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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 18  |  Issue : 4  |  Page : 201-207

Morbidity pattern and health-seeking behavior among the elderly residing in slums of Eastern Odisha: A cross-sectional study


1 Department of Community Medicine, SCB Medical College, Cuttack, Odisha, India
2 Department of Community Medicine, IMS and SUM Hospital, SOA University, Bhubaneswar, Odisha, India
3 Department of Community Medicine, SLN Medical College, Koraput, Odisha, India
4 Department of Community Medicine, FM Medical College, Balasore, Odisha, India

Date of Submission05-Sep-2022
Date of Decision08-Nov-2022
Date of Acceptance06-Dec-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Tapas Ranjan Behera
Department of Community Medicine, FM Medical College, Balasore, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_48_22

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  Abstract 


Introduction: Of the total population, elderly people comprised of 8.14% in India where in India or globally. Main challenges faced by the elderly in our country are feminization, ruralisation, migration, and an increasing number of 80-plus adults. This sudden change of environment or being left stranded alone unattended or being dependent on children for their necessities is a major cause of mental illnesses. Objectives: To study the socio-demographic profile, find out the different morbidities and assess the health-seeking behaviour of the study subjects. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of urban health and training center using the simple random sampling method. Results: The mean age of study subjects was 67.58 ± 6.53 years. Majority of participants, i.e., 308 (73.0%) were young old. 207 (49.1%) were illiterate, 272 (64.5%) unemployed 272 (64.5%) and 224 (53.1%) were living with their children, i.e., 224 (53.1%). Inappropriate health-seeking behavior was significantly associated with under-weight (P < 0.001) which accounted for 2/3rd of participants. Severe depression was observed among 59.5% participants. Females showed a higher proportion of myalgia (5.7%), whereas males showed preponderance of upper respiratory tract diseases (19.2%). The prevalence of inappropriate health-seeking behavior was higher in females (65.1%). The proportion of the elderly with poor health-seeking behavior was found to be 50.4%. Conclusion: Morbidity among the elderly is very high and health-seeking behavior is very poor. Hence, strong efforts are needed to provide them holistic care. Hence, this study was conducted to threw some light on health status of the elderly, their morbidity pattern and health-seeking behavior. It will help the policy-makers to prepare the intervention strategies at the community level.

Keywords: Elderly, geriatric, health-seeking behavior, morbidity, slum


How to cite this article:
Patnaik A, Mohanty S, Pradhan S, Behera TR. Morbidity pattern and health-seeking behavior among the elderly residing in slums of Eastern Odisha: A cross-sectional study. J Indian Acad Geriatr 2022;18:201-7

How to cite this URL:
Patnaik A, Mohanty S, Pradhan S, Behera TR. Morbidity pattern and health-seeking behavior among the elderly residing in slums of Eastern Odisha: A cross-sectional study. J Indian Acad Geriatr [serial online] 2022 [cited 2023 Feb 8];18:201-7. Available from: http://www.jiag.com/text.asp?2022/18/4/201/365774




  Introduction Top


Since the past decade, with the everexpanding population of India and increasing demand of better healthcare services, the health system has become more and more precise in delivering the services by categorizing the population into different groups. Earlier elderly people were treated as normal adult population. However, now with advanced science and technology, more emphasis is being given to their physiological and pathological changes, so as to enable them to lead a better life, free of any illnesses as long as possible.

As far as the issue about a concrete definition of the elderly is considered, there are different definitions at different places and under different circumstances. India adopted the National Policy on Older Persons in January 1999. This policy defines “senior citizen” or “elderly” as a person aged 60 years or above.[1]

According to the Census of 2011, 72.18% of people reside in rural areas, where there is a significant deficiency of proper health care services.[2] Among the total population, elderly people comprised of 8. 14%, i.e., 104 million, and in the next four censuses, they are expected to increase to 133.32 million (2021) 178.59 million (2031), 236.01 million (2041) and 300.96 million (2051), respectively. People of this age group are generally reluctant to visit a registered practitioner or a hospital for any minor illness which adds up to their morbidities, thus affecting their quality of life. According to ICMR, the most common morbidity among the elderly is hearing impairment, followed by visual impairment.[3] However, this pattern is subjected to wide variations according to different studies in various parts of the country. Common morbidities observed among elderly include arthritis, cardiovascular diseases, acid peptic diseases, ocular morbidities, diabetes, and hypertension.[4],[5],[6]

Like many other low- and middle-income countries, India too is going through rapid industrialization, urbanization, and modernization. In this chaos, with the dream of a better life, many rural youths are migrating to the urban areas, with or without their elderly family members. This sudden change of environment or being left stranded alone unattended or being dependent on children for their basic necessities is a major cause of mental illnesses, particularly depression among the elderly.

