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Abstract

This study aimed to identify the health behavioral needs of older adults based on the Omaha System. This descriptive study was conducted in Northern Cyprus between May and October 2021. The sample comprised 400 older adults who resided in the Gecitkale municipality. The problem-classification scheme of the Omaha system was used for data collection. The main behavioral health problems concerned nutrition (100%), physical activity (87.25%), and medication regimen (87.25%). In addition, all behavioral health problems defined by the Omaha system were evident in participants who were 75 years and older, female, single, childless, educated, and with incomes that did not cover expenses (p < .05). This study identified the basic healthcare needs of older adults, which increased in parallel with age. The Omaha system may help health professionals deliver services focusing on older people’s needs.

Plain language summary

This study, conducted in a descriptive research design, identified the health care needs of the elderly in a region of Northern Cyprus using the Omaha Classification System. It has been determined that the health care needs of older people are mostly related to nutrition, physical activity, and medication use. The results of this study suggest that valid and reliable care classification tools, such as OS, can help nurses plan interventions and assess patient outcomes related to the basic health-related needs of older adults, including nutrition, physical activity, medication adherence, and substance. resort. Interventions to promote and perform health behaviors and education to improve health-promoting behaviors in older adults to meet their needs in-home care may be suggested.

Keywords

Introduction

The share of older people in the total population is rising in Northern Cyprus and abroad due to the decrease in birth rates and the increase in life expectancy (Esmaeilzadeh, 2019; Lee & Oh, 2020; Türkiye Istatistik et al., 2019). The number of older people worldwide was about 703 million in 2019 and is expected to increase to more than 1.5 billion by 2050 (Türkiye Istatistik et al., 2019). In Turkey, the proportion of the population aged 65 years or older increased to 9.1% in 2019 and is projected to increase to 16.3% by 2040 (Türkiye Istatistik et al., 2019). In 2015, older people aged 65 and over accounted for 10.7% of the total population in Northern Cyprus (KKTC Devlet Planlama Orgutu, 2015).

Despite the global increase in the proportion of older people, improvements in their health have been neglected (Frey, 2018). With the increasing importance of community health in recent years, this issue has become increasingly important (Feng et al., 2020). As the proportion of older adults in the total population increases, their health needs must also be identified (İncirkuş & Nahçıvan, 2020). Healthcare programs that consider individual needs are required to improve older people’s quality of life. Under the World Health Organization’s goal of “active and healthy aging” (WHO), healthy lifestyle habits are needed to prevent chronic diseases and improve the quality of life of older people (Feng et al., 2020).

World Health Organization (WHO) (2020a) recommends a global surveillance framework to measure progress in the prevention and control of major chronic diseases, such as cardiovascular disease, chronic lung disease, and diabetes worldwide. Nurses on primary care teams are often in close contact with chronically ill patients and their families, thus being able to encourage patients’ self-management (Westland et al., 2018).

Nurses regard patients’ participation in their care as a precondition for health-conscious behaviors and willingness to assume more responsibility for their health (Sagsveen et al., 2018). Furthermore, when nurses can define the scope of their tasks in providing primary care, they make a significant contribution to promoting patient participation (Griffin, 2017). When nurses consider the psychological and social impact of chronic illness on their patients in promoting patient self-management, they can help them achieve a higher quality of life despite their illness (Griffin, 2017). Most chronic diseases, including cancer, heart disease, stroke, diabetes, and diseases of the central nervous system, can worsen patients’ overall health by limiting their ability to live, their functional status, their productivity, and their health-related quality of life (HRQoL). Psychosocial factors, such as problematic partner relationships, sexual functioning, body image, and less adaptive coping strategies (e.g., lack of positive cognitive restructuring), were associated with impaired HRQoL. For example, psychosocial factors play an important role in the HRQoL of breast cancer patients. Moreover, in patients with coronary artery disease (CAD) patients, depressive symptoms, chest pain, fatigue, and shortness of breath affect HRQoL. Adverse health-risk behaviors such as smoking, obesity, physical inactivity, and heavy drinking are associated with decreased HRQoL in patients with asthma and diabetes (Megari, 2013).

Improving health in older people involves helping them select healthy strategies (Arsenijevic et al., 2016). With successful interventions, older adults can lead independent, healthy, and physically active lives and improve their social relationships (Kouakou & Soyang, 2016; Rasool, 2016). Adopting health-enhancing behaviors and empowering older adults have become essential to healthy aging. Additionally, further studies are needed to analyze the extent to which older adults adopt and perform health-enhancing behaviors (Feng et al., 2020).

