Ageing is a natural process; always associated with physiological and biological decline. It is the outcome of certain structural and functional changes takes place in the major parts of the body as the life years increases. In the words of Seneca; “Old age is an incurable disease”. As Sir James Sterling Ross said “You do not heal old age, you protect it, you promote it and you extend it”. World population ageing is enduring; the proportion of older persons has been rising steadily, from 7 per cent in 1950 to 11 per cent in 2007, with an expected rise to reach 22 percent in 2050.¹ There are presently 740 million individuals in the world aged 60 years or over, and that number is expected to rise to 1 billion by the end of the present decade and possibly to 2 billion by mid-century. ² India alone has around 100 million elderly at present, and the number is expected to increase to 323 million, constituting 20 per cent of the total population, by 2050. ³ The Indian aged population is currently the second largest in the world. According to the 2001 census 7.7% of total population were above the age of 60 years and estimated to double i.e. 12.30% by 2025 .⁴Population of India as per census 2011 is =1,21,01,93,422 while population of Maharashtra   is 11,23,72,972.¹³ It took more than 100 years for the aged people to double in most of the countries in the world, but in India it has doubled in just 20 years.⁵Population around the world is growing old at high rate with increasing life expectancy.⁶Life expectancy at birth is increasing at very pace it was 63.8 for males and 66.1 for females in year 2001-05,67.3 for males and 69.6 for females in year 2011-15,and projected to be 69.8 for males and 72.3 for females in year 2021-25.⁷As a result of the current ageing scenario in India, there is a need to take care of all aspects of the geriatric persons namely, socio economic, financial, health and shelter. With these issues, safety and security of older persons are also of concern in India. The risk of having at least one chronic disease such as hypertension (HTN), diabetes mellitus (DM) ,arthritis ,cancers increases with age, this is not so much function of chronological age per se, but a reflection of lifelong accumulation of risk factors.¹⁰

According to WHO, factors increasing depression risk in elderly  adults include   genetic   susceptibility,   chronic   disease   and   disability, pain, frustration with activity  of daily living (ADL), personality traits (dependent, anxious or avoidant), adverse events in life (separation, divorce, bereavement, poverty, social isolation) and lack of adequate social support. Many studies have demonstrated a relationship between depression and various socioeconomic factors such as advanced age, low education, poverty and manual occupation. Thus, an older adult patient suffering from depression often has a combination of psychological, physical and social needs.¹² The Increased prevalence of major risk factors, viz., tobacco and alcohol consumption, inappropriate diet, physical inactivity, high blood pressure, high blood glucose and dyslipidaemias are driving the epidemic of Non communicable diseases.¹³

Objective: To study the socio-demographic profile of geriatric population in field practice area of Rural Government medical college of Maharashtra.

The present study was conducted in the field practice area of Urban Health Training Centre attached to Community Medicine Department, Government Medical College of Maharashtra to study socio demographic factors associated with geriatric health in study population.

Study Design: It is a Community based, cross sectional study.

Study area: The area for the study is Field practice area of Urban Health Training Centre an adopted community of Urban Health Training Centre, which is approximately 1.5 km away from Medical College. The unit of study is geriatric population i.e. aged 60 years and above living permanently infield practice area of urban health Centre.

Ethical considerations: Ethical committee approval was obtained prior to the start of the study from Institutional Ethics Committee of a Medical College.

Inclusion criteria:

(1)           Elderly aged 60 years and above were included study.

(2)           Those elderly who were willing to participate in a study.

Exclusion criteria:

(1)           Elderly less than 60 years of age.

(2)           Those who were not willing to participate in the study.

(3)           Elderly individual who were seriously ill.

(4)           House of who were permanently locked or have transferred their residence or elderly who cannot be contacted even after three successive visits to their homes was excluded.

Sample Size: No sampling was done. All eligibles according to Inclusion criteria, residing in field practice area of UHTC were included in study & 394 elderly were enrolled.

