The unprecedented increase in human longevity in the 20th century has resulted in the phenomenon of population aging all over the world. Countries with a large population like India have a large number of people aged 60 years (or) more, facing the biggest challenges against active aging. The National sample survey organization (64th round) revealed that the perception about their own health in the geriatric age group was that, 55%–63% of the population felt that they were in good or fair condition of health; In contrast to the above, 13%–17% of the population reported poor state of health without any sickness. This observation has lot of significance as self-perceived health status is an important indicator of health service utilization and compliance to treatment interventions.
There is a decreasing trend in the intrinsic capacity of elderly with common problems such as functional and cognitive impairment, affective disorders, visual and hearing problems, self-neglect and elder abuse, malnutrition, eating and feeding problems, sleep problems, and even dizziness and syncope which are the clinical conditions that do not fit into any discrete categories constituting the term “Geriatric syndromes.” There is a strong evidence that there is inverse relationship between multimorbidity and quality of life (QOL).
The comprehensive health of the geriatric population is influenced by multiple factors such as psychological; mental health, financial security, social involvement, their health perception, and life satisfaction. Their beliefs that there is no treatment available for their problems, older people may disengage from services, not adhere to treatment or not attend primary health care clinics. Therefore, there is a pressing need to develop comprehensive community-based approaches and to introduce interventions to prevent declining capacity and provide support to informal caregivers. Thereby, the concept of integrated care for older people has come up.
Hence, to measure the above dimensions in the elderly age group this study has been taken up with an objective to assess the psychosocial medical needs and their association with well-being among the Geriatrics in the Indian setup.
MATERIALS AND METHODS
Study design and setting
A community-based cross-sectional study was conducted at urban field practice area of teaching tertiary care institute in Hyderabad city of Telangana state.
June 2019 to September 2019.
In the study, all the participants aged 60 years and above and who had given the consent were included in the study. Participants whose age was below 60 years, not willing to participate and who were bedridden were excluded from the study.
Sample size was calculated using the formulae 4pq/l2 where the prevalence of psychosocial medical problems was 81%; and was taken as 116 (including 10% as nonresponse rate it was rounded to a total of 140).
Data collection tools
Pretested and predesigned questionnaire consisting sociodemographic variables, psychosocial medical needs were assessed using an “Integrated Care Tool-Brief” Questionnaire designed by the Department of Geriatric Medicine, AIIMS, New Delhi was adopted after taking approval through mail to use the questionnaire. This questionnaire created was a simple, easy to understand, socioculturally acceptable, less time-intensive, and self-assessment tool to screen the health needs of the geriatric population at their door steps. This is rated on Likert scale 1–5 which included domains such as physical, functional, psychological, mental health, geriatric syndromes, financial security, social involvement, and elder abuse; physical domain included the questions on vision, hearing, fall, chewing, deglutition, and eating; mental health included questions on depression, restlessness, forgetfulness, and sleep problem. Geriatric syndrome 1 and 2 included ability to dress up, difficulty in urination, getting up from chair or floor, urinary incontinence, constipation, going out of house per week, weight loss, polypharmacy, and hospital admission. Social involvement and financial security included questions related to social sharing and safety at home, financial management, safety outside home, and neglect at home. Physical and mental abuse were included for the elder abuse. Along with this, their overall well-being was assessed both on subjective evaluation of health by their self-perception and objective assessment with any of the morbidities they suffered in the last 1 month. With the help of medico social workers, about 220 households were contacted to reach the desired sample size in the community. Trained team of Community Medicine explained the purpose of the study and collected data which took 30–40 min for each participant.
Institutional Ethical Clearance approval was obtained (IEC-F027/11-2017) before the study. The purpose of the study was explained in detail to seek their permission and written informed consent was obtained from the participants either by signature or by fingerprint mark on the forms.
Data were entered in Microsoft Excel 2010 version developed by Microsoft corporation, (Redmond, Washington, United state of America) and analyzed. Descriptive statistics such as frequency, mean ± standard deviation were used and the binary logistic regression analysis was adopted with dichotomous variable of well-being as an outcome to assess the association between various predictor domains and well-being.
Socio demographical variable of our study participants
Community-based assessment of our study included 140 respondents consisting of 64 (45.7%) males and 76 (54.3%) females. The age-wise distribution of the demographic data included 84 (60%) between the age group of 60–70 years, 45 (32.1%) between 71 and 80 years, 9 (6.4%) between 81 and 90 years, and above 90 years were very few with 2 (1.4%), respectively. As per their marital status – unmarried were 2 (1.4%), married 94 (67.1%), widow/widower 32 (22.9%), and separated were 12 (8.6%). Living arrangement depicted as single among 1 (0.7%), nuclear family 17 (11.4%), joint family 113 (80.7%), and three-generation family 10 (7.1%). Educational status illustrated in Figure 1. Occupation wise distribution depicted 65 (46.4%) were retired and unemployed, 9 (6.4%) were farmers, 17 (12.1%) were daily wagers, working in private industries 4 (2.9%), clerical/shop keepers were 27 (19.3%), and housewives were 18 (12.8%).
