Geriatric Morbidity Pattern in field study area of Islampur in Guwahati

Geriatric
Morbidity
Pattern
A study of the morbidity
pattern in the geriatric age
group dwelling in the slums of
Guwahati
Abhineet Dey, Daniel Nowaz Mazumder, Navil
Farzad Islam, Rikita Agarwal, Bibhuti Handique,
Sabir Islam, Debarati Das, Yograj Sharma,
Ubaidullah Barbhuiya, Minakshi Doloi, Abhirun
Das, Sardar Hironjyoti Besera & Kaushik
Goswami

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Certificate
This is to certify that the following 7th
Semester students have submitted their project on the
study of the Morbidity pattern in the geriatric age group dwelling in the slums of Guwahati
under the guidance of Dr. Shashanka Shekhar Chakraborty, Dept. of Community Medicine,
Gauhati Medical College & Hospital.
Roll No. Name of Student
7 Bibhuti Handique
18 Daniel Nowaz Mazumder
29 Abhineet Dey
40 Navil Farzad Islam
51 Sabir Islam
62 Abhirun Das
73 Yograj Sarma
95 Kaushik Goswami
106 Ubaidullah Barbhuiya
117 Rikita Agarwal
128 Debarati Das
139 Minakshi Doloi
150 Sardar Hironjyoti Besera

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Acknowledgement
At the very outset, we would like to extend our sincere gratitude to the department of community
medicine, Gauhati Medical College and Hospital, Guwahati for giving us the opportunity of doing a
project on an important and relevant subject and to learn and understand the process of data
collection and to value its role and significance in the study of Medicine and to get an insight into the
basics of how surveillance is done.
We express our heartfelt thanks and gratitude to Dr Jutika Ojha, Professor and HOD of department
of Community Medicine, Guwahati medical College, for her kind support, valuable time and
guidance throughout the project.
We also express our utmost gratitude to our respected teacher and guide, Dr Shashanka Shekhar
Chakraborty, Assistant professor, Department of Community Medicine for his constant support and
his inspiring guidance which made it worthwhile for us to conduct our project. Without his support
this project would not have been possible.
Lastly, it is also for the kind response and cooperation of the people in the target slums that made
our project work come into reality. We, as a group shall feel rewarded if the recommendations made
in the report would help in decreasing morbidity in the geriatric population and creating awareness
in the society.
Guwahati Members of the project group
Date: 7th
semester MBBS students (Batch 2016)

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Contents
Geriatric Morbidity Pattern ....................................................................................................................4
Background .........................................................................................................................................4
Objectives ...........................................................................................................................................6
Special Objectives: ..........................................................................................................................6
Materials and method ........................................................................................................................7
Review Literature................................................................................................................................8
Results & Observations.....................................................................................................................11
Discussion..........................................................................................................................................31
Summary...........................................................................................................................................33
Conclusion.........................................................................................................................................34
Bibliography ......................................................................................................................................35

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Geriatric Morbidity Pattern
Background
There have been significant advancements in health care in the last century or so. After many years,
India’s overall health status has drastically improved from the pre independence era when epidemic
of leprosy, cholera and malaria were the order of the day1
, to the present day levels which are quite
at par with worldwide trends. India has been quick to adapt and learn about every new challenge in
addition to our own unique endemic conditions. However, these new developments come with their
own new set of challenges. One of the most important challenges is the growing geriatric population
worldwide, with a total population of 901 million in 2015 as compared to 607 million at the start of
the millennium, an increase of 48 percent2
.
With the advent of modern medical technology and a higher life expectancy, climbing from 32 years
at the time of independence to about 65 years in 20123
, we now have a large number of people
belonging to the geriatric age group in our country that need special care and an innovative
approach towards healthcare in general.
A study of the Census of Indiashows that while most age groups have remained relatively stable,
people aged beyond 60 years have almost tripled in our country since independence4
. This brings to
light the growing importance of this age group and the branch of medicine that deals with this
particular group.
Another comparative study shows a near identical pattern among developing countries with two
thirds of the world’s geriatric population living in the developing countries and the increase in the
geriatric population occurring at a much faster rate compared to the developed ones.5
Geriatric Medicine has its own set of challenges when it comes to treating the patient. From
diagnosis to treatment, different strategies have to be adopted. One of the main reasons is the
prevalence of co-morbidity 6
among individuals in this group. All this necessitates thorough history
taking and clinical examinations in addition to extensive lab tests. For example, a comorbid case of
iron deficiency anaemia and folic acid deficiency could lead to a hypochromic, normoblastic anaemia
in the elderly leading to complications in the management and prognosis of such patients7
.
Another obstacle lies in the majority of these morbidities being of a chronic nature and hence
multifactorial in origin, making the diagnosis and history of these diseases often difficult and their
management a long drawn out and expensive process8
. Consider for example, patients in this age
group with physical infirmities, who require special care nurses well equipped in courses for
management of such disorders as well as often special care physiotherapists in addition to the
doctor under whom the patient was diagnosed in the first place. These factors tend to complicate
matters in regards to geriatric healthcare worldwide necessitating the need for studies worldwide.
Hence, factors like co-morbidity, chronicity of illnesses, multiple care providers, etc. add to the cost
of treatment. This age groups bears the highest per-capita medical expenses by a huge margin, with
an increase of 100 billion dollars since the millennium just in the country of the USA9
.
Also complex drug regimens aided with regular clinical examinations are imperative to the
management of cases of this age group adding to the already high expenses. Proper allocation of
resources is hence10
, essential in this regard as rare cases will have fewer resources in general. The
authors of this study hope to add to the growing pool of information on morbidity patterns across
India to aid in such allocation of resources.

