Page 136 - GHES-2-2

Global Health Econ Sustain Improving health of older adults in rural Uganda

2.3.2. Screening for depression, dementia, energy details about older adults but also to identify, analyze, and
poverty, and functional disability address the decline in functional abilities that many elders
Six pilot villages were chosen for depression screening face. The Katz activities of daily living (ADL) Scale became
based on the perceived potential for VHWs to be the primary instrument of functional screening (Noelker &
successfully trained as peer counselors. VHWs screened Browdie, 2013), complemented by a contributive function
elders with observed depressive moods using the Patient scale (CFS), devised by the authors (HB, PB, and IM).
Health Questionnaire‑9 (PHQ‑9) depression scale. Older The CFS addresses for the first time the unmeasured and
adults with suicidality or severe depression were referred unremunerated contributions elders often make to their
immediately for follow-up by the mental health nurse (IO), families, even when home-bound. Items in the CFS include
either at the hospital or in the community. Those with mild farming, caring for the young, helping with meals, giving
or moderate depression were offered participation in small advice, solving conflicts, and participating in community
support groups using an adapted version of Interpersonal affairs.
Therapy (IPT), a peer counseling intervention developed VHWs were trained to administer the GHA at KDH
for low-resource countries and field-tested in Uganda with over two successive days. During the sessions, the form was
younger groups (Bolton et al., 2003). The IPT methodology reviewed, and VHWs engaged in supervised role-playing.
was culturally adapted to be culturally appropriate for the Subsequently, program coordinators observed each VHW
Kisoro older adult population and facilitated in Rufumbira, performing the assessment at five different households
the local language, initially by IO and IM, and later by a before certifying the VHW to survey the remaining elders
team of VHW peer counselors. in the village.
VHWs screened villagers suspected of cognitive 3. Results
problems using the Six-Item Dementia Scale for Africa.
Although the prevalence of dementia is not known, it is 3.1. Numbers of beneficiaries
not uncommon among older adults in Kisoro District and Table 1 summarizes the number of older adults screened
is often attributed in rural areas to curses or spirits. VHW for each problem area and the number of interventions
geriatric training sessions included instruction about made.
manifestations of dementia, behavioral and personality
changes, and communication strategies for interacting 3.2. Qualitative outcomes of interventions
with people with dementia. This training was incorporated It was beyond the scope of the project to measure the
into a VHW “home talk,” one of 25 topics in the VHW longitudinal outcomes of interventions with scientific
home talk repertoire, delivered in individual homes using rigor. However, VHWs are expected to obtain follow-up
flip charts (Moon et al., 2020). data concerning the effectiveness of interventions, and
In 2019, the intervention of solar lights to address their stipends are contingent upon this task. Beneficiaries
social isolation was added through partnerships with Let of interventions for vision, hearing, mobility and pain
There Be Light International (Buffalo, New York) and Solar problems almost universally reported improvements
Health Uganda (Kampala, Uganda). DGH census data and in function: Reading glasses enabled them to read,
VHW observational home visits were used to identify older thread needles for sewing, prepare food, sort harvested
adults in need of safe lighting. Impoverished elders living crops, and perform personal care; earwax washouts
alone without a source of indoor light receive small, solar- and listenator devices improved hearing for those with
powered units that can last through the night, illuminate a profound hearing loss; canes provided added stability on
room, and be easily recharged. uneven and rocky terrain; and pain medication alleviated
Screening for functional disability was incorporated musculoskeletal pains prevalent after a lifetime of working
into the new GHA (discussed in the subsequent section). in the fields, often allowing the older adult to return to the
tasks benefiting their families. In 2023, a new intervention
2.3.3. Becoming more data-directed and was introduced for pain: acupuncture for older adults
comprehensive with musculoskeletal pain refractory to paracetamol,
performed by a trained acupuncturist in the villages.
Aiming for comprehensive screening of all geriatric
persons in the 52-village catchment area, the Kisoro Elders These services have also been extremely popular and
Project, through supervised VHWs, undertook a GHA widely sought after.
over a 2 – 3 month period in 2021. This assessment targeted In 2019, a geriatric satisfaction survey was conducted
all elders in each village identified by the biannual health to assess the impact of interventions on the quality of
census. The GHA aimed not only to verify demographic life of beneficiaries. Data demonstrated overall high

Volume 2 Issue 2 (2024) 5 https://doi.org/10.36922/ghes.3000