Document Type : Original Article
Authors
1 Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
2 Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
3 Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract
BACKGROUND: The outbreak of COVID‑19 pandemic has made it difficult for older adults to utilize
ordinary elder services. This cross‑sectional study investigated the status of feeling the need, seek,
and utilization of health promotion services among older adults in Ardabil, Iran, covered by the
country’s comprehensive health system during the pandemic.
MATERIALS AND METHODS: This descriptive‑analytical and cross‑sectional study was conducted
on 739 elderly people in Ardabil province. Cluster random sampling method was used for sampling.
Data were gathered by referring trained individuals to the place of residence of the selected older
adults Questionnaires were consisted of three parts: demographic information, household’s economic
status, and feeling the need, seek, and utilization from health promotion services. Multivariate logistic
regression was used to separately model the need, seeking for, and utilization of health promotion
services in STATA ver. 14.
RESULTS: The mean age of the older adults in this study was 68.88 ± 4.72 years. The results
indicate that men showed significantly greater need, seek for, and utilization of health promotion
services during COVID‑ 19 than women. According to the results, people over the age of 80 had
4.08 times (95% confidence interval [CI]: 1.99–12.60) more need and utilization of health services
than the older adults under 65 years. The results also indicate that use of health promotion services
was significantly associated with being married (3.74, 95% CI: 1.22–2.62), having primary insurance
and supplementary insurance (1.92, 95% CI: 1.21–3.12), and obesity (2.05, 95% CI: 1.13–3.76) in
P < 0.05 level. Based on the results, people with chronic disease and obesity were more likely to
utilize health promotion services.
CONCLUSION: Findings suggest that the access and utilization of inpatient and outpatient health
services by the elderly in the COVID‑19 pandemic has somewhat decreased, which could be due
to the fear of the disease being referred to health centers by the elderly. Hence, enabling conditions
such as parental health care were major factors affecting health‑seeking habits among the Iranian
elder population.
Keywords
- Liang T. Handbook of COVID‑19 Prevention and Treatment.
Compiled According to Clinical Experience. China: The First
Affiliated Hospital, Zhejiang University School of Medicine; 2020.
p. 68.
2. Ahmadi A, Fadaei Y, Shirani M, Rahmani F. Modeling and
forecasting trend of COVID‑19 epidemic in Iran until May 13,
2020. Med J Islam Repub Iran 2020;34:27.
3. Moradzadeh R, Jamalian SM, Nazari J, Kamali A, Sadeghi B,
Hosseinkhani Z, et al. Age‑standardized mortality rate and
predictors of mortality among COVID‑19 patients in Iran. J Educ
Health Promot 2021;10:169.
4. Dey A. World report on ageing and health. Indian J Med Res
2017;145:150.
5. Noroozian M. The elderly population in Iran: An ever growing
concern in the health system. Iran J Psychiatry Behav Sci
2012;6:1‑6.
6. Afshar PF, Asgari P, Shiri M, Bahramnezhad F. A review of the
Iran’s elderly status according to the census records. Galen Med
J 2016;5:1‑6.
7. Schenker M, Costa DH. Advances and challenges of health care
of the elderly population with chronic diseases in Primary Health
Care. Cien Saude Colet 2019;24:1369‑80.
8. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B.
Epidemiology of multimorbidity and implications for health care,
research, and medical education: A cross‑sectional study. Lancet
2012;380:37‑43.
9. Sanjel S, Mudbhari N, Risal A, Khanal K. The utilization of health
care services and their determinants among the elderly population
of Dhulikhel municipality. Kathmandu Univ Med J (KUMJ)
2012;10:34‑9.
10. Izadirad H, Zareban I. The relationship of health literacy with
health status, preventive behaviors and health services utilization
in Baluchistan, Iran. J Educ Community Health 2015;2:43‑50.
11. Tanjani PT, Motlagh ME, Nazar MM, Najafi F. The health status
of the elderly population of Iran in 2012. Arch Gerontol Geriatr
2015;60:281‑7.
