https://orcid.org/0000-0002-6296-0563
Abstract
This study constructed the Healthy Aging Index (HAI) and identified its associated factors, using two waves of nationally representative data on the Vietnamese older persons in 2019 and 2022. HAI was constructed with 22 variables reflecting various domains of healthy aging, and its measurement ranged from 0 to 100. Descriptive statistics and multivariate Tobit regressions were conducted. We found that the overall HAI scores were relatively high in 2019 and 2022 (84.05 and 83.71, respectively), indicating that the Vietnamese older persons were relatively healthy. More advanced age, being women, living with at least a child, living with a spouse, being more affluent, having higher educational level, receiving social welfare benefits, performing household chores, and utilization of healthcare services were associated with the overall HAI scores as well as each factor of HAI scores. This study also discussed policies that can be designed to enhance well-being of older persons in Vietnam, including the investment in higher educational training, lifelong learning programs for older adults, increasing pension and social welfare benefits together with enhancing healthcare delivery for vulnerable groups, and the development of an integrated care model combining health and social care.
Various studies have discussed healthy aging with a single indicator (such as self-rated health), which does not measure health as a complex variable.
This study is the first to construct Healthy Aging Index (HAI) for Vietnam as a middle-income country facing critical aging-related health issues.
HAI and its associated factors can provide insightful, evidence-based policy recommendations for health promotion to different population groups.
Appropriate strategies and policies on health promotion and education help to adapt to a rapidly aging population and achieve healthy aging for all.
INTRODUCTION
Health challenges of aging populations have been observed and discussed widely in Asia and the Pacific with focuses on physical and mental health, health inequalities, and policy interventions (Laurin et al. 2001, Elwell-Sutton et al. 2013, Kien et al. 2019, Nguyen, Than et al. 2019, Nguyen, Le et al. 2019, Vu et al. 2019, Nguyen and Giang 2021, Phi et al. 2023). Given such contexts, healthy aging has been increasingly studied to examine to healthy statuses of different countries. World Health Organization [WHO] 2015) defined healthy aging as a comprehensive term referring to experiences of growing older while maintaining functional ability and promoting well-being of older persons. Several studies on healthy aging have been widely implemented (e.g. Ng et al. 2009, Assmann et al. 2016, Manasatchakun et al. 2016, Bélanger et al. 2017, Jaspers et al. 2017, Liu et al. 2017, Mejía et al. 2017, Whitley et al. 2018). These studies examined healthy aging statuses as comprehensive indices with multiple aspects (such as cognitive function, psychological well-being, and health behaviors) and highlighted their importance in assessing healthy aging.
Vietnam will be an “aged” society by 2036 (General Statistics Office, Vietnam [GSO] 2021) when the older population aged 65 and over will account for 14.2% of the total population. To date, older Vietnamese persons are facing numerous health issues, health equity, and difficulties in basic functions (Vietnam’s Women Union [VWU] 2012, Vu et al. 2017, Nguyen, Than et al. 2019, Nguyen, Le et al. 2019, Le et al. 2020, GSO 2021, Giang et al. 2023). These studies, however, have been examined single health issue rather than a comprehensive health-related well-being of older persons. Also, there has been a great shortage of using healthy aging as a key approach for policies and academic studies in Vietnam. Thus, this study is the first attempt to explore status and associated factors of healthy aging for older Vietnamese, and provide policy recommendations to the government of Vietnam (GOV).
DATA AND METHODS
Data
This study used data from the Survey on Older Persons and Social Health Insurance in Vietnam 2019 (OP&SHI 2019) and the Vietnam National Aging Survey 2022 (VNAS 2022). These were nationally representative surveys of older Vietnamese persons (those aged 60 and over) because both were derived from the Population and Housing Census 2019 with the probability proportional to size (PPS) and multiple-stage sampling methods to select locations and older participants. The total sample size of this study included 6232 older persons, of which 3049 of OP&SHI 2019 and 3183 of VNAS 2022.
Two surveys comprised rich personal and household information of older persons (e.g. age, gender, physical health, and healthcare utilization). These surveys had consistent questionnaires adapted from national surveys and comparable with surveys on older persons in other countries (such as Indonesia Longitudinal Aging Survey and Malaysia Ageing and Retirement Survey).
OP&SHI 2019 and VNAS 2022 were approved by the Institutional Review Board of the Institute of Social and Medical Studies (ISMS) with the Decision No.01/HDDD-ISMS dated 12 July 2019, and Decision No.04/HDDD-ISMS dated 18 July 2022, respectively.
Methods
Measurement of healthy aging
We constructed HAI with multiple domains based on WHO (2015) and other empirical studies on healthy aging (e.g. Sowa et al. 2016, Annele et al. 2019, Abud et al. 2022, Irshad et al. 2022). According to WHO (2015)’s theoretical framework and public health perspective, healthy aging is considered nonclinical aspects, comprising various fields, including functional ability, intrinsic capacity, environments, and well-being. Accordingly, functional ability refers to the health-related attributes that reflect a person’s capacity to perform activities. Intrinsic capacity is composition of an individual’s physical and mental capacities. Environments include all external factors that shape an individual’s life and have numerous subfactors (such as living environment, interpersonal relationships, and health policies). And well-being refers to a broad scope defined as the sense of satisfaction and fulfillment.
This study focused on key parts of WHO’s healthy aging definition: physical well-being, mental well-being, and social well-being (Abud et al. 2022). For the Vietnamese context, we proposed that HAI consisted of 22 items covering six domains, namely: (i) physical capabilities; (ii) physiological and metabolic health; (iii) general health status; (iv) mental health; (v) community engagement; and (vi) family relationship experience (Table 1). In particular, the domains (i), (ii), and (iii) represent the physical well-being aspect; the domain (iv) represents the mental well-being aspect; and the remaining domains (v) and (vi) describe the social well-being aspect.
Healthy aging indicators and harmonization of HAI
| Domains | Variable | Categories | Scale | |
|---|---|---|---|---|
| Physical capabilities | ADL | Eating | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 |
| Dressing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Bathing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting up when lying down | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting to and using toilet | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| IADL | Ability to use telephone | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Shopping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Food preparation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Housekeeping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Laundry | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Mode of transportation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Responsibility for own medications | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Ability to handle finances | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Physiological and metabolic health | Arthritis | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Blood pressure problem | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Cardiovascular diseases | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| General health status | Self-rated health | 0 = very good/good, 1 = fair, 2 = poor/very poor | 0 = 100 1 = 50 2 = 0 | |
| Mental health | Depression symptoms | 0 = Normal, 1 = Mild depression, 2 = Moderate depression, 3 = Severe depression | 0 = 100 1 = 66 2 = 33 3 = 0 | |
| Community engagement | Number of social groups participated | 0 = 0 group 1 = 1 group 2 = 2 groups 3 = 3 groups | 0 = 0 1 = 33 2 = 66 3 = 100 | |
| Family relationship experience | Harsh communication experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Communication rejection experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Domestic violence experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| The total score of all the 22 variables has normalized into 0–100 scale. | ||||
| Domains | Variable | Categories | Scale | |
|---|---|---|---|---|
| Physical capabilities | ADL | Eating | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 |
| Dressing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Bathing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting up when lying down | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting to and using toilet | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| IADL | Ability to use telephone | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Shopping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Food preparation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Housekeeping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Laundry | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Mode of transportation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Responsibility for own medications | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Ability to handle finances | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Physiological and metabolic health | Arthritis | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Blood pressure problem | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Cardiovascular diseases | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| General health status | Self-rated health | 0 = very good/good, 1 = fair, 2 = poor/very poor | 0 = 100 1 = 50 2 = 0 | |
| Mental health | Depression symptoms | 0 = Normal, 1 = Mild depression, 2 = Moderate depression, 3 = Severe depression | 0 = 100 1 = 66 2 = 33 3 = 0 | |
| Community engagement | Number of social groups participated | 0 = 0 group 1 = 1 group 2 = 2 groups 3 = 3 groups | 0 = 0 1 = 33 2 = 66 3 = 100 | |
| Family relationship experience | Harsh communication experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Communication rejection experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Domestic violence experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| The total score of all the 22 variables has normalized into 0–100 scale. | ||||
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
Healthy aging indicators and harmonization of HAI
| Domains | Variable | Categories | Scale | |
|---|---|---|---|---|
| Physical capabilities | ADL | Eating | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 |
| Dressing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Bathing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting up when lying down | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting to and using toilet | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| IADL | Ability to use telephone | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Shopping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Food preparation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Housekeeping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Laundry | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Mode of transportation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Responsibility for own medications | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Ability to handle finances | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Physiological and metabolic health | Arthritis | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Blood pressure problem | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Cardiovascular diseases | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| General health status | Self-rated health | 0 = very good/good, 1 = fair, 2 = poor/very poor | 0 = 100 1 = 50 2 = 0 | |
| Mental health | Depression symptoms | 0 = Normal, 1 = Mild depression, 2 = Moderate depression, 3 = Severe depression | 0 = 100 1 = 66 2 = 33 3 = 0 | |
| Community engagement | Number of social groups participated | 0 = 0 group 1 = 1 group 2 = 2 groups 3 = 3 groups | 0 = 0 1 = 33 2 = 66 3 = 100 | |
| Family relationship experience | Harsh communication experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Communication rejection experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Domestic violence experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| The total score of all the 22 variables has normalized into 0–100 scale. | ||||
| Domains | Variable | Categories | Scale | |
|---|---|---|---|---|
| Physical capabilities | ADL | Eating | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 |
| Dressing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Bathing | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting up when lying down | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Getting to and using toilet | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| IADL | Ability to use telephone | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Shopping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Food preparation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Housekeeping | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Laundry | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Mode of transportation | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Responsibility for own medications | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Ability to handle finances | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Physiological and metabolic health | Arthritis | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Blood pressure problem | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Cardiovascular diseases | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| General health status | Self-rated health | 0 = very good/good, 1 = fair, 2 = poor/very poor | 0 = 100 1 = 50 2 = 0 | |
| Mental health | Depression symptoms | 0 = Normal, 1 = Mild depression, 2 = Moderate depression, 3 = Severe depression | 0 = 100 1 = 66 2 = 33 3 = 0 | |
| Community engagement | Number of social groups participated | 0 = 0 group 1 = 1 group 2 = 2 groups 3 = 3 groups | 0 = 0 1 = 33 2 = 66 3 = 100 | |
| Family relationship experience | Harsh communication experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | |
| Communication rejection experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| Domestic violence experience | 1 = Yes and 0 = No | 1 = 0 and 0 = 100 | ||
| The total score of all the 22 variables has normalized into 0–100 scale. | ||||
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
In terms of the physical capabilities, we used activities of daily living (ADL) and instrumental activities of daily living (IADL) as measurements to reflect an older person’s intrinsic capacity, which was applied in various studies (Sowa et al. 2016, Gómez et al. 2021, Irshad et al. 2022). Older persons with no difficulties in ADL/IADL are assessed as healthy.
