|Year : 2020 | Volume
| Issue : 3 | Page : 95-100
Self-reported morbidity profile among geriatric population in ICMR-model rural health research unit, Kallur, Tirunelveli
Vasna Joshua1, K Sunitha2, G Muthu3, V Sinduja1, P Venkatesh1, P Nandini1, K Shantaraman2, P Manickam1, MV Murhekar1, Yuvaraj Jayaraman1
1 Health Systems Research & MRHRU, ICMR-National Institute of Epidemiology, Chennai, India
2 Department of Community Medicine, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
3 Health Systems Research & MRHRU, ICMR-NIE (Model Rural Health Research Unit), Tirunelveli, Tamil Nadu, India
|Date of Submission||21-May-2020|
|Date of Decision||28-Aug-2020|
|Date of Acceptance||27-Sep-2020|
|Date of Web Publication||23-Feb-2021|
Dr. Yuvaraj Jayaraman
ICMR.National Institute of Epidemiology, Second Main Road, Tamil Nadu Housing Board, Ayapakkam, Near Ambattur, Chennai - 600 077, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: The Model Rural Health Research Unit at Kallur, Tirunelveli, established by the Department of Health Research, Government of India, is linked to Tirunelveli Medical College. It is mentored by the ICMR-National Institute of Epidemiology, Chennai. The key objective was to develop area-specific models to undertake field health research depending on the disease profile, topography, morbidity patterns, and better health-care services. As a part of the ongoing activity, we constructed a cohort of 36,289 people and analyzed the self-reported information on morbidities experienced by the registered population from different aspects. In this communication, we report some of the findings extracted from the data sets as descriptive epidemiology on the self-reported magnitude of illness and their utilization of health services in the rural cohort of a primary health center among the geriatric population 60 years or more. Methods: A demographic health database of 11,006 households (HH) with 36,289 individuals was constructed in the study area under the Primary Health Centre, Nadu Kallur, Tirunelveli. This database consists of self-reported morbidity data collected at baseline, pertaining to the cohort members with age 60 years or more and analyzed it. Results: The study area's total geriatric population with 60 years of age or more was 4891 (13.5%). In this cohort, the gender ratio was 824 males for every 1000 females, with an average of 0.4 geriatric persons per HH, and 37% of them were illiterates. About 38% of the study population were either widowed or separated. Nearly 65% of the people in the cohort lived in the same house for more than 10 years. Around 10% were pensioners, and almost 36% had to work for their daily living. Only 27% had health insurance or were covered by a health scheme. About 52% (2564) of the individuals reported about their one or more ailments. The total number of different types of ailments reported was 3704. Among them, 402 (11%) were not treated. For the remaining (3302 ailments) one or more treatments were taken, i.e., in all 4705 instances, treatment was taken either consulting a physician or self-treatment. Hypertension (25%) and diabetes mellitus (21%) were the major cause of morbidity among the elderly in this cohort. Conclusion: The above rural baseline survey portrays the commonly reported morbidities and their treatment-seeking behavior of a cohort of elderly people living in the area under Government Primary Health Centre, Nadu Kallur, South India. The findings indicate that the commonly reported morbidity and their treatment-seeking behavior remain unchanged even after rapid strides in India's health-care delivery. This study's data strengthen the need to increase the services for the geriatric population to improve their quality of life.
Keywords: Geriatric morbidity, Model Rural Health Research Unit, utilization of health services
|How to cite this article:|
Joshua V, Sunitha K, Muthu G, Sinduja V, Venkatesh P, Nandini P, Shantaraman K, Manickam P, Murhekar M V, Jayaraman Y. Self-reported morbidity profile among geriatric population in ICMR-model rural health research unit, Kallur, Tirunelveli. J Indian Acad Geriatr 2020;16:95-100
|How to cite this URL:|
Joshua V, Sunitha K, Muthu G, Sinduja V, Venkatesh P, Nandini P, Shantaraman K, Manickam P, Murhekar M V, Jayaraman Y. Self-reported morbidity profile among geriatric population in ICMR-model rural health research unit, Kallur, Tirunelveli. J Indian Acad Geriatr [serial online] 2020 [cited 2022 Oct 2];16:95-100. Available from: http://www.jiag.com/text.asp?2020/16/3/95/309986
| Introduction|| |
According to census 2011, India is in a phase of demographic transition, with nearly 104 million people aged 60 years and above with almost 71% residing in rural areas. By 2026, this number is expected to grow to 173 million. Several studies in India have reported the majority of them to suffer from one or more morbidities,,, and a significant component of the burden of illness is due to chronic diseases.
