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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 17  |  Issue : 1  |  Page : 22-27

Prevalence and correlates of physical disability among elderly rural population in a community development block of Purba Bardhaman District, West Bengal


Department of Community Medicine, Burdwan Medical College, Purba Bardhaman, West Bengal, India

Date of Submission11-Mar-2021
Date of Acceptance03-Apr-2021
Date of Web Publication17-Aug-2021

Correspondence Address:
Sulagna Das
122/2, Banamali Ghosh Lane, Behala, Kolkata - 700 034, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_6_21

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  Abstract 


Introduction: With demographic transition and increase in life expectancy elderly population has increased substantially in recent years. Rapid growth in the elderly population resulted in high magnitude of noncommunicable diseases leading to physical disability, dependency on caregivers and poor quality of life. This study aimed to determine the prevalence and correlates of physical disability among elderly rural population in a community development block. Subjects and Methods: A community-based cross-sectional study was conducted in Bhatar block of Purba Bardhaman district from November 2020 to January 2021 among 350 elderly participants ≥60 years selected by multistage random sampling. With prior informed consent, data were collected using semi-structured pre-designed, pretested schedule and 10-item Barthel index. Bivariate and multivariable logistic regression was done to find out the correlates. Results: The prevalence of physical disability among elderly was 28.9% and proportion was more in ≥70 years age group, 62.6% of the subjects suffered from one or more chronic diseases. In bivariate analysis age (odds ratio [OR] = 5.36), caste (OR = 2.27), education (OR = 4.57), current employment status (OR = 0.13), type of family (OR = 2.15), socioeconomic status (OR = 4.04) and presence of any chronic diseases (OR = 1.86) was significantly associated with physical disability. Multivariable analysis revealed age (adjusted OR [AOR] = 2.96 [1.54–5.68]), education (AOR = 2.98 [1.60–5.54]) and current employment status (AOR = 0.23 [0.09–0.58]) as significant predictors. Conclusions: The prevalence of physical disability among elderly is substantially high in the study area. Effective promotive, preventive, curative, and rehabilitative geriatric health care services need to be strengthened for early diagnosis and treatment of health problems in the elderly.

Keywords: Barthel index, elderly, physical disability, prevalence


How to cite this article:
Saha C, Thakur RP, Das S, Das DK. Prevalence and correlates of physical disability among elderly rural population in a community development block of Purba Bardhaman District, West Bengal. J Indian Acad Geriatr 2021;17:22-7

How to cite this URL:
Saha C, Thakur RP, Das S, Das DK. Prevalence and correlates of physical disability among elderly rural population in a community development block of Purba Bardhaman District, West Bengal. J Indian Acad Geriatr [serial online] 2021 [cited 2021 Oct 24];17:22-7. Available from: http://www.jiag.com/text.asp?2021/17/1/22/323943




  Introduction Top


With increase in the life expectancy, the number of elderly population has increased substantially in recent years and the growth is projected to accelerate in the coming decades. Between 2015 and 2030, the number of people in the world aged 60 years or above is projected to grow by 56%, from 901 million to 1.4 billion, and by 2050, the global population of older persons is projected to more than double its size in 2015, reaching nearly 2.1 billion.[1] In India, the geriatric population which was 7.7% in 2001 increased up to nearly 8.14% in 2011, and it was 8.9% in 2016 and it is projected that by 2050, it will be nearly up to 20%.[2]

Ageing is a normal biological phenomenon, involving progressive cellular and physiological deterioration resulting increase in various chronic illness and disability, which hampers the quality of life. Rapid increase in the elderly population is associated with increased magnitude of noncommunicable diseases and chronic conditions often leading to disability. Elderly persons are at higher risk for multiple comorbidities which results in higher disability rates in them.[3] Disability in simple term implies restriction in the performance of normal activities of day-to-day life.[4] Disability makes a person dependent on others for care and support. The most common causes of disability include chronic diseases such as diabetes, cancer, cardiovascular disease and stroke; injuries; mental impairment; birth defects; HIV/AIDS; and other communicable diseases.[5]

