Factors Associated with Perceived Health Status of the Vietnamese Older People

Abstract

This study, using data from the Vietnam Aging Survey (VNAS) in 2011 with 2789 persons aged from 60 to 108, explored the factors associated with the perceived health status of the Vietnamese older people. Using logistic regression analysis, the study found that there were no statistically significant differences between older people in their perceived health status in terms of age group, gender, marital status, and living area. In contrast, however, the study also found that reading ability, working status, morbidity, activities in daily living, experience of domestic violence, household income, and satisfaction with housing conditions were strongly correlated with older people’s perceived health status. Based on these findings, the study provided a set of recommendations for developing and implementing policies in order to enhance health status of the Vietnamese older people.

Full text

Factors Associated with Perceived Health Status
of the Vietnamese Older People
Long Thanh Giang
1
&Dat Van Duong
2
&Yeop Jeong Kim
3
Received: 2 May 2017 /Accepted: 23 January 2018
#Springer Science+Business Media B.V., part of Springer Nature 2018
Abstract This study, using data from the Vietnam Aging Survey (VNAS) in 2011 with
2789 persons aged from 60 to 108, explored the factors associated with the perceived
health status of the Vietnamese older people. Using logistic regression analysis, the
study found that there were no statistically significant differences between older people
in their perceived health status in terms of age group, gender, marital status, and living
area. In contrast, however, the study also found that reading ability, working status,
morbidity, activities in daily living, experience of domestic violence, household in-
come, and satisfaction with housing conditions were strongly correlated with older
people’s perceived health status. Based on these findings, the study provided a set of
recommendations for developing and implementing policies in order to enhance health
status of the Vietnamese older people.
Keywords Ageing .Health .Older people .Perceived health status .Policy .Vietnam
Introduction
Population ageing is taking place nearly all around the world. The global share of older
people (those aged 60 years and over) increased from 11.7% in 2013 (or 841 million
people) to expected 21% by 2050 (or 2.1 billion people) (United Nations Department of
Population Ageing
https://doi.org/10.1007/s12062-018-9218-6
*Long Thanh Giang
giang.long@ippm.edu.vn
1
Institute of Public Policy and Management (IPPM), National Economics University, 207 Giai
Phong Street, Hai Ba Trung District, Hanoi 10000, Vietnam
2
United Nations Population Fund (UNFPA), 301 Kim Ma Street, Ba Dinh District,
Hanoi 10000, Vietnam
3
Faculty of Agricultural Economics, National Economics University, 207 Giai Phong Street, Hai Ba
Trung District, Hanoi 10000, Vietnam

Economic and Social Affairs - UNDESA 2013). As estimated by United Nations
(2012), the large older people population has put heavy pressure to the health care
system in all nations. For instance, while communicable diseases is responsible for a
much smaller fraction of disability-adjusted life year (DALY) among the older popu-
lation, at the world level, 85% of persons aged 60 years or over died from non-
communicable diseases (NCDs) in 2008. The percentage by region shows that in the
more developed regions, 92% of persons aged 60 years or over died from NCDs, while
in the less developed regions and least developed countries the percentages were 83%
and 74%, respectively (UNDESA 2013).
Vietnam is not exceptional from aging trend. The rate of older people will increase
from 10% in 2010 (or 8 million people) to 26% in 2050 (or about 26 million
people) (UNFPA 2011). The older persons are projected to exceed the number of
children for the first time in 2034, which is sooner than the global. At the same time,
various reports show that NCDs negatively affect the quality of life of older people
(Pham and Do 2009; Dam et al. 2009; Hoang 2013).
There are several factors influencing the health status of older people. For in-
stance, some studies indicated that the housing environment has been acknowledged
as one of the main settings that affect human health (Bonnefoy 2007,Barnesetal.
2013). Some studies showed the positive relationship between income and health
status of older people (Fillenbaum et al., 2013, Abegunde and Owoaje 2013,Aguila
et al. 2015), while some other studies were not able to demonstrate this association
(Feng et al. 2012,Parketal.2009,Chaoetal.2013). Moreover, few studies have
investigated on the relationship between housework and health benefit of the older
people in the current literature and findings from these studies are likely inconsistent.
While studies suggest that duration of housework per week are associated with poor
self-reported health status among women (Borrell et al. 2004), housework could be
productive, involves physical activity, and yields a clean and pleasing living envi-
ronment, all of which could contribute to good health status of the older people (Blair
et al. 1992,Bessonetal.2008).
Although studies on health status of older people and its determinants have been
conducted in both developed and developing countries, only few anecdotal studies on
the health status of older people was conducted in Vietnam. Particularly, no study with
in-depth analysis of various socio-economic factors associated with health status of the
Vietnamese older people has been undertaken. This study is, therefore, significant
because it contributes to the body of evidence on determinants of health status of the
Vietnamese older people. It also helps to provide evidence for policy makers at national
and sub-national levels to develop and implement appropriate programmes and policies
to enhance the health status of the Vietnamese older people as well as their contribu-
tions to the society.
Data and Methodology
Data
The research utilises the data from the Vietnam Aging Survey (VNAS) in 2011 to
explore factors associated with older people’s health status. VNAS was the first-ever
G. T. Long et al.

