Department of Psychiatry, Christian Medical College, Vellore, India.
Int Psychogeriatr. 2012 Feb;24(2):333-41. doi: 10.1017/S1041610211001669. Epub 2011 Sep 21.
Disability among the elderly is a cause of significant burden. There is dearth of relevant research from low- and middle-income countries. We aimed to establish the nature and factors associated with disability among the elderly in a rural south Indian community.
We recruited 1000 participants aged over 65 years from Kaniyambadi block, Vellore, India. We assessed their disability status, sociodemographic profile, psychiatric morbidity, cognitive functioning and anthropometrics using the following structured instruments: WHO Disability Assessment Scale II, Geriatric Mental State, Community Screening Instrument for Dementia, and Neuropsychiatric Inventory. We employed appropriate multivariate statistics to study the factors associated with a higher level of disability and to determine the population attributable fractions for various modifiable risk factors.
Advanced age, illiteracy, hunger, poor nutrition, arthritis, hearing impairment, gastro-intestinal and respiratory diseases, dementia and travel costs to primary health facilities increased the risk of disability significantly. Hypertension, diabetes and depression were not associated with disability. Modifiable social determinants and medical diseases together contributed to disability in this population.
Locally relevant social determinants combine with prevalent medical diseases to produce the disability burden among elderly. There is a need to focus on local contexts and modifiable risk factors to design locally appropriate public health policies and interventions.
老年人残疾是一个重大负担的原因。来自中低收入国家的相关研究很少。我们旨在确定印度南部农村社区老年人残疾的性质和相关因素。
我们从印度维洛尔的卡尼亚姆巴迪街区招募了 1000 名年龄在 65 岁以上的参与者。我们使用以下结构化工具评估他们的残疾状况、社会人口统计学概况、精神疾病、认知功能和人体测量学：世界卫生组织残疾评估量表 II、老年精神状态、社区痴呆筛查工具和神经精神疾病问卷。我们采用适当的多变量统计方法来研究与更高水平残疾相关的因素，并确定各种可改变的危险因素的人群归因分数。
高龄、文盲、饥饿、营养不良、关节炎、听力障碍、胃肠道和呼吸道疾病、痴呆症以及前往初级保健设施的交通费用显著增加了残疾的风险。高血压、糖尿病和抑郁症与残疾无关。可改变的社会决定因素和医学疾病共同导致了该人群的残疾。
当地相关的社会决定因素与普遍存在的医学疾病相结合，给老年人带来了残疾负担。需要关注当地情况和可改变的危险因素，以制定适合当地情况的公共卫生政策和干预措施。
