Factors of Intellectual Function Impairment in Older People in South

Denpasar, Bali

Ni Putu Kamaryati

and N. K. Sutini

Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Intellectual Function Impairment, Older People, Cross-Sectional Study.

Abstract: Global population of older people is reported to grow faster than other groups of age. Along with aging and

increase in the life expectancy of older people, the prevalence of intellectual function impairment tends to be

higher. This study aimed to determine factors associated with intellectual function impairment in older people

in South Denpasar, Bali. The study was a cross-sectional design, and it involved 139 respondents selected

through convenience sampling in four primary healthcare centres of South Denpasar. The respondents were

interviewed with a structured questionnaire consisting of demographic information and a Short Portable

Mental questionnaire. Data were analysed through descriptive statistics using Spearman’s Rank Correlation,

Chi-Square, and Fisher’s Exact test. Severe intellectual function impairment cases were found in 10.8% of

respondents (15 respondents). Age, gender, and occupation were not significantly associated with intellectual

function impairment (p > .05). Whereas education and marital status were significantly associated with

intellectual function impairment (p < .05). It is necessary for community nurses to actively screen intellectual

function impairment cases and develop strategies for enhancing older people ‘s cognitive functions.

1 BACKGROUND

Changes in the number of older populations are

reported to increase in all over the countries,

including Indonesia. The World Population Prospects

reported that the number of populations aged 60 was

962 million, growing faster than that of all younger

groups. The elderly population is projected to be 1.4

billion in 2030 and 2.1 billion in 2050, possibly

increasing to 3.1 billion by 2100 (United Nation &

Department of Economic and Social Affairs, 2017).

Nowadays, Indonesia is known to experience

aging. The Indonesian older population is estimated

to be 23.66 million older people (9.03%) in 2017 and

to increase to 27.08 million in 2020, 33.69 million in

2025, 40.95 million in 2030, and 48.19 million in

2035 (Ministry of Health, 2017). Bali province is

reported to be ranked fourth outside Java for having a

high number of older people reaching 10.71%

(Indonesian Ministry of Health, 2017)

The life expectancy of older population in

Indonesia increased from 70.1 years in 2010-2015

period to 72.2 years in 2030-2035 period (Statistic &

https://orcid.org/0000-0002-3882-0683

https://orcid.org/0000-0003-4721-6215

Bappenas, 2018). The number of older people in

Denpasar city increased every year from 5.20% in

2017 to 5.36% in 2018 (Statistics Bureau, 2015).

Along with aging and the increase in life expectancy

of older people, intellectual function impairment is

also reported to increase in this age group. The World

Health Organization (WHO) reported that about 47.5

million people lived with intellectual function

impairment in 2015. A total of 7.7 million new cases

of intellectual function impairment are reported

annually (Indonesia Statisctic Bureau, 2018).

Denpasar city was divided into 4 sub-districts and

has 11 primary healthcare centres in Indonesia called

Puskesmas. South Denpasar is one of the sub-districts

that has four primary healthcare centres and a large

number of older people population.

The first study on intellectual function

impairment involving a large sample of older

population was conducted in Yogyakarta in 2015. A

further study shows that the intellectual function

impairment was 1.6 times higher in older people in

Bali than in Yogyakarta (Suriastini et al., 2016).

Various factors that may affect the older people in

Kamaryati, N. and Sutini, N.

Factors of Intellectual Function Impairment in Older People in South Denpasar, Bali.

DOI: 10.5220/0011940200003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 72-75

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Bali include level of education, age, occupation, and

marital status. Even though the prevalence of

intellectual function impairment in Bali has been

reported, local reporting about this issue still needs to

be done by primary healthcare centres to optimize the

case management.

Based on a preliminary study in primary

healthcare centres of South Denpasar, intellectual

function impairment in older people was not well-

reported. Therefore, this study aimed to determine

factors associated with intellectual function

impairment in older people of South Denpasar, Bali.

2 METHODS

This study used a descriptive correlational design

with a cross-sectional approach; it was conducted in

four primary healthcare centres of South Denpasar.

The sample in this study was the older people aged 60

years and over, who visited the primary healthcare

centres from April to June 2019 and were willing to

be research respondents. With the use of purposive

sampling technique, 139 samples were involved

based on the inclusion and exclusion criteria.

Data were collected through interview with

structured question items in the questionnaire. The

Short Portable Mental Questionnaire (SPMSQ) was

used to measure intellectual function impairment. It

consisted of 10 items about orientation, personal

history, a memory of self-care, and calculation skill.

The score ranged from 0 to 10. The intellectual

function impairment was divided into four

classifications according to scores including good (0-

3), mild (4-5), moderate (6-8), and severe intellectual

function impairment (9-10). For further analysis, the

intellectual function impairment was classified into

two categories based on the median scores: mild

impairment scored ≤ 5 and severe impairment scored

> 5. The validity and reliability testing of the

questionnaire was conducted by Mursyid and

Rahman (Mursyid, S and Rahman, 2017). The

validity and reliability test were .443 and .884,

respectively.

