“Resolving Geriatric Syndrome Through Elderly Health Services,

September 7, 2019, Indonesia.

“Health Services for Elderly in

Thailand”

Associate Professor Dr. Khanitta Nuntaboot

Center for Research and Development in Community Health System
Faculty of Nursing Khon Kaen University
September 7-8, 2019
 “Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.

Topics
1. Situation of older population in Thailand
2 Approaches for the development of health care
services for the older population
3 Contributions of the community self management
on care of the aged
(1)The context of community care of the aged
(2)Development of community long term care for the aged
4 Long term care system for the older population
5 Key Success Factors
1
Situation of older population in Thailand
“Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.
 “Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.

Health services
At risk inheridity
Social welfare
group
Speed driving games addicts Self care
Stress Obesity
Drug use No one to care growth &
development
violence paralysis access to care
Obese bedbound vaccine
smoking immobility rights to care
Drinking living aloneChronic care
Children pregnancy
abused
No physical AbandonedAged Women
activities
blind เอดส์ Common illness
Unsafe food Disabled Chronic illness
self medication Critical & emergency
hearing loss DM COPD
poverty Cardiovascular
no health check immobilized Hypertension
Ashma feverdiarrhea
Brain
depts ตกงาน Cancer Kidney cough Sore throat
Mental disorder
chemicals Ach and pain
gambling Gastrointestinal
chill
Risky work situations trauma
Weak powerlessness

faint fail
 “Resolving Geriatric Syndrome Through Elderly Health Services
September 7, 2019, Indonesia.

Care and services for the older population

• O2 • Referrals
Emergency • Link and transfer •Etc
• observe patient condition
• vital signs
General care • wound care, tube care
• change tubes • Ventilation care
• pulsation, suction • CAPD care
•Cleanliness • turn every 2 hours • Blood glucose test
•Meals • passive exercise • Insulin injection
•Medicine • dosing • etc.
•Excretion • tube feeding
•Toss and turn • assist in defecate and void
•Mental health support • mobilize and transport
•Support when sitting, •Etc.
standing, walking
•Etc
• degenerative conditions,
disabilities, severe
• degenerative conditions, chronic symptoms
diseases, complications, unusual
• degenerative conditions, with symptoms
chronic illnesses in controlled Aged, chronic diseases, disabled, mental
condition disorders, end of life
2
Approaches for the development of
health care services for the older
population

Essential health, care, & social services
Ensuring comprehensive
care and welfare
particular health care demands,
social welfare, self care abilities,
adjust to the new social life
Conducting
surveillance and control
Specific local CD diseases
Universal access
Home assisted for self care
“Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.
Providing comprehensive
management
of diseases and illnesses, health risk reduction,
disease prevention, rehabilitation, assistance &
support in economy, pensions & allowance
especially those with chronic
conditions, disabilities, end of life
Social Economy
Environ
ment
Health
Ensuring essential
and accessible health care
Emergency-Hospitalized-
Managing home based-continuous
all common ailments, (the poor, the homeless, the PLWD,
basic medical care, delegated persons with psychiatric disorders)
medical treatment
Social services & support
 3 inter related systems underpins “Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.
community health care and welfare
• improve access to all public services • community initiated welfare system
•increase occupational safety • community fund management
• improve home conditions & environment • green market
•waste management • healthy food stalls
• alcohol and tobacco control •supports on local health
personnel development
• increase green areas • increase care skills
• establish center for
disaster management
Improvement Etc.
of human 0-5 years old Self initiated
Etc.
conditions school children health care • Encouraging
that affect health and assistance participation
including social to target
cultural and economic • Use and increase
Local Community groups capacity
government health care & • Planning
young Welfare women design integrate
Leaders adults • Data base decisions
disabled
adults • Design of health
Chiefs chronically ill services
to meet needs of
Organizations
old aged end of life target groups based
on use of data and
evidence

prove health services models responding Health • Family, kins, neighbors,

needs of the older population
•improve integrated health care services
• health protecting volunteers
• increase care skills
• increase health care coverage
Etc.
volunteers as care givers
service
• Caring culture and supports
system from institutes and organizations
strengthening to increase health care skills
• Community leaders initiates and support
caring environment
 Characteristics of the local community on health care and
assistance provision for the people in the community

1.Health services in 2. Health care and 3. Strengthening of the

the community by the assistance of the organizations in the
health service unit people in the community to create
community operations affecting health
• Provides public health
services needed • People in the community • To raise the operations that
• Using science, cultural living together to may affect the health of the
and social knowledge to support each other and people in the community
design the services the drive of the various • Main hosts are the local
• Cover the treatment of organizations to enhance administrative
common diseases, the community health organizations
continuous care, care issues
providing knowledge in • Main hosts of these
order to promote events are the family
healthy behaviors and members, relatives and
reduce risky behaviors. volunteers
“Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.

