Assessment of Physical Disability and Nutritional Status among elderly in a Rural Population in South India

INTRODUCTION : The world population is graying and the longevity which has been looked upon as The result of technological advancement is now being looked as a bane by many Societies. As a result of the decrease in mortality and fertility rates at varying Levels across the world, there was an increase in life expectancy, which resulted In more people living to enter the old age.(1) According to World Health Organization (WHO) the population of elderly across the world was steadily rising From 200 million in 1950 to 350 million in 1975 and is expected to be 1100 million By 2025, which will be 15 percent of the total world population. OBJECTIVES : To determine the prevalence of physical disability among elderly in a rural population. To identify the common type of disability among elderly in the above mentioned population. To determine the nutritional status of elderly in the same population. To identify the factors associated with physical disability and poor Nutrition. METHODS : A cross sectional study was conducted among elderly of age 60 years and above was conducted in Kaniyambadi block of Vellore district which was the service of Christian medical college Vellore, community medicine department. A sample size of 340 was calculated assuming a prevalence of mild disability as 27 percent, based on a study conducted in south India, with an absolute precision of 7, design effect of 2 and anticipated non responsiveness of 5 percent. Using cluster sampling method 17 clusters of size 20 were selected based on probability proportional to size (PPS). Within each cluster elderly were chosen using simple random sampling. A semi structured self administered questionnaire was used which included basic demographic details, Mini nutritional assessment (MNA) scale and Barthel index. Blood samples were collected for testing hemoglobin and serum albumin levels. Data was entered using the software epi info and was analyzed using SPSS Version 17. RESULTS : The prevalence of physical disability was 20.6 percent (95% CI 16.2- 25.0). According to the MNA scale nobody is malnourished. Disability is more in the age group 75 years and above (OR= 2.266 (1.276- 4.024), (p= 0.005) and among women (OR 2.814 (1.311- 6.041) (p= 0.004). There is no malnutrition among the elderly according the MNA scale. The prevalence of those who are at risk of malnutrition is 10.9 percent (95% CI 7.52- 14.28). Using BMI classification (revised by Ministry of health, India, WHO classification for Asia) the percentage of those who are malnourished is 62.1 percent of which 18.3 percent are under nourished, 16.8 percent are overweight and 27.1 percent are obese. The undernutrition according to the BMI has statistically significant association between gender (OR= 1.805 (1.021- 3.189) (p= 0.042) and ses (OR= 2.378 (1.251- 4.521) (p= 0.008). The total prevalence of anemia among the study population was very high, 38.2 percent (95% CI 33.0- 43.4) thus coming under the WHO classification of moderate to severe public health significance. Anemia among women is 38.7 percent and among men is 37.7 percent. Anemia is more in the age group 75 years and above as compared to 60 to 69 year age group (OR= 2.399 (1.177- 4.889) (p=0.016)

Senior citizens and over the counter drugs: challenges in rural India

Background: The geriatric population is on a rise in India, which is accompanied by an increase in their health care needs. As they are prone to have multiple diseases simultaneously the tendency for over the counter (OTC) or non-prescription drugs is much higher among the elderly population. A thorough knowledge about the medication practices among elderly is indispensable since the chances for adverse drugs events; drug interactions etc. are higher among them. The primary objective of the present study was to measure the prevalence of over the counter drug usage among those aged 60 years or above residing in a rural block of North Tamilnadu, India.Methods: A community based cross sectional study was conducted among those aged 60 years or above using an interviewer administered questionnaire and data was collected from 100 consenting participants who were selected using multi stage sampling.Results: The prevalence of the usage of over the counter drugs among the elderly population was found to be 51% (95% CI 41.1-60.9). It was shown that the usage of OTC drugs was associated with higher socio economic status (p value 0.015) and literacy (p value 0.003).Conclusions: Further studies need to done to identify whether such high prevalence of OTC drug usage among elderly is a reflection of drug practices among general population and if proven otherwise should explore the various reasons for the same so that necessary measures can be implemented to alleviate the situation.

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Geriatric health policy in India: The need for scaling-up implementation

In an anticipation of the rising geriatric population in India, the Central government constituted the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. A major strategy of this policy is to encourage families to take care of their older family members. The policy also encourages voluntary organizations to supplement the care provided by the family and provide care and protection to vulnerable elderly people. The implementation of this policy, particularly in the rural areas, has been negligible and calls for a scaling-up of programs to address the physical, psychological, and social needs of the poor. Due to breakdown of the joint family system and the migration of the younger generation to the towns and cities, the elderly parents in the villages are left to fend for themselves. Too old to work and with little or no source of income, the elders are struggling even to satisfy their basic needs. This article primarily focuses on the various facets of elderly care in India. As a fledgling nation in elderly care, we should take cues from other nations who have pioneered in this field and should constantly evolve to identify and face the various challenges that come up, especially from rural India. The Rural Unit for Health and Social Affairs Department of a well-known Medical College in South India has developed a “senior recreation day care” model which proves to be a useful replicable model to improve the quality of life and nutritional status of the elderly in the lower rungs of society. More than a decade since its inception, it is now the right time to assess the implementation of our geriatric health policy and scale-up programs so that the elderly in our country, irrespective of urban and rural, will have a dignified and good quality life

