Health status and mental health among elderly in rural, Thailand: a community based cross-sectional study

INTRODUCTION

The aging of the population is a global phenomenon and a topic of concern for governments worldwide. While the global birth rate is declining, the number and proportion of the elderly population are rapidly increasing. In 2022, there were as many as 1,109 million elderly people worldwide, accounting for 14% of the global population.¹ Thailand has been an aging society since 2005.² Thailand's population in 2022 was 66.1 million, with 12.5 million elderly people, accounting for 18.86% of the total population. By the year 2040, it is estimated that Thailand will have 18.9 million elderly population, 31.44% of the overall population, which transforming the country into a super-aged society.³ The transition to an aging society in Thailand over the past several years has had significant impacts across various sectors, including the economy, society, health, and the environment. For example, the labor shortage has necessitated the importation of workers from neighboring countries. Additionally, there are challenges in resource allocation and elderly welfare, which continue to rise. Issues also include the quality of life for the elderly, health and mental health problems, and the need to expand healthcare services and elderly care, requiring more healthcare professionals. Infrastructure development that accommodates the elderly is also essential.⁴

An aging society has considerable implications for the national healthcare system. The primary health issues for the elderly arise from chronic diseases such as cancer, cardiovascular diseases, respiratory diseases, sensory organ disorders (e.g., vision and hearing loss), and neurological disorders (e.g., dementia). Therefore, it is crucial to continually develop the public health service system, which involves substantial budgetary expenses. Efforts must focus on enabling the population to maintain self-care capabilities into old age, promoting health before aging, and reducing health risk factors such as smoking, alcohol consumption, unsafe sex, high blood pressure, and high body mass index, which remain prevalent issues in Thailand.⁵ The elderly is characterized by physiological changes in the body and a decline in bodily functions, increasing the risk of diseases. These changes impact the acceptance of these transitions, leading to psychological issues. When physical health deteriorates and self-sufficiency is lost, elderly individuals may feel they lack value to their families and society.⁶ Thai health survey revealed that elderly people suffer from various health issues: 60.7% have hypertension, 20.4% have diabetes, 23.8% have high cholesterol, 38.4% are obese, 39.8% have metabolic syndrome, and 17.6% have cataracts. Furthermore, 52.2% have fewer than 20 teeth and 26.4% have hearing problems.⁷ Several studies have also reported mental health issues among the elderly.^8,9 When elderly individuals experience illness, the clinical manifestations and progression of diseases differ from other age groups, often involving multiple concurrent health issues.¹⁰

As Thailand approaches the status of a "super-aged society," many elderly individuals face various changes in physical, mental, social, environmental, economic, and technological aspects. Some elderly individuals are left alone, resulting in decreased social participation, which adversely affects their health and quality of life. Therefore, it is essential to investigate the health and mental health status of the elderly in Thai society. The study aimed to assess the physical and mental health state of the elderly in rural Thailand. Understanding and having data on the health status of the elderly will guide the monitoring of health issues, health promotion, and the development of medical and social care systems to support the future aging society.

METHODS

A community based cross-sectional study was conducted among the elderly population residing in three rural areas of Sa Yai Som subdistrict, U Thong district, Suphan Buri province, Thailand. The study population included the elderly aged 60 years and older. Total population of 1,051 elderly. Sample size calculations are based on the formula for an estimation of a definite population.¹¹ The proportion of mental health of 0.86 from a previous study was used for sample size calculation by using the margin of error (0.05) with 5% significance. A total of 158 samples were collected.⁸

The accidental sampling approach was used. The inclusion criteria include elderly people aged 60 or older who have lived in Sa Yai Som Subdistrict, U Thong District, Suphan Buri Province for more than three years, have Thai nationality, and consent to participate in the study. Data was collected from August to September 2023.

Research instrument

The instruments utilized in this study were a questionnaire divided into 3 sections.

Section 1, Demographic characteristics

This section included gender, age, education level, occupation, smoking habits, and consumption of alcohol.

Section 2, Health status

This section employed the use of the Basic Geriatric Screening (BGS) instrument, which was developed by the Committee for the Development of Screening and Health Assessment Tools for the Elderly, Ministry of Public Health, and is detailed in the 2021 Elderly Health Screening and Assessment Manual. The BGS contains the following: nutritional status (Body Mass Index: BMI), hearing, vision, oral health, osteoporosis risk, osteoarthritis risk, urinary incontinence, sleep, and activities of daily living (ADL).¹²

Section 3, Mental health

The department of mental health established the Thai mental health indicators version 2007 (TMHI-15) 13, which were used in this section. The TMHI-15 is composed of 15 questions covering four components. Mental state, mental efficiency, mental quality and support factors.

Data analysis

Data were analyzed using descriptive statistics. Categorical data was presented as frequencies and percentages, while numerical data were provided as means, standard deviations, minimums, and maximums. The results are presented in three sections.