Regarding physiological and metabolic health, older persons are more likely to experience a higher prevalence of comorbidities than younger counterparts (Xu et al. 2020), in which blood pressure issues, cardiovascular diseases, and arthritis are usually reported as common physiological and metabolic health issues among older persons. These poor health conditions are significant causes of physical disabilities and deterioration of quality of life (Song et al. 2006, Ettehad et al. 2016). In this study, older persons without any of the above diseases were considered healthy.
The general health status was represented by self-assessed health as “very good/good,” “fair,” and “poor/very poor.” Within this domain, those reporting their health status as “fair” or “very good/good” were considered healthy (Sowa et al. 2016, Irshad et al. 2022).
The mental well-being is pivotal for successfully healthy aging (Abud et al. 2022, Irshad et al. 2022). In this study, we used the Geriatric Depression Scale short-form covering 15 items (or GDS-15) to measure depression in older persons as in other studies (Wancata et al. 2006, Nyunt et al. 2009, Nguyen and Nguyen 2020). Respondents were asked to answer 15 questions with “Yes” (coded as 1) and “No” (coded as 0), and thus the overall score ranges between 0 and 15. The depression symptom levels were then categorized into four levels: normal (0–4), mild depression (5–8), moderate depression (9–11), and severe depression (12–15) (Fountoulakis et al. 1999, Greenberg 2012, Mulat et al. 2021, Emebet 2022). Older persons categorized as “normal” were considered healthy persons.
Community and family significantly influence an older person’s health and quality of life (Hawton et al. 2011, Freak-Poli et al. 2022). In HAI, community engagements and family relationships reflect social cohesion of older persons (Manasatchakun et al. 2016, Thomas et al. 2017, Irshad et al. 2022). This study measured community engagements by the number of social and religious groups/activities that an older person was participating. For family relationships, older persons’ experiences with domestic violence (i.e. being spoken harshly, being refused to talk, and being shaken or hit by family members) were examined since it might have a strong impact on older persons’ mental health (Nguyen et al. 2016, Thomas et al. 2017) and reflect abuse of older persons (Gholipour et al. 2020). In this study, older persons without domestic violence were considered healthy persons.
Each of the 22 items above was coded as binary or ranking variables with values between 0 and 100. For each older person, the total score was generated by summing the total values of 22 items, divided by 22 and then harmonized into a HAI score ranging from 0 to 100. A higher HAI implies better healthy aging status.
Predictor variables
Based on WHO (2015), predictor variables had three main clusters, as follows.
Cluster 1—Sociodemographic and socioeconomic factors included age groups, gender, the highest level of education attainment, marital status, place of residence, living arrangements, and household wealth quartiles. More specifically, age groups included the young-old (60–69, as the reference group), the middle-old (70–79), and the oldest-old (80 and above). Gender included male (as the reference group) and female. The highest level of education attainment included no schooling or incomplete primary education (as the reference group), completed primary, completed secondary, and college and above. Marital status had other statuses (single, separated, divorced, or widowed) as the reference group, and currently married. Place of residence included urban areas (as the reference group) and rural areas. Living arrangements included living alone (as the reference group), living with spouse only, living with at least a child, and living with others. Household wealth indicator was constructed from various household assets (such as televisions and refrigerators) and housing quality (such as materials of the house’s roof and floor), using the principal components analysis, and then was distributed into four quartiles, in which the first and the fourth quartiles represented the poorest and the wealthiest group, respectively.
Cluster 2—Social capital, which is an important determinant of mental health and functional performance among older persons (Nyqvist et al. 2013, Coll‐Planas et al. 2017, Giang et al. 2020, Luo et al. 2020), included: (i) older persons’ contributions to their families, which were presented by care provision to grandchildren (under 10 years of age), care provision to other family members, and performance of household chores. These variables were respectively dichotomized as subgroups with “No” (as the reference groups) and “Yes”; and (ii) social support for older persons, which was analyzed using financial support (cash that an older person received from others such as children) and social welfare benefits (retirement benefits or social allowances that an older person received). These variables were divided into “No” (as the reference group) and “Yes.”
Cluster 3—Healthcare utilization, which is a predictor of healthy aging (Gómez et al. 2021), was measured by whether an older person had inpatient admissions and/or outpatient visits. These variables were dichotomous with “No” (as the reference group) and “Yes.”
Statistical analyses
For HAI measurement, Cronbach’s alpha was conducted to measure its internal consistency, while exploratory factor analysis (EFA) was applied to assess its validity. We used the scree plot to examine the threshold of eigenvalue where the curve flattened out, and the threshold value was 1.5. The Orthogonal Varimax rotation with Kaiser’s normalization was then employed to reallocate the 22 items into appropriate factor loadings (also known as domains of HAI measurement). In the EFA, a common cutoff point for factor loadings refers to the threshold where the loadings may be considered weak and less important for interpreting the factors if they are below the threshold. This study used threhold at 0.5 based on Joseph et al. (2009).
Because HAI scores are censored, multivariate Tobit regression models were conducted to identify factors associated with the healthy aging status among Vietnamese older persons. The models were used for HAI overall scores and each HAI domain. The Mann–Whitney U test investigated the median differences in HAI scores reported in 2019 and 2022. The statistical significance P-values were less than .05.
All calculations were conducted with the sample weight to ensure representativeness for the Vietnamese older population.
RESULTS
Table 2 presents background information on the Vietnamese older persons in 2019 and 2022 with different characteristics. The majority of older persons were in 60–69 group (58.91% in 2019 and 58.24% in 2022), female (55.18% in 2019 and 56.97% in 2022), currently married (69.90% in 2019 and 73.20% in 2022), and lived in rural areas (67.10% in 2019 and 65.40% in 2022). Most older persons performed housework (83.78% in 2019 and 79.38% in 2022), but few took care of their grandchildren (28.59% in 2019 and 28.49% in 2022) and other members (10.52% in 2019 and 7.75% in 2022). Inpatient rate was 18.39% in 2019 and 15.45% in 2022, while outpatient rate was 76.91% in 2019 and 69.60% in 2022.
Socioeconomic and health-related characteristics of the Vietnamese older persons in 2019 and 2022
| Variables | 2019 | 2022 | |
|---|---|---|---|
| N (%) | N (%) | ||
| Sociodemographic and socioeconomic factors | Age group | ||
| 60–69 | 1307 (58.91) | 1155 (58.24) | |
| 70–79 | 879 (23.48) | 1158 (26.07) | |
| 80+ | 863 (17.61) | 870 (15.69) | |
| Gender | |||
| Male | 1219 (44.82) | 1295 (43.03) | |
| Female | 1830 (55.18) | 1888 (56.97) | |
| Highest education attainment level | |||
| No schooling/incomplete primary education | 1425 (35.78) | 1422 (34.19) | |
| Complete primary | 643 (22.69) | 624 (17.72) | |
| Complete secondary | 852 (34.69) | 1014 (41.78) | |
| College and above | 129 (6.84) | 123 (6.31) | |
| Marital status | |||
| Others (Single/separated/divorced/widowed) | 1305 (30.10) | 1351 (26.80) | |
| Married | 1744 (69.90) | 1832 (73.20) | |
| Residence | |||
| Living in urban areas | 468 (32.90) | 549 (34.60) | |
| Living in rural areas | 2581 (67.10) | 2634 (65.40) | |
| Living arrangements | |||
| Alone | 318 (5.08) | 296 (5.03) | |
| With spouse only | 563 (19.24) | 602 (24.35) | |
| With at least a child | 1941 (66.92) | 344 (9.52) | |
| Others | 227 (8.76) | 1730 (61.10) | |
| Household wealth quantiles | |||
| 1st quartile (the poorest quartile) | 1063 (25.02) | 1062 (25.04) | |
| 2nd quartile (second poorest quartile) | 891 (24.99) | 877 (24.98) | |
| 3rd quartile (second wealthiest quartile) | 650 (25.90) | 807 (29.80) | |
| 4th quartile (the wealthiest quartile) | 436 (24.10) | 437 (20.18) | |
| Social capital | Grandchildren care provision | ||
| No | 2274 (71.41) | 2390 (71.51) | |
| Yes | 775 (28.59) | 793 (28.49) | |
| Care provision for other members (excluding grandchildren) | |||
| No | 2789 (89.48) | 2969 (92.25) | |
| Yes | 260 (10.52) | 214 (7.75) | |
| Household chores performance | |||
| No | 620 (16.22) | 807 (20.62) | |