Effective health policies and programs are needed to reduce chronic disease and improve the quality of life of the aging population (Poscia et al., 2017). It is important to help older people adopt an approach that enables them to increase control over their health and recognize healthy aging as part of aging (Rababa et al., 2020; Rasool, 2016). In addition, health-promoting behaviors can contribute to better health outcomes and improve quality of life (Lee & Oh, 2020; Mofrad et al., 2016). People’s behavior can be negatively affected by factors such as the lack of health literacy, conflicting belief systems, feelings of fear, distrust, and uncertainty, inaccurately processed information, feelings of discomfort, or experiences of disrespect or discrimination. These factors are often not considered in the design and implementation of policies, the organization of services, or the behavior of health professionals. Often these barriers to optimal health can be avoided or corrected by developing a better understanding of these social, behavioral, and cultural factors (World Health Organization [WHO], 2020b).

Learning about and assessing the culture and value system of older people helps to improve health and disease management and health. This assessment should include the health literacy of older persons living in multicultural societies and their ability to access, process, and understand healthcare services and make appropriate health decisions based on their cultural beliefs (Feinberg et al., 2017; Ilgaz, 2022). Culturally competent care requires the ability to read, write, and understand health-related information. This situation puts health literacy on the agenda and highlights the interactions between access to health services, healthcare providers, and individuals, which are important components of health literacy (Feinberg et al., 2017; Ilgaz, 2022).

The Omaha System (OS) is used to identify the needs of older people and implement care processes. It has been confirmed in various studies as an effective method for defining health problems and maintaining care processes (Aktas et al., 2016; Feng et al., 2020; İncirkuş & Nahçıvan, 2020). OS is considered an appropriate problem classification scheme to identify the health needs not only of the general population but also of specific groups (Feng et al., 2020).

Problems related to nutrition, physical activity, medication regimen, sleep, and rest (Hisar & Erdoğdu, 2014;M. C. Yılmaz, 2007; Yun, 2005), health monitoring (Yun, 2005), and personal care (Erdogan et al., 2013; Hisar & Erdoğdu, 2014) were the most commonly used for care diagnoses in the studies that used OS to assess the health needs of older people. Aktas et al. (2016) used OS to identify the health-related behavioral needs of older people, reported that the main problems were personal care (56.4%), nutrition (15.4%), medication (12.1%), sleep and rest (10.5%), and physical activity (5.7%), respectively. Similarly, Önder et al. (2015) found that 90.4% of older adults could not bathe, 82.7% could not dress, and 34.6% could not use their drugs without assistance.

Few studies have analyzed the healthcare of older people in Northern Cyprus and proposed a systematic approach to solve their problems. To provide continuous and effective care to older adults, it is necessary to systematically identify their needs according to the care process approach and to plan, implement and evaluate their healthcare. At the same time, health professionals in Northern Cyprus have reduced experience with the needs of older people receiving primary care services and the solutions to their problems (Tansu, 2020). The aim of this study was to identify the health needs of older adults using the problem classification scheme of OS. The results of this study can help to improve and record the healthcare of older people in need, improve the quality of care, and guide caregivers who play an important role in providing healthcare to these people. Healthcare for older people is a team effort, and community nurses, who are among the most active members of this team, should define the needs of these people in order to plan healthcare. Therefore, in this study, OS was used to determine the health-related behavioral needs of older people in the municipality of Geçitkale in Northern Cyprus and its six villages.

Methods

Study Sample and Design

This study used a descriptive cross-sectional design. Data were collected between May and October 2021. The study population included 449 older adults aged 65 years and older who received home care within the boundaries of the municipality of Geçitkale in Northern Cyprus and were recorded by the municipality’s health department. No sampling was performed, and all volunteers aged 65 years or above who could read and comprehend the study instructions, did not have hearing loss to prevent communication and could perform daily activities without assistance were included. Of the 449 older adults, 11 refused to participate because of the COVID-19 pandemic, four had died, 16 had Alzheimer’s disease, nine had hearing problems, and nine were bedbound. The study included 400 older adults, representing 89% of the population.

The healthcare needs of the participants were met by the Geçitkale Community Health Centre and nurses working in the municipality. Nurses at the health center monitored vital signs, prescribed medications for chronic diseases, dressed wounds, and performed invasive nursing interventions in homecare. No systematic diagnostic system was used in the center to monitor older adults receiving home care.

