Study of addiction problems and morbidity among geriatric population in rural area of Aurangabad district.

RESEARCH QUESTION: What is the addiction problems and morbidity profile pattern of geriatric population in rural area?
OBJECTIVES: i) To study the morbidity profile of elderly. ii) To study the addiction problems among elderly.
MATERIALS AND METHODS: The present study was carried out at the field practice area of Rural Health and Training Center (RHTC), Paithan of Government Medical College, Aurangabad during the period of September 1, 2006 to August 31, 2007. Total elderly population according to the definition at the field practice area of RHTC, Paithan was 3128. Enlisting of the study subjects was done by systematic random sampling by using Loksabha electoral list of 2005. A sample of 20% of total elderly population was taken by including every fifth elderly from the electoral list. STUDY
DESIGN: Cross-sectional study. SETTINGS: Field practice area of RHTC, Paithan of Government Medical College, Aurangabad. PARTICIPANTS: Elderly above 60 years of age. SAMPLE SIZE: 625 which was 20% of total elderly at RHTC, Paithan. STATISTICAL ANALYSIS: Chi-square test.
RESULTS: a) The study found that the prevalence of addiction among males was 68.34%, the prevalence of various addictions were smoking 29.96%, alcohol 18.18%, tobacco chewing 29.29% and among females, 45.42% elderly females use to chew tobacco. b) Prevalence of cataract was 40.16%, joint pain - 23.04%, chronic obstructive pulmonary disorder (COPD) - 7.52%, senescent forgetfulness - 10.88%, hemorrhoids - 8.64%, benign enlargement of prostate (BEP) - 7.20% in elderly males, hearing impairment - 24.8%, hypertension - 21.6%, diabetes mellitus - 13.92%, and anemia - 8.32%.

INTRODUCTION

The two extremes of life child and elderly need special care. Elderly life is full of problems – physical, social, and economic. While ageing of the population is essentially a simple phenomenon, its consequences are multiple and not always well recognized. It is rightly said by Sir James Sterling Ross - “You do not heal old age, you protect it, you promote it, and you extend it.”[1] The elderly are afflicted by the process of ageing which causes a general decline in health.

Certain diseases are more frequent among elderly than the young people, such as degeneration diseases of heart and blood vessels, cancer, accidents, diabetes, diseases of locomotor system, respiratory illness, and genitourinary tract diseases.

In India, although the percentage of aged persons to the total population is low in country, nevertheless, the absolute size of the aged population is considerate. Elderly with disability resulting from chronic diseases appear at high risk of acute illness and injuries.

Although Primary Health Centres along with their subcentres are distributed all over the country, they are not able to avail all the facilities at the PHC or its subcentres owing to lack of transport, geographical distance, or physical disabilities or for want of funds and physical help for travel. There is ample scope for research into the degeneration and other diseases of elderly, their treatment in hospital and general practice, and also into preventive geriatrics and the epidemiology affecting the elderly.[2]

MATERIALS AND METHODS

The present study was carried out at the field practice area of Rural Health and Training Center (RHTC), Paithan of Government Medical College, Aurangabad during the period of September 1, 2006 to August 31, 2007.

Total elderly population according to the definition at the field practice area of RHTC, Paithan was 3128. Enlisting of the study subjects was done by systematic random sampling by using Loksabha electoral list of 2005. A sample of 20% of total elderly population was taken by including every fifth elderly from the electoral list.

Home visit was paid to study subjects and were interviewed and examined for health and socioeconomic problems.

Elderly who had expired or houses of whom were permanently locked or have transferred their residence or elderly who cannot be contacted after three successive visits to their homes were excluded and next elderly in the list was included. All the elderly included in the study were thoroughly examined for any systemic disease or physical defects. Present complaints were asked initially and according to the proforma elderly was examined.

For history of addictions those persons having habit of smoking, alcohol consumption, or any other type of addictions for more than 6 months were considered

General examination by taking pulse rate, blood pressure, etc., was carried out. Then systemic examination was carried out. The criteria lay down by standard text books of Medicine, Surgery, OBGY, Ophthalmology, ENT and manual for clinical examination was used for diagnosis of medical conditions and also the help of case paper record available with individuals was taken into consideration.

RESULTS

The study subjects were interviewed and examined and the following observations were made. Out of total 625 elderly studied, 328 (52.48 %) were females and 297 (47.52 %) were elderly males.

Table 1 shows the addiction habits of elderly. 89 (29.96%) males were smoking and 54 (18.18%) were consuming alcohol. 87 (29.29%) males and 149 (45.42%) females were chewing tobacco. 120 (40.40%) males and 166 (50.60%) females were having addictions like Hukka, Bhang, betel, and pan. While 213 (34.08%) were having no addiction. Significantly higher proportion of males were having addiction of alcohol and smoking (P < 0.001).

Table 1

Addiction pattern among elderly

Table 2 shows that cataract was major morbidity in males 124 (41.75%) and 127 (38.71%) in females either in single or both eyes. 10 (3.36%) males and 3 (0.91%) females had active conjunctivitis. This table also shows the morbidities in musculoskeletal system. 39 (13.13%) males and 54 (16.46%) females had backache. 54 (18.18%) males and 90 (27.42%) females had either single or multiple joint/s pain. 3 males and 12 females had fracture femur due to fall. 38 (12.79%) males and 46 (14.02%) females had complaints of arthritis.

