MEDICAL COLLEGES OF NORTHERN PHILIPPINES

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DIE WILL BE DONE: THE PERCEPTION OF OLD-AGE PEOPLE TOWARD

TREATMENT AND HOSPITALIZATION

A Qualitative Research Presented to the

Faculty of College of Nursing of Medical Colleges of Northern

Philippines

In Partial Fulfillment of the Requirements in the subject

Research 1

Abuyuan, Irish Keith R.

Agaloos, Rose Vergenie C.

Alfonso, Kimberly Mae A.

Areola, Arlette V.

Asuncion, Angelika Jane R.

Bartido, Lala Marie

2022
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Chapter I

INTRODUCTION

Background of the Study

With increasing number of older adults worldwide, promoting health and well-

being becomes a priority for aging. Well-being and physical and mental health are

closely related, and this relation may become more vital at older ages as it may

contribute to aging well. The state of well-being is a multifaceted phenomenon that

refers to an individual’s subjective feelings and exploring perspectives of older adults on

aging well is developing to be an important area of research (Hadeel Halaweh et. al.,

2018).

The WHO defines active aging as “the process of optimizing opportunities for

health, participation, and security in order to enhance quality of life as people age

including those who are frail, disabled, and in need of care.” Aging is part of our life, and

as we grow old, our immune system weakens, and we develop some illnesses.

According to (Mattison, 2021), patients at 65 years old above, represent a large number

of hospitalized patients. When compared to middle-aged people, older adults are more

than twice as likely to require hospitalization. Sensory changes such as hearing loss

and vision loss, weakness and difficulty in performing daily activities are commonly

experienced as a result of aging. Cardiovascular disease, osteoporosis, and dementia

are common conditions of elderly. They are more likely to have coexisting chronic

diseases and disabilities, and they require age-appropriate therapy to reduce the risk of
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adverse outcomes while in the hospital. If the problem is not able to be solved, there is

a possible long-term hospitalization and treatment, underlying conditions may be severe

and life expectancy will be shortened.

As the aging process is continuously changing based on the environment over

time, and the timing and pace of this transition varies from region to region. Older and

younger population in the Philippines is growing at the same time. According to the data

of (Knoema, 2020), the Philippines' mortality rate for Filipinos aged 60 and over was

50.87 deaths per 100 persons. The Philippines' old-age Filipino mortality rate went from

34.69 deaths per 100 people in 1975 to 50.87 deaths per 100 population in 2020,

expanding at a 4.38% annual rate. Therefore, the demographic change on the data on

mortality rate can put a strain on the country’s actions towards the health of the citizens.

Nowadays, there is only limited data with the views and concerns of the old-age people

in the Philippines.

The study of (Carlos, 2019), on the worries of the elderly indicated that their

social security and poverty, health difficulties, and abuse are quite restricted. Aging in

the Philippines remains a subject that is severely under-theorized in research (Villegas,

2014). Although older Filipinos do appear in the country’s national reports, current

empirical studies incorporating older adults appears to be lacking in the Philippines. The

majority of research centered on older Filipinos appears to focus on perceptions of

aging, quality of life of older Filipinos, and older adults in the workforce. Since there are

few studies conducted in the Philippines with regards to the perceptions of older
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persons, the researchers believe that study in every parts of the country can be

conducted specifically in parts of Southern Cagayan (Penablanca, Tuguegarao, and

Solana), so that the data can help the health care providers and the old-aged people.

According to De Leon observed that, at best, the interests and concerns of the

elderly population impact talks concerning the Philippines' progress. He stated that,

while the government has established social welfare measures, their implementation

continues to meet challenges, owing to a lack of understanding of their problems.

Therefore, licensed health care providers, government health agencies, and

government authorities must foresee the gap between the growing death rates of older

adults and the health care programs offered to the older adults. A study on the attitudes

specifically on the old-aged people, with regards of the health care systems must also

be viewed and studied.