nationally representative quantitative survey on Vietnamese people aged 50 and over,
including older people (as defined, those aged 60 and over). The sampling of the
VNAS was based on the information of Population and Housing Census-PHC in 2009
(General Statistics Office 2016). The probability proportional to size (PPS) and
systematical random selection methods were used to conduct the survey sampling in
multi-stages. Eligible participants were selected from 12 provinces representing for six
ecological regions (defined by GSO in PHC 2009, which includes Northern Mountain,
Red River Delta, Central Coast, Central Highlands, Mekong River Delta, and South-
east) with 200 communes and 400 villages in Vietnam. Face-to-face interview was
applied to collect data by using a structured questionnaire. The questionnaire was
developed based on many research instruments used in ageing surveys by the World
Health Organization (namely, Study on global AGEing and adult health - SAGE) and in
other countries such as South Korea, China, and Thailand, as well as the questionnaires
used in other national surveys conducted in Vietnam (e.g., Demographic and Health
Survey, and Vietnam Household Living Standard Survey –VHLSS).
The response rate was about 96%, which yielded about 4000 persons aged 50 and
over for the final surveyed sample. For older population, VNAS included 2789 older
people aged 60 to 108. Among them, there were 1683 were female (60.3%) and 1106
were male (39.7%); and 2050 were living in rural areas (73.5%), while 739 were living
in urban areas (26.5%).
Analytical Method
As one of the most important indicators of well-being, health status is affected by
a number of socio-economic and health strategies and policies, which are
presented by health promotion, disease prevention programmes, and healthcare
services. As such, the determinants of health status for citizens in general and for
older people in particular are complicated and include numerous living
environment and policy domains. Dahlgren and Whitehead (1991) provided a
comprehensive conceptual framework to illustrate these domains, which comprise
different layers: (i) general macro conditions (such as socio-economic develop-
ment, and cultural tradition) which have important long-term health effects; (ii)
basic social, health, and economic institutions (such as education, employment,
and housing), which sustain or impair a healthy existence; (iii) social and com-
munity interactions/exchanges, in which individuals are influenced to have col-
lective decisions; and (iv) individual behavioural choices (such as health-risk
behaviors like smoking and drinking). In this paper, given the existing data, we
will apply this framework to take into account various individual and household
characteristics.
To define factors underlying health status of older people, we will use a multiple
logistic regression approach, in which the outcome variable (Y)–in this research, it is
the health status of an older person –is assumed to be binary which only takes two
values (0 or 1), and the independent variables (X) are individual and household-level
factors of older people. The logistic regression model is defined as follow.
Py
i¼1jXðÞ¼βiXiþεið1Þ
Factors Associated with Perceived Health Status of the Vietnamese...