Demographic characteristics, health status, which includes nutritional status, hearing, vision, oral health, osteoporosis risk, osteoarthritis risk, urinary incontinence, sleep issues, and ability to perform daily living activities, and mental health.

Ethical consideration

This study was conducted under the project The study for community health assessment by participatory learning process in Sa Yai Som subdistrict, U Thong district, Suphan Buri province. The study obtained ethical approval by the Human Research Ethics Committee, Bansomdejchaopraya Rajabhat University, on July 21, 2023 (COA No. BSRU-REC 660701). Ethical considerations were taken throughout the interview. Informed consent was obtained from all participants. The participants could deny and ask to stop the interview or testing at any time without giving reasons. The result did not show the participants’ names and addresses and could not be traced back.

RESULTS

Demographic characteristics

A total 158 elderly were study which include males 34.8% and females 65.2%. The mean age of the samples was 72.2±8.5, with a range between 60 and 96 years. The highest level of education was primary school for 75.3%. Most participants (44.3%) were unemployed. Smoking prevalence was 5.1%, while alcohol intake was 4.4% (Table 1).

Health status

About 69.0% of elderly has a prevalence of chronic diseases, with the most common being hypertension, diabetes, and hyperlipidemia. Additionally, 31.0% of the elderly had more than one chronic disease. Nutrition status found that 33.5% of participants has normal BMI, while 57.0% had overweight and obese. Finding shows that 10.1% of participants were hearing impairment, 63.9% have visual impairment, 71.5% have oral health problems, 19.0% and 36.7% have urinary incontinence and sleep problems, respectively. Moreover, this study found that 31.0% and 46.8% at risk of osteoporosis and osteoarthritis, respectively. Regarding the activities of daily living, 3.2% were dependent, and 5.0% as partial-dependent. Details are provided in Table 2.

Mental health

Overall, the mental health of the elderly was poor (19.6%), fair (37.3%), and good (43.1%). The age groups with the highest prevalence of poor mental health were those over 80 years old, 70-79 years old, and 60-69 years old, with rates of 29.4%, 20.8%, and 14.1%, respectively (Table 3).

DISCUSSION

The elderly are an age where the body's physiology changes. As a result, the body's functions decrease, causing the risk of disease and mental health problems. In this study, the prevalence of chronic diseases in participants were 69.0%, which the most common being hypertension, diabetes, and hyperlipidemia. The top three chronic diseases in this study also aligns with previous national studies.⁷ This finding is similar to a study conducted among elderly in rural Phrae Province, which reported a 73.7% prevalence of chronic diseases among the elderly.¹⁴ Furthermore, this study found that 31.0% of the elderly had more than one chronic disease. This might be due to age-related physical deterioration, leading to the development of chronic diseases and disabilities.¹⁵

More than half of the elderly (57.0%) in this study had overweight and obese, which is consistent with reported of Thai urban populations (61.7%).¹⁶ However, this finding goes in contrary to a study conducted by Muhammad T et al, who reported that elderly in rural and urban in India have a very different body mass index (13.8% vs. 33.3%).¹⁷ The fact that Thai elderly are overweight and obese may be related to a lack of physical activity.⁷ The prevalence of hearing problems in elderly which study in rural areas (10.1%) was lower than urban areas (31.8%) in previous national study.¹⁸ Conversely, the prevalence of visual problems is higher in the rural elderly (63.9%) compared to those in urban areas (53.6%). Nevertheless, were found that the prevalence of hearing problems among Thai elderly is similar to that in China. Whereas visual problems are significantly higher among Thai elderly compared to their Chinese.¹⁹

The oral health problems in this study were 71.5%, which were a higher than that of the study in rural areas in Lampang, Thailand (54.1%) and urban areas in Chaing Mai, Thailand (48.8%). These oral health problems are significant as they affect chewing, swallowing, speaking, smiling, communicating, and socializing, as well as the overall quality of life of the elderly.^20-23

The prevalence of urinary incontinence was 19.0%, higher than that found among the elderly in other rural area from previous study, which was only 12.2%, and also higher than in urban elderly in Thailand, where the prevalence was between 8.0% and 13.7%.^24-26, Urinary incontinence is a common issue among the elderly and affect their quality of life.²⁷ Our findings indicated that 36.7% of rural elderly had sleep problems, which is lower than in both rural (44.2%) and urban areas (59.2%) in Thailand.^28,29 There is empirical evidence that sleep problems are a result of chronic muscular discomfort and frequent nocturia.³⁰ Elderly who have osteoporosis and osteoarthritis have the risk of falling and breaking bones.^31-33 The study in Singapore reported that 52.0% of elderly has a moderate to high risk of osteoporosis, which is lower than our study (68.3%). Furthermore, the prevalence of osteoarthritis in the elderly was 46.8%, which was greater than the 24.5% reported in Saudi Arabia.³⁴ Thailand National study of elderly in rural and urban communities found that 9.2% had limitations in activities of daily living, with a tendency toward more limitations in the future.³⁵ Correspondingly, our study showed that 8.2% of the elderly had limitations in their daily activities. In addition, poor mental health was reported by 19.6% of the elderly, higher than the 13.6% found in rural Ubon Ratchathani and 13.1% found in urban Pathum Thani province.^36,37 The elderly with mental health issues also experience a negative impact on their quality of life in both social and national dimensions, leading to problems such as functional disorders in daily activities, sleep disorders, and suicidal behaviors due to significant health problems. Therefore, health management of the elderly is necessary.^38,39

