Journal of Community Medicine, January 2008, Vol .

4 (2) Original Article

HEALTH STATUS OF GERIATRIC POPULATION ATTENDING THE PREVENTIVE GERIATRICS CLINIC OF A TERTIARY HEALTH FACILITY

* PR Moharana , **NC Sahani , ***T Sahu

* PG Student,** Assistant Professor. Department of Community Medicine,MKCG Medical College, Brahmapur, Orissa, 760004.*** Director SIHFW,Orissa.

Abstract

Objective: To study socio clinical profiles & to assess the pattern of morbidities among geriatric population. Setting: Preventive Geriatrics Clinic of Department of Community Medicine, M.K.C.G. Medical College Hospital, Brahmapur, Orissa. Period of study: July September, 2007. Study design: Hospital based Cross-sectional Study. Participants: 88 elderly persons of age 60 years and above attending Preventive Geriatrics Clinic constitute study population. Statistical analysis: Percentage, Chi-square test. Results: Out of 88 elderly persons who attended the clinic 70(80%) were males. 69 (78%) persons were literate. 57 (65%) were pension holders. 42(48%) persons go for regular exercise daily. 45(52%) persons were vegetarians. 32(36%) persons had history of substance abuse. Half of the study population (51%) was hypertensive. 36 (41%) persons were overweight (BMI25 kg/m 2). 36% had Diabetes mellitus. 23 out of 36 (64%) Overweight persons had hypertension. 33 (37%) had osteoarthritis. Other significant morbidities recorded were Gastro-intestinal disorder (30%), Neuropathies (17%), Dental & Oropharyngeal problems (17%), Visual problems(11%) Impaired Hearing (11%) followed by respiratory and skin problems etc(10-20%). Conclusion: Over weight was found in a good proportion among urban elderly(41%), which was significantly associated with morbidities like hypertension diabetes mellitus and osteoarthritis. Different morbidities could be diagnosed early through periodic screening during regular health checkup and controlled by effective medical and surgical interventions. Behavioral changes for

weight reduction through dietary modification, sticking to regular exercise and avoidance of substance abuse can add quality to the lives of elderly people. Increasing public awareness about geriatric problems & care, healthy life styles and early identification & control of all risk factors will make the geriatric years more joyful.

Key Words: Geriatric, Morbidity, Overweight, Poly-pharmacy.

Moharana Population

Health Status of Geriatric

Introduction

Geriatric population includes the persons who are 60 years and above. They are categorized into young old (60-75yrs), old-old (76-85yrs) and very old (>85yrs)
(1)

. Elderly population contributed to 7% of total population in India in 2001 & it will

rise to 9% by 2016. By 2010, 100 million people will be in this age group (70 million in 2000) and by 2020 it will be 177million. According to an estimate they will constitute one third of total population of the world by 2050 AD
1, 2

Life expectancy in

India has increased from 37 years (1951) to 62 years (2000) due to overall socioeconomic developments and developments in medical science.

Ageing is inevitable. Ageing process is as such complex and multi-factorial. Geriatric health problem is a growing concern due to increase in absolute number of geriatric people and socio-demographic changes in community. There was an attempt by the department of Community .Medicine in M.K.C.G. Medical College, Brahmapur, Orissa to ensure comprehensive health care to this priority group

through Preventive Geriatrics Clinic which started on 13 th July of 2007. A total of 88 elderly persons attended the clinic within a period of problems. 2 months for different health

Materials & Methods Eighty eight elderly persons ( 60 years of age) of Brahmapur town who

attended the Preventive Geriatrics Clinic for different health complaints during JulySeptember, 2007 formed the study population. Data pertaining to each individual were recorded in a pre-designed, pre-tested socio-clinical case sheet. Data included their health complaints, socio-clinical history, and findings of systematic clinical examination and results of appropriate screening tests. Data collection was completed during 1st visit except the results of laboratory examination which were ensured on next follow-up day. Other departments were also consulted whenever necessary for further clinical evaluation. Results Out of 88 elderly persons, 70 (80%) were males & 18 (20%) were females. 58(83%) males were in age group 60-75 years, 9(13%) in age group 76-85 years and 3 (4%) males were above 85 years. All 18 females were in age group 60-75 years. 69 (78%) persons were literate. 57 (65%) of the elderly persons were found pension holders (Tab- I).

