How To Prevent Dementia In Old People

Transcription

1 1 2 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALT Work completed at The National Institute Epidemiology (NIHE) of Hygiene and NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY * LE VAN TUAN EPIDEMIOLOGY OF DEMENTIA IN OLD PEOPLE IN TWO DISTRICTS OF HA NOI Scientific guiders: 1. Prof. Dr. Le Duc Hinh 2. Prof. Dr. Hoang Van Tan Opponent 1: Opponent 2: Opponent 3: Major : Hygiene- sociology and Health organization Code : The thesis will be defended at the National Examination Board held in the National Institute of Hygiene and Epidemiology on.2014, at.. THESIS SUMMARY OF MEDICAL DOCTORATE Available for reference in: 1. The National Library HA NOI The National Institute of Hygiene and Epidemiology s Library

2 3 WORKS PUBLISHED BY AUTHORS INVOLVED IN 4 SYMBOLS AND SHORT-CUT WRITTING THE THESIS BMI (Body Mass Index) : Chỉ số khối cơ thể ĐTĐ : Đái tháo đường/ Diabetes 1. Lê Văn Tuấn, Lê Đức Hinh (2010), Solutions and programs of dementia control for old people in Ha Noi, Journal of medical practices, No.8(730), pg Lê Văn Tuấn, Hoàng Văn Tân, Lê Đức Hinh (2012), Some of risk factors to dementia in the Ha Noi s old people, Prevention medicine journal, No.6(133), pg ĐH-CĐ-TCCN HDL (High density lipoprotein) LDL (Low density lipoprotein) : Đại học - cao đẳng - trung cấp chuyên nghiệp University- collegevocational secondary school : Lipoprotein tỷ trọng cao : Lipoprotein tỷ trọng thấp 3. Lê Văn Tuấn, Lê Đức Hinh (2013), Disorders of awareness in elderly, Medical research journal, No.1(81), pg Lê Văn Tuấn, Lê Đức Hinh (2014), Some of risk metabolic factors to dementia in elderly in districts of Ha Noi, Viet Nam medicine journal, No.2(415), pg Lê Văn Tuấn, Hoàng Văn Tân, Lê Đức Hinh (2014), MMSE (Mini Mental State Trắc nghiệm đánh giá trạng thái tâm : trí thu nhỏ Examination) CI (confidence interval) : Khoảng tin cậy OR (Odd Ratio) : Tỷ suất chênh TBMN : Tai biến mạch não/ Cerebral vascular catastrophe Epidemiology of dementia in old people in some of districts of Ha Noi, Medical research journal, No. 2(87), pg TCYTTG THA : Tổ chức Y tế Thế giới/ World health organization : Tăng huyết áp/ Hypertension

3 5 INTRODUCTION 6 Based on that solutions were proposed to prevent dementia in old people in the community of Ha Noi area. Among the chronic non-infectious diseases dementia is a disorder commonly seen in old people. It is a severe disease that threaten the old people s life and quality of life. And, it is also a burden to the patient s family and the community as well as the society. It is predicted that an increase of population of old people in Viet Nam will be double up to 16% in 25 years. There have been many researches in dementia world-wide. In Viet Nam, however, there were only few researches into dementia in old people in the community, and there were not data related to epidemiology of dementia in old people, so far. We had, therefore, done research on: Epidemiology of dementia in old people in two districts of Ha Noi that aimed to: 1. Describe a real status of dementia in old people in communes of two districts Soc Son and Dong Da of Ha Noi from September 2010 to September Define risk factors to dementia in old people in communes of Districts of Soc Son and Dong Da of Ha Noi. 2. New scientific contribution - It was still new to research into dementia in old people in Viet Nam, this was the first time the epidemiology data to dementia in old people in the community introduced. - The research had found and defined of nine commonly risk factors for dementia in the old people. All of this nine risk factors are changeable and can be intervened in prevention of the problem. - From the findings, and based on interventions of impact to the nine risk factors some of solutions were proposed to prevent the old people s dementia in the community of Ha Noi. 3. Realistic value of research - This research into an issue of the day that related to health care for the elderly that was dementia in old people. - The research had described the real status of dementia in old people in the community, seen in two areas including urban and rural of Ha Noi city. It also defined mainly risk factors for dementia especially group of risk factors that can be changed and intervened in prevention, and then

