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175
The Journal of Public Health. Photon 115 (2013) 175-181
https://sites.google.com/site/photonfoundationorganization/home/the-journal-of-public-health
Original Research Article. ISJN: 4367- 5937
The Journal of Public Health
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A Community based study on socio-cultural problems and activities
of daily living pattern of the rural geriatric population in South India
Pallavi M.
a
, Bayapa Reddy N.
b
*, Madhavi E.
c
, Nagarjuna Reddy N.
d
, Radhakrishna L.
e
,
Narasimha Reddy C.
e
a Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamil Nadu, India
b Sri Venkateswara Institute of Medical Sciences, Tirupathy, Andhra Pradesh, India
c Chettinad Medical College, Chettinad University, Keelambakkam, Chennai, Tamil Nadu India
d Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamil Nadu, India
e Kanchikamakoti Child trust Hospital, Chennai, Tamil Nadu, India
Article history:
Received: 05 March, 2013
Accepted: 14 March, 2013
Available online: 01 April, 2013
Keywords:
Elderly, social, Cultural, and psychological problems,
Habits, activities of daily living
Corresponding Author:
Reddy B.N.*
Assistant Professor
Email: bayapreddy916@gmail.com
Phone: +919486400865
Pallavi M.
Scholar
Email: pallubiochem@yahoo.co.in
Phone: +919490782377
Madhavi E.
Assistant Professor
Email: drmadhavieerike@gmail.com
Phone: +919941476332
Reddy N.E
Junior resident.
Email: drnnreddy@gmail.com
Phone: +919840494069
Radhakrishna L.
Scholar
Email: lagisettyradhakrishna@gmail.com
Phone: +918015142018
Reddy N.C.
Junior resident.
Email: drsaichandamuri@gmail.com
Phone: +918098132659
Abstract
Introduction: There has been a sharp increase in
the proportion of elderly population in India as a
result of demographic transition. The psychology of
ageing is markedly influenced by the general
attitude towards the elderly. Social psychology
indicates the changing attitude towards them.
Objective of Research: To find out Socio-Cultural,
psychological problems, and activities of daily living
of the rural geriatric population. Methodology: A
community based Cross sectional study conducted
during the period of December 2010 to June 2011.
By simple Random sampling method twenty three
elderly persons who were aged 60 years and above
willing to participate were selected from each of the
eighteen selected village. Results: Majority elderly
231 (60.6%) said that they had good relationship
with family members. Less than half of the elderly
164 (43.1%) reported, their advice was honoured by
family members. More than half of the elderly 228
(55.4%) were current addicts. Disability with respect
to daily activities, 48 (11.7%) elderly needed help
for climbing the stairs. Conclusions: Elderly persons
who are physically fit due to their good lifestyle
practices should be made role models and motivate
others for better quality of health and promotion of
healthy lifestyle.
Citation:
Pallavi M., Reddy B.N.., Madhavi E., Reddy N.E.,
Radhakrishna L., Reddy N.C., 2013. A Community based
study on socio-cultural problems and activities of daily
living pattern of the rural geriatric population in South
India.
The Journal of Public Health. Photon 115, 175-181.
1. Introduction
India has acquired the label of aging nation
with 7.7% of its population being more than 60
years old. There has been a sharp increase in
the proportion of elderly population in India as
a result of demographic transition (World
Population Aging. 2007).
176
1.1 Culture
In India and China cultures, the elderly were
respected as the repositories of inherited
wisdom and experience and they were the
principal decision-makers. Nowadays,
however, in constantly changing societies
such as ours, the accumulated knowledge of
the elderly is rarely viewed as the Source of
wisdom-it is commonly regarded as something
outdated and obsolete.
1.2 Social
The elderly are also prone to abuse in their
families or in institutional settings. This
includes physical abuse (infliction of pain or
injury), psychological or emotional abuse
(infliction of mental anguish and illegal
exploitation), and sexual abuse.
1.3 Psychological
Elderly people are highly prone to mental
morbidities; the mental disorders that are
frequently encountered include dementia and
mood disorders. Other disorders include
neurotic and personality disorders, drug and
alcohol abuse, delirium, and mental psychosis.
1.4 Need of the Hour
Psychosocial medicine teaches us that every
disease or disorder is more or less conditioned
by unfavorable social factors. The limited data
about the epidemiology concerning the
settings where elderly persons die due to a
variety of social, cultural, and economic
factors. We therefore conducted this study to
find out socio-cultural and psychological
problems of elderly.