Data collection was collected by two research

assistants who have an education background

minimum diploma three in nursing. Before collecting

data, they explained to respondents about the

objective and procedures of the study. After that,

Primary Investigator (PI) asked the respondents to

sign a consent form to participate in the study.

Data were analysed by using SPSS 20 version.

Characteristics of respondents and categories of

intellectual function impairment were analysed using

descriptive statistics. Bivariate analysis was used to

analyse factors associated with intellectual function

impairment. Age in this study was a numerical scale;

the relationship between age and intellectual function

impairment was tested using the Spearman Signed

Rank Test because the assumption of the parametric

test was violated. Gender, occupation, education, and

marital status were analysed using Chi-Square and

Fisher’s Exact tests. This study was granted ethical

clearance by the Ethics Commission of the Faculty of

Medicine, Udayana University/Sanglah Hospital

Denpasar with Number 1107/UN.14.2.2.VII.

14/LP/2019 dated 18 April 2019.

3 RESULTS

The findings show demographic characteristics of

respondents, classifications of intellectual function

impairment, and factors related to intellectual

function impairment (see Table 1).

Table 1: Respondents’ demographic characteristics

(n = 139).

Characteristics f %

Median Age

Range (years)

(60-81 years)

Gender

Male

Female

49.6

50.4

Education

No formal education

Elementary school

Junior high school

Senior high school

Diploma/university

11.5

31.7

11.5

25.2

20.1

Marital status

Married

Divorce

126

90.6

9.4

Occupation

Unemployed

Government employee

Entrepreneur

Farmer

Housework

Pension

4,3

15.8

3.6

8,6

31.7

Religion

Hinduism

Islam

Christianity

Buddhist

Protestant

120

86.3

10.1

1.4

0.7

1.4

Factors of Intellectual Function Impairment in Older People in South Denpasar, Bali

Table 1 presents that respondents’ age ranges

from 60 to 81 years, and the median age is 66 years

old. The majority of respondents is female and

Hindus. Most of them were married and unemployed.

The respondents’ latest education is mostly

elementary school.

Table 2: Classifications of Intellectual Function Impairment

(n = 139).

Classification f %

Intellectual function impairment

by median score

Severe

Mild

124

10.8

89.2

Intellectual function impairment

Severe

Moderate

Mild

Good cognitive

2.2

8.6

21.6

67.6

Most of the respondents have good cognitive

functions (67.6%), and only 10.8% have severe

intellectual function impairment as shown in Table 2.

Table 3: Factors related to intellectual function impairment

(n = 139).

Variables

Mild

Intellectual

Function

Impairment

n (%)

Severe

Intellectual

Function

Impairment n

(%)

p-value

Median of age

(Range)*

(60-81 years)

.343

Gender**

- Male

- Female

4(5.8.)

11(15.7)

65(61.61)

59(84.3)

.107

Marital status#

- Married

- Divorced

11(8.7)

4(30.8)

115(91.0)

9(69.2)

.035

Education**

- Lower

- Highe

15 (19.7)

0 (0.0)

61(8.3)

63 (100)

.001

Occupation**

- Employee

- Unemploye

1 (3.0)

14 (13.2)

32 (97.0)

92 (86.8)

.120

*Spearman’s Rank;

Fisher’s Exact; **Chi-Square

IFI = Intellectual Function Impairment

Table 3 shows that only marital status and

education are significantly associated with

intellectual function impairment. In contrast, age,

gender, and occupation are not significantly

correlated with intellectual function impairment.

4 DISCUSSION

This study aimed to determine factors related to

intellectual function impairment. Based on the

results, 15 older people who suffer from severe

intellectual function impairment (10.8%). The result

of this study is not in line with research conducted by

Nurhasanah in Banda Aceh in 2016 (FahmiAdha, &

Nurhasanah, 2016). They reported that of 70 older

people, most of them experienced severe intellectual

function (FahmiAdha, & Nurhasanah, 2016). This

current study found a greater portion of respondents

with good cognitive functions.

In terms of education, all respondents with severe

intellectual function impairment had low educational

background (19.7%). Previous research conducted in

Tangerang shows a similar result that a significant

relationship exists between education and intellectual

function impairment (Fatimah & Lubis, 2018). Being

involved in learning activities such as reading or

analysing complex situations can improve mental

acuity and optimize brain function to reduce the risk

of severe intellectual function impairment.

Additionally, this study shows an association

between marital status and severe intellectual

function impairment. This finding is confirmed by a

prior study (Sari et al., 2018). Most of the respondents

who suffered from intellectual function impairment

had married status. A good marital relationship can be

used as family support in one's life to overcome and

prevent intellectual function impairment (Kamaryati

& Malathum, 2020).

