ORIGINAL ARTICLE
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Open Access Article
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Assessment of Morbidity Pattern among the Rural and Urban
Geriatric Population: A Cross Sectional Study
Manish Jain1, Rahul Prakash2, Rohit Jain3
Financial Support: None declared
Conflict of Interest: None declared
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copyrights of this article. However, reproduction of this article in the part or
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due acknowledgement of the source.
How to cite this article:
Jain M, Prakash R, Jain R. Assessment
of Morbidity Pattern among the Rural
and Urban Geriatric Population: A
Cross Sectional Study. Natl J Community Med 2017; 8(7):356-360.
Author’s Affiliation:
1Asst Prof, Dept of PSM, Jhalawar
Medical College, Rajasthan; 2Professor,
Dept of PSM, RNT Medical College,
Udaipur, Rajasthan; 3Medical officer,
CHC Khatkad, Bundi, Rajasthan.
Correspondence
Dr. Manish Jain
jain20147@gmail.com
Date of Submission: 04-01-17
Date of Acceptance: 20-07-17
Date of Publication: 31-07-17
ABSTRACT
Introduction: Aging has been define as progressive, generalized
impairment of function leading to lose of adaptive response to
stress and growing risk of age related disease. Objective: to assess
the morbidity pattern among the rural and urban elderly population and to identify possible factors influencing the morbidity pattern.
Material and method: A cross- sectional study was carried out in
rural and urban field practice areas of RNT Medical College,
Udaipur, Rajasthan from January, 2015 to December, 2015. Study
participants were subjected to- (a) Personal Interview and (b)
Clinical Examination. Medical records if available with the respondents were scrutinized to confirm medical conditions.
Results: Average numbers of illnesses per persons were recorded
as 3.03 among rural and 3.08 among urban geriatric participants.
Among rural elderly, Eye diseases were reported most commonly
(63.6%) followed by diseases of cardio-vascular system
(48.8%).Among urban geriatric participants, Diseases of cardiovascular system were reported most commonly (59.2%) followed
by eye diseases (57.6%). Psychosocial problems were more common among urban elderly.
Conclusion: Overall morbidities were high among the study
population, with non-communicable and degenerative diseases
comprising the major burden of diseases.
Key Words: Aging, Elderly, Morbidity, Cross- sectional study
INTRODUCTION
Aging has been define as progressive, generalized
impairment of function leading to lose of adaptive
response to stress and growing risk of age related
disease, resulting in progressive increase in age
specific mortality.1 The boundary of old age cannot
be defined exactly because it does not have the
same meaning in all societies. Government of India
adopted ‘National Policy on Older Persons’ in
January, 1999 which defines ‘senior citizen’ or ‘elderly’ as a person who is of age 60 years or above.2
Census 2011 figures say that in India 8.6 per cent of
the people are aged 60 and above, compared to 7.4
per cent in 2001. Old age Dependency Ratio is rising (142 in 2011 as compared to 131 in 2001) due to
higher life expectancy at birth. Both the share and
size of elderly population is increasing over time
from 5.6% in 1961 it is projected to rise to 12.4% of
population by the year 2026.3
Care of the elderly has till date focused on managing chronic disorders rather than on the promotion
of healthy lifestyle and prevention of chronic diseases. However changes in lifestyle and medical
care can prevent, postpone, or reverse age-related
morbidity; thus low cost strategies to avoid disease
and disability in this age group are imperative in
the 21st century.4Many health problems are known
to increase with age and this demographic trend
may lead to an increase in the absolute number of
health conditions in the population.4
If people can experience these extra years of life in
good health and if they live in a supportive envi-
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ronment, their ability to do the things they value
will be little different from that of a younger person. If these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more
negative. With this background, the present study
was conducted to assess the morbidity pattern
among the rural and urban elderly population and
to identify possible factors influencing the morbidity pattern.