2. Objective of Research
To find out Socio-Cultural, psychological
problems, and activities of daily living of the
rural geriatric population.
3. Methodology
3.1 Type of study
A community based Cross sectional study was
conducted during the period of December
2010 to June 2011.
3.2 Selection of study sample
In the first stage by stratified random selection
method eighteen villages were selected in the
Trichy district of Tamil Nadu state, one of the
South Indian state. In the second stage by
simple Random sampling method twenty three
elderly persons who were aged 60 years and
above willing to participate were selected from
each of the selected village. In final analysis a
total of 411 individuals included for this study.
3.3 Data collection
From this selected study sample the data was
collected by the pretested personal interview
questionnaire, following parameters was
included age, sex, mental status, economic
dependency, activities on daily living, and
addictions.etc.
3.4 Analysis
Data was analysed by Chi-square test, at 95%
confidence interval; p value less than
0.05(p<0.05) was consider for significant,
SPSS Version 12 Statistical Software was
used to analyze the data.
3.5 Tolls:
We used in this study were 3.5.1. Geriatric
Depression Scale (Short form) and
3.5.2.Barthel Index for Activities of Daily
Living.
4. Results
4.1 Demography
Out of the 411 elderly persons 214 (52.1%)
were males and 197(47.9%) were females.
Majority of the elders 245(59.6 %) were found
in the age group 60-69 years; among these
245, 122 (57.0%) were males and 123 (62.4%)
were females. Mean age for the entire study
population was 69.2± 7.8 years; mean age of
the males and females was 69.8 ±8.2 &
68.6±7.4 years respectively. The difference
between two means was not statistically
significant (P> 0.05). Out of 411 elderly
persons 288 (70%) were illiterate, 38 (9.2%)
were just literate and 28 (6.8%) were educated
up to primary level.
4.2 Cultural
Among the 381 elderly (8 Males and 22
females who were living alone were excluded
from this) 231 (60.6%) were said that they had
good relationship with family members {145,
86; 38.1% & 22.5%} males and females
respectively, while 88 (23.1%) and 62 (16.3%)
reported that they have fair and poor
relationship with their family members
respectively. Higher number of females
52(13.6%) have fair relationship with family
members compared to males 36(9.5%) and
this difference was found to be statistically
significant (χ
2
=17.89, df=2, p<0.001
Significant). Elderly advises received by family
members, out of the 411 elderly 164 (43.1%)
elderly were reported that their advise were
177
honored by family members [124& 40; 32.6%
& 10.5%] male and female respectively, 151
(39.6%) and 66 (17.3%) were reported that
their advise were by family members variable
response and ignored respectively. the
difference between male and female was
statistically significant (p<0.001 Significant).
4.3 Social
Majority of the elderly 206 (50.1%) and 104
(25.3%) were financially dependent on their
children either totally or partially respectively.
only 101 (24.6%) were financially independent.
Majority of the elderly females 160(38.9%)
were totally dependent on their children
compared to males 46(11.2%). This difference
was found to be statistically significant
p<0.001 Significant. Details of Leisure Time
Activities of Elderly have been provided in
Table 1.
Table 1: Distribution of Elderly Persons According to Leisure Time Activities
Leisure time activities Male Female Total P value <0.05
Significant
No. % No. % No. %
Gossiping 26 6.3 44 10.7 70 17.0 <0.01
Religious activities 39 9.5 27 6.6 66 16.1 >0.1
Play with grand
children 24 5.8 39 9.5 63 15.3 <0.02
Walking 37 9.1 17 4.1 54 13.2 <0.01
Taking care of
Domestic animals 26 6.3 14 3.4 40 9.7 >0.05
Listening to Radio 21 5.1 12 2.9 33 8.0 >0.1
Reading* 16 3.9 0 0.0 16 3.9
Do nothing 25 6.1 44 10.7 69 16.8 <0.01
Total 214 52.1 197 47.9 411 100.0 <0.001**
**(
χ
2
=29.07, df=6, p<0.001 Significant).* Excluded for calculating Chi square.