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Modern advancements have led to specialization of the subject in general. In this regard, treatments
and management of cases have also become more specific11
. Consider for example, the
management of heart failure in the elderly which also requires concomitant care for managing co
morbidities at the same time. All this implies more importance on proper assessment and planning
for the community in general for it requires an optimal allocation of resources and skill.
A comprehensive collection of data on the morbidity pattern in this age group in particular would go
a long way in targeted healthcare to the population. Resources could be better managed and there
would be more concrete data on the health status of the entire populace even if this particular study
pertains to a certain geographical area of the city of Guwahati, Assam, India.

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Objectives
General objectives:
 To study the morbidity pattern in the geriatric age group dwelling in the slums of Guwahati
Special Objectives:
 To determine the prevalence rates of various common diseases in the geriatric age group in
the slums of Guwahati.
 To identify factors associated with various morbidities in the geriatric age group.
 To identify the relation of socio-economic status with morbidity in the geriatric age group.
 To give recommendations based on the study for proper allocation of future resources
towards alleviation of the geriatric age group.

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Materials and method
1. Study design- Community based Cross sectional study
2. Study area- Islampur, Solapara Road, Punjabi colony, Bamunimaidam railway colony, ;
Guwahati; Kamrup(Assam)
3. Study period- 6 months; April,2016-September, 2016
4. Sample Size- The sample size was calculated to be 186; with a value of 93 obtained from the
standard formula Z2
p(1-p)/l2
with Z=1.96, p= 36.8 for a general morbidity rate of 36.8 %
(from NSSO report 2016 for urban morbidity in the geriatric age group) and l is the absolute
error taken as 10%, which on multiplying with 2 as a design effect, we get the value of 186.
5. Sampling technique- A total of 11 slums under the Ulubari Urban Health Center, under the
Kamrup (metro) district were selected and persons were selected at random at slum after
performing random door to door visits. In this way, a total of 187 people were selected and
their data was collected. Houses where members did not meet inclusion criteria were
rejected while houses where more than one member met the inclusion criteria, all the
members were selected. In this way, 19 people from each slum were selected by door-to-
door visits till the required number was met. Over and above, 4 more people were selected
at random.
6. Inclusion criteria-
 Persons belonging to Geriatric age group (aged 60 and above) who have been
permanent residents of their respective slums for at least 6 months
 Persons willing to participate in the study
7. Exclusion criteria- Seriously ill people who are not able to respond
8. Data collection tool- A pre-designed and pre tested pro forma along with anthropometric
measurements, Mercury thermometer temperature testing, stethoscope, Weighing
machine, Sphygmomanometer, Modified Kuppuswamy Socioeconomic Scale for
determination of socio economic status, Mini Nutritional Assessment for assessment of
nutritional status, Geriatric Depression Scale for assessment of depression, ADL scale and
IADL scale for assessment of mobility and locomotor status.
9. Data collection technique- House to house visit by interview method; extensive history
taking with clinical examination of the study population. Consent was taken before
beginning examination after clearly explaining the procedure. Patients were assured that
their medical data would be kept confidential and be used for academic purposes only.
10. Statistical analysis- Data collected was entered using Microsoft excel 2007 and analyzed
using the same. Prevalence rates and proportions were calculated for various variables and -
Chi-square test was used for analysis of categorical variables.