4 7 the solutions to prevention of dementia based on impacts to controllable-risk factors were proposed. 8 Chapter 1 BACKGROUND - The research contributes to the elderly health care, prevention and control of dementia in old people in the community, and also undertook the contents of the Ministry of Health s Circular letter No.35/2011/TT- BYT dated 15/10/2011 regarding the health care for old people. 4. Structure of thesis: This thesis includes 108 pages; 3 pages of Introduction; 30 pages of Background; 16 pages of Object and Method of research; 24 pages of Findings; 32 pages of Discussions; 2 pages of Conclusion; 1 page of Proposal; and 33 tables, 6 diagrams and 1 picture; Concept and characters of dementia Concept of dementia As the WHO s definition: "Dementia is a combination of disordered progression of the memory and process of idealization, at level of damage to daily activities, atleast appeared for 6 months with a disturbance atleast to one of the functions such as language, calculation, judgment, disorders of thingking, motional coordination, cognition or changes of personality. references including 53 of Vietnamese language and 182 references of foreign languages; and 6 appendices including: 1a) Form of data collection, 1 b) Form of Mini Mental State Examination (MMSE), 2) Form of dementia-mental-psychology test, 3) Form of nervous examination and blood test, 4) List of research objects, 5) Administrative map of the two districts researched, 6) Pictures of activities.

5 Aetiology of dementia Dementia occurs by various causes from which it was classified into the causes of degeneration and no-degeneration. Based on the site of injury and clinical presentations it was classified in two types of cortical dementia and subcortical dementia Stages of dementia * Early stage of dementia (20-24 points MMSE) * Mid-stage of dementia (10-19 points MMSE) 1.3. Researches into dementia in Viet Nam There had been some few of researches into dementia in Viet Nam, so far. In 2001, the National Institute of Psychiatric Health did a research on 8,965 people in Thai Nguyen city, in which 727 over 60 years old, shown that the prevalence of dementia was 7.9%. Research into dementia in old people in Ba Vi district (Ha Noi) shown the prevalence was 4.63%. Nguyen Thanh Van did a clinical research and * Severe stage of dementia (less than 10 points MMSE) found that the proportions of dementia after cerebral infact were Diagnostic criteria of dementia * Diagnostic criteria of dementia followed by International Classification of Diseases (ICD-10). * Diagnostic criteria of dementia followed by Diagnostic Statistic of Mental (DSM-IV) Researches into dementia world-wide and in Viet Nam There were many researches into dementia world-wide, so far. In Viet Nam there were only some of researches into dementia in old people in the community mainly focused on clinical, and there were no data of epidemiology regarding dementia in old people. 12.3%. Pham Thang and cooperators made assessments of the cognitive function in old people over 60 years old and shown that the mean of image memory test was increased by the education levels and decreased by ages. In summary, in the country beside some of clinical researches into Alzheimer as above mentioned there were not much of data regarding epidemiology of dementia, so far Risk factors for dementia Factors of individual, family, psychology-sociological and way of life

6 11 - Factors of individual and family such as age, sex, family history having someone with dementia were related to dementia found in many researches world-wide. - Psychology-sociological factors such as education, social activities, entertainment, physical actions play a certain role in development of dementia. - Factors regarding the way of life such as alcohol use, smoking and nutritions influence significantly the people s health especially old people. 12 trends in prevention and control of dementia is to early discover and well control these risk factors with hopes that the disease decreases or the start of disease is slow. Recently, the vascular, psychologysociology and molecular risk factors have being paid more attention Models of health care for old people world-wide and in Viet Nam There were many models of health care for old people and preventive solutions to dementia in old people applied dependently on each area and each nation Risk factors of vascular-heart and metabolic diseases: Hypertension, obesity, diabetes, heart disease and hyperlipidemia Risk factors at molecular level Pathology of Alzheimer was based on the hypothesis amyloid scale, but there still were different ideas, and it is needed to had continuous researches Some of preventive solutions of dementia in old people worldwide and in Viet Nam Beside unchangeably risk factors for dementia in old people there are some of risk factors that can be changed. One of the existing

