PRESENTATION OF SELECTED RESULTS FROM

1. PRESENTATION OF SELECTED RESULTS FROM • THE INTRA STUDY • FOCUS GROUP STUDY ON AGE FRIENDLY HEALTH CENTRES Presented by: Dr. The Most Hon. Denise Eldemire-Shearer

2. OVERALL HEALTH STATUS JAMAICA 60+ POPULATION • Chronic Disease: main cause of Morbidity and Mortality • Leading cause of Morbidity and Mortality: Hypertension and related problems • Female Mortality: Diabetes, second cause • Male Mortality: Diabetes, fourth cause • Hospital Morbidity: Diabetes, sixth cause

3. Study Population: 738 persons • Female 75% • Walked to clinic 28.2% • Used public transport 42% (Average arrival time under 30 minutes) • Needed accompaniment 16.5% • Lived alone 17.9% • Lived with partner 22.3%

4. Health Status Male Female Hypertension 54.9 68.9 Diabetes 33.3 43.8 Heart Conditions 12.3 16.6 Stroke 3.1 3.3 Chronic Conditions 35.2 46.4 (Mainly Arthritis) 40.4 51.4

5. Most Chronic Disease Varied with Age 55-59 65-69 75-79 Hypertension 55.6 74.8 61.4 Diabetes 47.5 43.5 41.4

6. Co-Morbidity • Diabetics with Hypertension 69.3% Males: 63.0 Females: 70.9 • Hypertensives with Diabetes 43.3% Males: 38.2 Females: 45.0 • Hypertensives with Cardiovascular Conditions 19.8% Males: 18.0 Females: 20.4 • Diabetics with Cardiovascular Conditions 19.2% Males: 18.5 Females: 19.4

7. Illnesses present for long periods >10 5-9 <5 Males Females Males Females Males Females Hypertension 34.8 30.9 17.9 23.8 44.9 45.3 Diabetes 23.5 21 38.6 43.5 37.7 35.4 Cardiovascular Conditions 5 10 15 11.1 80 78.9

8. Medications • One 23.9% • Two 25.8% • Three 22.3% • Four 8.7% • Five 2.5%

9. Complications • Reported awareness 45.6% • Reported a complication 33.4% - Retinopathy 34.6% - Cardiovascular Disease 10.5% - Do not Know 16.7%

10. Health Status Compared to Previous Year • Health better 47.0% • Health worse 11.5% • Health same 24.3%

11. Reason for Health Centre Visit Males Females Felt ill 10.5 10 Regular Check-up 45.7 36.4 Control Diabetes 15.4 22.7 Control Hypertension 12.3 17.4 Control Diabetes/ Hypertension 5.6 5.5

12. BUT Diabetics said check-up 35.7% Control of Diabetes 28.5% N.B: Similar results for Hypertension

13. Risk Factors Male Female Male Female Smoke Now Ever 4.9 4.5 40 9.1 p.a. 64.3% 63% NB. p. a = p.a for at least 30 mins. Majority walk.

14. Family History: Hypertension • Had a relative 55.1% • Did not know 24.7% • Had none 17.7%

15. Hypertensives Diagnosed • Same Health Centre 37.7% • Another Clinic 17.3% • Private Doctor 15.5% • Hospital 23.5%

16. 69.0% of clinics were public • 27.0% of clinics were private • Most 78.1% only go for Blood Pressure checks

17. Asked Questions During Health Centre Visit Males Females • Diet 38.9 56.2 • P.A. 20.4 15.4 • ROH 16.7 7.4 NB. Mainly by Doctors

18. Advice Given Males Females • Smoking 9.9 3.9 • Diet 41.4 60.3 • P.A. 12.7 24.4 • ROH 14.8 8.1 • Weight 19.1 35.2

19. Key Messages • Diet: Low salt; Low fat; more fruit/vegetables 60% • P.A: Very Little • Weight: Loose weight 66.7% • ROH: Do not drink with medication 37.5%

