http://e-journal.unair.ac.id/JNERS | 63 Jurnal Ners Vol. 15, No. 2, Special Issue 2020 http://dx.doi.org/10.20473/jn.v15i2.18931 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License Original Research Factors Related to the Utilization of the Integrated Health Services Center for the Elderly Sunik Cahyawati1, Windarti Rumaolat1,2, Nur Sayid Jalaludin Rumi2 and Wiwi Rumaolat1 1 STIKes Maluku Husada, Indonesia 2 Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia ABSTRACT Introduction: The health service center for elderly is a public health center program for the elderly so they can be are ready to face old age independently and healthy. The objective of the research was to find out if there was a relationship between the use of health services centers for the elderly and attitudes, family support, the role of cadres, and access distance to health services for elderly people. Methods: The method used was quantitative with a cross-sectional design; the sample contained 121 respondents, elderly people aged over 60 , the study time was 4 weeks. The instrument used was a questionnaire. The variables were elderly people’s attitudes, cadre roles, family support and the distance to the health service. The analysis was done using chi- square with a significant p-value (α <0,05). Results: The study obtained a significant relationship between the attitudes of the elderly p-value (0.001), family support p-value (0.00), the role of cadre p-value (0.00) and the use of the elderly health services center while the distance to the Integrated health center was not significantly related p-value (0.513). Conclusion: Family support and the role of cadres is needed to support the interests and readiness of the elderly in building a positive attitude for the Integrated health center, to the distance to the health services is not a problem. There is a relationship between the attitudes of the elderly, family support, the role of cadres to the use of elderly health services center while there is no relationship between the distance to access the health services center and the use of elderly. ARTICLE HISTORY Received: Feb 27, 2020 Accepted: April 1, 2020 KEYWORDS elderly; utilization; attitudes; cadre; family; health CONTACT Sunik Cahyawati  sunikcahyawati87@gmail.com  STIKes Maluku Husada, Indonesia Cite this as: Cahyawati, S., Rumaolat, W., Rumi, N. S. J., & Rumaolat, W. (2020). Factors Related to the Utilization of the Integrated Health Services Center for the Elderly. Jurnal Ners, Special Issues, 63-66. doi:http://dx.doi.org/10.20473/jn.v15i2.18931 INTRODUCTION The development of science and technology has a positive impact on welfare and health, one of which can be seen from the level of life expectancy. Add advanced age in the world. (Purwadi et al., 2016). The United Nations (UN) estimates that the number of people ≥60 years will increase from 901 million in 2015 to 1.4 billion in 2030 globally, increasing by more than 56% in 15 years. An estimated 71% increase in the elderly population will occur in developing countries(Guerra et al., 2015). Indonesia, with the 4th largest population in the world of around 258 million in 2015, also faces the challenge of a rapidly increasing elderly population. The number of elderly increased by around 4.12 million from 2000 to 2015, because life expectancy in Indonesia has increased from 67.25 to 70.8 years in the same period. With an increase in life expectancy and a decrease in fertility, it is expected that the rate at which contributions will age will also increase. By 2025, it is estimated that 11.8% of the population will be ≥60 years (Madyaningrum et al., 2018) The increasing number of elderly people needs to be anticipated because it will have broad implications in the lives of families, communities, and countries. A https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ http://dx.doi.org/10.20473/jn.v15i2. S. CAHYAWATI ET AL. 64 | pISSN: 1858-3598  eISSN: 2502-5791 study showed that the elderly tend to have lower health status, more cases of comorbidity and polypharmacy (Hajek et al., 2017). Therefore, the elderly need to get attention in national development. It is necessary to improve the type and quality of health and nursing services, whether carried out by the elderly themselves or by their families or other institutions, one of which is the services of the elderly health services center, a forum for activities from the community and for communities supported by cross- sectoral cooperation. The public health center provides support and technical guidance. The activities here especially in the area include preventive, promotive, curative and rehabilitative activities for the elderly (Purwadi et al., 2016) . However, in reality, there are still many problems related to the low utilization of the elderly health services center by the elderly. This is because there are several factors including knowledge, the distance of the house from the location of the health services center, family support, facilities and infrastructure to support the implementation of the health service center, attitudes and behavior of the elderly, income, support from health workers (Yang et al., 2014). From the observations in the field, researchers also found several factors related to the use of health services center for