Tab- I: Socio-demographic profile of study population (n=88). Characteristics Variables Number %

1. Sex: 80 Female 2. Age group:

Male

70

18 60-75years 76 9 3

20 86 10 4 65

76-85 years >85 years 3. Marital status: 74 Spouse living

Widower Widow Unmarried 4. Literacy: Literate Illiterate

20 2 1 69 19

22 3 1 78 22

5. Socio-economic status:

High Middle Low 60 12

16 68 14

18

6. Living condition in household

Widow/widower living: Alone 9 10 15 22

With family 13 With spouse only 25

with spouse and other family members 7. Accompanying Person: Came Alone Came with Spouse Accompanied by family/others 44 26

44 50 30 18

50

20

45(51%) persons were vegetarians. 32 (36%) persons gave history of regular use of one or more substance(s). 42 (48%) persons go for daily morning and/or evening exercise. 36(41%) were overweight according to their BMI status ( 25 kg/m2 ). Only 12 (33%) persons among overweight elderly persons go for regular exercise daily. It was observed that overweight persons suffer more from health

related problems than persons with BMI <25 kg/m 2. Co-morbidities were found in 66(75%) persons who suffered from 2 or more diseases (Tab- II ).

Tab- II : Personal & behavioral correlates of elderly population (n=88).

Attributes

Variables

No

1. Food Habits:

Vegetarians Non-vegetarians

45 43

52 48 42

2. Regular exercise: 48

Regular exercise

No exercise 3. Addiction: One/more substance No addiction 4. Body Mass Index: 25 kg/m2 <25 kg/m2 5. Co-morbidities: 1 disease 2 diseases 3 diseases >3 diseases No problem 6. Number of drugs advised: 1 drug 2 drugs 3 drugs >3 drugs (Poly-pharmacy)

46 56 32 36 52 14 28 26 12 8

52 64 36 41 59 16 32 29 14 9

31 14 25 18 20

35 16 29

Majority (51%) lived with hypertension. Mean age at which hypertension was diagnosed among study population was calculated to be 54.2 years (Age range: 30-68 years). 22(49%) hypertensives were overweight.

33 out of 88(37%) had problems related to different joints, clinically diagnosed to be osteoarthritis. Persons with history of exercise used to suffer less from joint related problems.

In total 31(36%) were found to have Diabetes mellitus and 14 were newly diagnosed cases after screening. 20 (65%) of elderly diabetics were type-2 and others were type-1.

Gastro-intestinal disorders include problems of chronic gastritis, constipation, loss of appetite etc and 30% had such health problems.

Tab- III: Distribution of different morbidities among study population.

Type of morbidity Hypertension Overweight Osteoarthritis Diabetes Mellitus Gastro-intestinal Disorder Mental Health Problems Neuropathy Dental & Oropharyngeal Visual Problems Hearing Impairment Respiratory Skin Genito-urinary Coronary Heart Disease

Numbers 45 36 33 31 26 16 15 15 10 10 8 6 5 3 51 41 37 36 30 18 17

17 11 11 9 7 6 4

Different mental health problems in the form of depression, anxiety, sleep related problems, dementia and bereavement were recorded in 16(18%) of elderly persons.68% of widows & widowers suffer from such mental disorders.

Other significant morbidities encountered were Neuropathies (17%), Dental & Oropharyngeal problems (17%), Visual problems (11%), Impaired Hearing (11%) followed by Respiratory (9%) and Skin (6%) disorders (Tab- III).

Polypharmacy (when a person is advised more than 3 drugs excluding vitamins, minerals and anti-oxidants) was recorded in 20% of study population.

Discussion

There are 933 women per 1000 men in India, But in age group 60 years there are 100 women for every 88 men (Sample Registration System Estimates of India, 2003). In present study poor female attendance (M:F::80:20) at the clinic may

be due to lack of awareness about the newly started clinic or other gender issues ignoring health problems of women and affecting voluntary attendance at health care facilities. All females and 83% of males were young old i.e. within 75 years of age.

In an urban set-up literacy status of elderly is high (78%) and 65% have definite financial security (pension holders).Half of them attended the clinic on their own without any attendant.

