An ageing population is susceptible to an increased risk of chronic disease and disability: hypertension, cardiovascular disease, chronic obstructive pulmonary diseases, blindness and visual impairment, mental health disorders, arthritis and diabetes, which can require life-long treatment or support. Chronic illness and disability impose high ongoing costs on individuals, families and societies. Poor health reduces older adults's capacity to actively participate in and contribute to their families, thus increasing their isolation and dependence. Individuals and families may have to sell their assets in order to purchase medicines, which thus increases their vulnerability. Family members may need to take time off from work to look after an older family relative who has a disability. Governments need to cope with increased demands for health services and increased costs to their health service providers for long-term care. And yet, much of this financial anxiety is avoidable because many chronic illnesses are preventable when healthy and active ageing is promoted, especially among people earlier in life.
A strong community-based health infrastructure contributes towards HIV/AIDS situations and the ability of communities to be more responsive to health needs in situations. But we live in an era of rapid and unprecedented global ageing - which is a
triumphant achievement for humanity. However, it presents major challenges in relation to poverty and access to appropriate health care in old age.
In Thailand 2008, people over the age of 60 accounted for 11 per cent of the population. By 2020, an estimated 15.3 per cent of Thailand will be older than 60. The proportion of Indonesians older than 60 will be larger than the proportion of Indonesians younger than 14.4.There are proven strategies that can change the future picture from overburdened health and social systems to older people living longer, more healthily and more productively. - World Health Organization (2004), Towards Age-friendly Primary Health Care. One key strategy to ensure improved health quality for older people and healthy ageing is to make primary health care facilities and services at the community level age-friendly or old-age-specific.
The Thailand Government needs to adapt its health infrastructure to address the future demands of ageing, and it must start now. The rehabilitation process ongoing in Phayao province, supported by a generous allocation of resources, presents an ideal opportunity to improve health infrastructure and to make health services responsive to the specific needs of older people. This moment in time, when the number of people older than 60 accounts for 11 per cent of Indonesia's population, provides a demographic window of opportunity to plan and develop health programmes that anticipate and address the challenges that ageing creates. The Government has committed itself to respond to the needs of older people through a 10th National Plan of Action for Older Persons (2010). The objectives outlined in that action plan are supported by a number of laws, decrees and regulations on older people's welfare and programmes related to poverty, health, participation and empowerment. This document is based on the results of research that Help Age International initiated to examine the current status of health facilities and gaps in service provision in Phayao province. The study aimed to identify ways to better utilize available rehabilitation resources to improve the health care system for older people's needs now and in the future.
From the statistic of Phayao province, it is found out that the province population has the highest death rate from AIDS. The infection rate in the province is ranged number one in the top five of provinces having people with AIDS. Therefore, the effect from the disease mentioned will surely occur to families, especially those who are in their aging state which is the state of deterioration both physically and mentally. They have lost their beloved children and have to face grief, and mourn more and more. Thus, communities should take part in taking care of health of those elders mentioned. The need for community and society to take care of and support these elders are essential to maintain the health of those elderly to live their lives independently.
The recommendations offer practical advice for helping the Thailand Government realize its policy commitments to older people within the context of community health care and health services. They are primarily intended for local and provincial government and nongovernment organizations working on health programmes and focus on strengthening the health system to be more responsive and age-friendly.
Research Question
1. What should be components of Age - friendly community model for older adult in Northern of Thailand ?
2. What are the effects of Age -friendly community model for older adult in Northern of Thailand ?
Research Objectives
1. To develop the Age - friendly community model for older adult in Northern of Thailand
2. To examine the effect of Age - friendly community model for older adult in Northern of Thailand.
Scope of the study
The study aims to investigate the effects of Age - friendly community model in order to support health of older adult in Moo5 Tambon Jadeekham, Ampur chiangkham, Phayao province.
Expected Outcomes and Benefits
1. The study will be benefit for older adult &family.
2. The results of this study will be apply to other communities.
3. The results of this study will be create good environment in communities
4. The results of this study will be useful for setting policy in communities.
Definition
An Age-friendly community is a community where policies, services and structures related to the physical and social environment are designed to support and enable older people to live in a secure environment, enjoy good health, and continue to participate fully in society (World Health Organization,2005). An age-friendly community is a community for all ages.
Older adult refer to persons over the age of 60 participating in this study.
Quality of life : WHO defines Quality of Life as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment. Quality of life of the older adults in the study referred to the perceptions of person towards life satisfaction and well being. In this study, quality of life was defined in 4 domains as follows:
1. physical domain
2. psychological status
3. social relationships
4. environment.