Period of Study: The study was conducted from 1 January 2015 to June 2016.

Material Used: Materials used were pretested semi structured   questionnaire, mercury sphygmomanometer, stethoscope, standard measuring tape, weighing machine, torch, and snellen’s charts for checking visual acuity, Tuning Forks for hearing assessment. Blood pressure was measured with a standard sphygmomanometer which was regularly checked and used same throughout the period of data collection.

All the elderly of 60 years age and above were first enlisted from house to house survey with the help of Voter ID, Aadhar card, Driving License etc like available records. If available records not available, then information was elicited by asking in reference to well-known historical events (e.g. India’s Independence in 1947) or asking age at birth of the first living child .Initially the pilot study was carried out in the field practice area for pretesting the questionnaire and necessary modification were made in the questionnaire and same was finalized.

Distribution of Study Subjects according to Type of operation:

Graph No.1 shows various types of operation undergone

by study subjects in the past. Out of 189 male, cataract was the commonest operation 33 (17.45%) followed by Prostectomy

25 (13.22%).

Table No .1: Distribution of Study Subjects according to Complaints at the time of data collection.

(**Total not mentioned as many participants were having multiple symptoms.)            

        Table no.1 shows distribution of elderly subjects according to type of complaints at the time of data collection. Out of 394 subjects the commonest complaint encountered during data collection was the joint pain i.e. in 95 (24.11) individuals followed by body ache 71 (18.02%), giddiness 35 (8.88%), cold 31 (7.87%), breathlessness 19(4.82%), cough18 (4.57), diarrhea 18(4.57), headache 15(3.81%), and fever 10(2.54%).A total of 164 (41.62 %) individuals do not have any complaints at the time of data collection.

(**Total not mentioned as many participants were having multiple joint involvement.)

         Graph no.2 shows distribution of study subjects according to type of joint involvements. Out of 394 study subjects most common affected being the knee joint i.e. 121 (30.71%) followed by ankle joint 84.

Table No .2: Distribution of Study Subjects according to Grade of Depression

According to the GDS scale, Out of 394 study subjects 241 (61.17%) subjects were not having problem of depression and 153 (38.83%) study subjects having various grades of depression.(Table no.2)

         Among the three, commonest grades was mild depression accounting 100 (25.39%) individuals followed by moderate in 35 (8.88%) and severe in 18 (4.56%) individuals. Gender wise, elderly females 86 (21.82%) were having more problem of depression as compare to male subjects i.e.67 (17.00%)

Table No.3: Distribution of Study Subjects according to Hematopoietic system wise Morbidity.

• Distribution according to presence of

Hematopoietic system morbidity

• Distribution according to Type of Hematopoietic system morbidity

Out of 394 subject 285 (72.33%) were anaemic and 109 (27.67%) were non anaemic.

Table No .4:  Distribution of Study Subjects according to musculoskeletal Morbidity

• Distribution according to presence of musculoskeletal morbidity.

1. Type of musculoskeletal morbidity.

Table no.4 show distribution of study subjects according to type of musculoskeletal morbidity. Out of 394 subjects 177 (44.92%) have musculoskeletal disorder.

         In musculoskeletal morbidity majority of subjects have arthritis 132 (74.58%) followed by low back pain/ Myalgia 33 (18.64%).

Table No .5: Distribution of Study Subjects according to Ophthalmic morbidity.

(a)  Distribution according to presence of Ophthalmic morbidity.

(b) Distribution according to Type of Ophthalmic morbidity.

Above table shows distribution of study subjects according to ophthalmic morbidity. Out of 394 subject 169 have ophthalmic problems.

In ophthalmic morbidity cataract was most common i.e. 91 (53.84%) followed by refractive error 43(25.45).

Table No.7: Distribution of Study Subjects according to Psychological morbidity.

