European Journal of Cardiovascular Medicine

Older adults' health issues are a vital part of any system that delivers health care. On April 7, 1999, the world health day topic was "ACTIVE AND HEALTHY AGEING." As stated by Dr. Shigeru Omi, the former Western Pacific Regional Director of WHO, "Our goal is not only to add years to life, but to add quality to those years." "The right of the individual must be maintained and protected as they age," he said. The "old old" is typically defined as being 70 to 79 years old, the "young old" as 60 to 69 years old, and the "oldest old" as 80 years and above¹

In India, the age of sixty is typically used to categorize people as elderly, whereas in the United States, the United Kingdom, and other western nations, it starts at age sixty-five. It is a normal process to age. Seneca once said, "Old age is an incurable disease." Nevertheless, Sir James Sterling Ross stated in a more contemporary statement that "you do not heal the old age, you protect it, you promote it, and you extend it"².

Chronic conditions such as hypertension, diabetes mellitus, cancer, cardiovascular illnesses, arteriosclerosis, kidney disease, Parkinson's disease, arthritis, dementia, etc. are common among the elderly. Elderly people frequently experience speech deterioration, vision impairments, hearing loss, and other chronic diseases, all of which can lead to social isolation. Men are more likely than women to have the disease in both rural and urban areas, which is likely due to behavioral differences, according to data from the National Sample Survey (NSS) carried out by the National Sample Survey Organization (NSSO 2011)³. An additional widespread issue among the elderly is malnutrition; 30% of them are undernourished⁴.

The risk of stroke increases sharply with age; individuals 75–84 years old have a ten-fold higher risk of stroke than those 55–64 years old⁴. Chronic disease-related disability is also a significant issue, as evidenced by a research conducted in Kolkata's rural areas⁵, where 23.8% of people were disabled. Health systems and social support networks in many less developed nations, where people are becoming older before they become wealthy, are facing new challenges as a result of the growing elderly population. An essential issue that significantly affects the senior population's quality of life is their health⁶.

The medical and socioeconomic issues that India's senior population faces must be brought to light, and methods for raising their standard of living must also be investigated. Perceived health, particularly psychological well-being, chronic illnesses, and functional status are the main components of health status. Hence the present study was undertaken to study the socio-demographical factors and health problems of elderly population.

OBJECTIVES:

1. To study the socio-demographic profile of the elderly population in the field practice area of Rural Health Training Centre.

^{2. To study the health problems among the elderly population in the field practice area of Rural Health Training Centre.} 

Study Design: Community based cross-sectional study.

Study area: The study was conducted at village Venkatachalam which is one of our villages in the field practice area, under department of community medicine, Narayana Medical College, Nellore. 

Study Period:  1 year (October 2019 to September 2020).

Sample size: Study consisted a total of 290 subjects.

The sample size was calculated according to the prevalence of morbidity of 58.1% among elderly people as shown in the study done by MA Ansari, Z. Khan, N. Khalique, S. Khalil in the rural area of Aligarh⁷.

Ethical consideration: Institutional Ethical committee permission was taken before the commencement of the study.

Study tools and Data collection procedure:

Survey instrument: The questionnaire contains six parts

The First part consists of personal data. It specifies the name, age, sex, religion, education, occupation, marital status, living arrangement, and approximate per capita monthly income. The Second part specifies data regarding habits like tobacco, alcohol, or any other medicine use. The form of tobacco use like smoking, chewing, or snuff was determined. The subjects were classified as current users, former users, and non- users. Current consumers are those who were presently consuming tobacco or alcohol. Former consumers used to consume tobacco or alcohol earlier, but not during the past year. Non-consumers were those who never consumed any of them. In the third part, the functional status was assessed. Difficulty during the past year in vision, hearing, chewing, and walking was evaluated, and the use of any aid like spectacles, dentures, hearing aid, or walking aid was asked. The reason for not using the aid was also assessed. According to the International Classification of Primary Care, the Fourth part consists of a list of common morbidities, WONCA International Classification Committee (WICC). In the fifth part, Activities of Daily Living were assessed using the ADL scale ( basic and instrumental), PADL ( physical activities of daily living), and IADL ( Instrumental activities of daily living) from the KATZ scale were used to assess ADL. The Sixth part consisted of Patient Health Questionnaire-9(PHQ-9), translated into a local language, which assessed depression in older people.

