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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 44-50

Comparative study between elderly with medical problems living in endwelling houses and with families in Banha City


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Benha, Egypt
2 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Benha, Egypt

Date of Submission22-Aug-2016
Date of Acceptance30-Dec-2016
Date of Web Publication25-Jul-2017

Correspondence Address:
Engy A El Sayed Saleh
Department of Family Medicine, Faculty of Medicine, Banha University, Benha, Al-Qalyubia, 13511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_450_16

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  Abstract 


Objectives
The aim of the present study was to assess and compare common medical health problems among the elderly living either in endwelling homes or with their families.
Background
The WHO defines aging as a 'process of progressive change in the biological, psychological and social structure of individuals'. Generally, aging is associated with progressive functional loss in perception, cognition, memory, and deterioration of physiological capacities. Health problems tend to increase with advancing age and very often the problems aggravate because of neglect, poor economic status, social deprivation, and inappropriate dietary intake.
Patients and methods
This case-controlled study was conducted on 70 elderly cases, aged 60–75 years, recruited from two homes for elderly in Banha City and 140 elderly participants (control group) matched for age, sex, and socioeconomic status recruited from two geriatric clubs. Data collected using a predesigned structured questionnaire included sociodemographic data, common medical history, medication history and health-seeking behavior, health problems affecting nutrition, and reasons of stay in endwelling homes.
Results
Ischemic heart diseases (50%) and memory disorders and history of falls (37.1 and 52.9%, respectively) had the highest prevalence among geriatric home residents. No significant differences were found regarding different health problems and the number of morbidities or medications. Residence in geriatric homes was associated with a large family size, memory disorder, and nutritional risks.
Conclusion
Elderly people of both groups are unhealthy. Aged people in geriatric homes have a multisystem morbidity besides memory disorders, falls, depression, malnutrition, elderly abuse, and loss of family support. There is a great need to conduct more research to improve our understanding of elderly populations, their health and psychosocial problems. Social support and medical care of elderly residents in geriatric homes should receive more attention.

Keywords: Banha City, clubs, endwelling houses, family support


How to cite this article:
Shaheen HM, Badr SA, El Sayed Saleh EA. Comparative study between elderly with medical problems living in endwelling houses and with families in Banha City. Menoufia Med J 2017;30:44-50

How to cite this URL:
Shaheen HM, Badr SA, El Sayed Saleh EA. Comparative study between elderly with medical problems living in endwelling houses and with families in Banha City. Menoufia Med J [serial online] 2017 [cited 2019 Apr 18];30:44-50. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/44/211502




  Introduction Top


The unprecedented cohort of persons over the age of 65 years increases daily. Projections are that this age cohort will expand from 39 million in 2010 to an expected 72 million by the year 2030 [1].

As population aging increases in both developed and developing countries, Egypt like many other countries is undergoing a demographic transition toward an aging society. There were 4 400 000 persons aged 60 and over, representing 6.9% of the total population in 2006, whereas the expected percentage of elderly population may reach 8.9% in 2016 and 10.9% in 2026, and finally 12% by 2030 [2],[3].

Definitions of health and well-being in late life have changed with the increase in life expectancy. Heart disease, cancer, and stroke have become the leading causes of death among older adults, whereas deaths due to infection have decreased. Adults surviving into late life suffer from high rates of chronic illness; 80% have at least one and 50% have at least two chronic conditions [4].

Older people commonly present with 'general deterioration' or functional decline. Acute disease is often masked but precipitates functional impairment in other areas. Therefore, atypical presentations such as falls, confusion, or reduced mobility are not social problems but medical problems in disguise. Often the history has to be sought from caregivers, over the telephone if necessary [5].

Illness increases with age. All else being equal, an older population has greater needs for healthcare. This logic has led to dire predictions of skyrocketing costs – 'apocalyptic demography' [6]. As a consequence of this graying of population, the care of older persons demands more attention and concerns about health, mental, social, and financial resources [6].

Older people often have age-related diseases with complex multisystem problems and are at an increased risk for morbidity and mortality [7].

Traditionally, care for older persons was a duty of the Egyptian family. Family support is particularly important for older persons, especially when they require assistance because of debilitating chronic conditions and diseases. However, effects of urbanization, with the increase in women's participation in the work force, and industrialization and a decline in the extended family may weaken this traditional support system and cause a decline in the capacity of the Egyptian families to adequately care the elderly [8],[9].

