Original Articles

A study on morbidity pattern among the geriatric people of Venkatachalem village, Nellore District, AP.

Pooja Chauhan¹, V. Chandrashekar²

¹Assistant Professor, Department of Community Medicine, MRIMS, Hyderabad, ²Professor and Head of department of Community medicine, Narayana Medical College, Nellore.

Abstract :

Background: Health problems of the old people are a very important component of any healthcare delivery system. Age related changes in immune system and degenerative phenomenon render people susceptible to a variety of infections, neoplasia and other disabilities.

Objectives: To study the morbidity pattern among elderly people of Venkatachalem village, Nellore.

Methods: A cross-sectional study was conducted in Venkatachalem village. 290 people of age 60 yrs and above were included in the study. Morbidity was assessed by history taking, clinical examination, reviewing past medical records and medicines taken by the study subject.

Result: The average number of morbidity per person was 3.5. The common morbidities were joint complaints (65.9%), anemia (56.6%), cataract (48.3%), and hypertension (34.1%) and generalized pain (13.4%). 9.3% of the elderly were found to be depressed.

Conclusion: We can conclude from the study that there is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet the needs of the disabled. Also the common morbidities among the elderly should be considered before planning for any intervention.

Key words: Geriatric, morbidity, Geriatric Depression Scale.

Corresponding Author: Dr Pooja Chauhan, Plot No 103, Methodist colony, Begumpet, Hyderabad- 500016, AP. E-mail- drpoojachauhan@yahoo.com

Introduction

Health problems of the old people are a very important component of any healthcare delivery system. Aging is the natural process. Ageing is generally defined as a process of deterioration in the functional capacity of an individual that results from structural changes, with advancement of age. Age related changes in immune system and degenerative phenomenon render people susceptible to a variety of infections, neoplasia and other disabilities. The frequent chronic ailments among elderly are Hypertension, Diabetes Mellitus, Cardiovascular diseases, Cancers, Arteriosclerosis, Kidney disease, Parkinson’s disease, Arthritis, Dementia, etc. Most often elderly may suffer from multiple chronic conditions, visual defects, hearing impairments and deterioration of speech which may cause social isolation.

In both rural and urban areas, the disease prevalence rate is higher among men than women, doubtless reflecting differences in behaviour patterns, as shown in National Sample Survey (NSS) conducted by the National Sample Survey Organisation (NSSO 1991). ^[1] Age is the single most important risk factor for dementia in elderly people, though some studies suggest a slight decline in Alzheimer’s disease after 90 years. ^[2] Malnutrition is also a common problem in elderly people, with 30% of elderly people being undernourished. ^[2] Strokes are clearly a disease of elderly people; about 70% of strokes occur in those aged >65 years. The incidence of stroke rises steeply with age, being 10 times greater in people aged 75-84 years than people aged 55-64 years. ^[2] Disability due to chronic diseases is also a major problem as shown in the study done in rural part of Kolkata ^[3] were prevalence of disability was 23.8%.

For the year 2003, the Sample Registration System ^[4] estimates that 7.2 % of the total population in India was above 60 years. At present the proportion of the people above 60 years is 7.7 % and is expected to reach 12.6 % in the year 2025. ^[5] The growth of the elderly population presents a new challenge to health systems and social support networks in many less developed countries where populations are becoming old before they become wealthy. In order to improve the quality of life of the elderly, it is essential to reduce the burden of disease. Primary Health Care is the mainstay of Health Care delivery in India. The effort should therefore be focused on the disease/conditions that could be effectively treated at Primary Health Centre (PHC) level. We therefore, decided to document the prevalence of common morbidities among elderly people.

Materials and Methods:

Place of study: The study was conducted at village Venkatachalem, which is one of the villages of the field practice area of Narayana Medical College, Nellore.

Study design: Community based Cross sectional study.

Study period: Present study was conducted from September 2009 to September 2010.

Sample size-

Sample size was calculated according to the prevalence of morbidity of 58.1% among elderly people as shown in the study done by Ansari MA et al in rural area of Aligarh. ^[6]

So, p = 58.1,

q = 100-58.1 = 41.9.

With 10% of allowable error, L= 5.81.

N = 4pq / L²

= 4 x 58.1 x 41.9 / 5.81 x 5.81

= 288.47

It is proposed to study 288 subjects aged 60 years and above.