The limitation in this study was depended on self-reported questionnaires may introduce bias. The participants might underreport or overreport their health status and mental health due to social desirability, which is prone to measurement errors.

CONCLUSION

Noncommunicable diseases, disability, and mental health were the most important health concerns among the elderly. This study concludes that promoting both physical and mental health is critical and should be a top focus for the elderly and their caregivers. Furthermore, relevant agencies should build an effective healthcare system for the elderly in order to prevent illness and impairment.

ACKNOWLEDGEMENTS

The author would like to thank all research participants for their complete engagement, and we are grateful to the community leader and director of subdistrict health promotion hospitals for their generous support and facilitation of essential data.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. AA J, Stover J. Drivers of future population growth in six most populous countries: Effect of demographic components on the population growth using decomposition analysis. Gates Open Research. 2023;7:118.
2. 2. Office of the National economic and social development council. population projections for Thailand 2010-2040. Bangkok: Office of the National economic and social development council. 2003. Available at: https://www.nesdc.gov.
3. 3. Sasat S, Bowers BJ. Spotlight Thailand. The gerontologist. 2013;53(5):711-7.
4. 4. Putson C, Pornsiriwatcharasin K. Solutions to the problem of an aging society in Thailand. Human Soc Sci Res Prom Netw J. 2018;1(1):25-36.
5. 5. United Nations Population Fund Country Office in Thailand. Impact of demographic change in Thailand. Thailand: United Nations Population Fund Country Office in Thailand; 2011. Avialable at: https://thailand.unfpa.org/sites/default.
6. 6. Kunkel SR, Settersten RA. Aging, society, and the life course. New York: Springer Publishing Company. 2021:1-17.
7. 7. Aekplakorn W. The report of Thailand population health examination survey 6. Bangkok: faculty of medicine ramathibodi Hospital. BMC Public Health. 2024;24:1024.
8. 8. Sawangbumrung M, Jaiwongya R, Rerkjaree S. Mental health of the older people at charabarnvutti wittayalai school, Doi saket distict, Changmai province. J Psyc Nurs Mental Health. 2020;34(2):99-117.
9. 9. Suksai P, Nanthamongkolchai S, Pitikultang S, Munsawaengsub C, Taechaboonsermsak P. Factors influencing mental health of the elderly in urban area, Ratcha Provin J Health Sci of Thailand. 2018;27(5):809-18.
10. 10. Pothisiri W, Vicerra PMM. Psychological distress during COVID-19 pandemic in low-income and middle-income countries: a cross-sectional study of older persons in Thailand. BMJ Open. 2021;11(4):47650.
11. 11. Wayne W. Daniel. Biostatistics: A Foundation of Analysis in the Health Sciences. 6, editor. New York: Wiley and Sons; 1995. Avialable at: https://faculty.ksu.edu.sa/sites.
12. 12. Institute of geriatric medicine. basic geriatric screening nonthaburi: Institute of geriatric medicine; 2021. Available at: http://agingthai.dms.go.
13. 13. Mongkol A, Vongpiromsan Y, Tangseree T, Huttapanom W, Romsai P, Chutha W. The development and testing of thai mental health indicator version 2007. J Psych Asso Thailand. 2013;54(3):299-316.
14. 14. Daengthern L, Thojampa S, Kumpeera K, Wannapornsiri C, Boonpracom R. Factors affecting quality of life and longevity in the elderly people in Phrae City, Thailand. Asian Pac Isl Nurs J. 2020;5(2):48-54.
15. 15. Ng CW, Luo N, Heng BH. Health status profiles in community-dwelling elderly using self-reported health indicators: a latent class analysis. Qual Life Res. 2014;23(10):2889-98.
16. 16. Ratanopas W. Nutritional Status Assessment of the Elderly in the Academic Services Areas of Kamphaeng Phet Rajabhat University. Academic J Comm Pub Health. 2022;8(8):9-23.
17. 17. Muhammad T, Srivastava S, Hossain B, Paul R, Sekher TV. Decomposing rural–urban differences in successful aging among older Indian adults. Scientific Reports. 2022;12(1):6430.
