|Year : 2011 | Volume
| Issue : 1 | Page : 25-29
Geriatric health: Need to make it an essential element of primary health care
Sunil Agrawal1, Jayant Deo2, AK Verma3, Atul Kotwal4
1 Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Commanding Officer, SHO, Namkun, Jharkhand, India
3 Commandant, Military Hospital, Dehradun, Uttaranchal, India
4 Professor, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Web Publication||30-Jun-2011|
Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune - 411040, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Within the next few decades, we will see an extraordinary increase in the number of older people worldwide. The public health benefit of preventive medicine in old age comes from the compression of the time spent in dependency to a minimum. A community-based, cross-sectional study was conducted to assess the morbidity profile of the geriatric population in a rural area of Maharashtra. A total of 214 subjects, of age 60 years and above, were examined. Data were collected by structured interviews and clinical and laboratory examinations. Out of the total of 214 subjects, 190 were suffering from some or the other diseases and the major morbidities were visual (56%), musculoskeletal (38.3%), respiratory (32.7%), and hypertension (28%). Anemia was present in 62.6%, 5.61% had Diabetes Mellitus and 22.5% were found to be overweight. The average morbidity load was 2.61. The rising morbidities clearly showed that a regular, complete health checkup of the elderly should be embedded in the essential elements of the Primary Health Care. This would reduce the morbidity, improve the quality of life, and facilitate 'Active Aging'.
Keywords: Elements of primary care, Geriatric health, Preventive care
|How to cite this article:|
Agrawal S, Deo J, Verma A K, Kotwal A. Geriatric health: Need to make it an essential element of primary health care. Indian J Public Health 2011;55:25-9
|How to cite this URL:|
Agrawal S, Deo J, Verma A K, Kotwal A. Geriatric health: Need to make it an essential element of primary health care. Indian J Public Health [serial online] 2011 [cited 2022 Jun 29];55:25-9. Available from: https://www.ijph.in/text.asp?2011/55/1/25/82540
The decline in morbidity and mortality rates accompanied by an improvement in life expectancy and child survival rates has resulted in a progressive increase in the geriatric population. The ratio of older persons has changed dramatically from approximately one in fourteen in the fifties to about one in four at present. One common myth is that older persons mostly live in industrialized societies. In fact, 60% are found today in developing countries and in 25 years this proportion will have risen to 75%. 
Globally, the number of persons aged 60 years or over is expected to nearly triple, increasing from 673 million in 2005 to two billion by 2050.  India, had 72 million elderly persons above 60 years of age as of 2001, compared to China's 127 million. According to projections, the elderly in the age group of 60 and above is expected to increase from 71 million in 2001 to 179 million in 2031, and further to 301 million in 2051, and 21% of the Indian population will be 60+ by 2050 as compared to 6.8% in 1991. ,
The key features of aging are increased inter-individual variability, complexity, and comorbidity, which is why indicators of quality of care, based on single disease models, work less well among the older than younger people, and the care of the elderly is a major social and health problem in developed countries. In developing countries like India, aging is also associated with poverty, reduction in family support, social isolation, inadequate housing, mental illnesses, widowhood, bereavement, impairment of cognitive functioning, and limited options for living arrangement and dependency toward the end of life. 
The challenge in the twenty-firsy century is to delay the onset of disability and ensure optimal quality of life for older people. At a time when Governments are assessing ways to generate finances for curative and rehabilitative services for the elderly, it may be worthwhile to give due importance to preventive and promotive services for the elderly at the primary health care level. Individualized health promotion and preventive checkups for older people have been shown to be highly effective and are likely to be among the reasons for the falling disability among older Americans to the point of stabilizing healthcare expenditure on older people. , Arthritis is one of the major causes of disability in the elderly age group. It has been estimated that the total cost of the arthritis bill for the United States, in terms of hospitalization, doctor visits, medications, physical therapies, nursing-home care, lost wages, early death, and family discord is over $50 billion dollars annually. Such statistics are not available for India.
This study was conducted to assess the current morbidity profile of older persons in a rural community, to generate data for planning services, so that preventive checkup of the elderly was included as an essential element of primary health care in reducing the overall morbidity. The aim was to suggest recommendations for any changes in approach toward geriatric health care.
A cross-sectional study of the geriatric population was conducted in Kasurdi village, which was selected by the random sampling method, out of the five villages of our field practice area located in Taluka Haveli, Maharastra, between 1 st February, 2007 and 31 st March, 2007. All elderly persons in the age group of 60 years and above residing in the village were included in the study.
A detailed demographic profile of the village was conducted by the residents of the Department of Community Medicine of AFMC over a period of three months (November 2006 to January 2007) by household survey. The total number of persons in the age group of 60 and above were 239, out of which 214 (98 males and 116 females) participated in the study and the remaining 25 were either away from the village or could not be contacted inspite of repeated efforts.
The study was started with sensitization of the villagers. Each individual aged 60 years and above was informed about the survey and its objectives. They were requested to visit the Rural Health Training Center (RHTC) as per the mutually agreed date and time. Repeated house visits were made and only after three visits a person was declared unavailable.