12. Fiestas Navarrete L, Ghislandi S, Stuckler D, Tediosi F. Inequalities
in the benefits of national health insurance on financial protection
from out‑of‑pocket payments and access to health services:
Cross‑sectional evidence from Ghana. Health Policy Plan
2019;34:694‑705.
13. Li YN, Nong DX, Wei B, Feng QM, Luo HY. The impact of
predisposing, enabling, and need factors in utilization of health
services among rural residents in Guangxi, China. BMC Health
Serv Res 2016;16:592.
14. Gümüş R, Şahin A. Utilization of health services by the elderly
in Turkey between 2008 and 2012: Analysis of Turkstat Health
Surveys. Duzce University Journal of Health Sciences Institute J
DU Health Sci Inst 2016;6:74‑8.
15. Karimi S, Keyvanara M, Hosseini M, Jazi MJ, Khorasani E. The
relationship between health literacy with health status and
healthcare utilization in 18‑64 years old people in Isfahan. J Educ
Health Promot 2014;3:75.
16. Tandon R. COVID‑19 and mental health: Preserving humanity,
maintaining sanity, and promoting health. Asian J Psychiatr
2020;51:102256.
17. Mirzaei A, Kazembeigi F, Kakaei H, Jalilian M, Mazloomi S,
Nourmoradi H. Application of health belief model to predict
COVID‑19‑preventive behaviors among a sample of Iranian adult
population. J Educ Health Promot 2021;10:69.
18. Forlenza OV, Stella F; LIM‑27 Psychogeriatric Clinic HCFMUSP.
Impact of SARS‑CoV‑2 pandemic on mental health in the elderly:
Perspective from a psychogeriatric clinic at a tertiary hospital in
São Paulo, Brazil. Int Psychogeriatr 2020;32:1147‑51.
19. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide
survey of psychological distress among Chinese people in the
COVID‑19 epidemic: Implications and policy recommendations.
Gen Psychiatr 2020;33:e100213.
20. Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A.
Decomposition of inequity determinants of healthcare utilization,
Iran. Public Health 2013;127:661‑7.
21. Jiang Y, Tang T, Mei L, Li H. COVID-19 affected patients'
utilization of dental care service. Oral Dis. 2022 Apr;28 Suppl
1(Suppl 1):916-919. doi: 10.1111/odi.13568. Epub 2020 Aug 4.
PMID: 32696473; PMCID: PMC7405079.
22. Hanratty B, Zhang T, Whitehead M. How close have universal
health systems come to achieving equity in use of curative
services? A systematic review. Int J Health Serv 2007;37:89‑109.
23. ManskiRJ, MoellerJF, Chen H, Schimmel J, St Clair PA, PepperJV.
Patterns of older Americans’ health care utilization over time. Am
J Public Health 2013;103:1314‑24.
24. Statistical Center of Iran. Population and Household of the
Country by Province and Sub‑province in Population and
Housing Censuses, 2017. Tehran, Iran: Statistical Center of Iran;
2017.
25. Tabrizi JS, Pourasghar F, Gholamzadeh Nikjoo R. Status of Iran’s
primary health care system in terms of health systems control
knobs: A review article. Iran J Public Health 2017;46:1156‑66.
26. Bhandari A, Wagner T. Self‑reported utilization of health care
services: Improving measurement and accuracy. Med Care Res
Rev 2006;63:217‑35.
27. Redondo‑Sendino A, Guallar‑Castillón P, Banegas JR,
Rodríguez‑Artalejo F. Gender differences in the utilization of
health‑care services among the older adult population of Spain.
BMC Public Health 2006;6:155.
28. Gyasi RM, Phillips DR, David R. Explaining the gender gap in
health services use among Ghanaian community‑dwelling older
cohorts. Women Health 2019;59:1089‑104.
29. Park JM. Health status and health services utilization in elderly
Koreans. Int J Equity Health 2014;13:73.
30. MalikM, TahirMJ, JabbarR, AhmedA, HussainR. Self‑medication
during COVID‑19 pandemic: Challenges and opportunities.
Drugs Ther Perspect 2020;36:565‑7.