elderly people, namely: the attitude factor where the attitudes of elderly people who did not participate in elderly health service center activities were reminded of some health services center cadres when they did not go to a health services center; the role of the health professionnals as some are also not active in conducting health services at the center for the elderly or too lazy to call the elderly, while the encouragement factor of the family where elderly families do not participate in encouraging the elderly to go to the health services center for the elderly and also sending them to the health services center for the elderly because they are busy; the distance to access the health services center is also a factor when the health services center is located in the middle of the country settlement in front of the road and the distance that can be reached ≥ 1km for those who have a house far from the health services center location while having a house close to the health services center can be located in travel with a distance of ≤ 1 km. The data above shows that many elderly people do not visit the health services center. Previous studies found a relationship between the attitude of the use of elderly health services center, family encouragement and the use of elderly health services center, and the role of the staff with the use of elderly health services center. The researchers were interested in exploring "Factors Associated with the Utilization of Elderly health services center in the Elderly Work Area. MATERIALS AND METHODS This research is quantitative with a cross-sectional approach, which is research that emphasizes the observational time of the independent and dependent variables only once at a time. This research was conducted for 4 weeks from 22 July to 17 August 2019 at the Health Services Center Elderly. The sampling technique used purposive sampling and the sample had 121 respondents. The inclusion criteria were elderly aged > 60 and above, the elderly who were present at the time of the study and were willing to become respondents. Data collection techniques collected two types of data: primary data obtained directly from the elderly through questionnaires to find out the Factors Associated with the Utilization of the Health services center, and secondary data obtained from the records and reports to determine the number of elderly Health services center registered. Data processing: the analysis used is Univariate and Bivariate using Chi-square statistical tests with significance (α = 0.05). RESULTS Characteristics of the Respondents The 121 respondents, elderly who visited the Elderly LahaHealth services center in the TawiriPublic Health Tabel. 1 Characteristics of the Respondents (n=121) Variable (n) (%) Age 61-65 66-70 >70 61 53 7 50,4 43,8 5,8 Gender Male Female 51 70 42,1 57,9 Level Of Education Primary School Junior high school Senior high school Scholar 49 45 20 7 40,5 37,2 16,5 5,8 Job Retired Entrepreneur Housewife Farmer Fisherman 21 27 11 41 21 17,4 22,3 9,1 33,9 17,4 Primary data source in 2019 Tabel. 2 Univariate Analysis Variable N (%) Utilization Good 49 40.5 Poor 72 59.5 Attitude Good Poor 63 58 52,1 47,9 Family support Good Poor 47 74 38,8 61,2 The Role of the staff Good Poor 62 59 51,2 48,8 Distance to access Easy Difficult 71 50 58,7 41,3 Primary data source in 2019 JURNAL NERS http://e-journal.unair.ac.id/JNERS | 65 Center working area had the following characteristics. Univariate Analysis The univariate analysis conducted on the research variables will produce the frequency distribution and the percentage of each variable as follows. Bivariate Analysis The bivariate analysis is performed to determine whether there is a relationship between the dependent variable and the independent variable. DISCUSSION Attitude is someone's readiness to act in certain situations. The attitude of the elderly is a form of their response to the use of the elderly Health Services Center which includes several stages, namely, receiving responding, respecting and being responsible. The results of the study showed that the attitude of the elderly is still quite good and there is a relationship between the attitudes of the elderly towards the use of the elderly Health Services Center . (Notoatmodjo, 2012) According to the researchers' assumptions, a poorer attitude of the elderly, the less elderly they use the Health Services Center compared to the elderly who behave well the elderly who have a bad attitude have a tendency to act not to use the Health Services Center while the elderly who behave well have a high tendency to use the Health Services Center. A behavior that cannot be directly seen is the readiness or willingness of the elderly to carry out Health Services Center activities. Personal assessment or good attitude towards the staff is the basis or readiness of the elderly to participate in Health Services Center activities. While the elderly who has a good attitude in utilizing the Health Services Center, indirectly the target of achieving the use of the elderly Health Services Center is getting higher. (Notoatmodjo, 2013) Family support empowers the elderly to carry out activities. It also can increase the desire to know and use something that is still considered new or things that are rarely done by the elderly (Yang et al., 2014). Family support plays an important role in encouraging the interest or willingness of the elderly to participate in Health Services Center for the elderly. The family can be a strong motivator if they always take the time to accompany or bring the elderly to the Health Services Center, remind the Elder if he forgets, schedule and try to help overcome all the problems.