Currently, Indonesia is experiencing a dramatic demographic shift caused by the explosion of the elderly population, or people aged 60 years and older. In 2017, Special Region of Yogyakarta was the province with the highest elderly population in Indonesia. The increase of the elderly population requires action from all parties in anticipating various problems related to the elderly, especially elderly women, including their reproductive health, mental health, and change of nutrition needed. The peri and postmenopausal period constitutes a challenging transition time for women's health, and menopausal health is a crucial aspect in healthy and successful aging. Sleman Regency Government has implemented community-based health service or elderly integrated service post. Health care volunteers (cadres) play an essential role in carrying out the objectives of an elderly integrated service post. Therefore, it requires knowledge and skills enhancement of the cadres about elderly women’s health. Training that included lectures and discussion could improve the knowledge and skills of women elderly health cadres, provide the optimal quality of health service in elderly integrated service post, and increase public awareness about the importance of health services in providing health information for the women elderly.

Keywords cadre, women, elderly, health care

The elderly population is defined as people aged 60 years and older.¹ Currently, Indonesia is experiencing a dramatic demographic shift caused by the explosion of the elderly population. From 1971 to 2017, there was an increase of the elderly population by 23.4 million (8.97%), dominated by young elderly (60-69 years) as much as 5.65%. The National Socioeconomic Survey (SUSENAS) in 2020 data shows that 9.89% of the elderly live alone, the number of elderly women is more (14.13%) than the number of elderly men (5.06%). In the last five years, the number of working elderly tends to increase, namely 65.5% male elderly while female elderly 38.28%. The Central Bureau of Statistics projects that in 2035 Indonesia's population will reach 301 million in 2035 and from this projection, around 16.5% or 49.6 million are elderly. In 2017, Special Region of Yogyakarta was the province with the highest elderly population in Indonesia (13.90%), which consisted of 7.66% of young elderly (60-69 years), 4.30% of middle elderly (70-79 years), and 1.93% of old elderly (>80 years).²

Sariharjo is one of the villages in Ngaglik District, Sleman Regency, Special Region of Yogyakarta, Indonesia, with an elderly population of 4.886 people up until now.^3,4 The percentage of elderly women from the entire population in Sariharjo reaches more than 50 percent. The increase of the elderly population requires action from all parties in anticipating various problems related to the elderly, especially elderly women. In Indonesia most of the elderly stay at home and tend to spend their time on spiritual activities such as praying, rather than physical and social activities because there are no specific facilities to ensure their safety and satisfaction. The peri and postmenopausal period constitutes a challenging transition time for women's health, and menopausal health is a crucial aspect in healthy and successful aging. Many research stated that women elderly tend to develop poor physical and psychological health.³

To improve the health status of the women elderly, Sleman Regency Government has implemented integrated care for older people or elderly integrated service pos, so they can live healthy and productive lives socially and economically with human dignity. Elderly integrated service post is a community-based health service managed and organized by and for the community. It needs the active role of all parties, including the government, private sector, health workers, and healthcare volunteers (cadres). Cadres are chosen by the community where they live and trained by health care personnel to manage and provide basic health services. They are also expected to bridge the gap between health workers or experts and the community and help them identify and respond to their own health needs.^4,5 Optimizing cadres is highly recommended to achieve the optimal quality of health service in elderly integrated service post and increase public awareness about the importance of health services for the women elderly. Therefore, it requires knowledge and skills enhancement of the elderly integrated service post cadres about women elderly health, especially about reproductive health, mental health, and change of nutrition needed. This activity aims to provide women elderly health training for elderly integrated service post cadres in the Sariharjo Village, Ngaglik, Sleman as an initial step to improve their knowledge and skills about women elderly health that is expected to be sustainable to achieving better public health status for women elderly.

In this paper, we measured participants' knowledge about elderly woman health in Sariharjo Village, Ngaglik, Sleman. We used qualitative data from the evaluation and reports of lectures by experts and learning materials promotion to measure participants' knowledge. Three steps were conducted in this study: a) preparation; b) implementation; c) evaluation and report.