Research Question

Specifically, this study aims to answer the question:

- What are the perception, views, experiences, and preferences among old aged people

towards hospitalization and medical treatments?

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Theoretical Framework

INPUT PROCESS OUTPUT

- Profile - Guided interviews - Program
- Perceptions of old with old age people
age people towards
,
treatment and
hospitalizations.

The researchers will use this framework as a parameter in determining the

functional health about treatment and hospitalization of the old age people who lives

from their home in Southern Cagayan (Solana, Tuguegarao and Peñablanca). The

framework will also serve as a guide to determine the need of implementing what

programs are needed towards the problems of the elderly with their health concerns,

especially on how they view the

Significance of the Study

The following will benefit from the findings of the study:

Old age people- to give them wider understanding as to its importance to one’s health.

Health care providers- to provide insight on why the old-aged people reject the health

care that they intend to give.

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DOH- to know the side of the old-aged people and with that, they will know the things

that are needed to improve.

Future researchers- to serve as a reference in conducting their research and for them

to have more additional knowledge if they planned to conduct the research.

Definition of Terms

Perception- the act or faculty of perceiving or apprehending by means of the senses or

of the mind; cognition, understanding.

Treatment- medical care given to a patient for an illness or injury.

Hospitalization- admission to hospital for treatment.

Assumption

The researchers expected the respondents would be reliable source of

information that ensure the success of this research. The researchers assumed that

they would be honest and cooperative in responding the different questions given by the

researchers.

Scope and Limitations

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This study will determine the different perceptions, views, experiences and

preferences of old-age regarding medical treatment and hospitalizations. This research

will be conducted at Southern Cagayan specifically at Solana, Tuguegarao and

Peñablanca. The respondents of this study will be the old age people (age 60 and

above).

CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

Foreign Literature (Barriers of Health Care)

(Broder K, et. al., 2009) claimed that even in the absence of chronic illness, older

adults need to access medical care for acute conditions as they arise, as well as for

extensive preventive care services recommended by evidence-based guidelines (e.g.,

annual influenza vaccination; screening for hypertension, hypercholesterolemia, and

many cancers). The (Agency for Health Care Research and Quality: Guide to Clinical

Preventive Services, 2008) stated that access to a range of health services, therefore, is

critically important for preventing new illnesses, adapting therapies to changing needs,

potentially reducing acute care costs, and ultimately for maintaining the health and well-

being of our aging population.

According to (Levesque et. al., 2013)’s framework, the five dimensions combine

to facilitate access to care or serve as barriers. Approachability indicates that people

facing health needs understand that health care services exist and might be helpful.
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Acceptability represents whether patients see health care services as consistent or

inconsistent with their own social and cultural values and worldviews. Availability

indicates that health care services are reached both physically and in a timely manner.

Affordability simplifies one’s capacity to pay for health care services without

compromising necessities, and finally, appropriateness represents the fit between

health care services and a patient’s specific health care needs. This study focused on

the acceptability and appropriateness dimensions of access.

Furthermore, (Asian/Pacific Island Nursing Journal Volume 1, 2017) shows that

the common barriers to health care by the focus group participants were (a) financial

concerns (lack of health care insurance, inability to meet copayment requirements), (b)

difficulty obtaining care (transportation, long wait times), and (c) communication issues

(inability to communicate with health care providers and mistrust between patients and

health care providers resulting from communication barriers). Several women

commented that these barriers made it difficult to seek health care and most did not

seek care unless they were ill. Only one of the 21 participants identified preventive care

as a part of her health-seeking behaviors.

The study by (Nakamura JS et. al., 2022) builds on an extensive body of prior

research shows that age beliefs are associated with older persons’ health. According to

the study, in a sample of participants with a median age of 64 years, aging satisfaction

was associated with subsequent physical health (e.g., heart disease), health behaviors

(e.g. sleep problems), and psychological distress (e.g. depression). Previous findings
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shows that negative age-beliefs are associated with worst health (Levy BR et. al.,

2020). The authors claimed that there is a need to develop scalable age-belief

interventions. However, rather than targeting the negative age beliefs only at the

individual level, the most effective way to diminish the negativity is to target the root

cause of the association between age beliefs and health outcomes: structural ageism,

which is the discrimination against older persons by policies of institutions and the

actions of those affiliated with them.