(Setyorini, 2018) Based on the results of the research, family support is closely related to the use of Health Service Center because a better family support for the elderly means better use of Health Service Center for the elderly and vice versa. Family support has a great influence on the lives of the elderly. Elders need support, motivation to feel cared for, valued, and loved by those closest to them. Family support is interpreted to help them face an unpleasant situation in life. Because they feel they have family support, emotionally elderly feel cared for, get advice or a pleasant impression on him and the behavior of an activity or activities that can be observed or not. (Handayani & Wahyuni, 2012). Based on the above, we recommend elderly people’s families to always be given counseling about the benefits of the Elderly Health Services Center; the aim is to provide information to support parents in utilizing the Elderly Health Services Center. The staff are members of the community chosen from and by the community, willing and able to work together as volunteers sharing community activities. Health staff are responsible for the local community, they work and act as an agent of the health system. They are responsible for the village head and supervisors appointed by government officials or service personnel. The presence of elderly cadres plays a very important role in utilizing the elderly Health Service Center. If the cadres' attitudes and behavior are good, they will get a good assessment Tabel. 3 Bivariate Analysis Utilization of Health Services Center Independent Variable Poorly Good Total Sig n % N % N % Attitude p = 0,001 Poor 44 36,4 14 11,6 58 47,9 Good 30 24,8 33 27,3 63 52,1 Total 74 61,2 47 38,8 121 100 Family Support p = 0.000 Poor 64 52,9 10 8,3 74 61,2 Good 10 8,3 37 30,6 47 38,8 Total 74 61,2 47 38,8 121 100 The Role of the staff p = 0.000 Poor 51 42,1 8 6,6 59 48,8 Good 23 19,0 39 32,2 62 51,2 Total 74 61,2 47 38,8 121 100 Distance to access p = 0.513 Difficult 31 25,6 19 15,7 50 41,3 Easy 43 35,5 28 23,1 71 58,7 Total 74 61,2 47 38,8 121 100 Primary data source in 2019 S. CAHYAWATI ET AL. 66 | pISSN: 1858-3598  eISSN: 2502-5791 from the Health Service Center participants (Santjaka et al., 2013). Access to a nearby Health Services Center will make it easy for the elderly to come without having to experience physical fatigue due to decreased endurance or physical strength. The body that states it is easy but less active is caused by their physical condition, less supportive of visiting the Health Services Center and the attitudes of the elderly who prefer to check their health at the health center and the hospital because they think the facilities are more adequate. Based on the results of the research, distance to the Health Services Center is not related to the use of the Health Services Center (Notoatmodjo.2005). According to the researchers' assumptions, network access is not related to the use of Health Services Center for the elderly because access to the Health Services Center is not difficult and transportation costs are cheap. When investigating the research questions about the reasons why elderly are too lazy to go to the Health Services Center because, the reason is they tire easily. As a person grows older, his bodily functions will be reduced. But based on the analysis, the biggest obstacle is the poor attitude of the elderly, the absence of the family to take the elderly. A good use of Health Services Center can also affect the elderly in utilizing Health Services Center even though the distance between Health Services Center and the respondent is short but the attitude of the elderly is not good in utilizing the place.(Rusmin et al., 2017) CONCLUSION The variables related to the utilization of the Health Services Center for the elderly were the attitude, family support and the role of the health services center cadre, while there was no relationship to the distance to the Elderly Health Services Center. Empowering the cadre to conduct training ionn increasing knowledge about the management of the Elderly Health Services Center. It is necessary to motivate health workers to provide information to the elderly who visit health facilities and their families about the benefits of the center. CONFLICT OF INTEREST There is no conflict of interest. ACKNOWLEDGEMENT The author would like to thank the elderly for being willing to be respondents in this study, the leadership of the Public Health Center Laha who has allowed the author to conduct the research and also to colleagues who have helped in the research process. REFERENCES Guerra, M. L., Singh, P. J., & Taylor, N. F. (2015). Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: A systematic review. Clinical Rehabilitation, 29(9), 844–854. https://doi.org/10.1177/0269215514558641 Hajek, A., Bock, J. O., & König, H. H. (2017). 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