Development of a Holistic Long-Term Care Model for Dependent Older Adults through Network Participation in Phayao Province

Abstract

This research and development study aimed to develop and evaluate a holistic long-term care model for dependent older adults through network participation in Phayao Province. The study was conducted in four phases. Phase 1 examined the situation, context, and long-term care needs of dependent older adults across nine districts, involving 400 participants. Phase 2 focused on model development through a participatory process involving 30 stakeholders. Phase 3 implemented the developed model using a one-group pretest-posttest design over a six-month period in nine pilot areas. Phase 4 evaluated and validated the model with 16 experts and relevant stakeholders. Quantitative data were analyzed using descriptive statistics and the paired t-test, while qualitative data were analyzed using content analysis. The findings revealed that:

1. Most dependent older adults received care from their families in collaboration with village health volunteers and primary care units. They expressed a need for holistic care encompassing physical, psychological, social, spiritual, and environmental dimensions, with the environmental dimension being the area of greatest need.

2.The developed model, termed P-CARE Impact Loop with Area-Based Adaptation, comprised four components: inputs, processes, outcomes, and feedback. It integrated knowledge, community participation, and policy mechanisms as driving forces, with operational adjustments tailored to local contexts.

3. The implementation of the model demonstrated that, following the intervention, older adults showed improved ability to perform activities of daily living (ADL) and a significantly reduced risk of falls within the home across all types of areas (p-value < .001). Quality of life and mental health significantly improved specifically in urban and semi-urban areas (p-value < .001), whereas no statistically significant differences were observed in rural and mountainous/remote areas.

System-level recommendations for developing context-appropriate care models include an Active Aging approach for urban and semi-urban areas, Community Participation for rural areas, and Community Outreach combined with Telecare for mountainous and remote areas. These approaches aim to sustainably enhance the quality of life of older adults.