Medhi G K, Hazarika N C, Borah P K, Mahanta J
Regional Medical Research Centre, NE Region, ICMR, Dibrugarh.
J Assoc Physicians India. 2006 Jul;54:539-44.
To compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers) living in same geographical location.
Two hundred and ninety three and 230 elderly from urban setting and tea garden respectively aged > 60 years were included in the study. Subjects were physical examined and activity of daily living instrumental activity of daily living (ADL-IADL) was assessed. Diagnosis of diseases was made on the basis of clinical evaluation, diagnosis and/or treatment of diseases done earlier elsewhere, available investigation reports, and electrocardiography. Hypertension was defined according to JNC-VI classification. BMI (weight/height2) was calculated. Logistic regression analysis was performed to see the impact of important background characteristics on non-communicable diseases (NCD) and disability.
Hypertension (urban--68% and tea garden--81.4%), musculoskeletal diseases (urban--62.5% and tea garden--67.5%), COPD and other respiratory problems (urban--30.4% and tea garden--32.2%), cataract (urban 40.3% and tea garden--33%), gastro-intestinal problems (urban--13% and tea garden--6.5%) were more commonly observed health problems among community dwellings elderly across both the groups. However in contrast to urban group, serious NCDs like Ischaemic Heart Disease (IHD), diabetes were yet to emerge as health problems among tea garden dwellers. Infectious morbidities, undernutrition and disability (ADL-IADL disability) were more pronounced among tea garden dwellers. Utilization of health service by tea garden elderly was very low in comparison to the urban elderly. Both tea garden men and women had very high rates of risk factors like use of non-smoked tobacco and consumption of alcohol. On the other hand, smoking and obesity was more common in urban group. Most morbidities and disabilities were associated with identifiable risk factors, such as obesity, tobacco (smoked and non-smoked) and alcohol consumption. Educational status was also found to be an important determinant of diseases and disability of elderly population. Age showed a J-shaped relationship with disability and morbidity. Sex difference in health status was also detected.
This study highlights the physical dimension of health problems of elderly individuals. Social circumstances and health risk behaviours play important role in the variation of health and functional status between the two groups. Life-style modification is warranted to prevent onset of chronic diseases. To improve quality of life, rectification of poor health status through affordable health service for disease screening and better management of illness, nutritional improvement and greater health awareness are necessary particularly among low socio-economic group. Low-cost intervention like cataract surgery could make a difference in the quality of life of elderly Indian.
比较居住在同一地理位置的两个老年人群体（茶园工人和城市居民）的发病率、残疾情况（日常生活活动能力-工具性日常生活活动能力残疾）以及疾病和残疾的行为与生物学关联因素。
本研究纳入了分别来自城市和茶园的293名及230名年龄>60岁的老年人。对受试者进行体格检查，并评估日常生活活动能力和工具性日常生活活动能力（ADL-IADL）。根据临床评估、既往在其他地方进行的疾病诊断和/或治疗、现有检查报告以及心电图进行疾病诊断。高血压按照美国国家联合委员会第六版分类标准定义。计算体重指数（BMI，体重/身高²）。进行逻辑回归分析，以观察重要背景特征对非传染性疾病（NCD）和残疾的影响。
高血压（城市居民-68%，茶园工人-81.4%）、肌肉骨骼疾病（城市居民-62.5%，茶园工人-67.5%）、慢性阻塞性肺疾病和其他呼吸道问题（城市居民-30.4%，茶园工人-32.2%）、白内障（城市居民-40.3%，茶园工人-33%）、胃肠道问题（城市居民-13%，茶园工人-6.5%）是两组社区居住老年人中更常见的健康问题。然而，与城市组相比，茶园居民中诸如缺血性心脏病（IHD）、糖尿病等严重的非传染性疾病尚未成为健康问题。茶园居民中的传染性发病率、营养不良和残疾（ADL-IADL残疾）更为明显。与城市老年人相比，茶园老年人的医疗服务利用率非常低。茶园的男性和女性使用无烟烟草和饮酒等危险因素的比例都非常高。另一方面，吸烟和肥胖在城市组中更为常见。大多数发病率和残疾与可识别的危险因素相关，如肥胖、烟草（吸烟和无烟）和饮酒。教育程度也是老年人群疾病和残疾的一个重要决定因素。年龄与残疾和发病率呈J形关系。还检测到健康状况的性别差异。
本研究突出了老年人健康问题的身体层面。社会环境和健康风险行为在两组健康和功能状况差异中起重要作用。有必要改变生活方式以预防慢性病的发生。为了提高生活质量，特别是在低社会经济群体中，通过提供负担得起的疾病筛查医疗服务、更好地管理疾病、改善营养和提高健康意识来纠正不良健康状况是必要的。像白内障手术这样的低成本干预措施可能会改善印度老年人的生活质量。