Data Collection

Data were collected during home visits through face-to-face interviews. We contacted older adults registered for home care by the Geçitkale municipality and scheduled home visits. COVID-19 measures were implemented during home visits, which lasted approximately 30 to 45 min.

Data Collection Tools

Personal Information Form

The questionnaire was based on the literature (Mofrad et al., 2016; Tansu, 2020) and included 16 questions on sociodemographic characteristics, including age, gender, marital status, social security, income level, and access to health services.

Problem Classification Scheme of the OS

A problem classification scheme (PCS) was used to collect health individuals. The OMAHA system, developed by the North American Visiting Nurses Association (VNA), is the oldest classification system in use since 1975 and allows nurses to create and maintain records. The OMAHA system was adapted to the Turkish language by Erdogan and has proven to be a valid and reliable tool for Turkish society that can also be used in nursing education. The model is considered as a guiding tool to show the value of the nursing process in practice (Erdoğan et al., 2017). The PCS is the section where nursing diagnoses are classified. The schema diagnoses a person’s health problems holistically in four domains (environment, psychology, physiology, and health-related behaviors; Aktas et al., 2016; Erdoğan et al., 2017). It was found that the studies evaluating the effectiveness of the Omaha scheme in nurses’ practice were mostly conducted in home visits (Aktas et al., 2016; Erdogan & Esin 2006), home care (Erdogan et al., 2013; İncirkuş & Nahçıvan, 2020; Westra et al., 2010), and family health centers (Aylaz et al., 2010; Holt et al., 2020).

In this study, the health-related behavior domain of the problem classification scheme of OS was used to identify the healthcare needs of older adults. The health-related behaviors domain includes seven problems, namely, nutrition, sleep and rest patterns, physical activity, personal care, substance care, family planning, healthcare supervision, and medication regimen (Erdoğan et al., 2017).

Statistical Analysis

Study data were analyzed using SPSS (26.0) for the Windows Software Package Program. Descriptive statistics included numbers, frequencies, means, and standard deviations. Frequency analysis was used to present data on the sociodemographic characteristics of the older participants and health-related behavioral problems of the OS. Pearson’s chi-square test was used to compare sociodemographic variables and health-related behavioral problems. When the assumptions of Pearson’s chi-square test were not met, Fisher’s exact test was used for comparison. Statistical significance was set at p < .05.

Ethical Considerations

Ethical approval was obtained from the University Ethical Committee ([ETK00-2022-187]). Institutional permission was obtained from the XXX municipality (MYB.2.00-006-21/E.1682) and the written informed consent was obtained from all participants.

Results

We found that 66% of the participants were female, 79% were married, 87.75% had at least one child, 42.50% were literate, and 100% had nuclear families. Moreover, all participants did not work currently; 49.5% were homemakers, 67% lived with a spouse, and 67% expressed that their income met their expenses. In addition, 97.50% of participants had at least one chronic disease, including hypertension (71.28%), diabetes mellitus (69.74%), coronary heart disease (30%), hypothyroidism (13.33%), cancer (9%), or anemia (6.92%). Although 89.75% of participants had easy access to health services and all were regularly visited by a team of health professionals, all participants also felt that team members were inadequate.

Table 1 shows the health-related behavioral problems of the participants. All participants had a nutrition problem, with high severity (78%) and priority (78%). Second, 87.25% of the participants had physical activity and medication problems. The severity of physical activity and medication use was 77.65% and 98.75%, respectively. Finally, the priority of problems with physical activity and medication use was extreme in 77.65% and 98.57% of the participants, respectively.

Table 1.

Health-Related Problems of Older Adults (n = 400).

Problem	Nutrition		Sleep and rest patterns		Physical activity		Personal care		Substance care		Health supervision		Medication regimen
Problem	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Yes	400	100	313	78.25	349	87.25	296	74.00	271	67.75	321	80.25	349	87.25
No	—	—	87	21.75	51	12.75	104	26.00	129	32.25	79	19.75	51	12.75
Severity
Actual	312	78.00	197	62.94	271	77.65	223	75.34	211	77.86	260	81.00	344	98.57
Potential	88	22.00	116	37.06	78	22.35	73	24.66	60	22.14	61	19.00	5	1.43
Priority
Extreme	312	78.00	197	62.94	271	77.65	223	75.34	211	77.86	260	81.00	344	98.57
Minimal	88	22.00	116	37.06	78	22.35	73	24.66	60	22.14	61	19.00	5	1.43
Total	400	100	313	100	349	100	296	100	271	100	321	100	349	100

