WHAT WE DO

Analysing the behavioural responses to COVID-19 among the residents of Kobe, Japan

Background
During the early stages of the pandemic, many people globally did not get the healthcare they needed because of fear of COVID-19 infection, imposed restrictions on movement, or unaffordability of care. In Japan, studies have shown that it was common for people to adopt unhealthy lifestyles related to their diet, physical activity, or social activity, thereby increasing their risks for poor health outcomes. 

Goals
To describe the behavioural changes among the population 20 years and older, in Kobe City, Hyogo Prefecture, Japan, before and after the COVID-19 pandemic, and the effects of these behavioral changes on the health of this population.

Methods

• Cross-sectional and longitudinal analysis of Kobe City’s administrative data on medical care, long-term care and public health services use and population health and lifestyle surveys for the years 2016 to 2023.
• Study outcomes include health-promoting/risk behaviours, health status, preventive care use, foregone care, certifications of eligibility for long-term care, social isolation and health inequalities by sociodemographic characteristics and geography. 
• Study sample will include:
  • approximately 400,000 adults, 20 and older, who are registered in the city’s integrated healthcare system;
  • 10,000-12,000 older adults, 65 and older, who have participated in one or more waves of a panel survey on health and lifestyle behaviors conducted in 2016, 2019 and 2022;
  • approximately 5,000 adults, ages 20-64 who responded to a 2018 survey on health and lifestyle behaviors; and
  • an estimated 5,000 adults, ages 20-64, who are expected to respond to a follow-up survey in 2023. 
• The follow-up survey will be conducted in October-December 2023, data analysis will be initiated in 2024 and final research results are expected by the end of 2025.    

Expected outcomes
The findings will inform policy recommendations to Kobe City for addressing the observed health impacts in the post-pandemic period and preparing for future pandemics, with implications for other settings.
 

Analysing data availability and policies in Myanmar for the progressive realisation of UHC in light of population ageing

Background

Myanmar is committed to the progressive realization of Universal Health Coverage (UHC) for the entire nation. The number of persons 65 years and over is expected to more than double to 9.8% of the population by 2035. It is timely, therefore, to review policies and nationally available data relevant to inform policies on UHC in the context of population ageing.

Goal

To analyse available data and policy documents to address the needs of ageing populations in the next National Health Plan 2022-2025 and inform future planning of UHC to 2030.

Methods

1. National and international scoping review of published and grey literature covering issues related to UHC that is inclusive of ageing populations.
2. Identification, mapping and evaluation of available data, plans, policies, and legislation in all government sectors related to older people’s health needs and impact on UHC.
3. Interviews and consultations with key governmental and non-governmental stakeholders and service providers.

Results

1. The scoping review found that:

• Managing the health and social care needs of rural populations is a major issue for Myanmar since 77% of people with disabilities live in rural locales.
• Disability rates were high among older people, with 57% of the people 60 years and older reporting one or more physical difficulties, rising to 90% of those 80 years and older.
• Natural disasters present significant problems and impact the continuity of health and social care for older people, and those living with disabilities.

2. The policy and data mapping exercise revealed:

• Gaps in data about the health and social care needs of older people and their families, especially when compared to available data in other Asian countries such as China, Japan, Malaysia, and Thailand.
• No systematic means to assess disability and related service needs. 
• A lack of defined health and social care benefits for older people.

Key stakeholders focused on the need to adapt the health system; expand primary care services accessible and appropriate for older people, including health promotion, prevention and rehabilitation services; and a life-course approach to the national strategy for UHC.

Global implications

To make progress towards UHC that is inclusive of older people, countries such as Myanmar will need to collect more high-quality data on older people and their families’ health and social care needs. This study found that Myanmar may also need to prioritize rural primary health and social care services development, improve their resilience to disasters, and define the public benefits for older people.

Local implications

Lessons from the Kansai region about developing health and social care systems that are resilient to disasters and inclusive of older people in rural areas, including data management issues, could be relevant to Myanmar and other countries facing similar challenges. Valuable experience and expertise are important to share with other countries, who need to collect evidence to inform health systems adaptation to population ageing.   

Randomized controlled trial to evaluate a model of community integrated intermediary care (CIIC) services for older adults in Thailand

Background

Globally, healthy life expectancy significantly lags behind life expectancy. The average difference between life expectancy and healthy life expectancy at birth is 12.2% across all WHO regions. Therefore, as people live longer, the probability increases that people will develop and manage chronic conditions that require care. 