Preparation

First preparation was coordination with related parties, so they could understand the objectives of the activities and support the implementation of the program. We announced the program to the Integrated Service Post cadres and the head of the village. Based on our discussion, during COVID-19 pandemic the program was conducted the program through online sharing (zoom meeting) and direct visits with community health workers. The event was held on 29 December 2021 in Sariharjo Village Hall, attended by 45 caders. The preparation also includes material preparation, resource preparation, and properties used during the training.

Implementation

The implementation of program was the lectures and discussions by the experts about the reproductive health, mental health, and nutrition of women elderly. There are 5 topics carried out in the training:

1. Disfungsi Dasar Panggul & Masalah Seksualitas Pada Perempuan Lanjut Usia (Pelvic Floor Dysfunction & Sexuality Problems in Elderly Women) by Dr. dr. Nuring Pangastuti, Sp.O.G., SubSp. Urogin
2. Kesehatan Perempuan Pada Usia Lanjut (Women's Health in Elderly) by Dr. dr. Probosuseno, Sp.PD, KGer, FINASIM, SE, MM
3. Penyakit Keganasan Organ Reproduksi Pada Perempuan Lanjut Usia (Malignant Diseases of the Reproductive Organs in Elderly Women) by dr. Muhammad Nurhadi Rahman, Sp.O.G
4. Kesehatan Mental Pada Perempuan Lanjut Usia (Mental Health in Elderly Women) by dr. Anis Widyasari, Sp.O.G
5. Kebutuhan Nutrisi Lanjut Usia (Elderly Nutritional Needs) by dr. Akbar Novan Dwi Saputra, Sp.O.G

Participants also received the learning materials promotion regarding the health of the women elderly, including videos, guidebooks, and leaflets, which could be used as a medium to promote women elderly health in the community.

Evaluation and report

The activities were assessed based on the goals that have been achieved in each activity. A direct visit to the location and observation the cadres explain the training materials to the elderly in the Elderly Integrated Service Post (contact is made via WhatsApp due to the Covid-19 pandemic situation). A strength, weakness, opportunity, and threat (SWOT) analysis was also applied. We also distribute questionnaires to assess participants’ knowledge about reproductive health of woman elderly health.

Overall, the activity was done on schedule, with 45 cadres’ attendance. The training was carried out in lectures and discussions with five topics on women elderly health. We also displayed banners and distributed leaflets, guidebooks, and videos explaining the topics presented. Participants were also allowed to share the training materials with the elderly and the community in their Elderly Integrated Service Post. The participants' enthusiasm could be seen in their active participation throughout discussions and role-plays. The expected outcome of this program is an increase in the competence of elderly health cadres and health services at the Elderly Integrated Service Post Figure 1-3.

Figure 1 Situation of cadre mentoring activities.

Figure 2 The obstetricians deliver counseling to the cadres.

Figure 3 Involvement of obstetricians and local government in this activity.

In Indonesia, the elderly population continues to rise year after year. As the most important mover in carrying out the objectives of an Elderly Integrated Service Post, cadres need to be given training about elderly health. Based on some studies, there was a significant increase in cadres' knowledge after being trained compared with those who only read the module.^6,7 Lecture and discussion methods are used in most training, including training in this study.⁸ Lecturing as an educational method could be used to deliver information to the target group verbally. This method can reach huge audiences but tends to make the participants passive and inhibits their critical thinking. To balance it, we combined lecture methods with discussions with the experts. Discussion can encourage participants to think critically and share their opinions. The combination of interactive lectures and discussion has proven to have a significant effect on increasing participants' knowledge and skills.⁹ Using various learning media such as films, videos, and leaflets can increase the creativity and imagination of the participants, also helping the participants increase their understanding. Video is easier to understand and more interesting since it contains sound and images. It also has bigger target audience, can be used as a discussion tool, and can be presented repeatedly. A leaflet is a piece of paper with simple pictures and short, easy-to-understand words that provide brief information about an issue. It is affordable and contains messages in attractive packaging.¹⁰

Improving elderly health cadres’ knowledge and skills about woman elderly health by training can help them provide the optimal quality of health service in Elderly Integrated Service Post and increase public awareness about the importance of health services for the elderly.

Funding for the activity comes from community grants from the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, for community service. Community service activities are carried out in collaboration with the Sleman Health and Demographic Surveillance System (HDSS) unit.

No conflict of interest.

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