Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme.

ABSTRACT

BACKGROUND: An estimated 68 million Indians are above the age of 60 years; however, information on their health status and needs is limited. Experience in developed countries shows that multiple chronic illnesses, nutritional deficiency and functional disability are common features of old age. For the development of any health programme, reliable situational information is essential. We therefore assessed the health and functional status of older Indians seeking health services. METHODS: We carried out a prospective cross-sectional observational study on 1586 subjects > or = 60 years of age (1035 men and 551 women), who attended the Geriatric Clinic of the All India Institute of Medical Sciences, New Delhi. A clinical and laboratory evaluation was carried out through a pre-designed protocol evolved after reviewing the relevant literature. The protocol included a questionnaire on demographic details, personal habits, socio-economic variables, family structure, past and present medical history, use of medications and aids, presence of certain common symptoms and perceived functional disability. Evaluation included a detailed physical examination, functional assessment, psychiatric assessment and a set of laboratory tests. RESULTS: Ninety-five per cent of the subjects were < 80 years of age and 87% of them sought medical attention for an acute illness that had occurred in the month prior to their coming to our clinic. One or more chronic illnesses were present in 96% and each subject had a mean of 2.5 diagnoses. However, they suffered from a limited number of illnesses of which the 10 most common accounted for 80% of the diagnoses. Hypertension, cataract and osteoarthritis were the 3 most common illnesses. About one-third of a subset of 209 subjects had a psychiatric illness; depression accounted for 50% of all psychiatric illnesses. A detailed functional assessment was carried out in 1268 subjects which showed that deficits of vision and hearing were the most frequent disabilities. Impairment of daily activities and cognition accounted for 6.9% and 5.1% of the diagnoses, respectively. A majority of them considered their home free from the hazard of accidents and were sure of support from their families at times of need. CONCLUSION: Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India. It is difficult to assess the total service needs of the population from this study because of its unrepresentative character, though it provides a fair picture of the expectations of care of older people in India.