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      Clinical Interventions in Aging (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on prevention and treatment of diseases in people over 65 years of age. Sign up for email alerts here.

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      Subjective health and quality of life among elderly people living with chronic multimorbidity and difficulty in activities of daily living in rural South Africa

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          Abstract

          Background: South Africa has been experiencing a growing proportion of elderly population with rapid increases in the burden of non-communicable diseases (NCDs) characteristic of population aging. Rural areas in South Africa represent a far smaller fraction of the population, however, share a relatively higher burden of NCDs. In the current literature, there is limited evidence on rural studies in the context of chronic diseases and activities of daily living (ADLs) among the elderly population (60 years and above) in South Africa.

          Purpose: In this regard, we undertook the present study with the objective of examining the demographic, behavioral, and socioeconomic predictors of subjective health, depression, and quality of life among elderly men and women living in the rural areas (n=2,627).

          Methods: Data for this study were collected from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Main explanatory variables were self-reported NCDs and difficulties in ADLs. The predictors of subjective health, depression, and quality of life were assessed using multivariable regression methods.

          Results: We found that the proportion of participants who reported good health, not having depression, and good quality of life was respectively 44.7%, 81.3%, and 63%. Women in the oldest age group (80+ years) were significantly less likely to report good health (OR=0.577, 95% CI=0.420, 0.793) and quality of life (OR=0.709, 95% CI=0.539, 0.933) compared with those in the youngest group. Having more than one chronic condition and ADL difficulties significantly lowered the odds of good health, having no depression, and quality of life among men and women.

          Conclusion: The present findings suggest the involvement of sociodemographic factors in health and quality of life outcomes among elderly South Africans, and call for enhanced efforts to address these health limiting conditions such as ADLs and chronic multimorbidity.

          Most cited references29

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          Assessing the validity of single-item life satisfaction measures: results from three large samples.

          The present paper assessed the validity of single-item life satisfaction measures by comparing single-item measures to the Satisfaction with Life Scale (SWLS)-a more psychometrically established measure.
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            Health in South Africa: changes and challenges since 2009.

            Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2·0% of national health spending. However, large racial differentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              The burden of non-communicable diseases in South Africa.

              15 years after its first democratic election, South Africa is in the midst of a profound health transition that is characterised by a quadruple burden of communicable, non-communicable, perinatal and maternal, and injury-related disorders. Non-communicable diseases are emerging in both rural and urban areas, most prominently in poor people living in urban settings, and are resulting in increasing pressure on acute and chronic health-care services. Major factors include demographic change leading to a rise in the proportion of people older than 60 years, despite the negative effect of HIV/AIDS on life expectancy. The burden of these diseases will probably increase as the roll-out of antiretroviral therapy takes effect and reduces mortality from HIV/AIDS. The scale of the challenge posed by the combined and growing burden of HIV/AIDS and non-communicable diseases demands an extraordinary response that South Africa is well able to provide. Concerted action is needed to strengthen the district-based primary health-care system, to integrate the care of chronic diseases and management of risk factors, to develop a national surveillance system, and to apply interventions of proven cost-effectiveness in the primary and secondary prevention of such diseases within populations and health services. We urge the launching of a national initiative to establish sites of service excellence in urban and rural settings throughout South Africa to trial, assess, and implement integrated care interventions for chronic infectious and non-communicable diseases.
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                Author and article information

                Journal
                Clin Interv Aging
                Clin Interv Aging
                CIA
                clinintag
                Clinical Interventions in Aging
                Dove
                1176-9092
                1178-1998
                17 July 2019
                2019
                : 14
                : 1285-1296
                Affiliations
                [1 ] School of Public Policy and Management, China University of Mining and Technology , Xuzhou, People’s Republic of China
                [2 ] School of Safety Engineering, China University of Mining and Technology , Xuzhou, People’s Republic of China
                [3 ] Department of Industrial Development, China National Center for Biotechnology Development , Beijing, People’s Republic of China
                [4 ] School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, People’s Republic of China
                [5 ] Research Center for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education , Wuhan, People’s Republic of China
                [6 ] Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University , Chongqing, People’s Republic of China
                [7 ] Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa , Ottawa, ON, Canada
                [8 ] School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, People’s Republic of China
                Author notes
                Correspondence: Rui HuangSchool of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology , 13 Hangkong Road, Wuhan430030, Hubei, People’s Republic of ChinaEmail hys19810612@ 123456163.com
                Shangfeng TangSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology , 13 Hangkong Road, Wuhan430030, Hubei, People’s Republic of ChinaEmail sftang2018@ 123456hust.edu.cn
                Article
                205734
                10.2147/CIA.S205734
                6645605
                31409978
                8cf18666-f946-402c-b6ff-ff5ffe6f5ecb
                © 2019 Wang et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 17 February 2019
                : 03 June 2019
                Page count
                Tables: 4, References: 40, Pages: 12
                Categories
                Original Research

                Health & Social care
                activities of daily,elderly population,non-communicable diseases,rural health,south africa

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