4.4 Psychological
More than half of the elderly 228 (55.4%) were
current addicts, 36 (8.8%) were ex-addicts and
147(35.8%) were non addicts. Higher
proportion of males 151(70.6%) current
addicts compared to females 77(18.7%). This
difference was found to be statistically
significant (p<0.0001). Details of addiction
pattern among elderly were shown in table 2.
Table 2: Addiction Pattern of Elderly Population (Multiple Response)
2.1 Addiction Male (n=214) Female (n=197) Total (N=411)
No. % No. % No. %
2.2 Current Addiction Tobacco chewing 149 69.6 57 28.9 206 50.2
Tobacco smoking 74 34.6 34 17.3 108 26.3
Ganja/Bhang 18 8.4 0 0 18 4.4
Alcohol 7 3.3 0 0 7 1.7
2.3 Past Addiction Tobacco chewing 8 3.7 19 9.7 27 6.6
Tobacco smoking 14 6.5 10 5.1 24 5.8
Ganja/Bhang 8 3.7 0 0 8 1.9
Alcohol 0 0 0 0 0 0
Note: Tobacco chewing includes khaini and gutka. Tobacco smoking includes beedi’s, cigarettes, chillum and
hookah.
Prevalence of mental illness was 97 (23.6%)
among the 411 elderly persons. of which
women were 67 (34.1%) and men were 30
(14.0%) (p<0.001). Majority of them were 81
(19.7%) depressed according to Geriatric
Depression Scale (GDS >5). A higher number
of elderly females 60 (30.5%) were depressed
compared to males 21 (9.8%), this difference
found to be statistically significant (OR=4.025,
Z=2.19, P=0.01426 Significant). the details
have been given in table 3.
Table 3: Distribution of Mental Diseases among Elderly Population
Disease Male(n=214) Female(n=197) Total(N=411) P value <0.05
Significant
No. % No. % No. %
Depression 21 9.8 60 30.5 81 19.7 <0.001
Anxiety disorder 5 2.3 4 2.0 9 2.1 >0.5
Dementia 4 1.9 3 1.5 7 1.7 >0.5
Total 30 14.0 67 34.1 97 23.6 <0.001
178
4.5 Activities of daily living:
Regarding disability with respect to specific
activities, of the 411 elderly persons 48
(11.7%) needed help for climbing the stairs
and 34 (8.3%) needed minor help for transfer
from bed to chair and back. Thirty two (7.8%)
elderly persons needed help for going to the
toilet, 27 (6.6%) for dressing and 15 (3.6%) for
bathing. Ten (2.4%) walked with help from
other person. The details have been provided
in table 4 & 5.
Table 4: Distribution of elderly according to Barthel index of activities of daily living
Barthel Index Male Female Total
No.
%
No.
%
No.
%
Independent (Barthel score >18) 182 44.3 179 43.6 361 87.9
Moderately disabled (Barthel score 15-18) 22 5.4 8 1.9 30 7.3
Severely disabled (Barthel score <15) 10 2.4 10 2.4 20 4.8
Total 214 52.1 197 47.9 411 100.0
(
χ
2
=5.86, df=2, p>0.05 Not significant).
Table 5: Distribution of elderly according to specific activities of daily living of Barthel Index
S No Indicators Male Female Total
No % No % No %
5.1 Bowels :
Occasional accident
Continent
9
205
4.2
95.8
5
192
2.5
97.5
14
397
3.4
96.6
5.2. Bladder :
Incontinent
Occasional Accident
Continent
2
17
195
0.9
7.9
91.1
5
26
166
2.5
13.2
84.3
7
43
361
1.7
10.5
87.8
5.3. Grooming :
Needs help & Personal care
Independent
9
205
4.2
95.8
11
186
5.6
94.4
20
391
4.9
95.1
5.4. Toilet :
Dependent
Needs some help
Independent
2
19
193
0.9
8.9
90.2
1
13
183
0.5
6.6
92.9
3
32
376
0.7
7.8
91.5
5.5. Feeding :
Unable
Needs help
Independent
1
4
209
0.5
1.9
97.6
1
5
191
0.5
2.5
97.0
2
9
400
0.5
2.2
97.3
5.6. Dressing :
Dependent
Needs help
Independent
1
13
200
0.5
6.1
93.4
1
14
182
0.5
7.1
92.4
2
27
382
0.5
6.6
92.9
5.7. Transfer (Bed to chair & back ):
Unable
Major help (1-2 people)
Minor help (verbal/physical)
Independent
0
2
22
190
0
0.9
10.3
88.8
0
3
12
182
0
1.5
6.1
92.4
0
5
34
372
0
1.2
8.3
90.5
5.8. Mobility :
Immobile
Bed ridden
Walks with help from 1 person
Independent (but may use aid)
0
1
4
209
0
0.5
1.9
97.6
0
1
6
190
0
0.5
3.1
96.4
0
2
10
399
0
0.5
2.4
97.1
5.9. Stairs :
Unable
Needs help
Independent
1
28
185
0.5
13.1
86.4
2
20
175
1.0
10.2
88.8
3
48
360
0.7
11.7
87.6
5.10. Bathing :
Dependent
Independent
7
207
3.3
96.7
8
189
4.1
95.9
15
396
3.6
96.4
5. Discussion
5.1 Demography
In the present study 59.6% of the elderly were
found in the age group 60 to 69 years, with
males and females contributing 57.0% and
62.4% respectively for that age group. Similar
studies conducted by Anjali R, Aarti K., 2006.