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Literature Review
In general, Cataract, Hypertension, Musculoskeletal morbidities, and some other diseases and
ailments occur most frequently within the geriatric age group. A study of the Morbidity Pattern
Among the Elderly Population in a block of Dibrugarh district of Assam by Ram Kumar Dutta and
Prof Alak Barua 12
found the prevalence of cataract was found to be 37.2% in one or both eyes. The
prevalence of hypertension in the entire population was 36.2%. The total prevalence of respiratory
disease was 43.2%. There was a high prevalence of COPD and bronchial asthma, which was found to
be 33.3% in male and 33.6% in females. While 43.7% of the elderly had musculoskeletal problems. 13
Most of the elderly (55.4%) were ‘young old’ (60-69 years); 42.7% of the elderly were ‘old old’ (70-79
years) while a very small proportion (1.9%) of the study population belonged to the category of
‘oldest old’ (>80 years).14
This pattern of morbidities is similar among the geriatric age groups located in other places as well
like another study in Aurangabad, Bihar had shown. In the study of morbidity profile of geriatric
population in the field practice area of rural health training centre, Paithan Govt. Medical College,
by Jadhav V.S et al 15
it has been seen that 41.75% males and 38.71% females had Cataract in single
or both eyes. Presbyopic morbidity was present in 8.75% males and 12.80% females. 3.36% males
and 0.91% females had active conjunctivitis. While 2.35% males and 1.82% females had pterygium.
13.13% males and 16.46% females had backache. 1.68% males and 0.91% females had complaints of
spondylitis. 12.79% males and 14.02% females had complaints of arthritis.16
13.80% males and 8.23% females were having senescent forgetfulness. While 8.41% males and
12.80% had history and symptoms of depression. 6.06% males and 3.35% females suffered from
Hemiplegia. 0.91% females were having various deformities of Leprosy. 17
6.73% males and 8.53% females had acid peptic disease, 11.11% males and 6.40% females had
complaints of haemorrhoids. While 9.42% males and 4.62% females had the problem of
constipation. 18
7.40% males had complaint and symptoms of benign enlargement of prostate. 4.57% females were
suffering from urinary tract infection. 1.01% males and 0.60% females had faecal incontinence while
4.04% males and 2.43% females had urinary incontinence. The incidence rates of urge incontinence
and stress incontinence were 19.8% (with 3.1% often) and 14.5% with 1.9%, respectively. 19
10.43% males and 17.07% females were having the complaints of Diabetes mellitus and 14.47%
males and 28.04% females of hypertension. 8.53% females were having anaemia. 1.32% males and
3.04% females were taking treatment for cancer. 5.38% males and 1.82% females presented with
various skin disorders. While 21.21% males and 28.04% females had various degree of hearing
impairment.20
Out of total 625 elderly studied, 328 (52.48 %) were females and 297 (47.52 %) were elderly males.21
In another study of Morbidity pattern and treatment seeking behaviour of geriatric population in
Jamnagar city by Mahesh Choudhary et al22
, major geriatric problems reported were visual
problems (65%), hypertension (40%), dental problems (34%), diabetes (26%), joint complain (26%)
and hearing problems (22%)23
. High prevalence of eye disorders was also reported by Goswami et al
[11] and Ajay K. et al [12]. In a study by Hanger et al [13] and Rahul Prakash et al [14] reported 43.6%
and 48 % elderly were hypertensive respectively.

