Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

A Study of Morbidity Pattern Among Geriatric Population in an Urban Area of Udaipur Rajasthan

Author(s): Rahul Prakash, S.K. Choudhary, Uday Shankar Singh

Vol. 29, No. 1 (2004-01 - 2004-03)

Deptt. of Community Medicine, R.N.T. Medical College, Udaipur

Abstract:

Research question: What is the morbidity pattern among geriatric population in urban Udaipur?

Objectives: To assess the morbidity pattern among elderly population. To assess the smoking pattern among them. To know the psycho-social problems of elderly.

Study design: Cross-sectional.

Setting: An urban area of Udaipur - a field practice area of deptt. of Community Medicine.

Study subject: 300 elderly peoples having 60+ age including 190 males and 110 females.

Statistical analysis: Proportions, chi square test.

Result: Out of total 300 elderly (60+) 29.3% belonged to socio-economic class V, 24.6% and 14.6% were grouped in class II and I respectively.48% had hypertension. Chronic Bronchitis was seen only in males (6.3%) and bronchial asthma was found in 11.5% and 18.2% males andfemales respectively. Musculoskeletal problem was present in 11.6% and 20% males and females respectively. Nervous system disorders were found in 8.6%. 34.7% males and 60% females had cataract. Feeling of loneliness was seen in 21.05% males and 27.3% females, followed byfeeling of neglect.

Key Words: Morbidity pattern, Geriatric population, Urban area, Smokers

Introduction:

Aging is a universal process. In the words of Seneca "old age is an incurable disease". But more recently Sir James sterling Ross Commented" your do not heal old age, you protect it, you promote it and you extend it. These are in fact the principles of Preventive Medicine.

Expectation of life at birth for males and females has increased more in recent years. In India, it is projected to be 67 years in 2011-16 for males and 69 years for females. Projections beyond 2016 made by United Nations1 has indicated that 21 % of the Indian population will be 60+ by 2050 which was 6.8% in 1991.

Demographic2 transition has been accompanied by changes in society and economy. Instead of strong family ties in India, the position of a large no. of old persons has become vulnerable due to which they cannot take for granted that their children will be able to look after them.

Industrialization, urbanization, education and exposure to western life styles are bringing changes in values and life style. Much higher costs of bringing up and educating children and pressures for gratification of their desires affect transfer of share of income for the care of parents. Due to shortage of space in urban areas with higher rents, migrants prefer to leave heir parents in their native places. Changing roles and expectations of women, their concepts of privacy and space, desire not be encumbered by caring responsibilities of old people for long periods.

The contribution of elderly populations to demographic figures is increasing day by day. Increasing problems of health care, psycho-social, personal and socio-economic factors associated with the elderly further overwhelms this.

Old age is not a disease in itself, but the elderly are vulnerable to long term diseases of insidious onset such as cardiovascular illness, CVA, cancers, diabetes, musculoskeletal and mental illnesses. They have multiple symptoms due to decline in the functioning of various body functions.

The Govt. should also effectively plan Health Care Services for the elderly and prepare a feasible implementation design relevant to country needs. The problems associated with the aging of the population are that of absence of facilities for medical treatment and of providing economic and social support hence information on morbidity profile of this population is essential for planning its health care facilities.

Material and Methods:

A cross-sectional study of morbidity status of geriatric population in the urban area of Udaipur was planned in the field practice area of Deptt. of PSM, RNT Medical College, Udaipur. All elderly persons in the age group of 60 years and above were included in the study.

There were 360(5.2%) persons in the age group of 60 and above of which 300 (190 males and 110 females) could be contacted in the study and rest 60 were either non-co-operative or could not be contacted despite making sincere efforts. Each individual in the study was subjected to personal interview and clinical examination.

The information was collected on a pre tested performa. Each individual aged 60 years and above was informed in his or her own house. For all those who could not be contacted in the first instance, two further visits were made before declaring the subject unavailable. The purpose of the study was explained and confidentiality of the information was assured.

A detailed history was also taken regarding housing and sanitary condition along with the history of present and past illness.