The driven approaches for the development of community
health care system
1. The development by using
the potential and the social
capital of the area as the base
2. Conducting community
based research
3. Learning from the good
operating results
4. The development
of the public policy
“Resolving Geriatric Syndrome Through Elderly Health Services,
September 7, 2019, Indonesia.
• Strengthen the local communities
• Driving the development of the
community health care systems
• Collaborative operation with the main
organizations and the social capital
• Build the knowledge obtained from the actual
operating in the area
• Synthesis to obtain the knowledge for using in
learning, extending the concept, expanding
operations and developing the public policy
• knowledge management process that can lead to
real operating
• Can change of practices by learning in three
phases : awareness, learning , management
• Conclusion and the development of the agreements and
the rules in support of the main organizations in the
community to work together to drive the operation of
the community health care
 “Resolving Geriatric Syndrome Through Elderly Health Services,

3 Actions for community strengthening

September 7, 2019, Indonesia.

Information
sharing
Key protagonists Organizations
in the Tambon and institutions

Managing Learning
changes
Policy makers
3
Contributions of the community self
management on care of the aged
Strategies S-2I Health care of 13 groupsLocal mechanisms
6 activities LAO
Psychiatric

S
End of
Capacity Patients Persons PLHIV life
Working
ystematization building ages
with
disabilities ผู้ต้องการ
Environment Pregnant ความ
Chronic
management Children mothers ช่วยเหลือ
0-5 Youths illness Chiefs

I
Development
of services Children
0-5 Senior
nnovation Data Youth
management Govern
Welfare Smoking Food ment
and fund Alcohol security
units
Integration
Regulations
and rules

Reduce health risks Community

Agencies
Local governments 2,816 14
 Activities to strengthen community health
9 Community economy self

Career
sufficiency center
Community financial
institutions
Manufacturer market
promotion fund
Career group
Household
Health center Volunteers
Senior club
Tambon HP Hospital
Health care
Orthotics center
Financing Units
Model households economy and services Family development center
Learning center Community Bank
Farmers group 1. Physical 2.Data Community Saving
Plant and Food structures system Social Community Trust
animal
9 Leadership Local Welfare Moral center
conservation
security 3.Campaigns
building Chief Dependable center
groups LAO oscc
Gabage bank 8 Financing Com Government ICT
Waste & system Agencies Units 4.Regulations Life long Religious groups
Model village
pollutions 7 Learning Rules learning Child Development
Learning center system
5 Negotiation Center
Waste 6 Participation
Management Schools
and Pollution Energy Natural resources Local community
❖ Equality replacement
Agricultural services management Cooperation courses
❖ Coverage with
& distribution center Conservative
❖ Supportive Champions government
groups Ad hoc
❖ Fairness
volunteers committee
 Information sharing for learning
Social capital, community Target populations : child,
organizations, institutes, clubs, aged, disabled, poor,
groups, saving and other living alone, farmers,
financing organizations, etc.) vocational groups, etc.

Social capital Problems,

Community • identify social capital conditions,
Capacity • identify 13 target situations, etc.
population from
problems and
demands
Rapid Ethnographic Community
Assessment Process (RECAP) Thailand Community Network
Appraisal Program (TCNAP)
Community based research
(of the community, by the community, for the community)

(Nuntaboot, 2012)
 Community Social Capitals
Health
Area based Volunteers
Government Family Support
units Center
Social Groups &
Organizations
Situations
Aged
•Social
•Home bound
Care Givers
• 60-69 •Bed bound
• 70-79
Local Administrative • 80-89

Older Dependency
• 90+ Disabled elders
Organization
Living conditions Immobility
• With sibling Bed ridden activities
• With older • Confusion and dementia Family
• Immobility
•
•
Alone
As care giver severe illness Members
• End of life

Community
Chiefs Health
Promoting
School for
Hospital
Seniors
 Area expansion/add workers
50-59 y
1. Capacity building
Active aging 2. Environmental

Innovations
management
Olders

•Self help 3. Modify health services

Chronic •Limited movement 4. Welfare and supports
illness •Home bound 5. Develop and use of data
•Bed bound
•End of life 6. Agreements and policies
•Self help 7. etc.
Disabled •Limited movement
• Home bound
•Bed bound Innovation /new groups
•End of life Integration Specific
 ๕ อ. Five personal activities
be able to do and lead others
1 Vocation or income
2 Exercise and physical
generating activities
activities

