An analysis of the health care needs of the Jamaican elderly
Mitchell-Fearon, Kathryn Grace Camille
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Jamaica is experiencing a rapidly ageing population, within a volatile economic and social environment. This limits the adoptability of developed country evidence and makes it important for Jamaica to quantify its own ageing related trends, and to respond in a targeted, context specific manner. This study has the primary goal of producing elder-sensitive primary health care (PHC) policy recommendations suitable for the Jamaican government. This task will be accomplished through: i) a review of international and national PHC and ageing frameworks; ii) the use of survey data to develop an epidemiological profile, and a PHC access and utilization profile of the elderly; and finally iii) through the use of evidence from systematic reviews and randomized controlled trials. The health profile of the elderly revealed high rates of chronic diseases (76.4%), cognitive (11%) and mental (16%) impairment, and falls (21.7%) in this population. The ability to undertake activities of daily living (ADLs) was high in this cohort (93%), while ability to undertake instrumental activities of daily living was more moderate (77%). Generally, women reported a higher disease burden than men, and disease prevalence showed a positive relationship with age (i.e. the over 80 group had the highest disease burden). In terms of access and utilization, most persons (93%) reported having a routine source of care and annual check-ups (80%), however preventive services were significantly under-utilized especially in the public sector. The major barriers to accessing services were reported as: cost (81%), drug availability (23%), waiting time (21%), and transport issues (14%). In spite of a ‘no user fee’ policy in the public sector, 43% of the cohort reported having paid for services. PHC recommendations focused on addressing barriers to care identified from study analysis and from international literature. Recommendations were developed to be practical, applicable and most of all financially viable in the Jamaican setting. Most policies were developed for easy integration into already operational systems, thus increasing the likelihood of implementation success, and sustainability.