Study subjects:

290 elderly people of age 60 years and above were included in the study.

Inclusion criteria-

Both males and females of age 60 years and above, willing to participate in the study were included.

Exclusion criteria-

Houses which were locked.

Elderly people not willing to participate in the study.

Sampling method:

Systematic random Sampling technique was followed for data collection.

Sampling frame:

Total number of houses in the study area is 1310 and the sample size required is 290. So, sampling interval will be,

n = 1310 / 290,

= 4.51

The sampling interval was taken as 4. One house was selected randomly and thereafter every 4^th house was visited. If the house didn’t had the study subject the next house was visited, and then the next house was selected according to the sampling technique. If one house consisted of two eligible persons, one person was selected randomly. This was done till the required sample size was achieved. Data collection was done after getting informed consent.

Methodology:

First, oral informed consent was taken from the study subject. A predesigned, pretested, semi-structured questionnaire was used to collect data. Morbidity was assessed by history taking, clinical examination, reviewing past medical records and medicines taken by the study subject. International Classification of Primary Care, ^[7] by Wonca International Classification Committee (WICC) was used to list the common morbidities among elderly. Geriatric Depression Scale ^[8] was used to assess depression among the elderly people. Height and weight were measured as per standard guidelines laid down by World Health Organisation. ^[9] Body Mass Index was calculated and classified as per guidelines. ^[10] Blood Pressure was measured and classified as per guidelines. ^[11]

B.G. Prasad’s socio-economic status scale ^[12] was used to classify the socio-economic status of study subjects. Updated for per-capita income according to All India Wholesale Price Index (AIWP) ^[13] for July 2009 were used.

Processing and Analysis of Data:

The data were entered and analysed by using SPSS 17^th version.

RESULTS:

The present study was conducted at village Venkatachalam, which is part of rural field practise area of Narayana Medical College, Nellore. A total of 290 elderly people were studied in that area, out of whom 98 (33.8%) were males and 192 (66.2%) were females.

Table1 shows that out of total 290 village elderly, 33.8% (98) were males and 66.2% (192) were females. Maximum numbers of elderly (42.8%) were in the age group 60-65 years. Only 8.3% of them were above 80 years. Among males, 39.8 % of them were in the age group of 60-65 years and 29.6% were in the age group of 66-70 years. Among females, 44.3% were in the age group of 60-65 years and 28.1% were in the age group of 66-70 years.

Majority of them i.e. 248 (86%) were Hindus, followed by Muslims 36(12%) and Christians 6(2%). 70.8% of the females were widows, whereas 70.4% of males were currently married. This can be explained by the longer life expectancy of females. 35% of the elderly were living with their children alone, 29% were living with spouse and children; and 13% of elderly were living alone. It was also seen that 82.1% of them were illiterates. Majority of elderly females (92.2%) were illiterate and only 7.8% had primary or secondary education.

Table 2 shows that 28.6% of the elderly were poor whereas only 1% belongs to high class. 29.7% of the elderly were from lower middle socio-economic class.

The average number of morbidity per person was 3.5.Table 3 shows that 30% of the elderly had weakness, anemia was found among 56.6% of the elderly, and diabetes was found in 8.3% and skin morbidities among 9% of the elderly.

Table 4 show that 69.3% of the elderly had eye morbidity, 69.7% had musculoskeletal, 16.2% had digestive morbidity and 14.5% had hearing complaints. Of the eye morbidity, 48.3% had cataract and 21% had refractive error.

Table 5 shows the cardiovascular and respiratory morbidity. 34.1% of the elderly had hypertension and 38.3% had cardiovascular morbidity. Respiratory morbidity was found among 26.9% of elderly individuals, of which shortness of breath (9.3%) and cough (9.7%) was most common.

Table 6 shows that neurological morbidity was found among 6.2% of elderly and psychological morbidity was found in 12.8% of the elderly. Of the psychological morbidities, the most common was disturbed sleep (7.2%).

Table 7, represents data regarding the morbidities related to male and female genital and urological morbidities. It shows that 5.7% of the elderly females had breast and genital morbidity (2.1% lump in breast and 3.6% prolapsed uterus); 5.1% of elderly males had genital morbidity (hydrocoele 5.1%); and 7.2% had urological morbidity (painful urination 4.1% and incontinence of urine 3.1%).According to Geriatric Depression Scale, it is seen that 9.3% of the elderly people had scores above 5 on Geriatric Depression Scale, suggesting depression.