Living conditions of Elderly in India: An
overview based on nationwide data. Ind Jr of
179
Geront, 20, 250-263. Rajan S I., 2006. Centre
for Enquiry into Health and Allied Themes.
Population Ageig and Health in India. and In
Eun-kyung W, Changsu H, Sangmee AJ, Min
KP, Sungsoo K, Eunkyung K, et. al., 2007.
Morbidity and related factors among elderly
people in South Korea: results from the Ansan
Geriatric (AGE) cohort study. BMC Public
Health, 7, 10. all reported similar age
distribution. Out of the 411 elderly persons
52.1% were males and 47.9% were females,
the sex ratio was found to be 921 females per
1000 males in the present study. Where in sex
ratio of the elderly population were 920
females per 1000 males.
5.2 Culture
Nearly 43% of the elderly persons said that
their advice was honored by family members,
40% and 17% were reported they received
variable response and ignored their advice
respectively. In a similar studies conducted by
Goel et al., 2005; Garg et al., 1981; Matta et
al., 2005. Nearly 61% to 66% of elderly stated
that their advice was honoured by family
members and 34% to 39% stated that their
advice was ignored respectively. These
findings were higher compared to the present
study 43.1% elderly. Higher percentage of
honored may be due to they were classified
into two categories. Humanity of a society is
measured according to its attitude towards
children and the elderly. Together with the
quality of life and healthy lifestyles in old age,
the most important are pre-morbid personal
characteristics and lifestyle in young and in old
age. Among the elderly 61% reported that they
had good relationship with family members,
while 23% and 16% reported fair and poor
relationship respectively with family members.
Majority of the females reported poor
relationship with their family members
compared to males and the difference was
found to be significant (p<0.001). In a similar
study by Matta et al., 2005. Observed in
58.3% of the aged persons reviled that they
had good relation and 41.7% of elderly
subjects stated that they were neglected with
their family members. Garg et al., 1981. Also
found similar findings. In a study by Sonar and
Prasad, 2004. A significant proportion of the
elderly persons reported good relations with
children and grand children. Since traditional
patriarchal familial relationships have been
gradually disappearing, the elderly have lost
the halo of wisdom and their social prestige
has been degraded. These social and ethical
deformations are the darker side of our
civilization.
5.3 Social
In this study only one fourth of the elderly
were financially totally independent, three
fourth of the elderly were dependent on their
children either totally or partially. Higher
proportion of females was economically
dependent than males. In other similar studies
conducted by Goel et al., 2005; Garg et al.,
1981. Also confirmed our findings by stating
that 58.5% and 50% of elderly were financially
dependent respectively and the dependency
rate was higher among females compared to
males.
Most common leisure time activities of elderly
were gossiping 17% and did nothing 17%
followed by participating in religious
activities16%, playing with grand children15%,
walking 13%, taking care of domestic animals
10% and 8% listening to radio. Most of the
females were involved in 22% were gossiping
and 22% were doing nothing, playing with
grand children 20%. In a study by Garg et al.,
1981. Most of the aged person passed their
leisure time at home. Nearly 77% of males and
93% of females spent their leisure time in
religious activities and marketing or shopping
37% of males and 61% of females, 40% of the
males went for morning or evening walks.
