Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Sonia Puri; Praizy Bhandari; NK Goel; Munish Kumar Sharma; Sarabmeet Singh Lehl; Monica Gupta

doi:10.4103/ijcfm.ijcfm_77_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 8 | Issue : 2 | Page : 115-120

Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India

Sonia Puri¹, Praizy Bhandari¹, NK Goel¹, Munish Kumar Sharma¹, Sarabmeet Singh Lehl², Monica Gupta²
¹ Department of Community Medicine, GMCH, Chandigarh, India
² Department of General Medicine, GMCH, Chandigarh, India

Date of Submission	28-Sep-2021
Date of Decision	14-Jul-2022
Date of Acceptance	18-Jul-2022
Date of Web Publication	31-Dec-2022

Correspondence Address:
Dr. Praizy Bhandari
Department of Community Medicine, GMCH, Chandigarh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcfm.ijcfm_77_21

Abstract

Introduction: Aging is a natural process that usually results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. Through this study, we got an opportunity to study the morbidity profile of the elderly and to assess their health-seeking behavior and its determinants in urban areas of Chandigarh.
Material and Methods: The sample consisted of 360 participants. Multistage and proportionate sampling techniques were used to recruit study subjects. A structured interview was carried out to get information on the different parameters of health-seeking behavior of the elderly population.
Results: The most pervasive determinant of health-seeking behavior was perceiving health issues related to age, no family support, and health-care expenditure.
Conclusion: The elderly had a positive behavior toward seeking help with regard to health care. Multiple morbidities were evident among the elderly, and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs.

Keywords: Determinants, elderly, health-care-seeking behavior

How to cite this article:
Puri S, Bhandari P, Goel N K, Sharma MK, Lehl SS, Gupta M. Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India. Indian J Community Fam Med 2022;8:115-20

How to cite this URL:
Puri S, Bhandari P, Goel N K, Sharma MK, Lehl SS, Gupta M. Morbidity profile and dynamics of determinants of health-seeking behaviour in geriatric population of Chandigarh, India. Indian J Community Fam Med [serial online] 2022 [cited 2023 May 28];8:115-20. Available from: https://www.ijcfm.org/text.asp?2022/8/2/115/366552

Introduction

In recent years, there has been an increase in the worldwide elderly population, which is expected to reach 22% by 2050. More than 800 million persons over the age of 60 make up 12% of the global population.^[1] India's elderly population is expected to be 98 million, accounting for 8.0% of the overall population. In India, the demographic transition has resulted in an exponential graying population due to increased longevity and reduced fertility.^[2] Aging is a natural process that results in physiological, biological, emotional, and financial decline. As a result, a robust health system is required to meet their escalating health needs. The Indian joint family system has always provided social and economic security to the elderly. However, due to the exodus of the younger population to cities in pursuit of livelihood, there is a growing disintegration of joint families. This in turn has given birth to “couple families” or “nuclear families,” exposing the elderly to emotional, physical, and financial vulnerability.^[3],[4] The Government of India has taken an initiative and launched a nationwide program for the elderly population. Many schemes have also been launched, although their effectiveness among the elderly is unknown. The term “health-seeking behavior” refers to “any series of activities performed by someone with a health problem to locate an acceptable solution.” It is a significant determinant of the community's health state and plays a vital role in the development of health programs.^[5],[6] People's perceptions of the cause of their health problem, as well as their perceptions of symptoms, have a big effect in their decision to seek medical help. A person who believes he or she is sick exhibits distinct behavioral changes, such as limiting to the bed, avoiding ordinary tasks, or visiting a health practitioner.^[7] Age, sex, education, health status, associated comorbidities, financial situation, distance to the health facility, attitude of health professionals toward the aged, contentment of the elderly in a health facility, and other factors all influence health-seeking behavior.^[8] Health-care-seeking behavior has improved as knowledge and awareness have improved. On the contrary, due to financial constraints and rising costs of living, health care supplied at the household level has declined, providing concern for the elderly. They are typically hesitant to seek medical attention for their diseases. Typically, they are thought to be a natural component of the aging process. They are also clueless about the nature of problems and treatment options in the vast majority of cases. This exacerbates existing issues and leads to the development of complications. However, prompt management can help prevent issues from worsening in the elderly.^[9] As a result, an effort was undertaken in this study to examine the elderly's health-seeking behavior.

Aims and objectives

To study the morbidity profile of the elderly in urban areas of Chandigarh
To assess their health-seeking behavior along with its determinants.

Material and Methods

This community-based cross-sectional study was conducted from January 2019 to December 2019 in Chandigarh.

