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PROBLEMS OF GERIATRIC POPULATION IN AN URBAN AREA
RB GURAV*, S KARTIKEYAN**
*Lecturer; **Associate Professor, Department of Preventive and Social Medicine, Rajiv Gandhi Medical College, Kalwa, Thane 400 605.
This community-based study conducted in an urban slum area has depicted the socio-demographic and health profile of the aged population. The geriatric population comprised 6.4% out of the total population comprising 3,157 individuals. Out of 202 participants in the study, 17.33% were economically active. 32.18% suffered from cataract, 16.34% from hypertension and 9.41% from diabetes. There is an urgent need for interventions in order to cope with the consequences of increasing longevity in the Indian population.
INTRODUCTION
The geriatric population is defined as population aged 60 years and above.[1] The phenomenon of population ageing (defined as increase in the median age of the population),[6] is already a major social and health problem in the developed countries. According to the 1991 census, the geriatric population constituted 6.3% of the total Indian population.[1] As a proportion of the total population, the geriatric population has been steadily increasing over the decades. This rapid growth of the population of the elderly is a challenge to the medical profession, the administration and society. The elderly people suffer from a variety of problems which are increasingly drawing the attention of the Government and the public.
On retirement, the income is suddenly reduced. Economic hardship, with continued low standard of living, affects the body and the mind.[3] Retirement, change in housing, illness or death of spouse greatly affect the physical wellbeing of the aged person.[9] The socioeconomic problems of the elderly are aggravated by the lack of social security,[4] inadequate facilities for health care, rehabilitation and recreation. In most of the developing countries, pension and social security is restricted to those who have worked in the public sector or the organized sector of industry.[4]
The mental changes include impairment of memory, rigidity of outlook and dislike of changing trends (especially sociocultural norms).[2] The social problems have been caused by the break-up of the joint family system, the nuclearization of families, housing shortages in urban areas and the increasing participation of women in the workforce. Women continue to be the health care providers for the elderly at the household level.
Human ageing is characterized by progressive decline (referred to as homoeostenosis) in the homoeostatic reserve of every organ system. This phenomenon is usually evident by the third decade although, the rate and extent of the decline may vary. The decline of each organ system appears to occur independently of the changes in the other organ systems and is influenced by diet, environment, personal habits and genetic factors.[8] The elderly suffer from health problems due to the ageing process[2] like - senile cataract, glaucoma, nerve deafness, musculo-skeletal changes affecting locomotion, failure of special senses and poor reflexes (resulting in accident proneness) and enlargement of prostate in males.
Degenerative diseases and long-term illnesses (also called age dependent diseases by Robert Katzman[7]) also affect the elderly. The most common diseases in this category are ischaemic heart disease, hypertension, diabetes, cancer, respiratory diseases (due to chronic bronchitis and emphysema).[2] These are characterized by an increasing incidence of these conditions in a geometric or exponential fashion, as a function of age.[7] The elderly also suffer from conditions which are in the domain of psychology and psycho-sociology. Diminution of sexual activity, reduction in living standards due to retirement and social mal-adjustment, are some of the major causes.
While the advances in science and technology have prolonged the expectancy of life, population ageing has brought about changes in cultural and social patterns which have deprived the elderly of their social status, quality of life and self-esteem and of a chance to function usefully in society.[3]
The purpose of this study was to delineate the socio-economic and health profile of geriatric population in an urban area.
MATERIAL AND METHODS
The study was conducted in the urban field practice area of a medical college. The study population comprised individuals in the geriatric age group, which was defined as 60 years and above.[1] The house-to-house approach was adopted since this would not affect the daily routine of the respondents, thus ensuring compliance. The complete enumeration technique was used to conduct the present study. The advantage was that the sampling biases would be eliminated. A pre-tested proforma was used for recording the personal details and socio-demographic data like age, sex, occupation, marital status, type of family. The proforma also sought opinion of the respondents about their own status in their families, their levels of economic dependence and satisfaction in life. Their current health problems were recorded. A limitation in this study was that it was not possible to verify certain responses to queries on age, literacy levels, economic status and health problems.
The observations were analysed using appropriate statistical test and discussed.
RESULTS
The total population of the study area was 3,157. Out of this population there was 202 (6.4%) geriatric population as defined above.[1] Out of this 202 geriatric population 97 (48.02%) were males and 105 (51.98%) were females. 61.88% belonged to the age group of 60-64 years and comprised the majority. 3.48% of the subjects were aged 80 years and above (Table 1). Only one subject in this study, a female, was over 100 years of age. According to the 1991 census, the geriatric population in India constituted 6.3% of the total population. A study in rural Tamil Nadu [1] showed that the geriatric population comprised 5.4% and that 7% of subjects were aged 80 years and above. The difference in age composition may be attributed to immigration of young people to urban areas, which changes the denominator for calculations.