For assessment of income, per capita monthly income was calculated followed by classifying into various socio-economic groups according to social classification, suggested by Prasad and amended (1991 )3, which is linked with CPI of country.

Smokers were broadly divided into (UICC 1976)4.

Non smoker: Who never smoked as much as one cigarette a day for as long as six month. Current smoker: At least one cigarette a day. Ex-smoker: Had smoked at least one cigarette a day for as long as six months but doesn't smoke now.

Criteria for diagnosis:

Hypertension:

Clinical examination included a general physical examination. Height and Weight were taken, blood pressure measured, and if high BP detected in 1st instance, two more readings were taken on different occasions to confirm hypertension. According to blood pressure reading subjects were graded as (WHO 1978)6 Normotensive syst. BP <140 mmHg, Diast. BP<90.

Results:Table I: Distribution of elderly as per diagnostic groups.

Hypertensive >160 mmHg and Diast. >95 Border line BP between above two lines To identify and to diagnose other chronic diseases, separate diagnostic criteria for each of the diseases was applied.

Respiratory disease:

- Particularly chronic bronchitis, asthma and tuberculosis were accepted as diagnosed by clinicians earlier with necessary investigations among elderly population.
- While URI and coryza were diagnosed and accepted as per investigator's expertise.

Masculo-skeletal diseases:

As kyphosis, arthritis and spondylitis already diagnosed by orthopedician with necessary investigation and these cases were accepted as such.

Nervous system disorders:

Such as cerebral infarction, epilepsy, hemiplegia, neuritis, tremors, anxiety, dementia and depression etc. already diagnosed by neuro physician and psychiatrist with necessary investigation and accepted as such.

Eye diseases and psychosocial problems:

Diagnosed by the investigator in the field with the help of snellens chart, torch and digital tonometry with clinical signs and symptoms. Psychological problems were elicited by large discussion on some of the personal problems related with psychosocial trouble.

Systems Male (n=190)
No. (%)
Female
(n=110)
No. (%)
Total (n=300)
No. (%)
Eye 128 67.4 82 74.5 210 70.0
Hypertension 84 44.2 60 54.5 144 48.0
Psycho-social Problems 72 37.8 54 49.0 126 42.0
Resp 78 41.0 30 27.3 108 36.0
Musculoskeletal 22 11.6 22 20.0 44 14.6
Nervouos system 16 8.4 10 9.1 26 8.67
Ear 16 8.4 8 7.3 24 8.0
GIT 8 4.2 6 5.5 14 4.7
Endocrine 10 5.3 - - 10 3.33
Genito Urinary 4 2.1 2 1.8 6 2.0
Skin 2 1.05 - - 2 0.66
Hernia 2 1.05 - - 2 0.66

Out of 300 elderly people examined, 70% had problems 49% females had psycho-social problems, related with vision, 48% had hypertension. 38% males and

Table II: Distribution of elderly as per eye diseases.

Disease Male (n=190) Female (n=110) Total (n=300)
no. % no. % no. %
Cataract 66 34.7 66 60 132 44
Refractory Error 60 31.6 14 12.72 74 24.7
Conjunctivitis - - 02 1.8 02 0.66
Glaucoma 02 1.05 - - 02 0.66
Total 128 67.4 82 74.5 210 70

Cataract was the cause of diminishing vision in 44% of 0.66% the cause was glaucoma, the subjects, whereas, 24.7% had refractive errors and only in

Table III: Relation of hypertension with smoking status

  No. Non-smoker Current Smoker Ex-smoker Tobacco chewing
No. % No. % No. % No. %
Hypertension 144 76 52.8 38 26.4 20 13.9 10 6.9
Normotensive 156 112 71.8 28 17.9 12 7.7 4 2.6
Total 300 188 62.66 66 22 32 10.66 14 4.66

χ2= 11.56, df=l; p<0.001

Elderly hypertensive were found to be 144 out of which not present, also 17.9% current smokers were also not having 52.8% were non-smokers, 26.4% were current smokers, 13.9% hypertension, were ex-smokers. In 71.8% non-smokers, hypertension was

Table IV: Distribution of elderly as per psycho-social problems.