7 13 Chapter 2 OBJECTS AND METHODS OF RESEARCH administration units of commune level in the district. 14 * Communes of Thanh Xuan and Minh Tri (short called as two out of town communes): 2.1. Objects of research Old people who were sixty years old and over living in Ha Noi city Sites of research Carried out in 2 communes of Dong Da district and 2 communes of Soc Son district, all these belong to Ha Noi city Dong Da district: As being in the central area of Ha Noi capital the district is of all characteristics of urban area of Ha Noi city. Among the Ha Noi s districts it is the largest (9.96 km2) and the most populated area, with various strata of society and religion. * Communes of Phuong Mai and Kim Lien (short called as two within the city communes): These are the two of 21 communes in the Dong Da district. These are the two communes among a total of 25 communes of Soc Son district Period of work: from September 2010 to September Methods of research: Design of research: - Phase 1: Cross-sectional study to affirm the proportion of dementia in old people in the 4 communes of the 2 districts Soc Son and Dong Da. - Phase 2: Controlled clinical study to affirm the risk factors for dementia in the two districts of Ha Noi city Sampling size: - Sampling size of cross-sectional study: the following formulation used: p (1 p) Soc Son district: Based in the northern and far from the center of n = Z 2 (1 - /2) Ha Noi it is one of the districts outside the center of Ha Noi having a larger area and most densely populated. There are a town and 25 Sampling size calculated n= 800. Approximately 5% (40) did d 2

8 15 not cooperate at every area. Such, sampling size at every area = 840 (two areas = 1,680). Sampling size at one commune = Sampling size of controlled clinical study: + Chosen criteria for patients: The old people of 60 years old and over suffering from dementia (followed by the diagnostic criteria of DSM- IV), household and residence in the research areas, at least know how to read and write. + Chosen criteria for the controlled: 60 years old and over, without dementia (followed by the DSM-IV), the same age and sex as the patients, at least know how to read and write, and living nearest the patient. - Sampling size of controlled clinical study calculated by using the following formulation: 16 Ha Noi city was divided into two areas of within the city and out-of-town, one within the city district and one out-of-town district from the two areas were chosen as sites of research. Choose within the city districts: Purposive target choice of Dong Da district. Choose out-of-town districts: Purposive target choice of Soc Son district. Choose communes: Randomly chosen 2 communes of the Dong Da district. Randomly chosen 2 communes of the Soc Son district. - Sampling unit (old people): + Sampling for cross-sectional study: having a list included all the people who were 60 years old and over in the 4 chosen communes for study sites as above mentioned. Sampling followed by method of doorto-door. n = {Z 2 (1- /2)[1/P 1 (1-P 1 )+ 1/P 2 (1-P 2 )] [ln(1 - )] 2 + Sampling for controlled clinical study: with rate of 1 case/2 controlled. Sampling sizes calculated: group of disease = 75, controlled group = 150 (persons) (rate of 1 case of desease/2 controlled). Total of sampling size needed for controlled clinical study was 225 persons Sampling technique: Progress of study, technique and tools for data collection a) Affirmation of dementia prevalence: the two following steps done: Step 1: Screen survey: - The surveyor came to meet the old people at home and asked

