1. Alterations of Intra and Extra Mitochondrial Enzyme in the Muscle Fibersof Rat Hind Limbs: Role of Exercise




Название1. Alterations of Intra and Extra Mitochondrial Enzyme in the Muscle Fibersof Rat Hind Limbs: Role of Exercise
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Methods

The study is based on case-study materials collected from purposively selected five women elderly belonging to the village named Majilpur and Taldih in 24 Parganas (S), Lokenath in Hooghly, Haturaia in Howrah and Sankra in Purulia. The case-studies were verified with the help of neighbors. Interview and observation methods were also followed. While the principal investigator supervised the collection of case-studies through tape-recorder by a trained lady field investigator, the male investigator remained busy in interviewing the heads of the household with a questionnaire-schedule. The B. Stat (Hons.) students of the Indian Statistical Institute were also interested to take case-history and other relevant data from the Jainagar village. One girl-student was so much excited that she applied life-history technique to extract live data.

Incidentally, the principal investigator was entrusted upon to conduct a survey among the rural people belonging to different West Bengal districts in 1994. Moreover, he was commissioned to organize a 3-day workshop along with a senior psychologists at the Haturia-2 Gram Panchayat to explore local resources for rural development. In this way, rapport was built in the village in advance. For the selection of Loknath case in Hooghly and Sankra case in Purulia, prior experiences of the team members helped a lot to obtain case study and other data.

Case Studies

Case # 1

Manoda Mondol (68) was a widow living at Majilpur Village, 24 Parganas (South) with her son, Badol, daughter-in-law, (Moyna) and ground children.

She belonged to small peasant household. She lost her husband 5 years ago. The family owned 8 bighas of land, a pond, kitchen, garden and two coconut trees. Besides, there were a pair of bullocks, one milched cow and a calf, and three goats. Manoda kept herself busy in supervising the household work, looked after the kitchen garden, milked the cow, and took care of the cow-boy who tender the cattle and goats and fetch the fodder. Manoda earned money by selling green coconuts, and excess products of the kitchen garden. She spends her leisure times by listening to the religious discourse at the village community center. She would take important family decision like when the rice-taking ceremony of the youngest grand child would be held, whom to be invited, selection of mate for the grand daughter, when the annual household worship to be performed and so on. Manoda was a good story-teller. She took the role of a fun-seeker, playmate and story-teller. The grand children often make fight among themselves over their sleeping arrangement with the grandmother. In fact, Manoda seemed to be the most dominant at the same time cordial member of the Mandol family.


Case # 2 :

Lakkhi Bala (69) a married woman lived with her husband Haran Naskar (80) in the Bangal Para of Taldih village, South 24 Parganas in an empty nest. Her husband is seriously ill and also having a sight problem she herself is having chronic pain in the knees Lakkhi Bala’s two sons and two daughters lived elsewhere. The eldest son, being stayed in the same village but at different hamlet named Ghosh Para, occasionally visits his parents and help them with money. The old couple were not completely denied of the filial care. For, from time to time, the parents used to enjoy the company of their grandchildren and also the taste of good food items from them. Lakkhi had to keep herself busy in doing household chores, nursing Haran, and frequently visited the Gram Panchayat office to enquire about the status of her husband’s old age pension. In the afternoon, she would make broom sticks from the coconut leaves to supplement family income and produce fueling materials out of dried coconut leaves. She was a god fearing woman. Everyday she would worship household deities with flower, nakuldana and water. Her daily domestic chores include sweeping the uthon (court yard), cleaning the goatary shed, feeding the goats with jack-fruit leaves, tending them by a cow-boy, ship-shape the bed, prepare breakfast for her husband, attend to her husband’s various needs, cook meals, goes to the groceries, and haat (village market) for buying vegetables, spices and fish. From her activities of daily life it appears that inactiveness is a concept unknown to her.

