Journal of Education and Health Promotion

Evaluation of Elderly’s Integrated Healthcare components in primary healthcare centers of Tehran, Iran

Document Type : Original Article

Authors

. Hajar Ziaeefar
. Maryam Tajvar
. Mehdi Yaseri 1
. Abolghasem Pourreza 2

1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract
BACKGROUND: Over the past few decades, significant demographic and epidemiological changes
have been occurred and led to serious changes in the health-care needs of the elderly. Integrated
care has been emerged as a strategy to provide better care for the elderly in the community. The aim
of this study was conducted to evaluate components of integrated health-care program of the elderly.
MATERIALS AND METHODS: This quantitative cross-sectional study was conducted in Tehran
(Iran) in 2019. For the purpose of the study, a two-stage cluster sampling method was employed.
In the firs stage, primary health-care centers were selected, then in the second stage, a systematic
random sampling was conducted based on the number of the elderly covered by each center. level
of frailty, medication use awareness, and self-care ability were evaluated by the elderly self-report
questionnaire. The questionnaire was piloted with thirty respondents. The test–retest reliability score
for the questionnaire was r = 0.795, P < 0.001. Data analysis of the questionnaire was conducted
using generalized estimating equation model by SPSS software Version 22. Statistical significance
for all analyses was set at P < 0.05.
RESULTS: Findings of the components showed that the mean ± standard deviation of frailty (80 ± 17)
and self‑care ability (87 ± 17) were higher than the mean of medication use awareness (49 ± 19).
Frailty and self‑care ability (β = frailty, self‑care) of the elderly had a positive statistical significance
with the ones with good financial status (β = 5, 10) and without chronic disease (β = 4, 5). Medication
use awareness had a negative statistical significance with illiteracy (β = −9.5).
CONCLUSIONS: It is suggested that the medication use awareness of the elderly should be prioritized
by improving integrated health‑care program.