TABLE 1
Age-wise distributionAgegroup
(years)Sex Total Males Females Number Percent 60-64 54 71 125 61.88 65-69 16 17 33 16.33 70-74 18 9 27 13.36 75-79 7 3 10 4.95 80+ 2 5 7 3.48 Total 97 105 202 100 Percent 48.02 51.98 100
In the present study, 97 (48.02%) were males and 105 (51.98%) were females. As regards occupation, a total of 14 males and 21 females were economically active. Nine (9.28%) males were working with private establishments and five (5.15%) were self-employed. Out of the economically active women, 10 (9.52%) were self-employed and 11 (10.48%) were working in the private sector. 69 women were housewives. The occupational distribution of the respondents was statistically significant in this study. More than one-third of the individuals (38.61%) had retired from service and were currently not involved in any type of economic activity (Table 2). Nearly 95% of the participants in this study lived in joint families whereas 10 (4.9%) lived in extended nuclear families. Nearly one-half of the respondents (58.42%) were economically dependent on their children. However, one unmarried male (0.49%) revealed that he was economically dependent on a relative. 22 women (10.89%) were widowed and were dependent on their children. A study conducted in rural Tamil Nadu by Elango[1] revealed that only 12% were economically independent. 27% of the aged persons were engaged in some part-time jobs whereas 73% were not economically active. Lack of job opportunities in rural areas may be responsible for the differences in the occupational profiles in these two studies.
TABLE 2
Occupational distributionOccupation Sex Total Males Females Number Percent Traders* 5 (05.15) 10 (27.77) 15 11.28 PVT. Sector* 9 (09.28) 11 (30.55) 20 15.04 Self-employed** 12 (12.37) 08 (22.22) 20 15.04 Employed** 71 (73.20) 07 (19.44) 78 58.64 Total 97 (100.00) 36 (100.00) 133 (100.00) Figures in parentheses indicate percentages. *Economically active at the time of the study. **Not Economically active at the time of the study. 69 women were housewives. Chi Squre = 34.45, Significant at p < 0.001
In the present study, none of the respondents was educated above the 12th standard level. In all, 43.56% of the respondents (65.98% males and 22.86% females), were literate as depicted in Table 3. The difference in the literacy rates for males and females was statistically significant in this study. In comparison, in a rural study conducted in Tamil Nadu, the literacy rates were 52.56% and 10.60% for males and females respectively.[1] Only onemale was unmarried. There were no divorced or separated individuals. 22 (10.89%) were widows compared to only one (0.49%) widower. Elango[1] found that widows outnumbered widowers. These trends may be attributed to the fact that women live longer than males and tend to marry men who are older than themselves.
TABLE 3
Education - wise distributionEducation Sex Total Males Females Number Percent Illiterate 33 (34.02) 81 (77.14) 114 56.44 Primary school 42 (43.30) 23 (21.90) 65 32.18 Secondary schoo l 15 (15.46) 01 (00.95) 16 15.24 Higher secondaryschool 07 (07.22) 00 (00.00) 7 6.66 Total 97 (100.00) 105 (100.00) 202 100 Figure in parentheses indicate percentages. Chi Square = 38.14, Significant at p < 0.001
177 (87.62%) respondents revealed that their status in their families was the same as it was earlier. However, 25 (12.38%) said that their status had deteriorated. As regards queries on satisfaction at this stage in life, 147 (72.77%) reported to be satisfied, 39 (19.31%) were partially satisfied and 16 (7.92%) were not at all satisfied. Perceptions regarding one’s status in family and satisfaction in life have their limitations since they are subjective indicators which are prone to variations.
124 (61.39%) of the respondents were apparently free from health problems at the time of the study. Out of 78 participants who reported various health problems, 29 (37.18%) were males while forty nine (62.82%) were females. The most common health problems were cataract (32.18%), followed by hypertension (16.34%). Two males were diagnosed to be suffering from benign enlargement of the prostate gland. The distribution of various health problems are outlined in Table 4. 17.5% had no apparent illness in Elango’s study[1] in a rural area of Tamil Nadu.
TABLE 4
Health problemsHealth Problem Age group (years) Total 60-64 65-69 70+ Cataract 46 11 8 65 (32.18) Asthma 8 5 3 16 (07.92) Diabetes 12 5 2 19 (09.41) Psychiatric illness 4 1 2 07 (03.47) Musculoskeletal 11 6 5 22 (10.89) Bronchitis 2 1 4 07 (03.47) Hypertension 18 8 7 33 (16.34) Stroke 2 2 6 10 (04.95) Dental problems 9 8 13 30 (14.85) Others 8 4 6 18 (08.91) Total 120 51 56 227 Figures in parentheses indicate percentages.