18. 18. Roongruang A, Satayavongthip B. Prevalence and factors associated with risks for dementia among elderly in sungnoen subdistruct municipality, nakhon ratchasima province. Region Health Prom Cen J. 2023;17(1):272-87.
19. 19. Luo Y, He P, Guo C, Chen G, Li N, Zheng X. Association between sensory impairment and dementia in older adults: evidence from China. J Am Geriat Soci. 2018;66(3):480-6.
20. 20. Wicha S, Saovapha B, Sripattarangkul S, Manop N, Muankonkaew T, Srirungrueang S. Health status of dependent older people and pattern of care among caregivers: a case study of Hong ha health promoting hospital, Lampang, Thailand. Asian J Pub Opi Res. 2018;5(3):228-49.
21. 21. Wanichsaithong P, Goodwin M, Pretty I. Oral health status of Thai older adults with different oral health literacy levels. Chiang M Dental J. 2021;42(2):104-13.
22. 22. Petersen PE, Kandelman D, Arpin S, Ogawa H. Global oral health of older people--call for public health action. Community Dent Health. 2010;27(4):257-67.
23. 23. Ortíz-Barrios LB, Granados-García V, Cruz-Hervert P, Moreno-Tamayo K, Heredia-Ponce E, Sánchez-García S. The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis. BMC Oral Health. 2019;19(1):141.
24. 24. Pitanthananukul P. Health status of older persons living in Yaplong, Srisaket province. Nursing Journal CMU. 2018;45(1):12-25.
25. 25. Fumaneeshoat O, Phaktongsuk P. Prevalence of Urinary Incontinence in the Elderly in Banpru Municipality, Hat Yai District, Songkhla Province, Thailand. Songklanagarind Med J. 2017;35(2):133-8.
26. 26. 26. Petchmunee J, Kiennukul N, Klinhom P, Sutthigoon W, Pongeim T, Makpate N, et al. A Study of Health Status Screening Results of the Elderly Person in Ratchaphruek Clinic, Nopparat Rajathanee Hospital. J Depart Med Serv. 2024;49(1):48-54.
27. 27. Murukesu RR, Singh DKA, Shahar S. Urinary incontinence among urban and rural community dwelling older women: prevalence, risk factors and quality of life. BMC Public Health. 2019;19(4):529.
28. 28. Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand. Epidemiol Health. 2018;40:2018018.
29. 29. Suri K, sununsirikul K, Tonsuvan K. Quality of Sleep and associated factors in elderly at Urban community, Nakhon Sawan, Region 3. Med Pub Health J. 2022;19(1):15-27.
30. 30. Chopsiang L, Khantichitr P, Kaewmanee C. Factors Related to Sleep Quality among the Elderly without Dependence in Ubon Ratchathani Province. J Nur Health Care. 2023;41(2):264153.
31. 31. Tasci Bozbas G, Sendur OF, Aydemir AH. Primary knee osteoarthritis increases the risk of falling. J Back Muscu Rehabil. 2017;30:785-9.
32. 32. Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001;12(8):699-705.
33. 33. Wang P, Abdin E, Shafie S, Chong SA, Vaingankar JA, Subramaniam M. Estimation of prevalence of osteoporosis using osta and its correlation with sociodemographic factors, disability and comorbidities. Intern J Envir Research Pub Health. 2019;16(13):2338.
34. 34. AlKuwaity KW, Mohammad TN, Hussain MA, Alkhanani AJ, Ali AMB. Prevalence and Determinant factors of osteoarthritis of the knee joint among elderly in Arar, KSA. The Egyptian J Hospital Med. 2018;72(9):5173-7.
35. 35. Nontarak J, Bundhamcharoen K, Prasitsiriphon O, Aekplakorn W. The association of sociodemographic variables and unhealthy behaviours with limitations in activities of daily living among Thai older adults: cross-sectional study and projected trends over the next 20 years. Asian Pac Isl Nurs J. 2023;7:42205.
36. 36. Churak P, Praditsorn P, Meenongwah J, Wimonpeerapattana W. Factors associated with nutritional status of elderly in Ubon Ratchathani, Thailand. Asia Pac J Sci Technol. 2019;24(10):14456.
37. 37. Mongkolsomlit S, Homkom N, Ivanovitch K. A Survey of epidemiology of health and needs assessment among aging people living in town municipality, Pathum Thani province. J Health Sci Thailand. 2022;31(2):199-210.
38. 38. Kim YJ, Hur JS. The relationship between self-esteem, growth mindset and depression among elderly Korean man and women. J Advan Res Rep. 2021;1(2):135-42.
39. 39. Hickey A, Barker M, McGee H, O'Boyle C. Measuring health-related quality of life in older patient populations: a review of current approaches. Pharmacoeconomics. 2005;23(10):971-93.