News

Perceived need for care and assistance among older people in Malaysia

Malaysia’s population of older people over the age of 60 is expected to double in the next twenty years, making it important to plan for the health and social care this population will need over the long term. 

Findings from research on the older population in Malaysia supported by the WHO Kobe Centre was recently published in the International Journal of Environmental Research and Public Health. The study used a survey instrument adapted from the Japan Gerontological Evaluation Study (JAGES) to establish how many older people needed assistance and the types of assistance they required. 

The research was based on face-to-face interviews with a sample of 1204 older people living at home in Selangor state (excluding those with serious physical or cognitive impairment). It found that, on average, only 8% of respondents reported that they needed care or assistance in their daily life. Yet, a significant proportion of them reported having difficulty seeing (69%), walking or climbing stairs (50%), remembering (38%) and hearing (27%).  Many of them also reported being unable to perform activities of daily living on their own, like filling out documents (42%), using public transportation (36%), or withdrawing and depositing money (36%). Forty percent of them expressed that they were “very concerned” about falling.   

While the older people’s perceived need for daily care and assistance was low, they commonly reported physical and functional challenges that could be addressed through greater availability of services. Perceptions of need for care and assistance alone can be misleading. Thus, objective measures are also important to inform service delivery and planning.

WKC Director presents at Tokyo University of Foreign Studies

The WKC Director, Dr Sarah Barber, presented online to the students attending the seminar about “How does the UN System Work?” among briefings by UN Officials on 27 Jan, 2021. She discussed the research programs at the WKC about universal health coverage and health emergencies, collaborations with the local community in Hyogo and Kobe, and the challenges during the COVID-19 pandemic.

WKC’s first online Forum honors nurses

23 November 2020

Nurses, public health nurses and midwives are at the forefront of healthcare, dealing with health crises caused by infectious diseases such as COVID-19 and emergencies such as natural disasters.

As part of the International Year of the Nurse and Midwife, the WHO Kobe Centre (WKC) collaborated with local nursing partners to host its first Forum held online due to COVID-19,  on “Nurses at the Forefront – their Role and Prospects in Global Health” to recognize the key contributions of nurses and midwives.

Around 300 people participated in the Forum with strong engagement of local academic and service provision partners (1) Using WHO’s State of the World Nursing Report which has been translated into Japanese, they discussed the current situation of nursing in Japan and issues facing Japanese nursing personnel. The meeting also heard from nurse academics and practitioners on the role of nursing in responding to COVID-19 and its impact on nursing in homes, hospitals, quarantine stations and nursing centres, as well as the future role of nursing.

“The COVID pandemic has brought to light the tremendous contribution that nurses and midwives make throughout the world, while at the same time facing challenges in service provision, heavy workloads, and sometimes limited resources. Sadly, some health professionals have faced COVID-related stigma and discrimination, just when we need solidarity to face the pandemic together,” said WKC’s Director, Dr Sarah Barber in her opening remarks.

The meeting organiser and WKC technical officer responsible for disaster management and health emergencies, Dr Ryoma Kayano, reminded delegates about the difficulties for nurse professionals working with great responsibility and expectations on challenges facing the world for the first time. He stressed that nurses and nursing needed to be supported throughout society.

“In line with Kobe City’s slogan ‘Be Kobe’, WHO’s three slogans for COVID-19 are: ‘Be Safe, Be Smart, and Be Kind’. I want to emphasise ‘be kind’ and the need to show respect and compassion,” said Dr Kayano.

“No matter how careful you are, you may get infected, but blaming a person will drive the infection into hiding and result in further spread of the disease. You could be in that position tomorrow. Healthcare and nursing professionals are taking risks themselves to contribute to the future of humanity. Remember that when you are in need, it is the healthcare worker who will help you.”

Participants expressed their gratitude to WKC for the opportunity to showcase nurses and nursing. WKC will continue to provide support so that healthcare workers, including nursing professionals, and people in society can work together to tackle the pandemic.