Main challenges faced by the elderly in our country are feminization, ruralization, migration, and an increasing number of 80-plus adults.[7]

According to the census 2011, 9.4% of Odisha's population is above 60 years of age, which is higher than the national average.[8]

In order to curb the suffering of the elderly and to improve their quality of life, the government of India took the initiative to launch several national health programs and policies through various ministries like Integrated Programme for Older Persons, RashtriyaVayoshriYojna, Indira Gandhi Old Age Pension Scheme, Varistha Pension BimaYojna, The Pradhan MantriVayaVandanaYojna, and National Programme for the Health Care of Elderly.[9]

With the rising trend of nuclear families, many senior citizens are living on their own with no one to take care of them in their time of need. Loneliness, joblessness, and various morbidities of old age all lead to negligence of their health leading to the adoption of inappropriate health-seeking behaviors like opting for over-the-counter medications, relying on quacks etc.

Many studies have been conducted for analyzing the morbidity pattern of the senior citizens in India but most of them have been conducted in rural and urban areas and scarce data is available regarding the situation in urban slums. Keeping this in view, we conducted this study among the elderly people residing in an urban slum of Cuttack district of Odisha.

Objectives

  1. To explore the s ocio-demographic profile of the elderly residing in the urban slum of Cuttack
  2. To find out the different morbidities among these elderly
  3. To assess the health-seeking behavior of the study subjects.



  Materials and Methods Top


Study type

A community-based cross-sectional study.

Study area

  • The study was conducted in the field practice area of Urban Health and Training Centre (UHTC) of SCB Medical College and Hospital, Cuttack
  • Under UHTC, 4 wards and 12 Anganwadi centers are there
  • It provides health care services to a population of 19,171 of whom 9642 are men and 9529 are women. This centre maintains information of all the residents in the form of family folders.


Study duration

June to December 2019.

Study population

People aged 60 years and above.

Study subjects

Inclusion criteria

  1. People aged 60 years and above
  2. People who were willing to participate and gave their consent
  3. Those people who were residing in that area for >6 months.


Exclusion criteria

  1. Extremely ill patients
  2. Bed-ridden patients
  3. Houses that were locked even after 3 attempted visits.


Sample size calculation

Considering the prevalence of morbidity among elderly population to be 51.6%[10] as was found in a study conducted in the field practice area of a medical college in Gunturand by using the formula N = Z2pq/d2where,

Z = 1.96

P = prevalence i.e., 0.51

q = 1 − p i.e., 1–0.51 = 0.49

d = allowable error = 5% = 0.05

The sample size was calculated to be 384.

Considering a nonresponse rate of 10%. The final sample size was 422.2 (rounding to 422).

Sampling

  • There are four wards in the field practice area of UHTC. In order to get the desired sample size, 106 elderly people were chosen from each ward by simple random sampling method. The household number in each sahi wasthe sampling frame
  • From each household, one elderly individual was being selected
  • In case there was more than one eligible study participant in a single household, the eldest of them was being interviewed
  • In case there were no elderly people in a household, then next house was selected.


Data collection and study tools

  • The socio-demographic data like age, sex, religion, marital status and educational status was collected by one to one interview using a pretested, semi-structured questionnaire
  • The general examination of each study participant was done and past medical records were checked
  • Depression was assessed using Geriatric Depression Scale (GDS)[11] translated and validated in local language i.e., Odia.


Operational definitions

  1. Morbidity (from Latin morbidus: sick, unhealthy) is defined as a diseased state, disability, or poor health due to any cause. The term may be used to refer to the existence of any form of disease, or to the degree that the health condition affects the patient.[12] The morbidities were assessed based on the following criteria:


