Dr Shawkat Hussain Parray, MBBS, MHA (trainer) and Dr Bashir Gaash, MD, PhD (Principal) are from the Regional Institute of Health & Family Welfare, Kashmir.
Dr Danish Ahmed is a scholar from the University of Delhi Medical School. Dr Muzaffar Ahmed, MD, FAMS, FACP is Director Health Services, Kashmir
Correspondence: Dr. Bashir Gaash,
Regional Institute of Health & Family Welfare, Kashmir.
[Email: gaashb_10 (at) yahoo.co.in]
Objective: To study the status and morbidity profile of elderly population in the Kashmir Valley
Study Design: Cross-sectional study, with multistage sampling; pre-designed, pre-tested schedules (with close-ended questions). House-to-house visit covering all members aged more than 65 years living in rural/urban areas of district Budgam.
Subjects: Six hundred and ninety two persons aged 65 years and above (578 from rural and 114 from urban areas)
Results: Of 692 elderly registered in the study 321 were males and 371 females. Majority of the subjects (89%) was suffering from at least one medical problem. Morbidity in rural subjects was lower than the urban subjects. Females had a higher rate of morbidity. Common presenting symptoms were pain/swelling of joints (36.5%), backache(20.2%), indigestion/heartburn (17.7%), headache (17.4%) and excessive tiredness. Medical history and clinical examination revealed that most common diseases, in order of frequency, were hypertension (58%), osteoporosis (50.55%), cataract (18.51%), gastritis (17.67%) and BPH (13.14). Most of the elderly females had osteoporosis and males benign prostatic hyperplasia. Conclusion: Finding support need for paying more attention to the health needs of the geriatric population in J&K. There is an urgent need to develop geriatric health care services, and establish separate geriatric OPDs at all hospitals. Special hospitals are needed for mentally ill and badly incapacitated elders.
Key words: Geriatric population, morbidity pofile, Kashmir Valley
Old age is traditionally considered to be synonymous with deteriorating physical and mental health. There are well-recognised health problems which accompany old age. Vision dwindles, hearing diminishes, bones become weak, muscle tone decreases, and memory starts failing. Many studies have been conducted in different parts of the world which have accorded statistical credence to our age-old presumptions, yet till date no field-based study has been done in this part of the world to specifically determine the morbidity profile of our geriatric population.
Budgam, literally meaning the ‘big village’ is a relatively small district, both areawise (1371 sq km) and population-wise (6.30 lakh as per the 2001-Census) and consists of dusty plateaus as well as lush meadows, the most famous of which is world-known ‘Yusmarg’. The district has an area of 1,371sq kms, half of the district comprises of forests, covering its 750 sq kms. The literacy rate is mere 38.47%; the lowest in the State. It is predominantly rural district; urban population is merely 71 thousands. The average household size is 7.3.
The study was conducted in both the urban and rural areas of the district, with 88.71% rural and 11.28% urban population. The district has 9 health blocks and 121 sub centres. For the study, a single PHC with approximately 10 subcentres was chosen from each block. Study subcentres were selected by stratified randoth proportional allocation in urban and rural areas. The team visited the catchment areas of the selected subcentres and conducted the house to house survey enquiring for the presence of any member aged 65 years or more. A total of 3072 rural and 1072 urban households were selected surveyed.
A team comprising of epidemiologist, medical officers, health educators, ophthalmic technician, was oriented in survey techniques at Research and Survey Section of the Regional Institute of Health and Family welfare Kashmir to facilitate qualitative collection of data. The team visited the selected number of houses and collected information in a pre-designed and pre-tested format. Part I of the format comprising of oral questionnaire was using interview technique. Part II of the format, comprised of medical history and symptoms, was filled by male or female doctor. A general and systemic examination was also performed in every case. Screening for hearing impairment was done by using tuning fork and hearing test, and vision was tested by Snellen’s Chart. The investigations were conducted at the same time. The data was entered in the computer and statistical analysis was done using SPSS software. The study was done over a period of one year in 2006-2007.
A total of 4144 households with 30,252 family members were visited. There were 692 elders in these families; geriatric population (65 years and above) constituted 2.28% of the total visited population. Twenty seven were not included due to their non-availability on the day of survey. Out of 692 study subjects interviewed, 578 were from rural area and 114 from urban area; 321 (42.3%) were males, and 371(57.7%) females. Majority (66.6%) was in the age group of 65-74 years followed by 26.8% and 6.6% in 75-84 years and 85 years and above age group, respectively.