20. Clinical Practice Males Females Blood pressure taken 87% 87.9% Sugar test req 74.4% 72.3% Cholesterol 23.3% 23%

21. Blood Pressure Control Varied Males Females Normal 60.4 57.9 Abnormal 18.7 28.2 Do not know 20.9 14.1

22. Clinic Attendees satisfied with specific care • Number of visits described as adequate • Time spent by Doctor • Staff attitudes • 75% said waiting time adequate • 8.3% had difficulty attending clinics

23. Payments • Paid nothing 7.6% • Paid a part 38.1% • Paid in full 47.6%

24. Age Friendly Guidelines (AFGs) for Primary Health Care Objectives • To reduce discrimination on the basis of age, and support appropriate access and responsive service. • To recognise and address barriers that deter appropriate access. • Can be a catalyst for the creation of policy and funding support for interventions that render primary health care more age friendly.

25. Issues - Service UsersPerception of health “Without health you cannot enjoy life” “Health means life” “Health is a natural gift from God” • quality of life - economic and social • result of a spiritual connection • linked to food intake; less to exercise

26. Issues - Service UsersAttitudes/Motivation “I do not go to the doctor unless I am sick” • under-appreciation of health promotion and disease prevention • visited doctor mainly when sick (esp. pain) • those with chronic illnesses sometimes did not visit physician • wanted more “checks”

27. Issues - Service UsersAttitudes/Motivation “Anytime I go I want to see a doctor.” “Nurse can’t diagnose what is wrong!” • health care had to be promoted or administered by a physician • clinics without a regular doctor were not seen as useful • home remedies/herbs strongly supported

28. Issues- Service usersBarriers “I went to the clinic with a bad pain … it’s a good thing I took money;….. I waited so long and then they told me to register, I left and went to a private doctor.” “The secretary will tell you what is happening even when the doctor is late.” (ref. to private clinics) • behaviour of young persons problem – noise, shoving, language, way of dress • physical inadequacies of waiting area – persons had to arrive two hours early (6.oo am) to get an appointment number • lack of hot drinks; bathrooms not kept clean • unavailability of bathroom facilities prior to clinic opening

29. Issues- Service usersBarriers • high staff turnover – mainly in public facilities • lack of service on nights and weekends • cost – financial difficulties (especially in private sector and for medications) • perception that ill health was inevitable • no guarantee of being seen on a given day without appointment • disappointment with doctors’ care for pain relief of chronic arthritis

30. Issues - Service usersBarriers “Doctor has no time, has to rush you through …. too many patients.” “I never see the same doctor twice!” • too many patients and too little time (esp. in public health centres) • unable to deal with other complaints due to time pressure • blamed the system rather than the doctors – said there should be more doctors

31. Issues- Service usersCosts “And if you cannot afford the medication, there is no point!” • transport and medication main issues • regularity and availability of transport a problem • transport problems worse for rural areas • cost of drugs most times higher than cost of seeing doctor • few mentioned the costs of tests (labs etc)

32. Issues - Service users Suggestions for improvement • facilities inside and out should be kept clean • have an outside waiting area with bathroom (or open health centre earlier) • special clinic day for seniors • more doctors so more time can be spent with doctor • staff should be aware of bus/transport schedules • make drugs available at health centres • drug card should be accepted at all pharmacies • more flexible opening hours for those who work • mobile unit for very rural group

33. Service providersViews on providing care “Most of the damage has been done” • services mainly curative focusing on chronic diseases • too late for anything but curative services - frustration with inability to do more “ I think as physicians we need to be more informed” • Many doctors (although denying it) did not appear to have a thorough understanding of the ageing process and its impact on behaviour.

34. Service providersAttitudes “they are miserable and difficult and set in their ways” “I have lost the passion for work” “some of our attitude is our own fear of ageing”

35. Service providersBarriers • Heavy workload main factor affecting care • Did not have time to encourage preventive services

36. Service providersBarriers • Large numbers of patients • Inadequate space • Lack of drugs • Inadequate working conditions

37. IssuesService providers Need for a supportive work environment Need for training - to understand the needs and behaviours of older persons