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ORIGINAL RESEARCH

Prevalence of dementia among the elderly


and health care needs for people living with
dementiain an urban community of central
Vietnam

Doan Vuong Diem Khanh1*, Vo Van Thang1, Ho Dung1, Tran BinhThang1,


Hoang DinhTuyen2, Hoang Dinh Hue2, Le Dinh Duong2

ABSTRACT
Introduction: Dementia is one of the major
causes of disability and dependency among
older people. There is little research on the
prevalence of dementia, its related factors and
health care needs for people living with
dementia in Vietnam. Aims: The aims of this
study are: (i) to examine the prevalence of
dementia, its related factors among people
aged 65 years and abovein Hue City of
Vietnam, (ii) examine the needs of health care
for dementia patients. Methods: 905 people
aged 65 years and aboveliving in Hue City in
central Vietnam were interviewed and
examined. MMSE test (Mini Mental State
Examination) was used as a screening
instrument for dementia. Diagnosis of
dementia was undertaken using ICD-10

research criteria. Results: Overall prevalence


estimates for dementia was 9.4%. Age,
medical history of stroke, physical activities
and entertaining activities were significantly
associated with dementia. The most common
health care needs for people living with
dementia were medication (76.5%), receiving
consultation regarding how to care for people
with dementia (75.3%), having support and
professional advice on how to deal with mental
and
behavioral
disorders
(63.5%).
Conclusion: In this population, probable
dementia is common. Comprehensive care
delivery for people living with dementia is
urgently needed in Vietnam.
Keywords: Dementia, prevalence, related
factors, health care needs, Vietnam.

Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy

Faculty of Public Health, Hue University of Medicine and Pharmacy

Corresponding author: Doan Vuong Diem Khanh, Institute for Community Health Research (ICHR), Hue University of
Medicine and Pharmacy (Hue UMP), 06 Ngo Quyen Street, Hue city, ThuaThien Hue province, Vietnam. Fax: 00-84-984118-925. Website: http://iccchr-hue.org.vn/ Email: diemkhanh1972@gmail.com

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INTRODUCTION

elderly above 60 years old3.

Life expectancy of human beings has been


increasing worldwide. In Vietnam, people
aged 60 years and over occupy 10.2% of
population, whereas the percentage of people
aged 65 years and over is 7.1%1. Vietnam is
now in the period of aging population. The
time for Vietnamese population to change
from aging population into the aged
population is predicted to be much shorter than
many other nations1.

A study on the prevalence of dementia in a


rural area of Vietnam (Ba Vi district)
conducted in 2005 among 5,712 adults aged 60
years and over in 2006 found that the
prevalence of dementia was 4.6% among this
population4. This prevalence of dementia
increases with age. Prevalence of dementia
among persons aged 65 years and over was
5.8%, among those aged 60-64 was 0.8%, aged
70-74: 3.8%, aged 75-79: 5.9%, aged 80-84:
8.5% and among those aged above 85 was
16.4%. Prevalence of dementia reduced
among the group of the elderly with higher
education: This prevalence was 9.7% among
group of elderly who just knew how to read
and write, among group of primary school was
2.4%, group of secondary school and above
was 1.8%4.

Challenges of aging population issue,


including access to health care for the elderly,
have been especially paid attention by many
countries in general and Vietnam in particular.
Dementia is among the leading causes of
disability and death among the elderly2. It not
only affects seriously the patients quality of
life but also physical, psychological and
socioeconomic impact on caregivers, family
members and society2.
Worldwide, there are approximately 35.6
million people living with dementia and 7.7
million new cases every year. Most of
researches worldwide recognize that
prevalence of dementia increases remarkably
with increasing age. The prevalence of
dementia is approximately 1% among people
aged 60-64, 5-10% among people aged 65 and
over, and up to 30-50% among people aged 85
and over2.

This study tries to examine the prevalence of


dementia, its associated risk factors and
determine the needs of health care for patients
living with dementia in Hue city, Vietnam. The
study will provide importance evidence
regarding the burden of this syndrome, the
related factors and the extent to which people
living with dementia is in needs of health care.
This will help policy makers to design
practical strategies and activities to improve
mental health care and quality of life for
thousands of people in central Vietnam.

Up to now, there are very few studies in


Vietnam regarding epidemiological aspects of
dementia as well as the needs of health care for
people living with dementia in Vietnam. A
large study among 8,965 persons in an urban
community in the north of Vietnam (Thai
Nguyen city) in the year 2000 revealed that
prevalence of dementia was 0.64% of the
general population and 7.9% among the

A cross sectional study was carried out in Hue


city, central Vietnam between June and August
2014. Multi-stage cluster sampling method
was used. Stage 1: 6 quarters in Hue city were
randomly selected. Stage 2: from each quarter,
5 sub-administrative units were randomly
selected. Stage 3: From 30 sub-administrative

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METHODS

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Doan Vuong Diem Khanh et al.


units selected, a total of 905 individuals aged
65 and above, who were permanent residents,
were randomly selected (based on the list of
the elderly provided by the local commune
health centers). A response rate of 98.7% was
obtained. Data collection was undertaken
using face to face interview at participants
households with the assistant of family
members when necessary. Diagnosis of
dementia was undertaken using a two phase
process. The first phase was the screening one
for dementia using MMSE test (Mini Mental
Status Examination). MMSE has been used
widely in Vietnam and internationally. It is a
brief 30-point questionnaire test. The total
score ranges between 0-30. A total of 878
persons among 905 undertook MMSE test.
Individuals who had a total score of MMSE <
24 (MMSE positive) were recruited to enter the
second phase to diagnose dementia by using
ICD-10 criteria5. 280 persons did diagnostic
test (253 persons with MMSE< 24 plus 27
persons not did MMSE). Individuals who could
not undertake MMSE for any reasons were also
examined for diagnosis of dementia
(impairment of visual or hearing capacity).

logistic regression model to examine


simultaneously factors associated with
dementia while controlling for the effects of
other factors.
ETHICAL APPROVAL
The study was approved by the Research
committee of Hue University of Medicine and
Pharmacy.
RESULTS
The sociodemographic characteristics of the
participants were presented in Table 1. There
are a majority of participants being females
(64.6%) and a high percentage of them was
Table 1. Socio demographic chararteristics of
the sample

Data analysis was undertaken using SPSS.16.


Descriptive statistics were used for presenting
prevalence of dementia and demographic
characteristics distribution of the study
sample. Simple regression was undertaken for
exploring associated factors of dementia
(including age, sex, religion, occupation,
education level, perceived household
economic situation, family history of
dementia, living situation, history of
hypertension, heart disease, stroke, diabetes,
blood lipid disorder, Parkinson; habits of
smoking, drinking, physical and entertainment
activity). Factors statistically associated with
dementia were then entered into the multiple
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Doan Vuong Diem Khanh et al.


widowed (39.9%). Most participants were
Buddhism (67.3%). Regarding education
level, nearly 20% were illiterate, 21.3% knew
how to read and write and 24.2% attended
primary school. 29.1% of participantss main
occupation (during lifetime) were farmers;
60.4% perceived their family economic
situation as moderate. There were 9.1% of the
elderly in this sample currently living alone.
PREVALENCE OF DEMENTIA AND
ASSOCIATED FACTORS
Our results revealed that prevalence of MMSE
positive (MMSE < 24) was 28.8%.
Prevalence of dementia and 95% CI are
reported in Table 2. The overall prevalence
estimates for dementia was 9.4% (12% in
women and 4.7% in men). This ranged from
0.5% among people aged 65-69 years to 37.7%
among those aged 90 years and above.
Mean values for age of onset and total years
living with dementia were 76.6 years

(SD=17.8) and 8 years (SD=15.0) respectively


(results not shown in the tables)
Simple logistic regression revealed that age,
sex, marital status, occupation, education
level, living situation, medical history of
stroke, habits of physical activities and habit of
entertainment activities were statistically
associated with dementia (p<0.05).
Table 3 presents the multiple logistic
regression model examining the associated
factors of dementia. Only independent
variables which were statistically associated
with dementia were presented in the table. The
model found that only age, medical history of
stroke, habits of physical activity and
entertainment activity were statistically
associated with dementia. The elderly aged 75
and above had higher risk of acquiring
dementia compared to those of 65 to 69 years
old. People with a history of stroke were 16
times higher probability of suffering from
dementia than those without stroke. People

Table 2. Crude prevalence of dementia by sex


and age group

Table 3. Multi-logistics regression model


examines the associated factors of
dementia.