Problem male (n=190) Female (n=110) Total (n=300)
No. % No. % No. %
Lonliness 40 21.05 30 27.3 70 23.3
Feeling neglected/ignored 30 15.8 22 20.0 52 17.3
Sexual 02 1.05 - - 02 0.66
Exploitation - - 02 1.8 02 0.66
Total 72 37.89 54 49.09 126 42

Table IV shows 23.3% were facing loneliness and 17.3% insufficiency and similar proportion had the feeling of being neglected by the kins, 0.66% were facing sexual exploitation.

Disease male (n=190) Female (n=110) Total (n=300)
No. % No. % No. %
Asthma 22 11.57 20 18.2 42 14
Coryza 28 14.7 10 9.1 38 12.7
Chronic Bronchitis 12 6.31 - - 12 04
URI 12 6.31 - - 12 04
T.B. 04 02.1 - - 04 1.3
Total 78 41.05 30 27.27 108 36

Asthma was the leading respiratory problem among both and tuberculosis. males and females followed by coryza, chronic bronchitis, URI

Table VI: Distribution of elderly as per musculoskeletal diseases.

Disease male (n=190) Female (n=110) Total (n=300)
No. % No. % No. %
Arthritis 16 8.42 19 17.3 35 11.6
Spondylitis 05 2.6 03 2.7 08 2.6
Kyphosis 01 0.52 - - 01 0.3
Total 22 11.57 22 20 44 14.6

Commonest musculoskeletal disease was arthritis followed by spondylitis and kyphosis.

Table VII: Distribution of elderly as per diseases of nervous system.

Disease male (n=190) Female (n=110) Total (n=300)
No. % No. % No. %
Neuritis 04 2.1 02 1.8 06 2
Tremors 03 1.5 01 0.9 04 1.3
Anxiety 03 1.5 01 0.9 04 1.3
Dementia 02 1.5 02 1.8 04 1.3
Cerebral Palsy - - 02 1.8 02 0.66
Epilepsy - - 02 1.8 02 0.66
Hemiplegia 02 1.05 - - 02 2.066
Depression 02 1.5 - - 02 0.66
Total 16 8.42 10 9.09 26 8.66

Table VII shows that 2% elderly people were suffering from neuritis and 0.66% were suffering from cerebral infarction, epilepsy, hemiplegia and depression. Anxiety, tremors and dementia were present in 1.3% elderly.

Discussion:

Well being of older person has been mandated in the Article 417 of constitution of India, which directs 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 age.

Study shows that 70% elderly were suffering from one or other ophthalmic problems followed by 48% with hypertension and 42% had psycho-social problems and in this case number of females was high (49%) and 36% were suffering from respiratory diseases and the others were living with musculoskeletal, GIT, ENT and nervous system problems.

According to WHO (1984)8 it has been stated that in both young and older adults blood pressure increases with age, but the decrease in mean blood pressure in males with 76+ age may be because of less mental tension and overall responsibilities of the house.

In a study by Hanger et al (1990)9 reported in their Christ Church study of elderly observed prevalence of hypertension as 43.6% with 5.9% having postural hypertension. In a study by Chadha et al10 reported a prevalence rate of 52.2 and 58.4 among males and females respectively. Kutty et al11 observed a prevalence rate of 272 and 323/1,000 persons above the age of 60 years. In the present study 48% of individuals had hypertension and is comparable with these studies.

As regards the smoking status of elderly 62.6% were non-smokers, 22%, current smokers, 4.66% tobacco chewers and 10.6% ex-smokers. In the total no. of 300 subjects, 48% elderly were hypertensive, out of which 52.8% were non-smokers and 48.2% were smokers or tobacco chewers. Relationship between smoking and hypertension tested highly significant statistically.

In a study by Groppelli et al (1992)12 reported that nicotine may cause a rise in both systolic and diastolic blood pressure for 15-30 min., and in a study by Hirsch et al 199213 reported that even more prolonged elevations in the blood pressure follow the use of smokeless tobacco or tobacco chewers. In two different studies by Mann et al (1991) and Westman (1995) also reported that smoking and smokeless tobacco may raise blood pressure. The present study is comparable to these studies.