Case # 3


Tulshibala Giri (75) was an widowed woman whom the investigator met at her daughter’s house at Haturia in the district of Howrah. She was a wretched woman compelled to lead a life of a bhager ma (shared mother) moving from one family to another of her two sons and a daughter under a system locally named as pala (rotatory) for 4 months in a family. The investigator got interested in her case to explore how far she was dependent upon her children for sustenance and care and the nature of voluntary services contributed to the family. From a priori information from the Panchayat member the lady investigator gathered that Tulshi’s husband was small peasant owning 6 bighas of cultivable land and also worked as tenant cultivator. When he was terminally ill, the eldest son persuaded him to transfer the land to him and his brother which Tulshi’s husband did with the hope that they would look after their. But the commitment was not honored. Ultimately, the Panchayat had to intervene for settling the disputes concerning Tulshi’s sustenance and care. The settlement was that each of the two sons and the daughter would look after their mother rotationally for four months in a year. Thus, Tulshi had to move from one family to another with utter disgrace.

As Tulshi was quite fit to render her services to the family of her daughters-in-law and daughter by way of performing domestic works such as sweeping the floor, helping as a baby sitter, acting as an ayah to perform pre-natal and post-natal care, and so on. She used to enjoy ample freedom at her daughter’s place to spend times with the company of other older women nearby and would stand by them during crisis.

But the situation was not so congenial at her sons' family. Besides rendering help in domestic chores, she had to make cow dung cakes, prepare prickles, aam sattva (a kind of thin cake made of the sweet juice of ripe mango drying it in the sun), aam-chur (dried slices of green mango preserved in salt) and bori (a small conical ball made of the paste of pegion pea and dried in the sun) etc. During the rainy season she used to make paper packet known as thonga for supplementing her son’s family income. However, neglect, abuse and compel to face filthy words from her daughters'-in-law were the usual treatment which she had to suffer. Tulshibala’s case may not reveal much of her involvement in productive ageing because of her loss of family status, utmost dependence on children and advanced age.

Case # 4


Safiunnisha Begum (64) was an educated married woman lived at Bahirkhand village, Hooghly in a joint family. She was a retired primary school teacher and actively involved in the movement of women’s upliftment. Her husband was a bed-ridden paralytic patient. Safiunnisha’s two sons, Helal (35) a married son having three girls, and Kamal (20) was a Higher Secondary student, and two daughters, Ayesha and Tuktuki. Her husband’s younger brother, Sirajul (68) also lived in the same family with his married and unmarried children. Cultivation, service and wholesale dealer of clothes and owning a ration shop were the sources of family income of Safiunnisha Begum. Although Safiunnisha had mother-in-law aged about 90 yet the entire family reported to have under her own control. She got pension, invested her terminal benefits into the small saving schemes and Govt. bonds but allowed their earning sons and other member of the family to spend as per their respective will, of course, after contributing a portion of their income for household expenditure. Although the head of the family was her mother-in-law, yet actually her husband’s brother Sirajul functioned as a de-facto head.

Safiunnisha engaged herself in full-time community welfare work holding the position of a member of the panchayat. However, she would pay whole hearted attention to her ailing husband and also took part in important family decisions like education of grand children daughter’s marriage, transaction of property and so on. Being a religious minded lady, she performed the namaaz (prayer) daily before sun-rise.

Case # 5


Parul Badyokar (66) belonged to the poorest of the poor family at the Sankra village of Para block in Purulia. Signs of under-nutrition were traced in every member of her family. She lived with her only son, Tarak (42) who was married and having his family. Her husband died in a car accident some 20 years ago while returning from the market in the evening in a drunken state. It was by dint of Parul’s relentless fight against the poverty that her family could survive and eke out its living. She used to engaged in her family’s traditional occupation in basketry like many other Badyakars in the locality. Her son, Tarak (40) read up to primary level and worked as an agricultural labour. Tarak’s wife was a domestic maid in a Mahato family. But whenever they had leisure lines, joined Parul in making busketry, winnowing fan, broom sticks, small fish basket etc. Tarak used to buy bamboo from the neighboring Mahato families and his wife, Kushum (30) would accompany her mother-in-law for disposing of the products to their fixed customers in and around the village in exchange of crop and cereals. Parul’s eldest grandson (12) worked as a bagal (cattle grazer) to graze the cattle of the Sarak families, while the next one (10) collected cow-dung with which Parul and Kushum would make cakes. Besides contributing family income, Parul had to look after the children, feed them, send the youngest one to school and participate in other domestic activities. The only recreation which she could afford to have was casual attendance to the religious discourse that held in the Horibol (village community center) in the evening.