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Majority of the elderly were in the age group of 71-75 years of age (28%) followed by 60-65 years of
age (21%) and only 11 per cent of respondents were in the age group of >80 years of age. Males
constituted 57 percent and females 43 percent of the respondents. Majority of the respondents
belonged to three generation family (62%) while others belonged to joint family (23%) and nuclear
family (15%). 34 percent of respondents were illiterate while 66 percent were literate, out of which
21 percent were educated up to primary level, 25 percent up to secondary level and 20 percent are
up to higher secondary level. Majority of respondents were not working (78%) and had lost their life
partner (79%), also 69% were having some kind of addiction.24
However, in some, musculoskeletal problems were found to have higher prevalence than the most
common geriatric morbidity, that is visual problems. In a study of Morbidity Status and Its Social
Determinants among Elderly Population of Lucknow District, India by Mrinal Ranjan Srivastava et
al25
. it was found that, 76.4% of males and 78.4% of females in rural areas had musculoskeletal
problems and 58.1% of males and 71.1% of females of urban areas had musculoskeletal problems. In
all 65.7% of males and 75.4% of females had musculoskeletal problems. 26
More than half of the males (68.5%) and 73% of females in rural area had symptoms of eye problem.
However, 51.6% males and 67.1% females in urban area had problems of eye. Overall 58.7% of
males and 70.6% of females had eye problems. 47.2% of males and 26.1% of females in rural areas
and 28.2% of males and 21.1% of females in urban areas had problems of respiratory systems.
Overall 36.2% of males and 24.1% of females had respiratory problems. 41.6% of males and 36% of
females in rural areas and 31.5% of males and 38.2% of females of urban areas had problems of
gastrointestinal tract. Overall 35.7% of males and 36.9% of females had gastrointestinal problems.27
More than one third (38.2%) of the males and 15.3% of females in rural area were in the age group
of 60-64 years, in urban areas 28.2 % of males and 15.8% of females belonged to 60-64 yrs. age
groups. 29.2% of males and 48.6% of females in rural areas belonged to age group 65-69 years, in
urban areas 31.5% of males and 40.8% of females were of the age group of 65-69 yrs. 28
About one fifth (20.2%) of the males and 31.5% of females of rural areas were in the age group of
70-74 years, in urban areas 25.0% of males and 38.2% of females were in the age group 70-74 yrs. 29
Only 12.4% of the male and 4.5% of females in rural areas were ≥75 years, in urban areas 15.3% of
males and 5.3% of females were ≥75 yrs. In total, 32.4% of the males and 15.5% of females were in
the age group of 60-64 years. However, 30.5% of the males and 45.5% of females belonged to 65-69
years. About one fifth (23%) of the males and 34.2% of females were in the age group of 70-74
years. Only 14.1% of males and 4.8% of females were ≥75 years.30
In another study of Morbidity Pattern Among the Elderly Population in the Rural Area of Tamil
Nadu, India by Anil Jacob et al31
. at the time of survey, 72.4% of the study population was suffering
from at least one ailment while 48.1%, 24.1% of the population were suffering from two and three
or more ailments respectively. As the table shows, complaints of joint pains/joint stiffness 43.4% was
the most common, followed by dental and chewing problems 45.3%. Visual problems due to
cataract and refractive errors were seen in 68%. Hypertension was found in 25.9% and diabetes in
8.3%. Gastrointestinal complaints/diarrhoea in 12%, dermatological in 9.4%, heart illnesses in 9%
and respiratory in 7.3% were less common.32
The largest age group was 60-64 (41.8%) and 10.3% were above 80 years old. The majority 98.7%
were Hindus and 57.3% belonged to a scheduled caste group. Most individuals were illiterates 78.7%
and the very poor numbered 62.8%. The predominant occupation was agricultural labour 64.7% and
28.3% were fully 46 Morbidity Pattern Among the Elderly Population in the Rural Area of Tamil

P a g e 10 | 37
Nadu, India dependent. 67.5% were living with their spouses and 32.3% were widowed. Regarding
personal habits, 61% of the elderly group chewed tobacco, 33.3% of males were smokers and 28.7%
regularly consumed alcohol. General health awareness regarding common causes of prevalent illness
and their prevention (respiratory infections, diarrhoea) was found only among 20.3%.
33

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Results & Observations
Table 1: Distribution of age in the population under study
Age Male Female Total
60-64 33 (28.7) 24 (24.5) 57 (26.8)
65-69 45 (40.7) 35 (35.7) 80 (37.5)
70-74 14 (12.1) 12 (12.2) 26 (12.2)
75-79 16 (12.9) 16 (16.3) 32 (15.0)
80-84 5 (4.0) 8 (8.2) 13 (6.0)
85-89 1 (.8) 2 (2.1) 3 (1.4)
90-94 1 (.8) 1 (1.0) 2 (0.9)
Total 115 (100) 98 (100) 213
*figures in parentheses () indicate percentages that add up column-wise at the bottom and row-wise
at the right-most column
Fig 1
Comment: A Majority of males (40.7 %) in the geriatric age group in slums belonged to the 65-69-
year-old category and a majority of females (35.7 %) belonged to the same category.
60-64 65-69 70-74 75-79 80-84 85-89 90-94
Female 24 35 12 16 8 2 1
Male 33 45 14 16 5 1 1
0
10
20
30
40
50
60
70
80
90
Axis
Title
Age distribution

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Table 2: Distribution of religion in the population under study
Religion Hinduism Islam Christianity Sikhism Total
Number 85 (40) 114 (53.5) 2 (0.9) 12 (5.6) 213 (100)
*figures in parentheses () indicate percentages that add up column-wise
Fig 2
Comment: A Majority of members of the study population (53.5 %) adhered to Islam followed by
Hinduism (40 %)
42%
56%
1% 1%
Distribution of religion
Hinduism
Islam
Christianity
Sikhism

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Table 3: Distribution of Marital status among the population under study
Marital
status
Married Unmarried Widow/Widower Divorcee Total
Number 168 (78.9) 3 (1.4) 40 (18.8) 2 (0.9) 213 (100)
*figures in parentheses () indicate percentages that add up row-wise
Fig 3
Comment: A majority of the participants in the study (78.9 %) were of a Married marital status
followed by the Widow/Widower group (18.8 %)
79%
1%
19%
1%
Distribution of Marital status
Married
Unmarried
Widow/Widower
Divorcee

