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Year : 2019 | Volume : 7 | Issue : 3 | Page : 91 - 94  


Original Articles
Risk factors of morbidity status among elderly in rural field practice area of a Medical College

Zare VR1, Kokiwar PR2*, Sushma K3, Sonkar V2, Gaiki VV3, Arun Kiran4, Soumya V4, Ramesh B5

1Assistant Professor, Department of Community Medicine, RKDF Medical College, Bhopal, Madhya Pradesh, India

2Professor & HOD, 2Professor, 3Associate Professor, 4Assistant Professor, 5Statistician cum Lecturer, Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India

*Corresponding Author:                                                                                                                 

Email: pkokiwar@gmail.com                                                                                                          

Abstract:

Background: The increase in the expectancy of the life has resulted in the increased elderly population and at the same time increase in diseases of chronic in nature and degenerative diseases. Chronic diseases like diabetes, hypertension, stroke, cancers etc are on the increase

Objective: To study the associated risk factors for various morbidities among elderly population in the rural field practice area

Methods: A community based cross sectional study was carried out among 832 randomly selected elderly persons in the rural area. Common morbid conditions like diabetes, hypertension, gastrointestinal diseases, respiratory diseases, psychological diseases were surveyed. Associated risk factors were studied. Data was analyzed using odds ratio, chi square.

Results: the prevalence of hypertension was 42.4%. It was found to be associated with advanced age of more than 70 years. The prevalence of diabetes was 14.1%.it was found to be associated with lack of physical exercise and alcohol use. The prevalence of gastrointestinal diseases was 26.1%. It was associated with age, lack of physical exercise and alcohol use. The prevalence of respiratory diseases was 6.5%. It was associated with lack of physical exercise, alcohol use. The prevalence of psychological diseases was 2.3%. It was associated with lack of physical exercise.

Conclusion: The most common morbid condition among elderly was hypertension in 42.4%. Lack of physical exercise was the most common risk factor for all the morbidities studied except hypertension.

Key words: risk factors, morbidities, elderly, rural area

INTRODUCTION: 

Globally it has been estimated that about one billion will be above the age of 65 years by 2020. Out of these one billion, 71% will be seen in the developing countries. The overall decrease in the fertility rates as well as the rates of the mortality, there is increase in the expectancy of life. It has been expected that the expectancy of the life will be around 74 years by 2025. 1

The increase in the expectancy of the life has resulted in the increased elderly population and at the same time increase in diseases of chronic in nature and degenerative diseases. Chronic diseases like diabetes, hypertension, stroke, cancers etc are on the increase. 2

In one person, there can be presence of more than one morbidity i.e. one person can have diabetes, hypertension, arthritis etc. it has been reported that 83% of the geriatric people from India were found to have more than three morbid conditions at one point of time. It has been reported from rural India that the mean morbidity per elderly person was 2.77. Data from China suggest that proportion of elderly persons having minimum two morbid conditions was 21.7% and proportion of people having minimum three morbid conditions was 15.9%. 3

The so called multi-morbidity i.e. one person having more than one morbid condition at one point of time can be defined in various ways. Commonly used method is personal interview, clinical examination etc. 4

Simple method is to just count the number of morbid conditions present in the elderly person. It will depend upon how the disease has been defined and the diagnostic criteria used. One study found that when all the known diseases were included 63% had two or more morbid conditions compared to 49% when only eight common conditions were included. 5

It has been found that people from low social classes have more morbid conditions compared to those from upper social classes. And hence if we include only people from upper social classes, then the mean morbidity will be less compared to if we include only people from lower social classes. 6

A person having more morbid conditions will have poor outcomes including poor quality of life. There is possibility of longer duration of the hospital stay. Mortality rate is also higher. 7

Present study was carried out to study the associated risk factors for various morbidities among elderly population in the rural field practice area 

METHODS: 

Study design: Community based cross sectional study

Settings: Present study was carried out in the rural field practice area of Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India

Study period: Present study was carried out from January 2017 to December 2017

Study population and sample size: Present study was carried out among 832 randomly selected elderly people above the age of 60 years in the rural field practice area of Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India

Ethical considerations: Institutional Ethics Committee permission was obtained. Informed written consent was taken from the study participants. Appropriate treatment was offered to those who were found to have any morbidity at the RHTC.

