Sangduen Piyatrakul

Background: Dementia is a growing public health concern in Thailand, placing significant demands on families, communities, and the healthcare system. Despite national policies supporting integrated care, community-based dementia services face challenges related to resource limitations, caregiver burden, and access to training. Objective: This study aimed to explore the delivery of dementia care for community-dwelling older adults in Thailand, focusing on care processes, challenges, and support systems from the perspectives of community health nurses (CHNs), village health volunteers (VHVs), and family caregivers. Methods: A qualitative descriptive approach was used. Twenty-two participants, including CHNs, VHVs, and family caregivers, were purposively selected from a metropolitan district in Thailand. Data were collected through semi-structured interviews and focus group discussions, supplemented by contextual health assessments. Thematic analysis was conducted using Sandelowski’s content analysis framework, with rigor ensured through member checking, audit trails, and peer debriefing. Results: Six categories emerged: 1) Care processes involved integrated services across prevention, promotion, treatment, and rehabilitation, with family playing a central role; 2) Conditional factors included strong cultural values of filial responsibility and provider-community trust; 3) Care outcomes reflected partial independence in older adults, with caregivers experiencing varying levels of well-being and frequent stress due to lack of support and training; 4) Successes were attributed to supportive policies, family dedication, and healthcare providers’ intrinsic motivation; 5) Barriers included staff shortages, caregiver health issues, limited training, and insufficient confidence in VHVs; 6) Model development emphasized the need for policy backing, multidisciplinary collaboration, caregiver capacity-building, and dementia-specific community services. Conclusion: Community-based dementia care in Thailand is driven by cultural commitment and dedicated local health workers but hindered by systemic constraints. Strengthening caregiver education, expanding service networks, and enhancing integrated support systems are critical for improving care quality and reducing caregiver burden. Equipping CHNs and VHVs with dementia-specific training and supporting their role in caregiver education and interdisciplinary coordination can further enhance the effectiveness and sustainability of dementia care in community settings.

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted family caregivers of older dependents, leading to fatigue, anxiety, depression, and financial burdens, which in turn diminish their quality of life. This study investigated the integration of community participatory systems in older care to address potential COVID-19 recurrence and develop policy proposals for the integrated care of dependent older people. Methods: An explanatory sequential design was used, with stratified random sampling across six provinces, resulting in a sample of 440 family caregiver dyads and 154 full-time community stakeholders (October 2021--May 2022). Five validated tools were employed, with a content validity of 0.91 and a Cronbach’s alpha of 0.69. The data analysis included descriptive statistics and thematic analysis. Results: Among the 440 primary caregiver households, 42.73% of the older people had moderate dependence, 30.00% had severe dependence, and 27.27% had complete dependence, with common health issues, including chronic illness and comorbidities. Most older adults lived with their children/grandchildren, had insufficient income, and were informed about COVID-19 prevention measures. Family caregivers, predominantly female (average age 54), had multiple underlying conditions and provided an average of 37 hours of care per week, primarily communicating via phones or apps. The 154 stakeholders included public health volunteers and professional nurses, with an average age of 55 years, and were predominantly female (74.55%). They adhered strictly to COVID-19 precautions during their caregiving duties. This study highlights the impact of trust and COVID-19 perceptions on older care, emphasizing the need for specific forms of care, community support, and resources. Perceptions of “trust”, “stay home”, “self-care”, and “distance” significantly influenced care for dependents. The findings will inform health and social workers’ planning, operation, and training, addressing the specific care needs of dependent older adults. Conclusion: This study recommends policy interventions such as budget allocations for essential equipment, better compensation for community work, and the fostering of expertise in elder care. Emphasis is placed on fostering collaborative community agreements.