MATERIAL AND METHOD
An Observational, Cross- sectional study was carried out in rural and urban field practice areas of
Department of Community Medicine, RNT Medical College, Udaipur, Rajasthanfrom January, 2015
to December, 2015. Elderly people aged 60 years or
more, residing in rural area Vallabhnagar (Rural
health training center) and urban area Dhanmandi
(Urban health training center) were included for
the study after satisfying inclusion and exclusion
criteria. Elderly people aged 60 years or more attending out-patient departments of Rural and Urban Health Training Center during the study period, who were willing to participate in study,
without compulsion, were included. Elderly persons with missing information in sociodemographic profile and diagnosis or patients not
providing available medical records, non cooperative patients, not willing to participate in the
study or not giving written consent for participation or seriously ill requiring immediate hospitalisation were excluded from the study. The sample
size was calculated using the formula,5
N = Z2 (1-α/2) pq/d2 (Where Z (1-α/2) = 1.96 at 95% confidence level; p = prevalence of morbidity, q = 1-p;
d=allowable error). Using the above formula, a
sample size of 209 elderly people was derived on
the basis of morbidity prevalence rate of 64.8% as
per reports of ‘Building a Knowledge Base on
Population Ageing in India (BKPAI)’, a multicentric study, by the United Nations Population
Fund (UNFPA), India in Cooperation with the
Government of India (2008-12)6with 95% confidence interval and allowable error d=10% of p.
Taking into account 10% as non-respondents, the
total number came out to be 230. In all, 250 elderly
persons aged 60 years and above, were selected
from each field practice area for assessment and
making comparison in morbidity pattern among
rural and urban elderly population for the present
study. Nature and Purpose of the study was fully
explained to the study participants before the
study. Persons satisfying the inclusion and exclusion criteria, were instructed to attend a specific
day of the week (Thursday for UHTC and Saturday for RHTC) at the outpatient departments of
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Rural and Urban Health Training Centres with the
previous medical records (if available). Every
week, on that specific day, people were examined
and data obtained until the requisite number of
sample size met.
A pre-tested, semi-structured questionnaire was
used for data collection after taking an informed
written consent from each individual. Each individual included in the study was subjected to- (a)
Personal Interview and (b) Clinical Examination.
Medical records if available with the respondents
were also scrutinized to confirm medical conditions. Elderly were examined physically from head
to toe and any signs and symptoms of illness were
recorded. A person was considered to be a hypertensive if he/she was an already diagnosed case of
hypertension and /or on treatment for hypertension or with a Systolic Blood Pressure ≥ 140 and/or
Diastolic Blood Pressure ≥ 90 (JNC VII classification)7at the time of examination.Moreover Respiratory diseases, cardiovascular diseases, musculoskeletal disorders and nervous system disorders,
endocrine and genitourinary disorders already diagnosed by clinicians with necessary investigations
if present were recorded and accepted as such.
Chronic diseases from at least three months and
acute disease from at least one month duration as
per WHO’s International Classification of Diseases
were included for assessing morbidity of geriatric
people.2 Snellen’s chart was used to assess the visual acuity. Impaired hearing was defined as inability to hear a whisper at a distance of 1 meter.8
Anaemia was judged clinically by examination of
palpebral conjunctiva, oral mucosa and palms. If
any of the examined part was pale, then was considered as anaemic.8Psychosocial problems were
elicited by large discussion on some of the personal
problems related with psychosocial trouble. Illiterate was defined as ‘a person who is unable to read
and write in any language2 and Literate as ‘a person who can read and write with understanding in
any language. A person who can merely read but
cannot write was not classified as literate.9 Modified B.G. Prasad’s socio-economic status classification was adopted and modified for the year 2015
using AICPI for the base year 2015 i.e. 254 (as of
January 2015)10.Currently married were defined as
those who were currently living with their spouse
at the time of study. Widowed were defined as a
person whose husband or wife has died.11Data was
entered in MS Excel 10 and analyzed using Epiinfo 7 software. P-value of <0.05 was considered to
be statistically significant. The study protocol was
submitted to the Institutional Ethical Committee
before the study and ethical approval was obtained. Besides, informed written consent of the
each study participant was taken before the study.