In the recent years, institutional care became indispensable due to unavailability of cares and the financial, emotional, and physical burden of caring [10].

Therefore, in Egypt the number of social welfare institutions for elderly people has increased. There were 115 houses in 2007, which rose to 152 houses at the end of 2013 and reached 176 houses in 2015 [11]. The expected increase of the number of establishing elderly homes shows clearly the size of the problem of the increasing number of the elderly [3].

Many studies on the relationship between social and family support and health status of the elderly have shown that emotional support may be especially important for the elderly who face a variety of age-related challenges to their functional ability and health [12]. Moreover, poor social support leads to decline in psychosocial and mental health, which brings about problems of loneliness and depressive symptoms [13].

Aim

The present study was conducted to improve the health status of elderly either living in endwelling homes or with their families, and to find out geriatric health problems among the elderly living in endwelling homes and compare them with health problems among the elderly living with their families.


  Patients and Methods Top


The study was a case-controlled study conducted in Banha City, Al-Qalyubia Governorate, Egypt, for 6 months' period (from April to November 2015). The cases comprised 70 elderly patients aged 60–75 years old and recruited from the only two homes for elderly in Banha City that receive governmental funds. The control group comprised 140 elderly participants matched for age, sex, and socioeconomic status and recruited from two geriatric clubs in the same city during the same period. All attendants of the geriatric clubs aged 60 years and more who lived with their families were eligible for the study. The elderly patients who were unwilling to participate in the study and those living alone were excluded, with a 90.3% response rate. All participants in the study were subjected to comprehensive geriatric assessment evaluation through an administrated questionnaire. Data were collected through personal interviews using a predesigned structured questionnaire. Some of the data were obtained from the participants' medical reports regarding health problems. All data were confirmed also by the caregivers at elderly homes or family members when needed. The objective of the study was adequately explained to participants and their consent was obtained with assured confidentiality.

The study questionnaire involved six parts. In the first part, participants' sociodemographic data were assessed using seven parameters, occupation, education, family size, per capita income, crowding index, home sanitation, and use of computer for the assessment of socioeconomic status according to the scoring system for socioeconomic status with some modification, as proposed by Fahmy et al. [14]. The total score was calculated and the cut-off points were set to be used for socioeconomic status classification, where a high level was indicated as at least 70%, a medium level as 40 to less than 70%, and a low level as less than 40% of the total score.

The second part included common health problems (visual impairment, hearing impairment, memory impairment, self-reported depressed mode, unintended weight loss during last 6 months, urinary incontinence, stool incontinence, history and frequency of fall, and exposure to abuse and its type) and also common medical problems (hypertension, diabetes, ischemic heart disease, respiratory diseases, gastrointestinal diseases, liver diseases, renal diseases, arthritis, and dental problems). As people age, they develop more chronic conditions. The wealth of guidelines available for chronic disease indicate that with aging, the prevalence of many chronic condition increases, such as hypertension, diabetes, cardiovascular diseases, and geriatric syndrome, with more detailed history for whom known to be hypertensive or diabetic.

The third part included questions about medication history for the detection of polypharmacy in elderly and questions about drugs and alternative herbs, including drugs use, alternative herbs and vitamins and its regimens, side effects of these drugs and herbs, medical prescription for those drugs, herbs and vitamins, system for taking medications regularly, degree of commitment to the dates of medications, and follow-up with the physician.

The fourth part included questions about health-seeking behavior regarding compliance to medications and follow-up visits.

The fifth part included questions about any health problems affecting the nutritional status.

The sixth part included causes of admission in endwelling homes.

Ethical consideration

The required administrative regulations were fulfilled. The district health and social affairs authorities approved the study before it was conducted. An official permission letter was obtained and directed to the administrators of geriatric homes and clubs in Banha City. The objective of the study was adequately explained to the participants and their consent was obtained with assured confidentiality.

Statistical analysis

SPSS (16.0; SPSS Inc., Chicago, Illinois, USA) statistical software was used to analyze data. Continuous variables were described as means ± SD. Discrete variables were described as number and percentage. The differences of means were tested by using the independent t-test for parametric data, Mann–Whitney test for nonparametric, and the comparison between qualitative variables with the c2-test. Statistical significance was set at P value less than 0.05.