Table 2 shows the signs and symptoms of health-related behavior problems at OS. Regarding nutrition problems, 54.25% of participants did not adhere to the prescribed diet, while 48% had an inappropriate diet plan for their age. Signs and symptoms of sleep and rest patterns included insomnia (63.58%) and too little sleep/rest for their age/physical condition (57.19%). In contrast, insufficient or inconsistent exercise routines (91.69%) and a sedentary lifestyle (83.09%) were the main physical activity problems. In personal care, 84.12% of participants were unable to clean and wash their clothes, while 42.91% had difficulty in oral hygiene, brushing or flossing their teeth. Signs and symptoms of substance use also included smoking/using tobacco products (70.11%) and worsening reflexes (61.62%). Healthcare problems included inadequate health resources (72.59%) and inability to obtain routine healthcare (58.26%). Finally, problems related to the medication regimen included non-compliance with the recommended dose/treatment program (85/96%) and an inadequate system for taking medication (63.61%).

Table 2.

Distribution of the Signs & Symptoms of Actual Related With the Problems in the Health-Related Behavior Domain of the Omaha System (n = 400).

Problems	Signs/symptoms of actual	n	%
Nutrition	Nonadherence to prescribed diet	217	54.25
	Improper feeding schedule for age	192	48.00
	Malnutrition	186	46.50
	Exceeds established standards for daily calorie/fluid intake	184	46.00
	Weights 10% more than average	169	42.25
	Insufficiency in nutrition/preparing meals	115	28.75
	Hyperglycemia	75	18.75
	Weights 10% less than average	54	13.50
	Unexplained/progressive weight loss	14	3.50
	Lacks established standards for daily calorie/fluid intake	21	5.25
	Hypoglycemia	2	0.50
Sleep and rest patterns	Insomnia	199	63.58
	Insufficient sleep/rest for age/physical condition	179	57.19
	Frequent night awakening	169	53.99
	Sleep and rest patterns causing discomfort to family members	97	30.99
	Sleep apnea	89	28.43
	Snoring	50	15.97
	Nightmare	35	11.18
Physical activity	Inadequate/inconsistent exercise routine	320	91.69
	Sedentary lifestyle	290	83.09
	Inappropriate type/amount of exercise for age/physical condition	11	3.15
Personal care	Inability to clean and wash clothing	249	84.12
	Difficulty in performing oral care / tooth brushing / flossing	127	42.91
	Difficulty in washing and combing hair	101	34.12
	Foul body odor	84	28.38
	Forgetting / not willing / not being able to do personal care activities	81	27.36
	Inability to have a bath	40	13.51
	Difficulty in cleaning himself/herself after going to the toilet	7	2.36
	Difficulty in wearing lower body clothing	1	0.34
Substance care	Smokes/uses tobacco product	190	70.11
	Deterioration in reflexes	167	61.62
	Difficulties in performing daily routines	90	33.21
	Exposure to cigarette smoke	81	29.89
	Alcohol abuse	15	5.54
Healthcare supervision	Inadequate healthcare resources	233	72.59
	Inability to receive routine/protective healthcare	187	58.26
	Discontinuous healthcare resources	183	57.01
	Inability to receive treatment for the symptoms requiring diagnosis/therapy	180	56.07
	Inability to coordinate more than one treatment plans	141	43.93
	Nonadherence to recommended therapy	125	38.94
Medication regimen	Non-compliance with the recommended dose/treatment program	300	85.96
	Inadequate system for taking medication	222	63.61
	Inappropriate ways of medication storage	208	59.60
	Inability to maintain immunization	190	54.44
	Inability to replace backup medications	148	42.41
	Inadequate medication regimen	103	29.51
	Side effects/undesired responses	70	20.06
	Failure to take medication without aid	64	18.34

Table 3 shows the factors influencing health-related behavioral problems. According to the results, sleep and rest behavior problems were significantly higher among participants who were 75 years and older, female, single, educated, and had no children. In addition, physical activity, personal care, substance maintenance, health monitoring, and medication use problems were significantly higher among participants who were 75 years and older, female, single, educated, or had an elementary school degree, did not have children, and whose income did not cover expenses (p < .05).

Table 3.

Comparison of the Health-Behavior Need Problems With the Sociodemographic Characteristics.