9 17 questions to the object of study directly or the family s members using available form, and made an screen assessment with the MMSE. - Based on results from the screen survey all the objects with doubt of dementia (total points of MMSE 23) should be informed and carried out deeply professional assessments by using other forms in step 2. Step 2: Survey, deeply professional assessments: - The old people who was in doubt of dementia was invited to the examination room for neurology-psychology sited just in the community. The surveyor used combinations of questions, a set of neurology-psychology test to assess the various functions of cognition. - Diagnosis of dementia followed by the Diagnostic Statistic Mental diseases the fourth edited DSM-IV. Findings from the step 2 allowed a diagnosis of dementia or no-dementia. b) Affirmation of risk factors for dementia in old people: This done after having deeply professional assessments in step 2 mentioned above. 18 public health, with unified forms, and they were test before used. The community collaborators who worked as a guide were living in the local area. Well trained to surveyors. Entering and analysis of data was diectly done by the head and group of research Issue of morals in the research The research outline and process was approved by the Examination Board for the outline and morals of The National Institute of Hygiene and Epidemiology (NIHE). Individual information was absolutely secret. The objects of research were voluntary and collaborative. The patients were examined and received free medicines dependent on the patient s health status. The data and results were preserved as the regulation of record management Methods of data processing The data were processed following the method of bio-medical statistics with the software SPSS 17.0 for Windows Control of error: Standardization of the tools before using for weights and measures, and checked them up after the day of use. Survey forms were clearly and specifically designed by experts of geriatrics, neurology and Chapter 3 FINDINGS

10 Proportion of old people by sex 3.1. Proportion of old people and characteristics of old people in the two districts of Ha Noi Proportion of old people in total population of the two districts of Ha Noi Proportions of old people were 9.1% of the population in the 4 communes studied Characteristics of old people in the 2 districts of Ha Noi Proportion of old people by group of ages Table 3.2. Proportion of old people by group of ages: The higher of age the lower of proportion of old people in the two areas within the city and out of town. Table 3.3. Proportion of old people by sex: Female was 55.9%, and male was 44.1% Education levels Table 3.4. Educated in the old people: Old people with high educated (University- college- vocational secondary school) were of highest proportion (34.2%) Epidemiology characteristics of dementia in old people Prevalence of dementia in old people Table 3.5. Proportion of dementia in old people: Proportions of dementia in old people in the two districts of Ha Noi were 4.24% in year of 2010 from which the two out-of-town communes (5.06%) higher than the two within city communes (3.56%) Proportion of dementia by group of age Table 3.6. Proportion of dementia by group of age: The higher of age the higher proportion of dementia Proportion of dementia by sex Table 3.7. Proportion of dementia by sex: Proportions of female (4.8%) higher than those of male (3.6%).

11 Proportion of dementia by education level Table 3.8. Proportion of dementia by education level: Proportion of dementia was trending to decrease in group of high education Proportion of dementia by history of hypertension Table 3.9. Proportion of dementia by history of hypertension: Proportion of dementia in persons with hypertensive history was little higher than those in persons without hypertensive history Proportion of dementia by history of cerebrovascular disease Table Proportion of dementia by history of cerebrovascular disease: Proportion of dementia in persons having history of cerebrovascular disease was higher than those in persons without history of cerebrovascular disease Proportion of dementia by history of vascular-heart disease Table Proportion of dementia by history of vascular-heart disease: Proportion of dementia in persons having history of vascularheart disease was lower than those in persons without history of Proportion of dementia by history of decreased memory: Proportions of dementia by history of the old people with decreased memory were higher than those without decreased memory Proportion of dementia by history of diabetes Table Proportion of dementia by history of diabetes: Proportions of dementia in persons with history of diabetes were lower than those in persons without history of diabetes. Proportions of dementia in persons having family with history of diabetes were higher than those in persons having family without history of diabetes Proportion of dementia by history of hyperlipidemia Table Proportion of dementia by history of hyperlipidemia: Proportions of dementia in persons with history of hyperlipidemia were lower than those in persons without history of hyperlipidemia Risk factors for dementia found from controlled clinical study Relations between vascular risk factors and dementia Table Relations between cerebrovascular disease and dementia vascular-heart disease. Proportion of dementia in persons having family with history of vascular-heart disease was little lower than those in persons with family of no-history of vascular-heart disease. Cerebrovasul ar disease Dementia (n = 75) No-dementia (n=150) Numbe Proporti Numbe Proporti OR (95% CI) p

