|Year : 2014 | Volume
| Issue : 2 | Page : 95-98
Illness response of rural elderly
Pawan Kumar Goel1, Khursheed Muzammil2, JV Singh2
1 Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Mewat, Haryana, India
2 Department of Community Medicine, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
|Date of Web Publication||13-Nov-2014|
Dr. Pawan Kumar Goel
Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Mewat - 122 107, Haryana
Source of Support: None, Conflict of Interest: None
Background: A dramatic increase in the population of elderly individuals has intensified the need to make geriatric care services easily available. Little research has been conducted to find out the response of rural elderly residents to illness. Aims: To identify the response of elderly rural Indian residents to illness and examine the reasons for these actions . Materials and Methods: A cross-sectional community-based study was designed and conducted at block level Primary Health Centre, Khatauli, (District Muzaffarnagar), the Rural Health Training Centre of the Department of Community Medicine, Muzaffarnagar Medical College, Muzaffarnagar (UP) covering the area by a network of 40 sub-centers, comprising of 384 elderly aged 60 years and above for a period of 6 months. Results: Less than half (49.4%) subjects preferred to use home remedies as first response to illness. During severe illness, 68.4% of elderly visited a private practitioner. Out of them, 73.1% visited private practitioners because they were near the residences of elderly, while 97.2% visited private practitioners during medical emergencies. Conclusion: Inaccessibility and inability to pay were found to be the main reasons for inadequate utilization of health services. This gap can be filled by integration of geriatric care with the primary healthcare facilities, by increasing the patients capacity to pay by broadening the base of old-age pension or by introducing a uniform health insurance program for the aged.
Keywords: Geriatric care, illness response, rural elderly
|How to cite this article:|
Goel PK, Muzammil K, Singh J V. Illness response of rural elderly. Afr J Med Health Sci 2014;13:95-8
| Introduction|| |
The demographic transition from "pyramid to pillar", also called the graying of the nation, can no longer be viewed as "just another statistical projection" nor should it be a source of pride that life expectancy has finally raised to a respectable level. While age may be described as the caress of time, for some, it becomes less of a caress and more of castigation.  By any conventional measurement of health or illness, there are very limited services available for the elderly, and most of these services are only available to patients in large urban areas.  Pradhan N. studied the response of elderly to illness and the reasons associated with such responses in urban areas.  Tran Thi Mai Oanh (Vietnam,  IS Abdulraheem (Nigeria),  Syed Masud Ahmed (Bangladesh),  and Priti Biswas (Bangladesh)  have studied the health-seeking behavior as well as the contributing factors in determining the health-seeking behavior of elderly persons. The objective of the present study was to determine the response of elderly living in rural areas to illness and the reasons for these responses. The purpose of this study was to generate the data that may serve as a baseline for geriatric programming and evaluation.
| Materials and Methods|| |
A cross-sectional community-based study was designed and conducted at block level Primary Health Centre, Khatauli, (District Muzaffarnagar), the Rural Health Training Centre of the Department of Community Medicine, Muzaffarnagar Medical College, Muzaffarnagar (UP) covering the area by a network of 40 sub-centers. For the purpose of study, a sample of 355 elderly people aged 60 years and above derived on the basis of morbidity prevalence rate of 52 percent as per reports of National Sample Survey Organization 1998  with 95 percent confidence interval and a relative precision of 10 percent was decided.
To cover the sample, 10 elderly people aged 60 years and above from each of the 40 sub-centre villages were studied by house-to-house visit starting from a random point. In all, 400 persons aged 60 years and above were selected for the study; however, 16 persons (4.0%) were dropped from the study due to their handicap, being deaf, mentally ill, non-cooperative attitude and non-availability at home during the study period. Hence, the study comprised of 384 elderly aged 60 years and above for a period of 6 months.
In the present study, the tool used was a pre-designed and pre-tested questionnaire to obtain information by personal interview with sample unit. The collected data was subjected to suitable statistical analysis. The participants were explained the purpose of the study before starting the study. Informed consent was obtained from them, and confidentiality and anonymity were ensured. The necessary clearance was obtained from the institutional ethical committee.
Exclusion criteria: Elderly who were deaf, mentally ill, non-cooperative attitude and non-available in the study area during the study period were excluded.
| Results|| |
The study covers 384 elderly aged 60 years and above, spread over 40 sub-center villages under Primary Health Center, Khatauli. Out of these 384 study subjects, 198 (51.6%) were male and 186 (48.4%) were female.