In which:
&X
i
represents individual and household-level factors affecting the health status of an
older person;
&β
i
is coefficient for each variable X
i
;
&ε
i
is the error term, which is assumed to follow normal distribution.
For each dummy variable, it is categorized into two groups: the reference group and
the comparative group. In estimation, when compared to the reference group, an odds
ratio of less than one means that the comparative group is less likely to be healthier,
while a value of more than one indicates a greater likelihood. Statistical significance is
indicated for the 5% level.
Dependent Variable –Perceived Health Status of Older People
Health status of an older person is measured by his/her perceived health status. In
VNAS questionnaire, a respondent rated his/her own health status in a five-point
scale, in which the highest point (5) represents for the Bvery good^health, and
then 4 for Bgood^,3forBnormal^,2forBbad^,and1forBvery bad^.Forthe
purpose of this paper, the model will examine the probability that an older person
is set into the group Bgood health^(which includes those stated that their health is
Bvery good/good/normal^, and will be valued at 1) or the group Bbad health^
(which includes those stated that their health is Bpoor/very poor^,andwillbe
valued at 0).
Independent Variables
Independent variables include those representing for individual and household charac-
teristics of older people in the data.
The individual variables include:
&Age: The older people are divided into three groups by age: (i) young old (60–69);
middle old (70–79), and (iii) the oldest old (80 and over). The first group is the
reference group.
&Gender: The variable is used to examine the discrepancies in health between old
female and male respondents. In the estimation, males are the reference group.
&Marital status: This variable composes of two main groups, i.e., currently married
and currently non-married (including never married/single, divorced, separate, and
widowed). The former group is the reference group.
&Reading ability: This variable is used as a proxy for an older person’s educational
level. If a person can read, he/she can be able to get information related to daily
living, including those for healthcare. This variable has two categories, i.e.,
Breading easily^and Breading with difficulty or not able to read^, in which the
former is the reference group.
&Working status: That an older person was working might be their wish to be active,
or their must to earn a living. Thus, it is quite difficult to predict how working
would influence on health status of older people. In the estimation, this variable is
G. T. Long et al.

defined by two groups, i.e., Bcurrently working^and Bcurrently not working^,in
which the former is the reference group.
&Morbidity: This variable is clearly important factor influencing health status of
older people. In the estimation, it presents the situation that an older person faced
any physical illness in the past 12 months, and includes two groups, i.e., Bhad any
sickness^,andBhad no sickness^. The former group is the reference group.
&Activities in Daily Living (ADLs): ADLs are an important indicator showing an
older person’s capability in doing some basic activities such as washing faces,
wearing clothes, and eating. This variable composes two groups, i.e., Bhad any
difficulty in ADLs^and Bhad no difficulty in ADLs^, in which the former group is
the reference group.
&Experience of domestic violence: Domestic violence is a crucial factor influencing
health of older people. This variable contains two groups –one is those who
experienced any domestic violence (being spoken harshly, being refused to talk
with family members, or being shaken/hit by family members), and the other is
those who did not experience any domestic violence. The former is the reference
group.
The household-related variables include:
&Living area: Older people divided into two groups –one includes those lived in
urban areas, and the other includes those lived in rural areas. The former group is
the reference group.
&Household’s annual income in the past 12 months: The older households are
divided by two groups –one with VND 50 million (equivalent to $US 2200) and
above, and the other one with less than VND 50 million. The threshold VND 50
million shows the economic situation of an older person’s household. In the
estimation, the former is the reference group.
&Satisfaction with housing: Housing conditions are important to quality of life, and
thus health status of older people. In VNAS, the respondents show their satisfaction
with housing conditions in a five-point scale, in which the highest point (5)
represents for the Bvery satisfied^, and then 4 for Bsatisfied^, 3 for Bnormal^,2
for Bnot satisfied^,and1forBvery dissatisfied^. For this variable, the estimation
will divide by two groups –one is for Bsatisfied with housing^(which includes
those stated that they felt Bvery satisfied/satisfied/normal^, and will be valued at 1)
and the other is for Bdissatisfied^(which includes those stated that they felt
Bdissatisfied/very dissatisfied^, and will be valued at 0).
There have been a number of studies showing that older people are particularly
different in various socio-economic and health indicators in terms of gender (i.e., males
vs. females) and area of living (i.e., urban vs. rural). Thus, before conducting the
logistic model as in (1), we will conduct Chow tests to determine whether male and
female and/or urban and rural older people are statistically different in terms of health
status. If the null hypothesis (i.e., there are.
In all calculations, we will use the sample weights to make the whole sample or sub-
samples to be representative for the whole older population or specific groups of older
people in Vietnam.
Factors Associated with Perceived Health Status of the Vietnamese...