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Doan Vuong Diem Khanh et al.


lacking
of
physical
activities
and
entertainment activities were associated with
1.9 and 2.0 fold higher probability of acquiring
dementia than those engaging in physical
activities and entertainment activities.

approximately 42.4%, 29.4% and 29.4% of


respondents respectively.

Table 4. Health care needs for people living


with dementia

Independent variables included in the model:


age, sex, marital status, occupation, education
level, living situation, medical history of
stroke, habits of physical activities and habit of
entertainment activities. Only independent
variables which were statistically associated
with dementia were presented in the table. NS:
non-significant
HEALTH CARE NEEDS FOR PEOPLE
LIVING WITH DEMENTIA
Among 85 people living with dementia
identified by this study, only 18.8% (n=16) had
ever been examined and received some
treatment for dementia; just 9.4% (n=8)
reported having adequate treatment by health
professionals.
Methods of treatment among group received
treatment were medication only (87.4%),
combination between medication and
occupational therapy (6%), and occupational
therapy only (6.3%). No cases received
psychotherapy.
Health care needs for people living with
dementia were presented in Table 4. The most
common health care needs for people living
with dementia (reported by patients and
family members) were medication (76.5%),
receiving consultation regarding how to care
for people with dementia (75.3%), having
support and professional advice on how to
deal with mental and behavioral disorders of
dementia patients (63.5%). Needs for
psychotherapy, occupational therapy and
physical therapy were identified by
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DISCUSSION

Prevalence of dementia and associated factors:


The overall prevalence of dementia in this
study was 9.4% (95% CI, 7.6%-11.5%).
Compared with other studies conducted in
Vietnam, this prevalence appears to be higher.
For example, one previous study conducted in
2006 among the elderly aged 65 years and
above in a rural community of North Vietnam
reported the prevalence of dementia of 5.8%4.
One other study conducted in 2000 among the
elderly above 60 years old in an urban
community in North Vietnam reported
dementia prevalence of 7.9 %3.
Findings of the prevalence of dementia in our
study are in line with the range reported
internationally,
which
indicated
that
prevalence of dementia among 65 years of age
and above ranged between 5% - 10%2. One
systematic review and meta-analysis of 11
epidemiological studies on dementia in Korea
published in 1990-2013 found the pooled
dementia prevalence among the elderly (aged
65 yr) was 9.2% (95% CI, 8.2%-10.4%),
which was quite similar to that of our study6.
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However, it is difficult to have an accurate
comparison between studies due to differences
regarding methodology, sampling methods,
diagnostic criteria and age structure.
The findings that prevalence of dementia
increased remarkably with the increasing of
age in this study was consistent with the
previous studies conducted in many other
countries, such as China7, Tanzania8, Turkey9,
India10. As prevalence of dementia increases
with age, it is more accurate to compare the age
specific prevalence of dementia between
studies. One meta-analysis of dementia
prevalence surveys, published between 1980
and 2010, among a total elderly population of
105,866 in 48 studies covered 21 provinces and
municipalities in China7 showed that the pooled
prevalence of dementia were 1.3%, 3.1%,
19.7% and 26.3% among the elderly aged 6569, 70-74, 80-84 and 85+ respectively, which
appeared to be higher than those found in our
study (0.5%, 1.5%; 13.1% and 25.3%
respectively). However, the prevalence of
dementia among group aged 75-79 in our study
was higher than that reported in the study of
China (12% vs. 9.3%). Other recent study in
rural China in 2011 also reported higher
prevalence of dementia among groups aged 8084, 85-89 and 90+ compared to those revealed
in our study (23.5%, 29.1%, 40.0% vs. 13.1%,
16.9% and 37.7% respectively11).
History of stroke was found to be a very
strong predictor of dementia in our study,
which increased the risk of dementia by up to
16 times. The mechanism of stroke as a risk
factor of vascular dementia was well
established. This finding is in agreement with
the previous studies, which found that
personal history of stroke was associated with
higher risk of cognitive impairment and
dementia among the elderly11,12.
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Lacking habits of physical activities were


