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Table 3 Health Service Needs, Utilisation and Responsiveness

From: Health needs of older populations affected by humanitarian crises in low- and middle-income countries: a systematic review

Author, date, reference, (quality score) b

Context

Definition of older age

Outcome of interest/ study design (analysis)

Health service needs/utilization

Responsiveness of services

Ardalan et al., 2010. [25] (9/10)

Iran

earthquake

60+

Perceptions of older persons of post-disaster needs.

Qualitative - focus-group and interviews (content analysis)

 

Inappropriate services: Aid-agencies distributing food and equipment without attentions to special needs of older people. Not receiving appropriate attention for their physical limitations. Unable to benefit from some provided supplies due to physical constraints. Affronts to dignity in the ways that the relief aid was provided. Aid delivered in a competitive way that disadvantaged older people. Not consulted about needs. Due to physical restrictions, older people would have preferred assistance to be given in their homes. Perception that asking for help in public was degrading. Maintaining respect was a priority.

Ardalen et al., 2011 (b) [27] (7/10)a

Iran

earthquake

60+

Accessing medical services & difficulty measure (SRQ)/

cross-sectional (multivariate)

Difficulty accessing medical services 2 months after event: 58.6% (not significantly associated with ADL or IADL score)

 

Chan et al., 2009(a) [31] (4/10)

Pakistan

earthquake

45+

Attendance and conditions treated at clinic/clinic records review (bivariate)

Utilisation: fewer older people utilized rural clinic (compared to urban): 14% vs.26% (no significance test available) suggesting geographical barrier.

Gender: Men predominant users of rural clinic 70% (vs. females 30%). Women’s use of services were inversely related to travel distance to the clinic.

When only male doctors available (in rural clinic) attendance decreased by 30%. Men had no access to psychosocial support (available programs targeted only women and children).

Absence of documentation regarding chronic diseases in clinic records. Only acute medical problems were treated despite findings of existence of chronic conditions in 38% of rural study sample (physical examination).

Chan, 2009(b)

[32] (4/10)

Pakistan

earthquake

Not specified

Healthcare provider perspective on health needs of older people/quantitative - stakeholder survey (descriptive analysis)

 

Planning: 6.6% had planning/consideration of older poeple in their available programs. No local organizations had awareness of guidelines for geriatric services.40% of INGO’s had heard of guidelines but none had planned for such services.1 national agency had guidelines and had considerations in their program.

Awareness: No one provided geriatric specific services in the emergency programs.

Capacity: No one had staff trained in geriatric sub-specialities. 40% had staff trained in NCD management. 60% had drugs to treat common geriatric illnesses. 20% had access to mobility aids. INGO’s performed the worst in terms of age- and gender sensitive programs. 80% of INGO’s had relevant drugs. No INGO provided geriatric specific services or mobility aids.

Duggan et al., 2010 [34] (7.5/10)

Sri Lanka

tsunami

60+

Perceptions of older people on disaster response and preparedness/qualitative (content analysis)

Problems accessing government services (scarcity of services and cost of transport); older people excluded from rehabilitation programs due to targeting; lack of outreach programs; strong feelings of self-responsibility and inability to affect the situation.

Inclusion and consultation: Agencies failing to consult older people on needs. Older people reported no exposure to disaster preparedness information. Perception of unfair system of distribution of aid. Lack of relief addressing long-term needs. Rarely consulted on their needs for accessing services.

Jia et al., 2010

[39] (8/10)a

China

earthquake

60+

PTSD (PCL-C), general psychiatric morbidity (GHQ-12)/quantitative - cross-sectional (multivariate)

Younger adults: more utilization of mental health services (19.6 vs.12.3%). Difference non-significant (p = 0.10).

 

Johns Hopkins & Institute for Policy Studies, 2012 [40] (8/10)

IDPs in Georgia/war

60+

Older people’s perspective on current problems for internally displaced older adults/qualitative (thematic analysis)

Health access problems: money for medications, no or insufficient health insurance, expensive and ineffective medical treatments.

 

Lutala et al., 2010 [43] (3/10)

Democratic Republic of Congo /war

60+

Healthcare seeking behaviours of older people (SRQ) /quantitative - cross-sectional (descriptive)

Knowledge: Knowledge of modern health structure 37.2%; unaware of any health facility 6.4%; unsure of how to answer the question 57%

Health utilisation: private facility and traditional healer: 56.6%; public health facility: 3.3%; facility preference - public health facility 36%, private health facility: 1.2%

 

Strong et al., 2015

[52] (5/10)

Syrian & Palestinian refugees

in Lebanon/war

60+

Reasons for not seeking care/quantitative - cross-sectional (descriptive)

98.5% reported difficulties in accessing health care. Main reasons for not seeking care: financial 79%; lack of knowledge of where to go 12%; physical inability to travel 4%.

97% reported difficulties in accessing medicines. Main reasons for not accessing medicines: financial 87%; lack of knowledge of where to go 7%; physical inability to travel 3%.

 

Wong et al., 2015 [55] (5/9)

21 crisis-affected countries (conflict & natural disasters)

(50+)

Intra-operative mortality & surgical procedure types – retrospective cohort of routine data (93,385 operative cases, 11% older people) at MSF facilities, June 2008 to Dec 2012 (descriptive)

A lower proportion of urgent surgical cases when compared to younger age groups (<50 years).

Most commonly performed surgical procedures for older people included herniorrhaphies, simple and extensive wound debridement, abscess incision and drainages, minor tumorectomies, and urological procedures

 

Wu et al., 2015 [56] (5/10)a

China, flooding

60+

Healthcare seeking behaviour

Utilisation: two-week health-care seeking rate was significantly higher in the post-flood group (p = 0.013) (vs. reference population)

 
  1. a These were the only studies that conducted tests of statistical significance
  2. b For detailed results on quality assessment, please email corresponding author