Economic Dependency and Depression in Elderly

Transcription

1 ISSN ORIGINAL ARTICLE Eonomi Dependeny and Depression in Elderly 1 1* 1 1 Charhit P. Mehta, Atul V. Desale, Vandana A. Kakrani, Jitendra S. Bhawalkar 1 Department of Community Mediine, Dr D. Y. Patil Medial College, Pimpri-Pune (Maharashtra) India Abstrat: Bakground: Aging has beome greatest hallenge globally. In developing ountries inluding India elderly population (persons aged 60 years and above) is projeted to outpae the rih world resulting in perent of them expeted to be staying in resoure onstraint ountries. By 050 of the total population more than 0 perent will be elderly. Depressive illness assoiated with dementia is one of the important problems in elderly. With inrease in longevity there will be sharp rise in old age dependeny ratio whih an drain the resoures in any ountry due to expenditure on health, soial seurity and eduation. Aim & Objetives: The present study was arried out to assess the extent of degree of depression in elderly and study the assoiated fators like eonomi dependeny. Material and Methods: Randomly seleted subjets were administered the questionnaire of Geriatri Depression Sale (GDS), in the Geriatri Clini of a tertiary are hospital, to ategorize them based on the sores, into mild, moderate and severe. Some of the fators were studied and analysed to nd out their assoiation with depression like working status, soioeonomi status and eonomi dependeny. Results: Proportion of elderly having depression was 5.4% with females outnumbering males. Depression seems to be more in those elderly who were not working, were from low soioeonomi status and not having pension as 38.6% who had no pension were depressed. Moderate to severe depression was more in eonomially dependent (0%) as ompared to those who were independent nanially. Conlusion: Eonomi dependeny seems to be important assoiated fator responsible for depression in elderly along with other fators like soioeonomi status, pension status et. Implementation of adequate health servies and soial seurity system is needed to prevent the marginalization of elderly. Keywords: Elderly depression, GDS, Eonomi dependeny. Introdution: By 05 the elderly population globally is expeted to rise more than 1. billion with lose to 75% of it in developing ountries thus making population ageing a great hallenge [1]. Aging is a more reent phenomenon in developing ountries that is outpaing the rise in elderly population in rih world due to whih 50 to 80 perent of elderly will be living in these ountries []. Rapid eonomi and soial hanges in reent years, inluding migration and urbanization of nonelderly adults, have weakened the foundations of the joint family system, leaving the elderly in vulnerable eonomi onditions [3]. Due to improved life expetany at all ages and derease in fertility rates, there has been inrease in elderly population in India as well. This demographi aging has resulted in India beoming home for millions of people aged 60 years and above [4]. Journal of Krishna Institute of Medial Sienes University 100

2 Charhit P. Mehta et. al. Among the age related health problems in elderly, one of the most important problems is depression. The ost of taking are of a person with depression assoiated dementia in India is roughly more than 43,000 Rupees per annum, thus putting their families under extra nanial stress [5]. The overall prevalene rate of depressive disorders among the elderly is 10 to 0%, the variation depending on the ultural situations as per the World Health Organization [6, 7]. Among the disability due to hroni diseases, depression in elderly is expeted to beome leading ause along with ishemi heart disease [8]. With inrease in longevity there will be a sharp rise in old age dependeny ratio. The biggest absolute inrease by 050 will be in Japan where ratio of 35.1 perent in 010 will be doubled to 73.8 perent, while in China pensioners will be 38.8 perent of its labour fore i.e., up from 11.6 in 010 [9]. Eonomi dependeny of the population with high dependeny ratio an drain the resoures in a ountry due to expenditure on health, soial seurity and eduation. The relatively faster inrease in the elderly population in India will ontribute to a higher dependeny ratio of the population in the non-produtive age group. The old age dependeny ratio in India showed an inreasing trend from 10.9 % in 1961 to 13.1% in 001. About 65 perent of aged depends on others as per NSS survey 004. Of these 85 % were dependent on their own hildren [10]. Therefore, responsibility for aring for the elderly will fall either on young wageearner whih is the produtive part of population or on the government. But at the same time there are sixty plus elderly who are independent while many of those so alled working age group are atually not working. Therefore 'eonomi dependeny ratio' seems to be important to assess the demographi and eonomi status of elderly population. This study was undertaken to nd out the assoiated important fators like eonomi dependeny among the depressed elderly. Material and Methods: Randomly seleted patients attending the geriatri lini at tertiary are hospital were inluded in the study and the information about their identi ation, their soio-eonomi variables, pension status, eonomi dependene et was olleted. The soio eonomi status was found out by Kuppuswami Sale (Kuppuswami B,1981: inome ranges for 01) [11]. Informed onsent was obtained before the information was olleted. Institutional Ethis Committee learane was obtained before starting the study. It was a hospital based study where patients above 60 years of age and of both sexes were interviewed for a period of two months. Considering the prevalene of depression in elderly as 5%, sample size was taken as 75 and a total of 100 elderly were studied. Those not willing to partiipate in the study, patients with severe mental deterioration, severe ognitive impairment, deafness or severe physial morbidity were exluded. The data was olleted on a predesigned, strutured proforma whih was translated into loal language. For assessment of depression Geriatri Depression Sale-15 (GDS-15) questionnaire was administered for soring after Journal of Krishna Institute of Medial Sienes University 101

3 Charhit P. Mehta et. al. explaining the purpose of study. As per the sale sores were given and assessment done, based on positive and negative orret answers.the GDS- 15 sore of >5 is suggestive of depression (Sore: 0-4: normal, 5-8: mild, 9-11: moderate, 1-15: severe). After identifying and ategorizing, the subjets with mild depression were referred for ounselling while moderate to severe ones were referred for expert are. The data about soio-demographi orrelates was olleted. Some of the fators like marital status, family type, living arrangement, and eduation and oupation status have been published in a separate artile [1]. Further data analysis was done as per their oupation status, pension status, eonomi dependeny et. As the number of severe and moderate degree ases was less, they were lubbed together for further analysis. Statistial analysis of the data olleted was arried out by using SPSS-0 software with appropriate statistial tests.the Geriatri depression sale is found to be 9% sensitivity and 89% spei ity when evaluated against diagnosti riteria. The validity and reliability of the tool has been supported through both linial pratie and researh [13]. Results: Soio-demographi pro le of the subjets studied was analysed, and proportion of depressed elderly and the degree of depression was assessed as per the age group.almost half of the study partiipants (50.5%) were in the age group of yrs. The study sample omprised of 56.3 % of females. Most ommon religion was Hindu (91.3%). The perentage of study partiipants who were married was 76.7 % and most of them (81.6%) were eonomially dependent. Very few (19.4%) were getting pension. Only 5.8% of the study partiipants were living alone and rest all were living either with their spouse or hildren. Most of the study partiipants were from upper lower (34%) and upper middle (3%) lass family.majority of elderly i.e. 6.1% of them were not working (Table 1). Table 1: Soio-demographi Pro le of Elderly Frequeny Perentage 1 Age Sex Male Female Religion Hindu Muslim Buddha Contd... Journal of Krishna Institute of Medial Sienes University 10

4 Charhit P. Mehta et. al. Contd... Frequeny Perentage 4 Eduational status Illiterate Primary to higher seondary shool Graduate & Above Marital Status Married Widowed, Divored & Separated Eonomi dependeny Dependent Independent Pension Reeiving pension No pension Living arrangement Alone With spouse only With spouse & hildren With hildren only Family Type Nulear Joint Extended Soioeonomi status Lower Upper Lower Lower Middle Upper Middle 33 3 Upper Oupational status Working Not working Journal of Krishna Institute of Medial Sienes University 103

5 Charhit P. Mehta et. al. Table : Sex Wise Degree of Depression Sex Normal (%) Mild (%) Moderate to Severe (%) Total (%) Male 6 (57.8) 13(8.9) 6(13.3) 45(100%) Female 4(41.4) 0(34.5) 14(4.1) 58(100%) Total 50(48.5) 33(3) 0(19.4) 103(100%) χ = P=0.04 Females were more likely to be depressed (mild depression 34.5% and moderate to severe depression (4.1%) as ompared to male study partiipants. (Table-) Oupational status Table 3: Depression and Working Status Normal (%) Mild (%) Moderate to Severe (%) Total (%) Working 16(41.0) 14(35.9) 9(3.1) 39(100%) Non-working 34(53.1) 19(9.7) 11(17.) 64(100%) Total 50(48.5) 33(3.0) 0(19.4) 103(100%) χ =1.455 More perentage of working (35.9%, 3.1% mild and moderate to severe depression respetively) P=0.483 study partiipants were depressed as ompared to non-working study partiipants (Table-3). Table 4: Depression and Pension Status of Elderly Pension Normal (%) Depressed (%) Total (%) With pension 15(75) 5(5) 0(100%) Without pension 35(4.) 48(57.8) 83(100%) Total 50(48.5) 53(51.5) 103(100%) χ = 5.70 P= There was a signi antly higher rate of depression among those who did not reeived pension as ompared to those who got pension. Classi ation of depression into mild and moderate form in relation to getting pension was as follows- Journal of Krishna Institute of Medial Sienes University 104

6 Charhit P. Mehta et. al. Table 5: Depression level and Pension Status of Elderly Pension Normal (%) Mild (%) Moderate to Severe (%) Total (%) With pension 15(75) 1(5) 4(0) 39(100%) Without pension 35(4.) 3(38.6) 16(19.3) 64(100%) Total 50(48.5) 33(3.0) 0(19.4) 103(100%) χ = 9.46 P= 0.10 Mild depression was very high (38.6%) among the study partiipants who were not getting any pension as ompared to those who were getting it (5%). However in ase of moderate to severe depression there was very slight differene among study partiipants who were getting pension and those who were not getting pension. (Table-5) Table 6: Depression and Soio-eonomi Status Soioeonomi status Normal (%) Mild (%) Moderate to Severe (%) Total (%) Lower 0(0.0) 3(60.0) (40.0) 5(100%) Upper lower 17(48.6) 11(31.4) 7(0.0) 35(100%) Lower Middle 7(38.9) 7(38.9) 4(.) 18(100%) Upper Middle 18(54.5) 10(30.3) 5(15.) 33(100%) Upper 8(66.7) (16.7) (16.7) 1(100%) Total 50(48.5) 33(3.0) 0(19.4) 103(100%) χ = P=0.457 Both the types of depression, mild (60%) and moderate to severe (40%) were ommon in study partiipants who were from lower soioeonomi group.extent of depression went on dereasing with inrease in soioeonomi status (Table-6). Journal of Krishna Institute of Medial Sienes University 105

7 Charhit P. Mehta et. al. Table 7: Depression and Eonomi Dependeny Eonomi dependeny Normal (%) Mild (%) Moderate to Severe (%) Total (%) Dependent 40(47.6) 7(3.1) 17(0.) 84(100%) Independent 10(5.6) 6(31.60) 3(15.8) 19(100%) Total 50(48.5) 33(3.0) 0(19.4) 103(100%) χ = P=0.061 Moderate to severe depression was more ommon in eonomially dependent (0%) study partiipants as ompared to those who were independent (Table-7). Although the differene did not reah the level of signi ane, the p-value was very lose and approahing the level of signi ane. Disussion: WHO has highlighted the issue of geriatri health over the years, with various World Health Day themes dediating to the health of the elderly [14]. The sample size in the present study may be adequate to determine the prevalene of depression among the elderly, but it was not adequate to study the assoiated fators. 5.4% elderly studied were found to be depressed in the present study while the gure was more than 60% in similar studies onduted in India using GDS [15, 16]. The ndings of the present study were in aordane with another study i.e. 33 reported that among 165 elderly studied, 35 (1.%) suffered from depression, with possibility of depression in another 5 (31.5%) and 78 (47.3%) were normal [17]. Similarly in a hospital based study it was found that nearly 5.5 perent of patients with hroni medial illness suffer from psyhiatri illness of whih depression is the ommonest [18]. Male dominant traditional soieties in whih ontrol of soures of nanes is exlusively with males along with low eduational level in females may ontribute to more eonomial dependene. Elderly females seem to be more prone to depression (Table ) in other studies also it was seen that more female elderly were depressed as ompared to males [19, 0]. Some researhers have observed that 7% were normal, 7% were border line and 66% were depressed. Depression was found to be more in females 75% [1]. The eduational and oupational status of elderly are important fators assoiated with depression in old age, in our study severe depression was ommon in illiterate subjets from lower soioeonomi status and more working elderly were having mild to moderate depression (Table 3,4 & 5). Multiple logisti analyses revealed in a study that the signi ant independent preditors of depression were higher age, low eduation and nanial dependene, unemployment and illiteray were also seen to be assoiated fators in other studies [15, 16]. Journal of Krishna Institute of Medial Sienes University 106

8 Charhit P. Mehta et. al. Eonomially dependent elderly had more hanes of depression as ompared to the independent ones. If the sample size was suf iently big, it might have reahed the level of signi ane (Table 7). A study at Bengaluru for prevalene of depression, it was signi antly more i.e. 70%in medium standard of living index group as ompared to 8.9% from high standard living index group, Other researh workers also have shown that depression is assoiated with poor soioeonomi status [-5]. In the present study mild depression is present in 38.6% of elderly in those elderly who had no pension (Table 5). As per our study elderly from low soioeonomi status are prone for getting depression as all reported having either mild or moderate to severe form of depression, further it has been observed that the pension is found to be assoiated with inreased expenditure on medial are and eduation of family members []. Eonomi dependeny seems to be an important reason for depression apart from soial, ultural and organi auses. In a ross setionalstudy in Andhra Pradesh as per GDS sale, out of 53 elderly interviewed, 131 (4.6%) were totally dependent and 130 (4.43%) were partially dependent on family members. Out of 61 who were eonomially dependent 68% were depressed [6]. A hospital based ross setional study undertaken on 306 patients from geriatri OPD in Kolkata, prevalene of depression and assoiated fators were studied. It was found that 65.3% had depression and eonomi dependeny was important fator identi ed as a signi ant fator statistially assoiated [7]. Many others have studied eonomi dependeny in elderly whih seems to range from 8.3% to 66 % in different studies [8-3].Some researhers in their study on morbidity among elderly persons residing in a resettlement olony of Delhi found that out of 33 elderly studied, 145 (6%) elderly were eonomially dependent, 48 (1%) were independent and 40 (17%) were partially dependent [33]. Epidemiologists in their study on health of the urban elderly Ludhiana, Punjab and reported that among 165 elderly studied, 15 (75.8%) were nanially dependent, 40(4.4%) were having their own inome [17]. A study arried study on the psyho-soial pro le of the elderly people in urban area of Meerut ity reported that dependeny was more in females 77.5% as ompared to males 1.8% [34].The relatively faster inrease in the elderly population will ontribute to a higher dependeny ratio of the population in the non-produtive age group. Implementation of various strategies under National Poliy on Older Persons (NPOP) in the form of modern soial seurity system and adequate health are servies is warranted to ensure that elderly are not ignored and marginalized [35, 36]. Conlusions: Depression in elderly often goes undeteted and is onsidered to be normal part of aging proess and is taken as part of stereotyping as elderly are onsidered as less energeti, less valuable to potential employerand for the family making Journal of Krishna Institute of Medial Sienes University 107

9 Charhit P. Mehta et. al. them eonomially dependent, this attitude an lead to disrimination, and an beome important fator for depression. As per results obtained in the present study, the prevalene of depression in elderly is quite high and elderly an be onsidered as vulnerable population at speial risk of depression. The Geriatri Depression Sale (GDS) an be taken as a tool whih is simple, easy to use, without any intervention, and an be used by even paramedial interviewer for early detetion of depression in elderly. Among the fators assoiated with depression like soio-eonomi status, pension status and eonomi dependene on others are important fators assoiated with depression in elderly. Considering the rise in elderly population in near future, early identi ation of elderly having probable depression and taking prompt ation in the form of Senior itizen pension/elderly allowane or easy insurane shemes is important. Existing provisions onsidered by the government should be effetively implemented to make them nanially seure and independent whih will go a long way in addressing the problem of eonomi dependeny leading to depression in elderly. Aknowledgement: The artile is a part of the results of a study whih was approved and sponsored by Indian Counil of Medial Researh (ICMR) as a Short Term Student (STS) Researh projet. 1. WHO, Primary Health are: Indian senario, Geneva; WHO Journal Neeraj Kaushal, How Publi Pension affets elderly labour supply and wellbeing: evidene from India NBER working paper series-19088, National Bureau of Eonomi Researh, May Pal Sarmistha and Robert Palaious. Understanding poverty among the elderly in India: Impliations for soial pension poliy.journal of Development Studies 011;47(7) : Zile Singh. Aging: The Triumph of Humanity- is we prepared to fae the hallenge? Indian Journal of Publi Health 01; 56(3): RabindraNath Sinha: Make dementia a publi health priority in India, Indian Journal of Publi Health 011; 55(): Rangaswamy SM. Geneva, Switzerland: The World Health Organization; 001. World Health Report: Mental Health: New understanding New Hope. 7. Wig NN.World Health Day, 001. Indian J Psyhiatry001; 43: Murray C J and Lopez AD. Alternate projetions of mortality and disability by ause , Global burden of disease study.lanet 1997;349 : Referenes 9. http// The Eonomist. Aessed on Soio-eonomi pro le of elderly population in Situational Analysis of The Elderly in India,June 011,Central Statistis Of e,ministry of statistis and Programme Implementation,Government of India 11. Ravi Kumar, Shankar Reddy Dudala. Kupuswami' Soioeonomi status Sale a revision of eonomi parameter for 01, International Journal of Researh and Development of Health 013; 1(1):-4 1. Vandana A Kakrani, Atul V Desale, Charhit P Mehta. Geriatri Depression Sale (GDS):A tool for assessment of depression in elderly. JKIMSU 015; 4(3): Greg SA. The Geriatri Depression Sale (GDS) 01;4 gerirn.org/uploads/ le/try this- 4.pdf 14. WHO Ative aging: A poliy framework Non ommuniable Disease Prevention and health Promotion, Aging and life ourse,geneva, Switzerland WHO Hussain Akhtar, Amir Maroof Khan, K Vikram, Vaidhyanathan, Pragati Chhabra, A T Kannar. Soiodemographi preditors of depression among the Journal of Krishna Institute of Medial Sienes University 108

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