Building new evidence to guide policies on addressing rapid ageing in Myanmar

The initial survey results of the first longitudinal cohort study of older adults in Myanmar have been published in BMJ Open, providing baseline data for the country to create evidence-based policies to prepare for rapid ageing. The study was jointly supported by WKC and the Japan Agency for Medical Research and Development.

By 2030, about 13% of the population in Myanmar is expected to be 60 years or older. Similar rapid ageing is occurring in many South-East Asian countries, although effective medical and long-term care systems remain underdeveloped.

The cohort study was modelled after the Japan Gerontological Evaluation Study (JAGES), initiated in 2010 to investigate the health and well-being of older Japanese adults in the world’s most aged society. The study is the first to adapt and validate the JAGES questionnaire outside Japan. Directly comparable with JAGES data, the results will enable evaluation of the long-term care needs and their possible determinants among older adults in Myanmar.

The baseline survey found that older people (60 years and older) living in the rural Bago region have lower socioeconomic status and more commonly self-reported poor health. Those living in urban Yangon reported less social interaction and had a higher average body mass index but scored better on their self-reported ability to perform daily living activities. Women in both regions reported poorer physical and cognitive function compared to men, controlling for age.

The follow-up survey will be conducted in 2021 to gather outcome data on mortality, changes in mobility, and declines in physical health and cognitive function. This will allow a prospective risk-assessment of older adults who may require assistance with activities of daily living. The data can also inform the translation of research evidence into policy and practice, such as the need for outreach and support to disadvantaged older women.

Further details about the study and the research article can be found here.

How does healthy ageing affect economic growth?

Globally, decision-makers are concerned that population ageing will result in slower economic growth and therefore greater demands for health and social care. 

However, a new set of six country studies by the European Observatory for Health Systems and Policies, WHO Western Pacific Regional Office, and WKC, shows how country investments in healthy ageing could positively affect economic growth across a range of country settings (Australia, Japan, Korea, Mongolia, New Zealand and Viet Nam) in the Western Pacific Region with over a third of the world's population 65 years and older.

Investments in healthy ageing can health countries realize the full potential of its older population and contribute to economic growth.

Read the 6 case studies here

Message of WKC Director for International Universal Health Coverage Day 2020

This International Universal Health Coverage Day on 12 December finds the world in a crisis. The coronavirus disease (COVID-19) pandemic has exposed inadequate health systems, gaps in social protection and inequalities. It has highlighted the importance of basic public health, strong health systems and emergency preparedness.

Universal health coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship. The theme this year is “Health for all: protect everyone.” This means everyone - no matter their age, gender or ability - has a right to health care. Health for all is not wishful thinking. It is the basis of stable, equitable and peaceful societies that protect everyone.

COVID-19 and health emergencies disproportionately affect older people, those with multiple health problems and those who can least afford it.  A WHO survey found that COVID-19 disrupted essential health services in 90% of countries studied, including services for immunizations, chronic diseases, mental health and others. Better investments in resilient health systems will ensure that a crisis doesn’t derail progress ever again.

Primary health providers, such as nurses, midwives and community health workers, are the backbone of health systems. They are critical partners in driving health for all, bringing care directly to the people that need it most. Health for all means supporting them by ensuring they are first in line for treatment and a future vaccine so that they can provide health care. 

The WHO Centre for Health Development (Kobe Centre (WKC)) makes available accurate, scientific information accessible to professionals and the public in Hyogo Prefecture through translations of technical guidance and general information documents.

Safe and effective vaccines, diagnostics and therapeutics are vital for ending the pandemic, but will only be effective if they are available to those most vulnerable, in all countries. Over 180 countries have joined the COVID-19 Vaccine Global Access (COVAX) facility to ensure equitable global vaccine delivery. The pandemic isn’t over anywhere until it’s over everywhere.

We all must work together to ensure no one is left behind this UHC Day and every day going forward.