The Model Rural Health Research Unit (MRHRU) is the Department of Health Research's flagship project, Government of India. There are 15 such units across India. Each unit is linked to a medical college in the region and mentored by the nearest identified Research Institute of Indian Council of Medical Research. The MRHRU, Tirunelveli, is located in the Primary Health Centre, Nadu Kallur, is linked to Tirunelveli Medical College, Tirunelveli, and mentored by ICMR-National Institute of Epidemiology, Chennai. One of the key objectives of the MRHRU is to develop area-specific models to undertake field research depending on the disease profile, topography, morbidity patterns, and providing better health-care services by undertaking relevant research on local health issues identified by participating institutions.
In this communication, we report the summary of self-reported ailments by the geriatric population at baseline and their health-care utilization patterns.
| Methods|| |
As a part of the rural cohort construction, a demographic health database of 11,006 households (HH) with 36289 individuals was collected in the area under PHC Nadu Kallur, Tirunelveli. The study area comprises 21 revenue villages conveniently classified into 14 clusters varying from 186 to 3417 HH. All the 36289 individuals in the village area were enumerated. Each of the HH, along with key landmarks in the study area was geotagged, using global positioning system and a digitized map of the study area was generated. A predesigned, pretested, structured questionnaire in the local language was used to collect the information. The data collection was done in various sections in the schedule. The demographic profile included HH characteristics; self-reported morbidity and treatment-seeking behavior by trained field staff using Geographic Information System synchronized tablets. The data capture performa was developed using Open Data Kit Software (https://getodk.org/) software and loaded in each tablet used for data collection. Each HH was visited by a health worker and information was collected over a reference period of the previous 2 weeks from the interview date. The survey was done from January 2016 to August 2019. Written informed consent was obtained from all the study participants after explaining the purpose of the exercise and data collection procedures. In this communication, we report the findings on the analysis of the self-reported magnitude of illness and their utilization of health services in the rural geriatric population aged 60 years or more.
Simple descriptive analysis was done. Qualitative variables were presented as frequencies and proportions, and for quantitative variables, measures of central tendency were calculated. SPSS software for Windows (version 21.0, Chicago, IL, USA) was used for the statistical analysis.
| Results|| |
The average number of geriatric persons per HH was 0.4 (one individual per 2.2 HH or ten individuals for every 22 HH) and the geriatric gender ratio was 824 males for every 1000 females. About 61% were aged < 70 years and nearly 9% were aged = 80 years. Almost 37% of the population were illiterates. The majority (65%) of the study population lived in the same house for more than 10 years, followed by 13% for 5–10 years, 16% living for 5 years, and only 6% were living in the same house for a year. Thirty-nine percent of the population were either widowed or separated or never married. The population's major occupation was agricultural work (21%), 14% did some skilled/unskilled work, 10% pensioners, 1% beedi-makers, and the rest were homemakers or were not gainfully employed. A health scheme or health insurance covered only 27% of the population, and among them, 64% were covered under state health insurance scheme; another 32% were covered by employer/employee health scheme (either as self or as a dependent) and 4% under other agencies like HDFC, etc.
Prevalence and nature of ailments
All the individuals were asked for details of ailments in the fortnight proceeding to the survey. The schematic diagram [Figure 1] shows the ailments reported of the geriatric population. Fifty-two percent (n = 2564) of the individuals reported one or more illness; hence, a total of 2564 were reported as their first ailment; 900 ailments were reported as their second ailment; 197 as their third ailment; 33 as their fourth ailment; and ten as their fifth ailment.