In 2016, 16% of the Thai population was 60 years and over, which is projected to increase to 33% by 2040. Thailand is in the process of improving its care system and policies for the continuous care of older people, especially for those suffering from chronic diseases. Care in Thailand for older people is still primarily dependent on the family, which may not be sustainable.

Community-integrated intermediary care (CIIC) is a novel service model designed to enhance and support the traditional family-based informal caregiving. It provides community-based care prevention exercises in order to prevent long-term care needs among older people and consequently also reduce the burden on family caregivers. In addition, the CIIC facility offers a short-term stay service as community-based respite care in a small formal care home. Furthermore, CIIC provides family caregivers training and assistance to improve their caregiving capacity.

Goal

This study aimed to evaluate the effectiveness of the CIIC model in selected communities in Thailand and whether it results in less burden on the family caregiver and better functional ability and quality of life for the older person. 

Methods

A cluster-randomized controlled trial was conducted with 2,788 participants: 1,509 participants in 6 intervention clusters and 1,279 participants in 6 control clusters. The COVID-19 pandemic delayed the intervention and participation was less than expected. Overall loss to follow-up was 3.7%. The primary outcome was the family caregiver burden measured at 6-month follow-up using the Caregiver Burden Inventory (CBI). Secondary outcomes consisted of biopsychosocial indicators including functional ability, measured using the Activities of Daily Living (ADL) scale; depression, measured using the Geriatric Depression Scale (GDS); and quality of life of older people, measured using the EuroQol 5-dimensions 5-levels scale. All analyses were conducted at the cluster level based on intention-to-treat analysis.

Results

After six months of CIIC services, there was significantly lower caregivers’ burden, less functional decline and fewer people with depression in the intervention clusters. However, GDS scores increased globally in both arms when comparing the baseline and evaluation, possibly reflecting the stress induced by the pandemic. No improvement could be seen in the participants’ quality of life. Follow-up studies over a longer period of time may be needed to detect that full range of effects of CIIC including its impact on quality of life. 

Global implications

Innovation models for caregiving are needed to address the health and social care needs of older adults as populations age which also take into consideration the difficulties that family caregivers face. Despite the stress likely caused by the COVID-19 pandemic, older Thai residents who had CIIC in their communities were less likely to become frail compared to the residents in the control site. This was associated with reduced burden on family caregivers. This study suggests that the CIIC model may promote healthy ageing and help reduce long-term healthcare needs and costs. As many other countries also have traditional family-based, long-term care systems, the findings of this study may inform other countries wishing to adopt similar community-integrated care models for older people and their caregivers.

Local implications

The CIIC model may offer useful lessons for the various initiatives in the Kansai region that also use a community-based integrated care model to provide care and support to older people and their family caregivers. The methods used for evaluating the CIIC model in this study could be adapted for the purpose of evaluating such initiatives in Kansai.

Researching sustainable primary care in Cambodia

Background

Populations around the world are ageing rapidly and accompanying this is a rise in the prevalence of non-communicable diseases (NCDs). Progress towards Universal Health Coverage (UHC) could be accelerated by adopting affordable and sustainable service delivery models that attend to NCDs and their risk factors, so that NCD-related disability and morbidity are managed.

Economic development, together with health reforms since the early 1990s, have resulted in substantial gains in life expectancy in Cambodia. However, while total mortality has decreased over the last 15 years, the number as well as the proportion of death and disability due to NCDs has risen steeply.

National strategic and multi-stakeholder plans for the prevention and control of NCDs in Cambodia have highlighted the role of commune-level health centres serving as the nexus of primary health services. However, at present, health centres have limited experience in providing NCD services, with most visits being related to maternal and child health, communicable diseases and basic health education and promotion services. Further, while there have been efforts to provide guidance on establishing NCD services at health centres, such activities need to be tailored to the local context.

Goal

To contribute to a functioning and sustainable primary care system in Siem Reap province.

Methods

1. Assessed current capacity and key barriers faced in providing NCD services through a survey of representative primary care sites in the Siem Reap province. A “readiness” index was constructed to assess the level of resources available to provide basic prevention and treatment services for hypertension and type 2 diabetes. Facility readiness was measured and averaged across five domains: basic equipment, essential services, diagnostic capacity, counselling services and essential medicines.
2. Developed tools for providing NCD services in primary care sites informed by the survey results and international literature review. Tailored it to the local context in consultation with key stakeholders including representatives of the Ministry of Health, the Siem Reap Provincial Health Department, commune-level health centres and non‐profit organisations working to improve NCD care in Cambodia.