12 23 rs on % rs on % Yes No ( ) < Persons who had carotid murmurs were in risk of dementia 5.6 times higher than those without carotid murmurs. The difference was of significant statistic (p<0.05) Relations between flitting lack of brain blood and dementia Persons who suffered from cerebrovascular disease were in risk of dementia 4.4 times higher than those without this history (p<0.001) Relations between hypertension and dementia in old people Table Relations between hypertension and dementia Table Relations between flitting lack of brain blood and dementia in old people: Persons who had flitting lack of brain blood were in risk of dementia 3.7 times higher than those without flitting lack of brain blood. The difference was of significant statistic (p<0.05). Dementia No-dementia Relations between overweight-obesity and dementia Hypertension (n = 75) Numbers Proportion % (n=150) Numbers Proportion % OR (95%CI) p Persons with overweights/obesity were in risk of dementia 0.9 times higher than those without overweights/obesity. The difference was of insignificant statistic (p>0.05). Yes No ( ) <0.01 The old people with hypertension were in risk of 3.1 times higher than those without hypertension. The difference was of significant statistic (p<0.01) Relations between carotid murmurs and dementia Table Relations between carotid murmurs and dementia:

13 Relations between hypercholesterolemia and dementia Table Relations between hypercholesterolemia and dementia 26 without changed HDL. The difference was of insignificant statistic (p>0.05). Hypercholest erolmia Dementia (n = 75) Number s Proport ion % No-dementia (n=150) Numbe Proporti rs on % OR (95%C I) p Relations between changed triglycerid and dementia Table Relations between changed triglycerid and dementia: Persons with changed triglycerid were in risk of dementia 2.3 times higher than those without changed triglycerid. The difference was of Yes No ( ) < significant statistic (p<0.05) Relations between changes of blood sugar during hunger and dementia Persons with hypercholesterolemia were in risk of dementia 7.6 times higher than those without hypercholesterolemia (p<0.001) Relations between changed LDL and dementia Table Relations between changed LDL and dementia: Persons with changed LDL were in risk of dementia 11 times higher than those without changed LDL. The difference was of significant statistic (p<0.001). Table Relations between changed blood sugar during hunger and dementia: Persons with changes of blood sugar during hunger were in risk of dementia 2.9 times higher than those without changes of blood sugar during hunger. The difference was of significant statistic (p<0.05) Relations between educated levels and dementia Table Relations between educated levels and dementia Relations between changed HDL and dementia Table Relations between changed HDL and dementia: Persons with changed HDL were in risk of dementia 1.4 times higher than those Educate d levels Dementia (n = 75) No-dementia (n=150) Numbe Proporti Numbe Proporti OR (95%C I) p

14 27 r on % r on % Low <0.0 High ( ) Persons with low education were in risk of dementia 4.2 times higher than those with high education level (p<0.01) Relations between social activities and dementia Table Relations between social activities and dementia: Persons without social activities were in risk of dementia 3.3 times higher than those with social activities. The difference was of 28 activities (n = 75) (n=150) (95%CI) Proportion Proportion Number Number % % No Yes ( ) Persons without physical activities were in risk of dementia 2.3 times higher than those with physical activities. The difference was of significant statistic (p<0.05) Relations between nutritions and dementia Table Relations between nutritions and dementia <0.05 significant statistic (p<0.05). Dementia No-dementia Relations between entertainment activities and dementia Table Relations between entertainment activities and dementia: Persons without entertainment/recreation activities were in risk of Relevant nutrition (n = 75) Number Proportion % (n=150) Number Proportion % OR (95%CI) p dementia 1.7 times higher than those with entertainment/ recreation activities Relations between physical activities and dementia Table Relations between physical activities and dementia Physical Dementia No-dementia OR p No Yes ( ) Persons without relevant nutritions were in risk of dementia 2.2 times higher than those with relevant nutritions (p<0.05) Relations between alcohol use and dementia <0.05

