Social and Health Status of Elderly Population in Far-Western Region

Abstract

Social and Health Status of Elderly Population in Far-Western Region Aging population means an increase in the share of the elderly in the total population. It is closely related with the dynamic process of demographic and socio-economic transformation. It is well known that the elderly is fragile age; they are both physically and psychologically weak, so they need proper physical as well as social care during this period. If the families are notable to provide proper care and support then they will have problems in their social relation as well as in their personal health. In Nepal elderly population has always been considered passive recipients of support. Their choices, their satisfaction and their subjective perception towards their quality of life, their psychosocial problems, etc have mostly been undermined. Ageing is considered a problem in our society. Old people are even considered as burden for family. Ageing is not a problem if the caring of old people is developed as a social tradition. Family members must take proper care of the old people. Elderly people should be encouraged to do activities like moving around house or garden that provides glee and light exercise. Old people need regular interval of rest throughout the day between varied activities, which prevents tiredness. Old people must be provided nutritious food and proper facilities for their cleanliness, similarly there should be also safe and adaptable environments for old people. The quality of life is not assessed for elderly peoples, which may be due to the negligence, lack of manpower and lack of resources. Healthy aging is not a contradiction terms, but due to the physical weakness it becomes mandatory to be very careful about their health and try to keep it in optimum condition with regular checkup, exercise, proper hygiene, prophylaxis, repairment of visual and auditory impairment, screening for chronic diseases and regular medicine on having such diseases. Similarly their social status is also deteriorating due to the isolation from their family as well as society. In Nepal, the older population is increasing both in terms of absolute numbers and as a proportion of the total population, i.e. there were 1.6 million elderly inhabitants, which constitute 7.46% of the total population in 2001, which is estimated to be double by 2017. This population is also regardedto be vulnerable as they suffer from the cumulative effects of a lifetime of deprivation, poor health and nutrition, low social status, discrimination and restriction on mobility, lack of means to fulfill their basic needs such as food, clothes, shelter, health care, love and affection. This study is designed to assess their social and health situation. This is a descriptive/cross-sectional study and includes both qualitative as well as quantitative data. Three districts of far-western development region were selected randomly having one each from terai, hilly and mountainous area. Kanchanpur was selected out of two districts of terai, Doti was selected out of four districts of hilly area and Darchula was selected out of three districts of mountainous district. From each district one VDC was randomly selected and out of the total ward of the VDC, one ward was randomly selected from where the all the population above the age of 60 years were taken for the study, if the total study subjects were not sufficient in that selected ward than again one of the adjoining ward was randomly selected to take the remaining respondents. A total 325 subjects were interviewed using this pre-tested questionnaire by the health personnel who were trained by the investigators. The interview was carried out in the local language. The respondents were explained the purpose of the study and oral informed consent was obtained. Care was also taken to ensure privacy and confidentiality of the interview as part of the study. In order to avoid the interference and influence of other family members and neighbors, each respondent was called and interviewed privately where they could feel comfortable. The collected data was tabulated and analyzed using the statistical package SPSS, Version 11.5 for Windows. Findings were described using proportions and percentage. The physiological decline in ageing refers to the physical changes due to which an individual experiences the decline in the normal functioning of the body resulting in poor mobility, vision, hearing, inability to eat and digest food properly, a decline in memory, inability to control certain physiological functions and various chronic conditions. Change in socio-economic status adversely affects the individual's way of life after retirement. The economic loss is due to a change from salary to pension or unemployment leading to economic dependency on children or relatives. A feeling of low self-worth may be felt due to the loss of earning power and social recognition. From the findings it shows that the respondents were from all groups ranging from 60 years to 80 years and above. About 77% of the study respondents were from young elderly group (i.e. 60-74 years). Similarly 51% of the respondents were female and 49% were male. According to the caste, about 79% of the study respondents were from the upper caste, similarly 99%of the respondents were Hindu. Finding on the marital status shows that about 33% of the respondents were at the state of not having any of one partner (death of their spouse).The study shows the significance association between the respondent being at the state of married and their involvement in the social organization (p=<0.05). Study shows high child bearing practice among 23% of the respondents where they had more than five children. On their living status, about 77% of them were living in a joint