Research Projects

Background

Presently, older people comprise a small share of the total population in Malaysia and Myanmar. In both countries, it is projected that this share will double in the next 30 years, which has strong implications for advancing Universal Health Coverage (UHC). For example, as populations age, the capacity of health systems to effectively manage chronic conditions and comorbidity will be essential. Information about the health and social service needs and coverage of older populations will be useful to inform health system development to better meet the needs of an older population. The study aims to adapt the survey instrument of the Japan Gerontological Evaluation Study (JAGES) to facilitate measurement and monitoring of the health and physical functioning of older people in Malaysia and Myanmar.

Goal

To adapt and validate the JAGES survey instrument so that it can be used to measure health and function and assess health inequalities among older populations in Malaysia and Myanmar.

Methods 

• Questionnaire adaptation and validation: In Malaysia, the English-translated version of the JAGES questionnaire was back-translated into Bahasa Malaysian and pilot-tested with 30 older patients visiting an urban primary care clinic in Kuala Lumpur. In Myanmar, the questionnaire was back-translated into Burmese and pilot-tested on 20 older people in the Yangon area. Based on the pilot-test results, the questionnaires were modified to be linguistically and culturally appropriate as well as feasible to administer with older people in each country.
• Sampling: The adapted questionnaires were then used to conduct surveys of the older population in Malaysia and Myanmar, respectively. Multistage random cluster sampling was used to draw representative samples of older people 60 years and above from Hulu Langat and Kuala Selangor districts of Selangor State in Malaysia, and from Yangon and Bago regions of Myanmar.
• Survey administration: Trained surveyors visited the homes of the older residents to administer the survey in person. Persons with severe physical or cognitive impairment were excluded. After obtaining informed consent, an interview was conducted on a range of topics including physical health and functioning, mental wellbeing, health care utilization and social/community engagement. Objective measurements were also obtained from the participants including blood pressure, body weight and height, and grip strength. Each interview took about 45 minutes. Data were collected in December 2018-April 2020 in Malaysia and September-December 2018 in Myanmar.

Results

1. Face validation and content validation: Several of the questions and response options in the JAGES questionnaire were modified so that they were relevant and appropriate to the local context, for example, descriptions of the type of health care services available to them or typical social activities for older people.
2. Data were successfully collected from a total of 2404 older persons (1204 from Malaysia and 1200 from Myanmar) with a 100% completion rate among those who were included in the interview.  
3. Survey findings: Results from Malaysia showed that the majority (74.5%) of respondents report being diagnosed with multiple chronic conditions. Over half of respondents report foregoing care, with women, those with poor perceived health and those with difficulty walking being more likely to forego care. Results from Myanmar showed that women were more likely than men to report poorer health status as well as functional decline, controlling for age and other factors. Some risk factors, such as underweight, were more common in rural areas whereas other risk factors, such as being homebound, were more common in urban areas.

Global Implications

In many low- and middle-income countries undergoing rapid population ageing, there may be a lack of validated survey instruments that can be used to collect data on the health and social service needs and utilization among older people. Adapting and validating existing survey instruments may be an efficient alternative and provide data that are comparable to other countries. This approach can also fill an urgent need for local data on the health of the older population as well as contribute to a global evidence base of comparable data on the health needs and services coverage of older people.

Local Implications

Only a small number of high-level administrative indicators and databases relevant to the provision of health and social care for older people are available that enable comparisons between local governments in Kansai. Participation in existing survey research initiatives could offer a complementary source of information. Until recently, Kobe was the only municipality in Kansai that had participated in JAGES going back to the 2010-11 survey. However, in the latest survey wave conducted in 2019-20, nine other municipalities from Kansai have joined. These municipalities could compare their survey results and their various applications of data to inform local policies and programmes development. They could also help promote the use of research data for policy making in other municipalities of Kansai.  

Publications

1. Shah, S.A., Rosenberg, M., Ahmad, D. et al. Prevalence and determinants of unmet needs for hypertension care among the older population in Selangor: cross-sectional study. Health Res Policy Sys 20 (Suppl 1), 127 (2022). https://doi.org/10.1186/s12961-022-00915-1
2. Nozaki, I., Shobugawa, Y., Sasaki, Y. et al. Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study. Health Res Policy Sys 20 (Suppl 1), 114 (2022). https://doi.org/10.1186/s12961-022-00918-y
3. Shah SA, Safian N, Ahmad S, Nurumal SR, Mohammad Z, Mansor J, Wan Ibadullah WAH, Shobugawa Y, Rosenberg M. Unmet health care needs among older Malaysians. J Multidiscip Healthc. 2021;14:2931–2940. doi: 10.2147/JMDH.S326209. eCollection 2021.
4. Shah SA, Safian N, Ahmad S, Wan Ibadullah WAH, Mohammad ZB, Nurumal SR, et al. Factors associated with happiness among Malaysian elderly. Int J Environ Res Public Health 2021;18:3831. https://doi.org/10.3390/ijerph18073831 
5. Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, et al. Rural–urban differences in the factors affecting depressive symptoms among older adults of two regions in Myanmar. Int J Environ Res Public Health 2021;18:2818. https://doi.org/10.3390/ijerph18062818
6. Safian N, Shah SA, Mansor J, et al. Factors associated with the need for assistance among the elderly in Malaysia. Int J Environ Res Public Health 2021;18:730. doi: 10.3390/ijerph18020730
7. Win HH, Nyunt TW, Lwin KT, et al. Cohort profile: healthy and active ageing in Myanmar (JAGES in Myanmar 2018): a prospective population-based cohort study of the long-term care risks and health status of older adults in Myanmar. BMJ Open 2020;10:e042877. doi: 10.1136/bmjopen-2020-042877