Results and Discussions
Demographic Characteristics
Demographic parameters of the VNAS 2011 are presented in Table 1. The age of the
surveyed population was ranged from 60 to 108 years old, and the mean age of the
respondents was 71.93 years old (SD = 8.89). By age group, the young old accounted
for 45.7%; middle old accounted for 33.5%, while the oldest old accounted for 20.8%
of the total surveyed population.
Regarding marital status, 57.8% were married, 38.7% were widowed, while other
accounted for a very small proportion.
The respondents had low readability: only 53.1% could read with ease; 24.3% could
read with difficulty; and 18.8% could not be able to read. This was quite consistent with
their reported highest educational achievement: more than 50% did not complete
primary school or had no schooling, while only 17.2% could complete primary school
(VWU 2012).
About 38% of the respondents were working. The report by VWU (2012)showed
that, among working persons, farming work accounted for the majority (about 63%),
while wage workers accounted for very small proportion (only 3.5%).
The results for morbidity showed that 27.9% of the respondents had no chronic
disease; 28.2% had one chronic disease, while 43.9% had multi-morbidities (at least
two diseases at the same time).
For the activities of daily living (ADLs), about 74% of the respondents said that they
did not have any difficulty, while the remaining 26% of the respondents said that they
had difficulty in at least an activity. Among those reported to have difficulty with at
least an activity, VWU (2012) found that the proportion of the older people who report
the level of difficulties when eating, getting dressed or undressed, bathing/washing
yourself, getting up, and using the toilet at Bmild^or Bmoderate^level were 73%, 57%,
50%, 73% and 64% respectively. On the other hand, the proportion of those who rated
these activities as Bsevere^or Bcannot do it at all^were 27%, 43%, 50%, 27%, and
36%, respectively.
About 11% of the respondents experienced a type of domestic violence. According
to the report by VWU (2012), women and more advanced age persons had higher rates
of experience with domestic violence than did their counterparts.
In terms of household’s annual income, the results show that about 68% of the
respondents said that their households had the annual income at less than Vietnam
Dong (VND) 50 million. The report by VWU (2012) showed that it was likely more
men had the annual income bigger than VND 50 million compared to women (44.5%
compared to 27.1%, respectively) (P-value<0.01).
For their satisfaction with housing, the proportion of the respondents who reported
Bsatisfied^was about 85.5%.
Health Status of Older People
Our data analysis found that of the investigated respondents, 12.2% perceived that they
had very poor health, and 57.1% had poor health status. In contrast, 26.6% perceived
normal and only 4.2% perceived good and 0.5% perceived very good health.
G. T. Long et al.

Tab le 1 Demographic variables of the respondents
Characteristics N % (weighted)
Age 2789 100.0
60–69 1275 45.7
70–79 934 33.5
80 and over 580 20.8
Gender 2789 100.0
Male 1106 39.7
Female 1683 60.3
Marital status 2789 100.0
Married 1612 57.8
Widow 1078 38.7
Single 65 2.3
Divorced 19 0.7
Separated 15 0.5
Reading ability 2786 100.0
Yes, easily 1479 53.1
Yes, but with difficulty 678 24.3
No 523 18.8
I used to but forgot 106 3.8
Wor king s ta tus 2783 10 0. 0
Currently working 1066 38.7
Currently not working 1717 61.3
Morbidity 2783 100.0
Having no disease 776 27.9
Having one chronic disease 785 28.2
Having multi-morbidities 1222 43.9
ADLs 2783 100.0
No difficulty 2062 74.1
Had difficulty 721 25.9
Experienced with domestic violence 2783 100.0
Yes 312 11.2
No 2471 88.8
Area of living 2789 100.0
Urban 884 31.7
Rural 1905 68.3
Household income in the past 12 months 2783 100.0
Less than VND 50 million 1895 68.1
VND 50 million and over 888 31.9
Satisfaction with housing 2783 100.0
Satisfied 2352 84.5
Dissatisfied 431 15.5
Source: Own calculations, using VNAS 2011
Factors Associated with Perceived Health Status of the Vietnamese...

Table 2presents health complaints of the older people in 30 days prior to the survey
date. It shows that the majority of respondents experienced with a number of health
issues: back pain (72.4%), headache (70.6%), dizziness (69.0%), joints pain (68.9%),
feeling weak (61.2%), coughing (52.7%). In addition, over one-fifth of the respondents
also experienced with constipation (27.1%), stomachache (24.8%), vomiting (24.5%),
skin problem (22.3%), and fever (20.2%). Moreover, a smaller proportion of the
respondents reported to have diarrhea (14.3%) and loss of bladder control (9.7%). In
addition, our analysis of data also found that 45.4% of older people were diagnosed
with blood pressure problems; 34.1% had arthritis; 17.4% had chronic lung disease
emphysema and/or bronchitis; 16.5% had heart diseases, 10.4 had cataract; 8.6% had
oral health; 8.3% had angina; and 7.5% had liver diseases. The proportion of the
respondents had diabetes, cancer and depression was small: 5.5%, 1.3% and 0.5%,
respectively. Among the respondents who diagnosed with a disease, a majority of them
received treatment: diabetes (90.8%), blood pressure problem (85.9%), arthritis
(84.0%), chronic lung disease emphysema/bronchitis (84.0%), heart diseases
(82.2%), angina (76.4%), and liver diseases (74.5%).
Factors Associated with Older People’s Health Status
We conducted logistic regression analysis to explore the factors associated with the
perceived health status of older people. Prior to the logistic model, as discussed above,
we conducted Chow tests to examine whether (i) male and female older people are
different in their perceived health statuses, and (ii) urban and rural older people are
different in their perceived health statuses. The results indicated that the null hypotheses
(i.e., male and female older people / urban and rural older people are not different in
their perceived health statuses) are not rejected. This means that we will not need to
separate the male and female samples as well as urban and rural samples in the logistic
model. Table 3presents the results of the logistic model for the pooled data.
In term of age, the results show that there were no differences between the young
old, the middle old compared to the oldest old in their perceived health status. The
analyses by VWU (2012) and Le and Giang (2016) consistently indicated that there
were no statistical differences between these groups of older people in their perceived
health statuses. In fact, for the diagnosed health status, data from VNAS showed that
more advanced ages were statistically correlated with higher number of morbidities.
Such contradictory findings imply that there must be some other related factors from
the respondents (such as cultural tradition in expressing self-assessment).
For both gender and living area factors, the results are quite consistent with the
Chow tests, showing that there were no statistically significant differences between
older people in their perceived health statuses in both gender and living area
perspectives. Le (2015) also proved these findings various statistical tests. The same
finding was also implied in regard to the marital status of older people as the P-value of
this variable was greater than 0.05.
With a regard to the literacy level, which is presented by reading ability, the results
indicated that it was a significant variable: it was likely that those could read easily had
2.24 times chance to higher than those who had difficulty in reading in having better
perceived health status (OR = 2.242, 95%CI = 1.534–3.275, P-value<0.001). Reading
could help older people access to various sources of information, including those for
G. T. Long et al.

