Factors associated with geriatric morbidity and impairment in a megacity of Pakistan

Saniya R Sabzwari, Romaina Iqbal, Zafar Fatmi, Iqbal Azam, Saniya R Sabzwari, Romaina Iqbal, Zafar Fatmi, Iqbal Azam

Abstract

Background: The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan.

Methods: A cross-sectional study was conducted during 2013-2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged ≥60 years, using standardized questionnaires. Geriatric impairment was assessed through validated questions and tools. We screened for depression, dementia, mobility and functional status. Descriptive statistics were computed for socio-demographic factors. We estimated the prevalence and 95% CI for geriatric impairments and comorbidities.

Results: A total of 1200 community-dwelling elderly participated in this study. More than half (n = 663, 55.3%) were females. The average age of the participants was 68.7 (SD = 7.8) years. Two-thirds suffered from chronic illness and the most common impairments were psychological and cognitive. Females were 2.45 times more at risk of developing three or more geriatric impairments. Participants with no formal education had the highest proportion (43.8%) of geriatric impairments. Participants living with more children were more likely to have three or more impairments.

Conclusion: A high burden of non-communicable diseases and associated impairments were identified among elderly in Karachi, Pakistan. High rates of psychological and cognitive impairments require urgent attention for resources and strategic planning in anticipation of a growing geriatric population.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Co morbid illnesses among elderly…
Fig 1. Co morbid illnesses among elderly (≥60 years) in Karachi, Pakistan.
Fig 2. Impairments among elderly (≥60 years)…
Fig 2. Impairments among elderly (≥60 years) in Karachi, Pakistan.