    1. Diabetes: All the known cases of diabetes mellitus as well as those participants whose random blood glucose was found to be >200 mg/dl using standard glucometer, with or without symptoms were considered diabetics[13]
    2. Hypertension: All the known cases of hypertension and newly diagnosed cases. A study participant was considered as a new case if his/her SBP or DBP was found to be >140 mmHg or >90 mmHg, respectively, on 2 separate readings taken on same day with the participant properly rested in a well seated manner[14]
    3. Anaemia: Subjective assessment was done by examining pallor on palpebral conjunctiva, tongue and palms of study participants
    4. Skin diseases: A head to toe examination was conducted for the presence or absence of common skin diseases like eczema, tinea, pustules etc., Those participants with documented evidence of other skin diseases like psoriasis were also included in the study
    5. Hearing defects: The participants sat at a distance of 5 feet from the investigator and were asked to repeat 4–5 bi-syllablesin normal conversational tone. Failure to repeat any one, was considered as a hearing defect. Along with this, participants with hearing-aids were included in the study[15]
    6. Poor vision: This was assessed using a snellen's chart. Participants were asked to read the chart at a distance of 20 feet, unaided with one eye closed
    7. Acute episodes of diarrhea: Participants complaining of 3 or more episodes of loose stools in the last 24 h were diagnosed as acute cases of diarrhea
    8. Acid-peptic disease: Participants complaining of pain in the epigastric region and/or burning sensation in chest and/or regurgitation of acid and/or under medication for the same within the past 6 months were diagnosed to be suffering from acid-peptic disease
    9. Joint pain: Participants complaining of pain in one or more joints with or without medication since the last 6 months were diagnosed to have joint pain
    10. Myalgia: Participants complaining of pain in one or more muscle or group of muscles with or without medication since the last 6 months were diagnosed to have joint pain
    11. Depression: It was assessed using GDS-30 depression scale. Based on the responses, participants were classified as normal, mildly depressed or severely depressed.


  2. Health seeking behaviour: Defined as sequence of remedial actions taken by the person to rectify perceived ill-health[16]
  3. Appropriate health seeking behaviour: Participants who were seeking treatment or health advice from doctors (Allopathic and AYUSH) situated either in private or public health institutions and did not take any treatment for the same ailment before visiting health professional were considered to be having appropriate health seeking behaviour[17],[18]
  4. Inappropriate health-seeking behavior: Participants who resorted for over-the-counter medications and/or were seeking help from faith healers and/or resorted to home remedies for curing their ailment and never visited a registered medical practitioner for the same or visited after resorting to above mentioned methods were considered to be having inappropriate health-seeking behavior
  5. Addictions: Participants were asked for the history of consumption of chewable tobacco like Gutkha, tobacco smoking like beedi, alcohol consumption and consumption of beetle leaves, i.e., pan in the past 1 year.


Ethical considerations

  • Ethical clearance was obtained from the Institutional Ethics Committee vide letter no. 976/01.12.2021prior to the study. Written informed consent was obtained from the study participants.


Data analysis

Data were analysed using the Statistical Package for Social Sciences version 19, IBM Corp, Armonk, NY, USA. The categorical variables were expressed as percentage and continuous variables were expressed in terms of mean and standard deviation Pearson's Chi-square test was used to find out the association between different variables at 95% confidence interval and P < 0.05 was considered statistically significant.


  Results Top


A total of 422 subjects aged 60 years and above were enrolled as study participants. The mean age of study subjects was 67.58 ± 6.53 years (males: 68.8 ± 7.5 years and female: 66.5 ± 5.3 years) with female: male ratio of 1.18:1. Majority of participants, i.e., 308 (73.0%) were young old, followed by old, i.e., 12 (2.8%) and the rest were oldest old. Hinduism was the predominant religion, i.e., 371 (87.9%). Out of all the participants, near about half of the study participants, i.e., 207 (49.1%) were illiterate, as well as unemployed 272 (64.5%) were unemployed and 224 (53.1%) were living with their children, i.e., 224 (53.1%). Almost equal proportions managed their own finances and received financial assistance from children, i.e., 174 (41.2%) and 209 (49.5%), respectively.

[Table 1] shows the health seeking behaviour in relation to various baseline characteristics of study participants. Near about 2/3rd females i.e., 149 (65.1%) had adopted inappropriate health seeking behaviour and they relied mostly on the Over TheCounter drugsfor their illness (P < 0.001). Inappropriate health seeking behaviour was more prevalent among illiterates (66.7%) and those who were taken care of by people other than their family members (87.5%) followed by children (51.7%). These findings were statistically significant with P < 0.001. Moreover, higher rates of negligence was observed where the health expenses were borne by children (50.7%) with P = 0.003. Moreover, it was observed that more than half, i.e., 185 (56.1%) of the participants who were not enrolled in any kind of pension scheme, showed inappropriate health-seeking behavior (P < 0.001).
Table 1: Effect of different demographic variables on health seeking behaviour