Sociodemographic Characteristics	Sleep and rest patterns			Physical activity			Personal care			Substance care			Healthcare supervision			Medication regimen
	Yes	No	p	Yes	No	p	Yes	No	p	Yes	No	p	Yes	No	p	Yes	No	p
Age group
65–69 years	64.25	35.75	0.000*	80.45	19.55	0.000*	63.13	36.87	0.000*	49.16	50.84	0.000*	67.60	32.40	0.000*	80.45	19.55	0.000*
70–74 years	85.06	14.94		89.61	10.39		81.17	18.83		77.27	22.73		86.36	13.64		89.61	10.39
75 years and above	100.0	0.00		100.0	0.00		86.57	13.43		95.52	4.48		100.0	0.00		100.0	0.00
Gender
Female	82.58	17.42	0.003*	94.32	5.68	0.000*	79.17	20.83	0.001*	72.35	27.65	0.006*	86.36	13.64	0.000*	94.32	5.68	0.000*
Male	69.85	30.15	0.003*	73.53	26.47	0.000*	63.97	36.03	0.001*	58.82	41.18	0.006*	68.38	31.62	0.000*	73.53	26.47	0.000*
Marital status
Married	74.68	25.32	0.001*	85.13	14.87	0.014*	72.15	27.85	0.102	65.51	34.49	0.063	76.27	23.73	0.000*	85.13	14.87	0.014*
Single	91.67	8.33	0.001*	95.24	4.76	0.014*	80.95	19.05	0.102	76.19	23.81	0.063	95.24	4.76	0.000*	95.24	4.76	0.014*
Has children
Yes	75.21	24.79	0.000*	85.47	14.53	0.001*	70.37	29.63	0.000*	70.37	29.63	0.003*	77.49	22.51	0.000*	85.47	14.53	0.001*
No	100.0	0.00	0.000*	100.0	0.00	0.001*	100.0	0.00	0.000*	48.98	51.02	0.003*	100.0	0.00	0.000*	100.0	0.00	0.001*
Education level
Literate	91.76	8.24	0.000*	99.41	0.59	0.000*	80.00	20.00	0.000*	74.71	25.29	0.000*	91.76	8.24	0.000*	99.41	0.59	0.000*
Primary school	81.88	18.13		93.13	6.88		87.50	12.50		79.38	20.63		87.50	12.50		93.13	6.88
Secondary school	37.14	62.86		44.29	55.71		28.57	71.43		24.29	75.71		35.71	64.29		44.29	55.71
Income
Meets expenses	77.61	22.39	0.659	81.72	18.28	0.000*	77.24	22.76	0.035*	65.67	34.33	0.205	79.48	20.52	0.580	81.72	18.28	0.000*
Does not meet expenses	79.55	20.45	0.659	98.48	1.52	0.000*	67.42	32.58	0.035*	71.97	28.03	0.205	81.82	18.18	0.580	98.48	1.52	0.000*

p < .05.

Discussion

In this study, home visits were conducted and the OS was used to identify the health-related behavioral needs of older people living within the boundaries of a community in Northern Cyprus. Nutrition, physical activity, and medication adherence were the main care diagnoses of health-related behavioral needs of the OS, which were influenced by age, gender, number of children, education and income levels, and marital status of the participants.

Similar to our findings, some studies reported that nutrition and physical activity (Gökdoğan et al., 2008; M. C. Yılmaz, 2007; Yun, 2005), medication adherence (Yun, 2005), and sleep/rest behavior (M. C. Yılmaz, 2007) are important health-related behavioral needs of older people. Akan (2018) investigated the attitudes of 410 older adults toward diet and nutrition, concluding that all participants were able to perform physical, healthcare, and personal care activities without assistance, with the exception of bathing. Gökdoğan et al. (2008) examined the home care needs of older people with chronic diseases and found that half of the participants required assistance with healthcare, nutrition, and physical activity. Aktas et al. (2016) found that the health-related needs of older people are the problems of personal care, nutrition, medication, sleep/rest, and physical activity, respectively.

The problems of aging are due to the interaction of various factors, including genetic factors, lifestyle, and social and physical environment, which can be controlled to some extent to lead a healthy life (Aslan et al., 2017). Mental health was also considered to ensure a healthy lifestyle. Active aging is the ability of individuals to maintain their cultural, social and economic activities in everyday life, as well as to maintain their life in a healthy and safe environment with its physical, mental and social dimensions (Liotta et al., 2018). In addition to improving the physical and mental health of older people, it is important to prevent disease, facilitate adherence to treatment regimens, provide a healthy and safe environment, and ensure that accident prevention, immunization, and hygiene requirements are met (Lök & Lök, 2016).