CHAPTER II
LITERATURE REVIEW
This study adopted the principle of An Age-friendly community to modify health of older adults in northern of thailand. This chapter critically review the existing literature that relevant to study. The review will start with the general data of The Thai older adults situation. Thereafter, the effects of HIV/AIDS impact to older adults and strategies of An Age-friendly community, PRECEDE-PROCEED Model concept, Action research concept,followed by Research relevant and conceptual framework.
According to the review, it still has gaps exist in our knowledge regarding factors affects a variety of domain of quality of life in the older adults. Because of the scarcity of studies, conclusion cannot be draw regarding factors influence quality of life
unclear, Furthermore, this present study needs to be done in examination the
association between factors and quality of life in the older adults. This research is
based on a modified PRECEDE-PROCEED Model (Green and Kreuter, 1999) as a
framework in order to examine the relationship between predisposing, enabling,
reinforcing factors, health status, health behavior, and quality of life among the older
adults living in Bang pa-In districts, Ayutthaya province. The result of this study could
be used in benefit health and social services for the older adults to promote their
quality of life.
The quality of life in older adults is the goal of human development on The
Nation Economy and Social Development Plan, especially in the Nation Public Health
Plan. According to demographic change, quality of life and living condition can be
used as indicators of well being among older adults. Quality of life can be assessed in
term of (a) activity of daily living, (b) physical health, (c) mental health, (d) social, (e)
economy, and (f) environment (Fillenbaum, 1984 and Fillenbaum1987). Similarly,
WHO identified 5 components to be assessed (WHOQOL-BREFTHAI, 1996). There
are many compositions that explained elderly's good quality of life; which depend on
individual's beliefs and experience.
Although few studies examined factor related to very little evidence has been
reported about the interaction between older adults and their environment. Thus, the
researcher, a public health nurse is interested in studying quality of life in The since
researcher is interested in studying the relationship between characteristics of
demographic, Health status, Health behaviors, Social support and the quality of life,
the PRECEDE-PROCEED model will be used as conceptual framework for this study. The findings of this research will benefit health and social services for older adults to promote their quality of life.
Duangporn Hoontrakul.(2008: 1 ) studied the result of the development of Age-Friendly Primary Health Care: Case Study of One Primary Care Unit. This mutually collaborative action research aimed to develop age-friendly primary health care (AFPHC) for older people at one primary care unit (PCU), under the supervision of the university hospital, Khon Kaen province, Thailand. The findings of six concepts of AFPHC: Respect, direct services, equity in elders group, good death, family care, and age-friendly environment, led to the process of developing age-friendly primary health care for the elders in four phases. These were: 1) awareness of AFPHC concepts, 2) changes in health service behaviors and age-friendly environments, 3) developing age-friendly services and activities, and 4) building age-friendly service networks. The results of this study suggested that age-friendly primary care comprised of three components: age-friendly behaviors, age-friendly services, and an age-friendly environment. Factors contributing to the development of AFPHC were: 1) positive thinking of participants, 2) management for mutual benefits, 3) social capital of local stakeholders, and 4) input from gerontological advanced practice nurses in the community. Barriers to the development of AFPHC were: 1) the changed policies of the PCU administration, 2) the personnel outcome evaluation system that focused more on individual than groups or project based.
Penny Hollander Feldman (2003: 2 ) studied the result of the developing community indicators to promote the health and well-being of older people. Population is older people in USA. Qualitative research was conducted to inform the development of a model of an elder-friendly community and a set of indicators to measure and help improve community capacity to promote the health and well-being of older residents.
The results were remarkably similar across sites Participants said that a community could be considered elder- friendly if it helped older residents continue active participation in the community, sustain their independence, and reduce the risk of isolation. Participants identified the following factors as being necessary for successful aging in place: financial security, health and health care, social connections, housing and supportive services and transportation and safety.
David Hanson (2006: 3 ) Studied the Assessing a Community's Elder Friendliness. Studied in Western Washington community USA. Studies of the topic have examined a range of phenomena-physical environments, religious communities, and access to services-in an attempt to develop a comprehensive model for community assessment. This article describes an elder-friendly community model developed by The AdvantAge Initiative, discusses how it was used to identify assets and areas for improvement in one Western Washington community and how this assessment is informing strategies to improve older adults' quality of life.
Andrew Kochera and Kim Bright (2006: 4 ). Studied Livable Communities for Older People in Washington, D.C USA. . The result shows the Positive outcomes for older people include more than physical independence. They include the ability of older people to function and remain active in their setting of choice and to continue to enjoy their desired level of support from and interaction with other people. In this context, homes, neighborhoods, and mobility options all play a key role in how residents invest
themselves in the community around them. Yet research suggests that our communities are not always designed to provide the elements that people need to remain active and socially connected throughout the lifespan. There are many ways that policy can support livable communities. For instance, programs that promote a variety of affordable housing options (including home repair) enable individuals to remain in the communities to which they have long-term attachments. At the same time, zoning, industry standards, and other incentives for good home design enhance quality of life by enabling individuals to enjoy the full use of their residence as they age. Transportation and mobility options have a profound impact on the lifestyles of older Americans. Of course, most people in the United States drive to get where they want to go. However, among those individuals who do not drive, whether by choice or necessity, options like well designed. destination oriented-sidewalks or public transportation can contribute to personal independence and quality of life.
