Prevalence of dementia among the elderly and health care needs for people living with dementiain an urban community of central Vietnam , Vo Van Thang 1 , Ho Dung 1 , Tran BinhThang 1 , H
Trang 1Prevalence of dementia among the elderly and health care needs for people living with dementiain an urban community of central Vietnam
, Vo Van Thang 1
, Ho Dung 1
, Tran BinhThang 1
, Hoang DinhTuyen 2
, Hoang Dinh Hue 2
, Le Dinh Duong 2
ABSTRACT
Introduction: Dementia is one of the major
causes of disability and dependency among
older people There is little research on the
prevalence of dementia, its related factors and
health care needs for people living with
dementia in Vietnam Aims: The aims of this
study are: (i) to examine the prevalence of
dementia, its related factors among people
aged 65 years and abovein Hue City of
Vietnam, (ii) examine the needs of health care
for dementia patients Methods: 905 people
aged 65 years and aboveliving in Hue City in
central Vietnam were interviewed and
examined MMSE test (Mini Mental State
Examination) was used as a screening
instrument for dementia Diagnosis of
dementia was undertaken using ICD-10
research criteria Results: Overall prevalence
estimates for dementia was 9.4% Age, medical history of stroke, physical activities and entertaining activities were significantly associated with dementia The most common health care needs for people living with dementia were medication (76.5%), receiving consultation regarding how to care for people with dementia (75.3%), having support and professional advice on how to deal with mental and behavioral disorders (63.5%)
Conclusion: In this population, probable
dementia is common Comprehensive care delivery for people living with dementia is urgently needed in Vietnam
Keywords: Dementia, prevalence, related
factors, health care needs, Vietnam.
1 Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy
2 Faculty of Public Health, Hue University of Medicine and Pharmacy
* Corresponding author: Doan Vuong Diem Khanh, Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy (Hue UMP), 06 Ngo Quyen Street, Hue city, ThuaThien Hue province, Vietnam Fax: 00-84-984-118-925 Website: http://iccchr-hue.org.vn/ Email: diemkhanh1972@gmail.com
Trang 2Life expectancy of human beings has been
increasing worldwide In Vietnam, people
aged 60 years and over occupy 10.2% of
population, whereas the percentage of people
now in the period of aging population The
time for Vietnamese population to change
from aging population into the aged
population is predicted to be much shorter than
Challenges of aging population issue,
including access to health care for the elderly,
have been especially paid attention by many
countries in general and Vietnam in particular
Dementia is among the leading causes of
only affects seriously the patient’s quality of
life but also physical, psychological and
socioeconomic impact on caregivers, family
Worldwide, there are approximately 35.6
million people living with dementia and 7.7
million new cases every year Most of
researches worldwide recognize that
prevalence of dementia increases remarkably
with increasing age The prevalence of
dementia is approximately 1% among people
aged 60-64, 5-10% among people aged 65 and
over, and up to 30-50% among people aged 85
Up to now, there are very few studies in
Vietnam regarding epidemiological aspects of
dementia as well as the needs of health care for
people living with dementia in Vietnam A
large study among 8,965 persons in an urban
community in the north of Vietnam (Thai
Nguyen city) in the year 2000 revealed that
prevalence of dementia was 0.64% of the
general population and 7.9% among the
A study on the prevalence of dementia in a rural area of Vietnam (Ba Vi district) conducted in 2005 among 5,712 adults aged 60 years and over in 2006 found that the prevalence of dementia was 4.6% among this
increases with age Prevalence of dementia among persons aged 65 years and over was 5.8%, among those aged 60-64 was 0.8%, aged 70-74: 3.8%, aged 75-79: 5.9%, aged 80-84: 8.5% and among those aged above 85 was 16.4% Prevalence of dementia reduced among the group of the elderly with higher education: This prevalence was 9.7% among group of elderly who just knew how to read and write, among group of primary school was 2.4%, group of secondary school and above
This study tries to examine the prevalence of dementia, its associated risk factors and determine the needs of health care for patients living with dementia in Hue city, Vietnam The study will provide importance evidence regarding the burden of this syndrome, the related factors and the extent to which people living with dementia is in needs of health care This will help policy makers to design practical strategies and activities to improve mental health care and quality of life for thousands of people in central Vietnam
METHODS
A cross sectional study was carried out in Hue city, central Vietnam between June and August
2014 Multi-stage cluster sampling method was used Stage 1: 6 quarters in Hue city were randomly selected Stage 2: from each quarter,
5 sub-administrative units were randomly selected Stage 3: From 30 sub-administrative
Trang 3units selected, a total of 905 individuals aged
65 and above, who were permanent residents,
were randomly selected (based on the list of
the elderly provided by the local commune
health centers) A response rate of 98.7% was
obtained Data collection was undertaken
using face to face interview at participants’
households with the assistant of family
members when necessary Diagnosis of
dementia was undertaken using a two phase
process The first phase was the screening one
for dementia using MMSE test (Mini Mental
Status Examination) MMSE has been used
widely in Vietnam and internationally It is a
brief 30-point questionnaire test The total
score ranges between 0-30 A total of 878
persons among 905 undertook MMSE test
Individuals who had a total score of MMSE <
24 (MMSE positive) were recruited to enter the
second phase to diagnose dementia by using
test (253 persons with MMSE< 24 plus 27
persons not did MMSE) Individuals who could
not undertake MMSE for any reasons were also
examined for diagnosis of dementia
(impairment of visual or hearing capacity)
Data analysis was undertaken using SPSS.16
Descriptive statistics were used for presenting
prevalence of dementia and demographic
characteristics distribution of the study
sample Simple regression was undertaken for
exploring associated factors of dementia
(including age, sex, religion, occupation,
education level, perceived household
economic situation, family history of
dementia, living situation, history of
hypertension, heart disease, stroke, diabetes,
blood lipid disorder, Parkinson; habits of
smoking, drinking, physical and entertainment
activity) Factors statistically associated with
dementia were then entered into the multiple
logistic regression model to examine simultaneously factors associated with dementia while controlling for the effects of other factors
ETHICAL APPROVAL
The study was approved by the Research committee of Hue University of Medicine and Pharmacy
RESULTS
The sociodemographic characteristics of the participants were presented in Table 1 There are a majority of participants being females (64.6%) and a high percentage of them was
Table 1 Socio demographic chararteristics of
the sample
Trang 4widowed (39.9%) Most participants were
Buddhism (67.3%) Regarding education
level, nearly 20% were illiterate, 21.3% knew
how to read and write and 24.2% attended
primary school 29.1% of participants’s main
occupation (during lifetime) were farmers;
60.4% perceived their family economic
situation as moderate There were 9.1% of the
elderly in this sample currently living alone
PREVALENCE OF DEMENTIA AND
ASSOCIATED FACTORS
Our results revealed that prevalence of MMSE
positive (MMSE < 24) was 28.8%
Prevalence of dementia and 95% CI are
reported in Table 2 The overall prevalence
estimates for dementia was 9.4% (12% in
women and 4.7% in men) This ranged from
0.5% among people aged 65-69 years to 37.7%
among those aged 90 years and above
Mean values for age of onset and total years
living with dementia were 76.6 years
(SD=17.8) and 8 years (SD=15.0) respectively (results not shown in the tables)
Simple logistic regression revealed that age, sex, marital status, occupation, education level, living situation, medical history of stroke, habits of physical activities and habit of entertainment activities were statistically associated with dementia (p<0.05)
Table 3 presents the multiple logistic regression model examining the associated factors of dementia Only independent variables which were statistically associated with dementia were presented in the table The model found that only age, medical history of stroke, habits of physical activity and entertainment activity were statistically associated with dementia The elderly aged 75 and above had higher risk of acquiring dementia compared to those of 65 to 69 years old People with a history of stroke were 16 times higher probability of suffering from dementia than those without stroke People
Table 2 Crude prevalence of dementia by sex
and age group Table 3 Multi-logistics regression model examines the associated factors of
dementia.
Trang 5lacking of physical activities and
entertainment activities were associated with
1.9 and 2.0 fold higher probability of acquiring
dementia than those engaging in physical
activities and entertainment activities
Independent variables included in the model:
age, sex, marital status, occupation, education
level, living situation, medical history of
stroke, habits of physical activities and habit of
entertainment activities Only independent
variables which were statistically associated
with dementia were presented in the table NS:
non-significant
HEALTH CARE NEEDS FOR PEOPLE
LIVING WITH DEMENTIA
Among 85 people living with dementia
identified by this study, only 18.8% (n=16) had
ever been examined and received some
treatment for dementia; just 9.4% (n=8)
reported having adequate treatment by health
professionals
Methods of treatment among group received
treatment were medication only (87.4%),
combination between medication and
occupational therapy (6%), and occupational
therapy only (6.3%) No cases received
psychotherapy
Health care needs for people living with
dementia were presented in Table 4 The most
common health care needs for people living
with dementia (reported by patients and
family members) were medication (76.5%),
receiving consultation regarding how to care
for people with dementia (75.3%), having
support and professional advice on how to
deal with mental and behavioral disorders of
dementia patients (63.5%) Needs for
psychotherapy, occupational therapy and
physical therapy were identified by
approximately 42.4%, 29.4% and 29.4% of respondents respectively
DISCUSSION
Prevalence of dementia and associated factors: The overall prevalence of dementia in this study was 9.4% (95% CI, 7.6%-11.5%) Compared with other studies conducted in Vietnam, this prevalence appears to be higher For example, one previous study conducted in
2006 among the elderly aged 65 years and above in a rural community of North Vietnam
One other study conducted in 2000 among the elderly above 60 years old in an urban community in North Vietnam reported
Findings of the prevalence of dementia in our study are in line with the range reported internationally, which indicated that prevalence of dementia among 65 years of age
systematic review and meta-analysis of 11 epidemiological studies on dementia in Korea published in 1990-2013 found the pooled dementia prevalence among the elderly (aged
≥ 65 yr) was 9.2% (95% CI, 8.2%-10.4%),
Table 4 Health care needs for people living
with dementia
Trang 6However, it is difficult to have an accurate
comparison between studies due to differences
regarding methodology, sampling methods,
diagnostic criteria and age structure
The findings that prevalence of dementia
