Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCDs clinic plus: multilevel analysis.

Abstract

Abstract Background Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Clinic Plus of hospitals in 1 year. Methods This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: 1) 600 older adults having at least one diagnosis of hypertension, diabetes, and hyperlipidemia and receiving services at NCDs Clinic Plus and 2) 12 nurses in charging of the NCDs Clinic Plus at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis. Results Only 24% of older adults with NCDs could control their MetS within one year. Receiving service from NCDs Clinic Plus at the hospitals providing complete MetS screening was significantly correlated with the MetS control (OR = 1.76, 95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (OR = .34, 95% CI [.22, .53]) and a 54% (OR = .46, 95% CI [.29 − .71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06–2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively. Conclusion Health service provision at the NCD Clinic Plus should include MetS screening, polypharmacy assessment, dietary pattern assessment, and following-up on medication adherence every time older adults with NCDs come for the services. Especially to control the MetS in older adults with NCDs having high risks for MetS, the service should pay particular attention to those who are female, labor-employed, and take polypharmacy.