It is very important to obtain regular and high-quality healthcare, especially during old age when chronic diseases are increasing. For this reason, it is necessary to facilitate access of older adults population to health services, expand home care services, cooperate with universities to train specialized medical personnel who know the characteristics and needs of the old age period, increase the number and qualifications of institutions such as nursing homes, rehabilitation centers, and hospitals serving older adults; and allocate a sufficient budget for all these (Liotta et al., 2016). In addition to increasing life expectancy, it may also be possible to ensure quality of life through adequate and effective health services. In cases where the services offered are not sufficient, preventive measures offered to people and simple applications that can be carried out at home can help protect health and improve the quality of life (Canlı & Karatas, 2018).

Epidemiological studies on the relationship between modifiable lifestyle factors and health outcomes such as mortality and chronic diseases have identified physical immobility, smoking, malnutrition, and drug abuse (including alcohol consumption) as modifiable lifestyle factors. Existing studies suggested that improvements in these factors may prevent functional limitations and result in more active and independent aging (Aktas, 2016; Feng et al., 2020; Kulakçı & Emiroğlu, 2012).

Decreases in basal metabolic rate and physical activity are the main causes of obesity in older adults and are currently increasing in almost all countries (Arıkel, 2019). All participants in our study had problems related to the behavioral health needs domain of the OS, and all had nutritional problems, such as malnutrition, an inappropriate diet plan for age, and nonadherence to prescribed diets (Table 2). Ongan & Rakıcıoğlu (2015) observed obesity in 47% of female and 20.8% of older adults living in nursing homes. The study by Tannen et al. (2012) of 5,521 residents of 15 hospitals and 76 nursing homes found that 30.3% and 15.1% of participants were overweight and obese, respectively. Güler et al.’s (2009) study on health needs of older people found that 30.4% of the participants were overweight and 25.9% did not adhere to the diet. Arıkel (2019) studied older people who lived in nursing homes or received home care and found that 42.5% of participants were class 1 obese. Similar to the literature, our study found that all participants had nutrition problems and half were unable to adhere to the prescribed diet (Table 2). This problem could be related to the level of education, the lack of dietitians in health centers to monitor and plan their diet, and the lack of nursing interventions for diet planning. Therefore, dietitians and nurses are responsible for prescribing balanced diets and exercise plans to older people with obesity.

Physical activity and exercise are closely related to a healthy life. Regular physical exercise increases the functional capacity and the quality of life and reduces chronic diseases in older people (Canlı & Karataş, 2018). Compared to other age groups, the impact of physical activity is higher in people aged 65 and older because the negative consequences of physical immobility are greater in this age group (Halaweh, 2016). Lök and Löks (2016) study of physical activity levels in 251 older people found that 62.2% of participants were physically inactive. The aging process is usually associated with a significant decrease in physical activity (Canlı & Karataş, 2018). Kazoğlu and Yueruek (2020) reported that older people living both at home and in nursing homes do not engage in regular physical activity (Kazoğlu & Yueruek, 2020). Similar to these findings, this study also found that a sedentary lifestyle and inadequate or inconsistent physical activity routines are the most important signs and symptoms among older adults (Table 2).

The increase in life expectancy has led to a gradual increase in the proportion of older adults in the total population. Polypharmacy is developing due to chronic diseases during the aging period and the number of medications used. During this period, the unreasonable use of medications has health (S. Joseph & Alpert, 2017; İ. Yılmaz, 2019). Table 2 shows that most of the older adults in our study had problems with medication adherence, such as non-adherence to the recommended dose/treatment program and inadequate medication adherence system. The studies in the literature report that medication omission, excessive medication intake, and untimely medication intake are the main problems related to medication regimen (Ekenler & Koçoğlu, 2016; Furuta et al., 2013; Yoo, 2011). Ekenler and Koçoğlu (2016) found that 26.2% of participants increased or decreased their medication dose without consulting a physician. In Solmaz’s (2008) study on medication adherence among older people receiving home care, forgetting or not taking medications on time and not adhering to the recommended medication dose were mentioned as the main problems related to medication regimen. In our study, most participants had multiple chronic diseases and were taking multiple medications (Table 2). Therefore, medication monitoring systems and educational programs are needed to improve adherence and raise awareness of judicious medication use. In addition, educational materials such as public service announcements, brochures, posters, and videos can be distributed during visits to older adults (Ponticelli et al., 2015; Sonkaya & Çakır, 2015). In addition, attempts to raise awareness about sensible drug use can target low-income individuals (S. Joseph & Alpert, 2017; Meyer et al., 2012). Finally, community health nurses that follow up with older people may play a more effective role in increasing the awareness of these people (Ponticelli et al., 2015; Sonkaya & Çakır, 2015).