| Yes | 2429 (83.78) | 2376 (79.38) | |
| Social financial supports | |||
| No | 304 (9.52) | 406 (14.00) | |
| Yes | 2745 (90.48) | 2777 (86.00) | |
| Social welfare benefits | |||
| No (not received) | 1604 (59.61) | 1583 (57.05) | |
| Yes (received) | 1445 (40.39) | 1600 (42.95) | |
| Healthcare utilization | Hospitalization (inpatient admission) in the previous 12 months | ||
| No | 2424 (81.61) | 2584 (84.55) | |
| Yes | 625 (18.39) | 599 (15.45) | |
| Medical (outpatient) visits in the previous 12 months | |||
| No | 795 (23.09) | 1047 (30.40) | |
| Yes | 2254 (76.91) | 2136 (69.60) | |
| Variables | 2019 | 2022 | |
|---|---|---|---|
| N (%) | N (%) | ||
| Sociodemographic and socioeconomic factors | Age group | ||
| 60–69 | 1307 (58.91) | 1155 (58.24) | |
| 70–79 | 879 (23.48) | 1158 (26.07) | |
| 80+ | 863 (17.61) | 870 (15.69) | |
| Gender | |||
| Male | 1219 (44.82) | 1295 (43.03) | |
| Female | 1830 (55.18) | 1888 (56.97) | |
| Highest education attainment level | |||
| No schooling/incomplete primary education | 1425 (35.78) | 1422 (34.19) | |
| Complete primary | 643 (22.69) | 624 (17.72) | |
| Complete secondary | 852 (34.69) | 1014 (41.78) | |
| College and above | 129 (6.84) | 123 (6.31) | |
| Marital status | |||
| Others (Single/separated/divorced/widowed) | 1305 (30.10) | 1351 (26.80) | |
| Married | 1744 (69.90) | 1832 (73.20) | |
| Residence | |||
| Living in urban areas | 468 (32.90) | 549 (34.60) | |
| Living in rural areas | 2581 (67.10) | 2634 (65.40) | |
| Living arrangements | |||
| Alone | 318 (5.08) | 296 (5.03) | |
| With spouse only | 563 (19.24) | 602 (24.35) | |
| With at least a child | 1941 (66.92) | 344 (9.52) | |
| Others | 227 (8.76) | 1730 (61.10) | |
| Household wealth quantiles | |||
| 1st quartile (the poorest quartile) | 1063 (25.02) | 1062 (25.04) | |
| 2nd quartile (second poorest quartile) | 891 (24.99) | 877 (24.98) | |
| 3rd quartile (second wealthiest quartile) | 650 (25.90) | 807 (29.80) | |
| 4th quartile (the wealthiest quartile) | 436 (24.10) | 437 (20.18) | |
| Social capital | Grandchildren care provision | ||
| No | 2274 (71.41) | 2390 (71.51) | |
| Yes | 775 (28.59) | 793 (28.49) | |
| Care provision for other members (excluding grandchildren) | |||
| No | 2789 (89.48) | 2969 (92.25) | |
| Yes | 260 (10.52) | 214 (7.75) | |
| Household chores performance | |||
| No | 620 (16.22) | 807 (20.62) | |
| Yes | 2429 (83.78) | 2376 (79.38) | |
| Social financial supports | |||
| No | 304 (9.52) | 406 (14.00) | |
| Yes | 2745 (90.48) | 2777 (86.00) | |
| Social welfare benefits | |||
| No (not received) | 1604 (59.61) | 1583 (57.05) | |
| Yes (received) | 1445 (40.39) | 1600 (42.95) | |
| Healthcare utilization | Hospitalization (inpatient admission) in the previous 12 months | ||
| No | 2424 (81.61) | 2584 (84.55) | |
| Yes | 625 (18.39) | 599 (15.45) | |
| Medical (outpatient) visits in the previous 12 months | |||
| No | 795 (23.09) | 1047 (30.40) | |
| Yes | 2254 (76.91) | 2136 (69.60) | |
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
Socioeconomic and health-related characteristics of the Vietnamese older persons in 2019 and 2022
| Variables | 2019 | 2022 | |
|---|---|---|---|
| N (%) | N (%) | ||
| Sociodemographic and socioeconomic factors | Age group | ||
| 60–69 | 1307 (58.91) | 1155 (58.24) | |
| 70–79 | 879 (23.48) | 1158 (26.07) | |
| 80+ | 863 (17.61) | 870 (15.69) | |
| Gender | |||
| Male | 1219 (44.82) | 1295 (43.03) | |
| Female | 1830 (55.18) | 1888 (56.97) | |
| Highest education attainment level | |||
| No schooling/incomplete primary education | 1425 (35.78) | 1422 (34.19) | |
| Complete primary | 643 (22.69) | 624 (17.72) | |
| Complete secondary | 852 (34.69) | 1014 (41.78) | |
| College and above | 129 (6.84) | 123 (6.31) | |
| Marital status | |||
| Others (Single/separated/divorced/widowed) | 1305 (30.10) | 1351 (26.80) | |
| Married | 1744 (69.90) | 1832 (73.20) | |
| Residence | |||
| Living in urban areas | 468 (32.90) | 549 (34.60) | |
| Living in rural areas | 2581 (67.10) | 2634 (65.40) | |
| Living arrangements | |||
| Alone | 318 (5.08) | 296 (5.03) | |
| With spouse only | 563 (19.24) | 602 (24.35) | |
| With at least a child | 1941 (66.92) | 344 (9.52) | |
| Others | 227 (8.76) | 1730 (61.10) | |
| Household wealth quantiles | |||
| 1st quartile (the poorest quartile) | 1063 (25.02) | 1062 (25.04) | |
| 2nd quartile (second poorest quartile) | 891 (24.99) | 877 (24.98) | |
| 3rd quartile (second wealthiest quartile) | 650 (25.90) | 807 (29.80) | |
| 4th quartile (the wealthiest quartile) | 436 (24.10) | 437 (20.18) | |
| Social capital | Grandchildren care provision | ||
| No | 2274 (71.41) | 2390 (71.51) | |
| Yes | 775 (28.59) | 793 (28.49) | |
| Care provision for other members (excluding grandchildren) | |||
| No | 2789 (89.48) | 2969 (92.25) | |
| Yes | 260 (10.52) | 214 (7.75) | |
| Household chores performance | |||
| No | 620 (16.22) | 807 (20.62) | |
| Yes | 2429 (83.78) | 2376 (79.38) | |
| Social financial supports | |||
| No | 304 (9.52) | 406 (14.00) | |
| Yes | 2745 (90.48) | 2777 (86.00) | |
| Social welfare benefits | |||
| No (not received) | 1604 (59.61) | 1583 (57.05) | |
| Yes (received) | 1445 (40.39) | 1600 (42.95) | |
| Healthcare utilization | Hospitalization (inpatient admission) in the previous 12 months | ||
| No | 2424 (81.61) | 2584 (84.55) | |
| Yes | 625 (18.39) | 599 (15.45) | |
| Medical (outpatient) visits in the previous 12 months | |||
| No | 795 (23.09) | 1047 (30.40) | |
| Yes | 2254 (76.91) | 2136 (69.60) | |
| Variables | 2019 | 2022 | |
|---|---|---|---|
| N (%) | N (%) | ||
| Sociodemographic and socioeconomic factors | Age group | ||
| 60–69 | 1307 (58.91) | 1155 (58.24) | |
| 70–79 | 879 (23.48) | 1158 (26.07) | |
| 80+ | 863 (17.61) | 870 (15.69) | |
| Gender | |||
| Male | 1219 (44.82) | 1295 (43.03) | |
| Female | 1830 (55.18) | 1888 (56.97) | |
| Highest education attainment level | |||
| No schooling/incomplete primary education | 1425 (35.78) | 1422 (34.19) | |
| Complete primary | 643 (22.69) | 624 (17.72) | |
| Complete secondary | 852 (34.69) | 1014 (41.78) | |
| College and above | 129 (6.84) | 123 (6.31) | |
| Marital status | |||
| Others (Single/separated/divorced/widowed) | 1305 (30.10) | 1351 (26.80) | |
| Married | 1744 (69.90) | 1832 (73.20) | |
| Residence | |||
| Living in urban areas | 468 (32.90) | 549 (34.60) | |
| Living in rural areas | 2581 (67.10) | 2634 (65.40) | |
| Living arrangements | |||
| Alone | 318 (5.08) | 296 (5.03) | |
| With spouse only | 563 (19.24) | 602 (24.35) | |
| With at least a child | 1941 (66.92) | 344 (9.52) | |
| Others | 227 (8.76) | 1730 (61.10) | |
| Household wealth quantiles | |||
| 1st quartile (the poorest quartile) | 1063 (25.02) | 1062 (25.04) | |
| 2nd quartile (second poorest quartile) | 891 (24.99) | 877 (24.98) | |
| 3rd quartile (second wealthiest quartile) | 650 (25.90) | 807 (29.80) | |
| 4th quartile (the wealthiest quartile) | 436 (24.10) | 437 (20.18) | |
| Social capital | Grandchildren care provision | ||
| No | 2274 (71.41) | 2390 (71.51) | |
| Yes | 775 (28.59) | 793 (28.49) | |
| Care provision for other members (excluding grandchildren) | |||
| No | 2789 (89.48) | 2969 (92.25) | |
| Yes | 260 (10.52) | 214 (7.75) | |
| Household chores performance | |||
| No | 620 (16.22) | 807 (20.62) | |
| Yes | 2429 (83.78) | 2376 (79.38) | |
| Social financial supports | |||
| No | 304 (9.52) | 406 (14.00) | |
| Yes | 2745 (90.48) | 2777 (86.00) | |
| Social welfare benefits | |||
| No (not received) | 1604 (59.61) | 1583 (57.05) | |
| Yes (received) | 1445 (40.39) | 1600 (42.95) | |
| Healthcare utilization | Hospitalization (inpatient admission) in the previous 12 months | ||
| No | 2424 (81.61) | 2584 (84.55) | |
| Yes | 625 (18.39) | 599 (15.45) | |
| Medical (outpatient) visits in the previous 12 months | |||
| No | 795 (23.09) | 1047 (30.40) | |
| Yes | 2254 (76.91) | 2136 (69.60) | |
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
The validity and reliability checks of HAI measurements in 2019 and 2022 are presented in Table 3. The Cronbach alpha results were 0.85 and 0.86, respectively, indicating good internal HAI measurement consistency in the 2019 and 2022 analyses. For EFA, Bartlett’s sphericity test was significant and the sample adequacy test statistic was relatively high (Kaiser–Meyer–Olkin = 0.926 and 0.932 for 2019 and 2022 analyses, respectively), suggesting that the data were appropriate for applying EFA. Table 3 also indicates that the factor structure observed in the 2019 analysis was similar to that in the 2022 analysis. In other words, the 22 items could be consistently reclassified into three factors in both 2019 and 2022 analyses: Factor 1 consisted of ADL, IADL, and community engagement variables, Factor 2 consisted of general health status and physiological and metabolic health variables, and Factor 3 included variables related to mental health and family relationship experience. These three factors accounted for 47.16% and 49.77% of the total variance of the HAI scores in the 2019 and 2022 analyses, respectively. In this study, Factors 1, 2, and 3 were respectively named “ADL+IADL+Community engagements”; “Health conditions”; and “Depression and family relationships.”