Discussion


It is usually held that ageing for women in rural areas brings with it insecurity and utmost economic dependency. Aged women, constitute a vulnerable group which is often subject to physical and mental abuse. Women are undoubtedly the most productive group in rural areas and they occupy a unique position by virtue of their productive power. The older population continues to be dominated by women who are widows. A majority of them are being forced to live at the margin of survivality and work in an unorganized sector. Recently, “the introduction of modern farming methods and mechanization in the industrial sectors had have an adverse affect reducing the elderly in work participation. Due to decreased activity in work place during old age more and more elderly persons have to stay back home by engaging themselves in household chores. The economic value of the women are mostly invisible in the sense that it is neither remunerated nor acknowledged.

From the case studies of five elderly women from the villages of South 24 Parganas, Hooghly and Purulia districts, it revealed that the contribution of these women in the economic sphere cannot be overlooked. Although the rate of participation and extent of supplement to the family income tend to vary from case to case yet not an elderly women could be found to remain idle at home by becoming fully dependent on other members, if of course, they are not physical unfit. So far as physical aspects of productivity is concerned, two out of five cases seem to suffer from gout and debility. Mentally also. Cases # 3 suffers from emotional isolation, loneliness and inferiority complex because her social status has gone down because of the demise of husband. She led the life of a bhager ma (shared mother). Poverty, lack of compromising attitude and frequent quarrels with her own people made her a psychic patient. Affluency, economic solvency and higher education make a rural elderly woman productive in economic physical and social aspects as the revealed in Case No. 4. The social as well as family status of the elderly woman seemed to have enhanced much because of her involvement in both private and public welfare programs. Abject poverty and lack of landed property and other asset force an elderly women to get involve in income generating process. Poor illiterate elderly women in rural areas can hardly think of empowerment of woman – which is why except in a solitary case none could be found interested in active participation in women’s organization. Perhaps, the wide-spread negative attitude towards old age such as feeling of low self-worth, self-esteem, helplessness, and above all patriarchal social system which are ingrained among the elderly women in rural areas make them apathetic towards active participation in polities. “Bringing attitudinal changes among the rural women in particular, and society in general, is imperative for them to be considered as a special persons and inspire them leading meaningful lives” (Chowdhary, 2001).

It is of urgent necessity to make an intervention plan for the rural aged women in every village in the form of “initiating a set of co-ordinate activities so that the disadvantageous conditions which surround the older women and which hamper their fuller participation in family and community life are reduced, paving the way for psycho-social upliftment, economic and holistic security (Chowdhary, 2001). However, during the period of rapid rural appraisal by a team of anthropologists, demographer, statistician, and physician throughout the length and breath of Purulia district in 1990s, all the members were unanimous in one respect that ageing was not a liability for rural elderly women. For, barring those who are permanently disabled and incapacitated, not many women elderly could be seen sitting idly by withdrawing themselves from productive process or abstain from taking care of the members of the family in crisis.

Conclusion

Ageing for many a rural elderly women is neither a curse nor a blessing. It hardly frightens them. Rather, some women earnestly desire to undertake the role reversal. Traditional values are still rampant in Indian rural areas. It is the elderly women who continue to sustain Indian culture. They act as a buffer to promote natural acceptance of the ageing process. “Religious and cultural ideas about birth and cycle as ever recurring, tradition of respect for the aged mitigates the socio-psychological problems associated with the ageing to some extent (Prakash, 1996). Rural elderly women are still not a liability unlike that of their urban counterparts. But that does not make us complacent because prevention is better than cure. Field experience indicates that women do not lack ability to improve their lot if the gender discrimination in decision-making process is minimized.

The traditional notion that women’s actual place is confined to hearth and home, especially for those who are older in age, needs to be given a second thought. There are many elderly women all over the world who excelled in the later part of their life. The only point is that elderly women – be they in rural or urban areas should be given equal opportunities, access to education, employment and alternative role instead of home maker (Prakash, 1996). More than anything else, finding ways in which older women can feel in control in their lives (like for instance, Safiunnisha Begum of case no. 4) will go a long way in reducing the helplessness that older women face.