The problem of health surveillance includes signs and symptoms such as inability to obtain routine/protective treatment, inability to obtain treatment for symptoms requiring diagnosis/therapy, and inadequate health resources. More than half of the participants in our study reported problems with healthcare (Table 2). A study of older adults receiving home care in Turkey reported that 78.7%, 9.5%, and 7.3% of participants received physical examination, pressure ulcer care, and urinary catheterization, respectively (Karaman et al., 2015). Another study found that 54.2% of older adults in Croatia received minimum and 30.6% intensive care (Nadarević-Štefanec et al., 2011). In another study, 51% of older adults receiving home care in Cyprus reported psychological needs such as conversation, emotional support, and anxiety (Kouta et al., 2015). Studies that adopt an approach that prioritizes early diagnosis, treatment, and monitoring are highly important when evaluating older people receiving homecare (Çevik, 2017). To prevent health problems of older people, evidence-based policies can be developed that focus on older adults, healthcare systems can be aligned with the needs of older adults, caregivers can be integrated into the system, infrastructure and workforce can be developed to provide long-term care, a senior-friendly environment can be created, and the health of older adults can be continuously monitored (Kouta et al., 2015).

Older people usually find it difficult to fall asleep or to sleep regularly (Güneş & Özvurmaz, 2020). The length and quality of sleep may vary in older adults during normal aging. Frequent nighttime sleep interruptions lead older adults to nap (Hu et al., 2021; Tsou, 2013). Physiological, psychological, and social changes during aging can worsen sleep quality (Hu et al., 2021; Patel et al., 2018). Sleep and rest behaviors were among the major problems of the participants in our study (Table 2). Sleep and rest were also cited as one of the most common problems in older people in other studies (Güneş & Özvurmaz, 2020; Tsou, 2013). The fact that the majority of older adults are retired and live alone has led to increased smoking and alcohol consumption and affects sleep quality. Accordingly, insomnia may increase the likelihood of headaches, restlessness, lack of motivation, and involuntary behaviors in older adults. Nicotine, the active ingredient in cigarettes, is an addictive substance that not only makes it difficult to quit smoking, but can also lead to poor sleep and insomnia due to severe withdrawal symptoms (Gulia & Kumar 2018). Studies have found that 39% of patients complain of insomnia during nicotine withdrawal. Sleep disturbances often occur with depressive moods, and withdrawal symptoms occur during addiction (Jaehne et al., 2012). These can be important problems for both physiological and psychosocial health. For this reason, caregivers caring for older adults should assess the quality of their sleep and implement strategies to overcome these problems and improve their sleep health (Kazoğlu & Yueruek, 2020; Tsou, 2013).

Inability to clean and wash clothes and difficulties with oral care were the two major personal care problems in our study (Table 2). Older adults’ ability to meet their personal care needs or the problems they face in meeting those needs are very common among older adults in other studies. In developed countries, nearly a quarter of older adults require assistance with daily activities such as bathing or dressing (Farzianpour et al., 2015; Yin et al., 2013). Dental problems are the health issues closely related to oral and general health and quality of life among older adults (Mooventhan & Nivethitha, 2017; Sears et al., 2013). These are among the most common community health problems worldwide (Erol et al., 2016; Mooventhan & Nivethitha, 2017). Therefore, oral and dental health of older adults should be frequently examined and education on this topic should be provided (Erol et al., 2016). These findings are consistent with the results of our study and demonstrate the importance of oral and dental health education to improve the health of older adults.

The main substance use problem in our study was smoking or using tobacco products (Table 2). This finding may be related to education level. Liao et al. (2019) found that smokers in China have lower education levels in terms of the association between smoking and sleep quality. Other studies have reported that education is an important factor influencing smoking habits. People with higher education levels are more aware of the adverse health effects of smoking and have more control and management information on smoking cessation (Benson et al., 2014). Therefore, there is a clear need for smoking cessation interventions among older adults.

All health behaviors defined as problematic by OS occurred among participants who were 75 years of age or older, female, single, had no children, were literate, and had incomes that did not meet expenses (Table 3). Therefore, the impact of sociodemographic factors on health behaviors should be considered when planning nursing interventions, and the increasing need for care during the aging process should be taken into account when developing care plans.