[Figure ]2 (drawn using ArcGIS version 10 software (Esri, Redlands, CA, USA)) shows the ailments reported (in percentages) by the geriatric population by village clusters. While the persons from village Suthamalli reported the highest proportion of ailments (36.5%), Karungadu reported the lowest proportion (1.5%). The total number of ailments reported during the fortnight reference period was 3704, of which 3302 (89%) of the ailments were treated, and no treatment was availed for the remaining ailments. Since 70% of the reasons, were considered “not serious” and for “financial considerations” by the respondents. Nearly 88% of the ailments pertained to illness lasting for = 1 year, and almost 22% of the chronic ailments lasted for >10 years. In general, females reported ailments more (9%) than males, especially females in the age group of 60–64 years; the ailments were more than 10% [Figure 3].
|Figure 1: Self reported morbidity of the geriatric population of Kallur Village, Tirunelveli, 2016-19|
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|Figure 2: Percentage distribution of the ailments reported by the geriatric population by villages , Kallur, Tirunelveli, 2016-19|
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|Figure 3: Sex wise morbidity pattern of the geriatric population, Kallur Village,Tirunelveli, 2016-19|
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Hypertension (HT) and diabetes mellitus (DM) were reported as the major ailments that accounted for 25% and 21% of the total ailments. The other conditions that accounted for at least 10% of the morbidity were musculoskeletal/bone/joint/connective tissue diseases (13%) and visual disability (10%) including blindness and excluding cataract [Table 1].
|Table 1: Distribution of morbidity reported among the geriatric population, Kallur, Tirunelveli, 2016-2019|
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[Table 2] shows the morbidity reported according to the age groups. HT was higher in the age group 80–84, and DM was higher in the age group 60–64, followed by visual disability (22.7%) (2.3% underwent cataract surgery) and hearing loss (13.6%) was reported higher in the age group of 90 years or more.
|Table 2: Percentage distribution of morbidity according to the age group, Kallur 2016-2019|
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Utilization of health services
In all 2564 persons reported (one or more ailments), 3704 ailments and about 4705 treatments were taken. Only 3302 of the reported ailments were treated, and a physician was consulted, and treatment was taken in 3765 instances (92%) [Table 3]. Further for 310 (8%) instances, the individual resorted to self-treatment or treated by a lay family member or purchased medicines directly from a medical shop. The findings were similar in both genders, except it was 1.2% less for females who have not taken treatment.
|Table 3: Treatment taken (in %) among the geriatric population according to the health agency, Village, Tirunelveli, 2016-2019|
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The findings are set out according to morbidity condition and ailment as shown in [Table 4]. The first two self-reported ailments were treated by more than one health agency, whereas the third, fourth, and fifth ailments were not fully treated. Nearly, 43% of the treatment was taken from government doctor, 35.7% from a private doctor, 2.3% AYUSH government doctor, 1.4% from AYUSH private doctor, and 8% were taken by self/from friends/relatives/medical shop, etc., Considering all ailments combined [Table 4], consultation with a physician was most common (89%). Treatment taken without medical consultation was 14% for musculoskeletal/bone/joint/connective tissue diseases; accidents/injuries/fractures/foreign body (13%); skin and subcutaneous tissue diseases (13%), visual disability including blindness (excluding cataract) 12%, neurological disorder (11%), and gastritis/gastric or peptic ulcer (11%).
|Table 4: Treatment taken according to morbidity among the geriatric population in Kallur, Tirunelveli, 2016-2019|
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All the 4891 individuals were also asked about the preference of health agency for shorter and longer ailments. Fifty-four percent (n = 3152) reported as government hospital for ailments of shorter duration, and 83% (n = 4075) preferred a longer duration for ailments.
| Discussion|| |
This communication describes the self-reported morbidity and treatment-seeking behavior of the geriatric population living in a rural area, South India. The number of female geriatric people was more than males and confirmed the report of the 60th National Sample Survey, highlighting that there were more geriatric females than males (males: females as 706:1000) in rural areas. About 38% of the population reported having lost their spouses in this study area emphasizing that the health needs are more pronounced, whereas it was 33.1% in another study.