The process of empowerment for the “productive” aged womenfolk in rural Bengal can go a long way to not only generate innovative ideas for improving their quality of life but also act as a catalyst for social change. Thus by utilizing their time, knowledge, skills, experience and wisdom the elderly women can make individual benefit and contribute to social development. Productive ageing is not a utopian concept for the elderly especially for the women in rural area. The need of the hour is to undertake intervention program by the N.G.O.s or Mahila Panchayat for generating awareness among the elderly women about the widening scope of productive ageing.
References

Chakrabarti, Prafulla (1995). “Contemporary situations of the elderly in rural Nadia”, in : Vijaya Kumar, S. (Ed.), Challenges before the elderly : An Indian Scenario, New Delhi. M. D. Publications Pvt. Ltd. 77–78.

Chowdhary, Aabha. (2001). Productive ageing : A step towards socio-economic empowerment of rural elderly women in Himalayan areas in : Prakash, Indira Jai (Ed.) Aging the Indian experience, Report of the workshop organized during 9–10 August, Bangalore, Bangalore University, 44–57.

Kumar, Vinod (1997). Productive Aging for the young old, Research and Development Journal, 4 (1) : 18 – 26.

Kumar, Vinod (1996) (Ed.) Aging : Indian Perspective and Global Scenario, New Delhi, All Indian Institute Medical Science.

Prakash, Indira Jai (1996) (Ed.). Quality Ageing : Collected Papers, Varanasi, Association of Gerontology in India.


Indian Journal of Gerontology

2008, Vol. 22, No. 1. pp 73 -84


The Morbidity Profile of the Aged in Surat City


Mukesh Kumar, Manoj Bansal and Raj Kumar Bansal

Surat Municipal Institute of Medical Education & Research, Surat- 395010 & U.N. Mehta Institute of Cardiology & Research Centre, Ahmedabad.


ABSTRACT


This study explores the morbidity profile among 68 residents of four old age homes run in Surat city through interview technique. Unwillingness of family members to take care of the elderly emerges as the main reason of their stay at these homes. The person prevalence of diagnosed physical ailments was 80.9% with an average prevalence of 1.3. The study also describes their complaints and feelings relating to mental health and the perceived wishes of the respondents. The study discusses their patterns of seeking of internal and external medical care and the hindrances that resulted into unmet health needs. The study gives appropriate recommendations for the appropriate health care provision of the elderly.

Key Words: Aged, Morbidity profile, Unmet needs,

According to the 2001 census, India is home to more than 76 million people aged 60 years and over. This age group, currently 7.4% of the population, is expected to grow dramatically in the coming decades. This aging and also the demand for specialist services should be more evident in regions with favourable health indicators (Sathyanarayana & Shaji, 2007). Presently, limited studies have been carried out and also due to the absence of a nation wide registry of older people comprehensive community-based data on morbidity and disability is unavailable (Dhar, 2005). There is a strong need for making available information on the health needs of this rapidly greying population, especially those disabled, as this would be one of the most important challenges, which the community will face in view of the rise in life expectancy (Grover et al., 2000; Khan and Khan, 2001).

In India and Asia traditionally there are culturally imbedded norms about respect for elderly and the responsibility of the young to care for old. The NFHS surveys of 1992-93 and 1998-99 document that still traditional familial support, especially through son, is available to around 88 percent of elderly in India. However, the demographic ageing coupled with fertility reductions implies fewer children to support the aged and the social structures at large (Reddy, 1996).

Dr. Uton Muchtar Rafei, Regional Director of the WHO- SEARO office had surmised that unfortunately the contemporary milieu has witnessed the inopportune erosion and the gradual phasing of joint family system in India with around 12 per cent rural living alone and increasing. These findings suggest that further erosions in traditional family values are inevitable. In absence of well organized social networks and universal access to social security, the scenario for the aged in India, more so the abandoned, remains grim and it is likely that in the not so distant future many of the elderly would be compelled for making their own living arrangements in senior citizens homes. Such a scenario would eventually culminate into greater governmental responsibilities for the care of the aged. It is in this context that this study attempts to explore the morbidity profile of the aged and some important variables affecting the same among elderly people residing in old age homes in the city of Surat.

METHODS

This study explores the health and morbidity profile and important variables affecting the same among 68 residents, aged 60 years and above, of four old age homes run by various trusts located in the city of Surat, through the interview technique, from Oct. 2006 to Jan. 2007, spanning a period of four months after obtaining consent from the organizers and the residents of these old age homes. Out of these four homes two were paid homes, one was a free home for a select religion and the remaining was a free home open to all.