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RESULTS
Total 250 elderly from rural and 250 elderly from
urban area were assessed in present study. The
socio-demographic characteristics of the rural and
urban study subjects are depicted in table 1. Mean
age for the rural and urban study participants was
67.8 ± 6.7 years and 68.0 ± 7.2 years respectively.
The system wise morbidities observed among rural
and urban elderly persons are shown in table 2.
Among rural elderly, Eye diseases were reported
most commonly (63.6%) followed by diseases of
cardio-vascular system (48.8%). Average morbidities per person were 3.03 among rural geriatric
study participants. Among urban geriatric participants, Diseases of cardio-vascular system were reported most commonly (59.2%) followed by eye
diseases (57.6%).Average numbers of illnesses per
persons were recorded as 3.08 among urban geriatric participants. Hypertension was found to be
most frequent morbidity (49.0%) among both in
rural and urban geriatric people. However, hypertension was more prevalent in urban elderly
(55.2%) as compared to rural elderly (42.8%) and
difference was statistical significant (p <0.05).
At the time of study, 73.2% of the rural and 77.6%
of the urban participants were suffering from at
least one morbidity. Overall, prevalence of morbidity was 75.4% among geriatric people (Table 3).
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Table 1: Socio-demographic characteristics of the
rural and urban geriatric study participants
Characteristic
Rural
Urban
(n=250) (%) (n=250) (%)
Age group (years)
60-69
156 (62.4)
148 (59.2)
70-79
71 (28.4)
77 (30.8)
≥80
23 (9.2)
25 (10.0)
Gender
Male
153 (60.8)
133 (53.2)
Female
97 (39.2)
117 (46.8)
Religion
Hindu
168 (67.2)
148 (59.2)
Muslim
71 (28.4)
72 (28.8)
Others
11 (4.4)
30 (12.0)
Literacy Status
Illiterate
98 (39.2)
77 (30.8)
Literate
152 (60.8)
173 (69.2)
Socio-Economic Status10
Class I
20 (8.0)
26 (10.4)
Class II
53 (21.2)
87 (34.8)
Class III
71 (28.4)
59 (19.6)
Class IV
55 (22.0)
45 (18.0)
Class V
51 (20.4)
33 (13.2)
Occupational Status
Unemployed
182 (72.8)
205 (82.0)
Employed
68 (27.2)
45 (18.0)
Marital Status
Currently Married
179 (71.6)
190 (76.0)
Widowed or Divorced
71 (28.4)
60 (24.0)
(Figures in parenthesis indicate percentages)
Table 2: System wise classification of the morbidities in rural and urban geriatric study subjects
System involved*
Rural (%) (n = 250)
Endocrine, Nutritional & Metabolic diseases
81 (32.4)
Diseases of Respiratory system
85 (34.0)
Diseases of Digestive system
47 (18.8)
Diseases of Cardio-vascular system
122 (48.8)
Diseases of Oral cavity & Dental problems
101 (40.4)
Diseases of Musculoskeletal system
107 (42.8)
Diseases of the Eye
159 (63.6)
Diseases of the Ear
27 (10.8)
Diseases of Nervous System
22 (8.8)
Diseases of Genitourinary System
33 (13.2)
Diseases of Skin & Subcutaneous tissue
22 (8.8)
*Multiple Responses; (Figures in parenthesis indicate percentages)
Urban (%) (n = 250)
92 (36.8)
40 (16.0)
56 (22.4)
148 (59.2)
97 (38.8)
124 (49.6)
144 (57.6)
33 (13.2)
15 (6.0)
25 (10.0)
16 (6.4)
Table 3: The most frequent morbidities among rural and urban elderly
Morbidity*
Rural (%) (n = 250)
Urban (%) (n = 250)
Cataract
99 (39.6)
87 (34.8)
Hearing impairment
27 (10.8)
33 (13.2)
Anaemia
47 (18.8)
40 (16.0)
Diabetes Mellitus
27 (10.8)