• Distribution according to presence of Psychological morbidity

• Distribution according to Type of Psychological morbidity

Above table shows morbidity due to depression. Out of 394 subject 149 (37.81%) were have depression, in which female are most common i.e.86 (21.82%)

Table No.8: Distribution of Study Subjects according to Cardio-Vascular Morbidity.

• Distribution according to presence of Cardio Vascular morbidity

• Distribution according to Type of Cardio Vascular morbidity

Above table shows distribution of study subjects according to cardio vascular morbidity. Out of 394 study subjects 120 (30.45%) cardio vascular system problems. In study subjects hypertension was most common cardio vascular morbidity i.e. 107(87.17%) followed by ischemic heart disease 13(10.83%).

Table No. 9:  Distribution of Study Subjects according to Dental related Morbidity.

• Distribution according to presence of Dental related morbidity

(b)Distribution according to Type of Dental morbidity

Out of 394 study subjects 101 (25.63%) have dental problem. According to dental morbidity loss of teeth is most common i.e. 60 (59.40%) followed by toothaches 21 (20.80%), oral ulcer 11 (10.89%), and dental caries 9(8.91%).

Table No.10:  Distribution of Study Subjects according to Respiratory morbidity.

• Distribution according to presence of Respiratory morbidity

• Distribution according to Type of Respiratory morbidity.

Above table shows distribution of study subjects according to respiratory morbidity. Out of 394 study subjects 84 (21.31%) have respiratory system morbidity. According to type of respiratory morbidity 41(48.81%) study subjects have URTI followed by bronchial asthma 16(19.05%), bronchitis 13(15.48%), pulmonary T.B 8(9.52%) and LRTI 6(7.14%).

Table No .11:  Distribution of Study Subjects according to Ear, Nose, and Throat morbidity.

• Distribution according to presence of Ear, Nose, and Throat morbidity.

• Distribution according to Type of Ear, Nose, and Throat morbidity

Above table shows distribution of study subjects according to type of Ear, Nose, and Throat morbidity. Out of 394 study subjects 124(31.47%) have ENT problems. According to type of ENT morbidity 116 (93.54%) have hearing impairment followed by Epitaxis 8 (6.46%).

Table No .12:  Distribution of Study Subjects according to Gastrointestinal morbidity.

• Distribution according to Presence of Gastrointestinal morbidity

• Distribution according to Type of Gastrointestinal morbidity

Above table shows distribution of study subjects according to gastrointestinal morbidity. Out 394 study subjects 75 (19.03%) have gastrointestinal morbidity. According to type of gastrointestinal morbidity haemorrhoids 32 (42.67%) were more common followed by gastritis 19 (25.33%), hernia 13 (17.33%) and constipation11 (14.67%).

Table No .13:  Distribution of Study Subjects according to Genito Urinary morbidity.

• Distribution according to presence of Genito Urinary  morbidity

• Distribution according to Type of Genito- Urinary morbidity.

Above table shows distribution of males according to Genito- urinary morbidity. Out of 394 subjects 42 males having genito- urinary system problems, in which most common  was BEP 25 (59.52%) followed by UTI 8 (19.47%),  Renal/ Ureteric/ Bladder calculus 6 (14.29%), CRF 3 (07.14%). 

Above table shows distribution of study subjects according to Genito- urinary morbidity. Out of 394 subjects 33 females having genito- urinary system problems. According to type of genito - urinary system 20(60.60%) females having genito-urinary problem followed by Renal/ Ureteric/ Bladder calculus 3(09.09%), CRF 10(30.31%). 

Table No .14:  Distribution of Study Subjects according to Central Nervous System morbidity.

• Distribution according to presence of Central Nervous System morbidity.

• Distribution according to Type of Central Nervous System morbidity.