Disability can be assessed by measuring the individual's ability to perform activities of daily living (ADL) using tools like Barthel or Katz index. Barthel index is a 10-item index[6] and Katz index is a 6-item index[7] of ADL for the assessment of disability. Based on 10-item ADL index, the prevalence of physical disability among elderly population in various rural areas of India has been reported to be 16.16% in West Bengal,[8] 21.4% in Haryana,[9] 32.4% in Bengaluru.[10] The prevalence of disability using the same scale was estimated to be around 15% to 28.3% in studies conducted in other developed or developing countries.[11],[12],[13],[14] Based on 6-item ADL index, the prevalence of physical disability among elderly population in rural Haryana is 18%.[9]

Assessing the magnitude of physical disability among the elderly population and finding out its association with various socio-demographic factors will help in developing and implementing different strategies and measures for the elderly and thus reduce the burden of the community and the nation. In this context, the present study was conducted to determine the prevalence of physical disability and to find out its association with various socio-demographic factors among the elderly population in a community development block of Purba Bardhaman District, West Bengal.


  Subjects and Methods Top


Study design, study area and study subjects

This community-based cross-sectional study was conducted in Bhatar block of Purba Bardhaman district, West Bengal from November 2020 to January 2021 among the elderly population (age 60 years or above) permanently residing in the study area for at least last 1 year. Individuals who did not give consent, not found after two repeated visits and severely ill and moribund patients were excluded from the study.

Sample size and sampling

Considering the prevalence of physical disability among elderly population using 10-item Barthel index 16.16% in Tarakeswar Block, Hooghly district, West Bengal,[8] 95% confidence level, absolute precision of 5%, design effect of 1.5 and 10% nonresponse rate the minimum required sample size was 344.

Multistage random sampling was followed for selecting the study subjects. There are total 14 gram panchayat in Bhatar block. From each gram panchayat one village was selected randomly. Thus, a total 14 villages were selected. It was decided to include equal number of study subjects (344 ÷ 14 = 24.57-–25) from each village. In the second stage, in each village, a sampling frame of eligible study subjects were prepared with the help of village level functionaries and 25 study subjects were selected by simple random sampling from the sampling frame. Thus, finally, the total number of study subjects was 25 × 14 = 350.

Tools and techniques

A semi-structured pre-designed, pre-tested schedule that includes various socio-demographic factors and self-reported chronic diseases/ailments such as hypertension, diabetes, arthritis, dementia, cataract, hearing impairment, stroke/paralysis, heart disease, chronic kidney disease, chronic obstructive pulmonary symptoms etc., and 10-item Barthel index was used to interview the study subjects. 10-item Barthel index was used to measure person's ability to perform ADL. The 10-item index that includes performance in feeding, bathing, dressing, grooming, toileting, bladder control, bowel control, transfer from bed to chair, walking and stair climbing for disability assessment.[6]

Subject's performance in each item was assessed by self-reported performance over the last 24–48 h. For each item, the subjects were categorized as unable, need help (verbal or physical) or independent and scoring was done accordingly as 0, 5, 10, 15 as per the guidelines of Barthel index. Total score of 10-item Barthel index ranges from 0 to 100.

For this study, Barthel score <100 was regarded as physical disability, i.e., any subject who was unable to perform or needed help in one or more of these ADL activities, was regarded as physically disabled.

Data collection and ethical considerations

Data were collected from selected elderly individuals by house-to-house visits. Each household was visited maximum twice. The purpose and nature of the study was briefed to the study subjects and informed consent was obtained from them before data collection. They were assured about the confidentiality and anonymity of information.

Statistical analysis

Collected data were checked for completeness and consistency and then the data were entered in the Microsoft ExcelTM spreadsheet software. Further analysis was done using the IBM Statistical Package for Social Sciences (SPSS), version 20. Bivariate and multivariable logistic regression was done to find the association and predictor variables. Crude odds ratios (ORs) and adjusted ORs (AORs) with 95% confidence intervals were calculated. P ≤ 0.05 was considered as statistically significant.