family. On their present staying place, it shows that about 87% were living with their own family whereas 9% of the elderly populations were found to be staying alone. It was observed that about 64% of the respondents’ homes had a risk of indoor pollution and 25% respondent’s homes had risk of dust pollution. Similarly only about 35% of the total respondents had facility of toilet at their home, remaining has to go for open field defecation. Data shows that about 63% of the respondents have facility of Safe and clean drinking water at their home. Similarly about 57% of the respondents didn’t have separate room at their home, so they have to share their room with some other family members. Finding also shows that only 45% of the respondents were satisfied with the status of their living home. Agriculture was the main sources of family income for 67% of the respondents, similarly about 41% of the respondent’s personal income was also dependent on the agriculture but 44% of the respondents told that they don’t had any sources of income. For about 66% of the respondents, their personal expenses is supported by their family, where as 27% of them were self capable to manage their financial sources for their personal expenses. Majority of the elderly peoples above 70 years told that they get the elderly allowance that is being provided by the government, but they are not getting it regularly. On their personal relation with their family members, it shows that only about 63% of the respondents were satisfied with their relation. Similarly it was found that only 18% of the respondents were involved in some organization or social groups. Results shows that 56% of the respondents had the habit of addiction, regarding their major addictive substance that they use, about 62% of the respondents have addiction of cigarette, about 21% told of having addiction of chewing tobacco, about 15% told on having addiction of alcohol and about 2% had addiction of taking “guttkha/pan”. According to the response, only about 65%of the respondent’s told that they regularly do exercise. On the eating frequency majority i.e. 57% of the study respondents told that they take their food just twice a day, but still about 12% of the respondents told that take their food just once in a day. It shows that only about 48% of the respondents were found to be satisfied with the daily food that they take. Regarding the place they visit for taking health services, it shows that about 68% of the respondents visit the health facility, similarly 15% visit the traditional healers and about 11% told that they don’t go anywhere for taking the service. Similarly the study shows that about 67% of the respondents’ daily activities had been affected by their health status. On the major health problems of the respondents that were identified among the respondents were eye problem (among 93%), dental problems (among 80%), digestive problem (54%), respiratory problems (among 45%), skeletal and muscular problems (among 46%), urinary problems (among 28%) and cardiovascular problem (among 19%). Although the existence of the problem was found to be at higher rate but it was found that only about 17% of respondents were having regular health checkup, which is considerably low, it may due to dependency of the respondents on their family members for managing the cost of the health expenses that they need for regular medical checkup. Dental and Eye problems also develops with the process of normal aging, study shows that about 80% of the respondents have incomplete dentition. Similarly about 92% of the respondents have some sort of ocular problem, out of those about 36% of them had multiple problems in eye. Taking the reference of WHO classification, 26% eyes were found to have visual impairment (i.e. less than 6/18-6/60) in the presenting visual acuity, where as no severe visual impairment (having vision <6/60-3/60) and blind (having vision <3/60) were found. Their quality of life was assessed by taking the indicators with reference to EQ-5D. Mainly their movement, self care taking state, doing daily activities, pain and discomfort, having anxiety and tension and their present day health status was rated as compared to the past 12 months. Study finding shows that 11% of the respondents were just confined to the bed due to the severity of problem. About 9% of them expressed that they were unable for washing, bathing and changing their cloths. Similarly 19% of the respondents expressed that they are unable to perform their usual activities and about 18% of the respondents expressed that they have extreme pain and discomfort. Anxiety and depression are commonly seen among the elderly peoples as they are more susceptible due to the physical and hormonal changes and also due to their social and family relations. Study results shows that about 31% of the respondents were extremely anxious and depressed. There are many concerns and problems of elderly population. They are concerned for their health, diminished social status and insecurities about their importance among other people, difficulty in adjusting to their change of daily routine. Insecurity brought about by feelings of inadequacy in meeting daily life situations, loss of ability to socialize. Due to these problems, it is important to improve their living stander. Above findings shows that elderly peoples have considerable health and social problems. Since majority of them have to depend on their families for their personal expenses, so their accessibility toward the source and service is always limited, which ultimately result in low health and social status. In developing county like Nepal, it is necessary to develop senior citizen welfare program in such a way so that they can maintain their social and health status and develop the feeling of “senior” not “old and absolute”.