Statistical analysis: The data was entered into MS Excel, & the statistical analysis was carried out with IBM SPSS Version 20.0. The data values for categorical variables are expressed as numbers and percentages. The data values for continuous variables are shown as mean & standard deviation.

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

Rounded to 290.

Sampling Technique:  A systematic random sampling technique was followed for data collection.

Inclusion criteria: Both males and females aged 60 years and above, willing to participate in the study were  included.

Exclusion criteria:

• Houses that are locked.

Older people were not willing to participate in the study

A total of 290 older people were studied in that area, out of whom 87 (30% ) were females, and 203 ( 70% ) were males.

Table 1: Age-wise distribution of the study Participants According to Sex (n = 290 )

Out of 290 village elderly, 30% (87) were females and 70% (203) were males. Maximum numbers of elderly (55.2%) were in the age group 60 - 65 years. Only 0.5% of them were above 80 years. Among males, 52.7% were in the age group of 60 - 65 years, and 31% were in 66 - 70 years. Among females, 60.9% were in the age group of 60 - 65 years, and 28.7% were in 66 - 70 years.

In our study, most of them, i.e., 85% were Hindus, followed by 8% Muslims and 7% Christians.

Table 2: Literacy Status of Study Participants According to Sex ( n = 290 )

The literacy status of the study population according to their sex. It shows that 44.5% of them were illiterates. The majority of elderly females (56.3%) were illiterate, and only 8% had primary or secondary education.

In our study, 32.5% of males were engaged in Agricultural work, and 32.5% could not do work. Among females, 48.3% were unable to do work, and 19.5% were working as laborers. The majority of the elderly were unable to do work because of their disability. Out of 290, 131(45%) of the elderly were receiving the pension, and 159 (55%) were not receiving the assistance.

In our study only 48.3% of elderly males and 19.5% of elderly females were economically independent 19.5% of elderly females were financially independent.

Table 3: Socio-Economic Classification of Study Participants

The socio-economic status of the elderly according to modified BG Prasad classification. It shows that 59.7% of the elderly were lower- middle class and 27.9% were low, respectively. Only 2,8% of elderly adults were high class, and 1.7% were upper high class. It was found that of elderly were living in their own house, had a kutcha house, had semi pucca house, and had a pucca house.

43.8% of males and 13.8% of females used tobacco. Of those who used tobacco, 61. 38% of males and 9.90% of females were current users of tobacco. 26.6% of males and none of the females were using Alcohol. Of those who are using Alcohol, 68.5% of males and none of the females were current alcohol users.

Table 4 - Showing Classification of Study Participants according to BMI (n=290)

Underweight and obesity were defined according to the BMI. Table 40 shows that 21% of the elderly populations were underweight, 13.4% are overweight, 15.9% are pre-obese, and 2.4% are obese.

Table 5: Psychiatric morbidities in Study Population (n=290)

30.3% elderly population had sleep disturbance followed by suicide tendency in 5.2%.

Table 6: Digestive system morbidities in Study Participants (n=290)

33.8% of older people had heartburn, followed by constipation in 13.4%.

 Table 7: Eye morbidities in Study Participants (n=290)

43.1% elderly had vision problems in the form of a cataract followed by refractive errors in 7.2%.

Table 8: Cardiovascular system morbidities in Study Participants (n=290)

27.2% of the elderly population had hypertension.

Our study showed that 53.4% of the elderly had difficulty in vision. Out of those who had trouble in vision (155), only 15.48% (24) used a visual aid. And 25.9% of the elderly had difficulty in hearing. Of them, 97.3% are not using any aid for their hearing disability. In our study, chewing difficulty was present among 32.4% of the older people. Among them, only 4.2% of them are using aid. 36.6% of the elderly had difficulty in walking. Among them, only 7.5% are using aid for their walking problem. 1.7% of the elderly population are dependent on family members for daily living. 5.2% of the older people are partially dependent. 10.3% of the elderly population were suffering from a mild major depressive disorder.

