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Indian Journal of Community Medicine

An Epidemiological Study of Correlates of Osteo-Arthritis in Geriatric Population of UT Chandigarh

Author(s): MK Sharma, HM Swami, V Bhatia, A Verma, SPS Bhatia, G Kaur

Vol. 32, No. 1 (2007-01 - 2007-03)

MK Sharma, HM Swami, V Bhatia, A Verma, SPS Bhatia, G Kaur

There has been a remarkable increase in the growth of the elderly population. In India 5.3% of males and 4.8% of females are aged more than 65 years. Although the proportionate percentage of elderly people in developing countries is lesser but absolute number is more than the developed world. Old age cannot be healed or prevented. However much can be done by health workers in helping the elderly to lead a normal life, which is necessary for them to perform their activities of daily living (ADL) smoothly. The commonest obstacle for elderly to carry out ADL is the problem of joint-pain and decreased mobility. Worldwide osteo-arthritis is the most common articular disease of people 65 years and older1. It represents a major cause of disability in the United States. The prevalence of this disorder in certain elderly group is as high as 85%. There is a rise in the annual consultation rate for osteo-arthritis. An attempt has been made in this study to find out the prevalence of osteo-arthritis and its relation with age, obesity, overweight, place of residence and anaemia amongst elderly of UT, Chandigarh.

Material and Methods

The study was conducted in the urban and rural areas in the UT, Chandigarh during the year 1999. Sampling was done from 9 sectors in the urban areas and from 7 villages in the rural areas. A team comprising of doctors, medical social workers and lab technicians was given training in the deptt. of community medicine to enable uniform collection of data. A list of all houses in 9 randomly selected sectors of city was made. Households for study were selected by systematic random sampling technique. The data was collected by house to house survey on a pre-designed and pre-tested format. Osteoarthritis was considered if an elderly was suffering from pain/swelling/limitation of movement of larger joint or if one has already been diagnosed as having osteoarthritis or has been on treatment5. The body mass index (BMI), was calculated by the standard formula. A BMI of more than 25 was considered as overweight and one over 30 as obese. The prevalence of osteoarthritis was determined separately for anaemic and non-anaemic elderly. The males with haemoglobin concentration of <13 gm%, and females with <12gm% were considered anaemics as defined by WHO, The available medical records were checked and information collected from the subjects and caretakers. The data was entered in computer and analyzed on Fox-pro programme. The methodology adopted for selecting and visiting the households in rural areas was similar to that of methodology adopted for urban areas.

Results

In the present study, 362 elderly of more than 65 years were interviewed and assessed clinically. The examinations were conducted in 1882 houses comprising of 7937 persons. The study revealed that the majority (66.6%) of elderly belonged to age group 65-74 years, about 6.6% were aged >85 years. The overall prevalence of osteo-arthritis in elderly of UT, Chandigarh was 56.6%; in rural areas it was 32.6% and in urban, it was 60.3%. (p <0.001). Osteoarthritis was more in females as compared to males (70.1% Vs 41.6%). Table 1 depict that as the age increased prevalence of osteoarthritis also increased. Osteo-arthritis was present in only 50.2% of the elderly aged 65-74 years, whereas it was 97.7% in elderly aged 84 years or older. (p <0.001) Prevalence of osteoarthritis increased as body mass index (BMI) increased. It was 51.36% amongst elderly with BMI less than 25, whereas it increased to 100% amongst elderly with BMI equal to or more than 40 (p <0.001). The prevalence of osteo-arthritis amongst anaemic and non anaemic males was 41.6% and 33.3%. The similar figures for elderly females were 71.5% and 50.0% respectively.

Table 1: Distribution of osteoarthritis by age and body mass index (BMI)

  No. of
Elderly
Osteo-artheitic (%)
Age Group (Yrs) 65-74 241 121 (50.20)
  75-84 97 62 (63.92)
  84+ 24 22 (97.67)
  c2 = 24.69, df = 2 P<0.001
BMI < 25 294 151 (51.36)
  25-29 49 28 (70.00)
  30-39 25 22 (88.00)
  40+ 03 03 (100)
  Total 362 205 (56.7)
  c2 = 68.47, df = 3 P<0.001

Discussion

The prevalence of osteo-arthritis among elderly as per the present study was 56.6%. Community survey data in rural and urban areas of India shows the prevalence of osteoarthritis to be in the range of 17 to 60.6%. The prevalence of osteo-arthritis amongst elderly in rural areas of Amritsar was 60.6%2, while it was 17% amongst the elderly of rural areas of Wardha (Maharastra)3. In Aligarh the prevalence of osteo-arthritis was 30.2%4.

Present study showed significant difference in the prevalence of osteo-arthritis in elderly of rural and urban areas. The low prevalence of osteo-arthritis in rural elderly could be due to differences in their life style. Rural elderly are usually more mobile, (in present study also limitation of movements in rural elderly was significantly less than in urban elderly) have less obesity compared to urban elderly and have better socialinteractions.

The last factor makes rural elderly to divert their minds away from symptoms. It was seen in the present study that peak prevalence of osteo-arthritis was among the elderly of age group 84 year and older. As degeneration increases with age, osteo-arthritis also increases with age. This has been demonstrated by many studies including one by Kumar5. The prevalence of osteo-arthritis was almost 100% among the severely obese elderly as against 51.36% among the non-obese. Felson has estimated that obesity is the number one preventable cause of osteo-arthritis.

The higher prevalence of osteo-arthritis among persons of both sexes having anaemia is as per expectation because such individuals become weak and low tolerants of disease symptoms and present/complain with health care providers more frequently. A high morbidity of osteoarthritis among elderly needs strengthening of geriatric health care services both community based and hospital based. A programme needs to be developed to provide facilities in the form of early diagnosis, counselling, diet control, correction of anaemia, regular exercise and physiotherapy in addition to treatment.

References

  1. Gupta SJ. Osteoarthritis and Obesity. Orthopaedics today. 2001;3:137-41.
  2. Padda AS, Mohan V, Singh J, Deepti SS, Singh G, Dhillon HS. Health profile of the aged persons in urban and rural field practice areas of Medical College, Amritsar. Indian J of Community Medicine 1998;23:72-76.
  3. Kishore S, Garg BS. Sociomedical problems of aged population in rural area of Wardha District. Indian J of Public Health 1997;41:46-48.
  4. Khan JA, Khan Z et al. A study of the leading causes of illness & physical disability in an urban aged population. Indian J Prev Soc. Med. 2000;32:121-24.
  5. Kumar PJ, Levy G. Osteoarthritis in: Robert H Fitzgerald, Herbert Kaufer & Arthur L Malkani Orthopaedics Mosby Inc, Missouri, 2002:810.

Department of Community Medicine, Govt. Medical College & Hospital, Chandigarh- 160 032.
Received: 5.9.2005

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