increased remarkably with the increasing of
age in this study was consistent with the
previous studies conducted in many other
with age, it is more accurate to compare the age
specific prevalence of dementia between
studies One meta-analysis of dementia
prevalence surveys, published between 1980
and 2010, among a total elderly population of
105,866 in 48 studies covered 21 provinces and
prevalence of dementia were 1.3%, 3.1%,
19.7% and 26.3% among the elderly aged
65-69, 70-74, 80-84 and 85+ respectively, which
appeared to be higher than those found in our
study (0.5%, 1.5%; 13.1% and 25.3%
respectively) However, the prevalence of
dementia among group aged 75-79 in our study
was higher than that reported in the study of
China (12% vs 9.3%) Other recent study in
rural China in 2011 also reported higher
prevalence of dementia among groups aged
80-84, 85-89 and 90+ compared to those revealed
in our study (23.5%, 29.1%, 40.0% vs 13.1%,
History of stroke was found to be a very
strong predictor of dementia in our study,
which increased the risk of dementia by up to
16 times The mechanism of stroke as a risk
factor of vascular dementia was well
established This finding is in agreement with
the previous studies, which found that
personal history of stroke was associated with
higher risk of cognitive impairment and
Lacking habits of physical activities were associated with higher risk of dementia in our study was also supported by several previous studies One study in China among 1,264 people aged 55 and above in a highly educated community revealed that individuals without habits of physical activities had 2.2 higher risk
of dementia compared to those having habits
longitudinal study in the Netherland among 4,406 inhabitants aged 55 years and older during a follow up period up to 14 years found
a higher level of physical activities to be associated with a lower risk of dementia (adjusted for age, sex, education , smoking, APOE-е4 carrier status, hypertension, BMI,
Having engaged in entertainment activities was associated with lower risk of dementia in this study One longitudinal cohort study examined lifestyle factors and risk of dementia was conducted in Australia (first assessed in
1988, followed up 16 years) among 2,805 men
study found that, in a proportional hazards model for dementia, daily gardening predicted
a 36% lower risk of dementia, daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in
walking on reducing risk of dementia might be considered as the combination effect of both physical and entertainment activities
Needs of health care for people living with dementia
This study found that access to diagnosis and treatment was very low among this population Only 18.8% dementia patients have ever been diagnosed and received some treatment and only 9.4 % of cases reported having complied
Trang 7the treatment (results not shown in the table).
This raised a very important point for public
health intervention that need to target in the
future Raising awareness and knowledge
among the public for early detection and
diagnosis as well as compliance of treatment
of dementia should be taken into account
Among dementia patients who received
treatment in our study, medication was the
most common ways of treatment; other types
of treatment (occupational treatment) were
very limited or unavailable Especially no case
has received psychotherapy
Health care needs for dementia patient are
presented in Table 4 Our study found that the
needs for medication, receiving consultation
on how to care for people with dementia,
having support and professional advice on
how to deal with mental and behavioral
disorders of dementia patients were especially
high (76.5%, 75.3% and 63.5% respectively)
Needs for occupational therapy and physical
therapy were identified by approximately 1 in
3 respondents Noticeably, most of relatives
and caregivers of patients had not been
provided necessary information and skills on
how to care for patients with dementia Up to
75.3% of relatives and caregivers would like to
receive consultation on how to care for
dementia patients The needs of receiving
support and professional advice on how to deal
with mental and behavioral disorders were
also very high (63.5%) Helping family
members to know on how to give care to
patients have not only benefits for patients but
also for caregivers in reducing their
psychological distress One systematic
literature review of studies reported between
1990 and 2009 revealed manifestation of
depressive symptoms appeared among 1 in 3
caregivers and these manifestation appeared to
be higher among care givers of dementia
CONCLUSION/ RECOMMENDATION
In conclusion, this study found that dementia
is common among the elderly in Hue City of Vietnam Age, history of stroke, habits of physical activities and entertainment activities were significantly associated with dementia Access to health care and treatment is very limited This study pointed out some important recommendations which include strengthening health education for community
in reducing risk factors of dementia (importantly, decreasing stroke among the elderly via management of hypertension, encouragement of physical activities and entertainment activities) Early diagnosis of dementia and providing comprehensive care delivery for people living with dementia are urgently needed in Vietnam
LIMITATIONS
Some limitations of this study should be taken into account First, this study was cross sectional study and we could not ascertain the time sequence between independent variables and dependent variable Therefore, cause effect relationship could not be able to establish Secondly, no subtype of dementia was clarified which might had different risk factors We were not able to include hospitalized people in our sample as well
DECLARATION OF CONFLICTING INTERESTS
There are no known conflicts of interest and all authors claim responsibility for the manuscript
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