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Journal of the Academy of Hospital Administration

Profile of Geriatric in-Patient Admissions

Author(s): K. Vijaya*, E. Ravi Kiran**

Vol. 16, No. 2 (2004-07 - 2004-12)

Key Words:

Average duration of hospitalization, Duration of Hospitalization, Discharged, Left against Medical Advice, Improved.

Key Messages:

  • Maximum admissions were observed in age group of 60-62 years.
  • Heart diseases formed the majority of aged in-patient admissions.
  • Average duration of hospitalization was maximum for neoplasms.
  • Average duration of hospitalization was 8.67 days for males and 8.47 days for females.
  • 82.7% of the aged in-patient admissions who were admitted have improved.

ABSTRACT

Ageing is a universal process and inevitable. With the increase in life expectancy the percentage of old people in the population has increased dramatically. Industrialization, urbanization, education and exposure to western culture have brought about changes in our values and lifestyles. The escalating costs of bringing up and educating children and meeting their demands and desires have affected income levels leading to cut short the expenses for looking after the health and well-being of the old parents. Besides want of privacy and space, higher house rents in urban areas many of them are either left in their native places or entrusted to the care of an old age home. Increasing problems of health care, psychosocial, personal and socio-economic factors associated with the elderly are overwhelming the demographic figures. The present research paper delves into the socio-demographic and morbidity profile as well as the hospital administration parameters for effective planning of geriatric health care services in a teaching hospital.

INTRODUCTION

Ageing is a natural process. It is a vulnerable phase of life where physical, mental and social disruption is more pronounced. In the words of Seneca, "Old age is an incurable disease", but more recently, Sir James sterling Ross commented: "You do not heal old age. You protect it, you promote it; you extend it."1

There are more than 76 million elderly people in the country who constitute 77% of Indias population. By the year 2020, the estimated population of the elderly with be 142 million or about 11% of the countrys population.2

Various age groups seek hospital admissions for various causes of morbidity. Geriatric morbidity, of late is seen on the rise as reflected by the admission rates in recent times. This requires in depth studies of the epidemiological profile and type of geriatric morbidities for a teaching hospital to equip itself with the medical expertise and technical know-how in clinical gerontology.

Taking this into consideration a prospective study was carried out to assess the morbidity profile of elderly patients getting admitted into this teaching hospital.

MATERIALS AND METHODS

The medical records of the geriatric patients, aged 60 and above were collected from the beginning of the year i.e. from January Ist 2003 to 31st December 2003 as and when the patients are admitted to the Fr Muller Medical College teaching hospital in Mangalore, Karnataka. Around 2,554 aged patients were recorded and the data of these in-patients was analysed with reference to various parameters.

RESULTS

Of the 2,554 (100%) geriatric admissions, maximum, 529 (20.7%) were seen in the age group of 60-62 years and the minimum were noted in the age group of 90 and above. There were 1,324 (51.8%) males and 1,230 (48.2%) females in the study population. (See Table-I on next page)

Table-I : Distribution of geriatric patients as per age and sex

Age in years Males (%) Females (%) Total (%)
60-62 261 (19.7) 268 (21.8) 529 (20.7)
63-65 132 (10.1) 259 (21.1) 391 (15.3)
66-68 274 (20.7) 99 (8.0) 373 (14.6)
69-71 267 (20.2) 187 (15.2) 454 (17.8)
72-74 98 (7.4) 112 (9.1) 210 (8.2)
75-77 146 (11.0) 125 (10.2) 271 (10.6)
78-80 35 (2.6) 86 (6.9) 121 (4.7)
81-83 57 (4.3) 37 (3.0) 84 (3.7)
84-86 47 (3.6) 35 (2.9) 82 (3.2)
87-89 4 (0.3) 13 (1.1) 17 (0.7)
90+ 3 (0.2) 9 (0.7) 12 (0.5)
Total 1,324 (100) 1,230 (100) 2,554 (100)

Old people of different religions wee admitted but the maximum admissions 1197 (46.9%) were of Christians. This is because the teaching hospital is run by the Christian missionaries and the Christians have a natural preference over other teaching hospitals in the area. This is followed by Hindus who constitute 945 (37%) in number and Muslims 329 (12.9%) and other 83 (302%). (Table –II)

Table II : Distribution of geriatric patients as per religion

Religion Males (%) Females (%) Total (%)
Hindus 492 (37.1) 453 (36.8) 945 (37.0)
Muslims 178 (13.4) 151 (12.3) 329 (12.9)
Christians 615 (46.5) 582 (47.3) 1,197 (46.9)
Others 39 (3.0) 44 (3.6) 83 (3.2)
Total 1,324 (100) 1,230 (100) 2,554 (100)

