Assistant Professor, Dept. of Community Medicine, Christian Medical College, Ludhiana, Punjab, INDIA.

Email: deepshikhakamra@gmail.com

Research Article

 

       Table 1: Distribution according to Socio-Demographic Profile of Participants

 

The table no.1 describe, out of total 220 subjects, maximum were in the age group of 60-69 years (Males=53.6% & Females = 46.4%) respectively. Regarding marital status, majority of the subjects were currently married (60%). In regards to educational status 64% were illiterates (Females=61% & Males=39%) and only 4 (1.8%) of subjects were graduate or had high school education. As far as occupation was concerned, majority (71.3%) of the subjects were engaged in household activities whereas 18.2% were sitting idle. Table further illustrates that 61.8% were supported by family and 32.3% subjects had their own income as far as source of livelihood was concerned.

 

Table 2: Distribution of Subjects according to Main Source of Health Care Facility Availed

Majority of the subjects (92.7%) were utilizing non-government health care facility as main source of health care.

 

Table 3: Distribution of Subjects according to Non-Governmental Health Care Facility Availed

^*Rural Health and Training Center of Dayanand Medical College and Hospital, Ludhiana

 

Out of the total using non government health care facility 52.9% were going to unqualified doctors, 28.9% going to private hospitals for health care.

 

Table 4: Distribution of Subjects according to Main Reason for not Utilizing Government Health Care Facility

The table no 4 depicts that most common reason for not utilizing government health care facility was long distance from house (33.3%).20.6% said lack of medicine, 17.6% said staff not cooperative, 10.8% said lack of doctors, 10.8% said it takes more time and 4.4% said they were not aware.

 

Table 5: Distribution of Subjects according to Source of Medical Expense

 

Table 5 shows that in majority (70.8%) of subjects family was source of medical expense. In 93.4% of female subjects, family provided medical expense. In 28.2% of subjects source of medical expense was own income. Only one male subject was having health insurance.

 

Table 6: Distribution of Subjects according to System of Medicine Preferred

 

Table 6 depicts that majority (93.6%) of subject’s preferred modern medicine as system of medicine while only 4.1% preferred Ayurvedic medicine.

 

Table 7: Distribution of Subjects according to reason for Medicinal non Adherence

According to table no.7 ignorance and being dependant on others to bring medicines accounted for more than 65% of non-adherence to medicines. The cost of medicines leads to 27.1%non-adherencein the study subjects.

 

 

DISCUSSION

The present study was a community based cross sectional study carried out over a period of one year i.e. from 1^st March, 2007 to 29^th February, 2008 conducted in rural field practice areas of the Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana. The total sample consisted of 220 subjects, 50.9% being male and 41.9% being female. The age wise distribution is in consonance with findings of Goel PK et al who reported a similar age distribution in their study on the elderly in rural population of Merrut.⁴ The present study reveals that 60% of the subjects were currently married and 35% of subjects were widow/widowers. The marital status seen in present study is similar to the figures reported in the 2001 Census⁵ In the present study nearly two third of the subjects were illiterate with women (61.0%) far out numbering men (39.0%). This is expected because of very low school enrolment rates that must have existed in rural areas in the pre independence era. The present study shows that more than half of subjects were involved in household work with females (64.2%) outnumbering men (35.8%).72.7% of subjects were living in joint families. This is expected in a rural setting, where the traditional system is still continuing and may be an important buffer to combat loneliness and promote social support. The present study shows that majority (61.8%) of the subjects were supported by family as far as their source of livelihood was concerned. This is in tune with the findings that 72.7% of the subjects (vide supra) were living in the joint family.

 

HEALTH CARE SEEKING BEHAVIOUR

In our study it was observed that majority (92.7%) of subjects do not generally seek healthcare from government source and the most common reason for not utilizing government facility was long distance (38%). NFHS-3 data⁶ also showed that 72% of household generally do not seek health care from government facility. Among households that do not use government health facilities, the main reasons given for not doing so are poor quality of care (55%), lack of nearby facility (42%), and long waiting times (25%). Similar results were found in a study conducted in Bangladesh⁷ who revealed that more than half the respondents did not avail government facilities because of a lack of proper and /or sympathetic care from the doctors. About one-sixth of the respondents mentioned the distance to be travelled or the long waiting time as deterrents to the use of Government Hospitals. Goel PK et al⁸ in their study also found that in59.2% of cases the distance of government health facilities was more than 3 kms. As far as system of medicine was concerned 93.6% preferred modern medicine as system of choice in our study. Similar findings were observed by Joshi K in his study in urban and rural area of Chandigarh⁹, WHO reported that most preferred system of medicine was allopathic system in 92.2% of elderly and the rest 7.7% relied on either ayurvedic or homeopathic system of medicine. The major source of medical expenses in our study was from the family as most elderly in our country are dependent on their families. The most common reason given for medicinal non adherence was dependent on others and ignorance.

 

CONCLUSION

The study among the elderly in the rural area of Punjab has highlighted a rapid expansion in the elderly population of the country. There is an urgent need to develop various schemes and enhance the existing policies for better utilization of services of health care among elderly population all over the country.

 

RECOMMENDATIONS

• To motivate aged people to utilize government health services.
• Evaluate reasons for failure of government institutions to attract large number of elderly population.
• In order to nullify the effect of inflation on elderly, pension and old age pension needs to be enhanced.

 

LIMITATIONS OF THE STUDY

Due to lack of time and resources we could not follow up the study. Misreporting and underreporting might increase with age and varies greatly with the disease considered. There are increased chances of recall bias in the study as it deals with elderly population. One possible source of biased reporting of medical conditions may arise from differential access and utilization of health care services by different segments of the population.

 

REFERENCES

1. Health Seeking Behaviour of Aged Population of a Rural Block in West Bengal May 2005 [Online]. Available from: URLwww.sctimst.ac.in/amchss/ publications/ wp/wp_8.pdf.
2. Guralnik JM, Fried LP, Salive ME. Disability as a Public Health Outcome in Ageing Population. Annu Rev Public Health; 1996. 17: 25-46.
3. Santos EB. Evolution of the needs of older persons. Ageing Clin Exp Res. 2002; 14(4): 287-92.
4. Goel PK , Garg SK, Bhatnagar M, Chopra H, Bajpai SK. Unmet needs of the elderly in a rural population of Merrut. Indian J Comm Med 2003;38:165-7.
5. Registrar General of India, Indian Census. Population of elderly, 2001.
6. International institute for population sciences(IIPS) and macro international.2007. National family health survey (NFHS-3), 2005-06: India: Volume 1. Mumbai : IIPS
7. Gupta I, Dasgupta P, Sawhney M. Health of the Elderly in India - some aspects of vulnerability. India: Inst of economic Growth, University Enclave Delhi; 2000. pp. 4–28.
8. Goel PK, Garg SK, Singh JV, Bhatnagar M, Chopra H, Bajpai SK. Unmet needs of elderly in rural population of Meerut. Indian J Community Med.2003;28:165-6.
9. Joshi K. Assessment of health related quality of life(HRQOL) among elderly more than 60 years of age.[Dissertation]. Chandigarh: Baba Farid University of Health Sciences, Faridkot; 2000.

Source of Support: None Declared Conflict of Interest: None Declared