A semi-structured discussion schedule was employed containing variables on socio-economic aspects, diseases and disability profile, health care seeking behaviour, dietary patterns, physical and leisure activities, variables regarding homes for the elderly; dignity. Revisits were made in case we wanted to gather further information or for any clarification or for providing medical care to them. The information collected and other additional information that we judged as important to us was noted in individual interview forms. The collected information was entered in Microsoft EXCEL and subsequently analysed using SPSS package supplemented by manual analysis of the qualitative data.

The intention behind this project were to explore the problems faced by this highly vulnerable group which has been largely discarded by their kith and kin and left to fend for themselves at the end of their life on order to provide medical care to them in the aftermath of the devastating floods of August 2006 which inundated the entire city and decrease their unmet needs.

RESULTS AND DISCUSSION

Their general profile reveals that majority of the respondents were males (54.4%); aged 71 years and above (63.2%); had received primary education (48.5%); were employed in the past (45.6%) or were housewives (39.7%); ever married (69.1%); spouse was alive (29.8%); had children (47.1%); had been staying at the old age home for more than 3 years (58.8%).

Inability of the aged to live alone and the unwillingness of family members to take care of them emerged as the main reason behind their stay at the home. The family members had expressed this in the form of abuse, neglect and refusal to live with them and care for them. The finding of abuse is similar to that reported by other studies (Chokkanathan and Lee, 2005) using logistic regression techniques of 1993 survey data from three states of South India: Kerala, Tamil Nadu and Karnataka had reported that negative self rated health is associated with death of spouse and familial social support ties as the presence of specific kin.

The reluctance or stoppage of the inter-generational family system to take care of the elderly is a matter for serious concern as there is no doubt that if these stop caring for the aged then our infrastructure is simply not in a position to even take care of a fraction of them. This finding documents the strong need to check the erosion of the entrenched family values and ensure that our traditional age and kinship roles are preserved. Otherwise those elderly who are marginalised and economically deprived would be the first to suffer.

Table 1 : Distribution of the physical health problems of the respondents

Health problems Frequency (Percentage)

Joint pains & partial immobility 17 (25)

Diabetes 13 (19.1)

Hypertension 19 (27.9)

Total physical immobility 9 (13.2)

Varicose veins 1 (1.5)

Mouth ulcers 1 (1.5)

Asthma 2 (2.9)

Neurological disorders 1 (1.5)

Prolapsed vertebral disc 1 (1.5)

Back pain 6 (8.8)

Severe dental problems 9 (13.2)

Chronic cough 3 (4.4)

Totally blind 1 (1.5)

Partially blind 1 (1.5)

Hearing loss 6 (8.8)

Total 90 (Multiple response)

The diagnosed physical morbidity of the elderly is as shown in Table 1. What is particularly worrisome is the observation that 80.9 percent are suffering from a diagnosed health problem and the average prevalence per aged person is 1.3. Such a prevalence of diagnosed health disorders is indeed high. It can be seen that the majority were suffering from chronic and degenerative diseases and non-communicable diseases. This pattern is similar to that reported by Reddy based on the 42nd Round of the National Sample Survey, though our prevalence is double that reported by the NSS, as the letter had collected information on seven chronic diseases selective (Reddy, 1996). The pattern of our disease profile reflects the common diseases affecting the elderly as reported by Dhar (2002).

Limited in house health care facilities were available in three of these homes in the form of daily free OPD services by a non-resident MBBS doctor; panel of doctors which can be consulted for routine free treatment and on call for serious patients; hospital of same community located adjacently. However, these three homes did not have any arrangements for free or subsidized referral and treatment of patients requiring specialised medical care, from any external facility. Whereas a well developed hospital was located in the premises of the fourth home. The elderly did not report of having any major problems with their in-house health care facilities. The elderly residing in the paid homes had reported of better quality and user friendliness of the in-house health care facilities as compared to the free homes.

The majority of these elderly frequented the public sector or the government health care facilities for seeking of medical care. They were excluded from the ambit of private providers due to high usage costs. The problems of this category of residents were predominantly related with difficulty to reach these centres and with the out of pocket expenses that had to be borne by them while seeking of care.