K. Vijaya, E. Ravi Kiran Some of the chronic diseases like cancer, diabetes, cataract, heart diseases etc. are common as a result of degeneration. Fractures and Injuries as a result of accidents are very common in old people. The bones become fragile and break easily because of osteoporosis. Of the total 2,554 (100%) geriatric in-patients the morbidity profile unfolds as noted below. Maximum, 522 (20.4%) had heart disease, followed by 427 (16.7%) in-patients who suffered eye and ear morbidity. Around 79 (3.1%) in patients were recorded under miscellaneous morbidity. Average duration of hospitalization was maximum in neoplasms which was around 13.8 days, followed by injuries and fractures which was 12.67 and the least was seen in mental and behaviour diseases which was around 6.17 days. The average duration of hospitalization for males was 8.67 days and for females it was 8.47 days. (Table-III)

Among the aged patients who had heart diseases, maximum 104 (19.9%) were found in the age group of 69.71 years and the minimum 3(0.6%) were of the 90 + age group. In the Eye and Ear disease category and age group of 60.62 had the maximum, 106 (24.8%) patients and the minimum 1(0.2%) were in the age group of 90 and above. Highest number 68(21.2%) were seen in the age group of 63-65 and the least 1(0.3%) were of patients aged 90 and above in Endocrine and Metabolic diseases. In the Mental and Behavioural disease category it was observed that the maximum 87 (37.2%) patients were of the age group of 60.62 and the minimum 1 (0.4%) were found in 78-80 and 81-83 years. The wee no patients in the age group of 87-89 years. Maximum 60 (26.6%) were in the age group of 63-65 years and the minimum 1 (0.4%) was in the age group of 87-89 years in Neoplasm category. There are no patients however in the age group of 90+. Maximum 52 (24.8%) old patients suffered from respiratory tract disease in the age group of 60-62 years. The least was only 1 (0.5%) patient who suffered from the same. 69-71 years age group had highest number of injuries and fractures and they constituted 38 (20.0%). There was only 1(0.5%) patient in age groups of 87-89 and 90+ who had injuries and fractures. Maximum 24 (18.6%) of the old patients who had CNS involvement were seen in the age group of 81-83 years and the minimum 1 (0.8%) was seen in the age group of 90 +. Maximum 25 (21.2%) of aged patient who had GI disease were noted in the age group of 39-71 years and the minimum 1 (0.8%) was seen in the age group of 87-89 years. Of the total aged 94 (100%) who had more than 1 disease, maximum 24 (25.5%) were noted in the age group of 60-62 years and the minimum 3 (3.2%) were noted in the age group of 66-68 and 72-74 years. There was no aged patients recorded in the age 87-89 and 90+ who had more than 1 disease. In the miscellaneous category maximum 15 (18.9%) wee recorded in 60-62 years and the minimum 3 (3.8%) in 81-83 years. Similarly as in the previous category there were no aged patients recorded in the age group of 8183 years. Similarly as in the previous category there were no aged patients recorded in the age group of 87-89 and 90 and above. (Table IV)

Table III : Distribution of geriatric patients as per sex and diagnosis

Diagnosis Males (%) Females (%) Total (%) Avg.
duration of
hospitalization
in days
Heart Diseases 270 (20.4) 252 (20.5) 522 (20.4) 6.9
Eye and Ear Diseases 221 (16.7) 206 (16.8) 427 (16.7) 8.6
Endocrine and Metabolic 166 (12.5) 154 (12.5) 320 (12.5) 7.1
Diseases Mental and Behaviour Diseases 122 (9.2) 112 (9.1) 234 (9.2) 6.17
Neoplasms 121 (9.1) 110 (8.9) 231 (9.1) 13.80
Respiratory Tract Diseases 109 (8.2) 101 (8.2) 210 (8.2) 6.51
Injuries including Fractures 98 (7.4) 92 (7.5) 190 (9.4) 12.62
CNS involvement 68 (5.1) 61 (4.9) 129 (5.1) 10.80
Gastrointestinal Diseases 61 (4.6) 57 (4.6) 118 (4.6) 8.42
More than one Diseases 48 (3.6) 46 (3.7) 94 (3.7) 10.01
Miscellaneous 40 (3.0) 39 (3.2) 79 (3.1) 7.8
Total 1,324 (100) 1,230 (100) 2,554 (100) 8.57
Avg. duration of hospitalization in days 8.67 8.47          

