越南活躍老化指標: 現況、因子、效益、跨國比較、與政策建議

Abstract

Introduction In response to the challenges of population aging, the WHO has developed a policy framework that promotes active aging, with an emphasis on the following three pillars: health, social participation, and security. Several advanced countries have conducted studies to measure and monitor active aging level and evaluate the implementation of aging-related policies. However, such studies are scarce in Vietnam, one of the world’s fastest aging countries. Therefore, this study was conducted to 1) adapt and validate the active aging index (AAI) in Vietnamese language; 2) assess the current status of active aging in Vietnam and compare it with that in China, South Korea, Taiwan, and 28 European Union (EU) countries; 3) identify the determinants of active aging; and 4) explore the potential benefits of active aging, including health outcomes, health utilization, life satisfaction, and quality of life (hereafter referred to as health-related outcomes). Research methods This study was divided into three phases. In the first phase, translation and modification were conducted to adapt the AAI to Vietnam culture. A series of one expert panel discussion and two focus groups among older adults were conducted to obtain their perspectives on the tool. The second phase consisted of a pilot test and a retest on 40 people to assess the different types of validity and reliability of the questionnaire. In the third phase, a cross-sectional investigation was conducted on 1105 older adults in three provinces representing three regions of Vietnam: Thai Nguyen (northern), Hue (central), and Ho Chi Minh (southern). A multi-stratified sampling method was applied to draw study participants. General linear regression and multiple ordinal regression models were used to identify the determinants and the potential benefits of active aging. Results Psychometric properties of the final version of Vietnamese AAI (VAAI). The VAAI had a good test–retest reliability with a minimum ICC of 0.70 for a single question and an acceptable internal consistency for 3 of 4 groups of items ( = 0.70, 0.94, and 0.65). It also showed acceptable construct validity with model fit indices of χ2/df = 3.8; RMSEA = 0.059; CFI = 0.939; and SRMR = 0.060. The content validity indices rated by 6 Vietnamese experts were 0.95 and 0.98 for relevant and clarity criterion, respectively. The VAAI also achieved concurrent validity. VAAI in comparison with other countries. Using the validated tool, we observed that Vietnam had an overall AAI score of 43.1, which was ranked 2nd among 32 countries. Vietnam was ranked high in terms of overall AAI due to high rankings in 2 domains, i.e., employment (ranked 1st) and social participation (ranked 5th). In contrast, Vietnam ranked 32nd the lowest in terms of independent/healthy/secure living and 26th in terms of capacity and enabling environment for active aging. These two domains had low rankings because several component indicators obtained low scores, including lifelong learning (7.0%), lived alone or with spouse (18.9%), use of internet (26.7%), having had a senior high school degree or above (26.7%), share of healthy life years (39.8%), no poverty risk (46.2%), and physical activity (47.1%). The AAI score for older men (44.9) was higher than that for older women (41.6). Determinants of active aging. The bivariate analysis showed that people who were younger, male, married, rural residents, northern residents, without limited activity, and without longstanding illness had significantly higher AAI scores than their counterparts (p < 0.05). However, after controlling for important covariates, only age (p = 0.001), region (p = 0.001), and limited activity (p = 0.001) were found to be significant determinants of the variation in AAI. Potential benefits of active aging. After controlling for potential confounders, we found that people with higher AAI scores were more likely to have good health, better life satisfaction, quality of life than those with lower AAI scores, and they were also less likely to be frail and suffer a fall. Discussion In addition to the interpretation of results and comparison with other studies, some useful policies from advanced countries that Vietnam could learn to promote active and healthy aging have been discussed in this study. At the end of this section, we discuss the present study’s strengths and limitations as well as the implications for future studies. Conclusion Analysis of the psychometric properties of the VAAI showed that this index is reliable and valid, which therefore ensures that the VAAI can be used in a country with a new cultural setting, such as Vietnam. Older Vietnamese adults were more active in labor force and social participation; however, they were not as healthy, independent, secure, and capable of being active as their counterparts in other Asian and EU countries. These findings indicate that Vietnam must improve low-score indicators, such as voluntary activity, physical activity, independent living, lifelong learning, educational attainment, use of internet, healthy life expectancy, and risk of poverty. The findings of this study also reveal that multidimensional active aging is a beneficial predictor of 5 of 8 health-related outcomes. However, when one is designing multidimensional active aging programs, more attention must be paid to people who are female, older, and/or with activity limitation, as they obtained lower AAI scores than their counterparts.