Inclusion criteria:

  1. Age more than or equal to 60 years
  2. Permanent residents of the field practice area

Exclusion criteria:

  1. Severely ill
  2. Not willing to participate

Methodology:

832 randomly selected elderly people were contacted and detailed history, thorough clinical examination was carried out.

Important morbidities like hypertension, diabetes, respiratory diseases, gastrointestinal diseases, and psychological diseases were identified and documented. Risk factors like age; gender, physical exercise, smoking, tobacco chewing, and alcohol use were confirmed and documented.

If the person was on treatment for hypertension, diabetes, respiratory diseases, gastrointestinal diseases, and psychological diseases then the prescription was checked and then they were labeled as having known case of that disease.

Blood pressure was measured and classified as per the standard guidelines. Blood sugar was measured and classified as per the standard guidelines. For psychological disease, the elderly depression scale was used.

Age was confirmed from any government card issued to the elderly person. Smoking was considered if the person gives history of smoking tobacco in any form.

Statistical analysis:

The data was entered in the Microsoft Excel worksheet and analyzed using open epi software which is freely available online. Odd ratio with 95% confidence interval was calculated. Yates corrected chi square was calculated. P value of less than 0.05 was considered as significant. 

RESULTS: 

Table 1: Association of various factors with hypertension 

Risk factors

Hypertension

OR (95%)

Yates corrected Chi square

P value

Yes

No

Total

Age (years)

> 70

108

95

203

1.78 (1.29-2.45)

12.18

0.0002

60-70

245

384

629

Gender

Male

185

251

436

1 (0.76-1.32)

0.005

0.9456

Female

168

228

396

Physical exercise

No

271

346

617

1.27  (0.92-1.75)

1.952

0.1625

Yes

82

133

215

Smoking

Yes

126

154

280

1.17 (0.88-1.57)

0.99

0.32

 

No

227

325

552

Alcohol

Yes

233

298

531

1.18 (0.88-1.57)

1.11

0.29

No

120

181

301

Tobacco chewing

Yes

31

41

72

1.03 (0.63-1.68)

0.0001

0.99

No

322

438

760

Table 1 shows association of various factors with hypertension. The prevalence of hypertension was 42.4%. It was found to be associated with advanced age of more than 70 years. But other factors like gender, physical exercise, smoking, alcohol and tobacco chewing were not found to be associated with hypertension. 

Table 2: Association of various factors with diabetes 

Risk factors

Diabetes

OR (95%)

Yates corrected Chi square

P value

Yes

Yes

No

Total

Age (years)

> 70

25

178

203

Age (years)

> 70

60-70

25

92

60-70

92

537

629

Gender

Male

69

367

436

Gender

Male

Female

69

48

Female

48

348

396

Physical exercise

No

180

535

215

Physical exercise

No

Yes

180

82

Yes

82

53

617

Smoking

Yes

33

247

280

Smoking

Yes

No

33

84

No

84

468

552

Alcohol

Yes

56

245

301

Alcohol

Yes

No

56

61

No

61

470

531

Tobacco chewing

Yes

5

67

72

Tobacco chewing

Yes

No

5

112

No

112

648

760

Table 2 shows association of various factors with diabetes. The prevalence of diabetes was 14.1%.it was found to be associated with lack of physical exercise and alcohol use. It was not associated with age, gender, smoking, and tobacco chewing. 

Table 3: Association of various factors with gastrointestinal diseases 

Risk factors

Gastrointestinal disease

OR (95%)

Yates corrected Chi square

P value

Yes

No

Total

Age (years)

> 70

148

55

203

Age (years)

> 70

60-70

25

92

60-70

162

467

629

Gender

Male

107

329

436

Gender

Male

Female

69

48

Female

110

286

396

Physical exercise

No

178

439

617

Physical exercise

No

Yes

180

82

Yes

39

176

215

Smoking

Yes

73

207

280

Smoking

Yes

No

33

84

No

144

408

552

Alcohol

Yes

105

426

531

Alcohol

Yes

No

56

61

No

112

189

301

Tobacco chewing

Yes

23

49

72

Tobacco chewing

Yes

No

5

112

No

194

566

760

Table 3 shows association of various factors with gastrointestinal diseases. The prevalence of gastrointestinal diseases was 26.1%. It was associated with age, lack of physical exercise and alcohol use. It was not associated with gender, smoking and tobacco chewing. 