Obesity was defined according to the BMI and it showed that 43.8% of the elderly are normal, 14.1% are overweight and 25.2% are obese. 16.9% of the elderly are found underweight.

Discussion:

Present study showed that 33.8% of the study subjects were males and 66.2% were females. This can be attributed to the longer life expectancy for females. Shweta Mangal ^[14] (n= 270) showed in her study in Jaipur urban area (Jan 2009), that 48.2% were males whereas 51.8% were females.

Our study shows that majority of them i.e. 248 (86%) are Hindus, followed by Muslims 36(12%) and Christians 6(2%). In the study done by Lena A ^[15] et al (n=213) in Udupi Taluk, Karnataka in 2003 showed a similar finding with 89% of the respondents being Hindu.

Our study shows that 82.1% of them are illiterates. Majority of elderly females (92.2%) were illiterate and only 7.8% had primary or secondary education. During earlier days educating females was not considered as important as establishing marriage at early age. According to National Sample Survey ^[16] 52^nd round 63% of the elderly are illiterate. Lena A et al ^[15] also showed a higher illiteracy rate among females (62%). A study done by Md Rafiq Islam ^[16] in rural area of Bangladesh (n=300) showed that 61% of the elderly were illiterate.

The average number of morbidities per person is 3.5. In the present study 74.4% of elderly had 3 or more morbidities. Kamlesh Joshi et al ^[17] showed a mean morbidities of 6.9 per person in rural area and 5.4 per person in urban area, also 93 % of the elderly in rural and 73% of elderly in urban had 3 or more morbidities. In the study done by SPS Bhatia ^[18] in Chandigarh (n=361), showed an average morbidities of 2 health related complaints per elderly.

The most common morbidity among elderly was joint symptoms/ complaints (65.9%) like joint pain, swelling and limitation of movements. 69.7% of elderly had musculoskeletal morbidity. Purty ^[19] in his study in Tamil Nadu showed that 43.4% of elderly had joint pains/stiffness. Pankaj Kumar Manda et al ^[3] showed that 49.8% of the elderly females were having osteoarthritis. Lena A ^[15] in her study in Udupi Taluk, Karnataka found that 41.3% of the elderly were suffering from osteoarthritis. SPS Bhatia et al ^[18] in Chandigarh showed a prevalence of 45.7% of morbidity related to musculoskeletal system.

69.3% of the elderly had eye morbidity. Of the eye morbidity, 48.3% had cataract and 21% had refractive error. Rahul Prakash et al ^[20] in Udaipur showed that 70% of elderly were suffering from ophthalmic problems (cataract 44%, refractive error 24.7%).

Diabetes was found in 8.3% of the elderly people in our study. Similar results were found in rural part of Tamil Nadu by Jacob Purty ^[19] with 8.1% of elderly having diabetes. Shashi Kant et al ^[21] in his study in Delhi showed a similar prevalence of 8.1%. Study done by Lena A ^[15] in rural part of Karnataka in 2003 showed a prevalence of diabetes in 10.3% of elderly individuals. A higher prevalence of diabetes compared to our results was observed by Pankaj Kumar Manda et al ^[3] with 13.4% of elderly suffering from diabetes. A study done in Chapai Nawabganj District of Bangladesh by Md. Mosiur Rahman ^[22] (n=300) showed that 19% of the study population had diabetes

In our study 34.1% of the elderly had hypertension and 38.3% had cardiovascular morbidity. A study done by Sithara Balan V ^[23] (n=800) in Thiruvananthpuram, Kerala showed that 33.37% of the elderly had hypertension. In the study done by HM Swami et al ^[24] in Chandigarh (n=362) showed that 58% of the elderly had hypertension, which is higher than the results found in our study. This study was done in urban area and higher prevalence can be attributed to the lifestyle of the elderly in urban area. In another study done by Mrs Sarasa Kumari ^[25] (n=202) in rural Thiruvananthpuram showed prevalence of Hypertension ranging from 50.6% to 66.4%, which is quite high as compared to our results, it can be attributed to the eating habits of people in Kerela where coconut is consumed in a high amount which contains high amount of saturated fatty acid.