Informed consent was obtained and confidentiality of the information was assured. The schedule of visits, along with the purpose of the study, was also displayed on the blackboards in front of the common place and Gram Panchayat office.
Each individual in the study was subjected to a personal interview and a clinical and laboratory examination. The information was collected on a pre-tested standard schedule. The interview was carried out in the local language by the medical team consisting of six6 residents and two medico social workers, who were trained and briefed about the objectives of the study. The data thus collected were compiled, tabulated, and analyzed using SPSS, Ver 14.0.
The clinical examination included a general physical and systemic examination. Height was measured in the standing position with the bare feet on a portable stadiometer and was calculated to the nearest 0.5 cm. Body weight was measured in kilograms using a spring weighing machine, to the nearest 0.5 kg, with light clothes on. Blood pressure was measured twice using a mercury sphygmomanometer from the right arm, with the elderly in the lying position. The Korotkoff phases I and V were recorded for systolic and diastolic pressures, respectively. If high BP was detected, two more readings were taken early morning, on different occasions, to confirm hypertension. They were subsequently graded as: Normotensive systolic BP < 140, diastolic < 90 mmHg; Hypertensive systolic BP ≥ 140, and diastolic ≥ 90 mmHg. 
Chronic systemic diseases, with established diagnosis by a specialist in that field was considered as a positive case, whereas, acute and chronic systemic diseases found by the investigators were investigated and confirmed by a specialist before being considered positive for the study.
The laboratory tests included hemoglobin estimation by Sahli's method, random blood sugar by an electronic glucometer, urine examination for albumin, and sugar by Uristic and Diastic. All these investigations were conducted at the time of examination or an appointment was given on the following days as per the convenience of the individuals. Patients found to have high random blood sugar (as per the WHO criteria) were asked to get both fasting and postprandial samples done on the next day for confirmation.
Out of the 214 elderly examined, 24 (11.2%) were found to be completely fit, while 190 were found to have one or more than one morbidity. Details have been provided in [Table 1]. The major morbidities belonged to the Diseases of the Eye, Musculoskeletal and Respiratory systems, Hypertension, and Dental. Details of important health problems among the study participants is given in [Table 2].
|Table 1: Morbidity profi le of study participants as per sex distribution|
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About 28.6% males and 17.3% females were found to be overweight (BMI ≥ 25). The overall prevalence of overweight was found to be 22.5%. However, 8.4% were also found to have underweight (BMI < 18). Taking a cutoff of 12 gm% Hb, the overall prevalence of anemia was 62.6% and prevalence in females was 65.5%. Random blood sugar level (BSL) was found to be 140 mg/dl or higher in 14 (6.5%) subjects. Fasting and postprandial BSL were then tested for these 14 individuals and 12 were then diagnosed to be suffering from diabetes mellitus, by the specialist concerned.
In our study, the average number of illnesses per person was found to be 2.61, which was in consonance with the studies among the elderly in South India, 2.42,  but higher than the elderly in rural North India, 1.93.  The distribution of morbidities found in our study was also similar to the findings in an urban setting of Gujarat. 
The presenting symptoms of the same disease may vary in the elderly in comparison to the younger population.  The leading cause of diminished vision in developing countries is cataract, which is also found in the present study (37.3%), whereas, among all eye cases cataract is present in 68.3%. It is almost similar to that found in other studies in the urban area of Rajasthan, 44%,  and rural areas of Kancheepuram district, 32.1%.  Cataract in the rural population may be due to increased exposure to ultraviolet radiation during long hours of work in open fields.  A matter of concern is the increase in cataract in the rural population during last few decades.
A high prevalence of arthritis / joint pain (38.3%) in the current study, especially among females, has also been reported in other studies. ,, This high prevalence in our study and also in other studies shows that preventive and promotive care at the primary health care level for the elderly in this aspect is an urgent necessity as it would improve their quality of life and save subsequent morbidity and a demand on the health care system for joint replacements and other expensive surgical procedures.
Our study finding of 28% prevalence of hypertension is higher than that found in Varanasi, 11.25%,  but much lower than the World Health Organization (WHO) report of 56%,  and also among the rural elderly in Haryana, India.  This low prevalence of hypertension can be attributed to continuous health education and health promotion activities being done in the village by the residents of this Medical College.
The body mass index (BMI) is a useful index for defining obesity and chronic energy deficiency (CED) at the community level.  It was observed that 8.4% of the elderly were thin and 22.5% were overweight, in contrast to the study done in Tamil Nadu where 49% of the elderly were thin and 9.7% overweight. 
Anemia was the most common morbidity, with over half of the population (62.6%) suffering from it. A study carried out in the Southern part of India reported a higher prevalence of anemia (82.9%) in the 60 years and above age group.  Anemia in the elderly may be multifactorial, with etiology as varied as nutritional, physiological, and pathological.  The presence of diabetes mellitus in 5.6% of the elderly further reflects the epidemiological transition and increasing burden of lifestyle diseases in the rural communities.
Randomized studies in Japan and Taiwan have clearly demonstrated a strong positive correlation between preventive services for the elderly at the primary care level and subsequent reduced morbidity and mortality. , The international organizations like the World Health Organization have focused on approaching aging as a part of the life cycle and restructured its program on the health of the elderly, given it a new name - Aging and Health. Healthy elderly can benefit society by making use of the skills and abilities, which they have acquired during their lives.
In our study we are recommending endeavors, including collecting prevalence / incidence data; conducting public health surveillance; identifying the best practices for prevention, diagnosis, management, and care of arthritis; promoting community-based and patient self-management programs and activities; developing public information and education programs; expanding physical activity programs; and informing the public about nutrition education opportunities.
The elderly deserve better than to be squeezed uncomfortably into a single disease model, designed to best assess the benefits and harms of treatment in younger populations. Effective preventive and promotive health care at the primary level will help them lead a socially productive and disability-free life.
This study among the elderly in the rural area of Maharashtra, India, has highlighted a high prevalence of morbidity and identified the common existing medical problems. Strengthening of geriatric health care services in accordance with the common existing problems, especially preventive and promotive services in the community, are required. Further qualitative research is needed to explore the depth of the problems of the geriatric age group. Efforts in this direction and follow-up of the elderly have already been initiated by the Department of Community Medicine of our Medical College.
| References|| |
|1.||WHO. The Global Embrace, Aging and Life Course. In: The Global Embrace Handbook. Geneva: World Health Organization; 2001. |
|2.||UN. The World Population Prospects: The 2006 Revision. Executive Summary. United Nations, New York: Dept of Economic and Social Affairs; 2007. |
|3.||Rajan SI, Sarma PS, Mishra US. Demography of Indian aging, 2001-2051. J Aging Soc Policy 2003;15:11-30. |
|4.||UN. The Sex and Age Distribution of Population. United Nations, New York; 1990. |
|5.||Chandwani H, Jivarajani P, Jivarajani H. Health and social problems of geriatric population in an urban setting of Gujarat, India. Internet J Health 2009;9:2. |
|6.||Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, Guralnik JM, et al. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 2006;61:1157-65. |
|7.||Manton KG, Gu X, Lamb VL. Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population. Proc Natl Acad Sci USA 2006;103:18374-9. |
|8.||Hypertension: Management of hypertension in adults in primary care. NICE Clinical Guideline 34. London, England: National Institute for Health and Clinical Excellence (NICE). 2006 Jun. Available from: http://www.nice.org.uk/nicemedia/pdf/CG034NICEguideline.pdf. [Last cited on 2011 Jan 17]. |
|9.||Niranjan GV, Vasundhra MK. A study of health status of aged persons in slums of urban field practice area, Bangalore. Indian J Community Med 1996;21:37-40. |
|10.||Shankar R, Tondon J, Gambhir IS, Tripathi CB. Health status of elderly population in rural area of Varanasi district. Indian J Public Health 2007;51:56-8. |
|11.||Holt PR. Approach to gastrointestinal problems in the elderly. In: Yamada T, Alpers DH, Owyang C, editors. Textbook of Gastroentrology. 2 nd ed. Philadelphia: JB Lippincott Company; 1995. p. 968-78. |
|12.||Prakash R, Choudhary SK, Singh US. A Study of Morbidity Pattern among geriatric population in an urban area of Udaipur Rajasthan. Indian J Community Med 2004;29:35-9. |
|13.||Purty AJ, Bazroy J, Kar M. Morbidity Pattern among the elderly population in the rural area of Tamil Nadu, India. Turk J Med Sci 2006;36:45-50. |
|14.||Angra SK, Murthy GV, Gupta SK, Angra V. Cataract related blindness in India and its social implication. Indian J Med Res 1997;106:312-24. |
|15.||Agarwal A, Advani SH. Anaemia. In: Sharma OP, editor. Geriatric care in India. Geriatrics and Gerontology. A textbook. 1 st ed. India: AONO B Publishers Pvt. Ltd; 1999. p. 421-6. |
|16.||WHO. Epidemiology and prevention of cardiovascular diseases in elderly people. Technical Report Series. 1995;853:52-3. |
|17.||Chadha SL, Radhakrishna S, Ramachandran K, Gopinath N. Epidemiological study of coronary heart diseases in rural population in Gurgaon district (Haryana State). Indian J Com Med 1989;14:141-7. |
|18.||Durnin JV. Low body mass index, physical work capacity and physical activity levels. Eur J Clin Nutr 1994;48 Suppl 3:S39-44. |
|19.||Shetty PS, James WP. Body mass index: A measure of chronic dietary energy deficiency in adults. Rome: Food and Agriculture Organization of the United Nations; 1994. |
|20.||Nakanishi N, Tatara K, Fujiwara H. Do preventive health services reduce eventual demand for medical care? Soc Sci Med 1996;43:999-1005. |
|21.||Chiou CJ, Chang HY. Do the elderly benefit from annual physical examination? An example from Kaohsiung city, Taiwan. Prev Med 2002;35:264-70. |
[Table 1], [Table 2]