  Results Top


As per the sociodemographic characteristics of the two groups, the mean age for elderly participants was 66.1 ± 3.5 years, ranging between 60 and 75 years; 28.6% of the elderly were greater than or equal to 70–75 years of age. Female/male ratio was 0.84 (45.7%). A significant difference was found (P < 0.0001) only regarding marital status, where all elderly home residents were either divorced, widowed, or single. Furthermore, as regards family size, most of the home residents (77.1%) had a family size of five members and more [Table 1].
Table 1 Sociodemographic characteristics of the studied groups

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Hearing impairment was the most prevalent functional impairment in the two groups, especially in the geriatric club group (90.7%); moreover, it was also higher in the resident elderly group (77.1%). A significant difference was found regarding memory disorders and history of falls, which were highest among geriatric home residents compared with the other group (37.1 and 52.9%, respectively). No significant differences were found regarding number of morbidities or medications [Table 2].
Table 2 Common health problems of elderly participants in both groups

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There was no statistically significant difference among the two groups regarding medications, number of drugs taken, side effects of medications, herbal and vitamin intake, and prescription for this medications and herbs [Table 3].
Table 3 Medication history in the studied groups

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There was a statistically significant difference among the two groups regarding regular intake of medication, which represented 87.1% of the elderly living with families and 35.7% of the elderly home residents. There was a significant difference among the two groups regarding taking medication with help from others and taking medication in time [Table 4].
Table 4 Health-seeking behavior regarding compliance to medication

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Higher percent of participants (40, 60%) in both geriatric club attendees and geriatric home residents, respectively, suffered from health problems, affecting their nutritional status. Loss of appetite represented 26.8 and 58.6% in geriatric club attendees and in the geriatric home residents, respectively; with high difference in the two groups for health problems affecting the nutritional status, Loss of appetite, loss of taste and bad mood among the two groups. There is no difference among the two groups regarding other problems as mouth ulcers and chewing problems [Figure 1].
Figure 1: Common nutritional problems of elderly participants of both groups.

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A high percent of the elderly home residents stay at endwelling homes as they need physical and medical assistance (54.3%), due to family troubles (25.7%), and to avoid being alone (20%) ([Table 2] and [Figure 2].
Figure 2: Reasons to stay at endwelling homes.

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  Discussion Top


Older adults living in facilities for the elderly will have to adjust to a changed living situation, and this adjustment can lead to serious psychosocial problems of loneliness and depression in absence of positive social, family, and emotional support [15], especially for the elderly who face a variety of age-related challenges to their functional ability and health [16]. Regarding family support in Pakistan, however, geriatric and nursing homes rarely meet all the psychological needs of their residents, leading to adverse effects on the physical and psychological well-being of the residents [17].

In the present study, despite relatively young age of elderly participants compared with other studies investigating different and common health problems among elderly population in Egypt and other developing countries, it was found that all elderly participants in study sample suffered from at least one of the chronic diseases and relatively high percent (48.1%) had three or more chronic morbidities, with no significant difference between those who were living with families and those in geriatric homes.

Poor nutritional status was found among 48% of elderly participants. However, it was significantly higher among the residents of geriatric homes compared with those attending geriatric clubs, which was in agreement with the findings of a study done by Khater and Abouelezz [18], and this reflects the extreme shortage of geriatric heathcare and nutritional services and the need for urgent plan for this increasing problem.

The high prevalence of ischemic heart diseases and hypertension followed by diabetes, and the high percent of elderly suffering from hearing and visual impairment among both elderly groups also came in line with the findings of many studies that investigated the common health problems among elderly in Egypt and other developing countries [19],[20].

However, memory disorders and history of falls, which were highest among geriatric home residents compared with elderly group living with families, can be attributed to psychosocial effects and stressful factors associated with residence in elderly homes [17],[21], which also reflected on the perception of their health status compared with those living with their families despite the relatively same heath problems and comorbidities.

In the current study, with all previous study findings, the relationships between different variables included were obvious when correlation was done where data analysis detected significant positive correlation with number of medications (r = 0.245) (P = 0.000), whereas no significant correlation was found with age, socioeconomic status, and number of morbidities.


  Conclusion Top


Elderly people both living in geriatric homes and living with families are unhealthy. The most common health and psychosocial problems elderly in geriatric homes face include multisystem morbidity besides memory disorders, falls, and malnutrition.

There is a great need to conduct more research to improve our understanding of elderly populations, their health and psychosocial problems. Social and health programs about the importance of family support for the elderly in our community are recommended, which will save a lot of medical and hospital care cost. Furthermore, social support and medical care of elderly residents in geriatric homes should receive more attention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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