Both patients and providers believe that language barriers present serious

obstacles to positive health outcomes, the (Robert Wood Johnson Foundation, 2001) in

United States survey found. According to patients, communication difficulties make it

much harder to fully explain symptoms and to ask questions, to follow through with

filling prescriptions, to believe that doctors understand their medical needs, to

understand doctors' recommendations, and to see doctors as often as needed. In fact,

19% of the Latino adults surveyed reported that, due to language barriers, they had not

sought care when they needed it. The health care providers said that language

difficulties make it harder for a patient to understand and follow through on the

information that a doctor provides on a medical condition or disease, and also increase

the risk that a doctor will not learn about some medication or home remedy that a

patient is using. Language barriers also make it more difficult for the doctor to compile a

complete, accurate medical history.

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Also, a study of (Hooker K, et. al, 2019) found that older persons who

experienced more age discrimination were less likely to engage in physical activity and

that this was mediated by self-perceptions of aging. In other research, age

discrimination in the form of patronizing language, referred to as elder speak, which

health care professionals often direct at older patients, can strengthen patient’s negative

age belief, which lead to experiencing cognitive problems (Schroyen S, 2014).

The study by (Bernard A, 2010) claimed that community-based frail older adults,

burdened with complex medical and social needs, are at great risk for preventable rapid

rehospitalizations. Few studies have looked at interventions to prevent

rehospitalizations in this large segment of the older adult populations. Similarly,

standardize disease management approaches that lower rates in an independent adult

population may not suffice for guiding the care of frail persons. However, impending

national imperatives aimed at reducing potentially avoidable hospitalizations will soon

demand and reward care management strategies that identify frail persons early in the

discharge process and promote the sharing of critical information among patients,

caregivers, and health care professionals. Opportunities to improve the quality and

efficiency of care-related communications must focus on the effective blending of

training and technology for improving communications vital to successful care

transitions.
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According to (Miguel A. et. al, 2021) barriers to health care access can greatly

affect one’s health status. Research shows that U.S adults with intellectual and

developmental disabilities (IDD) have poor health and face barriers such as long waits

for appointments. This study determined the top reasons of three racial and ethnic

groups (White, Black, and Latinx) for not having usual source of care, delaying or

foregoing medical care. According to the study, Black and Latinx adults with IDD, the

most-mentioned reasons were “don’t like/don’t trust doctors,” “don’t use doctors,” and

“don’t know where to get care.” On the other hand, White adult group’s biggest

perceived barriers were location and insurance related. All groups cited that being

unable to afford care was a top reason for delaying or foregoing care. The authors

claimed that there is a need to develop scalable age-belief interventions. However,

rather than targeting the negative age beliefs only at the individual level, the most

effective way to diminish the negativity is to target the root cause of the association

between age beliefs and health outcomes: structural ageism, which is the discrimination

against older persons by policies of institutions and the actions of those affiliated with

them.

Structural, or institutional, ageism is not only one of the most potent forms of

bias that exists today, but also one of the least acknowledged. A recent (World Health

Organization, 2022) report on ageism concluded that, “Often people fail to recognize
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the existence of such institutional ageism because the rules, norms, and practices of the

institution are long-standing, have become ritualized and are seen normal.”

Furthermore, (Chang ES, et. al., 2020) study found that 85% of the 149 studies

on health care access, clinicians were less likely to offer procedures and treatments to

older patients than to younger patients, even when they were equally likely to benefit.

In addition, (Levy B, 2022) shows that structural ageism is detrimentally associated

with older persons’ age beliefs, which, in turn, may detrimentally affect their health.

