การประเมินภาวะสุขภาพผู้สูงอายุชาวไทยภูเขาในจังหวัดเชียงราย ประเทศไทย

Analytic cross-sectional study design was conducted to assess physical health, mental, quality of life, living safety environment, and level of access to health care services among the hill tribe elderly population aged ≥ 60 years old and lived in Chiang Rai province. A questionnaire, physical examination form, lux meter, 5 ml blood specimen were used for collecting data from the subjects. Chi-square and logistics regression were used for detecting the associations between variables. The study lasted for 1 year.

Results; 793 subjects were recruited into the study from 61 hill tribe villages. 50.4% were females, 93.9 % had Thai identification card, 81.7 were aged 60-69 years, 35.2 were aged 70-79 years, 71.5% were Buddhist, 93.8% were illiterate, 66.8% were married, 70.5% lived with relatives, 62.9% were unemployed, 89.2% had income ≤5,000 baht/month. Regarding physical health, 19.7% smoked, 14.6% drank alcohol 14.6% ate uncooked food, 44.9%were chewing betel. Regarding health behaviors, 23.8% had a low level of self-care knowledge, 14.1% had a low attitude in self-care, and 12.5% had a low level of healthy practice. 45.0% had BMI ≥ 23, 6.8% were disabled, 4.5% had a history of TB treatment, 9.7% had cataract, 28.7% had hearing problem, 43.3% had oral health problem. Laboratory results, 8.8% had glucose ≥ 126 mg/dL, 25.7% had uric acid ≥ 7, 31.5% had cholesterol ≥200 mg/dL, 21.5% had triglycerides ≥200 mg/dL. Prevalence of diabetes was 16.4%, and hypertension was 37.6%. Regarding mental health, the overall quality of life and mental health among the subjects were in a high level, however, in physical aspect, it was in a low level. The prevalence of cognitive impairment was 50.2 %, 64.4%, and 23.3%, which was assessed by MMSE-Thai 2002, MNI-COG, and Modified IQCODE respectively. Age had statistical significant association with cognitive impairment (ORadj=1.44, 95%CI=1.01-2.06). The prevalence of depression among the hill tribe elderly was 32.9%. Two variables were found to be associated with depression a) those people who quit smoking were associated with depression (ORadj=1.95, 95%CI=1.04-3.62), b) Low quality of life was associated with depression (ORadj=1.92, 95%CI=1.13-3.27). Regarding living safety environment, 63.3% had narrowed 33.3% had a high slop road, 28.3% had no rail and 60.0% had no public transportation provided. 76.7% were ≤ 15 minutes far from a health care center. Regarding disaster, 86.7% were drought, 66.7 were earthquakes, and 61.7 were storm. 24.9% had injuries in a previous year, among them 17.8% had a fall, and most occurred around the residential area including the pathway to restroom. 60.3% of toilet, 68.4% of kitchen, and 77.2 of living rooms had been defined as under the standard lighting level. 43.8% of water supply and 73.8% of drinking water were untreated ground-water, and 83.0% of all sources of water had been contaminated by coli form bacteria. Regarding living sanitation, 58.5% had a mosquito, 18.1% had a corral nearby their home, 68.5% used no food-and –drug certificated food, 55.0% prepared their food on a wood surface material, and 8.7% prepared their food on a floor. Regarding the rights of access to health care services, most of them were under subsidized of the Thai universal coverage program. Due to lack of Thai citizenship, a few proportion of them had no free support from the Thai health care system. As a result, they used private clinics. The average cost of access to health care service per visit was 125.08 baht, 1,515.95 baht for indirect and opportunity costs, and 162.85 baht for transportation to a hospital. Regarding the level of access to health care, it was found that the hill tribe elderly populations had a middle level of satisfaction in access to Thai health care service, and statistically different satisfaction levels to access health care system between tribes. There was in “a middle satisfaction” in the aspect of individual perception of the sufficiency of numbers of health professional and health care setting. In the aspect of expenses of treatment including both direct and indirect costs were in a high level of their satisfaction, however, among the non-Thai citizen was in low satisfaction level in access tohealth care services. Finally, in the aspect of the convenience of access to health care service, we found that both accessibility and acceptability were dropped in a middle satisfaction level.

In conclusion, health promotion program developments are in need for improving health and well-being among the hill tribe elderly population.