Advisory Committee expresses appreciation for WKC contributions to COVID-19

The Advisory Committee of the WHO Centre for Health Development in Kobe (WKC) has concluded its 24th annual meeting which was held virtually for the first time this year due to the unprecedented situation of COVID-19. 

The Director-General of WHO appoints the Advisory Committee which comprises representatives from each of the six WHO Regions, the host country, the local area, and the Kobe Group [1] which provides generous material and financial support to the work of WKC.

The Advisory Committee deeply appreciated the Centre’s central role in disseminating COVID-19 information for health professionals managing the outbreak and preventing outbreaks in Japan. At the same time, the Centre has maintained its research focus during such difficult times.

The new member to the Advisory Committee, Dr Teiji Takei, Assistant Minister for Global Health and Welfare, Ministry of Health, Labour and Welfare (MOHLW) in Japan, thanked WKC for the central role it has  played during COVID-19, including translation of documents. WKC worked with UN agencies and local Japanese experts to translate over 100 WHO technical guidance and public information documents about COVID-19. 

The Committee acknowledged the breadth of WKC’s research of 29 projects across multiple countries, and its impressive scientific output of 33 scientific publications, including the WHO Guidance on Research Methods for Health Emergency and Disaster Risk Management, the world’s first reference book to guide research during health emergencies.

The chair of the 2020 Advisory Committee, Professor Irene Agyepong of the Public Health Faculty of the Ghana College of Physicians and Surgeons and the Dodowa Health Research Center, representing WHO’s Africa region, said: “We congratulate WKC on progress and excellent response to the 2019 recommendations, in particular the impressive output including the Guidance. It is good that the Centre is focusing on its niche areas of Universal Health Coverage and ageing, health emergencies and disaster risk management, which are its comparative advantage.”

The Committee also commended the Centre’s expanded partnerships within WHO and with academic institutes globally and in the Kansai region of Japan, and recommended that it use opportunities such as WHO’s Regional Committee meetings to disseminate its work to key decision makers to impact on health policy and practice.

“I am really impressed with the number of publications WKC has produced over the year which reflects good quality work, and its expanded collaboration, globally and in Japan,” said Professor Maged Al- Sherbiny, Higher Education Senior Advisor of Direct Aid International in Kuwait representing WHO’s Eastern Mediterranean Region.

The Committee endorsed WKC as a Centre of Excellence and Innovation, and recommended that WKC secure core financing from WHO to expand its work even further. The impact of COVID-19 with respect to equity, access to care and ageing populations was identified as an emerging niche area for future research.

Iranian study identifies gaps in monitoring Universal Health Coverage in the context of population ageing

WKC supported researchers in Iran conducted a study on “Measuring Universal Health Coverage (UHC) to Ensure Continuing Care for Older People,”  to be presented virtually in a poster at the 6th Global Symposium on Health Systems Research on 11 November 2020.

One of the investigators, Dr Sedighe Hosseinijebeli, explained that the team aimed to fill a gap and propose a new framework to measure UHC progress that is relevant for health systems to respond to population ageing. "We undertook a scoping review and conducted panel reviews of academics and policy-makers in Iran to examine the feasibility of recommended indicators for the Iranian context,” she said.

Of the 35 relevant documents analysed, the findings confirmed that no specific framework exists for measuring UHC in the context of ageing. Existing frameworks for monitoring UHC lack specific indicators of care for older people. Furthermore, in Iran and other low- and middle-income countries where long-term care systems are not fully developed, much of the care for older people relies on informal care and there are little or no data on the coverage and quality of care.

“This study highlights how neglected the measurement of health system performance in relation to older people’s care is in comparison to other areas like maternal and child care, and communicable diseases,” said Dr Hosseinijebeli.

The study proposes indicators that could be used for monitoring quality of care, service coverage, expenditure patterns on long-term care, and financial and social protection for older people. The researchers urge the inclusion of key indicators of healthy ageing and older person’s care in future UHC measurement frameworks.