Results

• None of the surveyed primary care health centres reached a readiness score of 70%, a benchmark threshold value used in other similar studies. Health centres who had received prior training on NCD care reported on average higher scores than those who had not.
• Tools for the management of chronic NCDs were developed to help staff at primary care‐level health centres in Cambodia assess, counsel, treat and manage patients with hypertension and diabetes.

Global implications

Strengthening the function and capacity of the primary care system to provide NCD care can serve as the first step toward a more comprehensive and sustainable health system in the context of population aging in low- and middle-income countries. This allows health workers at all levels of the system to be integrated into the care pathway for chronic NCDs.

Local implications

Experience from the Kansai region in managing chronic conditions is important to share with other countries that need to adapt their health systems from treating infectious diseases to managing chronic conditions.

Evaluating an enhanced community of care model for high-risk older people in Singapore

Background

Without appropriate care for older persons in place, health services may inadvertently place older patients in acute care facilities. This could drive up health care costs for patients, their families and the health system, and may not offer the most appropriate level of care. Preventing unnecessary readmissions to hospitals and use of emergency and outpatient department services is key to enabling more sustainable health care use by older people.

Low socioeconomic status (SES) has been well-established as an independent risk factor for various adverse outcomes including unnecessary hospital utilisation and readmission. In Singapore, public rental housing is a measure of low SES and is independently associated with increased readmission risk and frequent emergency department use. The reasons behind these associations include an inability to navigate a complex healthcare system, lower health literacy and misalignment of patient and caregiver goals. Enhanced Community of Care (ECoC) is a care model that incorporates health coaching using motivational interviewing techniques and facilitates the integration of health and social care for older populations living in low-income communities in Singapore. ECoC aims to empower patients with respect to self-care as well as improve patient understanding and management of transitions in care, for example, from hospital to the home.

Goal

To assess the impact of the ECoC model on reducing unnecessary utilisation of acute health services and empowering patients for the management of personal health.

Methods

1. The original protocol aimed for 150 participants of low-SES older patients, 50 years and older, in a non-randomised control study to evaluate ECoC. However, as a result of COVID-19 restrictions, between May 2019 and July 2021, complete data (i.e., those who completed the baseline and post-180-day follow-up surveys) were collected from only 59 participants. 
2. A qualitative review of the implementation and experience of health coaching was planned but could be conducted with three participants only.
3. The main outcomes planned to be evaluated included unnecessary utilisation of acute health services, as measured by lower rates of unscheduled hospital readmissions, emergency department and specialist outpatient clinic visits in the intervention arm. Patient improvements in self-care and health knowledge were to be assessed qualitatively and quantitatively by using a version of Hibbard’s Patient Activation Measure (PAM-13).

Results

Given the suboptimal recruitment, the research was unable to generate conclusive findings.  However, a research paper about the impact of the COVID-19 pandemic on health research with older people will be published, which elucidates six factors that were key to ensuring continuity during a health emergency when conducting research with older people. These were:

1. Building and maintaining rapport with older research participants;
2. Ensuring that interview questions are concise and easily understood by older participants;
3. Developing strategies to minimise the risks and rate of participant drop-out in research projects with long follow-up phases, especially when working with frail and vulnerable populations like low-SES older people;
4. Devising creative and safety-conscious measures to encourage older people to continue to engage with research during health emergencies;
5. Adapting methods of data collection to the literacy, educational and technological capabilities of the target population (e.g., avoiding digital data collection methods with a still largely digitally illiterate older population); and Key Performance Indicators
6. Placing participants’ needs, their safety and well-being above Key Performance Indicators or other metrics for research success during health emergencies.

Global implications

The COVID-19 pandemic has highlighted the importance of continual efforts to ensure that the experiences and voices of vulnerable older people are heard before, during and after health emergencies. Lessons learnt from this study can be adapted in diverse country contexts to ensure that research on vulnerable older populations can be conducted safely and ethically during the current and future pandemic and other health emergencies. The key message is that participant safety is paramount and research should be terminated if it is deemed the best course to protect participant safety, irrespective of research success considerations.

Implications for Kansai

The practical advice offered by the research team based on their experiences may be useful for local researchers and institutions in the Kansai region that also conduct research on older people. The insights gained from this study can improve local research about health issues among older people even during health emergencies. This can help ensure a continuous, safe and ethical stream of relevant information to help inform and adjust local policies and programmes. 
 

Publications

Maulod, A., Rouse, S., Lee, A. et al. Ethics of participation and social inclusion of older persons in research: lessons learned from the COVID-19 pandemic in Singapore. Health Res Policy Sys 20 (Suppl 1), 126 (2022). https://doi.org/10.1186/s12961-022-00930-2

Interprofessional training for delivering quality services for older people in the Philippines and Viet Nam

Background

Inter-professional education (IPE) occurs when two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. In the context of population ageing, IPE plays an important role in preparing the health workforce to deliver care for older people. WHO recognizes IPE as a necessary step in preparing a collaborative health workforce capable of responding to local health needs. In addition to strong political commitment to promoting the welfare of older people, workforce development may help integrate social and health care services to progressively ensure universal health coverage in the Philippines and Viet Nam as they undergo rapid population ageing.

Goal

To develop a competency-based IPE programme for health and social care workers in the Philippines, which can be adapted for use in Viet Nam and other low- and middle-income countries to better integrate health and social services.

Methods

1. Analysis of the Philippines National Demographic Health Survey (2003-2017) and of the Community Elderly Survey in Hue, Viet Nam (2018) to determine the characteristics and needs of people 60 years and older.
2. Review of the existing curricula and professional training programmes based on IPE related to the care of older people in Japan, Philippines, and Viet Nam, and a global literature review of the reliability and validity of evaluation tools, enablers and barriers, and mechanisms and initiatives for IPE, based on research published between 2008 and 2018.
3. In-depth interviews and focus group discussions involving 348 health and social care workers (i.e., doctors, nurses, rehabilitation therapists, social workers, nursing assistants, community health workers, caregivers, etc.) directly involved in the care of older adults from selected primary health care centres, hospitals (i.e., public and private), nursing homes, and faith-based care centres in the Philippines and Viet Nam (174 participants in each country); and meetings with local experts and public officials to identify gaps between knowledge and practice of interprofessional collaboration.
4. Used the evidence obtained from the secondary data analysis, document reviews and qualitative research to develop a three-day training programme with scenario-based case methods and task-based group work modules and piloted the training programme with hospital workers and community health workers in Tagaytay and Marikina municipalities.
5. Evaluation of the training programme piloted in the Philippines using a randomized control design with community health workers (n=42 in intervention group and n=39 in control group), and a pre-and-post-test design with hospital workers (n=40). Evaluation tools included Attitudes Toward Health Care Teams Scale (ATHCTS), Coordinated Activities Evaluation Scale (CAES), Readiness on Inter-Professional Learning Scale (RIPLS), and Facts on Aging Quiz (FAQ).

Results

1. The qualitative research findings revealed that interprofessional collaboration tends to occur only on an ad hoc and inconsistent basis. Participants attributed this to a confluence of barriers at the personal level (i.e., power differences and hierarchy, disengagement and neglect, and unfamiliarity with other professions’ services and competencies, existing cultural background intricacies), organizational level (i.e., resource bottlenecks), and particularly systemic levels (i.e., fragmented geriatric care system).
2. The pilot intervention study showed a statistically significant improvement in attitudes among community health workers in the intervention group, which was sustained for 6 months after the training (ATHCTS score at pre-test 78.4, at 6 months after training 84.7, p<0.001). Statistically significant improvements in attitudes and coordination were observed among hospital workers immediately after the training (ATHCTS score at pre-test 88.9, on last day of training 98.4, p<0.001; CAES score at pre-test 25.6, on last day of training 29.7, p<0.001).

Global implications

Countries are striving to better respond to the health needs of populations as they age. Strengthening human resources is a critical component of this effort. The training programme developed through this study showed that in-service interprofessional education improves attitudes and care-coordination performance towards the delivery of integrated care for the growing number of older people.

Local implications

The training materials developed in this study are partly based on curriculum previously developed in Japan. These materials could inform the development of similar training programmes in the Kansai region to strengthen its human resources to respond to the needs of older persons. In turn, experiences from the Kansai region could be relevant for other countries facing the challenges of responding to the needs of older adults.