Respiratory morbidity was found among 26.9% of elderly individuals, of whom shortness of breath (9.3%) and cough (9.7%) were the most common problems. Other morbidities are chronic bronchitis (4.1%) and upper respiratory tract infections (2.8%). In a study done by Jacob Purty et al ^[19] in rural part of Tamil Nadu showed that 11.3% of the elderly had cough.

Another study done by Rahul Prakash et al ^[20] in Udaipur Rajasthan showed that 36% had respiratory morbidities, 4% URI and 4% chronic bronchitis.

30% of the elderly had weakness and anaemia was found among 56.6% of the elderly. The study done by Purty et al ^[19] in rural area of Tamil Nadu during 2002-2003 showed a prevalence of 52.5%. A haemoglobin level of <12gms % was considered as the cut-off to diagnose anaemia, whereas in our study only clinical assessment was done.

18.6% of the elderly had difficulty in walking, 2.8% had history of trauma without fracture and 3.8% had fracture in the past. Amit Goel and Harpreet Singh ^[26] (n=47) in their study among elderly residents of senior citizens home in Delhi, showed that both balance and mobility are strong predictors of the physical function in the geriatric population and can provide crucial information for development of strategies for reducing misbalancing and falls.

In the present study, skin morbidities were found among 9% of the elderly. 4.1% of the elderly reported of pruritis. In a study done by Shashi Kant ^[21] in Delhi showed a prevalence of skin morbidity among 12% of the elderly. Kamlesh ^[17] showed in his study in northern India that 19.5% had pruritus. The difference in the findings can be attributed to the difference in weather conditions in the two regions.

16.2% had digestive system morbidity. SPS Bhatia et al ^[18] in Chandigarh showed that 12.2% of the elderly had morbidity related to digestive system.

14.5% had hearing complaints. Similar findings were reported by Shashi Kant et al ^[21] in Delhi with 14% of the elderly having auditory disability.

Neurological morbidity was found among 6.2% of elderly and psychological morbidity was found in 12.8% of the elderly. Of the psychological morbidities, the most common was disturbed sleep (7.2%). In a study done by Rahul Prakash et al ^[20] in Udaipur Rajasthan showed that 8.66% of elderly had diseases of nervous system.

Present study found that 5.7% of the elderly females had genital morbidity (2.1% lump in breast and 3.6% prolapsed uterus); 5.1% of elderly males had genital morbidity (hydrocoele 5.1%); and 7.2% had urological morbidity (painful urination 4.1% and incontinence of urine 3.1%). In a study done by Rahul Prakash et al ^[20] in Udaipur Rajasthan showed that 2.1% of males and 1.8% of females had genitourinary morbidity.

Obesity was defined according to the body mass index (BMI) and it showed that 43.8% of the elderly are normal, 14.1% are overweight and 25.2% are obese. 16.9% of the elderly are found underweight. A study done among the elderly residents of old age home by Neelam Wason ^[27] (n=56) in Jodhpur, Rajasthan showed that 21.4% of the elderly were underweight, 44.7% were normal weight and 33.9% were overweight.

9.3% of the elderly people had scores above 5 on Geriatric Depression Scale, suggesting depression. P Sengupta ^[28] in his study in Ludhiana (n=137), Punjab in the year 2006 showed that 21.2% of elderly suffered from depression. Another study among the elderly Indians in rural Karnataka by Ankur Barua et al ^[29] (n=627) for validation of WHO- Five Well-Being Index, reported prevalence of depression among males and females as 19.9% and 22.6% (overall 21.7%), this difference is because different scale was used to assess depression in rural Karnataka. A study done among geriatric clinic at a Tertiary Care Hospital by VB Singh (n=116) et al ^[30] showed a higher prevalence with 27.6% of elderly having depression. Another study done in a Tertiary Care General Medical Unit in Sri Lanka by Chaturaka Rodrigo ^[31] (n=100) reported that 69 % of the individuals had scores more than 5 suggesting of depression. This can be because of the fact that these were hospital based studies in Tertiary Care Hospital, so more likely to have patients with chronic disability and depression.