Table 2

Distribution of elderly according to the medical morbidities in ophthalmic and musculoskeletal system

Table 3 shows that elderly suffered from chronic obstructive pulmonary disorder (C.O.P.D,) males were 30 (10.10%) and females were 17 (5.18%). 8 (2.69%) males and 6 (2.24%) females had bronchiectasis.

Table 3

Distribution of elderly according to the medical morbidities in respiratory, gastric, genitourinary, and nervous systems

Table 3 also shows that 41 (13.80%) males and 27 (8.23%) female were having senescent forgetfulness. While 25 (8.41%) males and 42 (12.80%) had history and symptoms of depression. 18 (6.06%) males and 11 (3.35%) females suffered from hemiplegia. Leprosy was present in 3 (0.91%) females having various deformities. This table also shows that the males 20 (6.73%) and females 28 (8.53%) had the symptoms of acid peptic disease (APD). 33 (11.11%) males and 21 (6.40%) females had complaints of hemorrhoids. While 28 (9.42%) males and 14 (4.62%) females had the problem of constipation. It also shows that 22 (7.40%) males had the complaints of benign enlargement of prostate (BEP). 15 (4.57%) females were suffering from urinary tract infection (UTI). 11 (4.04%) males and 8 (2.43%) females had urinary incontinence.

Table 4 shows that 31 (10.43%) males and 56 (17.07%) females were having the complaints of diabetes mellitus. 43 (14.47%) males and 92 (28.04%) females were having hypertension. 38 (8.53%) females were having anemia. 4 (1.32%) males and 10 (3.04%) females were having presence of cancer and taking treatment. 16 (5.38%) males and 6 (1.82%) females presented with various skin disorders. While 63 (21.21%) males and 92 (28.04%) females had some degree of hearing impairment.

Table 4

Some other morbidity found in elderly

DISCUSSION

Adegbehingbe BO[3] found that of the 445 people examined, cataract 30 (42.3%), glaucoma 23 (32.4%), and uncorrected aphakia 7 (9.9%) were the leading causes of blindness and cataract 245 (54.2%), and glaucoma 176 (38.9%) were the most common causes of low vision followed by pterygium 10 (2.2%), corneal opacity 9 (1.8%), and refractive errors 6 (1.3%). Prakash et al.[4] found that cataract was the cause of diminishing vision in 44% of the subjects, whereas 24.7% had refractive errors and commonest musculoskeletal disease was arthritis 16 (8.42%).

Singh et al.[5] found a high prevalence of refractive errors (40.8%), cataract (40.4%), aphakia (11.1%) followed by pterygium (5.2%), glaucoma (3.1%), and corneal opacities (3%). These findings were comparable with present study. In a study, Mishra and Srivastava[6] reported cataract in 25.8% elderly, whereas Purohit and Sharma (1976) reported cataract in approximately 40% elderly.

Sharma et al.[7] in their study found that osteoarthritis was more in females as compared to males (70.1% vs. 41.6%). Purty et al.[8] studied 320 elderly, out of which the elderly most commonly complaint of joint pains/joint stiffness 139 (43.4%). He also found that 195 (61%) of the elderly chewed tobacco, 44 (33.3%) of males were smokers, and 38 (28.7%) regularly consumed alcohol. He also found hypertension in 83 (25.9%) and diabetes in 26 (8.3%) elderly. Gastrointestinal complaints/diarrhea in 38 (12%), dermatological in 28 (9.4%), and respiratory in 22 (7.3%).

Khokhar[9] in their study current smokers constituted 15.62%, whereas 30.35% of the men were current consumers of alcohol. 12.5% used tobacco and Singh Charan[10] reported that aged were addicted to one or more addictions. The addictions were significantly more (P < 0.001) among males (71.6%) than females (29.3%). Tobacco smoking was the most common addiction. Surekha Kishore[11] studied that hypertension was the most common problem (41.4%), followed by musculoskeletal problems (36.8%), respiratory problems (36.1%), and psychosocial problems (28.8%). Gurav[12] found that two males were diagnosed to be suffering from benign enlargement of the prostate gland. Gupta, et al[13] observed that prevalence of diabetes mellitus was 13%, respiratory disorders were observed (pulmonary tuberculosis - 16%, COPD - 10%, and asthma - 4.5%, while 1.5% had symptoms of urinary tract infection). Singh,[14] observed that arthritis (615) was the commonest disease in elderly followed by hypertension (510), ischemic heart disease (350), hearing impairment (300), diabetes mellitus (280), chronic bronchitis, asthma, emphysema (238), tuberculosis (220), peptic ulcer syndrome (210), varicose vein (200), hemorrhoids (180), and urinary problems (154).

CONCLUSION

The study highlights the various medical and social problems faced by the elderly population in a developing country such as India. The study found prevalence of different diseases common in elderly group. The study also found prevalence of different addictions common in elderly group. So if we take appropriate action in time that will be beneficial for old age persons. For problem of addictions, different educational and motivational activities are needed.