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[Table 2] depicts the effect of morbidity pattern of the study participants over their health seeking behaviour. Inappropriate health-seeking behavior was observed to be significantly associated with people who were under-weight, i.e., body mass index (BMI) <18.5 (P < 0.001) which accounted for 2/3rd of participants. One hundred and fifty-one (61.%) of participants with pallor showed inappropriate Health seeking behaviour (HSB) which may be attributed to a higher proportion of females in the study. This finding was statistically significant with P = 0.001.
Table 2: Association of morbidity profile and health seeking behaviour

Click here to view


As far as chronic diseases were concerned, majority of those who were known cases of diabetes i.e., 39 (65%) were availing services from healthcare facilities. However, most of the participants who were known cases of hypertension or those having both diabetes and hypertension were more negligent towards their health, i.e., 87 (60.8%) and 16 (66.7%), respectively. This pattern may have been observed because of lack of awareness, negligence on the part of care takers as well as on the part of patients. These findings were statistically significant with P = 0.001.

In this study, using GDS – 30 depression scale, it was found that a higher proportion of participants who had inappropriate health-seeking behavior suffered from severe depression i.e., 50 (59.5%) but the finding was not statistically significant. It was unlikely that this finding was associated with their health-seeking behavior directly.

[Figure 1] shows the presenting complaints of the study participants. It is evident that females showed a higher proportion of myalgia (5.7%), pain in joint particularly large joints like knee and hip (23.6%) as well as skin diseases such as tinea and eczema (3.5%). Whereas, males showed preponderance of upper respiratory tract diseases (19.2%), acute episodes of diarrhoealoose motion s (8.3%), and acid peptic disease (8.3%). Almost equal proportion of participants complained of head reeling. Low vision was more prevalent among females (8.7%), whereas hearing defect among males (6.5%).
Figure 1: Gender wise distribution of chief complaints

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[Figure 2] shows the gender wise distribution of health-seeking profile of the study participants. Marginal difference was observed between both the genders regarding preference for government and private facilities medicines. Most of participants resorted for both. However, the prevalence of inappropriate health-seeking behavior was higher in females (65.1%) as compared to males (33.2%). Only 28.4% of females were financially independent while nearly 2/3rd of them were dependent on their children for being taken care of.
Figure 2: Health seeking behaviour among elderly males and females

Click here to view



  Discussion Top


This study was conducted in the field practice area of SCB Medical College and Hospital. Every Thursday, NCD clinic is being organized in this UHTC as well as once a month all the BPL elderly gather here on a fixed day to receive their pension of Rs. 300/-(up to 79 years) and Rs. 500/-(for 80 years and above).

The mean age of participants was 67.58 ± 6.53 years with female: male ratio of 1.18: 1 which is higher than the national average of 0.9:1 (Census 2011).[19] The mean age of participants was higher in another similar study conducted by Thakur et al.[20] in slums of Pune, Maharashtra i.e., 72.6 and 69.2 years respectively. Near about half i.e., 49.1% were illiterate in the present study. Similar to this findingour finding of this study, 48% illiteracy among elderly was observed in a study conducted by Sharma et al.[21] Almost 64.5% participants were unemployed which is much higher than the findings of Thakur et al. and Adebusoye et al. wherein 45.7% and 45.2% were unemployed respectively.[20],[22]

The overall morbidity in the present study was observed to be 71. 6% i.e., 302 participants suffered from at least one disease which is much lower than the findings of similar studies conducted in various parts of the country but much higher than a similar study conducted in the field practice area of Guntur.[6],[10],[21],[23] Morbidity prevalence was higher in case of females (75.5%) thanmales (66.8%). The most common presenting complaint among females was joint pain (23.6%), followed by head reeling (14.8%) and low vision (8.7%). Whereas in case of males, the most common complaint was features of URTI like cough, rhinorrhoea etc., (19.2%). followed by head reeling (16.1%) and joint pain (13%). Similar to our findings, musculoskeletal problems like joint pain were observed to be the commonest presenting issue in identical studies conducted among elderly people residing in rural areas of Shimla and Varanasi by Kumar et al., Sharma et al. and Shankar et al.[21],[23],[24] In a study conducted by Adebusoye et al.,[22] generalised symptoms were reported to be the most common presenting complaints (41.2%) while in another study carried out in rural areas of Baldwani block in Nainitial by Bartwal et al.,[4] ocular morbidity was found in more than half of the participants. The prevalence of respiratory problems in our study is much higher than the findings of Bartwal et al. (13.4%) while other studies by Sharma et al. and Lena et al. estimated much higher values i.e., 32.7% and 34.1% respectively.[4],[21],[25] The prevalence of low vision was 8.7% in males and 2.1% in females in our study which is lower than the findings of Adebusoye et al.[22] who observed visual defects to be prevalent among 19.8% of participants. However, there are studies conducted by Barua et al.[6] in urban slums of Assam and Thakur et al.[20] in Pune, who observed ocular morbidities to be as high as 70.4% and 80.3% respectively. Hearing defects were observed in 6.5% males and 2.6% females which is similar to the findings of Agrawal et al.,[26] a study carried out in rural areas of Maharastra who found prevalence of hearing impairment to be around 4.5%. But there are other similar studies by Bartwal et al.[4] and Singh et al.[27] conducted in districts of Nainital and Patiala, where prevalence of hearing impairment was estimated to be much higher than present study's finding i.e., 17% and 38.1% respectively. Skin diseases like fungal infections, eczema and rashes were observed in 3.5% females and none among males which is higher than the finding of Bartwal et al. i.e., 6.5%.[4] Other similar studies by Kumar and Mohammed S[28] and Anitha et al.[29] reported prevalence of skin diseases to be up to 20%.