In the present study, most (52%) of the geriatric population reported one or more ailments. The geriatric population experiences multiple health problems, their morbidities for many reasons remain unreported and untreated till they become complicated before they seek treatment. HT and DM were the most common conditions reported by the geriatric population in this study area. This is in line with several earlier studies. The geriatric population has reported multiple chronic diseases that afflict HT, diabetes, rheumatism, and vision problems, including cataract and depression.,,,,,,,,
Furthermore, females reported higher ailments than males in this study area. Similar observations were published by others where women reported about their poor health status as compared to males., Forty-six percent (36% were employed, 10% were pensioners) of the elderly population had some income source, and a health insurance scheme covered only 27%. A physician was treating nearly 85% of the morbidities (out of 3704). Yet, in spite of the availability of social security of some form, treatment was not sought for nearly 11% of the morbidities because of financial constraints, or they considered that it was not serious. Although many published reports have highlighted similar findings that older people are confronted with financial constraints,, we observed that in this region, the geriatric people are completely dependent on the siblings for their health care and mobility needs. Most extended families live with fragile income and have little resources to be spared for their geriatric dependents. The frequent visits to doctors for their ailments cost the family money for health care and the loss of income of one adult. Their fragile incomes do not permit such luxuries, and the elders who chose to remain silent over their health problems are resigned to fate. Hence, some community-based health-care delivery for the geriatric population in the study area would be an option.
A report by the Indian Council of Medical Research (ICMR), on the morbidity profile, in the elderly population states that hearing impairment was the most common morbidity, followed by visual impairment. In this rural area, we found the morbidity as mentioned above conditions as the fifth and fourth commonly reported morbidity conditions. The geriatric population aged = 90 years adopted self-medication for visual disability and hearing loss and taken medicines bought by friends or nearby HH or directly from a medical shop person or a traditional healer.
Ten percent of the geriatric population is aged ≥80 years, and their lives are not free from morbidity or disability. Around 12% of the aging population are immobile and could not freely move due to eye problems. The elderly population in this area is mostly dependent on the government health-care delivery systems. Nearly 2% of them have mentioned that they need to wait for a longer time in the government sector; hence, they prefer other agencies. If multipurpose health workers (female) are trained to work with the geriatric rural community, it would be an added value for them and reduce mobility and improve their quality of life. According to the National policy of 2011, mobile health clinics' services are made available through PHCs; twice in a year. The PHC nurse is expected to screen the 80 + population of women in villages with public/private partnerships, recognizing the need to strengthen the services for geriatric and palliative health care in rural areas in increasing noncommunicable diseases in the country. This study's data enhance the need for increasing the frequency from a half-yearly to monthly basis to cover unmet health-care needs of senior citizens of 60 or more years and for both genders who are disabled and have poor health and nutrition status.
Although the entire population was surveyed and a geodatabase built, only the subcommunity of the geriatric population is presented. There is a need to construct at least one rural cohort in a rural area in a state to generate rural health database. Such information will provide much-needed information for planning health-care delivery for the rural people and provide a road map for future research.
Further in-depth qualitative research, on various dimensions of geriatric health, including socioeconomic challenges, psychosocial stress, and unmet needs, needs to be explored for the elderly population. Conducting routine geriatric population-based health promotion, screening in camp mode and curative services would be beneficial to this section of the community.
Limitation of the study
We collected data with a limited staff of five members. Hence, it took a longer duration to digitize the entire and complete the construction of the cohort in Kallur, Tirunelveli, South India. Although our study pertains to a period of 2016–2019, most of the geriatric population stayed in the same house for more than 10 years and the ailments reported are mainly chronic morbidities.
The study describes only the self-reported morbidities by geriatric population in rural cohort under a PHC area; there may be discrepancies between self-reported disease conditions and corresponding clinically diagnosed measures. The older adults may also experience lapses in memory or word recall and sometimes could feel hard of hearing; hence, there could be some misinformation effects. In-depth studies of examining complete health status with the clinical examination are required to determine the morbidities' precise prevalence and corroborate with the self-reported morbidities for reliability purposes.
The authors thank all staffs, including field staff at MRHRU and participants for their contributions.
Financial support and sponsorship
This study was financially supported by the Department of Health Research/Indian Council of Medical Research, New Delhi.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]