Research products

Published papers:

Nakamura, K., Siongco, K.L.L., Moncatar, T.R.T. et al. In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed-methods study. Health Res Policy Sys 20 (Suppl 1), 111 (2022). https://doi.org/10.1186/s12961-022-00914-2

Siongco KLL, Nakamura K, Seino K, Moncatar TRT, Tejero LMS, De La Vega SAF, et al. Improving community health workers’ attitudes toward collaborative practice in the care of older adults: an in-service training intervention trial in the Philippines. Int J Environ Res Public Health2021;18:9986. https://doi.org/10.3390/ijerph18199986

Moncatar TRT, Nakamura K, Siongco KLL, Seino K, Carlson R, Canila CC, Javier RS, Lorenzo FME. Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study.Hum Resour Health 2021;19:52.https://doi.org/10.1186/s12960-021-00568-1

Han TDT, Nakamura K, Seino K, Duc VNH, Vo TV. Do communication patterns affect the association between cognitive impairment and hearing loss among older adults in Vietnam? Int J Environ Res Public Health 2021;18:1603.https://doi.org/10.3390/ijerph18041603

Siongco KLL, Nakamura K, Seino K. Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003–2017.Environmental Health and Preventive Medicine2020;25:17.doi.org/10.1186/s12199-020-00854-9

Vo THM, Nakamura K, Seino K, Nguyen HTL, Vo TV. Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam. BMC Geriatrics 2020;20:141. doi.org/10.1186/s12877-020-01533-8

Moncatar TR, Nakamura K, Siongco KLL, Rahman M, Seino K. Prevalence and determinants of self-reported injuries among community-dwelling older adults in the Philippines: A 10-year pooled analysis. Int J Environ Res Public Health 2020;17:4372. doi.org/10.3390/ijerph17124372

Moncatar TR, Nakamura K, Rahman M, Seino K. Health status and health facility utilization of community-dwelling elderly living alone in the Philippines: A nationwide cross-sectional study. Health 2019;11:1554-72. doi.org/10.4236/health.2019.1111117s

Manuscripts under review:

Nakamura K, Siongco KL, Moncatar TRT, Tejero LM, Vega SA, Bonito S, Javier R, Tsutsui T, Tri HTD, Vo MTH, Tashiro Y, Al-Sobaihi S, Seino K, Vo TV, Lorenzo FM, Canila CC. In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed methods study. – Health Research Policy and Systems. Supplement issue.

Vo MTH, Nakamura K, Seino K, Moncatar TRT, Han TDT, Siongco KLL, Tashiro Y, Vo TV. Can collaboration among health and social care workers help overcome geriatric care challenges? A qualitative case study in Central Vietnam. – Health and Social Care in the Community.

Conference Presentations:

In-service inter professional training program for geriatric care. Seino K, Nakamura K, Siongco KL, Moncatar TJR, Canila C, Javier R, Lorenzo FM, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Determinants of collaboration for elderly care in a low-resource context. Moncatar TJR, Nakamura K, Siongco KL, Seino K, Canila C, Javier R, Lorenzo FM, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Improvement in attitudes toward collaboration in the Philippine healthcare setting. Siongco KLL, Nakamura K, Moncatar TJR, Canila C, Javier R, Lorenzo FM, Seino K, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Hearing impairment and cognitive function among older adults in Viet Nam. Han TDT, Nakamura K, Seino K, Vo MTH, Vo VT, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Association between living alone and fear of falling among Vietnamese elderly. Vo MTH, Nakamura K, Seino K, Han TDT, Vo VT, Takano T. 79th Annual Meeting of Japanese Society of Public Health, October 2020, Kyoto, Japan, J Jpn Soc Public Health, 67 (10 suppl.), 2020.

Workforce development to improve quality health and social care services for older adults in ASEAN countries. Nakamura K. 7th International Health Literacy Conference, Nov 2019, Ho Chi Minh City, Vietnam

Does residence of Filipino elderly living alone affects non-communicable disease and health facility use? Moncatar TJR, Nakamura K, Siongco KL, Seino K, Rahman M, Canila C, Lorenzo FM, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 598, 2019.

Predictors of type of health facility use among elderly in the Philippines. Siongco KLL, Nakamura K, Moncatar TJR, Canila C, Lorenzo FM, Seino K, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 191, 2019.

Instrumental activities of daily living of the elderly in the central Viet Nam. Han TDT, Nakamura K, Vo MTH, Seino K, Vo VT, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 263, 2019.