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Table 4: Distribution of educational status in the population under study
Educational
Status
Illiterate Primary
school
level
Middle
school
level
High
School
level
Secondary
school
level
Graduate Total
Number 36 (17) 68 (32) 41 (19) 32 (15) 24 (11.3) 12 (5.7) 213 (100)
Fig 4
Comment: A Majority of the participants in the study (32 %) had studied up to the primary school
level. The next largest group (19 %) was of those who had studied till Middle School followed by that
of illiterate participants (17 %).
36
68
41
32
24
12
Illiterate Primary School
Level
Middle School
Level
High School Level Secondary School
Level
Graduate
Distribution of Educational Status
Series 1

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Table 5: Distribution of nutritional status using Mini Nutritional Assessment in the population under
study
Nutritional
Status
Malnourished At risk of
malnourishment
Normal Total
Number 35 (16.4) 108 (50.7) 70 (32.9) 213 (100)
Fig 5
Comment: A Majority of the participants in the study (50.7 %) were at risk of malnutrition followed
by the normal nutritional status group (32.9 %) and the group of malnourished participants (16.4 %).
16%
51%
33%
Distribution of nutritional status using Mini Nutritional
Asssesment
Malnourished
At risk of Malnutrition
Normal

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Table 6: Distribution of Activities of Daily Living(ADL) scale status in the population under study
Status of ADL Functionally
independent
Dependent Total
Number 166 (78) 47 (22) 213 (100)
Fig 6
Comment: A Majority of the participants in the study (78 %) were functionally independent on the
ADL scale while a minority (22 %) was dependent according to the same scale.
78%
22%
Distribution of Activities of daily living(ADL) scale status
Functionally independent
Dependant

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Table 7: Distribution of state of mental depression according to the Geriatric Depression Scale in the
population under study
State of Depression Depressed Not depressed Total
Number 53 (24.9) 160 (75.1) 213 (100)
*figures given in parentheses () indicate percentages that add up row-wise
Fig 7
Comment: A Majority of the participants in the study (75.1 %) were found to be not depressed while
a minority (24.9 %) were found to be depressed according to the Geriatric Depression Scale.
25%
75%
Distribution of state of mental depression according to the
Geriatric Depression Scale
Depressed
Not Depressed

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Table 8: Distribution of exercising habits in the population under study:
Exercising habit Nil Mild (at least 45
mins 2-3 days
each week)
Moderate (at
least 45 mins
every day each
week)
Total
Number 203 (95.3) 9 (4.2) 1 (0.5) 213 (100)
*figures given in parentheses () indicate percentages that add up row-wise
Fig 8
Comment: A majority of participants under study (95.3 %) have no exercising habits while a smaller
group (4.2 %) has mild exercising habits and an even smaller group (0.5 %) has moderate exercising
habits.
95%
4%
1%
Distribution of exercising habits
Nil
Mild
Moderate

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Table 9: Distribution of history of past surgery in the population under study
Type of surgery Male Female Total
Appendectomy 28 (24.3) 17 (17.3) 45 (21.1)
Cholecystectomy 9 (7.8) 4 (4.1) 13 (6.1)
Fracture repair 29 (25.2) 10 (10.2) 39 (18.3)
No past surgery 49 (42.6) 67 (68.3) 116 (54.4)
Fig 9
Comment: The largest group of participants with history of past surgery among males (25.2 %)
reported surgery for fracture repair followed by appendectomy (24.3 %). The largest group among
females was that of those who had undergone surgery for appendectomy (17.3 %) followed by
fracture repair (10.2 %).
0
5
10
15
20
25
30
35
40
45
50
Appendectomy Cholecystectomy Fracture Repair
Distribution of history of past surgery
Male Female

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Table 10: Distribution of type of family structure in the population under study
Type of family Nuclear Joint Total
Number 142 (66.7) 71 (33.3) 213 (100)
Fig 10
Comment: A majority of the participants in the study (66.7 %) had a nuclear family structure while a
minority had a joint family structure (33.3 %).
67%
33%
Distribution of type of family structure
Nuclear
Joint

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Table 11: Distribution of type of housing in the population under study
Type of house Kutcha Pukka Total
Number 52 (24.4) 161 (75.6) 213 (100)
Fig 11
Comment: A majority of participants under study (75.6 %) had pukka houses while a minority had
kutcha houses (24.4 %).
Distribution of type of housing
Kutcha Pukka

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Table 12: Distribution of nature of diet in the population under study
Nature of diet Vegetarian Non-vegetarian Total
Number 18 (8.4) 195 (91.6) 213 (100)
Fig 12
Comment: A majority of participants under study (91.6 %) were non vegetarian while a minority
were vegetarian (8.4 %).
85%
15%
Distribution of nature of diet
Vegetarian
Non-vegetarian

