Physical Health Problems of the Elderly Women Living In Institutions and With Families.

Introduction:
Ageing is a universal biological fact and a natural process. It begins from the day we are born, or perhaps even before. Senior citizens are more vulnerable because of deterioration of mature organisms. India now has the second largest aged population in the world. According to recent statistics (2001) related to elderly people in India, it was observed that 80% reside in rural areas. About 48.2% of elderly persons were women, out of whom 55% were widows. 40% of them live below poverty line and 70.3% of elderly are illiterate (2000). About 90% of the elderly were from the unorganized sector, i.e., they have no regular source of income. Old age is commonly associated with frequent illness and requires medical care and associated health services. In the population over 70years of age, more than 50% suffer from one or more chronic conditions. (Reddy PH 1996).

The chronic illnesses usually include hypertension, coronary heart disease, and cancer. According to Government of India statistics, cardiovascular disorders account for one-third of elderly mortality. Respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning, and violence constitute less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal, and genito-urinary infections. (Guha R. 1994)

In India, 75% of aged individuals are afflicted by a physical disability (vision, hearing, locomotors, speech and senility) (National Sample Survey Organisation, 1998). The most common chronic conditions reported by India's elderly are joint problems (72.4%), cough (38.2%) and hyper/hypotension (33.2%) (National Sample Survey Organisation, 1998).

A study conducted in the rural area of Pondicherry reported decreased visual acuity due to cataract and refractive errors in 57% of the elderly followed by pain in the joints and joint stiffness in 43.4%, dental and chewing complaints in 42%, and hearing impairment in 15.4%. Other morbidities were hypertension (14%), diarrhea (12%), chronic cough (12%), skin diseases (12%), heart disease (9%), diabetes (8.1%), asthma (6%), and urinary complaints (5.6%). (Purty A J, Bazroy 2006). In a community based study conducted in Delhi among 10,000 elderly people, it was found that problems related to vision and hearing topped the list, closely followed by backache and arthritis. (Dey A.B, Soneja S, Nagarkar K.M 2001) 

Methodology:
The aim of the present paper is studying the physical health problems of elderly women living in institutions and in community. The universe of the present study is Bengaluru and its urban conglomerates, and is composed of aged people who have completed 60 years of age. The unit of the study is an aged person.  For this study 200 respondents were interviewed using an interview schedule.

In this study the researcher has selected Stratified sampling design. Initially the population was stratified in those living with their families and those living in homes for the aged. Further the researcher classified the old age homes (homes for the aged) into 2 stratas i.e., homes for the destitute aged and pay and stay old age homes.  The older persons living with their families were chosen from all the economic strates i.e., upper and middle class as well as people below the poverty line. Keeping all these in mind the researcher has taken 200 samples, in that sample fifty percent of the respondents were taken from Old Age Homes and remaining fifty percent from families of Bengaluru city. Of the 100 samples from old age institutions 50 were from pay & stay homes and 50 from destitute homes (more than 185 homes for the aged are functioning in Bengaluru city, in that 70% of homes are pay and stay homes and 30% homes are destitute aged, selected 20 homes for the aged from different locations of Bengaluru for data collection). The remaining 100 samples were taken from upper, middle and lower class families. 

Results:
The physical health of the respondents is assessed using Cornell Medical Index and each of the problems has been represented in the Table.  The percentage scores of the problems are grouped into 3 categories. These are the scores above 40% as high prevalence, 20 to 40% scores as moderate prevalence and below 20% as low prevalence. 

(Group: I- Pay & Stay Old Age Homes, Group: II- Homes for the Destitute Aged, Group: III- Upper & Middle Class Aged, Group: IV- Below Poverty Line Aged)

High physical health problems are found in feeling miserable due to poor health (52%) stomach burning sensation (47%), injuries and accidents (59.5%) and suffering from hypertension (46%). 

The moderate level problems were reported by those suffering from fever (34%) major operation (37.5%) joints pain (35.5%) back pain (30%) eyesight problem (31.5%) hearing problem (27.5%)  asthma (27%). Again, small variations are found in moderate physical health problem categories. Almost the same pattern prevails between the groups.

The lowest prevalence of physical health problems are found like Cancers, Tuberculosis etc. In the group – wise analysis group III and group IV member suffer more from these problems.
    
The figure shows group -wise analysis of high prevalence physical health problems of the elderly women in different groups.  More physical health problems depicted in group II and group IV was due to these two groups being financially weak.

Conclusion:
Aging is a complex process, consisting of, and affected by biological, psychological and social factors. In the past, institutionalization was often seen as one of the most effective methods of providing continuous support for older persons. In the context of the present study, the researcher find that major physical health problems are found more in respondents from destitute homes and below poverty line group compared to other groups.  
Suggestions: 
Conduct more health check-up camps, government should start geriatric clinics at-least in district level hospitals. To provide all the medicines free of cost to the all aged persons without any discrimination. There should be separate geriatric clinics in the private/government hospitals. Create more awareness programmes on health issues to prevent the disability among aged. To suggest to the government and non-government departments they should conduct health and dietary pattern awareness/ training programmes to their employees who they are over 50 years. (Through the medical doctors and gerontological social worker) State or central government should start Geriatric Mobile Medical Health care units. In these units along with medical practitioner appoint psychiatrist and one gerontological social worker compulsory.

References:-

1. Reddy, P.H. (1996):  The health of the aged in India. Health Transit Rev 1996; 6: Pp233.244.
2. Guha, R. (1994):  Morbidity Related Epidemiological Determinants in Indian Aged. An Overview. In: Ramachandran CR, Shah B, editors. Public Health Implications of Ageing in India. New Delhi: Indian Council of Medical Research.
3. Dey, A B, Soneja S, Nagarkar KM, Jhingan H.P. (2001): Evaluation of the health and functional Status of older Indians as a prelude to the development of a health programme. National Medical Journal of India 2001; 14: Pp135.138.
4. Purty, A. J., Bazroy, J., et al (2006): Morbidity Pattern among the elderly population in the rural area of Tamil Nadu, India. Turk Journal of Medical Science 36: Pp45-50.
5. National Sample Survey Organisation. The Aged in India, (1998): A Socio-economic Profile. National Sample Survey Fifty-Second Round, July 1995-June (1996). Department of Statistics, Government of India. 

Ranga Reddy Sridhara Channakeshava H.C
Dr. Hemalatha K