Goel et al., 2005. Study in rural area of
Meerut, founds attending social function
62.7%, informal meeting with other older
people 48.6%, attending religious functions
44.9%, household and family related jobs
8.7% and park activities (1.1%). Goel et al.,
2005.
5.4 Psychological
More than half of the elderly persons 55%
were current addicts, 9% were ex addicts and
only 36% were non addicts. Higher proportion
of males 71% was current addicts compared
to females 39%. Matta et al., 2005. Found that
64 % of elderly persons were addicted to one
or more addictives and also higher proportion
of males were addicted compared to females,
which is similar to the present study. Nearly
50% of elderly persons were currently
addicted to tobacco chewing, 26% to tobacco
smoking, 4% to ganja/bhang and 2% were
currently addicted to alcohol. Around 70% of
males and 29% of females were currently
addicted to tobacco chewing. Also 35% of men
and 17% of women were current smokers. No
women had ever been addicted to
ganja/bhang or alcohol. Purty et al., 2006.
Reported that 61 % of elderly persons were
addicted to tobacco chewing and 33 % of
males were smokers, comparable to the
present study. Prakash et al., 2004. Also found
180
that 22 % of the elderly were smokers, which
is similar to the present study. In a study by
Medhi et al., (2006) no female was found to be
addicted to alcohol, which is similar to the
present study. Prevalence of mental illness
among the elderly was 23.6%. Lal et al., 1997.
The prevalence was significantly higher
among women 34.1% compared to men
14.0% Dube, 1970; Premarajan et al., 1993.
Found psychiatric morbidity 22.3% and 17.3%
respectively comparable to the present study.
A higher prevalence was reported in other
studies. Nandi et al., 1997. and in Mehta et
al.,1985; Shaji et al., 1995. in their respective
community based studies on elderly observed
that more women suffered from psychiatric
disorders compared to men, similar to the
present study. Our study found that
depression present in 19.7% of the elderly. It
was significantly higher among women 30.5%
compared to men 9.8%. in studies of
Ramachandran et al., 1999. Observed was
22% and 24% of Depression among elderly
respectively.
5.5 Activities of daily living
In the present study only 7% were moderately
disabled (Barthel score 15-18) and 5% were
severely disabled (Barthel score <15) for the
activities of daily living. It is lower compared to
the results of Heslin J.M., 2001. Health status
and service utilization of older people in
different European countries. Scand Jr Prim
Hlth Care, 19, 218-222. who found that 26% of
the elderly were moderately disabled and 9%
were severely disabled in Europe. A likely
reason for this may be that in rural India
people continue to be active and independent
in performing their daily activities even at
advanced age may be due to economic
constraints make them ignore minor
disabilities.
Regarding disability with respect to specific
activities only 12% needed help for climbing
the stairs and 8% needed minor help for
transfer from bed to chair and back. Another
8% of elderly persons needed help for going to
the toilet, 7% for dressing and 4% for bathing.
Two percent walked with help from other
person. It is comparable to the study of
Chacko and Joseph, 1990. Wherein very few
elderly persons needed help for bathing, going
to toilet, dressing and walking.
Conclusions
The sequence of social interventions required
for the management of the elderly socio-
cultural problems. Elderly persons who are
physically fit due to their good lifestyle
practices should be made role models and
motivate others for better quality of health and
promotion of healthy lifestyle. Some measures
has to take to support the elders, establish
geriatric centers, advisory offices and services
to help the elderly. Vocational rehabilitation to
the elderly to live financial independent life by
giving less physical work jobs like story-tellers,
entertainers, instructors, duty to protect the
crops from birds and grasshoppers.
Accredited Social Health Activist (Asha),
village health workers and volunteers must be
trained to identify the Socio-Cultural problems
of elderly and to provide advice and treat
accordingly. ASHA must be involved to
generate awareness in the community
regarding the geriatric social and cultural
problems and change the community
behaviour towards caring elderly and the
village level elderly people must be promoted
to form committees so that they can discuss
their own problems among themselves and
find the solution.
Limitations & Future Research
1. The sample size was restricted to minimum
required elderly persons. Hence in future, a
similar study needs to be conducted on a
larger section of the elderly population.
2. Some of the recent small incidence would
give exacerbated response from the
responder, keeping in view the above
limitations, longitudinal studies on a larger
group of elderly men and women are needed
in future.
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