Above table shows distribution of study subjects according to central nervous system morbidity. Out of 394 subjects 35 (8.88%) have central nervous system problems. According to type of Central Nervous System morbidity forgetfulness/ Senescent i.e. 17 (48.58%) is most common followed by vertigo/dizziness 9(25.71%) epilepsy 5 (14.29%) and Hemiplegia 4(11.52%)

Table No .15:  Distribution of Study Subjects according to Endocrine System morbidity.

• Distribution according to presence of Endocrine system  morbidity

• Distribution according to Type of  Endocrine system  morbidity

Above table shows morbidity due to endocrine system. Out of 394 subjects 51 (12.94%) have Diabetes Mellitus and female were most common i.e. 30(7.61%).

Table No .16:  Distribution of Study Subjects according to Skin morbidity.

• Distribution according to presence of skin morbidity.

• Distribution according to Type of skin morbidity.

Above table shows skin problems in elderly. Out of 394 only 25 (6.34%) have skin problems. According to type of skin morbidity dermatitis 12 (48%) was the most common followed by hypo/hyper pigmentation 9 (36%) and scabies 4 (16%).

Table No .17:  Distribution of Study Subjects according to Associated morbidity.

• Distribution according to presence of Associated

• Distribution according to Type of Associated morbidity.

Above table shows distribution of study subjects according to other related morbidity. Out of 394 subjects only 42 (10.66%) have other problems, in which wound/ abscess formation 23(05.83%) was most common followed by, malaria 11(26.90%), enteric fever 5 (1.26%), herpes simplex/ zoster 3(00.76%).

Distribution of study subjects according to Type of morbidities:         

In present study, majority 290 (73.60%) had more than one morbidity, Morbidity load was higher in females (41.11) as compared to males (32.48)

TableNo.1: Few Major Morbidities and their prevalence among study subjects:

1. Anaemia in the elderly may be multifactorial, with etiology as varied as nutritional, physiological and pathological. In the present study (table no.40), among the different morbidities, anaemia reported to be the commonest morbidity accounting 285 (72.34%) out of 394 study subjects.

                The findings of present study were comparable with the studies by authors like Barman SK et al¹⁴ which stated that anaemia was the most common morbidity with the prevalence of 63.75% and Swami HM et al¹⁵ with 68.2%.

                The findings of present study in respect to anemia prevalence were not comparable with authors like Niranjan GV et al¹⁶ with 82.9 %, Bharti DRet al ¹⁷with 86% and Singh JP et al  96.5% showing a very high prevalence which may be low socio economic status, ignorance regarding elderly feeding practices or due to presence of multiple morbidity in the elderly groups.

2. Depession among the study subject was second commonest morbidity affecting 153 study subjects, in which female are more common i.e. 87 compare to male 67.Studies by authors like Jain RK et al ¹⁸reporting 45.9% depression prevalence, Taqui et al¹⁹. with 49.7%.

                In the present study, depression associated with age in years, educational status and socio economic class, significantly while, study by Barman SK et al¹⁴ depicts a statistically significant associated between depression and sex of an individual, age in years and educational status.

3. Arthritis among disorder of elderly was found to be common morbidity after depression accounting 132 out of 394 study subjects i.e. 33.50%. The results of present study were found to be comparable with the studies by different authors like Swami HM et al¹⁵ with 36.5%, Purty AJ et al²⁰ with 43.4.

                                The results from the present study were not comparable with authors like Prakash et al²¹ with 11.6 % , Sanjeev K et al²² with 16.44%, Barman SK et al¹⁴ with 21.25% arthritis prevalence.In the present study, arthritis associated with age in years significantly with age in years, sex and educational status of an individual.

4. 4. Another morbidity Hypertension was also a major concern with regards to geriatric morbidities accounting a total of 107 out of 394 study subjects i.e. 27.16%. The comparable results with present study reported by authors like Srivastava K et al²³ with 22.2%, Singh JP et al²⁴ with 34.75% also, Purty AJ et al²⁰ with 25.9% and Thakur RP et al²⁵ with 30.7% of hypertension prevalence.