Depending on the social structure, eating, and drinking habits, which are an important part of the culture, are learned early and remain for a long time. In recent years, in Northern Cyprus, especially in the cities, the lack of time combined with the fast style of life and becoming a consumer society has also affected the time spent on cooking, avoiding the traditional dishes that require long preparations. All these negative aspects have led to a change in understanding and behavior, and the traditional home and family meals that used to exist have been replaced by fast food, namely, fast eating habits. As a result, both the traditional table order and the rules associated with it and the traditional dishes that are prepared in cooperation and bring family members closer to each other have been forgotten (Arıkel, 2019; Gökbulut & Yeniasır, 2021). Weight loss and non-compliance with the recommended diet were noticed in all older people in the study.

Weight loss and nonadherence to the recommended diet were evident in all of older adults in the study. In addition to variables such as age, living alone, education level, income not covering costs, women contributing in family work to care for older adults and migrating from the village to the city, changing dietary habits, and dietitians from healthcare providers who do not provide services in primary health centers are other factors for the rapid increase in obesity. However, significant differences were found in all physical activity variables (Table 3). Limited walking routes, lack of information sessions to improve healthy lifestyles, too few healthcare workers, and too few physical therapists in the relevant facilities serving older adults also did not improve the situation.

Low education level, low health awareness, genetic predisposition characteristics, social environment, and family environment are risk factors for smoking. It is known that the risk of smoking is high, especially for people who have an outward structure and seek novelty or cannot control their impulses due to personality traits. In addition, some people use cigarettes for psychological support and to suppress their psychological state. Life events, stress experienced, and having someone smoking nearby are factors that increase their use (M. Joseph & Natalie, 2018). The idea that quitting smoking does not have great health benefits is one of the last pleasures in life, especially for older people, and it is difficult to change their habits, which makes it difficult to quit smoking (Doğan & Mevsim, 2020). It can be said that only living elderly people who do not receive family support are at risk of smoking. It is thought that coffee shops are common in Northern Cyprus, where older adults, especially men who live alone (Table 3), spend time and social and physical activity areas are limited, which will encourage older adults to start smoking again as passive smokers.

Implications for Practice

The results of this study suggest that valid and reliable care classification tools, such as OS, can help nurses plan interventions and assess patient outcomes related to the basic health-related needs of older adults, including nutrition, physical activity, medication adherence, and substance care. Interventions to promote and perform health behaviors and education to improve health-promoting behaviors in older adults to meet their needs in-home care may be suggested. Further studies that consider the four domains of OS should be conducted in older people.

Strengths and Limitations

This study was conducted in a municipality in Northern Cyprus. According to this method, the research results can only be generalized to the older adults interviewed. This study was conducted at a single center and cannot be generalized to all older people. The Omaha system data collection instrument is long and collected by documentation without electronic media, and the data collection time is prolonged. This study is the first step of a work focusing on a single domain OS. The reason we focused on a single domain of OS is because we intend to conduct another study to plan interventions for the identified health behaviors and to evaluate the effectiveness of these interventions. Although data were collected through the appointment system, sometimes the older adult was not at home.

Conclusions

In conclusion, health-related behavioral problems of older people receiving homecare in Northern Cyprus included nutrition, physical activity, and medication regimens. Based on these findings, healthcare and nursing professionals should organize a nutrition program that incorporates the cultural habits of older people and assesses their nutritional needs using standard measurement tools. In addition, nurses should plan activities aimed at increasing older people’s physical activity levels (e.g., encourage them to walk at least half an hour a day), assess physical activity status at specific times, and closely monitor newly developed physical activity programs and technologies to incorporate this into counseling and educational activities. The establishment of kindergartens by municipalities where older people can spend time and use their social aspects, the planning of a drug monitoring system for regular drug use by patients in the health system, and drug use situations should also be considered in this context. Care interventions for the behavioral health needs of these people should be identified and planned to build a systematic database for older people in Northern Cyprus. This study can provide important information for health professionals caring for older adults and managers to plan care and evaluate the quality of care.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Gülten Sucu Dag

Data Availability Statement

The data can be sent on request.

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Determining the Health Care Behavior Needs of Older Adults Based on the Omaha System

Abstract

Plain language summary

Keywords

Introduction

Methods

Study Sample and Design

Data Collection

Data Collection Tools

Personal Information Form

Problem Classification Scheme of the OS

Statistical Analysis

Ethical Considerations

Results

Discussion

Implications for Practice

Strengths and Limitations

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

Data Availability Statement

References