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Table 13: Distribution of socio-economic status using Modified Kuppuswamy’s Socioeconomic Scale in
the population under study:
Socioeconomic
status
Upper Middle Lower Middle Upper lower Lower Total
Number 46 (21.6) 92 (43.2) 74 (34.7) 1 (.5) 213 (100)
Fig 13
Comment: A majority of the participants under study (43.2 %) belonged to the Lower Middle class
group while the second largest group was that of the members of the upper lower class (34.7 %).
5%
53%
42%
0%
Distribution of socio-economic status using Modified
Kuppuswamy’s Socioeconomic Scale
Upper Middle
Lower Middle
Upper Lower
Lower

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Table 14: Distribution of History of past illnesses in the population under study
Name of disease Male Female Total
Hepatitis 41 (35.7) 32 (32.7) 73 (34.2)
Tuberculosis 14 (12.2) 16 (16.3) 30 (14.1)
Malaria 8 (7) 5 (5.1) 13 (6.1)
Gallstones 9 (7.8) 4 (4.1) 13 (6.1)
Appendicitis 28 (24.3) 17 (14.7) 45 (21.1)
Total 115(100) 98(100) 213
Fig 14
Comment: A majority of males under study (35.7 %) showed history of hepatitis followed by
appendicitis (24.3 %) while a majority of females showed history of hepatitis (32.7 %) followed by
appendicitis (14.7 %).
0
10
20
30
40
50
60
70
80
Hepatitis Tuberculosis Malaria Gallstones Appendicitis
Distribution of history of past illnesses
Male Female

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Table 15: Distribution of symptoms of morbidities in the population under study
Symptoms Male Female Total
Headache 45 (39.1) 34 (34.7) 79 (37.0)
Dizziness 52 (45.2) 48 (49) 100 (46.9)
Fullness of stomach 31 (27) 22 (22.4) 53 (24.9)
Burning urination 2 (1.7) 4 (4.1) 6 (2.8)
Nocturnal dripping
urination
24 (20.1) 0 24 (11.2)
Joint pain 78 (67.9) 82 (83.7) 160 (75.1)
Diminished vision 76 (66.1) 67 (68.4) 143 (67.1)
Diminished hearing 39 (33.9) 28 (28.6) 67 (31.4)
Difficulty in breathing 22 (19.1) 11 (11.2) 33 (15.4)
Change in urine
output
38 (33) 10 (10.2) 48 (22.5)
Cough 22 (19.1) 11 (11.2) 33 (15.4)
Fig 15
0
20
40
60
80
100
120
140
160
180
Chart Title
Male Female

P a g e 26 | 37
Comment: A majority of males (67.9 %) complain of joint pain followed by diminished vision (66.1 %)
and dizziness (45.2). A majority of females (83.7) complain of joint pain followed by diminished
vision (68.4) and dizziness (49).

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Table 16: Distribution of morbidity pattern in the population under study:
Disease name Male Female Total
Osteoarthritis 78 (67.9) 82 (83.7) 160 (75.1)
Cataract 40 (34.8) 38 (38.8) 78 (36.6)
Hearing loss 39 (33.9) 28 (28.6) 67 (31.4)
Hypertension 51 (45.3) 20 (20.4) 71 (33.3)
Gastritis 31 (27) 22 (22.4) 53 (24.9)
Diabetes Miletus 14 (12) 6 (6.1) 20 (9.0)
Presbyopia 36 (30.3) 29 (29.6) 65 (30.5)
Renal failure 1 (0.9) 0 1 (0.5)
Benign prostatic
hypertrophy
21 (18.2) 0 21 (9.9)
Dementia 27 (23.4) 24 (24.5) 51 (23.9)
Urinary tract infection 2 (1.7) 4 (4.1) 6 (2.8)
Respiratory infections 22 (19.1) 11 (11.2) 33 (15.5)
Fig 16
0
20
40
60
80
100
120
140
160
180
Distribution of morbidity pattern
Male Female

P a g e 28 | 37
Comment: A majority of males (67.9 %) in the population under study suffered from osteoarthritis
followed by a second highest affliction rate of Hypertension (45.3 %) followed by Cataract (34.8 %).
Among females the majority suffered from Osteoarthritis (83.7 %) with the second largest group
being that of cataract (38.8) followed by presbyopia (29.6 %).