Our study revealed that 4.8% of the elderly had generalized pain followed by weakness in 3.1%. And 25.2% elderly are suffering from diabetes, and 1.7% with thyroid problems. Pruritus is seen in 6.9% of the elderly population, followed by skin infections in 3.4%. And also 26.2% of the elderly had hearing complaints. 7.6% of older people are suffering from shortness of breath and asthma. 31.4% of the elderly population had tingling in hands/feet, and 10.7% suffered from dizziness. 7.2% of the elderly population suffered from painful urination, and 4.8% had urinary frequency/urgency. 1.7% female elderly population had a lump in the breasts, and 2.4% male elderly population had hydrocele. 89 (30.7%) of the elderly population were suffering from dental caries.

It can be observed that, of the 290 village seniors, the greatest proportion (55.2%) belonged to the 60–65 age group and 30.3% to the 66–70 age group. Similar findings were obtained in the study conducted in the rural area of Tamil Nadu (n=320) by Purty et al.⁸, which revealed that 30.3% of the elderly were in the 66–70 age group and 42.6% of the elderly were in the 60–65 age group. Shashi Kant et al.⁹ conducted a study in a Delhi resettlement colony (n = 233), which revealed that 67.8% of the study subjects were between the ages of 60 and 69. The present study showed that 70% of the study subjects were males, and 30% were females. Our study shows that the majority of them, i.e. (85%) are Hindus, followed by Muslims (8%) and Christians (2%). The study was done by Lena A et al.¹⁰ (n= 213) in Udupi Taluk, Karnataka, showed a similar finding, with 89% of the respondents being Hindu.

44.5% of them, according to our analysis, were illiterate. Eight percent of older ladies had completed their secondary school, while 56.3% were illiterate. In the past, early marriage was seen as a reason why female education was deemed unnecessary. NSS¹¹, 52nd round data indicates that 63% of senior citizens lack literacy. Lena A et al.¹⁰ also revealed that women had a greater percentage of illiteracy (62%). According to a survey conducted by Md Rakibul Islam¹², 61% of the elderly in a rural area of Bangladesh (n=300) lacked literacy.

It was found that 131 (45%) of the elderly are receiving a pension, and 159 (55%) do not receive a pension. 65.5% of females were engaged in household work. The study done by Kamalesh Joshi et al.¹³ (n= 200) showed that 76.5% of the elderly females were engaged in household work. Seventy percent of the elderly were financially dependent on their offspring. 11.9% relied on their spouse, 10.10% on their spouse and kids, and 7.9% on family members. It is comparable to NSS¹¹ data, which indicates that 70% of the elderly are supported by children. According to a study by Asiya Nasreen¹⁴ among senior people from poor socioeconomic strata in Delhi (n = 300), 40% of the respondents stated they turn to their offspring for financial assistance, while 4% indicated they turn to friends and family.

In the present study, 27.9% of the elderly are poor. 2.8% and 1.7% belong to the high class and upper high class, respectively. 59.7% of the elderly were from lower- middle socioeconomic class. It was found that 241(83.1%) of the elderly were living in their own house, 35 ( 12.1% ) had a kutcha house, 76 ( 26.2% ) had a semi - pucca house, and 179   ( 61.7% ) had a pucca house. The findings of the study done by Madhu Jain and Prerna Purohit¹⁵ ( n= 200 ) among the older people living in family and those living in nursing homes suggested that the living status of the elderly had a significant impact on the general health of the elderly.

Obesity was defined according to the BMI, and it showed that 47.2% of the elderly are normal, 21% are underweight. 13.4% are overweight, 15.9% pre-obese, and 2.4% of them are obese. A study was done among the elderly residents of old age home by Neelam wason¹⁶ (n= 56) in Jodhpur, Rajasthan showed that 21.4% of the elderly were underweight, 44.7% were normal weight, and 33.9% were overweight.