The conceptual framework
The theoretical concepts of Age-friendly community for older adult of WHO together with results from situational analysis of Age-friendly community for older adult of the study site were used as conceptual framework of this mutual collaborative action research
Concept of age friendly community (WHO)
- Outdoor spaces and buildings
- Transportation
- Housing
- Respect and social inclusion
- Social participation
- Communications and information
- Civic participation and employment
- Community support and health services
The situation of age friendly community for older adult at community participating in the study
â- Situation of older adult's health
â- age friendly community for older adult
- Outdoor spaces and buildings
- Transportation
- Housing
- Respect and social inclusion
- Social participation
- Communications and information
- Civic participation and employment
- Community support and health services
Action Research (mutual collaborative)
â- The participation of participants
â- Spiral action cycle (Reflect, Plan, Act & Evaluate, Re-plan)
Age-friendly community for older adult in northern of Thailand
CHAPTER III
METHODOLOGY
The chapter describes the research design and method used to developed An Age-friendly community for older adult in Phayao province. The action research, a selected learning qualitative enquiry, such as surveys, documentary, informant observation, focus group, was to develop a model Age-friendly community to care the older adult in Phayao province. The reason to use this kind of method was to look at older adults and developed Age-friendly community model. This chapter consisted of the description of methodology, including; population and participant selection, setting, protection of participants, role of the researcher, research instruments and quality assessment, data collection methods, and data generation of action research.
Population characteristics and sampling technique
The criteria for the selection of elderly people living with HIV/AIDS - affected families and their participation in the research was based on them or another household member being infected with the HIV virus. Elderly People are affected by HIV/AIDS through a variety of circumstances including:
1. Having a family member (adult child, spouse or close relative) living with
HIV/AIDS
2. Caring for grandchildren whose parents are living with HIV/AIDS
3. Having an adult child or spouse who has died of AIDS
4. Caring for grandchildren whose parents have died of AIDS
Participants in the study
The Key informants, Stakeholders, older adult's family, older adult
Setting
The researcher's data is collected from the people in Moo5 Tambon Jadeekham, Ampur Chiangkham, Phayao Province.
Research process
The Research process was divided in to two phase as follows:
Research Procedure & Data collection
Phase I Pre research Phase:
1. Understanding community context: community assessment, Interview the informants and studying previous reports from the community leaders.
2. Building the relationship with community : The researcher contacts and builds relationship with community leaders and public health volunteer who has power for recruiting the people in the community participate in the research project
3. Identify & preparing steak holder: After building relationship with community leaders and stakeholder, the researcher will asking about the other people who are the stakeholder in this problem and they should be include in the research project. Preparing research team before research phase.
4. Raising community's awareness: The campaign for increase awareness of age- friendly community problem among people in community is conduct by research team. The activities of campaign may include the education session.
Data collection
- Focus group discussion
- Interview with key informants
-Studying documents and records of community
-Age-friendly community assessment questionnaires
Phase II Research Phase:
- Step1: Situation analysis : The researcher team gather information about age- friendly community in community. The information is useful for understand the problems in real situation and guiding to develop age- friendly community model (focus group discussion, age- friendly community assessment guideline)
- Step 2: Model development : 1. AIC (Appreciation-Influence-Control) technique is applied for develop age- friendly community model in community.2.Interpreting and analyzing ( focus group discussion, Field note taking, Participant observation record)
- Step3 Implementing : After the participants got the action plan.The researcher will help the participants by taking the role as the facilitator ,collabolator, and organizer(focus group discussion, Field note taking, Participant observation record)
- Step4: Reflecting& Re-planning: During implementing is going on,the researcher team observed evaluateds and reflects the process,consequence of implementing plans both positive change and barriers that community or research team can do after acting the plan.( focus group discussion)
- Step5 Evaluation :based on PROCEDE-PRECEED including output evaluation, impact evaluation, outcome evaluation.
Research Instrument
- Community assessment guideline
Focus group guideline
Observation guideline: field note
- Age -friendly community assessment questionnaires( Outdoor spaces and buildings, Transportation , Housing, Respect and social inclusion, Social participation, Communications and information, Civic participation and employment, Community support and health services.
Referrence
Duangporn Hoontrakul.(2008: 1 )
Penny Hollander Feldman (2003: 2 )
David Hanson (2006: 3 )
Andrew Kochera and Kim Bright (2006: 4 )
Kochera A, Bright K. Livable communities for older people. Generations
2006; 24: 32-36.