Among chronic diseases, prevalence of hypertension was observed to be highest (33.9%). In the studies carried out by Adebusoye et al.[22] and Anitha et al.,[29] the prevalence of hypertension was observed to be higher than the present study accounting for near about 40%. In another study by Kumar et al.,[23] the prevalence of hypertension was observed to be on the lower side i.e., 30% and was the 2nd most common morbidity, unlike our study. The prevalence of diabetes mellitus in this study was found to be 14.2.% which is near about similar to the findings of Bartwal et al. (13.2%), Vaishali et al. (13.6%) and Lena et al. (13.4%) which were carried out among elderly people residing in Varanasi, Udupi and Puducherry respectively.[4],[25],[30] Much higher prevalence was observed by a study conducted among elderly people in Nainital district of Uttarakhand by Umesh Kapil and Tandon M.[31] Around 338 (80.1%) and 84 (19.9%) participants suffered from moderate and severe depression using GDS-30 questionnaire. In a study by Thakur et al., self-reported depression was found among 52.3% participants which is much lower than our finding.[20]

Inappropriate health seeking behaviour was observed among 213 participants i.e., 50.4% and was significantly associated with those who were under-weight for their BMI (66.4%), addicted to Gutkha (67.2%), anaemic (61.1%), suffering from hypertension (60.8%) and severe depression (59.5%). This finding is similar to those of Barua et al. where 51.8% of participants used allopathic medicines for their health problems.[6] Most of the patients availed healthcare services from private as well as government which may be attributed to the nonavailability or irregular supply of government medications. Inappropriate health seeking behaviour was more prevalent among females (65.1%). This inappropriate behaviour mostly included receiving over the counter medicines, self-medications with local remedies and visiting quacks. More than half of the males were self-dependent financially whereas near about 2/3rd of females were dependent on their children. In the study by Sharma et al., it was observed that government facilities were the commonest source of treatment and only 12.6% elderly preferred Over The Counter medications.[21] Further lower values of inappropriate Health Seeking Behaviour was observed in a study conducted by Goswami et al. where only 10% elderly preferred Over The Counter medications.[32]


  Conclusion Top


The burden of chronic morbidity and disability among elderly is increasing due to rise in their numbers globally as well as in India. Older age is often accompanied by emergence of several health issues. Hence, the health status of the elderly is an emerging public health issue which needs to be addressed immediately through primary health care.

With the increase in the elderly population, comprehensive geriatric health services at community level should be established for their easy access and utilization. Therefore, community-based studies among the elderly with more emphasis on their morbidity pattern and health-seeking behavior are needed.

This study conducted among the elderly residing in urban slums has thrown some light about their morbidity pattern and health-seeking behavior.

Among 422 subjects, the overall morbidity was found to be 71.6%. Common morbidity was joint pain in case of females and URTIs in case of males. Among chronic diseases, the prevalence of hypertension was observed to be the highest (33.9%).

The prevalence of inappropriate health-seeking behavior was higher in females (65.1%) as compared to males (33.2%). A statistically significant association was found between inappropriate health-seeking behavior and under-weight for their BMI (66.4%), addicted to Gutkha (67.2%), anemic (61.1%), suffering from hypertension (60.8%), and severe depression (59.5%).

These findings highlight the need of suitable health facilities and affordable health care to the elderly in slum areas to ensure their active aging as well as a good quality of life. There should be separate geriatric clinics in both government and private hospitals to deal with the problems faced by the elderly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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