Cognitive impairment and fear of falling among Vietnamese older adults. Vo MTH, Nakamura K, Han TDT, Vo VT, Seino K, Takano T. 78th Annual Meeting of Japanese Society of Public Health, October 2019, Kochi, Japan, J Jpn Soc Public Health, 66 (10 suppl.) 597, 2019.

Assessment of the prevalence of cognitive impairment in Lao People's Democratic Republic

Background

In Lao People's Democratic Republic, the prevalence of cognitive impairment is unknown. The Lao Tropical and Public Health Institute (TPHI) validated the Lao language assessment tool of cognitive function (revised Hasegawa’s Dementia Scale). HDS-R is an assessment tool for cognitive decline developed in 1974 by Japanese neurologists and has been broadly used in Japan as a simple screening tool applied in daily clinical settings. It consists of 9 questions with a maximum score of 30 and cut-off point of 20 to suspect cognitive decline [1]. A Lao language version of HDS-R was developed and validated in 2017 by the National Institute of Public Health, Ministry of Health, Lao People’s Democratic Republic [2]. Using this tool, a survey was conducted to describe the prevalence of cognitive impairment, available resources for caregivers and local attitudes towards cognitive decline to develop evidence-based policies in Lao People's Democratic Republic. 

Goal

To understand the prevalence of cognitive impairment among people 60 years and over and the attendant risk factors in regions of Lao PDR, the available resources for caregiving, and local attitudes towards dementia to better inform public health policies.

Methods

1. A community-based cross-sectional prevalence survey about cognitive impairment was carried out among adults ≥60 years of age who resided in six districts of three provinces in Lao PDR representing northern, central, and the southern regions. In total, 2206 individuals aged 60–98 years (1110 men and 1096 women) were interviewed using a pre-tested Lao version of the Revised Hasegawa Dementia Scale (HDS-R) and the WHO STEPwise approach to surveillance for risk factors for noncommunicable diseases (the STEPS survey tool). Adjusted odds ratios (AORs) were estimated using logistic regression models.
2. Interviews were conducted among local leaders to gather information about available formal and informal resources for people with cognitive decline, as well as local perspectives on cognitive decline. The study team interviewed health care professionals (HCPs) from three provinces, six districts, and 12 health centers. Village committee members from three leadership groups (village head, Lao women union, and the Lao front) were also interviewed in 70 villages. In total, 182 people participated. The qualitative data were analyzed using the inductive thematic analytic approach.

Results

• 49.3% of respondents (59.0% of which were women) had HDS scores ≦20. In addition to age, the following factors were significantly associated with cognitive impairment: having no formal education relative to those with a university education (Adjusted Odds Ratio = 9.5), living in the northern relative the central region (AOR = 1.4), living in a rural area (AOR = 1.5), needing assistance for self-care (AOR = 1.8) and being underweight (AOR = 1.5). Factors associated with no cognitive impairment among included moderate intensity physical activity lasting for 10 minutes and up to 1 hour (AOR = 0.6) and for more than 1 hour (AOR = 0.6).
• None of the HCPs interviewed had experience with assessment of cognitive decline. HCPs reported the need for advocacy and public awareness for the people with cognitive decline, which was perceived as a normal part of ageing in most families. HCPs also reported the need for reliable and accessible training for simple assessment tool for cognitive decline as well as capacity to follow-up.

Global Implications

There is a need to strengthen health systems to support the needs of populations as they age to progressively attain universal health coverage (UHC). As populations age, health workers and communities should understand the difference between normal ageing related memory loss and cognitive decline. Given limited resources in low- and middle-income countries, innovative approaches for capacity building and awareness are needed. Simple tools can be applied in limited resource settings with a short training to increase awareness among the public, healthcare professionals and government officials.

Local implications

The Kansai region of Japan embarked on the Kobe Dementia Study  in which a simple tool has been used to identify high risk populations for cognitive decline [3]. This could be applied in resource limited settings, and may be useful for other countries that wish to identify cognitive decline.