The number of aged patients who stayed more than 30 days in hospital constituted 120 (4.7%). The number of aged patients who stayed at least 1 day constituted 179 (7%). Maximum 714 (27.9%) of old patients had 2-3 days of hospitalization and minimum 167 (31.6%) had 2-3 days of hospitalization and the minimum 17 (3.2%) had more than 30 days of hospitalization. Of the 373 aged patients in 66-68 years age group maximum 89 (23.8%) had 2-3 days of hospitalization and minimum 31 (8.3%) had more than 30 days of hospitalization. In the ;age group of 69-71 years maximum 136 (29.9%) had 4-7 days of hospitalization and minimum 19 (4.2%) had 15-21 days of hospital stay. It was observed that in the age group of 72-74 years maximum 77 (36.6%) patients admissions had a hospital stay of 8-14 days and the minimum 6 (2.9%) had hospital stay of 15-21 days

Table-IV : Distribution of geriatric patients as per age and diagnosis

Diagnosis Distribution of aged as per age and diagnosis
  60-62 63-65 66-68 69-71 72-74 75-77 78-80 81-83 84-86 87-89 90+ Total
Heart Disease (%) 71 (13.6) 69 (13.2) 98 (18.8) 104 (19.9) 32 (6.1) 82 (15.7) 16 (3.1) 19 (3.6) 24 (4.6) 4 (0.8) 3 (0.6) 522
Eye and Ear Disease 106 (24.8) 26 (6.1) 99 (23.2) 78 (18.3) 40 (9.4) 29 (6.8) 29 (6.8) 9 (2.1) 7 (1.6) 3 (0.7) 1 (0.2) 427
E&M Disease* (%) 52 (16.2) 68 (21.2) 32 (10.0) 53 (16.6) 43 (13.4) 29 (9.1) 12 (13.8) 14 (4.4) 14 (4.4) 2 (0.6) 1 (0.3) 320
M&B Disease**(%) 87 (37.2) 54 (23.1) 23 (9.8) 37 (15.8) 15 (6.4) 12 (5.1) 1 (0.4) 1 (0.4) 2 (0.9) 0 (0) 2 (0.9) 234
Neoplasm (%) 59 (25.5) 60 (26.6) 23 (10.0) 37 (16.0) 18 (7.8) 21 (9.0) 8 (3.5) 2 (0.9) 2 (0.9) 1 (0.4) 0 (0) 231
R. Tract Disease (%) 52 (24.8) 44 (21.0) 20 (9.5) 37 (17.6) 18 (8.6) 20 (9.6) 11 (5.2) 2 (0.9) 2 (0.9) 3 (1.4) 1 (0.5) 210
Injuries +#(%) 26 (13.7) 25 (13.1) 36 (19.0) 38 (20.0) 12 (6.3) 29 (15.3) 6 (3.2) 7 (3.7) 9 (4.7) 1 (0.5) 1 (0.5) 190
CNS involve ment (%) 17 (13.2) 9 (6.9) 7 (5.4) 18 (13.9) 14 (10.8) 16 (12.4) 16 (12.4) 24 (18.6) 5 (3.9) 2 (1.6) 1 (0.8) 129
G.I. Diseases (%) 20 (16.9) 11 (9.3) 23 (19.5) 25 (21.2) 6 (5.1) 18 (15.3) 3 (2.5) 4 (3.4) 5 (4.2) 1 (0.8) 2 (1.7) 118
> 1 Disease (%) 24 (25.5) 17 (18.1) 3 (3.2) 13 (13.8) 5 (3.2) 3 (5.3) 12 (12.8) 9 (9.6) 8 (8.5) 0 (0) 0 (0) 94
Miscellaneous (%) 15 (18.9) 8 (10.1) 9 (11.4) 14 (17.7) 9 (11.4) 10 (12.7) 7 (8.9) 3 (3.8) 4 (5.1) 0 (0) 0 (0) 79
Total (%) 529 (20.7) 391 (15.3) 373 (14.6) 454 (17.8) 210 (10.6) 271 (10.6) 121 (4.7) 94 (3.7) 82 (3.2) 17 (0.7) 12 (0.5) 2,554

