A STUDY OF THE MORBIDITY PATTERN AMONG THE GERIATRIC POPULATION IN A RURAL AREA OF WEST BENGAL 1) AIMS AND OBJECTIVES :

Ageing is a global and an irreversible phenomenon intricately woven to the inherent cycle of life. The worlds elderly population people 60 years of age or older, is the fastest growing age group. While population ageing is a triumph of modern society and bears testimony to the unmistakeable advances of modern medicine and healthcare, and is a reflection of the overall improvement in global health but it also raises special challenges in the 21st century both in developed and developing countries the challenge of adequately understanding the needs and requirements of this special population group and realigning the existing healthcare infrastructure to cater to their needs. Given the fact that by 2050 about 80% of the elderly will be living in developing countries 3 , it is time that we gather more knowledge and skills to make ourselves prepared to meet this challenge. This special group of population has certain unique socio-demographic qualities which necessitates realignment of healthcare and other health promotive services to suit their needs. Firstly, there persists vast health inequalities , as the existing healthcare services are not adequate both in focus and expertise to cater to the elderly population . Most of the initiatives and programmes aim at other vulnerable population groups like children, pregnant mothers etc. However, it will be increasingly necessary to spend the resources for this section of the population. Secondly, accessibility of healthcare services may be disrupted as a significant proportion of the elderly population are bed ridden or have restricted mobility arising out of different morbidities, or simply because of frailty. Thirdly, disasters and emergencies severely impact the most vulnerable including the older people eg. highest percentage of fatalities in Indonesia caused by the 2004 Indian Ocean tsunami was in people aged 60 years and older this necessitates urgent planning to protect the elderly from emergencies. Finally, lack of earning power , dependence on family members , lack of emotional support and psycho-social factors further overwhelm the vulnerability of the older people.

Effective, community-level primary health care for older people is crucial to promote health, prevent disease and manage chronic illnesses in dependent and frail patients. By 2050, close to 80% of all deaths are expected to occur in people older than 60. Health expenditure increases with age and is concentrated in the last year of life - but the older a person dies, the less costs are concentrated in that period. Postponing the age of death through healthy ageing combined with appropriate end-oflife policies could lead to major health care savings. The challenge of 21st century healthcare is to delay the onset of disability and ensure optimal quality of life for the elderly. More venture has to be undertaken to formulate guidelines for a comprehensive geriatric healthcare approach. It is time that preventive healthcare strategies specific to the elderly are clearly formulated and tested. Now that we have achieved longevity of life, we should , as Sir James Sterling Ross has put it , try to protect it, promote it and extend it . Hence this study is taken up with the objective to assess the health status and morbidity pattern of the rural elderly with a view of providing data that will help in reorienting the health services to reduce their problems.

2) SPECIFIC OBJECTIVES OF THE STUDY :

A. To assess the physical and psycho-social morbidity pattern affecting the elderly population B. To know about the health care-seeking behavior of the elderly in different morbid conditions C. To study the quality of life and attitude towards life of the elderly D. To suggest measures to mitigate their problems , as will be found in this study

3) MATERIALS AND METHODS:

1. STUDY AREA : The study is proposed to be conducted in the rural field practice

area of the Dept. of Community Medicine of R.G.Kar Medical College ; the field practice area is in the Amdanga Community Development block of North 24 Parganas district of West Bengal. The area comprises a total population of 165,771 (2001) and is catered by the 2