Factor loadings of HAI measurement (varimax rotation)
| Items | 2019 | 2022 | ||||||
|---|---|---|---|---|---|---|---|---|
| % Healthy aging | Factor loading | % Healthy aging | Factor loading | |||||
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | |||
| No difficulty in eating | 96.39 | 0.69 | 96.80 | 0.68 | ||||
| No difficulty in dressing | 94.93 | 0.77 | 93.65 | 0.82 | ||||
| No difficulty in bathing | 93.96 | 0.80 | 93.19 | 0.84 | ||||
| No difficulty in getting up when lying down | 91.78 | 0.64 | 91.11 | 0.67 | ||||
| No difficulty in getting to and using toilet | 93.90 | 0.71 | 93.55 | 0.76 | ||||
| No difficulty in ability to use telephone | 81.90 | 0.51 | 83.70 | 0.51 | ||||
| No difficulty in shopping | 93.68 | 0.73 | 93.06 | 0.76 | ||||
| No difficulty in food preparation | 92.28 | 0.79 | 91.27 | 0.83 | ||||
| No difficulty in housekeeping | 91.37 | 0.80 | 89.11 | 0.82 | ||||
| No difficulty in laundry | 91.03 | 0.79 | 89.61 | 0.81 | ||||
| No difficulty in mode of transportation | 87.44 | 0.62 | 88.31 | 0.69 | ||||
| No difficulty in responsibility for own medications | 97.79 | 0.61 | 97.62 | 0.66 | ||||
| No difficulty in ability to handle finances | 95.50 | 0.74 | 93.62 | 0.78 | ||||
| Participated at least 1 social group | 89.63 | −0.58 | 79.24 | −0.48 | ||||
| No diagnosed as arthritis | 36.60 | 0.54 | 63.47 | 0.41 | ||||
| No diagnosed as blood pressure problem | 51.92 | 0.59 | 42.57 | 0.48 | ||||
| No diagnosed as cardiovascular diseases | 19.84 | 0.63 | 78.10 | 0.49 | ||||
| Positive self-rated health | 49.91 | 0.52 | 61.14 | 0.65 | ||||
| No diagnosed as depression symptoms | 65.63 | 0.58 | 74.67 | 0.45 | ||||
| No harsh communication experience | 86.15 | 0.65 | 91.76 | 0.66 | ||||
| No communication rejection experience | 97.86 | 0.62 | 98.79 | 0.60 | ||||
| No domestic violence experience | 99.42 | 0.61 | 99.66 | 0.54 | ||||
| Overall HAI score | ||||||||
| Mean (SE) | 84.05 (13.85) | 83.71 (14.47) | ||||||
| Mann–Whitney U test | P = .63 | |||||||
| HAI domains scores | ||||||||
| Mean (SE) | 57.31 (12.09) | 16.67 (2.51) | 10.06 (4.76) | 56.49 (12.65) | 10.03 (4.86) | 17.19 (2.03) | ||
| Reliability | ||||||||
| Cronbach’s alpha | 0.85 | 0.86 | ||||||
| Factor structure | ||||||||
| Bartlett’s sphericity | (P < .0001) | (P < .0001) | ||||||
| Kaiser–Meyer–Olkin | 0.926 | 0.932 | ||||||
| Eigen value | 7.06 | 1.61 | 1.69 | 7.56 | 1.75 | 1.63 | ||
| Percentage explained variance (%) | 32.12 | 7.71 | 7.33 | 34.37 | 7.98 | 7.42 | ||
| Items | 2019 | 2022 | ||||||
|---|---|---|---|---|---|---|---|---|
| % Healthy aging | Factor loading | % Healthy aging | Factor loading | |||||
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | |||
| No difficulty in eating | 96.39 | 0.69 | 96.80 | 0.68 | ||||
| No difficulty in dressing | 94.93 | 0.77 | 93.65 | 0.82 | ||||
| No difficulty in bathing | 93.96 | 0.80 | 93.19 | 0.84 | ||||
| No difficulty in getting up when lying down | 91.78 | 0.64 | 91.11 | 0.67 | ||||
| No difficulty in getting to and using toilet | 93.90 | 0.71 | 93.55 | 0.76 | ||||
| No difficulty in ability to use telephone | 81.90 | 0.51 | 83.70 | 0.51 | ||||
| No difficulty in shopping | 93.68 | 0.73 | 93.06 | 0.76 | ||||
| No difficulty in food preparation | 92.28 | 0.79 | 91.27 | 0.83 | ||||
| No difficulty in housekeeping | 91.37 | 0.80 | 89.11 | 0.82 | ||||
| No difficulty in laundry | 91.03 | 0.79 | 89.61 | 0.81 | ||||
| No difficulty in mode of transportation | 87.44 | 0.62 | 88.31 | 0.69 | ||||
| No difficulty in responsibility for own medications | 97.79 | 0.61 | 97.62 | 0.66 | ||||
| No difficulty in ability to handle finances | 95.50 | 0.74 | 93.62 | 0.78 | ||||
| Participated at least 1 social group | 89.63 | −0.58 | 79.24 | −0.48 | ||||
| No diagnosed as arthritis | 36.60 | 0.54 | 63.47 | 0.41 | ||||
| No diagnosed as blood pressure problem | 51.92 | 0.59 | 42.57 | 0.48 | ||||
| No diagnosed as cardiovascular diseases | 19.84 | 0.63 | 78.10 | 0.49 | ||||
| Positive self-rated health | 49.91 | 0.52 | 61.14 | 0.65 | ||||
| No diagnosed as depression symptoms | 65.63 | 0.58 | 74.67 | 0.45 | ||||
| No harsh communication experience | 86.15 | 0.65 | 91.76 | 0.66 | ||||
| No communication rejection experience | 97.86 | 0.62 | 98.79 | 0.60 | ||||
| No domestic violence experience | 99.42 | 0.61 | 99.66 | 0.54 | ||||
| Overall HAI score | ||||||||
| Mean (SE) | 84.05 (13.85) | 83.71 (14.47) | ||||||
| Mann–Whitney U test | P = .63 | |||||||
| HAI domains scores | ||||||||
| Mean (SE) | 57.31 (12.09) | 16.67 (2.51) | 10.06 (4.76) | 56.49 (12.65) | 10.03 (4.86) | 17.19 (2.03) | ||
| Reliability | ||||||||
| Cronbach’s alpha | 0.85 | 0.86 | ||||||
| Factor structure | ||||||||
| Bartlett’s sphericity | (P < .0001) | (P < .0001) | ||||||
| Kaiser–Meyer–Olkin | 0.926 | 0.932 | ||||||
| Eigen value | 7.06 | 1.61 | 1.69 | 7.56 | 1.75 | 1.63 | ||
| Percentage explained variance (%) | 32.12 | 7.71 | 7.33 | 34.37 | 7.98 | 7.42 | ||
Exploratory Factor Analysis (EFA) results.
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
Factor loadings of HAI measurement (varimax rotation)
| Items | 2019 | 2022 | ||||||
|---|---|---|---|---|---|---|---|---|
| % Healthy aging | Factor loading | % Healthy aging | Factor loading | |||||
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | |||
| No difficulty in eating | 96.39 | 0.69 | 96.80 | 0.68 | ||||
| No difficulty in dressing | 94.93 | 0.77 | 93.65 | 0.82 | ||||
| No difficulty in bathing | 93.96 | 0.80 | 93.19 | 0.84 | ||||
| No difficulty in getting up when lying down | 91.78 | 0.64 | 91.11 | 0.67 | ||||
| No difficulty in getting to and using toilet | 93.90 | 0.71 | 93.55 | 0.76 | ||||
| No difficulty in ability to use telephone | 81.90 | 0.51 | 83.70 | 0.51 | ||||
| No difficulty in shopping | 93.68 | 0.73 | 93.06 | 0.76 | ||||
| No difficulty in food preparation | 92.28 | 0.79 | 91.27 | 0.83 | ||||
| No difficulty in housekeeping | 91.37 | 0.80 | 89.11 | 0.82 | ||||
| No difficulty in laundry | 91.03 | 0.79 | 89.61 | 0.81 | ||||
| No difficulty in mode of transportation | 87.44 | 0.62 | 88.31 | 0.69 | ||||
| No difficulty in responsibility for own medications | 97.79 | 0.61 | 97.62 | 0.66 | ||||
| No difficulty in ability to handle finances | 95.50 | 0.74 | 93.62 | 0.78 | ||||
| Participated at least 1 social group | 89.63 | −0.58 | 79.24 | −0.48 | ||||
| No diagnosed as arthritis | 36.60 | 0.54 | 63.47 | 0.41 | ||||
| No diagnosed as blood pressure problem | 51.92 | 0.59 | 42.57 | 0.48 | ||||
| No diagnosed as cardiovascular diseases | 19.84 | 0.63 | 78.10 | 0.49 | ||||
| Positive self-rated health | 49.91 | 0.52 | 61.14 | 0.65 | ||||
| No diagnosed as depression symptoms | 65.63 | 0.58 | 74.67 | 0.45 | ||||
| No harsh communication experience | 86.15 | 0.65 | 91.76 | 0.66 | ||||
| No communication rejection experience | 97.86 | 0.62 | 98.79 | 0.60 | ||||
| No domestic violence experience | 99.42 | 0.61 | 99.66 | 0.54 | ||||
| Overall HAI score | ||||||||
| Mean (SE) | 84.05 (13.85) | 83.71 (14.47) | ||||||
| Mann–Whitney U test | P = .63 | |||||||
| HAI domains scores | ||||||||
| Mean (SE) | 57.31 (12.09) | 16.67 (2.51) | 10.06 (4.76) | 56.49 (12.65) | 10.03 (4.86) | 17.19 (2.03) | ||
| Reliability | ||||||||
| Cronbach’s alpha | 0.85 | 0.86 | ||||||
| Factor structure | ||||||||
| Bartlett’s sphericity | (P < .0001) | (P < .0001) | ||||||
| Kaiser–Meyer–Olkin | 0.926 | 0.932 | ||||||
| Eigen value | 7.06 | 1.61 | 1.69 | 7.56 | 1.75 | 1.63 | ||
| Percentage explained variance (%) | 32.12 | 7.71 | 7.33 | 34.37 | 7.98 | 7.42 | ||
| Items | 2019 | 2022 | ||||||
|---|---|---|---|---|---|---|---|---|
| % Healthy aging | Factor loading | % Healthy aging | Factor loading | |||||
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | |||
| No difficulty in eating | 96.39 | 0.69 | 96.80 | 0.68 | ||||
| No difficulty in dressing | 94.93 | 0.77 | 93.65 | 0.82 | ||||
| No difficulty in bathing | 93.96 | 0.80 | 93.19 | 0.84 | ||||
| No difficulty in getting up when lying down | 91.78 | 0.64 | 91.11 | 0.67 | ||||
| No difficulty in getting to and using toilet | 93.90 | 0.71 | 93.55 | 0.76 | ||||
| No difficulty in ability to use telephone | 81.90 | 0.51 | 83.70 | 0.51 | ||||
| No difficulty in shopping | 93.68 | 0.73 | 93.06 | 0.76 | ||||
| No difficulty in food preparation | 92.28 | 0.79 | 91.27 | 0.83 | ||||
| No difficulty in housekeeping | 91.37 | 0.80 | 89.11 | 0.82 | ||||
| No difficulty in laundry | 91.03 | 0.79 | 89.61 | 0.81 | ||||
| No difficulty in mode of transportation | 87.44 | 0.62 | 88.31 | 0.69 | ||||
| No difficulty in responsibility for own medications | 97.79 | 0.61 | 97.62 | 0.66 | ||||
| No difficulty in ability to handle finances | 95.50 | 0.74 | 93.62 | 0.78 | ||||
| Participated at least 1 social group | 89.63 | −0.58 | 79.24 | −0.48 | ||||
| No diagnosed as arthritis | 36.60 | 0.54 | 63.47 | 0.41 | ||||
| No diagnosed as blood pressure problem | 51.92 | 0.59 | 42.57 | 0.48 | ||||
| No diagnosed as cardiovascular diseases | 19.84 | 0.63 | 78.10 | 0.49 | ||||
| Positive self-rated health | 49.91 | 0.52 | 61.14 | 0.65 | ||||
| No diagnosed as depression symptoms | 65.63 | 0.58 | 74.67 | 0.45 | ||||
| No harsh communication experience | 86.15 | 0.65 | 91.76 | 0.66 | ||||
| No communication rejection experience | 97.86 | 0.62 | 98.79 | 0.60 | ||||
| No domestic violence experience | 99.42 | 0.61 | 99.66 | 0.54 | ||||
| Overall HAI score | ||||||||
| Mean (SE) | 84.05 (13.85) | 83.71 (14.47) | ||||||
| Mann–Whitney U test | P = .63 | |||||||
| HAI domains scores | ||||||||
| Mean (SE) | 57.31 (12.09) | 16.67 (2.51) | 10.06 (4.76) | 56.49 (12.65) | 10.03 (4.86) | 17.19 (2.03) | ||
| Reliability | ||||||||
| Cronbach’s alpha | 0.85 | 0.86 | ||||||
| Factor structure | ||||||||
| Bartlett’s sphericity | (P < .0001) | (P < .0001) | ||||||
| Kaiser–Meyer–Olkin | 0.926 | 0.932 | ||||||
| Eigen value | 7.06 | 1.61 | 1.69 | 7.56 | 1.75 | 1.63 | ||
| Percentage explained variance (%) | 32.12 | 7.71 | 7.33 | 34.37 | 7.98 | 7.42 | ||
Exploratory Factor Analysis (EFA) results.