Morbidity load was found to be 2.92 illnesses per person in this study which is more than that found by R. Shankar et al (2.18 illnesses per person) and Padda et al (2.55 illnesses per person) in their studies
3, 4

. According to Sharma AL frequency of

5.

illness varies from 2.5 to 3.5 illnesses per person

Similar to finding of SPS Bhatia et al 6, 91% had one or more health related problems. Co-morbidities (with 2 or more diseases) were common among 66(75%) persons which is coherent with finding of the National Sample Survey carried out by Govt. of India in 1986-87 7.Chronic illnesses were recorded in 64%.

In a community based study carried out in South India by ICMR in 1984, major causes of morbidity enumerated were Visual Impairment (88%),Locomotor

Disabilities(40%),Neurological disorder(18.7%), Cardiovascular disorder(16.1%) and Skin diseases(13.3%) 8. In our clinic based hospital study on urban elderly, major health problems were hypertension(51%), overweight(41%), osteoarthritis(37%), diabetes mellitus(36%), gastro-intestinal disorders(30%), followed by mental health problems, neuropathy, visual and hearing problems in 10-20% of elderly people.

Hypertension was the most prevalent condition (51%) among study population. It was found in 42% in a study carried out by SPS Bhatia et al in city area of Chandigarh6. R Shankara et all detected hypertension in 11.25% of elderly rural population
3

.This shows higher prevalence of hypertension in elderly persons

living in urban area in comparison to rural area. Mean age at which the hypertension was diagnosed was found to be 54.2 years (Age range: 30-68 years) among study population.

16(18%) persons had various mental health problems like depression, dementia, anxiety, sleep disorders and loneliness etc. These problems were more among widows or widowers and the finding is similar to that of Bhatia SPS et al and Jain

RK et al6,9.In contrast to the present study, prevalence of specific mental health problems in the form of depression(45.47%),dementia(31.45%) were found in higher proportion among elderly persons residing in urban slums in our previous study using mini-mental scoring method(Sahu T & Sahani NC et al) be due to less number of pension holders(17.74%),
10

.This could financial

more

dependence(91.25%), malnutrition(69.9%) and more number of widows (98.75%) among the elderly of slum area.

The

prevalence

of

Diabetes

mellitus

among

study

population

was found to be 36% which was more than the finding of SRS Bhatia et al (11.9%).It was more among males than females. Out of 31cases, 11(35%) cases were Type-1 and 20(65%) cases were Type-2 Diabetes mellitus. In the

community the prevalence of Type-1 cases and Type-2 cases are 15% and 85% respectively 1. The mean age at which Diabetes mellitus among study population diagnosed was calculated to be 53.8 years (Age range: 46-65 years).

41% aged persons were overweight. Although 66(75%) persons were suffering from 2 or more diseases, co-morbidities were significantly found in overweight elderly persons (x2=11.54, df: 1, p<0.001). Overweight was also significantly associated with Hypertension(x2=21.49,df:1,p<0.01), Diabetes

mellitus(x2=20.08,df:1,p<0.01) and joint related disorders(x 2=9.37,df:1,p<0.01). However, only 12 (33%) persons among 36 overweight regular exercise daily. elderly persons, go for

Conclusion

The present clinic based study reflects the extent & pattern of geriatric morbidities in an urban area. The major morbidities were found to be Hypertension (51%), Overweight (41%), Osteoarthritis (37%), Diabetes mellitus

(36%), Gastro-intestinal Disorder (30%) etc. Although it could be associated with iceberg phenomena, social & behavioral attributes were identified significantly associated with major disorders which need supportive and effective interventional measures. Overweight was significantly associated with Hypertension, Diabetes mellitus and Osteoarthritis.

Early identification of geriatric morbidities should be ensured through periodic screening and regular health check-ups. Regular & repeated counseling for monitoring of physical parameters is essential for timely interventions and treatment adherence. Treating physicians must take utmost care to reduce polypharmacy. Behavioral changes for weight reduction through dietary modification & regular exercise and avoidance of substance abuse will add quality to geriatric health.