Functional limitation among older adults in a rural area in South Kerala and its associated factors

Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health-care facilities for them, with respect to early identification and management of their functional limitations

The psychological and economic impacts of caregiving on family carers for people with probable dementia in rural South India

Informal carers play a vital role in the care and well-being of older people with dementia. This article examines the psychological and economic impacts caregiving has on carers of people with suspected dementia and the mechanisms by which they cope with challenges. A mixed-method design was adopted. A baseline survey of 123 older people was undertaken in a resource-poor setting in Kerala, India, using Addenbrooke’s Cognitive Examination – Malayalam Version (ACE-m) to identify those with probable dementia. This was followed by in-depth interviews with ten carers of those identified as having cognitive impairment. The data were later transcribed and thematically analysed using N-Vivo to identify main concepts and themes. Analysis of the in-depth interviews with carers revealed that dementia was often interpreted as a ‘second childhood’, but that this conceptualisation aided carers to cope better. Anger and irritation were the commonly expressed psychological reactions which got accentuated by lack of reciprocation of emotion on the part of care recipient. Government support through social security measures and medical care, along with traditional social practises, helped carers to tide over care expenses. These support systems lessened the psychological and economic impacts of caring. Misconstruction of the disease nature, for example by considering it a normal part of ageing, also seem inadvertently to have helped in coping with care requirements, although this comes at a cost of lower than optimal healthcare access for older people with cognitive impairment

Senior citizens and over the counter drugs: challenges in rural India

Background: The geriatric population is on a rise in India, which is accompanied by an increase in their health care needs. As they are prone to have multiple diseases simultaneously the tendency for over the counter (OTC) or non-prescription drugs is much higher among the elderly population. A thorough knowledge about the medication practices among elderly is indispensable since the chances for adverse drugs events; drug interactions etc. are higher among them. The primary objective of the present study was to measure the prevalence of over the counter drug usage among those aged 60 years or above residing in a rural block of North Tamilnadu, India.Methods: A community based cross sectional study was conducted among those aged 60 years or above using an interviewer administered questionnaire and data was collected from 100 consenting participants who were selected using multi stage sampling.Results: The prevalence of the usage of over the counter drugs among the elderly population was found to be 51% (95% CI 41.1-60.9). It was shown that the usage of OTC drugs was associated with higher socio economic status (p value 0.015) and literacy (p value 0.003).Conclusions: Further studies need to done to identify whether such high prevalence of OTC drug usage among elderly is a reflection of drug practices among general population and if proven otherwise should explore the various reasons for the same so that necessary measures can be implemented to alleviate the situation.

Seniors' recreation centers in rural India: Need of the hour

Aim: To empower and bring the underprivileged senior citizens in the rural areas to the mainstream of life through setting up of model “senior citizens' recreation centers” that can be replicated in the other parts of the country. Materials and Methods: Six senior citizens' recreation centers are run in six villages under a community health program of a leading Medical College in South India, which were started by looking into their perceived needs and in a location where organized self-help women groups (SHGs) showed willingness to take the role of caretakers. Together there are 140 members in 6 centers and the most deserving members were identified using a participatory rural appraisal (PRA) method. These centers are open for 5 days a week and the main attraction of the center has been provision of one good, wholesome, noon-meal a day, apart from several recreational activities. The members were also assessed for chronic energy deficiency (CED) and quality of life at the beginning of enrolment using body mass index (BMI) and WHO-BREF scale. Results: The attendance to these centers was nearly 90% of the enrolled beneficiaries. A statistically significant improvement was noticed in quality of life in the physical, psychological, social, and environmental domain (P < 0.05). There was also a significant increase in the average BMI after 1 year of the intervention (P < 0.05). Conclusion: Care of underprivileged senior citizens is a growing need in the rural areas and the “Recreation centers” proved to be a beneficial model that can be easily replicated

Household food security in an urban slum: Determinants and trends

Introduction: As we are moving from millennium development goals to sustainable development goals, food insecurity is imposing a formidable challenge to the policymakers, especially in developing countries such as India. A survey conducted in the urban slum areas of Vellore district, 6 years back, had reported food insecurity as high as 75%. The current study was a resurvey to assess the food security status in the aforementioned area. Materials and Methods: A community-based survey was conducted in which data were collected using a self-administered questionnaire from 150 households, selected through multistaged cluster sampling, who had given oral consent to be a part of the survey. The prevalence of food security calculated from this study was compared with the results from a previous survey to look for any significant improvement. Results: Nearly 42.7% of the households were food secure, while 26.7% were food insecure without hunger and 30.6% were food insecure with some degree of hunger. Low socioeconomic status (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.29–8.16; P < 0.012) and presence of debt (OR: 3.84, 95% CI: 1.90–7.73; P < 0.001) were the major risk factors for food insecurity. A comparison with the findings from the previous study has shown a statistically significant improvement in food security from 25.4% to 42.7% (Chi-square: 27.072, df: 2, P < 0.0001). Conclusion: Although food security levels have shown marked improvement over the years, much needs to be done for India to be free from the shackles of hunger