P a g e 29 | 37
Table 17: Distribution of disease frequency in the population under study:
Number of diseases
per person
Male Female Total
0 2 (1.8) 1 (1.1) 3 (1.4)
1 22 (19.1) 20 (20.4) 42 (19.7)
2 37 (32.2) 26 (26.5) 63 (29.6)
3 24 (20.9) 21 (21.4) 45 (21.1)
4 30 (26) 30 (30.6) 60 (28.1)
Total 115 (100) 98 (100) 213
Fig 17
Comment: A majority of males (32.2 %) show co-morbidity of 2 conditions while a majority of
females (30.6 %) show co morbidity of 4 conditions.
0
10
20
30
40
50
60
70
0 1 2 3 4
Female
Male

P a g e 30 | 37
Table 18: Addiction pattern in population under study
Habit Male Female Total
Tobacco 85 (73.9) 20 (20.4) 105 (49.3)
Smoking 63 (54.7) 3 (3.06) 66 (30.9)
Alcohol 25 (21.7) 0 (0) 25 (11.7)
No Addiction 20 (17.3) 78 (79.6) 98 (46)
*figures in the parentheses () indicate percentages that add up row-wise
Fig 18
Comment: A majority of males under study (73.9%) showed addiction to tobacco followed by
addiction to smoking (54.7%) and similarly a majority of females (20.3%) showed addiction to
tobacco followed by addiction to smoking (3.06%)
0
20
40
60
80
100
120
Tobacco Smoking Alcohol No Addiction
Addiction Pattern
Male Female

P a g e 31 | 37
Discussion
As the elderly population in India and the world is rapidly increasing, the burden of their health
problems is on a rise. It is, therefore, the need of the hour to keep an eye over the morbidity profile
of the elderly population which will not only provide vital information in setting priorities in health
services but also help in proper implementation of health programs and proper allocation of
resources. This study presents an overview of the morbidity pattern in the geriatric age group
dwelling in the slums of Guwahati.
In our study, it found that the majority of elderly population (64.3%) are in the age group of 60-69
years; 27.2 % are in the age group of 70-79 years; a low proportion (7.4%) belong to the age group of
80-89 years while a still lower proportion (0.9%) are in the age group of 90-94 years. [Table 1; Fig 1]
The results are similar to another study conducted by Ram Kumar Dutta and Prof Alak Barua34
where
most of the elderly (55.4%) were ‘young old’ (60-69 years); 42.7% of the elderly were ‘old old’ (70-79
years) while a very small proportion (1.9%) of the study population belonged to the category of
‘oldest old’ (>80 years)35
. In our study, 54 % of the elderly respondents are males while 46% are
females [Table 1; Fig 1] which is similar to another study conducted by Mahesh Choudhary et al36
where males constituted 57 % and females constituted 43 % of the respondents.37
Coming to religious composition, the majority of the elderly people are Muslims (53.5%) followed by
Hindus (40%), Sikhs (5.6%) and Christians (0.9%) [Table 2; Fig 2]. This is owed to the fact that a
majority of the slums we visited were Muslim dominated areas. Thus, this result might deviate from
other studies like a study conducted by Anil Jacob et al38
where 98.7% of the study population were
Hindus. 39
We also found 17% of the respondents to be illiterate while 83% are literate [Table 4; Fig 4]. which is
similar to another study conducted by Mahesh Choudhary et al40
where 34 % of respondents were
illiterates while 66 % were literates41
. This is significantly lower than the national literacy rate of
74.04% and the Assam Literacy Rate of 73.18%. Another reason for this result could be attributed to
the fact that since our study comprised of a majority of Muslim populace, the literacy rate could
have dropped since Muslims have the highest percentage of illiterates aged beyond seven years at
42.72%.
In terms of family structure, 66.7 % of the respondents belong to a nuclear family while 33.3 %
belong to a joint family [Table 10; Fig 10]. This is somewhat different from another study conducted
by Mahesh Choudhary et al42
where majority of the respondents belonged to a three-generation
family (62%) while others belonged to joint family (23%) and nuclear family (15%)43
.
In our study, 78.9% of the respondents were married and were living with their partners while 18.8%
were widowed. In another study conducted by Anil Jacob et al44
where 67.5% were married and
32.3% were widowed45
.
Regarding personal habits, it is seen in our study that majority of the elderly population chew
tobacco (49.3 %), 30.9% are smokers and 11.7% regularly consume alcohols [Table 18; Fig 18] which
is consistent with the results of another study conducted by Anil Jacob et al46
where 61% of the
elderly group chewed tobacco, 33.3% of males were smokers and 28.7% were alcohol addicts47
.
Another study conducted by Mahesh Choudhary et al48
showed that 69% of the study population
were having some kind of addiction49
.
In our study, 98.6 % of the elderly population are suffering from at least one ailment while 29.6 %
are suffering from two ailments and 49.2 % of the elderly population are suffering from three or
more ailments [Table 17; Fig 17]. This is because age related changes develop in parallel and affect
each other through many feed-forward and feedback loops.50
This results in higher comorbidity

