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June 2018, Volume 68, Issue 6

Student's Corner

Morbidity profile of chronic diseases in geriatric patients

Maham Tariq  ( Services Institute of Medical Sciences, Lahore )
Junaid Khalid  ( Services Institute of Medical Sciences, Lahore )
Hafiza Suqaina Sania  ( Services Institute of Medical Sciences, Lahore )
Sunniya Sarfraz  ( Services Institute of Medical Sciences, Lahore )
Zeeshan Aslam  ( Services Institute of Medical Sciences, Lahore )
Laiba Qamar Butt  ( Services Institute of Medical Sciences, Lahore )

Abstract

A cross sectional study was conducted in the Medical wards of Services Hospital Lahore from 17th May 2017 to 12th June 2017 to study the morbidity profile of chronic diseases in geriatric patients. Semi-structured questionnaires were used which were translated into the local language. In all 601 morbidities were documented by 171 subjects, with mean number of morbidities per person as 3.51±1.69. The most prevalent disease observed was Hypertension 105(61.4%), 42(50.6%) in males and 63(71.6%) in females. The 2nd most common was anaemia 80(46.8%), 20(24.1%) in males and 60(68.2%) in females. The 3rd most common morbidity was diabetes mellitus 59(34.5%), 20(24.1%) males and 39(44.3%) females. This study has assisted in understanding the patterns of health problems among the elderly, which will help to address the prevailing geriatric morbid conditions and application of appropriate interventions thereafter. Thus, it will help active ageing to be maximally functional in our society.
Keywords: Geriatric, Morbidity, Chronic diseases.


Introduction

Ageing, a universal process is regarded as a normal, inevitable biological phenomenon. Morbidity refers to departure from a state of physical or psychological well-being resulting from disease, illness, injury or sickness especially where the affected individual is aware of his or her condition. According to the World Health Organization (WHO) morbidity could be measured in terms of number of persons who were ill, illnesses these persons experienced and the duration of this illnesses.1 The geriatric population is defined as population aged 60 years and above. By the year 2025, the world will host 1.2 billion people aged 60 and over and rising to 1.9 billion in 2050. .2 A chronic disease, as defined by the U.S National Center for Health Statistics, is a disease lasting 3 months or longer. 3 Majority of the geriatric group has one or more chronic diseases like diabetes mellitus, hypertension and heart diseases. International and regional studies have been conducted to bring some common chronic diseases in geriatric patients into limelight. A study conducted in Civil Hospital Karachi showed that most prevalent morbidities were cerebrovascular accidents (13.6%), chronic liver diseases (7.7%) and hernias (7.7%).4 A similar study in India revealed that the most common disorders reported among elderly were eye diseases (51.7%) followed by endocrine, nutritional and metabolic diseases (38.4%). Diseases of circulatory system (33.1%), disorders of oral cavity (32.3%), musculoskeletal disorders (30.2%) and diseases of respiratory and digestive system were reported in about 10% of the geriatric people. 5 According to a previous conducted study in Saudi Arabia, the most prevalent of these is hypertension (59.1%) followed by diabetes mellitus (57.3%), stroke (34.9%), dementia (28.5%), osteoarthritis (24.2%), Alzheimer (21.4%), osteoporosis (17.2%) and ischaemic heart diseases (16.7%).6 Objectives of this study were to enumerate the common chronic diseases in the geriatric population. We intended to compare the prevalence of various morbidities amongst males and females and to assess the morbidities encountered by them along the lines of other variables like marital status, literacy and age. Such assessment of the morbidity profile amongst elderly will highlight some very common geriatric diseases in Pakistan. It will help to modify our lifestyles according to the need of time to prevent the development of these diseases in the future and implement interventions in early life. As the incidence of geriatric population is rising, this study will help us adopt a holistic approach. This means not only catering to their health problems but also uplifting their psychological and social wellbeing and providing them with a good nutritional support.

Methods and Materials

This cross-sectional study was conducted from 17th May 2017 to 12th June 2017 with prior approval from the ethical committee and the institutional review board of the Services Hospital Lahore, a renowned tertiary care teaching hospital. Sample was estimated using WHO sample size software7 by formula of estimation of population proportion at confidence level 95% and anticipated population proportion 50% with relative precision 15%. Using non-probability convenience sampling technique, 171 subjects were enrolled in this study. Patients of 60 years and above were included whereas patients who were not well oriented or unable to comprehend our questions were excluded. A semi structured questionnaire was designed with open ended and close ended questions of multiple choices to collect data. It was assessed by the Community Medicine\\\'s physicians and pre-tested before its approval. It covered patients\\\' socio demographic variables, presenting complaints, complete general and systemic examination and the associated laboratory investigations. Written informed consent was obtained from all the respondents. Personal interview of the patient was undertaken by translating the questionnaire into the local language. Patients files were meticulously examined as definitive diagnosis and history of chronic conditions given therein were taken as morbid conditions. SPSS computer software version 23.0 was used for the entry, compilation and analysis of data. For qualitative variables, frequency and percentage distribution tables were generated. Statistical test such as chi-square test was applied at 5% level of significance for qualitative data.