First response in illness
More than two-third (69.0%) of elderly did not visit any medical practitioner during illness. These included 48.9% who used home remedies, 10.9% taking over-the-counter drugs from medical stores, and the rest 9.1% preferring self-medication. There was statistically insignificant (P > 0.05) difference of rational and irrational usage amongst male and female elderly [Table 1].
|Table 1: Distribution of elderly by their first response to illness according to sex|
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First response in severe illness
More than two-third (68.7%) of elderly visited private practitioners in severe illness and only 28.1% visited government hospitals. There was statistically significant difference (P < 0.05) between use of private and public healthcare facilities amongst male and female elderly during severe illness as first response [Table 2].
|Table 2: Distribution of elderly by their first response to severe illness according to sex|
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Reasons of first response in severe illness
The majority of elderly who visited private practitioners during severe illness gave the reason of private practitioners being near to their home (73.1%). On the other hand, 90.7% of subjects using government hospitals stated their reason as the inability to pay [Table 3].
Distance of healthcare facility
It was observed that most private healthcare facilities were located within one kilometer (98.7%), while only 5.0% of public healthcare facilities were located within 1 km and majority (58.8%) of public healthcare facilities were located at a distance of more than 3 km [Table 4].
Response during medical emergencies
Similar to the responses to illness, nearly all (97.2%) elderly preferred visiting private practitioners followed by government hospitals (1.75) and nursing homes (1.1%) during any medical emergency.
| Discussion|| |
Only few studies have been conducted on the response of elderly population during illness. The available studies have been discussed here. Elango S. reported similar proportionate composition of study sample that is 60-69 years (63.5%), 70-79 years (29.5%), and 80 years and above 7.0% in a rural area of Tamil Nadu. 
Similar to the present study, 46.96% of elderly subjects reported a preference for home remedies as first response to illness while 64.78% of them used government run services for care during severe illness in an urban area of Delhi. 
Abdulraheem  reported that family care/family consultation was the first choice (44. 6%) of treatment for the most frequently reported illnesses irrespective of age and sex. Health worker (22.9%) and patent drug seller (18.4%) are the commonly consulted healthcare providers. Health worker includes trained nurses, community health extension worker, and village health worker. Qualified medical doctors played a small role in the health-seeking behavior of elderly people of Nigeria.
Syed Masud Ahmed  found that irrespective of age group, self-care/self-treatment was the most common choice of treatment by elderly of Bangladesh. The most commonly consulted type of provider was a health worker such as a village doctor or a medical assistant (paraprofessional).
Priti Biswas  reported that seeking healthcare from a formally qualified doctor is avoided due to high costs. Familiarity and accessibility of healthcare providers play important roles in health-seeking behavior of elderly persons. Flexibility of healthcare providers in receiving payment is a crucial deciding factor of whether or not to seek treatment, and even the type of treatment sought in rural elderly of Bangladesh.
Tran Thi Mai Oanh  reported that amongst Vietnamese elderly people, the most common reason for selecting healthcare places was proximity to their home.
| Conclusion|| |
The article aimed to find out the response of elderly people on falling ill and the reasons for that response. Findings indicate that study subjects have perception that old age and ill health are synonyms to each other. Approachability in terms of distance travelled had been an important determinant to avail health services. Majority of elderly subjects reported visiting private practitioners during illness due to easy accessibility. Poor paying capacity for health expenditure had also played some role in utilizing government healthcare facilities. Majority of those who visited government hospitals did so due to the inability to pay the private practitioners.
There is a need to make government healthcare facilities more accessible, as most of the private practitioners in sub-center villages are either faith healers or medically unqualified. In addition, health workers at sub-centers should be trained in geriatric care as well as to provide basic primary healthcare to this disadvantaged section of the community. Old-age pension should be granted to more elderly by making the eligibility criteria simple and easy. This would assist patients in paying private practitioners and would avoid delay in transporting patients to government hospitals during severe illness. A uniform health insurance program could also be introduced for the elderly people.
| Acknowledgment|| |
I am indebted to all my study subjects, who were the basis of this work and who permitted me to let undergo to tremendous task of completing my work successfully.
| References|| |
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[Table 1], [Table 2], [Table 3], [Table 4]