3 food and
nutrition
๕ อ.
5 Voluntary
4 saving
activities
 ๕ ก. Five community activities
by LOA HPH and community agencies
1 Prevention and
reduce accidents
2 Support
3 Support senior clubs
leadership
development
in school for
the aged ๕ ก.
4 support
4 Encourage and
development and
support
use of orthotics
continuous care
4
Long term care system for the older
population
 Health services and care system
for older population
1.
2. Long term care system 3.
Institutional-based care Community and home -
based care
• Nursing home
• Visiting nurse • Day care services
centers • Rehabilitation centers
Long term care
• Home based care
Hospital Community
• Home wards
Institutes • Home visit by volunteers
Home • etc.
Local community
Urban city (local government)
 Care system for older population Roles and services Supportive mechanisms
Capacity building of • Capacity building ➢ Nurse & Specialist Network
guideline community nurse • Network strengthening • Psychiatric Eyes
tools (complicated ADL) • Innovations finding • Emergencies accidents
hospitalized In Family capacity
community building • Services modifying • Chronic diseases
Capacity •Critical Complicated with CHN • Public policies • CD NCD
building •Emergencies (specialized) • End of life
services •Complicated • palliative etc
•End of life Community
Specialize agencies ➢ Referral system
Disease specific HPH
➢ Data base system
➢ Referral center
Data of social Specialist HPH Senior clubs • Collaborating ➢ Data base system
capital, network network network • Capacity building
volunteers, ➢ Network of nurse &
BMN • Services developing specialist
Allowance funds Data of • Guidelines • Data base • Healthy public policies
Aged, Data base care & • Capacity building • Model champions ➢ Network of community
disabled, Data of treatment • Services innovations innovations finding for nurses
Monks • Funds & welfare
poor aged network Volunteers sharing and learning ➢ Network of Lao
Healers LAO network (community health fund)
network network
➢ HPH Center of orthotics
• Meal, medicine intake ➢ LAO. Day care center family
• Assistance when in poverty support center
• Daily living rehabilitation • Capacity building (LTC,community health
Family • Environmental modification fund , Day services)
• Service care with • Services changes ➢ Tambon development
• Welfare Home complicated
• Prevention & control of • Data base committee
• Funds LAO Aged + 12 HPH ➢ OSCC
• LTC groups problems • Fund raising to support care
• Day services Community • rehabilitation • Healthy public policies ➢ School for seniors
➢Senior clubs
• School for seniors agencies • Care & problems solving ➢ Rescue & emergencies
• Emergencies • Senior clubs • Emergencies ➢ Funds
• Family support (in • Volunteers • OSCC
difficulties ) • Chiefs • traditional healing ➢ Volunteers
• Vocational groups • rescue, emergencies • Physical therapy ➢ traditional healers
response
 Continuous care system for the older population
Rehabilitation General
Rescue, assist hospital Advanced
OSCC Refer, Care, Help LTC medical &
Support nursing
Chronic illness, services
Health complications

Chronic illness, care plan

collaborate &

promoting
participation
rehabilitation

hospital
referal

Rescue, assist
Joint

LTC
Emergency
Agencies organizations

ฉุกเฉิน กู้ชีพ กู้ภัย

Community

รักษาต่อเนื่อง
local
Hospitals

LTC
government
ดูแล
สุขภาพ Primary care cluster
ที่บ้าน
Intermediate care
rehabilitation

cure,
Joint

Social groups therapeutic care,

continuous care
Support
Referal

Home
care
Home

rehabilitation
Bed & ward home

Joint
Day care Brain and body Rehab Social rehabilitation
center Social activities
activities
Joint
rehabilitation Joint rehabilitation
rehabilitation
 Long term care at secondary health services
HPH
1 LAO
HPH LAO.2 Primary Health services at
1 LAO care
LAO.2
HPH
3 cluster tertiary hospital
Primary Gov units
care HPH
HPH cluster 2 LAO.1
3 Private org
HPH Primary care cluster NGO
2 LAO.1 • Chronic illness
• Emergency District Network of
• Critical care Sheriff aged clubs
HPH. 1
LAO Nurses network
LAO.2 Primary
care
Referral system Community Integrated district
HPH cluster private LAO network
3 hospitals plan for QOL sector
HPH Unified data base
2 อบต.1
Network of the LAO Network of HPH, CM
• Community development plan for
HPH district health plan Public Village chief
1 LAO • Social Services Voluntary Social CG network VHV
health office VHV Traditional healer
LAO.2 Primary Platform volunteers
care HPH.
HPH cluster 1 LAO Network of
3 LAO.2 Primary family doctors
HPH care
2 LAO.1 HPH cluster
3
HPH
2 LAO1
Key Success Factors
1. The ratio of nurses and population in the area
2. Having a continuous logistic for the care of older population, to
link between home, hospital, and community based services
3. Having several financial systems in the community with different
purposes, but achieving the goal of comprehensive health care in
the community
4. The integration of the operations of health care and the activities
that can manage the factors that affect health care as a part of
the implementation of the social groups, the community
organizations, the local authorities, the volunteers, the charity
organization and the business sector
5. The systematic use of data to support care and services for the
older population
6. The creation of care and services by those involving organizations
fulfil the complete package for the needs of the older population