10.3% of the older people had a mild major depressive disorder in the present study. P Sengupta¹⁷, in his study in Ludhiana (n= 137), Punjab, showed that 21.2% of the elderly suffered from depression. A study by Madhu mathur¹⁸ in Meerut city ( n=400 ) showed an association between depression and lifestyle, showing that aged women with poor life style showed a higher trend of mild and moderate depression. Another study among the elderly Indians in rural Karnataka by Ankur Barua et al.¹⁹ (n=627) for validation of WHO- Five Well - Being Index reported prevalence of depression among elderly males and females as 19.9% and 22.6% ( overall 21.7%); this difference is because the different scale was used to assess depression in rural Karnataka. A study done among geriatric clinics at a Tertiary Care Hospital by VB Singh²⁰ (n= 116) et al. 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 Rodrigo²¹ (n=100) reported that 69% of the individuals had scores suggesting depression. This can be because these were hospital-based studies in Tertiary Care Hospital, so more likely to have patients with chronic disability and depression.

53.4% of the older people in our study had difficulty in vision. Out of those who had vision difficulty, only 15.4% were using a visual aid. 69% of those who didn't use visual aid felt no need for aid, and 30% did not have money. Venkatrao T et al²²., in their study in rural south India ( n= 974), i.e., Villupuram district in Tamil Nadu, showed that visual disability was present among 56% of elderly individuals and only 33% wore spectacles. The present study showed that 25.9% of the elderly had difficulty hearing, and 2.6% were using aid. The most common reason for not using aid was "no money" (95%), followed by "no need felt" (4%) and " no help from family" (1%). A study done in Chennai by Ravi Samuel²³ showed that 51.3% of the elderly had difficulty hearing.

The average number of morbidities per person is 4.7. In the present study, 75.4% of the elderly had three or more morbidities. Kamalesh Joshi et al.¹³ showed a mean morbidity of 6.9 per person in the rural area and 5.4 per person in the urban area. Also, 93% of the elderly in rural and 73% of the elderly in urban had three or more morbidities. The study was done by SPS Bhatia²⁴ in Chandigarh (n= 361) showed average morbidity of 2 health-related complaints per elderly. 53.1% of the elderly had eye morbidity. Of the eye morbidity, 43.1% had cataracts, and 7.2% had a refractive error. Rahul Prakash et al.²⁵ in Udaipur showed that 70% of the elderly were suffering from ophthalmic problems (cataract 44%, refractive error 24.7%).

Diabetes was found in 25.2% of the older people in our study. A study done in Chapai Nawabganj District of Bangladesh by Md. Moisur Rahman²⁶ (n= 300) showed that 19% of the elderly population had Diabetes. In our study, 27.2% of the elderly had hypertension, and 29.3% had cardiovascular morbidity. A study was done by Sithara Balan V et al.²⁷ (n=800) in Thiruvananthapuram, Kerala, showed that 33.37% of the elderly had hypertension. Respiratory morbidity was found among 21% of elderly individuals. Of whom shortness of breath (7.6%), asthma (7.6%), cough (4.5%) were the most common problems. A study done by Jacob Purty et al.⁸ in the rural part of Tamil Nadu showed that 11.3% of the elderly had a cough. Another study by Rahul Prakash et al.²⁵ in Udaipur, Rajasthan, showed that 36% had respiratory morbidities.

In the present study, skin morbidities were found among 11.7% of the elderly. 6.9% of the elderly reported pruritus. A study done by Shashi Kant et al.²⁸ in Delhi showed a prevalence of skin morbidity among 12% of the elderly. Kamalesh¹³ 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. 53.7% of the elderly population had digestive system morbidity, of whom Heartburn is seen in 33.8% of elderly, followed by Constipation in 13.4%.

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 at least the essential needs of the old people. Also the common morbidities among the elderly should be considered before planning for any intervention. Majority of elderly are out of work force and were partly or totally dependent for monetary terms on their family members, especially elderly females. It requires a policy to meet this need of the elderly.

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