31. Van Minh H, Byass P, Chuc NT, Wall S. Patterns of health status
and quality of life among older people in rural Viet Nam. Glob
Health Action 2010;3:2124.
32. Chen H, Hu H. The relationship and mechanism between
education and functional health status transition among older
persons in China. BMC Geriatr 2018;18:89.
33. Wang Y, Wang J, Maitland E, Zhao Y, Nicholas S, Lu M. Growing
old before growing rich: Inequality in health service utilization
among the mid‑aged and elderly in Gansu and Zhejiang
Provinces, China. BMC Health Serv Res 2012;12:302.
34. Harooni J, Hassanzadeh A, Mostafavi F. Influencing factors
on health promoting behavior among the elderly living in the
community. J Educ Health Promot 2014;3:40.
35. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID‑19 in
elderly patients: A comparison with young and middle‑aged
patients. J Infect 2020;80:e14‑8.
36. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al‑Jabir A,
et al. World Health Organization declares global emergency:
A review of the 2019 novel coronavirus (COVID‑19). Int J Surg
2020;76:71‑6.
37. Rosenstock I. M. (2005). Why People Use Health Services. The
Milbank Quarterly, 83(4),1-32. 10.1111/j.1468-0009.2005.00425.x.
https://doi.org/10.1111/j.1468-0009.2005.00425.x.
38. Richmond P, Roehner BM. Impact of marital status on health.
Physica A Stat Mech Appl 2017;486:542‑53. - 39. Compton J, Pollak RA (2021) The life expectancy of older couples
and surviving spouses. PLOS ONE 16(5): e0250564. https://doi.
org/10.1371/journal.pone.0250564.
40. Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors
for disease severity, unimprovement, and mortality in
COVID‑19 patients in Wuhan, China. Clin Microbiol Infect
2020;26:767‑72.
41. Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F,
Hosseinpour AR, et al. Inequality in household catastrophic health
care expenditure in a low‑income society of Iran. Health Policy
Plan 2012;27:613‑23.
42. de Alencar RR, Galvao TF, Antonio BV, Silva MT. Prevalence
of self‑reported chronic diseases and health services utilization
by ethnic minorities in Manaus metropolitan region. Ethn Dis
2018;28:49‑54.
43. Pong RW, DesMeules M, Heng D, Lagacé C, Guernsey JR,
Kazanjian A, et al. Patterns of health services utilization in rural
Canada. Chronic Dis Inj Can 2011;31 Suppl 1:1‑36.
44. ShahidZ, KalayanamitraR, McClafferty B, Kepko D, Ramgobin D,
Patel R, et al. COVID‑19 and older adults: What we know. J Am
Geriatr Soc 2020;68:926‑9.
45. Raveendran AV, JayadevanR. Reverse quarantine and COVID‑19.
Diabetes Metab Syndr 2020;14:1323‑5.
46. Oktarina S, Mindayani S, Harir W. The utilization of health
services by the elderly in lubuk buaya health center in padang
city. In: 4th International Symposium on Health Research (ISHR
2019). Published by Atlantis Press, Netherlands Atlantis Press;
2020.
47. Wagstaff A, Nguyen HT, Dao H, Bales S. Encouraging health
insurance for the informal sector: A cluster randomized
experiment in Vietnam. Health Econ 2016;25:663‑74.
48. Arroyave I, Cardona D, Burdorf A, Avendano M. The impact of
increasing health insurance coverage on disparities in mortality:
Health care reform in Colombia, 1998‑2007. Am J Public Health
2013;103:e100‑6.
49. Harmon C, Nolan B. Health insurance and health services
utilization in Ireland. Health Econ 2001;10:135‑45.
50. Finkelstein A, Taubman S, Wright B, Bernstein M, Gruber J,
Newhouse JP, et al. The Oregon health insurance experiment:
Evidence from the first year. Q J Econ 2012;127:1057‑106.
51. Banerjee D. The impact of COVID‑19 pandemic on elderly mental
health. Int J Geriatr Psychiatry 2020;35:1466‑7.
)