Table 4: Association of various factors with respiratory diseases 

Risk factors

Respiratory disease

OR (95%)

Yates corrected Chi square

P value

Yes

Yes

No

Total

Age (years)

> 70

13

190

203

Age (years)

> 70

60-70

13

41

60-70

41

588

629

Gender

Male

36

400

436

Gender

Male

Female

36

18

Female

18

378

396

Physical exercise

No

33

584

617

Physical exercise

No

Yes

33

21

Yes

21

194

215

Smoking

Yes

19

261

280

Smoking

Yes

No

19

35

No

35

517

552

Alcohol

Yes

43

488

531

Alcohol

Yes

No

43

11

No

11

290

301

Tobacco chewing

Yes

3

69

72

Tobacco chewing

Yes

No

3

51

No

51

709

760

Table 4 shows association of various factors with respiratory diseases. The prevalence of respiratory diseases was 6.5%. It was associated with lack of physical exercise, alcohol use. It was not associated with age, gender, alcohol and tobacco chewing. 

Table 5: Association of various factors with psychological disease 

Risk factors

Psychological disease

OR (95%)

Yates corrected Chi square

P value

Yes

Yes

No

Total

Age (years)

> 70

4

199

203

Age (years)

> 70

60-70

4

15

60-70

15

614

629

Gender

Male

9

427

436

Gender

Male

Female

9

10

Female

10

386

396

Physical exercise

No

19

598

617

Physical exercise

No

Yes

19

0

Yes

0

215

215

Smoking

Yes

7

273

280

Smoking

Yes

No

7

12

No

12

540

552

Alcohol

Yes

16

515

531

Alcohol

Yes

No

16

3

No

3

298

301

Tobacco chewing

Yes

0

72

72

Tobacco chewing

Yes

No

0

19

No

19

741

760

Table 5 shows association of various factors with psychological disease. The prevalence of psychological diseases was 2.3%. It was associated with lack of physical exercise. It was not associated with age, gender, smoking, alcohol, and tobacco chewing. 

DISCUSSION: 

The prevalence of hypertension was 42.4%. It was found to be associated with advanced age of more than 70 years. But other factors like gender, physical exercise, smoking, alcohol and tobacco chewing were not found to be associated with hypertension. The prevalence of diabetes was 14.1%.it was found to be associated with lack of physical exercise and alcohol use. It was not associated with age, gender, smoking, and tobacco chewing. The prevalence of gastrointestinal diseases was 26.1%. It was associated with age, lack of physical exercise and alcohol use. It was not associated with gender, smoking and tobacco chewing. The prevalence of respiratory diseases was 6.5%. It was associated with lack of physical exercise, alcohol use. It was not associated with age, gender, alcohol and tobacco chewing. The prevalence of psychological diseases was 2.3%. It was associated with lack of physical exercise. It was not associated with age, gender, smoking, alcohol, and tobacco chewing.

Khanam MA et al 8 found that the prevalence of multi-morbidity was 53.8%. It was more common in females than males, illiterates than literates, single than married. They reported that the prevalence of multi-morbidity was very high in their study area. They stressed that the elderly people need more proper attention by the health care delivery services.

Buvneshkumar M et al 9 noted that the prevalence of depression was 35.5%. They also reported that females, belonging to nuclear family, widowed, unemployed, low social class, financially dependent, existing co-morbidity, were significantly associated with depression. They concluded that proper care should be provided to the elderly for prevention of depression.

Sharma D et al 10 observed that 55% of the elderly were having musculoskeletal problems followed by hypertension in 40.5% of the elderly. 75% of the elderly were taking treatment from one or the other sources. Reasons for not taking treatment were lack of awareness that the diseases were just a normal age related phenomenon and accessibility issues.

Thakur RP et al 11 noted that females were more than males. 58.9% were using tobacco. Visual impairment was seen in 83.3% of the cases and in that the males were more affected than the females. Urinary complaints were 1.68 times more in males compared to females. 29.2% had cataract which was not operated. Hypertension prevalence was 30.7%, diabetes prevalence was 12%, ischemic heart disease prevalence was 7.6%, and dental problem prevalence was 32.6%. Depression was seen in almost half of the elderly.

Vyas S et al 12 found that 47.9% had diarrhea, 22.2% had ARI, 13% had pica, and 9.2% had worm infestations. It was more common in males compared to females. The author suggested improving the health care system at peripheral level to reduce the morbidities among the elderly. 

CONCLUSION: 

The most common morbid condition among elderly was hypertension in 42.4%. Lack of physical exercise was the most common risk factor for all the morbidities studied except hypertension. 

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