                While , results which were not comparable with present study were published by authors like Swami HM et al¹⁵ with 58%, Bhartati DR et al¹⁷ with 47.7%, Sanjeev K et al with 41.4% hypertension prevalence.

5. Cataract, leading cause of diminished vision in developing countries which was found to be a total of 91 out of 394 study subjects i.e. 23.09% in our study. The cataract prevalence of present study is comparable with the studies by different authors Singh JP et al²⁴. with 21%, and Thakur RP et al²⁵ 29.2%.Few authors named Prakash R et al²¹ with 44% and Barman SK et al¹⁴ with 61.25% of cataract prevalence were published their results which were not comparable with our present study.

6. Among the dental problems, loss of teeth or edentulous mouth being the most important morbidity in geriatric age group individuals. Out of the total 394 study subjects, 60 subjects (15.22%) were having this problem.

Results comparable to prevent study were depicted by authors named Singh JP et al ²⁴with 14.75% loss of teeth prevalence. While, authors with not comparable results were Barman SK et al¹⁴ with 40 % of prevalence.

In the present study, loss of teeth associated with age in years significantly. A study of Barman SK et al¹⁴ (2014) observed that loss of teeth was associated significantly with sex of an individual, age in years and educational status.

7. Hearing Impairment among elderly subjects is also a significant morbidity affecting 116 out of 370 subjects i.e. 29.44%. The present study shows comparable results to study by authors like Swami HM et al ¹⁵with 13.53% and Srivastava K et al²³ with 16.6% hearing impairment prevalence.

                While results of present study were not comparable with study by Singh JP et al²⁴ with 8.50% and Thakur RP et al²⁵ with 63.10% hearing impairment prevalence.

                According to Srivastava MR et al²³ (2013), hearing impairment in elderly individual was associated was significantly with age in years and religion of an individual.

8. 8. Out of 394 study subjects 51 (12.94%) suffer from Diabetes Mellitus. The results of present study were comparable with the studies by authors named Swami HM et al.¹⁵ with 12.15%, Singh JP et al²⁴ with 17.75%, Thakur RP et al²⁵ with 12 and Barman SK et al¹⁴ with 15% of diabetes mellitus prevalence.

                Comparatively low prevalence was reported by authors named Purty AJ et al²⁰. with 8.3%.              While, studies by author named Bharati DR et al.¹⁷ with 43%, diabetes mellitus prevalence found to have non comparable results with the present.

9. Upper Respiratory Tract Infection In our study, out of 394 study subjects 41(10.40%) have URTI. The results of present study were comparable with the studies by authors named Shraddha et al²⁶ (2012) found that 10 male and 8 female suffer from upper respiratory tract infection.

                While, studies by author named Sehgal et al.²⁷(2015)  found that 14.62% subjects suffer from  upper respiratory tract infection which is  not comparable results with the present.

10. Forgetfulness: In our study, out of 394 study subjects 17(4.31%) have forgetfulness. The results of present study were comparable with the studies by authors named Prakash R et al²¹ (2004) found that 15.8% male and 20% female felt forgetfulness.

                While, studies by author named Jadhav V.S et al ²⁸(2012) in which 41 males and 27 females are having senescent forgetfulness which is higher and not comparable results with the present.            

Distribution  of  study   subjects   according   to   type   of   surgery undergone:

                                In our study out of 394 study subjects, 143(36.29%) had surgery for some or other illness. Majority, 60(15.23%) underwent cataract surgery and the next most common procedure was hysterectomy 34 (8.63) .Out of 394 study subjects, sex wise elderly males were 69/189 (36.50%) females 74/205 (36.09%) underwent one or other form of surgery, females being slightly higher than males.

Joshi K et al (2003)²⁹ found that 38.5% of elderly subjects were noted to have had surgery for some illness. Most had undergone cataract surgery (27%) and the next most common procedure was cholecystectomy (2.5%).     

