for the data collection. If there were more than one elderly in one house the participant was chosen randomly by lottery method.
Face to face interview was done using semi-structured pre-tested Questionnaire to gather information regarding demographics and other variables. Participants reporting a chronic disease were asked to identify their problem(s) in a list of 5 chronic diseases used by package for Essential Non-communicable diseases Nepal.(16) Physical and sensory functional limitations were assesed with the ability to see newspaper print clearly, the ability to see the face of someone 4m away clearly, the ability to hear distinctly what is said in a conversation with one other person and the ability to chew hard foods without difficulty. The evaluation of activity restrictions examined the five activities of daily living (ADL) included in the Katz index, i.e. bathing, dressing, toileting, transferring, continence and feeding. Homebound status was defined as incapacity to leave the home without help.(6) Unmet health care need was defined as situations in which a participant needed health care but did not receive it. Two questions were used, the first question evaluating the need of care and the second question dealing with the use of health care resources.(6) Depressive symptoms were evaluated using Beck Depression Inventory 2nd edition (BDI-II). The BDI-II scale is validated for use in Nepal and the translated Nepali version was used.(17) In non-clinical populations, scores above 20 indicate depression, the Cronbach’s Alpha based on standardized items when tested for all the 21 items on BDI-II scale has shown a good consistency of 0.76. (18)
Ethical Clearance was obtained from institutional review committee of B.P Koirala Institute of Health Sciences. (Code No. IRC/1163/017) The permission to coduct study in respective area was obtained from municipality office.
Statistical analysis was done using the statistical package for social sciences. Descriptive analysis is presented in frequency, percentage and appropriate test of significance (chi-square test) was done for bi-variate analysis. Multivariate binary logistic regression was then further done to find the adjusted odds ratio for the determinants. Statistical significance is tested with a 95% confidence interval and p-value less than 0.05 is considered significant.
The term elderly has been used as a Senior citizen where "Senior Citizen" means a citizen of Nepal having completed the age of sixty years.(19)
The participants dwelling is stated as kachha if floor, wall and roof none were built with concrete material, semipukka if one of the parts was made of concrete material and pukka if all the materials were made of concrete materials.
Common Health problems were sensory functional limitations very commonly occurring due to ageing. (Nearsightedness, Farsightedness, Hearing and Chewing).(6)
Common presenting symptoms in the elderly were inquired by asking if they have any problems from a list of common presenting symptoms in elderly obtained by a study in Chandigarh.(20)
Depressive symptoms were referred to as scores above 20 in BDI-II.(18)
Ethnicity was categorized as per the HIMS (Health Information Management System) classification of ethnicity, which was based on Central Bureau of Statistics Population Monograph of Nepal. (21)
Poverty line: Poverty line was assessed according to the World Bank global poverty line revised in October 2015 (US$1.90 per day). Exchange rates used is the one fixed by Nepal Rastra Bank at the time of analysis on 1st October 2018 USD 1$ = 115 NRs. (22–24)
Per capita income was considered the income of a person annually which was generated by dividing family income annually divided by the number of family members.
The social activity was evaluated by the type of activity, frequency of activity per week, and time spent on each activity that they were involved in. (25)