associated with higher risk of dementia in our
study was also supported by several previous
studies. One study in China among 1,264
people aged 55 and above in a highly educated
community revealed that individuals without
habits of physical activities had 2.2 higher risk
of dementia compared to those having habits
of physical activities12. Importantly, one
longitudinal study in the Netherland among
4,406 inhabitants aged 55 years and older
during a follow up period up to 14 years found
a higher level of physical activities to be
associated with a lower risk of dementia
(adjusted for age, sex, education , smoking,
APOE-4 carrier status, hypertension, BMI,
diabetes, total cholesterol, HDL-cholesterol)13.
Having engaged in entertainment activities
was associated with lower risk of dementia in
this study. One longitudinal cohort study
examined lifestyle factors and risk of dementia
was conducted in Australia (first assessed in
1988, followed up 16 years) among 2,805 men
and women aged 60 years and older14. The
study found that, in a proportional hazards
model for dementia, daily gardening predicted
a 36% lower risk of dementia, daily walking
predicted a 38% lower risk of dementia in
men, but there was no significant prediction in
women14. The effect of daily gardening and
walking on reducing risk of dementia might be
considered as the combination effect of both
physical and entertainment activities.

Needs of health care for people living


with dementia
This study found that access to diagnosis and
treatment was very low among this population.
Only 18.8% dementia patients have ever been
diagnosed and received some treatment and
only 9.4 % of cases reported having complied
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Doan Vuong Diem Khanh et al.


the treatment (results not shown in the table).
This raised a very important point for public
health intervention that need to target in the
future. Raising awareness and knowledge
among the public for early detection and
diagnosis as well as compliance of treatment
of dementia should be taken into account.
Among dementia patients who received
treatment in our study, medication was the
most common ways of treatment; other types
of treatment (occupational treatment) were
very limited or unavailable. Especially no case
has received psychotherapy.
Health care needs for dementia patient are
presented in Table 4. Our study found that the
needs for medication, receiving consultation
on how to care for people with dementia,
having support and professional advice on
how to deal with mental and behavioral
disorders of dementia patients were especially
high (76.5%, 75.3% and 63.5% respectively).
Needs for occupational therapy and physical
therapy were identified by approximately 1 in
3 respondents. Noticeably, most of relatives
and caregivers of patients had not been
provided necessary information and skills on
how to care for patients with dementia. Up to
75.3% of relatives and caregivers would like to
receive consultation on how to care for
dementia patients. The needs of receiving
support and professional advice on how to deal
with mental and behavioral disorders were
also very high (63.5%). Helping family
members to know on how to give care to
patients have not only benefits for patients but
also for caregivers in reducing their
psychological distress. One systematic
literature review of studies reported between
1990 and 2009 revealed manifestation of
depressive symptoms appeared among 1 in 3
caregivers and these manifestation appeared to
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be higher among care givers of dementia


compared to those of other chronic diseases15.
CONCLUSION/ RECOMMENDATION
In conclusion, this study found that dementia
is common among the elderly in Hue City of
Vietnam. Age, history of stroke, habits of
physical activities and entertainment activities
were significantly associated with dementia.
Access to health care and treatment is very
limited. This study pointed out some important
recommendations
which
include
strengthening health education for community
in reducing risk factors of dementia
(importantly, decreasing stroke among the
elderly via management of hypertension,
encouragement of physical activities and
entertainment activities). Early diagnosis of
dementia and providing comprehensive care
delivery for people living with dementia are
urgently needed in Vietnam.
LIMITATIONS
Some limitations of this study should be taken
into account. First, this study was cross
sectional study and we could not ascertain the
time sequence between independent variables
and dependent variable. Therefore, cause
effect relationship could not be able to
establish. Secondly, no subtype of dementia
was clarified which might had different risk
factors. We were not able to include
hospitalized people in our sample as well.
DECLARATION OF CONFLICTING
INTERESTS
There are no known conflicts of interest and all
authors claim responsibility for the
manuscript.
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