Source: Own calculations, using OP&SHI 2019 and VNAS 2022.
Table 3 indicates that the weighted mean of the overall HAI score in 2019 was 84.05 (±13.85), in which the weighted mean of HAI score in Factor 1 was the highest, at 57.31 (±12.09). The weighted mean of the overall HAI score in 2022 was 83.71 (±14.47), and the weighted mean of HAI score in Factor 1 was also the highest, at 56.49 (±12.65).
HAI scores had left-skewed distributions and relatively similar visualizations (Fig. 1). The Mann–Whitney U test result (z = −0.48; P = .63) indicated no statistically significant differences in the weighted mean of HAI scores between 2019 and 2022 at a 5% significant level.
Distribution of Healthy Aging Index in Vietnam.
Table 4 presents the associations between HAI overall scores and each factor of HAI and older persons’ characteristics in 2019. Individuals at higher age groups had lower HAI scores: the overall HAI scores for the middle-old would be 1.39 points lower than the young-old, and among three factors of HAI scores, the middle-old were only associated with Factor 2. In other words, the middle-old had a significantly lower HAI score in Factor 2 (1.73 points) than the young-old. The oldest-old had 4.84 points of overall HAI scores lower than the young-old, and the lower HAI scores in Factor 1 and Factor 2 were only observed in the oldest-old compared with the youngest-old (4.35 and 1.00 points, respectively). These differences were statistically significant.
Factors associated with Healthy Aging Index in 2019
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −1.39* | 0.63 | 0.02 | 0.46 | −1.73*** | 0.35 | 0.21 | 0.19 |
| 80+ | −4.84*** | 1.25 | −4.35*** | 1.08 | −1.00* | 0.49 | 0.37 | 0.24 |
| Gender (male as reference) | ||||||||
| Female | −2.52*** | 0.64 | −1.40** | 0.50 | −1.08*** | 0.29 | −0.15 | 0.21 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.89*** | 0.79 | 1.98** | 0.61 | 0.87* | 0.38 | 0.02 | 0.25 |
| Complete secondary | 2.65** | 0.83 | 2.41*** | 0.69 | 0.13 | 0.35 | 0.10 | 0.20 |
| College and above | 4.27** | 1.33 | 2.21* | 0.94 | 1.87** | 0.67 | 0.21 | 0.39 |
| Marital status (others as reference) | ||||||||
| Married | 1.64 | 0.84 | 1.09 | 0.67 | 0.26 | 0.41 | 0.19 | 0.23 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.34 | 0.81 | −0.76 | 0.61 | 0.47 | 0.38 | 0.66* | 0.30 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −1.46 | 1.09 | −1.74* | 0.80 | 0.44 | 0.57 | −0.09 | 0.30 |
| With at least a child | −1.90* | 0.94 | −2.33** | 0.69 | 0.65 | 0.50 | −0.23 | 0.24 |
| Others | −1.57 | 1.21 | −2.09* | 0.81 | 0.56 | 0.70 | 0.01 | 0.34 |
| Household wealth quartiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 2.01** | 0.77 | 1.38* | 0.65 | 0.21 | 0.32 | 0.42* | 0.17 |
| 3rd quartile (second wealthiest quartile) | 2.37** | 0.81 | 0.96 | 0.68 | 0.81* | 0.36 | 0.70** | 0.25 |
| 4th quartile (the wealthiest quartile) | 3.74** | 1.14 | 2.10* | 0.95 | 0.55 | 0.48 | 1.08*** | 0.26 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.08** | 0.75 | −2.16** | 0.64 | 0.38 | 0.33 | −0.24 | 0.18 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 0.85 | 0.56 | 1.25*** | 0.33 | −0.42 | 0.33 | −0.04 | 0.22 |
| Care provision for other members (excluding grandchild) (no as reference) | ||||||||
| Yes | 0.11 | 0.91 | 1.11** | 0.35 | −0.29 | 0.55 | −0.66 | 0.33 |
| Household chores performance (no as reference) | ||||||||
| Yes | 17.47*** | 1.32 | 17.05*** | 1.21 | 0.59 | 0.40 | −0.05 | 0.22 |
| Social financial supports (no as reference) | ||||||||
| Yes | 0.06 | 0.76 | 0.16 | 0.47 | −0.02 | 0.42 | −0.05 | 0.27 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −4.28*** | 0.87 | −1.29 | 0.72 | −2.24*** | 0.37 | −0.87* | 0.40 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −1.48* | 0.71 | 1.88** | 0.60 | −3.19*** | 0.27 | −0.10 | 0.16 |
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −1.39* | 0.63 | 0.02 | 0.46 | −1.73*** | 0.35 | 0.21 | 0.19 |
| 80+ | −4.84*** | 1.25 | −4.35*** | 1.08 | −1.00* | 0.49 | 0.37 | 0.24 |
| Gender (male as reference) | ||||||||
| Female | −2.52*** | 0.64 | −1.40** | 0.50 | −1.08*** | 0.29 | −0.15 | 0.21 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.89*** | 0.79 | 1.98** | 0.61 | 0.87* | 0.38 | 0.02 | 0.25 |
| Complete secondary | 2.65** | 0.83 | 2.41*** | 0.69 | 0.13 | 0.35 | 0.10 | 0.20 |
| College and above | 4.27** | 1.33 | 2.21* | 0.94 | 1.87** | 0.67 | 0.21 | 0.39 |
| Marital status (others as reference) | ||||||||
| Married | 1.64 | 0.84 | 1.09 | 0.67 | 0.26 | 0.41 | 0.19 | 0.23 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.34 | 0.81 | −0.76 | 0.61 | 0.47 | 0.38 | 0.66* | 0.30 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −1.46 | 1.09 | −1.74* | 0.80 | 0.44 | 0.57 | −0.09 | 0.30 |
| With at least a child | −1.90* | 0.94 | −2.33** | 0.69 | 0.65 | 0.50 | −0.23 | 0.24 |
| Others | −1.57 | 1.21 | −2.09* | 0.81 | 0.56 | 0.70 | 0.01 | 0.34 |
| Household wealth quartiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 2.01** | 0.77 | 1.38* | 0.65 | 0.21 | 0.32 | 0.42* | 0.17 |
| 3rd quartile (second wealthiest quartile) | 2.37** | 0.81 | 0.96 | 0.68 | 0.81* | 0.36 | 0.70** | 0.25 |
| 4th quartile (the wealthiest quartile) | 3.74** | 1.14 | 2.10* | 0.95 | 0.55 | 0.48 | 1.08*** | 0.26 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.08** | 0.75 | −2.16** | 0.64 | 0.38 | 0.33 | −0.24 | 0.18 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 0.85 | 0.56 | 1.25*** | 0.33 | −0.42 | 0.33 | −0.04 | 0.22 |
| Care provision for other members (excluding grandchild) (no as reference) | ||||||||
| Yes | 0.11 | 0.91 | 1.11** | 0.35 | −0.29 | 0.55 | −0.66 | 0.33 |
| Household chores performance (no as reference) | ||||||||
| Yes | 17.47*** | 1.32 | 17.05*** | 1.21 | 0.59 | 0.40 | −0.05 | 0.22 |
| Social financial supports (no as reference) | ||||||||
| Yes | 0.06 | 0.76 | 0.16 | 0.47 | −0.02 | 0.42 | −0.05 | 0.27 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −4.28*** | 0.87 | −1.29 | 0.72 | −2.24*** | 0.37 | −0.87* | 0.40 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −1.48* | 0.71 | 1.88** | 0.60 | −3.19*** | 0.27 | −0.10 | 0.16 |
Tobit regression results. Figures in bold indicate coefficients with statistically significant. *P < .05, **P < .01, ***P < .0001.
Source: Own calculations, using OP&SHI 2019.