15 29 30 Bảng Table Relations between alcohol use and dementia: dementia Persons with alcohol use were in risk of dementia 2.9 times higher than those without alcohol use. The difference was of significant statistic No. Variables Value Factor of regression p 95%CI (p<0.05) Relations between smoking and dementia Table Relations between smoking and dementia: Persons with smoking were in risk of dementia 2.9 times higher than those without 1 Cerebrovascular disease Yes = 1 No = (a).. smoking. The difference was of significant statistic (p<0.05) Relations between sleep disorders and dementia Table Relations between sleep disorders and dementia: Relations between sleep disorders and dementia were not seen, yet. The difference 2 Hypertension Yes = 1 No = (a).. was of insignificant statistic (p>0.05) Regression model to affirm the risk factors for dementia in old people in Ha Noi Through progression of the levelled regression model with dependent 3 Hypercholesterolemia Yes = 1 No = (a).. variable of dementia from the 18 risk factors (shown in part 3.3) there were dependent variables in orders that were really risk factors for dementia as follows: Table Levelled regression model to affirm the risk factors for 4 Diabetes Yes = 1 No = (a)..

16 Education levels Low= 1 High= (-0.86) 0(a).. 0 Chapter 4 DISCUSSIONS 6 Social activities 7 Physical activities No = (-0.91) Yes = 0(a) No = (-0.18) Yes = 0(a) Research objects and sites - Objects of research (old people with dementia): + Described study: 1,767 old people + Controlled clinical study: 225 old people included 75 in group of disease (dementia), and 150 in the controlled group (no-dementia) in two communes (Thanh Xuan and Minh Tri) of Soc Son district and two communes (Phuong Mai and Kim Lien) of Dong Da, Ha Noi city. - Sites of research: 8 Relevant nutritions No = 1 Yes = , (-0.18) 0(a).. + Two-within the city communes Kim Lien and Phuong Mai: Phuong Mai with 5,482 households and population of 19,441. Kim Lien with population of 14,098 and 5,000 households. + Two-out of town communes: Thanh Xuan and Minh Tri are far from 9 Alcohol use Yes = the center of HaNoi city, the farmer areas. Thanh Xuan commune with population of 11,000, and Minh Tri with population of 14,300. No = 0(a) Epidemiology of dementia in old people in the two districts of

17 33 34 Ha Noi Proportions of dementia Research results from 1,767 old people in September 2010 shown that: Proportions of dementia in old people in the two areas, within the city and out of town were 4.24%; of the two-out of town communes were 5.06% while of the within the city were 3.56%. Proportions of dementia in the two-out of town communes were equivalent to Nguyen Ngoc Hoa s results of research in Ba Vi district, an out-of-town area of Ha Noi (4,6%; 95%CI=4,03-5,12). The result of this research was (4.24%) shown of lower or higher in comparision with results of other authors world-wide. The authors may be used the criteria DSM III/R for diagnosis of dementia and the objects of research were over 65 years old, most of studies done in the rural areas. It was rare to have a research that covered both the within the city (urban) and the out-of-town (rural) areas Proportion of dementia by ages For elderly, the older of age the higher in proportion of dementia. It increased by 1.5 times to 2 times every 5-10 years past, in accordance with Nguyen Ngoc Hoa studied in Ba Vi district of Ha Noi, and Nguyen Kim Viet in Thai Nguyen province and other authors world-wide Proportion of dementia by sex Proportions of female with dementia were higher than that in male. This was similar to the results of other authors Proportion of dementia by education levels Proportions of dementia in old people decreased as the education level was higher. The highest proportion of disease was at the lowest education with reading and writting level of 10.9%. The lowest proportion of disease was at the high education level (Universitycollege- vocational secondary school) of 1,8%. Prportion of dementia in this study was different from the other authors. It may be due to the ages of the research objects. In this study the objects were at 60 years old and over, while in the others from 65 and over Proportion of dementia by professions and economic conditions Study shown that, in the two-out of town communes, dementia was highest seen in the old people of farmers, while in the two-within the city communes dementia was highest seen in the retired old people formerly cadres, civil servants. It was not yet found that the old people