The sample size was calculated using a default prevalence of morbidity at 50% with a worst possible estimate at 45% on one side and 95% confidence interval. Using these inputs, the sample size calculated was 380 subjects. An approximation, a sample size of 400 subjects were taken.

Chandigarh was divided into four zones. From these zones, 100 elderly subjects were recruited. The elderly were selected by systematic random sampling technique [Figure 1]. The sampling interval was in proportion to the population of these areas. Elderly people who had a problem with communication, such as those with severe hearing impairment, or a previous diagnosis of dementia and severely ill were excluded from the study. If a house was found locked, then a minimum of three visits were paid to the locked house, before excluding that from our sample. If the selected household did not meet inclusion criteria, the next nearby household was considered. In households if there were more than one individual who met the inclusion criteria, the lottery method was used to select study participants for interview.

Figure 1: Recruitment of elderly participants

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After identifying the study subjects, data were collected from the elderly (if they could respond) or from the caregiver during serious illness by a team of trained health workers, interns, and medical social welfare officers. The study instrument used was pretested, validated, and structured questionnaire. The information retrieved was on – sociodemographic variables, comorbidities, awareness of accessible health facilities, health-seeking behavioral aspects during illness, type of treatment sought, place/person from where they seek health care, factors deterring them from seeking health care, and type of treatment sought for that illness. The subjects were categorized based on the type of treatment sought:

No treatment received
Self-medication (home remedies, over-the-counter drugs, and other herbal preparations without consulting a professional)
Traditional treatment (sought from Ayurvedic/herbal healers or spiritual healers)
Paraprofessionals (who had received training in diagnosis and treatment of common minor ailments and medical assistants and government and nongovernment community health workers who received basic preventive and curative health training)
Allopathic treatment (from a qualified allopathic practitioner either from a government or private setup), expenditure incurred, and their views leading to enhancement of utilization of these services.

This research proposal explored elderly perceptions of facilitators and barriers to seek health care in Chandigarh. Study instrument item responses pertaining to factors that helped and hindered in seeking health were thoroughly analyzed. Knowledge of factors that promote health was a major facilitator of health-seeking behavior; whereas competing priorities of daily living were perceived as barriers. Delving into facilitators and barriers to health-seeking behavior in this age group revealed ways for promoting engagement in health promotion programs addressing a healthy lifestyle.

Statistical analysis

Data were collected, compiled, edited, and entered into Epi Info statistical software version 3.5.1 [Epi Info,” is a trademark of the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA] after subjecting to its completeness as well as validation by the principal investigator.

Data were then exported to the SPSS version 20 statistical software for analysis [IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA)]. Descriptive statistics, such as frequency distribution, mean, and percentage were used for variables.

Ethical approval and clearance were obtained from the institutional research and ethics committee. Written informed consent was obtained from the respondents; however, in subjects with disabilities and other chronic morbidities, it was obtained from family/caregivers. Verbal informed consent was taken from illiterate subjects. Moreover, ethical guidelines were strictly adhered to throughout the study.

Operational definitions

Health-care-seeking behavior: Any action undertaken by individuals who perceive themselves to have health problems or to be ill for the purpose of finding an appropriate remedy.

Elderly: Subjects with age more than 60 years.

Comorbid conditions: It is defined as the co-occurrence of more than one chronic disease in the same person such as hypertension, diabetes, arthritis, anemia, dyslipidemia, visual impairment, and deafness.

Results

Among the total of 360 participants, females (50.2%) outnumbered males (49.7%). Maximum of elderly (38.1%) were in the age group of 65–69 years and the least (16.7%) were more than 75 years. Hindu participants (62.4%) were maximum among all other religions, followed by Sikhs (27.2%). In consideration to educational status, females (5.5%) were more illiterate than males (1.7%). However, more females were educated till 10^th (68.9%), whereas more males were had higher degrees. Around 80% of the elderly were married and one-fifth of them had lost her/his partner. Majority of the participants lived in a nuclear family (39.4%), followed by 38.8% staying alone. Only 21.6% were staying in a joint family. More than half (57.2%) were fully dependent on their children for their health issues. Only 11.1% were independent [Table 1].

Table 1: Distribution of subjects as per their sociodemographic profile

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Majority (61.4%) of participants had acid peptic disease. Among noncommunicable diseases, more than half of them had hypertension (55.6%), diabetes (52.5%), and arthritis (51.1%). Anemia was present in more than two-thirds of the female elderly participants (68.5%). Similarly, dyslipidemia was in almost 50% of them. Visual impairment (56.9%) was more in the elderly than deafness (45%) [Figure 2].

