|Year : 2018 | Volume
| Issue : 1 | Page : 47-51
A clinico-social study of functional disabilities among elderly in Palam Village of Delhi
Devendra Kumar1, Sanjeev Kumar Rasania2, Ranjan Das3
1 Junior Resident, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
2 Director Professor and Head, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
3 Director Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
|Date of Submission||20-Apr-2018|
|Date of Acceptance||23-May-2018|
|Date of Web Publication||1-Feb-2019|
Junior Resident, Department of Community Medicine, Lady Hardinge Medical Colleqe, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Aging, an integral part of living, typically is accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness and is further compounded by impairment of special sensory functions like vision and hearing and difficulties in performing their routine daily activities seriously affecting the economic, social and psychological aspect of life of older people with disabilities. Objective: To estimate the magnitude of functional disability and its association with various socio-demographic variables among the elderly persons in Palam village of Delhi. Material and Methods: People aged more than 60 years of both sexes and willing to participate were included in this community based cross-sectional study. Barthel ADL index was used for assessment of activities of daily living disability, Snellen's distance vision chart for visual acuity assessment and whisper test was used for hearing assessment. The participants were categorized as functionally disabled if either ADL disability or better eye presenting vision <6/60 or bilateral hearing impairment or a combination of either these were present. Results: The prevalence of functional disability was found to be 23.1% in the study population and was more unmarried/widow/widower group, among illiterates, lower socio-economic class and financially dependent group. Conclusion: Research and studies on elderly in India especially in field of functional disability are less and community dwelling elderly has been neglected at large. Hence it would be useful to estimate the burden of functional disabilities among elderly so that adequate and timely preventive and rehabilitative measures can be taken.
Keywords: Elderly, Functional disability, Activities of daily living
|How to cite this article:|
Kumar D, Rasania SK, Das R. A clinico-social study of functional disabilities among elderly in Palam Village of Delhi. Indian J Community Fam Med 2018;4:47-51
|How to cite this URL:|
Kumar D, Rasania SK, Das R. A clinico-social study of functional disabilities among elderly in Palam Village of Delhi. Indian J Community Fam Med [serial online] 2018 [cited 2021 Mar 7];4:47-51. Available from: https://www.ijcfm.org/text.asp?2018/4/1/47/251349
| Introduction|| |
Elderly or old age consists of ages nearing or surpassing the average life span of human beings. In India persons of age 60 years or above are considered as senior citizen or elderly Both the share and size of elderly population is increasing over time. From 5.6% in 1961, the proportion has increased to 8.6% in 2011. According to population census 2011, there are nearly 104 million elderly persons (aged 60 years or above) in India.
Aging, an integral part of living, typically is accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness. Although neither a disease nor a disability per se, aging nonetheless is associated with a high incidence of physical impairment and functional disability. This is further compounded by impairment of special sensory functions like vision and hearing and difficulties in performing their routine daily activities. Since the consequences of disability can seriously affect the economic, social and psychological aspect of life of older people with disabilities and also their families and communities as well, it is found to be a major health concern among older people. The present study was carried out to estimate the magnitude of functional disability and its association with various socio-demographic variables among the elderly persons in Palam village of Delhi.
| Material and Methods|| |
A Community based cross- sectional study was carried out in Palam village in West Delhi from January to December 2016 which is one of the field practice areas of Community Medicine Department, Lady Hardinge Medical College, New Delhi. Majority of the families of the area belong to lower middle socio-economic status. Both public and private medical facilities are available in the area. The government health service in the area is being catered by primary health centre, Palam which is under the central government of India. While a number of private practioners and private hospitals are there but Deen Dayal Upadhyay Hospital is the nearest tertiary care government hospital to area situated in Hari Nagar.
A Semi-structured interview schedule was administered to all the study subjects for obtaining socio-demographic details. Sample size was calculated using prevalence of 19% (at least one ADL restriction), absolute error of 5%, (confidence interval = 95%, power = 80%). Taking design effect of 1.25 and response rate of 90%, the effective total sample size was taken to be 350. 1st house was selected randomly and subsequent houses were selected by systematic random sampling (every 2nd house was taken to choose the study subjects). To obtain the total sample size of 350 elderly, a total of 418 households were screened.
People aged more than 60 years of both sexes in the study area and willing to participate were included in the study, while people more than 60 yrs of age who were known case of psychiatric disorder and who refused to give informed consent were excluded from the study.