The total prevalence of illnesses among 692 geriatric population was 632 (Table 2). Thus, the average number of illness per person came to 3.28. At the time of survey, 88.9% of the study population was suffering from at least one ailment while 69.9%, 47.3% and 16.9% of population, respectively, had two, three and four or more ailments. Consumption of medicines was more adequate and regular by urban than rural subjects. Chronic diseases like stroke, hemiplegia, cataract and other neurological disorders were responsible of IADL disability.
|Background Characteristics ( Morbidity profile of all 632 elderly population )|
|Age||Hypertension||Osteoporosis||Respiratory problems||Cataract||I HD٭||Diabetes||BPH٭٭|
Total 65-75=498; 75-85=93; above 85=41.
٭ IHD: Ischemic heart disease; BPH: Benign prostatic hyperplasia٭٭
Females (65-75)=286;(75-85)=51;(above 85)=14.
Males (65-75)= 212; (75-85)= 42;(above 85)=27.
Table 3 shows that, in comparison with urban areas, most of the elderly population in rural areas was illiterate. The Activity of Daily Living/Instrumental Activity of Daily Living (ADL/IADL) was assessed in terms of their ability to perform important activities (eg dressing, toileting, taking bath, eating and walking) without help. ADL/IADL disability also increased significantly with relation to age.
The present study recorded a high prevalence of morbidity (83.9%) among the geriatric population. A study carried out in Southern part of India reported a similar prevalence of 82.9% in the age group of 60 years and above.8 The present study used the 65 year cut-off as recommended by the WHO3. Experts suggest using the 65 year cut off for facilitating global comparisons3.
The average number of illnesses per person was 1.79; it was higher in urban elders, which might be due to a higher prevalence of hypertension and myocardial infarction among them. Other studies among the elderly in North and South India reported a still higher frequency (2.627 and 2.42, respectively).8
The presenting symptoms of the elderly are important since patients report to health care providers with these ailments. Thus, health workers and general physicians should be aware of the underlying diseases giving rise to these symptoms. The presenting symptoms of the same disease may vary in elderly in comparison to younger population. Most common symptoms, in order of their magnitude, were pain/swelling of joints, limitation of movements, headache, indigestion/heartburn and excessive tiredness. Presenting symptoms did not exactly match the morbidity profile because many presenting symptoms are not necessarily system specific eg. heart burn in the elderly could be arising from oesophagus, gallbladder, chest, or heart. Many of the diseases were detected on examination and investigations and the patient did not have any specific symptom.
More than 56% of the elderly were suffering from hypertension as per the WHO guidelines2,3. The present study considered a person to be hypertensive with level of blood pressure higher than 140/90 mm of mercury as per the WHO criteria.11 The presence of hypertension among the elderly in urban areas was about twice that in rural areas. It could be because of sedentary and modern life style and stress in urban areas. Hypertension was more in females as compared to males.8,12 Ironically, most of the hypertension among the study population was only detected in the survey.
A high prevalence of arthritis/joint pain in the current study, particularly among females, was also reported in other studies conducted in India.1,5. It does not come as a surprise, considering the hard, untiring life faced by women who never retire from household work unless totally disabled. About 39% of the elderly were suffering from immature and mature senile cataract. Cataract was more common in males and the prevalence increased with advancing age. Cataract was found to be more common in rural population which may be due to increased exposure to ultravoilet radiation during long hours of work in open fields.
The prevalence of blindness in India is 14.9 per thousand population and 80% of this blindness is due to cataract alone13,14. The National Blindness Control Programme has an important role in reducing the quantum of cataract in the community by organising eye camps.15 A number of elderly were suffering from gastritis because of poor nutrition, increased use of non-steroidal analgesics and indigestion owing to decreased physical activity. Gastritis was found to be more common in males. Diabetes mellitus ranged from 16% to 52% in the geriatric population as against 7% in the general population, which might as well reflect the increasing lifestyle diseases in the community. Diabetes was almost three times more prevalent in females than in males. In the process of caring and nurturing of other members of the family, women in India generally tend to neglect or overlook their own wellbeing. A higher morbidity among elderly calls for strengthening of geriatric health care services in tune with the commonly existing problems in different age groups. Preventive, curative and rehabilitative programmes for the elderly are required for the control and management of later part of the life.15
The present study has highlighted a high prevalence of morbidity among the elderly and has identified more common existing medical problems like hypertension, osteoporosis, osteoarthitis, cataract, IHD, BPH and diabetes mellitus. As there is a progressive increase in the number of elderly population, there is an urgent need to develop geriatric health care services in the developing countries and provide training to health care providers to manage the commonly existing health problems among the elderly. Life style modification at an earlier stage (childhood; youth) is warranted to prevent onset of chronic diseases, to improve quality of life, and rectification of poor health status. Disease screening, better management of illness, and greater health awareness particularly among the low-socio economic groups could make a difference in quality of life for the elderly Kashmiri population.