This pattern fits the stereotype embodiment theory that predicts the mechanism by

which negative age beliefs harm health can involve reduced self-efficacy and increased

stress (Levy B et. al, 2009). Also, a study of (Hooker K, et. al, 2019) found that older

persons who experienced more age discrimination were less likely to engage in physical

activity and that this was mediated by self-perceptions of aging. In other research, age

discrimination in the form of patronizing language, referred to as elder speak, which

health care professionals often direct at older patients, can strengthen patient’s

negative age belief, which lead to experiencing cognitive problems (Schroyen S, 2014).

Local Literature (Barriers of Health Care)

There is a limited source of information for literature about barriers of

health care under the local setting but there are two study found by the researchers.
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Interprofessional geriatric care provided by health and social workers was

observed to be currently limited to ad hoc communications typically addressing only

administrative concerns, according to the study by (Moncatar, et. al., 2021). This

limitation is imposed by a confluence of barriers such as personal values and beliefs,

organizational resource constraints, and a silo system care culture which practitioners

say negatively influences care delivery. As a result, care providers were unable to

access adequate care information, as well as delays and renders inaccessible available

care provided to vulnerable older adults. Additionally, uncoordinated care of older adults

also led to reported inefficient duplication and overlap of interventions.

The study of Gideon Lacso, Phd et al. 2022, shows that among low and middle-

income Filipinos, health financing is often a multipart process necessitating

various actors' participation and entailing predictable and unforeseen

complications throughout the illness trajectory. There are three major domains through

which ordinary Filipinos finance their health care: ‘pagtitiis’ or enduring illness,

‘pangungutang’ or borrowing money, and ‘pagmakakaawa’ or begging for help. The first

bears consequences for the medical system; the second unpacksthe nature of debt vis-

à-vis health financing; while the third questions the interrelation of politics and health—

how politics continues to undermine health financing, how health undermines politics.

PhilHealth can be considered a fourth domain, but due to its insufficient coverage and

the rampant lack of information about it, it has made a relatively insignificant impact on

many Filipinos' financial needs. Taken together, all of the above illustrates how illness
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not only leads to catastrophic expenditure; expenditure-related challenges conversely

account for poorer health outcomes.

Foreign Literature (Perceptions of Old-Aged on Health)

Tkatch et al. (2017) conducted a study on how older adults across spectrum of

health describe their perceptions of health. The qualitative study examined three types

of participants, the healthy and active, at risk, and very sick whose age is around 66-80.

The study revealed on the findings that the participants viewed their health in a holistic

way reflecting quality of life, more in terms of basic needs and comforts. They described

illness as something they just had to deal with but would not let their illnesses define

them. Moreover, the participants differ from how they deal with their underlying health

issues and on how they perceived their selves as a healthy individual. Almost all

individuals with multiple chronic conditions described themselves as healthy and active,

whereas many of those with few to no chronic conditions rated their health lower than

expected. The clinically healthier participants were not dealing with underlying health

issues and had poor coping mechanisms for changes occurring in their lives. Yet, those

with multiple chronic conditions were able to describe coping mechanisms for dealing

with conditions and appeared to be more resilient to their social changes.

According to the study of (Gabriel et. Al., 2019) South African elder care policy

places a strong emphasis on ageing in community rather than institutional settings, but
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the primary health care system is not geared to address the health needs of the older

people. Older people have different health care needs compared to younger people,

high-income respondents have a few challenges accessing quality care and support

services, and services available in lower-income respondents were much less

responsive and participants displayed low trust in the health care system. Low-income

respondents experienced poor-doctor patient communication often failed to comply with

treatment, while those who experienced patient-centered communication, either through

the private sector or NGO public sector partnerships had better perceptions of care.

Older persons complex health needs cannot be adequately addressed by a process-

driven approach to care. Supporting patient-centered communication and care may

help health workers to understand older person’s health needs and improve patient

understanding, trust and co-operation. This research paper suggests the importance of

community support services in enhancing health access and developing system that

enable health care providers to better understand and respond to older persons needs

in resource-constrained settings.