New study using ‘Big Data’ shows evidence of priority treatment for Japan’s older people

As Japan celebrates Respect for Older People’s Day (21 September), researchers published a novel study in BMC Health Services Research with WKC support on using information from large-scale health care databases to analyse access to health care associated with population ageing in Japan.

Few studies have been conducted about the quality of care for older patients with dementia, and even fewer have investigated the care they receive in acute care settings when they have accompanying medical conditions such as hip fractures.

This research explored whether acute hospital care was equitable and responsive to the needs of older people, and whether older people, and specifically those with dementia, had less access to surgery for hip fractures.

The researchers analysed secondary data from the Diagnosis Procedure Combination (DPC) Database, a national health care insurance claims database, and found 214,601 patients, 65 years old and over, with first-time diagnosis of hip fracture. Of these, 27% had mild dementia, nearly 21% had severe dementia, and 74% received hip surgery.

Among these patients who were treated in acute care hospitals, those with severe dementia were more likely to receive hip surgery and more likely to experience a shorter waiting time for the surgery than those without dementia. People in their 80s and 90s were less likely to receive the surgery compared to the younger-old, but those aged 90 years and above experienced a shorter waiting time before the surgery.

“I think the physicians recognize that patients with severe dementia can suffer greater consequences from the loss of function due to the hip fracture and want to treat their injury as soon as possible to prevent the dementia from worsening. This study presents some evidence of equity in the healthcare system in Japan,” said lead researcher, Dr Shinichi Tomioka of Hiroshima University at the time of the study.

“There are high quality data sets in each local hospital in Japan, but they are not fully utilized for health services research like this. We have provided trainings for hospital management staff from around the country on how to use the data, for example, to understand what types of care are most utilized at their hospital and which other facilities in the area it would be important to coordinate with. Through the trainings, we are cultivating potential leaders of the field for the future,” he said.

This study demonstrated that patients with dementia in Japan may be prioritized for hip surgery. It also found that patients living in remote areas were just as likely to receive surgery without delay as those living in urban areas, as long as they sought care in high-functioning hospitals. The research showed the usefulness of using big data to answer questions around health care and equity and adds to the global knowledge base of equity in health services.

For more on this study, click here:  https://extranet.who.int/kobe_centre/en/project-details/evidence-improving-health-care-provision-ensure-universal-health-coverage-amid-rapid

Information dissemination during a global pandemic: Experiences from WHO

On 26 August, Dr Sarah Barber, Director of WHO’s Centre for Health Development in Kobe (WKC) joined Dr David Malone, Rector of the United Nations University in Tokyo, in a virtual discussion on information dissemination during a global pandemic.

“The current COVID-19 pandemic has yielded overwhelming amounts of information. We are fighting an infodemic as well as an epidemic,” explained Dr Barber. “Too much information makes it difficult to identify what is factual and what is not. In turn, people struggle to know what to believe and what actions they should take.”

Thousands of rumours, conspiracy theories and reports of stigma around COVID-19 have spread rapidly on social media channels and in the media, fuelling mistrust of government and health workers, and contributing to unhealthy practices such as ingesting harmful substances in the hope of counteracting COVID. In doing so, these rumours undermine the people carrying out the pandemic response.

WHO has used a number of strategies to debunk myths and disseminate accurate scientific information for the public and decision-makers. EPI-WIN is an information network for epidemics which provides resources and regular updates, using a whole-of-society approach. It works with specific groups such as youth, journalists and faith-based organizations to co-develop guidance tailored to specific contexts and communities, to enable people respected in their communities to amplify the messages. A series of myth-busters were developed for social media platforms to dispel common and potentially harmful myths and curb stigmatizing behaviour.

“Importantly, individuals need to get information from trusted, reliable sources of health information like WHO, trusted academics or local public health institutes. The United Nations has a programme called “Take care before you share” to stress the need for everyone to verify the information first before sharing, and call out those who spread incorrect information. We can all play a role in saving lives and protecting people from misinformation. Each individual does have a responsibility to create a healthy neighbourhood in these social media environments,” concluded Dr Barber.

The UNU discussion may be viewed here.