Factors associated with Healthy Aging Index in 2019
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −1.39* | 0.63 | 0.02 | 0.46 | −1.73*** | 0.35 | 0.21 | 0.19 |
| 80+ | −4.84*** | 1.25 | −4.35*** | 1.08 | −1.00* | 0.49 | 0.37 | 0.24 |
| Gender (male as reference) | ||||||||
| Female | −2.52*** | 0.64 | −1.40** | 0.50 | −1.08*** | 0.29 | −0.15 | 0.21 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.89*** | 0.79 | 1.98** | 0.61 | 0.87* | 0.38 | 0.02 | 0.25 |
| Complete secondary | 2.65** | 0.83 | 2.41*** | 0.69 | 0.13 | 0.35 | 0.10 | 0.20 |
| College and above | 4.27** | 1.33 | 2.21* | 0.94 | 1.87** | 0.67 | 0.21 | 0.39 |
| Marital status (others as reference) | ||||||||
| Married | 1.64 | 0.84 | 1.09 | 0.67 | 0.26 | 0.41 | 0.19 | 0.23 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.34 | 0.81 | −0.76 | 0.61 | 0.47 | 0.38 | 0.66* | 0.30 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −1.46 | 1.09 | −1.74* | 0.80 | 0.44 | 0.57 | −0.09 | 0.30 |
| With at least a child | −1.90* | 0.94 | −2.33** | 0.69 | 0.65 | 0.50 | −0.23 | 0.24 |
| Others | −1.57 | 1.21 | −2.09* | 0.81 | 0.56 | 0.70 | 0.01 | 0.34 |
| Household wealth quartiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 2.01** | 0.77 | 1.38* | 0.65 | 0.21 | 0.32 | 0.42* | 0.17 |
| 3rd quartile (second wealthiest quartile) | 2.37** | 0.81 | 0.96 | 0.68 | 0.81* | 0.36 | 0.70** | 0.25 |
| 4th quartile (the wealthiest quartile) | 3.74** | 1.14 | 2.10* | 0.95 | 0.55 | 0.48 | 1.08*** | 0.26 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.08** | 0.75 | −2.16** | 0.64 | 0.38 | 0.33 | −0.24 | 0.18 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 0.85 | 0.56 | 1.25*** | 0.33 | −0.42 | 0.33 | −0.04 | 0.22 |
| Care provision for other members (excluding grandchild) (no as reference) | ||||||||
| Yes | 0.11 | 0.91 | 1.11** | 0.35 | −0.29 | 0.55 | −0.66 | 0.33 |
| Household chores performance (no as reference) | ||||||||
| Yes | 17.47*** | 1.32 | 17.05*** | 1.21 | 0.59 | 0.40 | −0.05 | 0.22 |
| Social financial supports (no as reference) | ||||||||
| Yes | 0.06 | 0.76 | 0.16 | 0.47 | −0.02 | 0.42 | −0.05 | 0.27 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −4.28*** | 0.87 | −1.29 | 0.72 | −2.24*** | 0.37 | −0.87* | 0.40 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −1.48* | 0.71 | 1.88** | 0.60 | −3.19*** | 0.27 | −0.10 | 0.16 |
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL + Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −1.39* | 0.63 | 0.02 | 0.46 | −1.73*** | 0.35 | 0.21 | 0.19 |
| 80+ | −4.84*** | 1.25 | −4.35*** | 1.08 | −1.00* | 0.49 | 0.37 | 0.24 |
| Gender (male as reference) | ||||||||
| Female | −2.52*** | 0.64 | −1.40** | 0.50 | −1.08*** | 0.29 | −0.15 | 0.21 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.89*** | 0.79 | 1.98** | 0.61 | 0.87* | 0.38 | 0.02 | 0.25 |
| Complete secondary | 2.65** | 0.83 | 2.41*** | 0.69 | 0.13 | 0.35 | 0.10 | 0.20 |
| College and above | 4.27** | 1.33 | 2.21* | 0.94 | 1.87** | 0.67 | 0.21 | 0.39 |
| Marital status (others as reference) | ||||||||
| Married | 1.64 | 0.84 | 1.09 | 0.67 | 0.26 | 0.41 | 0.19 | 0.23 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.34 | 0.81 | −0.76 | 0.61 | 0.47 | 0.38 | 0.66* | 0.30 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −1.46 | 1.09 | −1.74* | 0.80 | 0.44 | 0.57 | −0.09 | 0.30 |
| With at least a child | −1.90* | 0.94 | −2.33** | 0.69 | 0.65 | 0.50 | −0.23 | 0.24 |
| Others | −1.57 | 1.21 | −2.09* | 0.81 | 0.56 | 0.70 | 0.01 | 0.34 |
| Household wealth quartiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 2.01** | 0.77 | 1.38* | 0.65 | 0.21 | 0.32 | 0.42* | 0.17 |
| 3rd quartile (second wealthiest quartile) | 2.37** | 0.81 | 0.96 | 0.68 | 0.81* | 0.36 | 0.70** | 0.25 |
| 4th quartile (the wealthiest quartile) | 3.74** | 1.14 | 2.10* | 0.95 | 0.55 | 0.48 | 1.08*** | 0.26 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.08** | 0.75 | −2.16** | 0.64 | 0.38 | 0.33 | −0.24 | 0.18 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 0.85 | 0.56 | 1.25*** | 0.33 | −0.42 | 0.33 | −0.04 | 0.22 |
| Care provision for other members (excluding grandchild) (no as reference) | ||||||||
| Yes | 0.11 | 0.91 | 1.11** | 0.35 | −0.29 | 0.55 | −0.66 | 0.33 |
| Household chores performance (no as reference) | ||||||||
| Yes | 17.47*** | 1.32 | 17.05*** | 1.21 | 0.59 | 0.40 | −0.05 | 0.22 |
| Social financial supports (no as reference) | ||||||||
| Yes | 0.06 | 0.76 | 0.16 | 0.47 | −0.02 | 0.42 | −0.05 | 0.27 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −4.28*** | 0.87 | −1.29 | 0.72 | −2.24*** | 0.37 | −0.87* | 0.40 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −1.48* | 0.71 | 1.88** | 0.60 | −3.19*** | 0.27 | −0.10 | 0.16 |
Tobit regression results. Figures in bold indicate coefficients with statistically significant. *P < .05, **P < .01, ***P < .0001.
Source: Own calculations, using OP&SHI 2019.
The overall HAI scores of women were 2.52 points lower than those of men. Also, women had significantly lower HAI scores in factors 1 and 2 than men (1.40 and 1.08 points, respectively).
Those completing the primary level or higher had higher overall HAI scores than those with no schooling or incomplete primary level. The overall HAI scores of those who completed the primary level, with secondary education, and with college and above were 2.89, 2.65, and 4.27 points higher than those with no schooling or incomplete primary level, respectively. Interestingly, education was associated with higher HAI scores in Factors 1 and 2.
Those living with at least one child had 1.90 points of the overall HAI scores lower than those living alone, while this difference was statistically significant in Factor 1, at 2.33 points. Although living with a spouse only and other groups were statistically insignificantly associated with the overall HAI scores, these two groups were significantly associated with HAI scores in Factor 1 (respectively 1.74 and 2.09 points lower than those living alone).
Higher overall HAI scores were associated with higher wealth quartiles. Older persons in the second, third, and fourth quartiles had higher overall HAI scores than those in the first quartile, with 2.01, 2.37, and 3.74 points, respectively. Household wealth was associated with HAI scores in Factors 1 and 3.
The overall HAI score of older persons who received social allowances was 2.08 points lower than that of older persons who did not. However, this difference was only statistically significant in Factor 1.
Older persons who could perform household chores had 17.47 points of overall HAI scores higher than those who could not perform. The household chores performance was only associated with the HAI scores in Factor 1.
Older persons who used healthcare services had lower HAI overall scores than those who did not: 1.48 points for inpatient services and 4.28 points for outpatient services. These differences were found only in Factor 2.
Table 5 reports the results of the 2022 analysis. Similar to the 2019 analysis, the following factors were also associated with the HAI overall scores: age, gender, education, living arrangements, household wealth quartiles, social welfare benefits, performance of household chores, and healthcare utilization. The oldest-old had significantly lower overall HAI scores (6.14 points) than the young-old, but this difference was found merely in the HAI scores in Factor 1. Regarding gender, the HAI scores—both the overall HAI scores and HAI scores in three factors—of older women were lower than those of older men. Older persons with primary education levels had higher overall HAI scores (2.04 points) than those with no schooling or incomplete primary level. In terms of living arrangements, compared to those living alone, older persons in other living arrangements had lower overall HAI scores and HAI scores in Factor 1. Concerning the household wealth quartiles, older persons in the second, third, and fourth quartiles had higher overall HAI scores than those in the first quartile (with 1.95, 4.10, and 4.99 points, respectively). Those in the third and fourth quartiles had lower HAI scores in all three factors. Social allowance receivers had 2.43 points of overall HAI scores lower than non-receivers, but this difference was only statistically significant in Factor 1. Performers of household chores had 15.78 points of overall HAI scores higher than nonperformers. Performance of household chores was only associated with the HAI scores in Factor 1 (15.59 points). Regarding healthcare utilization, those who used healthcare services had lower overall HAI scores than those who did not: 0.79 points for inpatient services and 5.25 points for outpatient services, and these differences were statistically significant in all three factors of HAI scores.
Factors associated with Healthy Aging Index in 2022
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −0.66 | 0.68 | −0.14 | 0.51 | −0.42 | 0.37 | −0.08 | 0.13 |
| 80+ | −6.14*** | 1.29 | −5.68*** | 1.14 | −0.50 | 0.53 | −0.01 | 0.18 |
| Gender (male as reference) | ||||||||
| Female | −3.43*** | 0.71 | −1.98*** | 0.52 | −1.01** | 0.38 | −0.49*** | 0.13 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.04* | 0.87 | 2.10** | 0.72 | −0.24 | 0.45 | 0.13 | 0.16 |
| Complete secondary | 2.08 | 0.86 | 1.95** | 0.72 | −0.07 | 0.41 | 0.13 | 0.15 |
| College and above | 2.85 | 1.64 | 2.64* | 1.30 | −0.06 | 0.74 | 0.19 | 0.25 |
| Marital status (others as reference) | ||||||||
| Married | 1.30 | 0.96 | 1.44 | 0.79 | 0.15 | 0.44 | −0.26 | 0.17 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.75 | 0.89 | −0.02 | 0.67 | 1.01* | 0.45 | −0.13 | 0.16 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −4.54** | 1.48 | −4.72*** | 1.18 | −0.14 | 0.63 | 0.33 | 0.31 |
| With at least a child | −4.74** | 1.59 | −4.51** | 1.35 | −0.28 | 0.56 | 0.06 | 0.28 |
| Others | −5.79*** | 1.33 | −5.21*** | 1.11 | −0.82 | 0.53 | 0.19 | 0.24 |
| Household wealth quantiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 1.95* | 0.88 | 1.24 | 0.75 | 0.46 | 0.43 | 0.28 | 0.17 |
| 3rd quartile (second wealthiest quartile) | 4.10*** | 0.90 | 2.12** | 0.75 | 1.52** | 0.45 | 0.63*** | 0.17 |
| 4th quartile (the wealthiest quartile) | 4.99*** | 1.15 | 2.63** | 0.94 | 1.87** | 0.61 | 0.72** | 0.21 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.43** | 0.79 | −1.56** | 0.54 | −0.65 | 0.43 | −0.25 | 0.17 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 1.13 | 0.74 | 1.63** | 0.50 | −0.28 | 0.41 | −0.22 | 0.17 |
| Care provision for other members (excluding grandchild) (No as reference) | ||||||||
| Yes | 0.93 | 1.46 | 1.51* | 0.76 | 0.08 | 0.61 | −0.57 | 0.44 |
| Household chores performance (no as reference) | ||||||||
| Yes | 15.78*** | 1.22 | 15.59*** | 1.14 | 0.56 | 0.35 | −0.28* | 0.11 |
| Social financial supports (no as reference) | ||||||||
| Yes | −0.98 | 0.89 | −0.68 | 0.69 | −0.28 | 0.46 | −0.07 | 0.16 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −5.25*** | 0.88 | −2.82*** | 0.79 | −2.12*** | 0.40 | −0.51** | 0.16 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −0.79*** | 0.74 | 2.42*** | 0.59 | −3.15*** | 0.32 | −0.12 | 0.14 |
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −0.66 | 0.68 | −0.14 | 0.51 | −0.42 | 0.37 | −0.08 | 0.13 |
| 80+ | −6.14*** | 1.29 | −5.68*** | 1.14 | −0.50 | 0.53 | −0.01 | 0.18 |
| Gender (male as reference) | ||||||||
| Female | −3.43*** | 0.71 | −1.98*** | 0.52 | −1.01** | 0.38 | −0.49*** | 0.13 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.04* | 0.87 | 2.10** | 0.72 | −0.24 | 0.45 | 0.13 | 0.16 |
| Complete secondary | 2.08 | 0.86 | 1.95** | 0.72 | −0.07 | 0.41 | 0.13 | 0.15 |
| College and above | 2.85 | 1.64 | 2.64* | 1.30 | −0.06 | 0.74 | 0.19 | 0.25 |
| Marital status (others as reference) | ||||||||
| Married | 1.30 | 0.96 | 1.44 | 0.79 | 0.15 | 0.44 | −0.26 | 0.17 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.75 | 0.89 | −0.02 | 0.67 | 1.01* | 0.45 | −0.13 | 0.16 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −4.54** | 1.48 | −4.72*** | 1.18 | −0.14 | 0.63 | 0.33 | 0.31 |
| With at least a child | −4.74** | 1.59 | −4.51** | 1.35 | −0.28 | 0.56 | 0.06 | 0.28 |
| Others | −5.79*** | 1.33 | −5.21*** | 1.11 | −0.82 | 0.53 | 0.19 | 0.24 |
| Household wealth quantiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 1.95* | 0.88 | 1.24 | 0.75 | 0.46 | 0.43 | 0.28 | 0.17 |
| 3rd quartile (second wealthiest quartile) | 4.10*** | 0.90 | 2.12** | 0.75 | 1.52** | 0.45 | 0.63*** | 0.17 |
| 4th quartile (the wealthiest quartile) | 4.99*** | 1.15 | 2.63** | 0.94 | 1.87** | 0.61 | 0.72** | 0.21 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.43** | 0.79 | −1.56** | 0.54 | −0.65 | 0.43 | −0.25 | 0.17 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 1.13 | 0.74 | 1.63** | 0.50 | −0.28 | 0.41 | −0.22 | 0.17 |
| Care provision for other members (excluding grandchild) (No as reference) | ||||||||
| Yes | 0.93 | 1.46 | 1.51* | 0.76 | 0.08 | 0.61 | −0.57 | 0.44 |
| Household chores performance (no as reference) | ||||||||
| Yes | 15.78*** | 1.22 | 15.59*** | 1.14 | 0.56 | 0.35 | −0.28* | 0.11 |
| Social financial supports (no as reference) | ||||||||
| Yes | −0.98 | 0.89 | −0.68 | 0.69 | −0.28 | 0.46 | −0.07 | 0.16 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −5.25*** | 0.88 | −2.82*** | 0.79 | −2.12*** | 0.40 | −0.51** | 0.16 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −0.79*** | 0.74 | 2.42*** | 0.59 | −3.15*** | 0.32 | −0.12 | 0.14 |
Tobit regression results. Figures in bold indicate coefficients with statistically significant. *P < .05, **P < .01, ***P < .0001.
Source: Own calculations, using VNAS 2022.
Factors associated with Healthy Aging Index in 2022
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −0.66 | 0.68 | −0.14 | 0.51 | −0.42 | 0.37 | −0.08 | 0.13 |
| 80+ | −6.14*** | 1.29 | −5.68*** | 1.14 | −0.50 | 0.53 | −0.01 | 0.18 |
| Gender (male as reference) | ||||||||
| Female | −3.43*** | 0.71 | −1.98*** | 0.52 | −1.01** | 0.38 | −0.49*** | 0.13 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.04* | 0.87 | 2.10** | 0.72 | −0.24 | 0.45 | 0.13 | 0.16 |
| Complete secondary | 2.08 | 0.86 | 1.95** | 0.72 | −0.07 | 0.41 | 0.13 | 0.15 |
| College and above | 2.85 | 1.64 | 2.64* | 1.30 | −0.06 | 0.74 | 0.19 | 0.25 |
| Marital status (others as reference) | ||||||||
| Married | 1.30 | 0.96 | 1.44 | 0.79 | 0.15 | 0.44 | −0.26 | 0.17 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.75 | 0.89 | −0.02 | 0.67 | 1.01* | 0.45 | −0.13 | 0.16 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −4.54** | 1.48 | −4.72*** | 1.18 | −0.14 | 0.63 | 0.33 | 0.31 |
| With at least a child | −4.74** | 1.59 | −4.51** | 1.35 | −0.28 | 0.56 | 0.06 | 0.28 |
| Others | −5.79*** | 1.33 | −5.21*** | 1.11 | −0.82 | 0.53 | 0.19 | 0.24 |
| Household wealth quantiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 1.95* | 0.88 | 1.24 | 0.75 | 0.46 | 0.43 | 0.28 | 0.17 |
| 3rd quartile (second wealthiest quartile) | 4.10*** | 0.90 | 2.12** | 0.75 | 1.52** | 0.45 | 0.63*** | 0.17 |
| 4th quartile (the wealthiest quartile) | 4.99*** | 1.15 | 2.63** | 0.94 | 1.87** | 0.61 | 0.72** | 0.21 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.43** | 0.79 | −1.56** | 0.54 | −0.65 | 0.43 | −0.25 | 0.17 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 1.13 | 0.74 | 1.63** | 0.50 | −0.28 | 0.41 | −0.22 | 0.17 |
| Care provision for other members (excluding grandchild) (No as reference) | ||||||||
| Yes | 0.93 | 1.46 | 1.51* | 0.76 | 0.08 | 0.61 | −0.57 | 0.44 |
| Household chores performance (no as reference) | ||||||||
| Yes | 15.78*** | 1.22 | 15.59*** | 1.14 | 0.56 | 0.35 | −0.28* | 0.11 |
| Social financial supports (no as reference) | ||||||||
| Yes | −0.98 | 0.89 | −0.68 | 0.69 | −0.28 | 0.46 | −0.07 | 0.16 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −5.25*** | 0.88 | −2.82*** | 0.79 | −2.12*** | 0.40 | −0.51** | 0.16 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −0.79*** | 0.74 | 2.42*** | 0.59 | −3.15*** | 0.32 | −0.12 | 0.14 |
| Characteristics | HAI overall score | Factor loadings of HAI domains | ||||||
|---|---|---|---|---|---|---|---|---|
| ADL + IADL+ Community engagements (Factor 1) | Health conditions (Factor 2) | Depression and family relationships (Factor 3) | ||||||
| Coef | SE | Coef | SE | Coef | SE | Coef | SE | |
| Age groups (60–69 as reference) | ||||||||
| 70–79 | −0.66 | 0.68 | −0.14 | 0.51 | −0.42 | 0.37 | −0.08 | 0.13 |
| 80+ | −6.14*** | 1.29 | −5.68*** | 1.14 | −0.50 | 0.53 | −0.01 | 0.18 |
| Gender (male as reference) | ||||||||
| Female | −3.43*** | 0.71 | −1.98*** | 0.52 | −1.01** | 0.38 | −0.49*** | 0.13 |
| Highest education attainment level (no schooling or incomplete primary as reference) | ||||||||
| Complete primary | 2.04* | 0.87 | 2.10** | 0.72 | −0.24 | 0.45 | 0.13 | 0.16 |
| Complete secondary | 2.08 | 0.86 | 1.95** | 0.72 | −0.07 | 0.41 | 0.13 | 0.15 |
| College and above | 2.85 | 1.64 | 2.64* | 1.30 | −0.06 | 0.74 | 0.19 | 0.25 |
| Marital status (others as reference) | ||||||||
| Married | 1.30 | 0.96 | 1.44 | 0.79 | 0.15 | 0.44 | −0.26 | 0.17 |
| Residence (living in urban areas as reference) | ||||||||
| Living in rural areas | 0.75 | 0.89 | −0.02 | 0.67 | 1.01* | 0.45 | −0.13 | 0.16 |
| Living arrangement (alone as reference) | ||||||||
| With spouse only | −4.54** | 1.48 | −4.72*** | 1.18 | −0.14 | 0.63 | 0.33 | 0.31 |
| With at least a child | −4.74** | 1.59 | −4.51** | 1.35 | −0.28 | 0.56 | 0.06 | 0.28 |
| Others | −5.79*** | 1.33 | −5.21*** | 1.11 | −0.82 | 0.53 | 0.19 | 0.24 |
| Household wealth quantiles (1st quartile (the poorest quartile) as reference) | ||||||||
| 2nd quartile (second poorest quartile) | 1.95* | 0.88 | 1.24 | 0.75 | 0.46 | 0.43 | 0.28 | 0.17 |
| 3rd quartile (second wealthiest quartile) | 4.10*** | 0.90 | 2.12** | 0.75 | 1.52** | 0.45 | 0.63*** | 0.17 |
| 4th quartile (the wealthiest quartile) | 4.99*** | 1.15 | 2.63** | 0.94 | 1.87** | 0.61 | 0.72** | 0.21 |
| Social welfare benefits (not received social allowances as reference) | ||||||||
| Received social allowances | −2.43** | 0.79 | −1.56** | 0.54 | −0.65 | 0.43 | −0.25 | 0.17 |
| Grandchildren care provision (no as reference) | ||||||||
| Yes | 1.13 | 0.74 | 1.63** | 0.50 | −0.28 | 0.41 | −0.22 | 0.17 |
| Care provision for other members (excluding grandchild) (No as reference) | ||||||||
| Yes | 0.93 | 1.46 | 1.51* | 0.76 | 0.08 | 0.61 | −0.57 | 0.44 |
| Household chores performance (no as reference) | ||||||||
| Yes | 15.78*** | 1.22 | 15.59*** | 1.14 | 0.56 | 0.35 | −0.28* | 0.11 |
| Social financial supports (no as reference) | ||||||||
| Yes | −0.98 | 0.89 | −0.68 | 0.69 | −0.28 | 0.46 | −0.07 | 0.16 |
| Medical visits in the previous 12 months (no as reference) | ||||||||
| Yes | −5.25*** | 0.88 | −2.82*** | 0.79 | −2.12*** | 0.40 | −0.51** | 0.16 |
| Hospitalization in the previous 12 months (no as reference) | ||||||||
| Yes | −0.79*** | 0.74 | 2.42*** | 0.59 | −3.15*** | 0.32 | −0.12 | 0.14 |
Tobit regression results. Figures in bold indicate coefficients with statistically significant. *P < .05, **P < .01, ***P < .0001.