Tab le 2 Health complaints of the older people in the last 30 days
Health complaints N % (weighted)
Back pain (n=2786)
Yes 2017 72.4
No 769 27.6
Headache (n=2788)
Yes 1967 70.6
No 821 29.4
Dizziness (n = 2788)
Yes 1925 69.0
No 863 31.0
Joints pain (n=2788)
Yes 1920 68.9
No 868 31.1
Feeling Weak (n= 2787)
Yes 1707 61.2
No 1080 38.8
Coughing (n = 2788)
Yes 1470 52.7
No 1318 47.3
Breathing problem (n=2787)
Yes 1019 36.6
No 1768 63.4
Chest pain (n=2784)
Yes 1011 36.3
No 1773 63.7
Trembling hands (n=2785)
Yes 768 2 7. 6
No 2107 72.4
Constipation (n = 2786)
Yes 755 2 7. 1
No 2031 72.9
Stomachache (n = 278 5)
Yes 691 2 4. 8
No 2094 75.2
Vomiting (n = 2788)
Yes 684 2 4. 5
No 2104 75.5
Skin problem ( n = 2786)
Yes 622 2 2. 3
No 2164 77.7
Fever (n=2783)
Yes 563 2 0. 2
No 2220 79.8
Factors Associated with Perceived Health Status of the Vietnamese...

healthcare, and thus this would help them in daily living. Evidence on the impact of
education level to health status of the older people is documented in a number of
studies (see, for instance, Bodde et al. 2009,Macketal.,2003, Simsek et al. 2014).
Particularly, a study in Iran on obesity amongst the older people suggested that when
using the basic education level is used as the reference group, obesity odds ratios were
1.38 (95% CI: 1.08–1.76) for the moderate education level and 0.92 (95% CI: 0.56–
1.52) for the high education level group. Simsek et al. (2014) suggests that lower
education level and lower social class were found to be protective factors for smoking
in women. In women, the risk of unhealthy diet was found to be 1.54- and 2.18-fold
significantly higher, respectively, among those who graduated from primary school and
uneducated. With regard to self-perceived health status, education level is significantly
related to poor/very poor health status in women (Simsek et al. 2014).
Health is strongly related to working status of older people (Giang and Le 2017;Le
2015; Nguyen 2015). The results here also support for this evidence, indicating that
those who were working had about 1.5 times chance higher than those who were not
working in having better perceived health status (OR = 1.488, 95%CI = 1.031–2.145,
P-value<0.05). A study in South Korea found the ORs for obesity were respectively
1.172 and 1.164 in the part-time employees, and 1.451 and 1.399 in the unemployed
group for men and women, compared to the full-time employees (Kang et al. 2013).
However, in a study in Japan found that working status itself does not appear to
associate with health and health-care utilization among older people Japanese
(Tokuda et al. 2008). This means that health status should be correlated with other
socio-economic factors of older people in explaining their working purpose.
The findings for morbidity and ADLs are the same, in which those who had any
morbidity or difficulty in ADLs would have about 0.430 and 0.371 times chances lower
than those who had no morbidity or no difficulty in ADLs in having better perceived
health statuses, respectively.
Domestic violence is strongly associated with health of older people (VWU 2012;
UNFPA 2013). Our estimation showed that older people who experienced domestic
violence had 0.527 times chance lower than those who did not experience in having
better perceived health status. This finding provides an important implication for
protecting rights at home of older people.
The results also implied that amongst those who had their annual income at VND 50
million and higher were likely to have 1.835 times higher chance to have better
Tab le 2 (continued)
Health complaints N % (weighted)
Diarrhea (n = 2788)
Yes 399 1 4. 3
No 2389 85.7
Loss of bladder control (n = 2788)
Yes 270 9.7
No 2518 90.3
Source: Own calculations, using VNAS 2011
G. T. Long et al.