Barthel ADL, index was used for assessment of activities of daily living disability in the study population (ADL Disability). The ten variables addressed in the Barthel scale are fecal incontinence, urinary incontinence, grooming, toilet use, feeding, transfers, walking, and dressing, climbing stairs and bathing. Each performance item is rated on this scale with a given number of points assigned to each level or ranking yielded a score of 0–20. ADL disability is defined in the study subject if the total score in Barthel ADL index is < 20.,
Visual acuity was assessed by using Snellen's distance vision chart and visual disability defined as visual acuity of <6/60 in the better eye.
For hearing assessment, all the participants were first administered the whisper test. Those who fail the whisper test were examined with Rinne's test and Weber's test for hearing status, using a 512 Hz tuning fork. Hearing impairment was defined as conductive and/or sensorineural deafness of both ears as assessed by Whisper test, Weber's test and Rinne's test.
The participants were categorized as functionally disabled if either ADL disability or better eye presenting vision <6/60 or bilateral hearing impairment or a combination of either these were present.,
Weight, Height, Pulse rate, Blood Pressure, Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Pedal Edema were evaluated for every study subjects followed by systemic examinations. Approval for the study was taken from the ethical committee of Lady Hardinge Medical College and written informed consent was taken from all the study subjects.
Data was analysed using SPSS version 19. Observations were described in terms of mean, range and standard deviation for Continuous data and in terms of percentage / proportions for Categorical data. Chi square test was used to detect statistical significance for qualitative variables and p value < 0.05 was considered statistically significant.
| Result|| |
Of the total 350 study population, 166 (47.4%) were males and 184 (52.6%) were females. Mean age of the study subjects was 67.40 ± 6.63 years and Range was 60-93 years. On the basis of educational status it was observed that majority of the study subjects (47.1%) were illiterate. There were 80.7% of currently married males compared to 57.6% of currently married females and 42.4% of females were widows compared to 18.7% males who were widowers. Majority of the study subjects (86.6%) were living in joint families. Among males 74.7% were unemployed (mostly retired) and among females 85.9% were unemployed (mostly housewives). One hundred and twenty nine (36.9%) of study subjects were financially dependent on others.
The prevalence of functional disability was found to be 23.1% in the study population which was 21.1% in males as compared to 25.0% in females. An increasing trend in prevalence of functional disability was seen with increase in age in both male and female gender and it was observed to be higher (35.5%) among unmarried/widow/widower group as compared to currently married (17.5%) and the association was found to be statistically significant. [Table 1]
|Table 1: Association of functional disability with various socio-demographic variables|
Click here to view
The prevalence of ADL disability was found to be 20.3% in the study population, while prevalence of visual disability and hearing disability was found to be 6.3% and 1.4% respectively. It was observed that 4.0% of study subjects were having both ADL and visual disability and 0.2% were having all three (ADL+ visual +hearing) disabilities. The association of various socio-demographic variables with functional disability has been shown in [Table 1].
| Discussion|| |
The global demographic trend tells us that with the passage of time, the countries have experienced ageing of population which has profound social, economic and political implications for a country. This study was carried out to find the magnitude of functional disability in elderly population in an area of West Delhi and to find its association with various socio- demographic variables.
Various definitions have been used to describe functional disability in published literatures., In the present study the participants were categorised as functionally disabled if ADL disability is present or better eye presenting vision is <6/60 or bilateral hearing impairment is present or a combination of either. Only one study on functional disability in India has been done by Gupta P et al (2011-12) using the same definition criteria as used in present study. Since studies on functional disability among elderly persons using the same definition criteria are less, therefore comparison of findings of our study with other studies elsewhere is limited by definition criteria, difference in the ways disability was quoted and sample characteristics.
In the present study the prevalence of functional disability was found to be 23.1% in the study population. An increasing trend in prevalence was seen with increase in age and was found to be statistically significant. Similar pattern was seen in cross-sectional studies conducted by Deepthi R et al (2011) among rural elderly population in two villages of Bangalore district of Karnataka, and in international studies done by Yoshida et al (2005-06) in Japan and Abdulraheem et al (2010) in Nigeria.,, Gupta P et al (2011-12) reported higher prevalence of functional disability (38.4%) than our study using the same definition criteria for functional disability, however gender wise pattern was similar to our study, i.e. more in females (38.8%) than males (35.9%). Since the study was conducted in rural area of Haryana, so lack of available health care facilities could be the reason behind higher prevalence of female disabilities.