41(16.4)
Hypertension
107 (42.8)
138 (55.2)
Dental Caries
81 (32.4)
69 (27.6)
Osteoarthritis
87 (34.8)
104 (41.6)
COPD
45 (18.0)
15 (6.0)
APD
22 (8.8)
30 (12.0)
Any Medical Problem
183 (73.2)
194 (77.6)
*Multiple Responses; (Figures in parenthesis indicate percentages)
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Total (%) (n = 500)
186 (37.2)
60 (12.0)
87 (17.4)
68 (13.6)
245 (49.0)
150 (30.0)
191 (38.2)
60 (12.0)
52 (10.4)
377 (75.4)
P value
0.26
0.40
0.41
0.06
0.006
0.24
0.11
<0.001
0.24
0.25
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Table 4: Distribution of study subjects according
to number of morbidities per person
No of Morbidities Rural (n = 250) Urban (n = 250)
1
11 (4.4)
15 (6.0)
2
22 (8.8)
33 (13.2)
3
50 (20.0)
42 (16.8)
4
64 (25.6)
61 (24.4)
≥5
36 (14.4)
43 (17.2)
*Figures in parenthesis indicate percentage
The proportion of COPD was significantly higher
among males (p<0.05) while the proportion of Osteoarthritis was significantly higher among female
participants (p<0.05). Proportion of Osteoarthritis
was significantly higher among Hindu geriatric
participants (p<0.05). The proportion of Diabetes
Mellitus was significantly higher among partici-
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pants who belonged to socio-economic class I and
class II (p<0.05). None of the morbidities were significantly associated with the marital status of elderly in rural area (p>0.05).
Out of 250 rural elderly participants, 26.8% were
not suffering from any form of morbidity. Majority
(25.6%) were suffering from 4 morbidities followed
by 20.0% participants suffering from 3 morbidities.
Among urban elderly, 22.4% elderly had no morbidity. Majority (24.4%) of elderly were suffering
from 4 morbidities. 17.2% participants had 5 or
more morbidities (Table 4). Table 5 depicts the
psychosocial problems reported by study participants. Psychosocial problems were more common
among urban elderly and the differences were statistically significant (p<0.05).
Table 5 - Psycho-social symptoms reported by geriatric study participants
Psycho-social symptoms*
Rural
Male
Female
Total
(n=153)
(n = 97)
(n=250)
Lack of Sleep
18 (11.7)
6 (6.2)
24 (9.6)
Feeling of Loneliness
3 (2.0)
7 (7.2)
10 (4.0)
Feeling of Neglect
8 (5.2)
8 (8.2)
16 (6.4)
*Multiple Responses; (Figures in parenthesis indicate percentages)
DISCUSSION
The present study was conducted to assess the
morbidity patterns among the geriatric people and
to identify possible factors influencing the morbidity pattern among elderly population of the rural
and urban field practice areas. 250 elderly people
were selected as study participants from each area.
In present study, 62.4% rural elderly belonged to
the age group of 60-69 years, 28.4% belonged to 7079 years age group and 9.2% belonged to ≥ 80
years age group. Among urban elderly persons,
59.2 % were in age group 60-69 years, 30.8 % were
in age group 70-79 years and 10.0% were in age
group ≥ 80 years. Mean age for the rural study participants was 67.8 ± 6.7 while Mean age for the urban participants was 68.0 ± 7.2. These findings are
in accordance with the life expectancy projected in
2011–2016 which is 67 years for men and 69 years
for women in India12and could be explained by the
fact that there is a gradual decline in the number of
persons surviving with increasing age.