* Endocrine and Metabolic Diseases
** Mental and Behavioural Diseases

and >30 days. There weren't any old patients of the age group who stayed in the hospital for 22-30m days and minimum 9(9.3%) stayed in the hospital for 22-30 days. In the age group of 75-7 years maximum 79 (29.2%) stayed in the hospital for 2-3 days. It was noted that in the age group of 7880 years maximum 37 (30.8%) admissions has a hospital stay of 2-3 days while the maximum 1 (0.8%) admissions had hospital stay of 22-30 days and > 30 days of hospital stay. It was noted that among 84/86 years aged people maximum 25 (30.5%) had 4-7 days of hospital stay and minimum 5 (6%) had 15-21 days of hospitalization. Maximum 7 (41.2%) admissions in the age group of 87-89 years had 4-7 days of hospital stay while minimum 1 (5.9%) had 1 day of hospitalization. There werent any aged persons in the age group who had hospitalization of 22-30 days and > 30 days. In the age group of 90 and above maximum 3 (25.0%) patients had 4-7 days of stay in the hospital while the minimum 1 (8.3%) had 1, 8-14 and > 30 days of hospitalization for treatment.

Out of the total 1324 (100%) of male patients admissions, maximum 378 (28.5%) had 4-7 days of hospitalization. Similarly in total 1,230 (100%) old female patient admissions maximum 355 (28.9%) had 4-7 days of hospital stay.

(Table VI please see on next page)

Of the total 2,554 (100%) old patient admissions 2,111 (82.7%) were discharged because they had improved, 196 (7.7%) were discharged as they had completely recovered, 46 (1.8%) died, 111 (4.3%) left against medical advice and the condition of 90 (3.5%) old patients did not improve. Out of the total 46 (100%) aged in-patients who died, maximum 19 (41.3%) expired because of injuries and fractures. Out of the total 196 (100%) who had recovered 47 (23.9%) were of respiratory tract disease. (Table VII please see below)

DISCUSSION

In our study it was found that in the study population and maximum percentage (20.7%) in-patients were in the age group of 60-62 years. Least percentage of aged population was noted in the age group of 90 and above. Males (51.8%) were more than the females (48.2%). Similar observations were noted by Radha et al in her study were maximum aged in-patients admissions were in the age group of 60-62 years.3 Maximum number (36%) of patients in our study was observed in the age group of 60-65 years. This is similar to the observation made BY Kunwar in his study.4 Male (68.4% were also more than the females. However it differs from our observation where in study by Radha et al the least number of admissions was noted in the age group of 72-74 years.3

It was observed that there was maximum (46.9%) number of Christian patient admissions. This is in contrast to the study by Radha et al where the maximum were Hindus.3

It was seen in our study that the maximum admissions were heart diseases (20.4%) and the least admissions were of miscellaneous category (3.1%). This in contrast to the study by Radha et al where the maximum admissions were under

Table-V : Distribution of Geriatric Patients According to Duration of Hospitalization

Duration of
Hospitalization
in days
Age in Years
60-62 (%) 63-65 (%) 66-68 (%) 69-71 (%) 72-74 (%) 75-77 (%) 78-80 (%) 81-83 (%) 84-86 (%) 87-89 (%) 90+ (%) Total (%)
1 - 29 (5.5) 21 (5.4) 34 (9.1) 39 (8.6) 10 (4.8) 16 (5.9) 11 (9.1) 11 (11.7) 6 (7.3) 1 (5.9) 1 (8.3) 179 (7.0)
2-3 167 (31.6) 137 (35.0) 89 (23.8) 121 (26.7) 46 (21.9) 79 (29.2) 37 (30.5) 19 (20.2) 12 (14.6) 5 (29.4) 2 (16.7) 714 (27.9)
4-7 162 (30.6) 122 (31.2) 84 (22.5) 136 (29.9) 65 (30.9) 69 (25.5) 34 (28.1) 26 (27.7) 25 (30.5) 7 (41.2) 3 (25.0) 733 (28.7)
8-14 96 (18.1) 57 (14.6) 77 (20.6) 88 (19.4) 77 (36.6) 63 (23.2) 31 (25.6) 22 (23.4) 19 (23.2) 2 (11.7) 1 (8.3) 533 (20.9)
15-21 37 (6.9) 28 (7.2) 36 (9.6) 19 (4.2) 6 (2.9) 24 (8.9) 6 (4.9) 7 (7.4) 5 (6.0) 2 (11.7) 2 (16.7) 172 (6.7)
22-30 17 (3.2) 14 (3.6) 22 (5.9) 27 (5.9) 0 (0) 9 (3.3) 1 (0.8) 5 (5.3) 6 (7.3) 0 (0) 2 (16.7) 103 (4.03)
>30 21 (3.9) 12 (3.0) 31 (8.3) 24 (5.3) 6 (2.9) 11 (4.0) 1 (0.8) 4 (4.3) 9 (10.9) 0 (0) 1 (8.3) 120 (4.7)
Total (%) 529   391   373   454   210   271   121   94   82   17   12   2,554  