Results

Of the 171 study subjects, 88 (51%) were females and 83 (49%) were males. Out of 83 males, 21 were labourers, 8 were businessmen, 9 were government servants, 6 were farmers and others belonged to miscellaneous professions. Out of 88 females, 85 were housewives and 3 were working women. A total of 601 morbidities were reported by 171 subjects in this study, 349 (58.1%) in females and 252 (41.9%) in males.



Table-1 reflects mean number of morbidities according to socio-demographic variables. Mean number of morbidities per person is 3.51±1.69. Higher mean was noticed in females 3.97±1.82 than in males 3.02±1.39. Whereas, highest mean was observed in the age group >80years i.e. 4.17±1.65, and the least in the age group 60-64 i.e. 3.28±1.53. Moreover, greater mean was seen in literate 3.53±1.75 compared to illiterate i.e. 3.49±1.62. Marital status based diverse means were also recorded for e.g. 4.40±2.01 in widowed and 3.14±1.07 in singles.



Table-2 displays the morbidities in decreasing order of magnitude observed in the
geriatric population stratified by gender. Hypertension had the highest prevalence in 105 (61.4%) which was statistically significant p<0.005, comprising of higher number of females 63 (71.6%) than males 42 (50.6%). This was followed by anaemia which was 80(46.8%) p<0.001 [Females: 60(68.2%) vs. males: 20(24.1%)] and Diabetes mellitus with 59(34.5%) [Females: 39(44.3%) vs. males: 20(24.1%)] p<0.005. A significantly higher proportion of geriatric women suffered from osteoporosis [females: 25(28.4%) vs. males: 3(3.6%)], chronic liver disease [Females: 17(19.3%) vs. males: 5(6.02%)], dementia (females: 8(9.1%) vs. males: 1(1.2%)). On the other hand, the disease more frequently encountered in males than females was Parkinson\\\'s disease [males: 9(10.8%) vs. females: 3(3.4%)]. Whereas, benign prostatic hyperplasia in males accounted for 14 cases (16.9 %).

Discussions

Among 171 subjects, a total of 601 illnesses were registered. This study highlights that the most common morbidity was hypertension, more in females than in
males. The results are consistent with the studies conducted in Karachi, 4 India, 8,9 and South Korea. 10
Anaemia was found to be the 2nd most common morbidity. Age related anaemia, a common morbidity is due to declining ratio of bone marrow cells to fat cells and a reduced marrow response on stimulation from erythropoietin. 9,11 Higher ratio in geriatric women than men is related to multiple pregnancies, nutritional challenges and other gynaecological problems. Third in the list is diabetes mellitus, also highlighted by other studies. 8,10 Elderly are threatened for harbouring type 2 diabetes mellitus due to the combination of rising insulin resistance and falling pancreatic islet function. Interestingly, gender based diversity was observed in our study. For example, coronary heart disease was 2nd most common in males and 6th most common in females (Table-2). Aging comes with compromised elasticity and increased atherosclerotic thickening of the major arteries. Musculoskeletal ailments like osteoporosis and arthritis stand as 4th and 5th most prevalent diseases in females, being much lower amongst males. Hormonal withdrawal in elderly females leads to such osteoporotic and degenerative changes. These findings complemented those observed in other studies. 6,10 Highest mean in widowed was reflected suggesting their financial dependence on others for catering their medical needs in our setup. This has also been documented by another study. 6 Interestingly, larger number of diseased subjects were illiterate and had low awareness about the preventive measures for these morbidities.

Limitation

The subjects enrolled are heterogeneous with regard to their ethnicity, locality and time of presentation, thereby limiting the generalization of their findings. Furthermore, morbidities were recorded using patients\\\' files so any undiagnosed disease was not included.

Conclusion

The three most commonly encountered diseases in the geriatric population are hypertension, anaemia and diabetes mellitus. This data will enhance understanding of a dire need to create awareness among people regarding active ageing. Active aging is the process of optimizing health opportunities in early life, so that the risk of developing diseases in later life is substantially reduced.

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Disclosure: None to declare.

References

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