References

    1. World Health Organization. Ageing and Health. 2018. Available at: . Accessed Sep 2018
    1. World Health Organization. World report on ageing and health 2015. Available at: . Accessed Sep 2018
    1. Sabzwari SR, Azhar G. Ageing in Pakistan—a new challenge. Ageing International. 2011;36(4):423–7.
    1. Zafar SN, Ganatra HA, Tehseen S, Qidwai W. Health and needs assessment of geriatric patients: results of a survey at a teaching hospital in Karachi. JPMA The Journal of the Pakistan Medical Association. 2006;56(10):470–4.
    1. Saleem T, Khalid U, Qidwai W. Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan. BMC health services research. 2009;9:205 10.1186/1472-6963-9-205
    1. Spiers NA, Matthews RJ, Jagger C, Matthews FE, Boult C, Robinson TG, et al. Diseases and impairments as risk factors for onset of disability in the older population in England and Wales: findings from the Medical Research Council Cognitive Function and Ageing Study. The journals of gerontology Series A, Biological sciences and medical sciences. 2005;60(2):248–54. 10.1093/gerona/60.2.248
    1. Gutiérrez-Robledo LM. Looking at the future of geriatric care in developing countries. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(3):M162–M7.
    1. Sehgal RK, Garg R, Anand S, Dhot PS, Singhal P. A study of the morbidity profile of geriatric patients in rural areas of Ghaziabad, Uttar Pradesh. International Journal of Medical Science and Public Health. 2016;5(2):176–81.
    1. Barua K, Borah M, Deka C, Kakati R. Morbidity pattern and health-seeking behavior of elderly in urban slums: A cross-sectional study in Assam, India. Journal of family medicine and primary care. 2017;6(2):345 10.4103/2249-4863.220030
    1. Lee JC, Danker AN, Wong YH, Lim MY. Hearing Loss amongst the Elderly in a Southeast Asian Population-A Community-based Study. Annals of the Academy of Medicine, Singapore. 2017;46(4):145–54.
    1. Munshi YI, Iqbal M, Rafique H, Ahmad Z. Geriatric morbidity pattern and depression in relation to family support in aged population of Kashmir valley. The Internet Journal of Geriatrics and Gerontology. 2008;4(1).
    1. Chaudhry SI, McAvay G, Ning Y, Allore HG, Newman AB, Gill TM. Geriatric impairments and disability: the cardiovascular health study. Journal of the American Geriatrics Society. 2010;58(9):1686–92. 10.1111/j.1532-5415.2010.03022.x
    1. Won C, Yoo H, Yu S, Kim C, Dumlao L, Dewiasty E, et al. Lists of geriatric syndromes in the Asian-Pacific geriatric societies. European Geriatric Medicine. 2013;4(5):335–8.
    1. Rooth MA. The prevalence and impact of vision and hearing loss in the elderly. North Carolina medical journal. 2017;78(2):118–20. 10.18043/ncm.78.2.118
    1. Gill TM, Gahbauer EA. Overestimation of chronic disability among elderly persons. Archives of internal medicine. 2005;165(22):2625–30. 10.1001/archinte.165.22.2625
    1. Li C, Friedman B, Conwell Y, Fiscella K. Validity of the Patient Health Questionnaire 2 (PHQ‐2) in identifying major depression in older people. Journal of the American Geriatrics Society. 2007;55(4):596–602. 10.1111/j.1532-5415.2007.01103.x
    1. Tsoi KK, Chan JY, Hirai HW, Wong SY. Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry. 2017:bjp. bp. 116.186932.
    1. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. International journal of geriatric psychiatry. 1999;14(11):936–40.
    1. K Upadhyaya A, Rajagopal M, M Gale T. The six item cognitive impairment test (6-CIT) as a screening test for dementia: comparison with mini-mental state examination (MMSE). Current aging science. 2010;3(2):138–42.
    1. Sabzwari S, Bhanji S, Nanji K. Choosing a Reliable Cognitive Test for Community Screening of Dementia in Pakistan. Ageing International. 2016;41(2):167–77.
    1. Hessler J, Brönner M, Etgen T, Ander K-H, Förstl H, Poppert H, et al. Suitability of the 6CIT as a screening test for dementia in primary care patients. Aging & mental health. 2014;18(4):515–20.
    1. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000;80(9):896–903.
    1. Katz S. Assessing self‐maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society. 1983;31(12):721–7.
    1. Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ: British Medical Journal. 2004;328(7443):807 10.1136/bmj.328.7443.807
    1. Ramachandran A, Snehalatha C, Ma RCW. Diabetes in South-East Asia: an update. Diabetes research and clinical practice. 2014;103(2):231–7. 10.1016/j.diabres.2013.11.011
    1. Iqbal MN, Haidri FR, Motiani B, Mannan A. Frequency of factors associated with knee osteoarthritis. JPMA-Journal of the Pakistan Medical Association. 2011;61(8):786.
    1. Mithal A, Kaur P. Osteoporosis in Asia: a call to action. Current osteoporosis reports. 2012;10(4):245–7. 10.1007/s11914-012-0114-3
    1. Roth T, Kammerlander C, Gosch M, Luger T, Blauth M. Outcome in geriatric fracture patients and how it can be improved. Osteoporosis international. 2010;21(4):615–9.
    1. Mohd-Tahir N, Li S. Economic burden of osteoporosis-related hip fracture in Asia: a systematic review. Osteoporosis International. 2017;28(7):2035–44. 10.1007/s00198-017-3985-4
    1. Geronimus AT, Pearson JA, Linnenbringer E, Schulz AJ, Reyes AG, Epel ES, et al. Race-ethnicity, poverty, urban stressors, and telomere length in a Detroit community-based sample. Journal of health and social behavior. 2015;56(2):199–224. 10.1177/0022146515582100
    1. Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. The Lancet Neurology. 2008;7(9):812–26. 10.1016/S1474-4422(08)70169-8
    1. Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer’s disease. Alzheimer's & dementia: the journal of the Alzheimer's Association. 2007;3(3):186–91.
    1. Barua A, Ghosh MK, Kar N, Basilio MA. Prevalence of depressive disorders in the elderly. Annals of Saudi medicine. 2011;31(6):620 10.4103/0256-4947.87100
    1. Bhamani MA, Karim MS, Khan MM. Depression in the elderly in Karachi, Pakistan: a cross sectional study. BMC psychiatry. 2013;13(1):181.
    1. Korczyn AD, Halperin I. Depression and dementia. Journal of the neurological sciences. 2009;283(1–2):139–42. 10.1016/j.jns.2009.02.346
    1. De Jonge P, Roy J, Saz P, Marcos G, Lobo A. Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project. Diabetologia. 2006;49(11):2627–33. 10.1007/s00125-006-0442-x
    1. Nouwen A, Winkley K, Twisk J, Lloyd C, Peyrot M, Ismail K, et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Springer; 2010.
    1. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. The Lancet Neurology. 2006;5(1):64–74. 10.1016/S1474-4422(05)70284-2
    1. Group LS. 2001–2011: a decade of the LADIS (Leukoaraiosis And DISability) Study: what have we learned about white matter changes and small-vessel disease? Cerebrovascular diseases. 2011;32(6):577–88.
    1. Prince M, Acosta D, Albanese E, Arizaga R, Ferri CP, Guerra M, et al. Ageing and dementia in low and middle income countries–Using research to engage with public and policy makers. International review of psychiatry. 2008;20(4):332–43. 10.1080/09540260802094712
    1. Frisoli A Jr, Chaves PH, Ingham SJM, Fried LP. Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: results from the Women's Health and Aging Study (WHAS) II. Bone. 2011;48(4):952–7. 10.1016/j.bone.2010.12.025
    1. Cameron KA, Song J, Manheim LM, Dunlop DD. Gender disparities in health and healthcare use among older adults. Journal of Women's Health. 2010;19(9):1643–50. 10.1089/jwh.2009.1701
    1. Tajvar M, Arab M, Montazeri A. Determinants of health-related quality of life in elderly in Tehran, Iran. BMC public health. 2008;8(1):323.
    1. Marengoni A, Winblad B, Karp A, Fratiglioni L. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. American journal of public health. 2008;98(7):1198–200. 10.2105/AJPH.2007.121137
    1. Brayne C, Ince PG, Keage HA, McKeith IG, Matthews FE, Polvikoski T, et al. Education, the brain and dementia: neuroprotection or compensation? EClipSE Collaborative Members. Brain. 2010;133(8):2210–6.
    1. Miller SL, Wolfe RR. The danger of weight loss in the elderly. The journal of nutrition, health & aging. 2008;12(7):487–91.
    1. Chen H, Guo X. Obesity and functional disability in elderly Americans. Journal of the American Geriatrics Society. 2008;56(4):689–94. 10.1111/j.1532-5415.2007.01624.x
    1. Avlund K, Lund R, Holstein BE, Due P, Sakari-Rantala R, Heikkinen R-L. The impact of structural and functional characteristics of social relations as determinants of functional decline. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2004;59(1):S44–S51.
    1. Cramm JM, Van Dijk HM, Nieboer AP. The importance of neighborhood social cohesion and social capital for the well being of older adults in the community. The Gerontologist. 2012;53(1):142–52. 10.1093/geront/gns052

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel