A Study of Awareness of Health Problems of the Elderly with Reference to Mental Health

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OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 Original Article A Study of Awareness of Health Problems of the Elderly with Reference to Mental Health S.C. Tiwari, Mamta Trichal, Betsy Mehrotra, Safia Najeeb Department of Geriatric Psychiatry, CSMM University, Lucknow, U.P. ABSTRACT Objective: To access the public awareness about elderly mental health problems method 750 subjects of above the age of 18 years of urban sector were selected through purposive sampling technique. Method: The study sample consisted, 862 subjects male & female above the age of 18 years. Out of the total population 1724 (study universe) were identified from Lucknow Municipal corporation. Only 862 (families residing elderly persons) were selected for study and rest 750 could be contacted due to their non-availability during visit of research team on working days. Self developed Performa were used for assessment of elderly problem. Results: Awareness was found very low about the elderly mental health problems (Dementia 0.8%, Delirium 0.4%, Delusional Disorder 1.6%, Insomnia 1%, Stroke 1.71 etc). Surprisingly few educated urban residents included in the study opined that the treatment of elderly problems is not necessary. Mostly the subjects (98.8%) were found unaware about the immunization of elderly and were also unaware about the appropriate diet of elderlies. Conclusion: The study strongly suggests need for psycho-education of the community particularly of the care givers. Study was carried out to sought out the suggestions of caregivers about the public awareness programmes. Keywords: Elderly, Mental Health Problems, Awareness. Introduction The population aging is one of the humanities greatest triumphs. The reduction in fertility level, reinforced by steady increased in the life expectancy has produced fundamental changes in the age structure of the ageing population. The older population of India, which was 56.7 million in 1991 is 72 million in 2001 and is expected to grow to 137 million by 2021. Studies indicates that socially deprived elderly are more vulnerable to psychiatric illness 1 over 81% of the elderly confessed of facing increasing stress and psychological problems of modern society. While 81% of the people of aged over 65 are reported to have at least one chronic health condition and 69% more than one. Inspite of such grievance of problem mostly the public is not aware of elderly problems to promote the community action professional bodies would need to initiate action for public awareness and education about the problems /needs of the elderlies. Several health risks related to unhealthy life style have been identified through epidemiological research in the last few decades. These include malnutrition, inadequate consumptions of fibers and fruit, physical inactivity, smoking and excess alcohol consumption. To provide the proper care to the elderlies. It is necessary for the care givers that they should have proper knowledge of adequate food, exercise diet and healthy behavioral patterns for older 2-4. The benefits associated with regular exercise and physical activity contribute to Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society 263

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 OCTOBER 2009 heal their independent life style, greatly improving the functional capacity and quality of life for older adults with disease states, special attention to nutrition is essential for recovery and control illness, with little or not need for medication 5,6. Therefore, a community based study was conducted in the urban sector of Lucknow City to identify the public awareness about the mental and physical elderly problems appropriate diet nutrition and to make a public awareness programme with the help of community. Material and Methods: The study sample comprised of 862 subjects of above the age of 18 years. Both male and female were included in the study. Out of the total adult population (1724) of two sectors of Bajrang Wali Ward identified from the voters list obtained from Lucknow Municipal Corporation, 862 (Families residing elderly persons) were selected for the study. Out of the total 862 targeted sample, only 750 could be contacted due to their non availability during research team visits on working days. A semi structure programme comprising of following schedule was administered Socio-demographic details. Schedule for assessment of awareness of elderly problems / nutrition / diet and exercise. Community expectation about the public awareness programme. Results: Table-1. Socio-Demographic Profile of the Subjects (N - 750) S.No. Number Percentage 1. Age N % 18-28 303 40.4 29-30 295 38.33 40-50 152 20.22 2. Education Intermediate 130 13.00 Graduate 405 84.00 Post-Graduate 215 28.62 3. Sex Male 418 55.73 Female 332 44.26 4. Marital status Married 400 0.53 Single 340 45.33 Widow/Widower/ 10 1.33 Separated 5. Occupational Students 97 12.93 House Wife 103 13.73 Government 215 28.61 Employee Private Employee 332 44.26 Self Employed 03 0.41 6. Type of Family Nuclear 300 40.00 Joint 450 60.00 7. Monthly Income < 2000 7 0.93 2001-4000 85 11.33 4001-6000 208 27.73 6001-8000 302 40.26 8000 > 148 19.73 264 Table-2. Awareness About the physical Problems of the elderly (750) S. Physical Aware by Aware by Unaware Total No. Problems name only name & symptom Special Senses Problems 1. Presbyopia 2 0.26 748 99.73 750 100 2. Cataracts 22 2.93 682 90.9 46 6.13 750 100 3. Glare 2 0.26 748 99.73 750 100 4. Low Vision 13 1.73 149 19.86 588 78.26 750 100 5. Glaucoma 3 0.42 25 3.33 722 96.26 750 100 6. Dry eyes 2 0.26 29 3.86 719 95.86 750 100 7. Presbycusis 132 17.6 618 82.4 750 100 Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society

OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 Table - 2 Contd... S. Physical Aware by Aware by Unaware Total No. Problem name only name & symptom Dental Problems 1. Dental Hygiene 429 57.2 321 42.8 750 100 2. Gingivitis 2 0.26 3 0.42 745 99.33 750 100 3. Dry Mouth 121 16.13 629 83.86 750 100 Gastrointestinal Problems 1. Heart burn 26 3.46 724 96.53 750 100 2. Peptic Ulcer 23 3.06 727 96.93 750 100 3. Anal Fissure 3 0.42 21 283 726 96.83 750 100 4. Hepatitis A 7 0.93 25 3.33 718 95.73 750 100 5. Hepatitis B 3 0.42 31 4.13 716 95.46 750 100 6. Hepatitis C 11 1.46 739 98.53 750 100 7. Cirrhosis of Liver 8 1.06 742 98.93 750 100 Cardiovascular Problems 1. Angina Pectoris 2 0.26 4 0.53 744 99.23 750 100 2. Heart Failure 6 80.00 100 13.33 50 6.66 750 100 3. Hypertension 590 78.66 100 13.33 60 8.00 750 100 Sexual Problems 1. Prostatic 4 0.53 13 1.73 733 97.77 750 100 2. Blood in Urine 6 0.82 19 2.53 725 96.66 750 100 3. Vasinitis 3 0.41 19 2.53 728 97.01 750 100 4. Male impotency 91 12.73 180 24.00 271 36.13 750 100 Rheumatic and Orthopedic Problem 1. Osteoporosis 14 1.86 93 12.90 643 85.73 750 100 2. Osteoarthritis 10 1.33 147 19.60 593 79.06 750 100 3. Fungal Infection of the 30 4.13 720 96.00 750 100 Toe nails 4. Gout 23 3.06 727 9693 750 100 Skin Problems 750 1. Dry skin 14 1.86 129 17.20 667 80.93 750 100 2. Herpes Zoster 1 0.13 13 1.730 736 98.13 750 100 3. Fungal Infection 1 0.13 92 12.26 657 87.62 750 100 Dental Problems 1. Dental Hygiene 429 57.2 321 42.8 750 100 2. Gingivitis 2 0.26 3 0.42 745 99.33 750 100 3. Dry Mouth 121 16.13 629 83.86 750 100 Infections 1. HIV and Aids 5 0.66 223 29.73 522 69.62 750 100 Pulmonary Problems 1. Chronic Bronchitis 9 1.23 531 70.80 210 28.00 750 100 2. Asthma 633 84.40 117 15.60 750 100 3. Pneumonia 7 0.93 637 84.90 106 14.10 750 100 4. Tuberculosis 631 84.10 119 15.80 750 100 Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society 265

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 OCTOBER 2009 Table - 2 Contd... S. Physical Aware by Aware by Unaware Total No. Problem name only name & symptom Nutrition 1. Cholesterol 4 0.53 171 22.80 171 23.30 750 100 2. Weight Loss 18 2.42 409 54.50 427 56.90 750 100 3. Obesity 6 0.81 129 17.20 135 18.00 750 100 Hematologic Problem 1. Anemia 2 0.26 619 82.50 129 17.21 750 100 2. Lymphoma 3 10.40 747 99.82 750 100 Endocrine Problems 1. Hypothyroidism 2 0.26 10 1.33 738 98.41 750 100 2. Blood Sugar 51 6.80 699 93.20 750 100 Table - 3. Awareness about the Mental Health Problems of the elderly (N - 750) S. Mental Health Aware by Aware by Unaware Total No. Problems name only name Symptom 1. Dementia 10 1.33 6 0.82 734 97.86 750 100 2. Delirium 7 0.93 3 0.42 740 98.66 750 100 3. Depression 18 2.40 510 68.2 22 29.61 750 100 4. Anxiety Disorder 9 1.24 641 85.4 100 13.33 750 100 5. Post Traumatic 3 0.42 2 0.26 745 99.33 750 100 Stress Disorder 6. Late life Delusional 15 2.50 12 1.6 723 96.40 750 100 Disorder 7. Obsessive Compulsive 14 1.86 22 2.93 714 95.20 750 100 Disorder 8. Personality Disorder 14 1.86 29 3.46 707 94.26 750 100 9. Self neglect 351 46.8 399 53.22 750 100 10. Tremors 5 0.66 16 2.13 729 97.23 750 100 11. Stroke 3 0.42 13 1.73 734 97.86 750 100 12. Insomnia 2 0.26 8 1.06 740 98.66 750 100 13. Sleep-walking 539 71.86 211 28.13 750 100 14. Fall and instability 750 100.00 750 100 Results and Suggestions The community was formal largely unaware of Mental Health problems comparably of physical problems of elderly, as is evident from the Table-1 indicating overall very low awareness in the community about the problems of elderly, mostly the mental health problems and thus expelling the myth that people are not aware about mental illness of elderly. Mostly the subjects (46%) investigated, reported that Government hospital to be the best 266 Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society

OCTOBER 2009 DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 Table - 4. Opinion about the Treatment (N-750) S. No. Place of Treatment Yes N % 1. Government Hospital 335 44.66 2. Private Hospital 129 17.2 3. Specialized Clinic 257 36.0 4. Faith Healers 23 3.06 5. No Treatment Should 6 0.81 be given place of treatment, while few subjects (0.81) opined that treatment is not necessary of mental problems of elderlies. They were uncertain about the effectiveness of treatment.table-3 indicates that community is mostly unawar e about the immunization in graying population, very few people were found aware (1.2%) and of them very few were immunized their elderlies. While Table-4 indicates that generally the subjects were unaware about the appropriate diet/nutrition of elderly. Most of the subjects suggested guidelines for community education programme ensuring healthy ageing:- Table - 5. Awareness about the Diet of Elderly (N-750) S. No. Problem Mental Problems Increased Decreased Limited Total 1. Complex 372 49.6 368 49.06 10 1.33 750 100 carbohydrates and fibers (roots, fruits, vegetable & beans) 2. Simple Carbohydrates 321 80.65 398 53.06 31 4.13 750 100 (Sugar & Derivatives) 3. Calcium & Vitamin D 392 52.26 299 39.86 59 7.86 750 100 (mild, curd cheese green vegetables) 4. Salt Intake 23 3.06 348 46.43 379 50.53 750 100 5. Foods and antioxidant 217 28.93 341 45.46 192 25.6 750 100 properties i.e. carrots, sweet potato s, spinach, tomato and orange 6. Additional supplementation 206 27.96 23 3.06 521 69.46 750 100 of vitamin and micronutrients Table - 6. Awareness about the Immunization in Graying Population (N-750) S.No. N % 1. Aware 9 1.2 2. Unaware 741 98.8 (N-9) Receivers Immunized care % If Aware N % Yes No 1. Pneuimcoccocal Vaccine 1 0.13 1 0.13 2. Influenza 2 0.26 1 0.13 1 0.13 3. Tetanus/adult diphtheria (Td) 5 0.66 3 0.41 2 0.26 4. Varicella Zoster (chikenpox) 1 0.13 1 0.13 Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society 267

DELHI PSYCHIATRY JOURNAL Vol. 12 No.2 OCTOBER 2009 i. Details about mental/physical disease of elderlies should be given in appropriate words & easy language in booklets/pump lets. It should be displayed and provided house to house or be communicated through person to person communication. ii. To increase awareness the elderly problems due to decaying or a environment should be explained properly through knowledgeable / professional person. iii. Diet chart for elderlies should also be distributed through camps/personal meeting & at public gathering from where people can get easily ensuring healthy ageing will then be an objective of nutrition planning and dietary in termination at the individuals as well as societal levels. iv. Basic information should be available on phonic conversation through the professional/educator. v. In India vaccines are available but their wages is very hirited, because of back of awareness and the exorbitant cost. There is an urgent need of indigenous production of these vaccines to make them affordable for a population which needs health security interventions. vi. Camps and public awareness programmes should be organized time to time. vii. Family education regarding the care-giving should give through camps/in public gathering. Viii. Discussions should be on following topics- Topics: i. Physical activity of elderly ii. Regular Physical activity of elderly iii. Importance of Physical activity of elderly iv. Cooperation with care givers. v. Stress reduction for family caregivers: effects of adult day care use. vi. Self maintaining and instrumental activities of daily living of older people. On the basis of the above guide lines we can devise a strategy of educational programmes for older people as well as care givers using mass media and non formal communication channel continuing education programmes will be encouraged and supported. Creating mass awareness is therefore an important strategy for ensuring healthy ageing. It is noticed that in India, information, education and communication strategy using mass media, person to person communication, and group communication as in health education, school education and community education is almost non existent. References 1. Tiwari SC. Geriatric psychiatric morbidity in rural northern India : Implications for the future. Int Psychogeriatrics 2000; 12 : 35-48. 2. Hyer L, Blazer DG. Depressive symptoms. Impact and problems in long term care facilities. International J Behav Gerontology 1982; 1 : 33-44. 3. Baltimore Haley WE. The family care givers role in Alzheimer s disease pathway to understanding the experience. Johns Hopkins University Press, 2002. 4. Arno PC, Levine C, Mammodt MM. The economic value of informal care giving. Health Affilicted (Millwood) 1999; 18 : 182-188. 5. Gwyther LP. Family issues in dementia. Finding a new normal. Neural Clinic 2000; 18 : 993-1010. 6. Burton LC, Newsom IT, Schulz R et al. Preventive health behaviors among spousal caregivers. Preventive Med 1997; 26 : 162-169. 268 Delhi Psychiatry Journal 2009; 12:(2) Delhi Psychiatric Society

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