Assessment of the psychosocial medical needs (domain wise) and their association with overall well-being of the geriatric population
The overall well-being was found to be affected among 102 (72.9%) of our respondents and this was assessed on the basis of subjective evaluation of their self perception self-perception about their health as well as objective emphasis on the common ailments they suffered in the last 1 month [Table 1]. About 101 (72.1%) of them perceived their health to be poor.
On comparison of the mean scores of psychosocial medical domains with the overall well-being, we found higher mean scores with physical, geriatric syndrome 1 and 2, mental health, social and family security, and elder abuse among those whose Overall well-being is affected [Table 2].
These domains were entered into logistic regression analysis with binary outcome of overall well-being as affected and not affected which revealed statistically significant domains-Geriatric syndrome and elder abuse as the predictors [Table 3].
Our study revealed almost half the respondents as females - 54% and males as 46% with majority (60%) in the age group of 60–70 years and were married (67%) with living arrangement of joint family among 80.7%. Majority of them were illiterates (76%) and those with highest standard of education was high school among 18%. About 46.4% were retired and unemployed staying at home. According to their subjective and objective assessment, their well-being was affected among 72.9% mainly suffering with health problems related to noncommunicable diseases such as hypertension and related complications (51%), diabetes mellitus (43%), and osteoarthritis among 13%. There were higher mean scores recorded for those whose well-being is affected mainly for the domains such as physical, geriatric syndromes 1 and 2, mental health, social and family security, and elder abuse. On further analysis, these domains which were the main predictors for their affected well-being were elder abuse and geriatric syndromes.
In a comprehensive home assessment in Australia – Ian D Williams found 68% of females with mean age of 75–96 years living alone among 43% and living with partner among 44%. They reported perceived general health was significantly related to specific aspects of physical and psychosocial well-being. Mobility and independence were positively aligned with good general health and bowel problems were negatively related to health. About 20% reported clinically significant levels of depression in their study.
Boralingaiah etal. in their study among urban elderly of Mysore city found about half of the elderly were illiterate, 39.7% of the aged were widow and 5.7% were widower. Nuclear family was found in 48.9% of the elderly followed by three generations 34.8% and joint family 16.3%. Their functionality mean score using Katz Index of Independence in activities of daily living scoring method was found to be 5.66 + 0.84 among <75 years of age compared to >75 years the score was 4.98 + 1.66. Similar to our study Kumar etal. in their study among elderly in urban Puducherry found mean scores of physical domain 55.17 (12.50), psychological 54.61 (11.92), social relationship 36.68 (16.44), and environmental 52.49 (12.08) using the World Health Organization QOL BRIEF; With respect to morbidity status, 42.3% (127) were hypertensive, 35.3% (106) had musculoskeletal disorders, 30.7% (92) had low vision, 25.3% (76) had diabetes, 15.3% (46) had hearing impairment, and 6% (18) had impaired anti-defamation league (ADL).
Tkacheva etal., in their study among community clinics in Moscow reported 58.3% having visual or hearing impairment, 58.2% cognitive impairment, 46% mood disorder, 42% difficulty in walking, 28.3% urinary incontinence, 21.3% traumatic falls (over the previous year), and 12.2% weight loss and thereby the mean number of geriatric syndromes per patient was 2.9 ± 1.5 affecting their QOL.
Ibitoye etal. in their study among Nigerian elderly population found the predictors of psychological well-being as current working status (odds ratio [OR] 1.665) and receiving financial assistance from children (OR 1.955). Acierno etal. in their study among the United States geriatric population found poor health (OR 1.69), low social support (OR 2.95), and previous traumatic event (OR 1.57) as the correlates of physical abuse on logistic regression analysis; Moreover for emotional abuse, the following factors were statistically significant with low social support (OR 3.17), need for ADL assistance (OR 1.83), and previous traumatic event (OR1.57).
Study by Kharat etal. carried out in Pune city of Maharashtra also used Katz Activities of Daily Living scale to evaluate elderly for ability to perform essential life functions. Out of 200 elderly, 100 each were males and females. Out of 200 elderly, 189 (94.5%) were functionally able and remaining 11 (5.5%) were dependent for activities of daily living. Study concluded that continuous care and monitoring of activities of daily living is important to maintain standard of living among elderly population.
All these findings in different settings using different scales predict the most common variables as poor physical health mainly the geriatric syndromes, elder abuse, and low social support. This confers on our findings to have an integrated tool for care at door steps of the geriatric population so that they can avail and utilize the services to the maximum extent in order to plan for the health policy which can be implemented at primary health care to assess the psychosocial medical needs and also provide preventive strategies to promote health and improve their QOL.
Limitation of our study could be that the results may not represent the entire population and need to establish the reliability of such studies among wider populations in different settings using the same tool. Strength of our study is that it is a community-based sampling with no selection bias and tried to cover all the domains with the new – Integrated care tool developed by AIIMS, New Delhi in Indian setting for our population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
If any- We extend our sincere thanks to Dr. Prasun Chatterjee, Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India, All the participants and Medico social workers for their support in conduct of this study.
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