In this study, no relationship emerged between

occupation and intellectual function impairment.

Another research also found a supporting finding that

occupation was not related to dementia; this previous

study involved mostly retired respondents from being

civil servants who generally used their brain during

their work. The prevalence of dementia is influenced

not only by working status but also by work history

and type of work. Jobs that frequently require the

brain function tend to give a low risk of developing

dementia (Suriastini et al., 2016).

Although the incidence of intellectual function

impairment likely increases with age, the current

findings shows that there was no relationship between

age and intellectual function impairment (p = .343; r

= .81). It means that the younger age groups have

higher risk of severe intellectual function impairment

than the older age ones. Age was also not related to

the incidence of dementia because the proportion of

respondents aged 60-70 years is greater than that of

respondents aged above 70 years (71.9% vs. 28.1%).

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

The incidence of dementia in this study was found to

be the same in both age groups.

Most of the respondents in this study were female

as many as 69 people (50.4%). Although the

incidence of dementia possibly increases in female

individuals, this study shows no relationship between

gender and the incidence of intellectual function

impairment (p = .15). This result accords with a study

stating that gender had nothing to do with cognitive

disorders in elderly in Bali (Rini et al., 2018).

Classifications or categories of intellectual

function impairment in older people are essential

information that can be a strength of the current study.

However, some limitations of this study were found.

With limited analysis of variables i.e., respondents’

characteristics and intellectual function impairment,

this study did not inform deeper findings. Also, the

use of cross-sectional approach which only requires

single-point data collection results in one-time data.

Moreover, a purposive sampling technique used for

respondent selection limits the general applicability

of the findings to a larger number of other age groups.

5 CONCLUSIONS

This cross-sectional study which involved 139

participants shows that age, gender, and occupation

were not significantly associated with intellectual

function impairment (p > .05), but education and

marital status were significantly associated with

intellectual function impairment (p < .05). According

to the findings, nurses have to actively screen

intellectual function impairment cases and develop

strategies to solve them. Future studies should include

other variables using multivariate analysis and take a

probability sampling technique into account to obtain

a larger number of samples.

ACKNOWLEDGMENTS

The authors would like to thank I Gede Putu Darma

Suyasa for his valuable advice on the research project.

This study was funded by the Institute of Technology

and Health Bali (ITEKES Bali).

REFERENCES

FahmiAdha, M. R., & Nurhasanah, N. (2016). GEUNASEH

SAYANG ULEE KARENG BANDA ACEH THE

DESCRIPTION OF DEMENTIA IN ELEDERLY AT

REGIONAL TECHNICAL IMPLEMENTATION UNIT

OF RUMOH ACEH GEUNASEH SAYANG IN ULEE (

Nugroho , 2008 ). Usia permulaan tua menurut meliputi

sistem kardiovaskuler , pernafasan , Sel. 1–8.

Fatimah, S., & Lubis, V. H. (2018). MANDIRI DI PANTI

WHERDA BINA BHAKTI TANGERANG SELATAN

TAHUN 2018. II, 174–183.

Kamaryati, N. P., & Malathum, P. (2020). Family support:

A concept analysis. Pacific Rim International Journal

of Nursing Research, 24(3), 403–411.

Mursyid, S and Rahman, F. (2017). Hubungan Kesehatan

Mental dan Fungsi Kognitif dengan Kemandirian

Lansia di Panti Sosial Tresna Werdha Nirwana Puri

Samarinda. 1(3), 1619–1624.

Rini, S. S., Kuswardhani, T., & Aryana, S. (2018). Faktor

– Faktor yang Berhubungan dengan Gangguan

Kognitif pada Lansia di Panti Sosial Tresna Werdha

Wana Seraya Denpasar.

Sari, M., Ningsih, E. F., & Pratiwi, S. H. (2018).

DESCRIPTION OF DEMENTIA IN THE ELDERLY

STATUS IN THE WORK AREA HEALTH CENTER.

3(1), 1–11.

Suriastini, N.W., Turana, Y., Witoelar, F., Supraptilah, B.,

Wicaksono, T.Y., and Dwi M, E. (2016). Policy Brief.

1–4.

Indonesia Statisctic Bureau, C. (2018). Statistics Indonesia.

Indonesian Ministry of Health. (2017). Indonesia Health

Profile 2017. Jakarta

Statistic, & Bappenas. (2018). Projection population 2015-

2045. Jakarta Badan Pusat satatistic

Statistics Bureau, C. (2015). Statistics Indonesia Retrieved

from

United Nation & Department of Economic and Social

Affairs, p. D. (2017). World population prospects: the

2017 revision, key findings, and advance tables.

Working Paper No. ESA/P/WP/248 ed.

Factors of Intellectual Function Impairment in Older People in South Denpasar, Bali