18 35 in poor economic conditions suffered from dementia. It is needed to have more studies on the relations between professions, economic conditions and dementia in old people especially in the urban areas Proportion of dementia by the disease history Group of suffering from cerebrovascular disease was of highest proportion of dementia with 20.8%. Groups with history of decreased memory and the families having someone in status of decreased memory were of significantly higher proportions compared to groups without the history. Persons with history of hypertension were of higher proportion of dementia than the persons without the history. Proportions of dementia in persons with the history and without history of the disease were of insignificant differences Affirmation of risk factors for dementia in old people in the two districts of Ha Noi Relations between vascular risk factors and dementia: Analysed and assessed the levelled regression model with all variables on risk factors of vascular such as cerebrovascular diseases, hypertension, carotid murmurs, flitting lack of brain blood to affirm the effects of these factors on dementia in the levelled regression model, 36 and risk factors really related to dementia in old people were cerebrovascular diseases and hypertension affirmed. Results from the analysis affirm the role of vascular risk factors for dementia, the present of vascular risk factors makes increase of risk to develop dementia Relations between metabolic risk factors and dementia in old people Studied results in relation between metabolic risk factors and dementia in old people were similar to the authors reports world-wide as well in the country. However, it was different from the other authors that our research was carried out in both rural and urban areas. The results after doing the comparision and judgement and continually analysed by the levelled regression model to affirm the real relations between metabolic risk factors and dementia shown that the changes of entire cholesterolemia and diabetes were the really risk factors for dementia Relations between factors of psychology-sociology, way of life and dementia Through analysis of the levelled regression model by coupling the variables of risk factors of psychology-society and way of life the

19 37 38 really risk factors for dementia were low education level, non-social and non-physical activities, unsuitable nutritions, and alcohol use affirmed. Results from assessment of the levelled regression model on risk factors Commune Primary health care committee of psychology and way of life were similar to the other authors judgements and findings world-wide and in the country. Commune sectors, Communication groups Commune health station Commune society of old people 4.4. Solutions proposed for prevention of dementia in old people in Head of hamlets, sectors, head of villages Community health workers, Collaborators of population-nutritions Branches of old people at villages the community in Ha Noi From observations in the four studied communes; Based on the Caregivers for old people State advocacies and policies on old people and the guideline of the Old people Ministry of Health to health care for old people in the country; From results of solutions and models of health care for old people in the country and outside the country we would like to propose solutions for Strengthening social activities Strengthening physical activities Early found the common risks Limited alcohol use Relevant nutritions prevention of dementia in old people in Ha Noi as following model: Prevention, control of dementia in old people

20 39 Diagram.1. Model of prevention of dementia in old people in old people in Ha Noi Organization of the model: - The direction committee for implementation of model is the Commune primary health care committee available. All of model activities are integrated in the committee s activities. - Members of the model include: Representative of the People s committee of commune as Vice-chairperson of the commune People s committee, Commune health station, Commune Old people society, Strengtheningsocial activities Representatives of commune sectors, Community health workers, collaborators of population-nutritions in hamlets and villages, Head of hamlets and villages, Head of sectors and population organisations in hamlets and villages, Head of branch of old people, Caregivers are directly to usually take care of the old people at home, The old people are living in the four communes Approaches, contents and activities of the model: - Approaches of training: The model s members shall be trained on basic issues of health care and dementia in the old people, and approaches to the model s activities. Effective methods of teaching shall 40 be used. The commune health station will be used for practices. Relevant nutritions - Implementation: The members shall sign on the action plan, after trainings. The contents and action plan were monthly specific in the period of implementation. - Supervision to the model s activities: As the monthly process, practical activities of all members in hamlets and villages were monitored and supervised Limitations of work This was carried out in a larger area with the purposive study in four communes. The research group worked in cooperation with many of various sectors and units during carrying out the study. Based on the list of old people delivered by the commune old people society we had interviewed 709 objects in Thanh Xuan commune, 500 in Minh Tri, 600 in Phuong Mai and 500 in Kim Lien. The MMSE was only used for the old people who at least knew how to read and write, so 709 people were excluded. It was, therefore, not yet found proportions of dementia in the old people with illiteracy. In fact, the real numbers of old people with dementia in the community were probably higher than those of the studied results.