Table-VI : Distribution of geriatric patients, sex-wise according to duration of hospitalization

Sex Duration of hospitalization in days
1 (%) 2-3 (%) 4-7 (%) 8-14 (%) 15-21 (%) 22-30 (%) >30 (%) Total (%)
Male 93 (7) 369 (27.9) 378 (28.5) 276 (20.8) 89 (6.7) 54 (4.1) 65 (4.9) 1,324 (100)
Female 86 (6.9) 345 (28.0) 355 (28.9) 257 (20.9) 83 (6.7) 49 (3.9) 55 (4.5) 1,230 (100)
Total 179 (7) 714 (27.9) 733 (28.7) 533 (20.9) 172 (6.7) 103 (4.03) 120 (4.7) 2,554 (100)

Table-VII : Distribution of geriatric patients according to diagnosis and outcome

Diagnosis Discharged Expired (%) LAMA*(%) Not Improved Total
Improved (%) Recovered (%)
Heart Disease 437 (83.7) 31 (6.0) 8 (1.5) 39 (7.5) 7 (1.3) 522 (100)
Eye and Ear Disease 386 (90.4) 34 (8.0) 1 (0.2) 1 (0.2) 5 (1.2) 427 (100)
Endocrine and Metabolic Disease 295 (92.2) 10 (3.1) 0 (0) 9 (2.8) 6 (1.9) 320 (100)
Mental and Behaviour Disease 225 (96.2) 4 (1.7) 0 (0) 3 (1.3) 2 (0.8) 234 (100)
Neoplasms 155 (67.1) 12 (5.2) 13 (5.6) 11 (4.8) 40 (17.3) 231 (100)
Resp. Tract Disease 142 (67.6) 47 (22.4) 4 (1.9) 8 (3.8) 9 (4.3) 210 (100)
Injuries +# 121 (63.7) 16 (8.4) 19 (10.0) 30 (15.8) 4 (2.1) 190 (100)
CNS Involvement 115 (89.1) 2 (1.6) 0 (0) 4 (3.1) 8 (6.2) 129 (100)
G.I. Diseases 101 (85.6) 9 (7.6) 0 (0) 3 (2.5) 5 (4.2) 118 (100)
> 1 Disease 65 (69.1) 26 (27.6) 1 (1.1) 1 (1.1) 1 (1.1) 94 (100)
Miscellaneous 69 (87.3) 5 (6.3) 0 (0) 2 (2.5) 3 (3.8) 79 (100)
Total (%) 2,111 (82.7) 196 (7.7) 46 (1.8) 111 (4.3) 90 (3.5) 2,554 (100)

* Left Against Medical Advice

miscellaneous category (23.45%) and the lest were of carcinomas (4.90%).3 It is also in contrast to the observations made by Prakash R et al in his cross-sectional study in Udaipur, Rajasthan wee the maximum surveyed old people had eye diseases (70%) and the least had skin and hernia problems (0.66%).5

The average duration of hospitalization in days was maximum, 13.80 days in case of neoplasms and least, 6.17 days in case of mental and behaviour disease. This observation is similar to the observation made by Radha et al where the average duration of hospitalization in days was maximum in neoplasms.3 However it differs in the observation of least average number of days of hospitalization where the average duration of hospitalization in days was maximum in neoplasms.3 However it differs in the observation of least average number of days of hospitalization where it is 8.77 days in respiratory tract diseases.3 Injuries including fractures were found to have more hospitalization days after neoplasms in our study. Similar observation was also noted in the study on hospital admissions in the aged.3 Average duration of Hospitalization was 8.67 days in males and 8.47 days in females in our study which is in contrast to the observation made by Radha et al in here study where the average duration of hospitalization for males and females was 11.28 days and 11.75 days respectively3.

It was observed that in our study that maximum number of total cases, 733 (28.7%) were hospitalized for 4-7 days. This is however in contrast to the study by Radha et al that the maximum number of total cases was hospitalized for 8-15 days3. Likewise it was observed in our study that in 63-65 years age group maximum (35%) admissions had a hospital stay of 2-3 days whereas in Radha et al study it was noted for the maximum of the same age group had a stay in the hospital for 8-15 days. It was seen in our study that in the age group of 66-68 the maximum admissions (23.8%) had a stay in the hospital for 2-3 days whereas in the same age group the maximum (33.3%) admissions had a hospital stay for 4-7 days in study done by Radha et al3. Maximum (29.9%) admissions in age group of 69-71 years in our study had a hospitalization of 4-7 days which is similar to the observation of Radha et al who found for the same age group the maximum (24.76%) admissions had hospital stay for 4-7 days3.