perceived health status compared to those whose households had the annual income at
less than VND 50 million (OR = 1.835, 95%CI 1.211–2.780, P-value<0.01). The
finding was similar to those in other studies: A study conducted in Nigeria found that
low monthly income were significant predictors of hypertension (Abegunde and
Tab le 3 Factors associated with perceived health status of older people - logistic regression
Variables Odds Ratio 95% CI P-value
Lower Upper
Age group
80+ 1
70–79 0.931 0.586 1.480 0.763
60–69 1.021 2.771 1.740 0.939
Gender
Male 1
Female 0.900 0.618 1.312 0.584
Marital status
Currently married 1
Currently non-married 1.421 0.934 2.162 0.100
Reading ability
Reading with difficulty 1
Reading easily 2.242 1.534 3.275 0.000
Currently working?
No 1
Yes 1.488 1.031 2.145 0.033
Had any morbidity?
No 1
Yes 0.430 0.323 0.574 0.000
Had difficulty in ADLs
No 1
Yes 0.371 0.217 0.633 0.000
Experienced domestic violence?
No 1
Yes 0.527 0.340 0.816 0.004
Area of living
Rural 1
Urban 1.484 0.994 2.213 0.053
Household income in the past 12 months
Less than VND 50 million 1
VND 50 million and above 1.835 1.211 2.780 0.004
Satisfied with housing conditions?
No 1
Yes 1.830 1.211 2.767 0.004
Source: Own calculations, using VNAS 2011
Factors Associated with Perceived Health Status of the Vietnamese...

Owoaje 2013). Another study in Mexico showed that when the older people were
provided an additional $67 per month, a 44% increase in average household income,
significant health benefits associated with the additional income was demonstrated
(Aguila et al. 2015). It is worth noting that there were no relations between health and
income, depending on how they are measure. For instance, a study in China showed
that the health of the older people is not only affected by individual income (Feng et al.
2012). For South Korea, it was indicated higher income was associated with better
health status among the older people. However, these effects showed that health status
of the aged is related more closely to the individual’s wealth than income (Park et al.
2009). Similarly, a study in Italy did not show significant impact of financial issues to
health of the older people (de Belvis et al. 2008). Such controversial findings between
countries imply that, to provide comparative perspective between income and health,
there should be consistencies in definitions and measurements of these variables.
Regarding relation between satisfaction of housing conditions and perceived health
status, our results indicated that older people who were satisfied with their housing
conditions were 1.830 times higher chance to have better perceived health status than
were those who were not satisfied (OR = 1.830, 95%CI 1.211–2.767, P-value<0.01).
TheanalysesofVWU(2012) also support this finding, in which those who lived in a
house with better quality (such as the house with permanent structure, and kitchen and
bathroom were inside the house) had better perceived health status than those who lived
in a house with less quality (such as the house with semi-structure, and kitchen and
bathroom were outside the house). Barnes et al. (2013) also found thay poor housing
conditions are strongly associated with physical illnesses (such as eczema, hypother-
mia, and heart disease, which in turn seriously affect health status of older people.
Conclusions and Recommendations
Based on the findings of the study, we provide recommendations on the development
and implementation of national policies to enhance the health status of the Vietnamese
older people.
First, in order to improve the health status of the older people, health and social care
policies and programmes should consider multiple socio-economic factors. Particularly,
healthcare programmes should consider both adequate and affordable treatments of
chronic diseases, while social care programmes should consider various ADLs issues.
To do so, the government should develop policies that promote strong intergenerational
relationship in older people’s families and communities so that members can share
experience, workload as well as care and support to each other.
Second, to ensure the effective responses to the healthcare needs of the older people,
the government should develop a concrete national plan, which comprise various
strategies, policies and programmes, on social protection in which health rights of
older people should be included in socio-economic development agenda.
Finally, it also is emphasized that the active participation of older people is vital for
the effective development and implementation of policies for the older people. For
instance, policies encouraging older people in productive activities –either at their
households, communities or businesses –should be considered in order to get their
further economic contributions to the society and, at the same time, to prevent labor
G. T. Long et al.

exploitation. These policies in turn will contribute to protecting older people’shealth
rights.
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