Keywords

Elderly
integrated health care
medication review
risk screening
self‑care ability
1. Bloom DE, Boersch‑Supan A, McGee P, Seike A, et al. Population
aging: Facts, challenges, and responses. Benefits Compens Int
2011;41:22.
2. Mafauzy MB. The problems and challenges of the aging
population of Malaysia. Malaysian journal of medical sciences.
2000;7:1‑3.
3. Reinhardt Uwe. Does the aging of the population really drive the
demand for health care? Health Aff (Millwood) 2003;22:27‑39.
4. WhiteMS, Burns C, Conlon HA. The impact of an aging population
in the workplace. Workplace Health Safety 2018;66:493‑98.
5. Harnett PJ, Kennelly S, Williams P. A 10 step framework
to implement integrated care for older Persons. Ageing Int
2020;45:288‑304.
6. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman‑Hill R,
Horwood J, Ebrahim S, et al. Complex interventions to improve
physical function and maintain independent living in elderly
people: A systematic review and meta‑analysis. Lancet
2008;371:725‑35.
7. Béland F, Hollander MJ. Integrated models of care delivery for
the frail elderly: international perspectives. Gaceta Sanitaria
2011;25:138‑46.
8. Uittenbroek RJ, Reijneveld SA, Stewart R, Spoorenberg S,
Kremer H, Wynia K. Development and psychometric evaluation
of a measure to evaluate the quality of integrated care: The
Patient a ssessment of I ntegrated E lderly C are. Health Expect
2016;19:962‑72.
9. FabbricottiIN, JanesB, LoomanWM, Kuijper Rd, WijngaardenJDH,
Reiffers A. Integrated care for frail elderly compared to usual care:
A study protocol of a quasi‑experiment on the effects on the frail
elderly, their caregivers, health professionals and health care
costs. BMC Geriatr 2013;13:31.
10. Frank C, Wilson CR, Models of primary care for frail patients.
Canadian Fam Phys 2015;61:601‑6.
11. VerasRP, Caldas CP, da Motta LB, de Lima K, SiqueiraRC, da SVR
RT, etal. Integration and continuity of Care in health care network
models for frail older adults. Rev Saude Publica 2014;48:357‑65.
12. Looman WM, Huijsman R, Bouwmans‑Frijters CAM, Stolk EA,
Fabbricotti I N. Cost‑effectiveness of the ‘Walcheren integrated
care model’intervention for community‑dwelling frail elderly.
Fam Pract 2016;33:154‑60.
13. Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P,
Contandriopoulos AP, et al. A system of integrated care for older
persons with disabilities in Canada: Results from a randomized
controlled trial. J Gerontol A Biol Sci Med Sci 2006;61:367‑73.
14. Vedel I, De Stampa M, Bergman H, Ankri J, Cassou B, Mauriat C,
et al. A novel model of integrated care for the elderly: COPA,
coordination of professional care for the elderly. Aging Clin Exp
Res 2009;21:414‑23.
15. Spoorenberg SL, Uittenbroek R, Middel B, Kremer B, Reijneveld S,
Wynia K, et al. . Embrace, a model for integrated elderly
care: study protocol of a randomized controlled trial on the
effectiveness regarding patient outcomes, service use, costs, and
quality of care. BMC Geriatr 2013;13:62.
16. Briggs AM, Valentijn P P, Thiyagarajan J.A, de Carvalho A .
Elements of integrated care approaches for older people: a review
of reviews. BMJ Open 2018;8:e021194.
17. Avazeh M, Babaei N, Farhoudi S, Kalteh EA, Gholizadeh B. The
study of self‑care and related factors in the elderly with chronic
diseases in 2018. J Health Care 2019;21:135‑44.
18. Plácido AI, Herdeiro M T, Morgado M, Figueiras A,
Roque F. Drug‑related problems in home‑dwelling older adults:
A systematic review. Clin Ther 2020;42:559‑.72E+16.
19. Baxter S, Johenson M, Chambers D, Sutton A, Goyder E, Booth A.
The effects of integrated care: A systematic review of UK and
international evidence. BMC Health Service Research 2018;18:350.
20. de Carvalho IA, Epping‑Jordan J, Pot A‑M, Kelly E, Toro N,
Thiyagarajan J, et al. Organizing integrated health‑care services
to meet older people’s needs. Bulletin World Health Organ
2017;95:756.
21. Azimi MS, et al. (for health care staff); 2017, Integrated and
Comperhensive Health Care System for Elderly People; 2017.
22. Lotfalinezhad E, Abolfathi‑Momtaz Y, Nazari‑Panah N‑S,Honarvar M‑R, Arab‑Ameri F, Azimi M‑S. Effectiveness of
integrated and comprehensive geriatric care program of ministry
of health on physical and mental health of older adults in golestan
province. Iran J Ageing 2019; Doi: http://dx.doi.org/10.32598/sija
0.2020.3.2190.2.
23. Hardin JW, Hilbe JM . Generalized Estimating Equations. London:
Chapman and Hall; 2003.
24. Yaman H, Ünal Z. The validation of the PRISMA‑7 questionnaire
in community‑dwelling elderly people living in Antalya, Turkey.
Electron Phys 2018;10:7266.
25. Zhang Q, Guo H, Gu H, Zhao X. Gender‑associated factors
for frailty and their impact on hospitalization and mortality
among community‑dwelling older adults: A cross‑sectional
population‑based study. Peer J 2018;6:e4326.
26. Ganz DA, BaoY, Shekelle PG, Rubenstein LZ, et al. Will my patient
fall? Jama 2007;297:77‑86.
27. Setiati S, Aryana S, Seto, E, Sunarti, S, Widajanti, N, Dwipa, L,
Istanti, R, et al. Frailty status and its associated factors among
Indonesian elderly people. Innov iAging 2017;1:386‑86.
28. Bazán LM, Enfedaque‑Montes M.B, Cesari M, Soto‑Bagaria L,
Gual N, Burbano M.P, Tarazona‑Santabalbina F.G, et al.
A community program of integrated care for frail older adults:
AGIL Barcelona. J Nutr Health Aging 2019;23:710‑16.
29. Kim MY, Lee EJ. Factors affecting self‑care behavior levels among
elderly patients with type 2 diabetes: A quantile regression
approach. Medicina 2019;55:340.
30. Söderhamn U, Bachrach‑Lindstrom BM, EK A‑Ch. Self‑care ability
and sense of coherence in older nutritional at‑risk patients. Euro
J Clin Nutr 2008;62:96‑103.
31. Yang J, Meng L, Liu Y, Lv L, Sun Sh, Long R, Shan Xu , et al.
Drug‑related problems among community‑dwelling older adults
in mainland China. Int J Clin Pharm 2018;40:368‑75.
Journal of Education and Health Promotion
Volume 11, Issue 5
June 2021
Pages 1-6

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us