Our findings are in line with other Indian studies that have identified distant government health facilities, lack of economic independence and lack of awareness and utilization of geriatric welfare services as among the major needs of the elderly (Goel et al., 2003). Our finding also point to the need for investing in the quality of public services as argued by others (Levesque et al., 2007; Medhi, 2006). Rectification of poor health status through affordable health services and better management of illness and certain low cost interventions (Medhi et al., 2006) are essential to ensure that the elderly, who are often a marginalised lot, can receive a semblance of some equity in access, if not the ideals of essential health care as envisaged in the Alma Ata declaration.

The elderly had also reported on the absence of any routine screening for diseases. They were examined whenever they reported of any complaints. Screening for diseases and subsequent treatment has been identified as an important tool for improving health status (Medhi et al., 2006; Mohan et al., 2007).

Another important factor that merits attention is the reporting by these elderly of levying of user charges with significant out of pocket expenditures by the public and the government health care facilities. They had also reported that in addition to these user charges, the hospitals hardly dispense medicines etc. and prescribe these from outside, which they cannot afford. The levying of user charges and the unavailability of medicines in government and public hospitals is a very significant factor limiting seeking of health care, as many of these elderly, especially those residing among the free homes, had reported of facing severe budgetary constraints and with their priorities on spending. Therefore this tragically culminated into their forgoing of some treatments, which they perceived as too costly, thereby increasing their unmet needs.

This finding is in line with the conclusion of Gupta et al. (2001) who had used the Human Development Indicator Survey of 1994-95 to analyze the health-seeking behaviour of the elderly and had concluded that income was among the two key determinants in deciding who could seek care. Similarly studies from India have reported that, both, urban and rural, diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families is rising and the total direct cost has doubled from 1998 to 2005 (Ramachandran et al., 2007). Another important problems associated with management of diabetes is the wide gap between practice recommendations and actual delivery of diabetes care in India (Nagpal and Bhartia, 2007). Similar is the case with hypertension, wherein the majority of hypertensives remain undetected. Among those detected, for the majority, the control of hypertension is inadequate or left untreated (Mohan et al., 2007). Palatty et al. (2003) while studying the drug utilisation patterns in geriatric patients with diabetes and hypertension, attending a tertiary care centre, had reported that the drugs used currently in elderly precludes drug safety, compromises quality of life and increased healthcare costs unnecessarily.

The elderly had reported about the conspicuous absence of any charitable trusts, financially or otherwise, to assist them with seeking of external care. Often these residents had to forgo expensive treatments and face an irregular supply of medications for chronic diseases as diabetes.

The experences of the miniscule (16%) who could afford care from private provides were good, however such services were being utilised only by those better off and these were all residing in the paid homes. These observations are in line with the reports that the private sector is indeed the predominant source of inpatient care and the public sector has an important role in providing access to care for the poor. (Levesque et al., 2007).

The issues of high prevalence of physical immobility among the elderly as observed in our study merits particular attention as these are unable to perform even their basic functions without external support and their health care seeking behaviour is also very poor. In our study such an external support was fully available to the elderly without any restriction only in the paid homes. This support was available only in context of the services available in the home and not for external services. Further even among the paid homes, the service providers were far more courteous to those elderly who tipped them. Whereas, in the free homes, the intimates themselves had to make self-help through mutual internal arrangements for any assistance with bringing meals etc. to the invalid, whether temporarily or permanently. In the free home for the select religion these services ranged between the other two categories and were variable depending upon the directives of the elected community leaders.

Audinarayana and Sheela, (2002) had also reported of physical disabilities among half of the studied elderly population. Logistic regression analysis had shown that likelihood of physical disabilities increases significantly with age and decreases in higher socioeconomic class. Thus these immobile elderly suffer from the combined disadvantages of poor health status due to their increased age, low socioeconomic class and as well as poor care seeking behaviour due to immobility.

The unmet health care needs for diagnosed ailments were higher in the free homes (47.1%) as compared to the paid homes (32.3%). On the overall, the immobile and single elderly had harboured greater wishes of an early death; lower self esteem and were angry towards their children for reneging their kinship duties at their vulnerable age. These feelings were mainly a consequence of their sense of dependency and loss of privacy.

The respondents had reported of absence of any advices given to them in the context of vitamin and mineral supplementation or dietary advices or exercises. This assumes significant importance as osteoporosis is common among the elderly due either to excessive bone resorption or diminished new bone formation or both (Arya, 2000). Also numerous studies have brought out the benefits of adoption of healthy lifestyle and regular exercises, yoga and meditation.