DISCUSSION
There were 202 persons aged 60 years and above. This constituted 6.4% of the total population in the study area. The majority belonged to the age group of 60-64 years. The occupational distribution and the literacy rates for males and females were statistically significant. About one-third of the individuals had retired from service and were currently not involved in any type of economic activity. Approximately, half of the respondents were economically dependent on their children. The most common health problems were cataract and hypertension.
Old age is the last phase of human life cycle and the duration of this period depends upon the lifestyle enjoyed so far. Old age should be regarded as normal, inevitable biological phenomenon,[2] and ageing is an universal process.
Ageing of the population is an established phenomenon in the developed countries and is also seen in many developing countries. The common problems of the elderly can be tackled by interventions and dedicated team work using economic, social, mental and physical interventions. The purpose of rehabilitation is to promote independence by reducing the impact of disability using special organized therapeutic techniques and by optimising the environment. This is particularly important in geriatric medicine as the prevalence of disability is strongly related to age and is often associated with loss of ability to carry out activities necessary for daily living.[10]
The international organizations like the World Health Organization have focussed on approaching ageing as a part of the life cycle, rather than compartmentalizing the health care of the elderly as an age group set apart from the rest of the population. The WHO has restructured its programme on the health of the elderly and given it a new name - Ageing and Health. The World Health Day Theme for the year 1999 has emphasised the importance of active ageing. Reflecting the rapid ageing of the population worldwide, this area of health care is becoming a dominant concern in the new millennium.[11]
The Government - administered and traditional social security system (like the Provident Fund Schemes and the joint family system respectively) enhance the self-reliance of the elderly and helps them to lead a healthy and productive life. They can benefit society by making use of their skills and abilities which they have acquired during their lives.[5] It has been suggested that Governments can extend the social security coverage to uncovered working populations by devising self-financing schemes based on contributions from workers and employers, in collaboration with co-operatives, non-governmental organizations, trade unions and communities.[4 ]The Indian Government has initiated few schemes for the welfare of the aged. Notable among them are the schemes for assistance to programmes for the aged.
This assistance is available to panchayat raj institutions and voluntary organizations for constructions of old age homes. Senior citizens are entitled to travel-related and income tax concessions and a higher interest rate on money deposited with co-operative banks. Though a National Old Age pension scheme is still to be launched, some state Governments in India have already implemented schemes for financial assistance to elderly citizens without any source of support. The Sanjay Gandhi Niradhar Yojana is one such scheme.
Modern science has shown the way to grow old with grace and good health and as a useful member of the society.[9] The elderly must remain active, promote and sustain friendships, have positive thinking, regular activities, take balanced diet, have adequate rest and realize one’s own limitations.[5]
REFERENCES
1Elango S. A study of health and health related social problems in the geriatric population in a rural area of Tamil Nadu. Indian Journal of Public Health 1998; 42 (1) : 7-8.
2Park K. Park’s Text Book of Preventive and Social Medicine. 15th edition. Banarsidas Bhanot, Jabalpur. 1999; 388-90.
3. Mahajan BK, Gupta MC. Text Book of Preventive and Social Medicine. 2nd edition. Jaypee, New Delhi. 1995; 620-23.
4.Kartikeyan S, Pedhambkar BS, Jape MR. Social security the Global Scenario. Indian Journal of Occupational Health 1999; 42 (2) : 91-98.
5.Panse GA. Reproductive and Child Health (RCH) programme. VR Publications, Pune. 1999; 44-45.
6.Bhende A, Kanitkar T. Principles of Population studies. 6th revised edition, Himalaya Publishing House, Mumbai. 1997; 137-40.
7.Reddy PH. Epidemiological transition in India. Chapter in : Singh SN (Edited) : Population transition in India. BR Publishing Corporation, New Delhi. 1989; 1 : 281-90.
8.Resnick NM. Geriatric Medicine. Topic in : Fauci et al (Edited) : Harrison’s Principles of Internal Medicine. 14th edition. McGraw Hill, New York, USA. 1998; 1 : 37-45.
9.Mansharamani GG. Geriatric Medicine. Chapter in : Sainani GS (Edited) : API Text Book of Medicine. 6th edition. Association of Physicians of India, Mumbai. 1999; 1343-45.
10.Colledge NR. Principles of Geriatric Medicine. Topic in : Davidson’s Principles and Practice of Medicine. 18th edition. Churchill Livingstone, London. 1999; 1118-23.
11.Kalache A, Kickbusch I. Global strategy for healthy ageing. Swasth Hind. Central Health Education Bureau (DGHS). Government of India, New Delhi. 1998; 127.
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