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TABLES

Table 1- Age Distribution of the Study Population According to Sex (n= 290): AGE Sex TOTAL Male (%) Female (%) 60-65 yrs 39(39.8%) 85(44.3%) 124(42.8%) 66-70 yrs 29(29.6%) 54(28.1%) 83(28.6%) 71-75 yrs 6(6.1%) 18(9.4%) 24(8.3%) 76-80 yrs 18(18.4%) 17(8.9%) 35(12.1%) >81 yrs 6(6.1%) 18(9.4%) 24(8.3%) Total 98(33.8%) 192(66.2%) 290

 

Table 2- Socio-Economic Classification-

Social class	Frequency (%)
I- Upper High	0(0.0%)
II- High	3 (1.0%)
III- Upper Middle	21 (7.2%)
IV-Lower Middle	86 (29.7%)
V- Poor	83 (28.6%)
VI-Very Poor	97 (33.4%)
Total	290 (100.0%)

 

Table 3- General unspecified, blood, endocrine and skin morbidities. (n=290):

		Elderly having morbidity (%)
General and unspecified (n=290)	Generalized pain	39 (13.4%)
	Fever	24 (8.3%)
	Weakness	87 (30.0%)
	Fainting	12 (4.1%)
	Trauma	8 (2.8%)
	Malaria	3 (1.0%)
	Total	173 (59.7%)
Blood (n=290)	Anemia	164 (56.6%)
Endocrine (n=290)	Diabetes	24 (8.3%)
Skin (n=290)	Pruritus	12 (4.1%)
	Skin infection	3 (1.0%)
	Chronic ulcer	11 (3.8%)
	Total	26 (9.0%)

 

Table 4- Eye, ear and musculoskeletal problems (n=290):

		Elderly having morbidity (%)
Eye(n=290)	Refractive error	61 (21%)
	Cataract	140 (48.3%)
	Total	201 (69.3%)
Ear (n=290)	Hearing complaints	42 (14.5%)
Musculoskeletal (n=290)	Fracture	11 (3.8%)
	Joint symptoms/complains	191 (65.9%)
	Total	202 (69.7%)
Digestive system(n=290)	Abdominal pain	11 (3.8%)
	Heart burn	6 (2.1%)
	Flatulence/gas/belching	24(8.3%)
	GI Malignancy	6(2.1%)
	Total	47(16.2%)

 

Table 5- Cardiovascular and respiratory complaints (n=290)

		Elderly having morbidity (%)
Cardiovascular (n=290)	Palpitation	6 (2.1%)
	Hypertension	99 (34.1%)
	Stroke	6 (2.1%)
	Total	111 (38.3%)
Respiratory (n=290)	Shortness of breath	27 (9.3%)
	Cough	28 (9.7%)
	Upper Respiratory Tract Infections	8 (2.8%)
	Chronic bronchitis	12 (4.1%)
	Asthma	3 (1.0%)
	Total	78 (26.9%)

 

Table 6- Neurological and psychological problems (n=290)

		Elderly having morbidity (%)
Neurological (n=290)	Headache	6 (2.1%)
	Tingling hands/feet	7 (2.4%)
	Paralysis /weakness	2 (0.7%)
	Epilepsy	3 (1.0%)
	Total	18 (6.2%)
Psychological (n=290)	Sleep disturbances	21 (7.2%)
	Stammering/stuttering/tic	8 (2.8%)
	Memory disturbance	8 (2.8%)
	Total	37 (12.8%)

 

Table 7 – Breasts, Genital and Urological problems.

		Elderly having morbidity (%)
Female genital (n=192)	Lump in breast	4 (2.1%)
	Prolapsed uterus	7 (3.6%)
	Total	11 (5.7%)
Male genital (n=98)	Hydrocoele	5 (5.1%)
	Total	5 (5.1%)
Urological (n=290)	Painful urination	12 (4.1%)
	Incontinence of urine	9 (3.1%)
	Total	21 (7.2%)

 

Table 8- Prevalence of Obesity among Elderly (n=290):

Classification according to BMI	Number of elderly (%)
Underweight	49 (16.9%)
Normal	127 (43.8%)
Overweight	41 (14.1%)
Obese I	47 (16.2%)
Obese II	26 (9%)
Total	290 (100.0%)

 

Source of Support: Nil. Conflict of Interest: None