  Results Top


Background profile of study participants

Almost equal numbers of the study participants belonged to 60–69 years and 70–79 years of age group (44.9% and 42.9% respectively) and the rest to age group of 80 years or more (12.2%). Mean age of the study participants was 70.9 years (SD ± 12.54). Majority of the study participants were male (58%); Hindu (72%) by religion and belonged to general caste (43.4%). 40.6% of the study participants were illiterate. Most of the study participants were not employed (72%) and belonged to lower socioeconomic class (69.7%) as per modified BG Prasad scale (CPI [IW] January 2020: 330) [Table 1].
Table 1: Distribution of study participants according to their sociodemographic profile (n=350)

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Nearly two-thirds (62.6%) of the study participants suffered from one or more chronic diseases/ailments. Four of the most commonly reported chronic diseases were hypertension (35.7%), diabetes mellitus (29.4%), arthritis (22.9%), cataract (21.1%); and stroke/paralysis (4.3%), chronic kidney disease (7.1%) were least reported chronic disease [Table 2].
Table 2: Distribution of study participants according to the pattern of self-reported chronic diseases/ailments (n=350)

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Prevalence of physical disability and its correlates

The prevalence of physical disability among the elderly population was 28.9% (95% CI 24.2%–33.9%) according to 10-item Barthel index. Among the daily living activities, most of the study participants found to be disabled in stairs climbing (22.9%), followed by bladder (20%) and bowel (15.4%) control, dressing (15.7%), and toilet use (15.1%) [Table 3].
Table 3: Distribution of study participants according to physical disability status and activities of daily living (as per Barthel index) (n=350)

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[Table 4] shows the sociodemographic factors and its association with physical disability among study participants. Among the different factors age (OR = 5.36, P = 0.000), caste (OR = 2.27, P = 0.001), education (OR = 4.57, P = 0.000), current employment status (OR = 0.13, P = 0.000), type of family (OR = 2.15, P = 0.019), socioeconomic status (OR = 4.04, P = 0.000) and presence of any chronic disease (OR = 1.86, P = 0.000) was significantly associated with physical disability. While no significant association was found between gender, religion, and marital status with physical disability.
Table 4: Association of socidemographic factors with physical disability (n=350)

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Bivariate analysis and multivariable logistic regression model was done to find out factors affecting physical disability among study participants. Model was found fit (Hosmer–Lemeshow test P = 0.096). 31.4% of variance in the dependent variable (physical disability) can be explained by the independent variables by this model (Nagelkerke R2). After adjusting independent variables, age (AOR [CI] = 2.96 (1.54–5.68]), education (AOR [CI] = 2.98 [1.60–5.54]), current employment status (AOR [CI] = 0.23 [0.09–0.58]) were found to be significant predictors of physical disability in the study participants.


  Discussion Top


Old age is closely associated with developing physical disability resulting in functional decline and physical dependence, thus hampering the quality of life among elderly population. In the present cross-sectional study, the prevalence of physical disability among elderly rural population aged 60 years or above was assessed with the 10-item index of ADL (Barthel index), and it was found to be 28.9% (95% CI 24.2–33.9). Using the same index disability prevalence was found 21.4%, 22%, and 23.4% in rural areas of Haryana,[9] Tamil Nadu,[15] and Uttar Pradesh,[16] respectively. The prevalence of functional disability among elderly using the same index was found to be 25.6% in urbanized villages of Delhi.[17] Other rural community-based studies using 10-item Barthel index found a disability prevalence of 16.16% in Tarakeswar block of West Bengal,[8] and a much higher prevalence of 37.4% was found in Haryana[18] and 32.4% in Bengaluru city, Karnataka.[10] In another community-based study in the rural Tamil Nadu,[19] the prevalence was found to be 46.8%. This prevalence of physical disability using 10-item Barthel index is comparable to findings from studies conducted in other countries such as 15% in the USA,[11] 20% in Japan,[12] 24.7% in Malaysia,[13] and 28.3% in Nigeria.[14]