Source: Own calculations, using VNAS 2022.
In summary, either in 2019 or 2022 analyses, several key factors were consistently associated with overall HAI scores: individuals who were the oldest-old, living with at least one child, receiving social allowances, having outpatient visits, and having inpatient admission had significantly lower HAI scores than their counterparts. On the contrary, those who completed the primary level, in wealthier groups, and performed household chores were positively associated with the HAI scores.
DISCUSSION
Using WHO (2015)’s theory of healthy aging with 2019 and 2022 data sets on Vietnamese older persons, this study found that the factor structures and indicators of the HAI measurement in both years were similar with high internal consistency and remarkable reliability.
HAI scores of older Vietnamese were relatively high, and there were no statistical differences between 2019 and 2022, meaning that the status of healthy aging was stable, given the coronavirus disease 2019 (COVID-19) outbreak severely happened in between. Vietnam’s overall HAI scores were slightly higher than those in India (Irshad et al. 2022), Latvia (Miķelsone et al. 2023), and Iceland (Miķelsone et al. 2023), but lower than those in Thailand (Manasatchakun et al. 2016). Such differences might reflect different healthy aging statuses due to, for instance, differences in healthcare systems, biological statuses, and cultural contexts.
This study confirmed that healthy aging was significantly and consistently associated with various factors in analyses for both years, 2019 and 2022. The consistency underscored the importance of addressing these factors in public health strategies to promote healthy aging. More advanced-age persons and women were associated with lower levels of healthy aging, and this finding was consistent with previous literature (Park et al. 2010, Irshad et al. 2022). People at higher ages usually experience more difficulties in functional abilities than those of lower ages, and older women were more likely to have poorer health conditions and functional declines and were more frail than older men (Ahmed et al. 2016, Vaish et al. 2020).
Similar to previous studies (Sowa et al. 2016, Wagg et al. 2021), education acted as a protective factor in developing healthy aging. The positive impact of education on healthy aging is considered in the long term because older persons with higher education levels are more likely to have better opportunities, health literacy, and lifestyles.
Older persons living in wealthier households had higher overall HAI scores, and the finding was consistent with those from Gómez et al. (2021), Manasatchakun et al. (2016), and Sowa et al. (2016).
This study found that older persons living with at least one person (e.g. living with at least a child or spouse) had lower overall HAI scores than those living alone, and this was consistent with a study in Colombia (Gómez et al. 2021), but contradicted with a study in Australia (McNamara et al. 2016). This could be due to differences in healthcare systems and characteristics of older persons. In the Vietnamese context, living with at least one person might result in lower HAI scores, which could be explained by the fact that such older persons might have a higher level of dependency on other family members, thus limiting their physical and mental well-being. Also, if older persons lived with a child or spouse who attempted to isolate them from society, they might experience mental health disorders and even suicidal ideation (Kułak-Bejda et al. 2021). One thing to note is that social engagements and cohesion significantly benefit older persons’ health status and well-being, and these forms of social support are important for healthy aging (WHO 2015, Rudnicka et al. 2020). This study also interestingly reflected that older persons living with at least one person had only lower HAI scores in Factor 1, and these results were statistically significant.
For financial support, only social welfare benefits were significantly associated with the HAI scores, that is, receivers of social welfare benefits had lower HAI scores than non-receivers. In the Vietnamese context, receivers were classified as vulnerable, and as such, their well-being and HAI scores were supposed to be lower than non-receivers. Social welfare benefits can support older persons in financial security, healthcare access, and thus their well-being (Thomas 2010).
This study notably reported that those who performed household chores had much higher HAI scores than those who could not. Household chores require physical flexibility and energy, and those performing housework could improve their daily functional ability and boost their emotions. Also, older persons performing housework had higher HAI scores in Factor 1, and the results were statistically significant.
Healthcare service utilization reflected the healthcare needs of older persons, and this study found that those who utilized healthcare services had lower HAI scores than those who did not. This finding was similar to Gómez et al. (2021). Healthcare needs could be due to multiple reasons, such as poor physical conditions and mental health disorders. This explanation could be supported by the fact that healthcare utilization factors were significantly associated with all three HAI factors.
The above results reflected the multifaceted nature of older population health, in which demographic, socioeconomic, and healthcare access factors collectively influence their overall HAI scores and healthy aging status. In the Vietnamese context, family support plays a major role in assisting older persons, in which conventional cultural norms strongly emphasize filial piety. However, family support imposes several challenges and difficulties for family members and older persons. Family caregivers, who were usually female and unpaid caregivers, were more likely to face physical and mental health issues due to the unbalancing work and personal life, specifically when they provided care for older persons who were at high levels of dependency. Consequently, in some cases, these circumstances might create generational conflicts, tensions, and abuse toward older persons. Moreover, families with constrained finances and resources might fail to provide adequate care for older persons, resulting in unmet needs for care and worsening health outcomes for older individuals. Notably, older persons with complex health conditions require special and professional caregivers rather than family caregivers. Additionally, in the modern lifestyle, limited social interaction, especially if older persons rely solely on their family for companionship, can result in feelings of isolation, loneliness, and depression. On top of that, reliance on family support emphasizes the gaps in care services and policies to enhance the quality of life as well as the health outcomes of the older population.
In order to promote a healthy aging society, this study implied urgent needs for targeted policy interventions for Vietnam as well as other middle-income countries facing rapidly aging populations. These policy recommendations are expected to have long-term impacts on older persons’ physical and mental well-being, which encourages approaching a healthy aging society.
Firstly, the positive association between education and healthy aging status implies that the government should continually prioritize supporting citizens to study at higher educational levels, for instance, enhancing access to education and development of educational infrastructure. It will enable citizens to gain knowledge and enhance critical life skills, such as problem-solving and stress management. Moreover, well-educated individuals are more likely to obtain better occupations and proactive lives with better financial and health literacy, resulting in better retirement planning. These long-term investments are essential for maintaining citizens’ mental and physical health as they age.
Secondly, apart from mandatory education, lifelong learning programs specializing for older persons are vital for empowering them to engage more actively with society, particularly in productive activities. A healthy lifestyle and frequent exercise can maintain older persons’ physical and cognitive functions. Moreover, lifelong learning programs can foster social connections and reduce feelings of isolation among older persons. Along with that, public health campaigns promoting healthy aging should be conducted to enhance the awareness and literacy of older persons, particularly for productive activities and health protection.
Thirdly, this study’s findings underscored the need for economic support and social welfare benefits to improve the well-being of older persons. In addition, the government should prioritize mobilizing more pension funds and social benefits for older individuals who are vulnerable groups (such as economically disadvantaged, informal sector, or ethnic minority groups). It is expected to provide a more safety net for those without access to formal retirement schemes. Moreover, the healthcare delivery system should enhance the accessibility of vulnerable groups to affordable and adequate healthcare services. The common healthcare services may include preventive care and management of chronic diseases. If these above policies are promulgated, it would not only improve the well-being of older persons but also address wealth disparities in access to healthcare among older Vietnamese.
Lastly, older persons using inpatient and outpatient services were reported to obtain lower scores of HAI, which emphasized the need for long-term care for them to reduce the risk of functional decline, preventable health complications, and decreased quality of life. Given the current healthcare system, an integrated care model combining healthcare and social care for older persons is essential, particularly for those with complex health conditions and dependence. This model requires a strong cooperation of healthcare providers, social workers, and community organizations to deliver appropriate care services along with diverse needs of older persons. Home-based and community-based care models with professional caregivers should be developed to maintain long-term care for older persons. Residing in a community and receiving adequate care can boost older persons to live positively, mentally, and physically. In a middle-income country like Vietnam, home-based and community-based care services should be reasonable to increase accessibility and utilization of older persons, which in turn reduce unmet care needs.
CONCLUSION
Understanding various aspects contributing to the aging process can help design strategies and policies to enhance the overall well-being of older persons. The findings of this study showed that some targeted policy interventions are needed to promote healthy aging, including developing home-based and community-based care models, lifelong learning programs for older adults, enhanced economic support through social welfare benefits, and developing an integrated care model combining healthcare and social care services. By sharing the Vietnamese experiences, it is encouraged that further studies should be conducted on this important topic, particularly in middle-income countries facing rapidly aging populations.
Two main limitations need to be addressed for further improvements in this study. First, some HAI domains could not be covered due to data unavailability. Second, the causal relationship between healthy aging and its determinants could not be established due to cross-sectional data sets.
ACKNOWLEDGEMENTS
Dr Sakiko Tanaka and Dr Aiko Kikkawa (ADB) are gratefully acknowledged for their insightful and useful comments on various drafts of this research.
CONFLICT OF INTEREST
The authors have no conflicts of interest.
FUNDING
This work was supported by the Asian Development Bank (ADB) through the TA 6767-REG “Supporting Enhanced COVID-19 Vaccination and Post-COVID-19 Health Security Response in Southeast Asia.”
DATA AVAILABILITY
The authors do not have any permission to share the data sets.
ETHICAL STATEMENT
Not applicable, as the authors used the secondary data sets.