Correspondence: Dr. Nirmal Chandra Sahani, Assistant Professor, Department of Community Medicine, M.K.C.G. Medical College Hospital, Brahmapur, Orissa,760004. Email:sahaninc@rediffmail.com/ drprabir2007@rediffmail.com

Reference

1. Text Book of Community Medicine, Lal & Adarsha, 1 st Edn,CBS Publishers & Distributors, New Delhi,India,2007.

2. Parks Text Book of Preventive & Social Medicine,19 th Edn, M/s Banarsidas Bhanot Publishers,Jabalpur,India,2007.

3. Shankar R,Tondon J et al, Health Status of Elderly Population in Rural Area of Varanasi District, Indian Journal of Public Health,Jan-Mar,2007,51:1,p:56-58.

4. Padda AS & Mohan V et al, Health Profile of Aged Persons in Urban and Rural Field Practice Area of Medical College, Amritsar, IJCM, 23:2, p: 76-77.

5. Sharma AL, Geriatrics A Challenge for the Twenty First Century, Indian Journal of Public Health,Jul-Sep,2003,47:3,p:16-20.

6.

Bhatia

SPS,

Swami

HM

et

al,

Study

on

Health

Problems

and

Loneliness Among the Elderly in Chandigarh, Indian Journal of Community Medicine,OctDec,2007,32:4,P:255-7.

7. National Sample Survey Organisation (NSSO),Govt. of India ,Socio-economic profile of the aged persons, Sarvekshana, 1991, Vol:15, No.49, p:1-2.

8. Rao AV,Health Care of Rural Aged 1984-88,A Report of ICMR, New Delhi 1990.

9. Jain RK & Aras RY, Depression in Geriatric Population in Urban Slums of Mumbai, Indian Journal of Public Health,Apr-Jun,2007, 51:2, p: 112-113.

10. Sahu T & Sahani NC et al,Functional Status of Elderly Persons Residing in Urban Slums, Indian Journal of Gerontology,17:3&4,p:398-407,2003.

You have a whole lifetime of experience. Combined with advice from doctors and family, by now you know whats best for you. But even experts like yourself need to be reminded of how to lead a healthy lifestyle. Hence, below are a few healthy living quick tips, hot off the healthy living information press. Tip One: Do See Your Doctor Although most of us used our younger years to master the art of avoiding the doctor, it is imperative in our golden years to actually show up to those annoying and mostly hated doctor appointments. Unfortunately, many ailments and disorders are associated with increased age, and it is the reason many doctors organize a battery of tests and appointments for their older patients. Furthermore, perhaps you have certain dietary restrictions or specific prescription medications to take that may prevent you from doing certain exercises, keeping in touch with your physician prior to changing your diet or starting an exercise plan will ensure that both you and your doctor are on the same page when it comes to staying healthy. Tip Two: Dont Ignore Any Aches or Pains Sometimes a pain in your hip can be just that, a pain in your hip, or it could be a sign of something else altogether. As tip one pointed out, do see your doctor if any aches or painspersist. And above all else, stay in tune with and aware of your body so that you can identify the normal aches and pains from the abnormal ones. Tip Three: Know When Youve Done Too Much Are you suffering from sore joints or muscles from your fitness routine? Or have you overextended yourself by agreeing to take care of the grandkids? Be sure to not do too much. Its Ok, and even advisable to stay active, but remember its also equally important to rest. Tip Four: But Remember, You Do Need to Challenge Yourself Although you may be content with your daily routine, every now and then, try to challenge yourself. Being fit and active can also include taking risks and pushing yourself to achieve more. So that triathlon that youve wanted to compete in since you were twenty, why not do it now in your 60s? Tip Five: Keep In Mind the Importance of a Balanced Diet

Try scanning the web for a list of healthy snacks and foods that you can add to your meals to achieve a balanced diet. Many of us tend to eat the same vegetables, fruits, and legumes, when there are so many varieties that we have yet to try. So venture into the unknown and try something different. Its never too late for change! Tip Six: A Healthy Mind Is Just as Important as a Healthy Body Mental health is just as important as physical health and a huge part of mental health comes from being in the company of others. If youre lonely, seek out a group that shares your interests or take up another hobby to meet people. And most importantly, attempt to spend more time with loved ones, even if its just a few minutes a day. Overall, you already know what you need to do to stay healthy in the long run. Good eating habits, a commitment to exercise, and all around just caring for YOU will ensure a long, healthy, life.