With increasing age the disability increases, among the elderly people old elderly are more likely to suffer from physical disability than young elderly. In this study, it was found odds of being physically disabled are significantly higher among old elderly people. Study participants who were ≥70 years of age were 2.96 times more likely to be physically disabled compared to younger age groups. Similar findings were reported by Gupta et al.,[16] Vaish et al.[17] Gupta et al.,[18] Paul et al.[20] A study conducted by Gureje et al.[21] and Aguiar et al.[22] also found a significant association between increasing age and physical disability. Studies conducted in Malaysia and Argentina also reported physical disability in 49.6% and 50.5% of elderly age 75 years or above, respectively.[13],[14] Many studies[9],[12],[13],[14],[15],[18],[23] showed higher prevalence of physical disability among elderly women than elderly men, however, in this study, there was no significant association was found between gender and physical disability. It has been suggested that while ADLs may reflect pure disability in performing a task by men or women, limitations in instrumental ADL may be influenced more by genderspecific tasks.[24]

Various studies from different states of India and other countries[9],[11],[12],[13],[14],[18] reported ADL disability rates were significantly lower in “currently married” elderly than those whose marital status was “unmarried/divorced/separated/widowed,” however in this study there was no significant association was found between marital status and physical disability. In this study, it was found the physical disability rate was much higher among the study participants who were “currently unemployed” rather than “currently employed.” This is also supported by findings from previous studies.[9],[12],[18]

On bivariate analysis this study revealed physical disability rates were significantly higher among the study participants who belong to joint family than who belong to nuclear family; however on application multivariable logistic regression analysis, type of family was not observed to be significant. This finding also correlates with the findings from the study by Vaish et al.[17] Poverty and low socioeconomic status have detrimental effect on health. The health of elderly people who belong to lower socioeconomic class is often neglected resulting early physical disability and dependence. Disability and poverty forms a mutually enforcing cycle. In this study on bivariate analysis, it was found that the odds of physical disability were 4 times higher in elderly people who belong to low socioeconomic class than middle/high socioeconomic class. Similar findings were also reported in a study conducted by Gupta et al.[16] However, in the adjusted model, socioeconomic class did not predict for physical disability.

Elderly persons are more vulnerable to develop chronic diseases. Functional and physical disabilities often result from chronic disease.[25] Higher number of diseases, medication and other associated treatment modalities often lead to poor quality of life and social isolation among older population, thus resulting in functional disability.[26] Elderly who had any chronic disease were 1.86 times more likely to be physically disabled than those who did not suffer from any chronic disease. This finding correlates with the findings of study by Khan et al.[9] and Vaish et al.[17] Previous studies also reported high disability rates among elderly population with one or more chronic diseases.[13],[14] In the present study hypertension, diabetes, arthritis and cataract were the most frequently reported chronic diseases. Previous studies have also reported significant association of disability with hypertension,[27] diabetes[12],[13],[14] and arthritis.[8],[11],[12],[13],[14]

A community-based study in Ballabhgarh[28] in 2002 reported the prevalence of functional disability 47.8% using Katz scale, blindness, hearing impairment, and locomotor disability. This difference in the disability prevalence is possibly due to use of different scales and the inclusion of blindness, hearing impairment, and locomotor disability. In this study, physical disability was assessed by using 10-item ADL score only, blindness and hearing impairment were not included in the definition of functional disability which was used by the similar study conducted in Haryana;[20] so one of the limitations of this present study is that in addition to the commonly used ADL scale, blindness and hearing impairment should also be included as these factors greatly influence the ADL among elderly people and determine the overall functional disability status. According to the study conducted by Agrawal et al.[29] blindness and hearing impairment are significantly associated with mortality in this age group. Another limitation of the study was the chronic diseases/ailments were self-reported by the study participants. Objective measure of chronic disease status would reflect the true morbidity burden among the elderly people.


  Conclusions Top


The prevalence of physical disability among elderly population was substantially high in the study area. Although age is a non-modifiable risk factor for physical disability, prevention and control of chronic diseases will reduce the burden of physical disability among elderly. Thus, the focus needs to be directed more towards comprehensive preventive, promotive, curative, and rehabilitative services for the elderly population through targeted geriatric health services and prioritizing implementation of national health programs and policies.

Acknowledgment

We would like to acknowledge the Block Medical Officer in Charge (BMOH), Block ASHA Facilitator (BAF), community level health workers (ANM and ASHA) for their co-operation and support. We are also thankful to the study participants for their co-operation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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