Figure 2: Distribution of elderly as per morbidity status

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Majority were visiting the government health facilities (70%) for their health issues. More than half (55.8%) were taking self-medication and only 27.8% were going to private health facilities. Allopathic medicine was taken by 50.8% in comparison to 32.8% who were going to faith healers. AYUSH medicine was taken by 71.3% of them, more by female elderly (40.8%). Female elderly were more inclined toward self-medication (58%), faith healers (34.3%), and AYUSH medication (40.8%) [Table 2].

Table 2: Distribution of patients as per their health-seeking behavior

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Reasons for not seeking health care by the elderly were multiple. Majority of participants, especially females, i.e., 60.8% felt that the health issues were age-related. Around 40% were not even aware of their morbidity. More than half of the participants did not have any family support, i.e., 53.6% and almost 50% had financial issues. Many were dissatisfied with the working condition of health facilities, i.e., 40% and 21.9% had difficulty in accessing health facilities [Table 3].

Table 3: Distribution of barriers in health-seeking behavior of elderly

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Discussion

In this study, key revelations were of various determinants of health-seeking behavior of the elderly. Maximum elderly in this study, were in the age group of 65–69 years. Similar findings were evident in studies done by Baliga et al.^[10] and Anjali and Aarti^[11] where majority, i.e., 67.3% of participants were in the age group of 60–70 years.

Almost 40% of participants in our study dwelt in a nuclear family and half in a joint. These findings were in contrast to that study done by Sharma et al.^[12] where 90% lived in joint families. The trend of staying in joint families is now declining due to demographic transition and urbanization, leading to more of the young population moving to urban areas in search of livelihood. Hindu participants were 62.4% followed by Sikhs. This could be attributed to the proximity of Chandigarh to the neighboring state Punjab. These findings corroborated to the study done in Mumbai that showed the predominance of Muslim participants.^[13] Most subjects in our study were educated and only 3.6% were illiterate which differed from the results of Chauhan et al.,^[14] where more than half were illiterate.

Out of 360 participants, majority had comorbidities. Acid peptic disease, hypertension, diabetes mellitus, and arthritis were found to be the most common morbidities. Similar results were evident in another study conducted by Adhikari and Rijal^[15] and Sharma et al.^[12] Their study showed that a large number of participants were suffering from at least one health problem and other comorbid conditions were hypertension, diabetes mellitus, arthritis, hearing problem, etc. The prevalence of cancer was <1% in the study subjects and consistent findings were seen in a study done by Thomas et al.,^[16] where 2.4% suffered from cancer and were under treatment at that time.

As regards the health-seeking behavior of the participants, it was found in the current study that government health facilities (70%) were maximally visited for the health issues in comparison to going to private practitioners/private health facilities. Even in a study done by Kishore et al.,^[17] government facilities were the choice of maximum subjects. Similarly, a study by Barua et al.^[18] revealed that more than three-fourth preferred government health institution in major illness due to trust in the health-care services offered by them while for minor illness they opted home remedies. On the contrary Chauhan et al.'s^[14] study concluded that one-third of the study participants preferred a private practitioner during any ailment. The reasons for preference were availability, accessibility, and better quality of health care. Another interesting finding was the practice of self-medication in more than half of the subjects in our study. Moreover, around one-fourth were going to private health facilities and faith healers. It was found that female subjects were more inclined toward self-medication and AYUSH medication. These findings were similar to a study done by Barua et al.^[18] where 51.8% preferred allopathic medicine for their illness, 37.8% used both allopathic and AYUSH medication for their problems. Similarly in a study done by Gupta et al.,^[19] 48% of the study subjects chose an allopathic practitioner.

The present study revealed that the main deterrent for not seeking health care was the perception of the elderly taking the health issues as related to normal aging. In addition, one-third were unaware of their problems. More than half had financial problems along with lack of support from family members. Dissatisfaction with the health facility was also found in many. While a study done in Ethiopia showed that the main reasons for inappropriate treatment-seeking behavior by the participants were – not taking their illness seriously (53.3%), inadequate finances (26.7%), and no improvement by treatment in their illness (13.3%). In many other studies too, reasons for not seeking appropriate health care were poverty or financial crunch.^{[20],[21],[22],[23]}

One of the limitation of the study is it did not assess the psychosocial well-being and quality of life of the elderly other than the physical illness. The relation of risk of the elderly related to culture and lifestyle could not be measured.

Conclusion and Recommendations

The elderly had a positive behavior toward seeking help in regard to health care. Multiple morbidities were evident among the elderly and modern medication was the greatest choice. Improved perspective toward health, easy accessibility, and awareness regarding the disease may contribute to the willingness of seeking help for the health-care needs. Social support services, informal education, awareness programs targeting senior citizens, and studies covering a diverse population are recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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