Moreover, (Hadeel Halaweh et Al., 2018) claimed that with increasing number of

older adults worldwide, promoting health and well-being becomes a priority for aging

well. Well-being and physical and mental health are closely related, and this relation

may become more vital at older ages as it may contribute to aging well. The state of

well-being is a multifaceted phenomenon that refers to an individual’s subjective

feelings and exploring perspectives of older adults on aging well is developing to be an

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Alimannao Hills, Peñablanca Cagayan
Tel: (078) 304-1010; Telefax (078) 846-7549

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important area of research. Therefore, the aim of this study was to explore perceptions

on aging well among older adult Palestinians ≥60 years. Methods. A qualitative

research design in the context of focus group discussions was used; seven focus

groups were conducted including fifty-six participants (aged 63–81 years). Data were

analyzed using a qualitative interpretative thematic approach described by Braun and

Clarke. Results. Three major themes were identified, “sense of well-being,” “having

good physical health,” and “preserving good mental health.” The participants perceived

that aging well is influenced by positive feelings such as being joyous, staying

independent, having a life purpose, self-possessed contentment, and financially

secured, in addition to be socially engaged and enjoying good physical and mental

health. Conclusion. This study contributes to get a better insight concerning older adults’

perspectives on aging well. Enhancing physically active lifestyle, participation in social

and leisure activities, healthy eating habits, having a purpose in life, and being

intellectually engaged are all contributing factors to aging well. Vital factors are to be

considered in developing strategic health and rehabilitative plans for promoting aging

well among older adults.

Local Literature (Perceptions of Old-Aged People with Health)

(Stanford Medicine, 2019) claimed that Filipino older adults tend to cope with

illness with the help of family and friends, and by faith in God. Complete cure or even
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the slightest improvement in a malady or illness is viewed as a miracle. Filipino families

greatly influence patients’ decisions about health care. Patients subjugate personal

needs and tend to go along with the demands of a more authoritative family figure to

maintain group harmony. Before seeking professional help, Filipino older adults tend to

manage their illnesses by self-monitoring of symptoms, ascertaining possible causes,

determining the severity and threat to functional capacity, and considering the financial

and emotional burden to the family.

(Boldy et al., 2011) found that some of the primary reasons people choose to

remain in their homes and age in place are because they are comfortable where they

live, they feel safe and secure in their home, it is financially viable (especially if the

house is paid in full and the expenses are manageable), they like the neighborhood,

and they are in a good location. The problem with aging in place becomes more

apparent when age related changes occur. The changes are often a function of a

decline in personal health or the health of a spouse or loved one, as well as the possible

deterioration of the home.

According to Gargar, Cutamora, and Abocejo (2017) in their study entitled,

“Learning Needs and Quality Care Among Family Caregivers and Elderly Patients of

Guadalupe, Cebu City, Central Philippines”, with elderly patients’ perception about the

quality caregiving system as an indicator which revealed that the elderly respondents

had good perception of the family caregiver’s knowledge about caregiving. It is because
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the perception among elderly patients’ of the family caregivers’ attitude towards them is

good.

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Chuukese Migrant Women in Guam: Perceptions of Barriers to Health Care, 2017.

https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1049&context=apin

A Qualitative Study of Rural Health Care Providers’ Views of Social, Cultural, and

Programmatic Barriers to Health Care Access, 2022.

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07829-2

The Role of Structural Ageism in Age Beliefs and Health of Older Persons, 2022.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788860

Care Management’s Challenges and Opportunities to Reduce the Rapid Rehospitalization

of Frail Community-Dwelling Older Adults, 2010.

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https://eric.ed.gov/?q=care+of+older+adults&pg=2&id=EJ910475

Racial and Ethnic Disparities in Perceived Barriers to Health Care among U.S Adults with

Intellectual and Developmental Disabilities, 2021.

https://eric.ed.gov/?q=effects%20of%20barriers%20in%20health%20care%20in

%20the%20Philippines%20&id=EJ1284776