Amdanga BPHC, which has four PHCs under it viz. Amdanga, Berberia, Adhata and Maricha. 2. 3. 4. 5. STUDY POPULATION : The study population comprises of the individuals aged 60 STUDY PERIOD : One year which includes the period for data collection and SAMPLE SIZE : All the individuals who are aged 60 years and above and are SAMPLE DESIGN : The Amdanga block comprises of four PHCs. Each of the 4 years and above , who are permanent residents of the selected villages of the Amdanga block. subsequent analysis. residing permanently at the four selected villages will be taken as the study population. PHCs consist of 6 subcentres. Firstly, one subcentre will be selected from each one of the PHCs by simple random sampling. Secondly, one village will be randomly selected from each of the chosen subcentres again by the method of simple random sampling. For ethical reasons it is proposed that all the individuals aged 60 years and above residing in these 4 selected villages will be included as the study population . Effort is made such that the study population is representative of the whole Amdanga block. 6. 7. STUDY DESIGN : Community based descriptive epidemiological study with a PARAMETERS TO BE STUDIED : Prevalence of morbidity among the geriatric population including cardiovascular ailments (viz. hypertension ,coronary artery diseases etc ), neurological ailments, musculo-skeletal disorders, ocular diseases and other disorders Prevalence of psycho-social problems amongst the elderly like feeling of neglect, lonelinesss, abuse, sadness etc. To ascertain the prevalence of the common mental morbidities plaguing the elderly like depression, dementia etc. 8. To know their health care seeking behavior . To assess the lifestyle factors like smoking, alcoholism, alongwith their notion of their quality of life , and their attitude towards old age . Factors, if any , found relevant during the study STUDY TOOLS: Predesigned , pretested schedule Cross-sectional design.

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Secondary data like doctors prescriptions, hospitalisation records, laboratory reports etc. Digital weighing machine, measuring tape ( both steel & tailors tape) Stethoscope, sphygmomanometer, percussion hammer Torchlight, 512 Hz tuning fork Psychological scales like Geriatric depression scale, ADL scale, Clinical Dementia Rating Scale etc. STUDY TECHNIQUE : The purpose of the study will be explained to each subject

and an verbal informed consent will be sought from the subjects included in the study. The study subjects will be interviewed with the help of the predesigned and pretested schedule, will be examined clinically for any detectable morbidity and psychological evaluation will be done with the help of appropriate psychological questionnaire and scales. Review of the secondary data, where available will be done. 10. PLAN FOR ANALYSIS OF DATA : Analysis of the data will be done with the help of appropriate statistical methods.

4) REVIEW OF LITERATURE:
As an assertion of the growing socio-demographic importance of the geriatric population both in developed and developing countries, various studies have been conducted with the aim to assess the morbidity pattern amongst the elderly people , so that appropriate measures to cater to their specific health needs can be put to place. A year long study was conducted in rural Tamil Nadu in 2002-03 by Purty AJ et al of the Dept. of Community Medicine of Pondicherry Institute of Medical Sciences. This study revealed the quantum of diseases in an elderly person to be about 2.77 per person. Significantly, it showed pains and joint aches to be the most prevalent morbidity (43.4%) followed by chewing and dental problems . This is in contrast to another study set in urban Udaipur, conducted by Prakash R et al which revealed hypertension (48%) as the most prevalent disease, though ocular morbidity (70%) accounted for the most common group of systemic diseases. This was followed by psycho-social problems (42%) in

both sexes. Also this study showed the sex-wise distribution of the morbidity pattern and expectedly females accounted for a higher percentage in both the two most prevalent morbidities at 54% (hypertension) and 49% (psycho-social problems). In comparison to the study by Purty AJ et al the prevalence of musculo skeletal disorders was only 14.6% in both sexes combined. Another study conducted by Lena A et al in the field practice area of Kasturba Medical College , Mangalore, showed corroborative data , with hypertension (59.1%) as the most prevalent disease followed by osteoarthritis (41.3%). The study by Lena A et al also focused on the psycho-social problems faced by the elderly and their attitude towards old age . Significantly nearly half of the subjects felt neglected by their family members while 36.4% thought that they were a burden to the family.This is in contrast to the findings by Prakash R et al which reported that 17.3% of the respondents felt neglected by their family. The unfavourable attitude was more prominent among females than in males. Noticeably only about 35.7% of the elderly individuals were aware of the Govt. welfare schemes while only a meager 14.6% actually utilized the geriatric welfare services. While the study by Lena A et al reported that poverty and financial constratints was the principal cause of sadness (48%) amongst the elderly , Prakash R et al in their study found that loneliness (20%) was the main cause for feeling sad in the elderly, followed by a feeling of neglect by the family members.

5) REFERENCES:
1.