P a g e 32 | 37
among individuals of this age group. This result is somewhat consistent with another study
conducted by Anil Jacob et al51
where 72.4% of the study population was suffering from at least one
ailment while 48.1% was suffering from two ailments and 24.1% of the population were suffering
from three or more ailments.52
The majority of the elderly male population dwelling in the slums of Guwahati (67.9 %) complains of
joint pain followed by diminished vision (66.1 %) and dizziness (45.2 %) while majority of females
(83.7%) complain of joint pain followed by diminished vision (68.4%) and dizziness (49%) [Table 15;
Fig 15]. This is almost similar to another study conducted by Jadhav V.S et al53
where diminished
vision was the most common complaint (68%), followed by joint pain (43.4%) and dental and
chewing problems (45.3%)54
. In another study conducted by Mahesh Choudhary et al55
, the major
geriatric complaints reported were visual problems (65%), hypertension (40%), dental problems
(34%), diabetes (26%), joint complain (26%) and hearing problems (22%)56
which is somewhat
consistent with our study.
In our study, the majority of elderly male population (67.9 %) suffered from osteoarthritis followed
by a second highest affliction rate of Hypertension (45.3 %) followed by Cataract (34.8 %) followed
by hearing loss (33.9 %) [Table 16; Fig 16]. Among females the majority suffered from Osteoarthritis
(83.7 %) with the second largest group being that of cataract (38.8) followed by presbyopia (29.6 %)
followed by hearing loss (28.6 %) [Table 16; Fig 16]. This study is somewhat similar to another study
conducted by Jadhav V.S et al57
where the majority of male elderly population (41.75%) suffered
from cataract followed by hearing loss (21.21%) followed by hypertension (14.47 %) while among
the female elderly population, majority suffered from cataract (38.71 %) followed by hearing loss
(28.04%) and hypertension (28.03 %)58
. Similar results were also observed in the other studies.

P a g e 33 | 37
Summary
After analysis of collected data and computation of results it was found that a Majority of males
(40.7 %) in the geriatric age group in slums belonged to the 65-69-year-old category and a majority
of females (35.7 %) belonged to the same category.
A Majority of members of the study population (53.5 %) adhered to Islam followed by Hinduism (40
%). A majority of the participants in the study (78.9 %) were of a Married marital status followed by
the Widow/Widower group (18.8 %).
A Majority of the participants in the study (50.7 %) were at risk of malnutrition followed by the
normal nutritional status group (32.9 %) and the group of malnourished participants (16.4 %).
A Majority of the participants in the study (78 %) were functionally independent on the ADL scale
while a minority (22 %) was dependent according to the same scale.
A Majority of the participants in the study (75.1 %) were found to be not depressed while a minority
(24.9 %) were found to be depressed according to the Geriatric Depression Scale.
A majority of participants under study (95.3 %) have no exercising habits while a smaller group (4.2
%) has mild exercising habits and an even smaller group (0.5 %) has moderate exercising habits.
A majority of the participants in the study (66.7 %) had a nuclear family structure while a minority
had a joint family structure (33.3 %).
A majority of participants under study (75.6 %) had pukka houses while a minority had kutcha
houses (24.4 %).
A majority of participants under study (91.6 %) were non vegetarian while a minority were
vegetarian (8.4 %).
A majority of the participants under study (43.2 %) belonged to the Lower Middle class group while
the second largest group was that of the members of the upper lower class (34.7 %).
A majority of males (67.9 %) complain of joint pain followed by diminished vision (66.1 %) and
dizziness (45.2). A majority of females (83.7) complain of joint pain followed by diminished vision
(68.4) and dizziness (49).
A majority of males (67.9 %) in the population under study suffered from osteoarthritis followed by a
second highest affliction rate of Hypertension (45.3 %) followed by Cataract (34.8 %). Among
females the majority suffered from Osteoarthritis (83.7 %) with the second largest group being that
of cataract (38.8) followed by presbyopia (29.6 %).
The general prevalence rate and disease burden was found to be very high at 98.2 % for males and
98.9 % for females.

P a g e 34 | 37
Conclusion
A major overhaul of the health system with proper targeting of primordial preventive measures like
better nutrition seems to be the way forward for improvement of the health scenario among the
geriatric age group in slums of Guwahati.
The study among the elderly in the slum areas of Guwahati, India has highlighted a high prevalence
of morbidity and identified common existing medical problems like osteoarthritis, cataract,
diminution of hearing and hypertension. With increasing number of old people and with radical
change of social structure even in the rural area, it is high time that health policy makers take steps
to include health programme for the elderly within the purview of the primary health care. Lifelong
health education for healthy old age should be given. Provision of visual aids/mobility aids at
geriatric health facilities and the availability of physiotherapy services should be ensured. Family
counselling for old age care, creation of a viable family and social environment and competent
geriatric services will go a long way to improve the quality of life of elderly.

P a g e 35 | 37
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