References

1. Imai Y., Hasegawa K. The revised Hasegawa’s Dementia Scale (HDS-R) – Evaluation of its usefulness as a screening test for dementia. J.H.K.C. Psych (1994) 4, SP2, 20-24. https://www.easap.asia/index.php/find-issues/past-issue/item/503-v4n2-9402-p20-24
2. Kounnavong S., Soundavong K., et.al. Lao language version of the Revised Hasegawa’s Dementia Scale. Nagoya J. Med Sci. 79. 241-249, 2017. https://www.med.nagoya-u.ac.jp/medlib/nagoya_j_med_sci/792/31_SengchanhKounnavong.pdf
3. World Health Organization. “Managing people with cognitive decline: validation of a checklist; WHO Centre for Health Development.” WHO Centre for Health Development, https://extranet.who.int/kobe_centre/sites/default/files/Managing%20people%20with%20cognitive%20decline_validation%20of%20a%20checklist_27%20Sept_slb.pdf  

Publication

Kounnavong, S., Vonglokham, M., Sayasone, S. et al. Assessment of cognitive function among adults aged ≥ 60 years using the Revised Hasegawa Dementia Scale: cross-sectional study, Lao People's Democratic Republic. Health Res Policy Sys 20 (Suppl 1), 121 (2022). https://doi.org/10.1186/s12961-022-00919-x

Conference presentations:

Assessment of the cognitive function among adults over 60 years using the Revised Hasegawa’s Dementia Scale: A cross-sectional study in three regions of Lao People’s Democratic Republic. Kounnavong S. 10^th Annual Conference of Japanese Society for Dementia Prevention, June 2021, Yokohama, Japan.

Health systems improvement to manage dementia patients in Kobe

Globally, there has been a steady increase in life expectancy, population ageing, and a rapid upsurge in the number of people living with dementia. Japan has the highest proportion of people over 65 years of age in the world. More than 8 million Japanese have cognitive problems, with over 4.5 million people suffering from dementia. Currently no cure for dementia exists; therefore, the immediate goal is early detection and management to help slow cognitive decline and delay the progress of dementia. Evidence-based methods will help identify best practices for the early identification of symptoms and subsequent coping interventions. Such evidence can be used to devise pragmatic novel initiatives that support older adults in their communities as well as reduce the growing social losses caused by dementia.

Research Background

In cooperation with Kobe University and Kobe City, the WHO Kobe Centre initiated a joint research venture entitled, “Kobe Project for the Exploration of New Strategies to Reduce the Social Burden of Dementia”. This 3-year project aims to support the creation of an innovative “Kobe Model” for the early detection and management of dementia, to minimize societal impact, by using data from the Kihon Checklist (KCL) conducted by Kobe City on lifestyles of the elderly as well as data from the Frailty Check-up program started by Kobe City in 2017.

Research Outline

1. Analyze the health data of 80,000 Kobe citizens in their 70s collected via the KCL.
2. From the KCL, analyze data from approximately 5000 people who are at risk for dementia-related problems to measure cognitive function and evaluate quality of life.
3. Analyze data from approximately 5000 participants in the Frailty Check-up program to measure cognitive function and evaluate quality of life.
4. Study the impact of additional long-term cognitive training on approximately 100 participants from the “Brain Health Class” program administered by Kobe City.

Goals

The project will:
Clarify the association between cognitive function and the likelihood of requiring specialized long-term nursing care.
Identify evidence related to effective methods for the management of dementia, especially those that can slow decline in cognitive function.
Develop a community-based model for the early detection and management of dementia, and
Propose evidence-based policy options that can be evaluated within Japan and globally.

Research Team

Lead Institution: Kobe University
Yoji Nagai (PI): Professor & Director, Clinical & Translational Research Center, Kobe University Hospital;
Hisatomo Kowa, Professor, Graduate School of Health Sciences; and
Yasuji Yamamoto, Associate Professor, Graduate School of Medicine
Translational Research Informatics Center
Shinsuke Kojima, Medical Science Group, Division of Medical Innovation
Kobe Gakuin University
Kiyoshi Maeda, Professor, School of Rehabilitation
WHO Kobe Centre
Ryoma Kayano, Technical Officer

Publication

Kojima, S., Kikuchi, T., Kakei, Y. et al. Implication of using cognitive function-related simple questions to stratify the risk of long-term care need: population-based prospective study in Kobe, Japan. Health Res Policy Sys 20 (Suppl 1), 120 (2022). https://doi.org/10.1186/s12961-022-00920-4

Nagai Y, Kojima S, Kowa H, Kayano R, et al. Kobe project for the exploration of newer strategies to reduce the social burden of dementia: a study protocol of cohort and intervention studies. BMJ Open 2021; 11:e050948. https://doi.org/10.1136/bmjopen-2021-050948