In present study, average morbidity per person
was 3.03 among rural and 3.08 among urban participants. The findings of present study are much
higher than the report of research project ‘Building
a Knowledge Base on Population Ageing in India
(BKPAI),6 which revealed that average number of
chronic ailments per elderly person was 1.2 in both
rural and urban area. In contrary to our study, a
study by Swami HM et al13 (2002) in urban area of
Male
(n=133)
30 (22.6)
9 (6.8)
16 (12.0)
Urban
Female
(n=117)
16 (13.6)
17 (14.5)
23 (19.6)
P value
Total
(n=250)
46 (18.4)
26 (10.4)
39 (15.6)
0.005
0.006
0.001
Chandigarh revealed that average number of illnesses per person was 1.79. A study carried out by
Purtyet al14 (2006) in rural area of Tamil Nadu revealed that the average illness per person was 2.77.
In present study, overall prevalence of morbidity
was 75.4% among geriatric people. At the time of
study, 73.2% of the rural and 77.6% of the urban
study participants were suffering from at least one
medical ailment indicating higher prevalence of
morbidities among urban elderly people. This
could be due to increased number of life style diseases among urban people. 65.8% rural and 62.1%
urban elderly were suffering from at least one ailment in the report of research project ‘Building a
Knowledge Base on Population Ageing in India
(BKPAI)6. A study by Srinivasan et al (2010)15 in
urban area of Bengaluru revealed that majority of
the respondents (85%) had at least one morbidity.
In present study, among rural elderly, eye diseases
were found most commonly (63.6%) followed by
diseases of cardio-vascular system (48.8%). This
Morbidity pattern is comparable to study by
Kumar A et al (2012)16 in a rural area of Southern
India, which revealed that the most common morbidity among elderly in rural area were Eye problems (62.6%) followed by Hypertension (44.3%).
In present study, among urban elderly, diseases of
cardio-vascular system were most common (59.2%)
followed by eye diseases (57.6%). In accordance to
our study, Hypertension was reported by majority
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elderly (76.19%) in the study conducted by Kanfade M et al (2012)17 in urban area of Nagpur city.
In present study, hypertension was higher significantly in urban elderly (55.2%) as compared to rural elderly (42.8%). It could be because of sedentary
and modern life style and stress in urban areas. A
study by Sharma et al (2013)18 in an urban and rural area of Shimla hills found that Hypertension
was more prevalent in urban elderly (56%) as
compared with rural counterparts (25%). Prevalence of hypertension among the elderly in urban
areas was about twice that in rural areas in
Chandigarh in a study by Swami HM et al.13
In present study, common psychosocial symptoms
reported by elderly were lack of sleep (9.6% in rural and 18.4% in urban), feeling of loneliness (4.0%
in rural and 10.4% in urban) and feeling of neglect
by family members (6.4% in rural and 15.6% in urban). All these psychosocial symptoms were significantly more common among urban elderly participants. The main reasons could be loss of spouse,
ignorance by the family and co-morbid illnesses
which were expressed in form of sadness, crying
and a feeling of hopelessness. In contrast to our
study, only 3.7% of elderly had psychosocial problems in study by Bhatt R et al (2011)19. In study by
Barman et al (2014)20, 26.88% had a complaint of
feeling of loneliness and 31.25% had a feeling of
neglect. Study conducted by Kumar A et al (2012)16
revealed that psychological distress and symptoms
were present in 29.2% rural elderly.
CONCLUSION AND RECOMMENDATIONS
Overall morbidities were high among the study
population, with non-communicable and degenerative diseases comprising the major burden of
diseases. High prevalence of morbidities among
elderly people need strengthening of geriatric
health care services in the community. Promotive,
Preventive, curative and rehabilitative programmes for the elderly are required for the control and management of later part of the life. Effective joint family system, right mental attitude and a
healthy life style in adult life are the keys for enjoying the active ageing. There is also a need to increase awareness among the elderly group by IEC
activities to utilize the available health care services and periodic health checkups to allow early
detection and treatment of their morbidities.
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