36% elderly were found to have respiratory diseases 6.3% males had chronic bronchitis and 11.5% had bronchial asthma. 14.6% elderly persons had musculoskeletal problems in which 8.42% males and 17.3% females were suffering from arthritis of knee joints and 2.6% males and 2.7% females were suffering from spondylitis. Donel et al (1979) reported the involvement of musculo-skeletal system in 19% of elderly in England and in present study it is comparable.

Overall, 8.6% elderly were suffering from diseases of nervous system, this is in conformity with the study by 0. Kethy and Machnatty 1978, who reported the disorders of nervous system in 8.5%. In the present study, 2% were suffering from neuritis and neuralgia followed by 1.3% each with tremors and anxiety. The study conducted by Agrawal (1992)14 revealed anxiety and dementia in 82% and 0.65% respectively, but it was 1.3% in the present study.

The leading cause of diminished vision in developing countries is cataract, which was found in present study in 34.7% and 60% males and females respectively, followed by refractive errors in 24.7%. In a study by Purohit and Sharma (1976))15 reported cataract in approx. 40% elderly, whereas, Mishra (1980)16 reported in 25.8% elderly and Agrawal (1992)14 reported in 40% elderly in one or both eyes.

In the present study, total 42% elderly had psycho-social problems in which 21.05% males and 27.3% females had the problems of loneliness, 15.8% males and 20% females felt neglected/ignored by their kins. In a study by ICMR17 (1987) reported that prevalence of mental morbidity among elderly was 20.2 per thousand persons. This prevalence was twice that in the total population.

References:

  1. United Nations (UN). The sex and age distribution of population, 1990.
  2. Census of India (1991). Registrar General and Census Commissioner, India, Personal Communication Aug. 1992.
  3. Kumar P. Social classification - Need for constant updating. Indian Journal of Community Medicine 1993; 18(2).
  4. UICC: Recommendations of workshop on standardization of measurement of cigarette smoking rates, Lyon, 8-10th Sept., 1976, published in UICC TRS Vol 52 (1976): Guidelines for smoking control. 2nd Ed. Appendix 2 Pq IV.
  5. Gurmeet Singh. Issues and approaches in drug abuse prevention with special reference to alcohol use in Punjab. Ind Psych 1978.
  6. WHO. Arterial hypertension. Tech Rep Ser. 628, 1978.
  7. National Policy on older persons. 1996; 4-6.
  8. WHO. Health of the elderly -Tech Rep. Series, 779, 1989.
  9. Hanger HC, Saisbury R. Screening the elderly a Chirst Church study. The NZ Med. J. 1990 Oct.
  10. Chadha SL, Radhakrishna S. Epidemiological study of Coronary heart disease in urban population of Delhi Indian J. Med. Research 1990; 92: 424-30.
  11. Raman Kutty V, Balakrishna KG. Prevalence of coronary heart disease in the rural population of Thiruvanthapuram, Kerala, India. Int. J. Card. 1963; 39: 59-70.
  12. Groppelli A, Giorgi DMA, Ombonis et al. Persistent blood pressure increase induced by heavy smoking J. Hypertens 1992; 10:495-9.
  13. Hirsch JM, Hedner J et al. Hemodynamic effects of the use of oral snuff. Clin. Pharmacol Ther 1992; 52: 394-401.
  14. Agrawal AP (1992) studies on morbidity pattern in Rural area of Delhi.
  15. Purohit CK, Sharma R. A study of general health status of persons aged 60 years and above in RHTC area, Naila. Ind. J. Med. Research. 1976.
  16. Mishra VN, Srivastava BC. Prevalence of senile cataract in rural population. Ind. P&SM 1980.
  17. Collaborative study on severe mental morbidity, ICMR and Deptt. of Science and Technology, New Delhi 1987:52.
  18. ICMR: collaborative study on blindness -A report by Dr. Madan Mohan 1987.
Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica