|BRIEF RESEARCH ARTICLE
|Year : 2022 | Volume
| Issue : 3 | Page : 337-340
Intrinsic capacity of rural elderly in thar desert using world health organization integrated care for older persons screening tool: A pilot study
Arvind Mathur1, Pankaj Bhardwaj2, Nitin Kumar Joshi3, Yogesh Kumar Jain3, Kuldeep Singh4
1 Director, Asian Centre for Medical Education, Research and Innovation, Jodhpur, Rajasthan, India
2 Additional Professor, Community Medicine and Family Medicine, Coordinator, School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
3 Demonstrator, School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
4 Academic Head School of Public Health, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Submission||02-Jun-2022|
|Date of Decision||22-Jul-2022|
|Date of Acceptance||22-Jul-2022|
|Date of Web Publication||22-Sep-2022|
Asian Centre for Medical Education, Research and Innovation, Shastri Nagar, Jodhpur - 342 005, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Integrated Care for Older Persons (ICOPE) screening tool helps to address declines in physical and mental capacities in older people. In India, majority of the older population resides in rural areas and there is a paucity of studies that demonstrates the utility of the ICOPE screening tool in India. Thus, a cross-sectional study was conducted to demonstrate the feasibility of using the World Health Organization ICOPE screening tool in a rural population. Comprehensive geriatric assessment of intrinsic capacity revealed cognitive decline in 31.5% (n = 142) participants, diminished mobility 52.1% (n = 235) participants, eye problems in 49.4% (n = 223) participants, and hearing loss in 68.3% (n = 308) participants. Gender difference was statistically significant with mobility limitation (P = 0.005; χ2 = 7.95) and feeling of pain (P = 0.001; χ2 = 15.64), being more in females than males. This tool seems suitable in identifying the intrinsic capacity of the rural elderly.
Keywords: Delivery of health-care, geriatric assessment, integrated, rural population, social support, World Health Organization
|How to cite this article:|
Mathur A, Bhardwaj P, Joshi NK, Jain YK, Singh K. Intrinsic capacity of rural elderly in thar desert using world health organization integrated care for older persons screening tool: A pilot study. Indian J Public Health 2022;66:337-40
|How to cite this URL:|
Mathur A, Bhardwaj P, Joshi NK, Jain YK, Singh K. Intrinsic capacity of rural elderly in thar desert using world health organization integrated care for older persons screening tool: A pilot study. Indian J Public Health [serial online] 2022 [cited 2022 Sep 28];66:337-40. Available from: https://www.ijph.in/text.asp?2022/66/3/337/356617
Population aging is one of the most concerning demographic phenomena of the current times with an ever increase in the geriatric population as a result of declining fertility and increasing longevity. Reports from the World Health Organization (WHO) project 1 amongst every 6 people to be aged 60 or above by the time the world witnesses 2030. In India, the elderly population has risen by 32.7% in the last decade corresponding to a staggering 34 million and further expected to rise by 56 million in the coming decade. This will be associated with its own set of public health issues related to health conditions, diminishing intrinsic capacity, care and finance-related hardships.,
Functional ability to do what a person value is essential for one's well-being, for which, WHO recommended the Integrated Care for Older Persons (ICOPE) approach in 2017, emphasizing the focus on improving the intrinsic capacity and functional ability of an individual as the key toward healthy aging. ICOPE screening tool helps to address declines in physical and mental capacities in older people and the recommendations could serve as the basis for support and inclusion in the national guidelines, primary care programs and essential care packages for universal health coverage to prevent care-dependency. As there is a paucity of studies which demonstrate the utility of the WHO ICOPE screening tool, this study was conducted to demonstrate its feasibility for community-based screening of older people in rural India, where the majority of elderly population resides.
Two rural villages were selected from different tehsils of Jodhpur which is amongst the highest populated districts of Rajasthan, the largest state of India. After due approval from the Institutional Ethical Committee, a cross-sectional study was conducted comprising a total of 451 geriatric people aged 60 years and above through a home-based survey. WHO ICOPE screening was done for a comprehensive geriatric assessment of intrinsic capacity by determining cognitive decline, decline in mobility, malnutrition, sensory loss, depressive symptoms, health risks, and social care and support. In addition, demographic details and information about any habits were gathered and physical examination was carried out to measure vitals. Impact on caregivers was recorded through a questionnaire and risk of abuse of the elderly was recorded through careful observation by the interviewer.
The participants included in the study were found to have a mean age of 68.36 (standard deviation [SD] = 7.73) years ranging from 60 years to 98 years and maximum participants (n = 175; 38%) aged between 60 and 64 years. Among these, males were 54.5% (n = 246) with the mean age of 67.84 (SD: 6.68; range: 60–98) years and females were 45.5% (n = 205) with the mean age of 68.98 (SD: 8.81; range: 60–98) years and. Married individuals were 76.1% (n = 343) and 23.1% (n = 104) were widowed. Majority (68.3%; n = 308) were illiterate and earned their livelihood doing farming (40.8%; n = 184). Almost every participant (91.4%; n = 412) lived with children and their family and did not face any problem related to accommodation (94.9%; n = 428), nevertheless, 12.2% (n = 55) faced difficulties due to finance related issues. The demographic details of the study participants are shown in [Table 1].
On the assessment of the intrinsic capacity, cognitive decline was prevalent in 31.5% (n = 142) participants, while mobility was diminished in 52.1% (n = 235) participants. Eye problems were reported by 49.4% (n = 223) participants, and 68.3% (n = 308) were observed to be suffering from hearing loss. Recent weight loss was reported by 17.5% (n = 79) individuals and appetite loss was reported by 33.7% (n = 152) individuals. Self-reported health was “Good” by 39.7% (n = 179) individuals and “Fair” by 38.4% (n = 173), but nearly half 46.8% (n = 211) of the participants experienced symptoms of some illness, with 63.0% (n = 284) having a pre-existing systemic disease. The pain was experienced by 50.8% (n = 229) of the respondents with a history of fall among 9.5% (n = 43) respondents in the past 12 months. Inability to sleep well was reported in 21.3% (n = 96) and 19.3% (n = 87) reported feeling depressed. Despite these values, 88.5% were able to undertake daily activities independently and 98.9% (n = 446) of caregivers did not feel that the elderly had a negative impact on their lives. The intrinsic capacity decline is illustrated in [Table 2].
|Table 2: Intrinsic capacity decline as per the integrated care for older persons screening tool|
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Limitation in mobility observed with the chair rise test and feeling of pain was found to be significantly associated with gender difference, with more limitation in females than males (P = 0.005; χ2 = 7.95) and more pain felt by females than males (P = 0.001; χ2 = 15.64).
More than half (n = 321; 71.2%) of the surveyed population were found to be using tobacco products of some kind (smokeless, smoked, or both, while 12 (2.7%) participants reported to consume alcohol daily.
A quarter of the study participants (n = 124; 27.5%) were found to have an elevated systolic blood pressure (>140 mmHg) suggestive of systolic hypertension, out of whom, 66 (32.2%) were females and 58 (23.6%) were males. Elevated blood sugar levels were observed in 23 (5.1%) participants with 8 (3.9%) females and 15 males (6.1%).
More than a third of study participants (n = 180; 40%) did not require caregivers support while another third (n = 165; 36%) admitted that they were not able to undertake any domestic activities like cooking and shopping. More than 90% of respondents were observed to have no risk of abuse and had a supportive caring family.
This feasibility study revealed that the majority of the participants were illiterate and earned their livelihood doing farming. These results are line with others surveys and studies conducted among rural elderly population of India. Various studies have mentioned that in elderly population in rural India is far more illiterate as compared to elderly living in urban areas. The low literacy status negatively impacts the health-care utilization and makes rural elderly more vulnerable in terms of having poor health outcomes. Results of this study also coincides with the findings of the other studies that mentions that most elderly in rural areas are mostly self-employed in the agriculture sector and related occupations and have with no retirement age or pension benefits. Poor and illiterate elderly in rural areas has a higher rate of untreated morbidities due to lack of access and means to use health care facilities. ICOPE screening tool can be very useful for identifying poor physical and mental function in such population experience chronic conditions.,,
In this study, cognitive decline was found in more than 30% of the rural elderly which is considerably higher than depicted in other studies conducted in other states of India. The reason for this might be attributed to the method used is determining cognitive decline as per the ICOPE screening in comparison to other studies which used MMSE scale.
More than half of the participants reported to have limited mobility. As there is a paucity of studies about mobility limitation in the elderly in India and available studies have shown mobility impairment to be associated with increased risk of falls, more studies are need to augment the findings in rural context.
Eye problems were observed in half of the participants. Similar findings were disclosed in the first Longitudinal Ageing Study in India. This study provided insight into the extent of vision-related disorders among India's elderly. According to the Longitudinal Ageing Study of India (LASI) study, 45% of elderly has vision-related problems in the state of Rajasthan. In the elderly population, nonworking status, economic dependency, illiteracy, and tobacco use are supposed to be linked to visual impairment. Those with visual impairment have a lower quality of life when it comes to eyesight. Studies have shown that elderly people with eye problems have a lower quality of life and are more likely to be depressed. There is evidence that having poor vision increases the risk of falling in elderly people.
According to the WHO, older persons and people of all ages with preexisting medical issues are more likely than others to suffer a serious illness. This study revealed that more than 60% elderly has preexisting systemic disease. India Report on LASI Wave-1 also revealed that more than 70% elderly in India suffer from chronic diseases. By 2030, the elderly are predicted to bear 45% of the entire burden of diseases, the majority of which are non-communicable. Therefore, adequate investment in aged healthcare and effective policies as well as their timely management is critical.
The WHO ICOPE screening tool has provided a good yield in identifying the intrinsic capacity of rural elderly. This tool seems suitable for identifying rural individuals with poor physical and mental function.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bloom D, Luca D. The Global Demography of Aging. In: Handbook of the Economics of Population Aging. Vol. 1. North Holland; 2016. p. 3-56.
World Health Organization. Integrated Care for Older People (ICOPE) Implementation Framework: Guidance for Systems and Services. World Health Organization; 2019. Available from: https://apps.who. int/iris/handle/10665/325669
. [Last accessed on 2022 Jan 31].
Srivastava S, Gill A. Untreated morbidity and treatment-seeking behaviour among the elderly in India: Analysis based on National Sample Survey 2004 and 2014. SSM Popul Health 2020;10:100557.
Sathyanarayana KM, Kumar S, James KS. Living Arrangements of Elderly in India: Policy and Programmatic Implications. In: Giridhar G, Sathyanarayana KM, Kumar S, James KS, Alam M, editors. Population Ageing in India. Cambridge: Cambridge University Press; 2014. p. 74-95.
Sharma D, Mazta SR, Parashar A. Prevalence of cognitive impairment and related factors among elderly: A population-based study. NTR Univ Health Sci 2013;2:171-6.
Barker AL, Nitz JC, Low Choy NL, Haines TP. Mobility has a non-linear association with falls risk among people in residential aged care: An observational study. J Physiother 2012;58:117-25.
Lord SR, Smith ST, Menant JC. Vision and falls in older people: Risk factors and intervention strategies. Clin Geriatr Med 2010;26:569-81.
[Table 1], [Table 2]