Table 2: Distribution of complains/ feelings relating to mental health

Complains Frequency (Percentage)

Pervasive feelings of loneliness 42 (23.2)

Feelings of failure 32 (17.6)

Feelings of betrayal 34 (18.7)

Feelings of anger 37 (20.4)

Loss of self esteem 36 (19.8)

Total 181 (Multiple Response)

Complaints relating to mental health constituted a major chunk of the problems of the elderly, averaging 2.6 complaints per individual. Our discussions with them revealed that the majority (70.6%) of these elderly were deeply affected by the rejection by their family and infrequent visits by their relatives, friends or children, which probably found expression through their feelings of loneliness, failure, betrayal and anger.

It was observed that the feelings of loneliness to be all pervasive and discussions with the subjects revealed that there was not even a single resident who had not harboured such feeling at numerous occasions. Greater satisfaction was observable among those elderly cohabiting with their spouse and those residing in paid homes alike that observed for physical complaints. This finding assumes great importance as studies have shown that mental health conditions are important causes of morbidity and premature mortality for the older people (Sathyanarayana & Shaji, 2007) and account for over one quarter of all disability-adjusted life years (DALYs) in this group. It has been stated that the current prevalence of dementia was around 60% in 2001 and could increase from 71% to 300% by 2040 in India coupled with problems as depression and other mental health problems and will emerge as a major public health problem. Goel et al. (2003) had reported that sad attitude towards life, loneliness and ignorance to their advice by family members as among the major needs of elderly.

Typically, the mental problems remain hidden and evade seeking of care due to their low perceived priority (Sathyanarayana & Shaji, 2007) and the usual primary care physicians are often not likely to be involved in such medical care provision. Similarly informal screening by community health workers is likely to result in low sensitivity and positive predictive values.

Table 3: Distribution of the wishes of the respondents

Wishes Frequency (Percentage)

Death 26 (38.2)

Good health 30 (44.1)

Relaxed life 18 (26.5)

Money 5 (7.4)

Rebirth as human being 3 (4.4)

Happiness 15 (22.1)

Total (Multiple Responses)

The wishes of the elderly, as seen in Table 3, portray their needs and mirror their physical and mental health and their desire for good health tops this list. Their desires reflect their perception to be able to lead a normal, happy and a healthy life as brought out in our discussions. In their desires they aspired for a better health as was realistic at their age and not for the idealistic norms. Their desire for death as observed among 38.2% is disturbing and reflects their mental health. The discussions with respondents revealed various reasons suggestive of this desire such as those listed earlier among mental health complaints; isolation from their family members; physical immobility and disabilities. The desire for death was strikingly absent among elderly cohabiting with their spouse.

Only 47.1% and 27.9% of these residents were supportive of the concept of regular medical assistance or with provision of free medicines through our departmental facilities as their present in-house OPD services were of a better quality as compared with our limited services. However, they were appreciative of the help that we could provide to them for meeting their specialised and referral needs and call us for advice and remedy whenever they are unable to meet some pressing health need, bringing out the vital need for free specialised care provision to elderly.

The study also brings out the need to train our primary care physicians to deliver comprehensive health services to elderly, encompassing curative interventions for physical and mental illnesses for long-term support and with chronic disease management. This would necessitate a major paradigm stemming from these evolving needs. It is practically infeasible to conjecture that elderly would actually be able to utilise services which involve long waits in crowded clinics for brief consultations with insensitive staff.

We need to ensure that advances in mental health are eventually actualised by incorporating our socio-cultural values and structures and macro-economic factors in existing health policies and programmes to culminate into user-friendly mental health services (Prince et al., 2007; Sathyanarayana & Shaji, 2007), which appears improbable in context of our prevailing health infrastructural capabilities and strengths. This would imply the need for extensive training and empowering of health care personnel and their sensitization to the needs of the elderly.

While surmising based on the present findings, this study would like to point out the fact that our health services would need major paradigm shift in our attempts to ensure that the health care needs of our aged are met and that they are able to live their remaining life with minimum disabilities and with dignity.

References

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Indian Journal of Gerontology

2008, Vol. 22, No. 1. pp 85 -106
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