ADL disability has been used in a number of studies to quote functional disability based on Barthel ADL scale. Using the 10 items Barthel scale, prevalence of ADL disability in the present study was found to be 20.3% which was 22% in study done by Venkatarao et al (1998-99) and 16% in study done by Chakrabarty et al., Day et al reported only 6.9% ADL disability as it was a hospital based study and included the elderly who attended the geriatric clinic only.
The prevalence of ADL disability in the present study was similar to some studies done in countries like Japan (20%), Malaysia (19.8%)., However lesser prevalence was noticed in studies carried out in USA (15%) done by Chaudhry SI et al (1992), which can be due to better health care facilities and health seeking behaviour of the study population in that geographical portion. The prevalence was reported to be higher in studies done in other developing countries like Nigeria (28%) and Brazil (40%).,
Vision loss has a profound impact on daily functioning and is regarded as an important contributor to disability. In the present study, prevalence of visual disability as quoted by visual acquity <6/60 in the better eye was observed to be 6.3% and an increasing trend was observed with the increase in age. Presenting vision <6/60 in the better eye was observed in 8.5% in a nationwide survey done by Murthy et al (1999-2001) among persons aged 50 years and above. In a study done by Deepthi R et al (2011), 12.6% of the study subjects were reported to be blind and significant association was seen with increasing age. Sanbaz and Tel (2006) reported in their study that a large portion of the elderly had problems in performing their activities due to loss of sight and hearing. Most studies have shown people with higher level of visual impairment are more probable to report disability in activities of daily living.,,
Prevalence of hearing impairment as assessed by whisper voice test and Rinne's test and Weber's test was observed to be 1.4% in the present study. There is difference in the prevalence of hearing impairment in present study and other studies because of difference in the study instruments used to measure hearing impairment. In a study done by Lasisi et al (2010) prevalence of self-reported hearing impairment was observed to be 6.1%. Prevalence of hearing impairment was 33.5% in persons aged 60 years and a study conducted by Khandekar et al using screening audiometer. Deepthi R et al (2011) reported 24.6% of the elderly had disabling hearing impairment using pure tone audiometry.
In addition to the commonly used ADL disability, visual disability and hearing impairment were also included to quote functional disability in our study as they also have the potential to restrict the functional ability of persons. Study subjects with more than one disability i.e. combination of disabilities were also found in the study population similar to the study done by Gupta P et al (2011-2012). So if appropriate curative or rehabilitative measures are taken in due course of time, it will reduce the suffering faced by them due to the above quoted disabilities.
| Conclusion|| |
The increasing number of older persons put a strain on health care and social care systems in the country as growing age leads to various disabilities and thereby increasing their health care needs also. To face the challenges of ageing population, the country needs to be well prepared. Appropriate social and economic policies are need to be made to mitigate its ill effects which should also address their health care needs.
Based on the conclusions derived from the study, the following recommendations are put forth:
- Comprehensive geriatric care should be incorporated into all levels of health care and particularly in primary health care.
- The high prevalence of functional disability among the study population requires suitable interventions at the community level itself.
- Social security schemes and medical benefits for the elderly should be strengthened up and made available to larger sections of the elderly
- Elderly living without families or under difficult conditions should be identified in the community and proper care should be provided to them with the help of health workers.
- Elderly needing Supportive items like Walking Sticks / Calipers, Walker (ordinary), Spectacles, Hearing Aids etc should be identified and should be provided with them starting from the sub centre level only.
| References|| |
National Policy for Older Persons [Internet] 1999 [cited 2017 April 2]. Available from http://socialjustice.gov.in/ writereaddata/UploadFile/National%20Policy%2 0for%20 0lder%20Persons%20Year%201999.pdf
Elderly in India - profiles and programmes [Internet] 2016 [cited 2017 April 5]. Available from http://mospi.nic.in/sites/default/files/publication_reports/ ElderlyinIndia_2016.pdf
Konjengbam S, Bimol N, Singh AJ, Singh AB, Devi EB, Singh YM. Disability in ADL Among the Ederly in an Urban Area of Manipur. Indian J Pharm Med Res. 2007; 18 (2): 41-43.
Venkatarao T, Ezhil R, Jabbar S, Ramkrishnam R. Prevalence of disability and handicaps in geriatric population in rural south India. Indian J Public Health. 2005;49(1):11-17.
Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61-3.
Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability?. Int Disabil Stud. 1988;10(2):64-7.
Definition of visual impairment. [Internet] 2017 [cited 2017 April 15]. Available from http://www.bpaindia.org/VIB%20Chapter-I. pdf.
Deafness and hearing impairment. [Internet] 2017 [cited 2017 April 20] Available from: http://www.who.int/mediacentre/factsheets/fs300/en/index.html;WorldHealth Organization.
Gupta P, Mani K, Rai SK, Nongkynrih B, Gupta SK. Functional Disability Among Elderly Persons in a Rural Area of Haryana. Indian J Public Health. 2014;58(1): 11-16.
The disabled elderly and their use of long-term care. [Internet] 2017 [cited 2017 April 10]. Available from: http://www.aspe.hhs. gov/daltcp/reports/diseldes. htm#chap1.
Kasthuri A. Visual and hearing impairment among rural elderly of south India: A community-based study. Geriatr Gerontol Int. 2012;12(1):116-22.
Yoshida D, Ninomiya T, Doi Y, Hata J, Fukuhara M, Ikeda F et al. Prevalence and causes of functional disability in an elderly general population of Japanese: the Hisayama study. J Epidemiol. 2012;22(3):222-9.
Abdulraheem IS, Oladipo AR, Amodu MO. Prevalence and correlates of physical disability and functional limitation among elderly rural population in Nigeria. J Aging Res 2011;2011:369894.
Venkatarao T, Ezhil R, Jabbar S, Ramkrishnam R. Prevalence of disability and handicaps in geriatric population in rural south India. Indian J Public Health. 2005;49(1):11-17.
Chakrabarty D, Mandal PK, Manna N, Mallik S, Ghosh P, Chatterjee et al. Functional disability and associated chronic conditions among geriatric populations in a rural community of India. Ghana Med J. 2010;44(4):150-54.
Dey AB, Soneja S, Nagarkar KM, Jhingan HP. Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme. National Med J India. 2000;14(3):135-38.
Woo J, Ho SC, Yuen YK, Yu LM, Lau J. An estimation of the functional disability burden in elderly Chinese age 70 years and over. Disabil Rehabil. 1996;18(12):609-12.
Aris M, Aznan M, Draman S, Ab Rahman J, Samsuddin N. Functional disabilities and its associated factors among elderly patients in primary care clinics. Int Med J Malaysia 2009;16(4):251-56.
Chaudhry SI, McAvay G, Ning Y, Allore HG, Newman AB, Gill TM. Geriatric impairments and disability: the cardiovascular health study. J Am Geriatr Soc. 2010;58(9):1686-92.
Fillenbaum GG, Blay SL, Andreoli SB, Gastal FL. Prevalence and correlates of functional status in an older community- representative sample in Brazil. J Aging Health. 2010;22(3):362- 83.
Murthy GV, Gupta SK, Bachani D, Jose R, John N. Current estimates of blindness in India. Brit J Ophthalmol. 2005;89(3):257-60.
Sahbaz M, Tel H. Determination of the Relationship between the Dependence Status on Daily Living Activities and Home Accidents among 65 years of Age and Older Individuals Living at Home. Turk J Geriatr 2006. 85-93.
Laitinen A, Sainio P, Koskinen S, Rudanko SL, Laatikainen L, Arroma A. The association between visual acuity and functional limitations: findings from a nationally representative population survey. Ophthalmic Epidemiol 2007;14(6): 333-42.
Haymes SA, Johnston AW, Heyes AD. Relationship between vision impairment and ability to perform activities of daily living. Ophthalmic Physiol Opt 2002; 22(2): 79-91.
Swanson M, McGwin G. Visual impairment and functional status from the 1995 National Health Interview Survey on Disability. Ophthalmic Epidemiol. 2004;11(3): 227-39.
Lasisi AO, Abiona T, Gureje O. The prevalence and correlates of self-reported hearing impairment in the Ibadan Study of Ageing. Trans R Soc Trop Med Hyg. 2010;104(8):518-23.
Khandekar R, Al Riyami A, Attiya M, Morsi M. Prevalence and determinants of blindness, low vision, deafness and major bone fractures among elderly Omani population of Nizwa Wilayat (Nizwa elderly population study-2005). Indian J Ophthalmol. 2010;58(4):313-20.