It was seen in our study that the maximum (36.6%) admissions in the age group of 72-74 had hospitalization for 8-14 days. Thee werent any admissions in the age group who had hospital in Bombay, where it was observed that maximum (38.5%) of admissions had a hospital stay of 8-15 days. Similarly there were no admissions in the age group in 22-30 days of hospitalization category3.

It has been observed in our study that maximum (29.2%) admissions had a hospital stay for 2-3 days in the age group of 75-77 whereas in the study by Radha et al the maximum (23.14%) admissions had a hospital stay for 8-15 days in the age group of 75 +3.

It was observed in our study that in the males the maximum (28.5%) had a hospitalization stay for 4-7 days. Similarly in the females the maximum (28.9%) had a stay in the hospital for 4-7 days. This is in contrast to the study at Bombay Hospital where it was found that in males the maximum (25.04%) had a hospitalization for 8-15 days and in females the maximum (24.8%) had a hospitalization of 8-15 days3.

It was observed in our study that maximum cases that where discharged were of Eye and Ear diseases. Similarly it was noted in study at Bombay Hospital where the maximum discharges were of Eye diseases3. It was seen in our study that maximum of the old patients who expired were due to injuries and fractures where as in the study by Radha et al it was seen in old patients of Heart diseases3. It was seen in our study that maximum of the old patients who expired were due to injuries and fractures where as in the study by Radha et al it was seen in old patients of Heart diseases3. The maximum of the old patients who left against medical advice in our study were patients of heart disease whereas in the study at Bombay Hospital it was patients of GI tract disease and injuries including fractures.

It was observed in our study that the number of patients who were discharged constituted 90.4% which compares favourably with the study by Radha et al where it was 81.57%3. The aged people who left against medical advice in our study constituted 4.3% which also compares favourably with study by Radha et al where it was 5.8%3. The aged who expired in our study was 1.8% compared to 10.31% in the study by Radha et al3 and 19.5% in study by Kunwar4, which were old studies of the year 1981 and 1961 respectively. The mortality rates have come down with passage of time with better patient care and facilities that \are catered to the aged patients in this hospital.

CONCLUSION

With the increase in life expectancy and decrease in death rates, the elderly population in on a rise in our country. It is high time that teaching hospitals should cater to the health needs of the geriatric age group by having a dedicated geriatric ward and gerontologists. In depth epidemiological studies on old people are the need of the day for the management and health administrators to understand and reflect on the necessities of the geriatric population and make the hospitals more geriatric friendly. This can be feasible if they start on with the help and approval of the ministry of health and family a Geriatric friendly hospital Initiative by starting with PG disciplines in Gerontology, Nursing care , Infrastructural modifications, Geriatric OPD counters, Counseling, Psychiatric services and the like. Well-being of older person has been mandated in the Article 41 of the constitution of India that the state shall within the limits of its economic capacity and development make effective provision for securing the right to public assistance in case of old age6.

REFERENCES

1. Weir JH. Roy. Soc. Hlth. Jr. 1967:87, 144.

2. Manju Nandi. Need for specialty nursing care for senior citizens. Geriatric update by O.P. Sharma. 1999 : 122-3.

3. Radha Y.A, Rashid SSA. Hospital admissions in the aged – A retrospective study. Ind. J. of comm.. Med. 1983; 8 (3): 11-6.

4. Kunwar KB. Geriatrics on emergency. Journal of clinical society. K.G. Medical college, Lucknow. 1961.

5. Prakash R, Choudhary SK, Singh US. A Study of morbidity pattern among geriatric population in an urban area of Udaipur, Rajasthan. Ind. J. of comm. Med. 2004:29 (1); 35-40.

6. National Policy on Older persons. 1996: 4-6.

* Associate Professor of Community Medicine, FrMuller Medical College, Kankanady, Mangalore-575002
** Associate Professor, Deptt. Of Community Medicine, Kasturba Medical College, Mangalore-575001

** Address for correspondence: E.Ravi Kiran M.D., Associate Professor, Deptt. Of Community Medicine, LHH Road, Kasturba Medical College, Managalore-575001

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