Distribution of depression among study subjects according to

Geriatric Depression Scale (GDS) 15 :

In the present study, out of 394 subjects, majority 214(61.17%) had GDS-15 score between 0-4, revealing that they were not in depression, while 153(38.82%) had GDS-15 score between 5-15 and thus were screened positive for depression. Among 394 subjects, 100(25.8%) had GDS-15score between 5-8 suggesting mild depression, 35(8.88%) had GDS-15 score between 9-11 suggesting moderate depression, 18 (4.56%) had GDS-15 score between 12-15 suggesting severe depression.

Similarly, Jain RK et al¹⁸ (2007)  found that 45.9% of the study population had depression and  Dasgupta A et  al³⁰  (2014)  found  that depression  was  seen  in  46.9%  study  subjects.

While, Nair SS et al (2013)³¹  found that 32.4% of individuals were suffering from depression.

According to type of operation out of 394 study subjects 143 (36.29%) had gone through various type of operation at the time of data collection.

In which cataract operation is most common followed by Haemorrhoidectomy47, Hysterectomy 34, Prostatectomy 25, CABG 26, and Hydrocele 15. About 187 subjects not having any operation at the time of data collection. For diagnosis of DM, criteria laid down by WHO were used. Known cases of DM were excluded from OGTT and included in the study as the known cases of DM. A 2-hour post OGTT plasma glucose level ≥200mg/dl was considered as DM.

A patient was diagnosed as anemic on basis of hemoglobin levels done by Sahli’s hemoglobin estimation method. Cut off for diagnosis of anemia was decided according to WHO classification. A person was considered to be   hypertensive if he / she was a already diagnosed case of HTN and/or on treatment (known case of HTN) or with a current systolic blood pressure ≥140 mm of Hg and/or diastolic blood pressure ≥90 mm of Hg as according to JNC VII criteria.

A Short Form Geriatric depression scale (GDS) consisting of 15 questions was used. Following morbidities in the study subjects were diagnosed in accordance by using documents and investigation reports already available with the participants, chronic bronchitis, joint pain, piles, BPH, APD, Cataract, hearing impairment, skin diseases, dental problems and TB.

In our study we found, diseases like hyper pigmentation, hypo pigmentation, scabies, dermatitis psoriasis and fungal infections. These were together clubbed into skin diseases. Similarly, dental caries, toothache, tooth decay, mobile tooth, bleeding gums, grouped collectively into dental problems.

Similarly, known case of peptic ulcer, chronic gastritis, chronic heart burn, chronic diarrhea and recurrent vomiting were grouped into APDs. Majority, 285(59.64%) had anaemic, followed by Depression 149 (37.82%), Arthritis 132(33.50%), Hearing Impairment 116 (29.44%)  HTN   107 (27.16%), cataract 91 (23.10%) Loss of teeth 60 (15.23%), chronic bronchitis 3.30%, APD 27.3%, DM 11%, skin diseases 7.5%, piles 7.2%, BPH 3.7% and TB 1.0%.Majority 486 (81%) had multiple morbidity, 89(14.8%) had single and only 25(4.2%) were not suffering from any type of morbidity.

Morbidity load was higher in females (97.6%) as compared to males (93.5%) and the difference was statistically significant.(χ2= 6.513, df = 2,p =0.039) Majority  517(86.2%)  had  chronic  illness,  followed  by  58(9.7%)suffering from both acute and chronic illness, 21(3.5%) had no illness, and only  4(0.7%)  were  suffering  from  acute  illness.  Among all subjects, 145(24.2%) had surgery for  some  or  other  illness.  Majority 97(16.2%) underwent cataract surgery and the next most common procedure was hysterectomy (2.3%). Majority, 307 (51.2%) had GDS-15 score between 0- 4, revealing that they were not in depression, while 293(48.8%) had GDS-15 score between 5-15 and thus were screened positive for depression.

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