Abstract
Introduction:
The proportion
of the elderly population in the United Arab Emirates
is constantly growing. The aging population presents
a challenge for the public healthcare system.
Accurate health data is required both from an
epidemiological and strategic health care planning
perspective.
Objectives: To estimate the prevalence
of disease, impairment and disability among the
elderly.
Methodology: A retrospective study was
carried out and records of comprehensive assessment
forms of elderly patients aged 60 years and over
registered in the elderly home based primary care
at Dubai Health Authority were reviewed and analyzed.
Results: The gender ratio of the elderly
patients in the study was 2.1 female: 1.0 male.
The mean (SD) age was 78.77 (9.50) years. The
majority of elderly patients (70.4%) had 4 or
more multiple chronic conditions. The most common
prevalent disease was hypertension (67.5%), followed
by dementia (57.8), diabetes mellitus (52.4%),
osteoarthritis (45.6%) and cerebrovascular accident
(38.8%). Almost 70% of elderly patients were either
bed bound or chair bound. Functional Assessment
(ADL) showed that, only 5.8% of elderly patients
were independent.
Conclusion: This study provides a valuable
insight into the magnitude of disease, impairment
and disability among elderly patients. It revealed
that, the prevalence of multiple chronic conditions
is high. The aging population continues to need
a high quality care program, focused on managing
multiple chronic conditions and preventing impairment
and disability in order to improve health and
quality of life of elderly.
Key words:
Elderly, Diseases, Impairment, Disability, Dubai
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Introduction
Ageing is a universal process and it affects every individual,
family, community and society. It is a normal, progressive
and irreversible process. Ageing is generally defined
as a process of deterioration in the functional capacity
of an individual that results from structural changes,
with advancement of age. (1) Population ageing is a
global phenomenon. The proportion of the elderly population
is growing much faster than the overall population due
to decreasing fertility and increasing life expectancy.
(2)
The Eastern Mediterranean Region is witnessing an increase
in the number and percentage of the population aged
60 and above. In 2000, the number of persons aged 60
and older in the region was around 26.8 million (5.8%
of the total population). By 2025, it is projected that
the percentage will increase to 8.6% and in 2050 the
elderly will make up 15% of the population. (3)
The same trend is observed in the United Arab Emirates
(UAE); the proportion of elderly population is increasing
constantly. The proportion of elderly population in
the UAE aged 60 years and above was 5.1% in 2000 and
is expected to increase by more than four fold in 2025
(23.6%). In addition, life expectancy had increased
from 74 years in 2000 reaching 78 years in 2013.
This could be attributed to the improvements in the
standards of living, health care facilities and prevention
of many communicable diseases.(3)
Health status is an important factor that has a substantial
influence on the quality of life of the elderly
population. Many health problems are known to increase
with age. The health problems of the elderly are usually
multiple which results in a rapid decline in health
status and a greater likelihood of disability. (4)
Understanding the disability process may help elucidate
interventions needed to improve the elderly's general
health status. Impairments have been considered an intermediary
between chronic disease and disability. For example,
elderly patients with chronic arthritis may develop
mobility impairment. Due to mobility impairment, the
elderly may become unable to carry out tasks which are
essential for independent living. (5-7)
The aging population presents
a challenge for the public healthcare system. Accurate
health data is required both from an epidemiological
and strategic health care planning perspective. Many
countries have been making tremendous efforts to improve
the understanding of the health status of this age group.
This is especially important when characterizing elderly
who are at greatest risk for disease, impairment and
disability. (3,8)
There have been few studies on the health profile of
the elderly in Arab countries in general, and in the
Gulf Area in particular. A study was conducted in Saudi
Arabia (2011) which reported that 50.4% of elderly had
four or more chronic health conditions. (9)
Objective
Objective of the study is to estimate the prevalence
of disease, impairment and disability among the elderly.
Methodology
Study design & setting
Retrospective study was conducted in Primary health
care sector at Dubai Health Authority.
Target population
Elderly patients aged 60 years and over registered in
the elderly home based primary care (EHBPC) at Dubai
Health Authority from 2011- 2013.
Data collection
Records of comprehensive assessment forms of elderly
patients were reviewed and analyzed. Indications for
service were:
Elderly patient with
physical, cognitive or social disability which prevents
them from attending health care.
Elderly patients requiring follow up care post
hospitalisation.
Elderly patients who require special nursing
care.
The comprehensive assessment
form was filled in by the physician. It includes the
following sections:
System review section includes: cardiovascular,
respiratory, gastrointestinal, endocrine, neurological,
mental, musculoskeletal, cancer, kidney and liver diseases.
Impairment section includes: vision, hearing,
mobility (bed bound or chair bound) and urinary incontinence.
Disability section includes: activities of daily
living (ADLs) and focuses on six basic activities: bathing,
dressing, toileting, transfer, continence and feeding.
Each activity is categorized as follow (independent,
assisted, totally dependent). A score of (1) means independent,
score of (2) means assisted and score of (3) means totally
dependent. The maximum total score of ADLs questions
is 18 points and categorized as follows: score of 6
= independent, 7-17 = assisted and 18 = totally dependent.
Statistical Analysis
Statistical Package for social science (SPSS) program,
version 20 was used for analysis of data as follows:
Descriptive statistics were carried out in the
form of mean, standard deviation, and range for quantitative
values.
Frequency and percentage was done for qualitative
variables.
Results
The present study comprised 206 elderly patients. The
age ranged from 60-113 years with a mean of 78.77 ±
9.50. The gender ratio of the elderly patients was 2.1
female: 1.0 male. (Table 1)
Table 1: Distribution of
elderly patients registered in EHBPC in Dubai according
to socio-demographic characteristics
Table 2 illustrates the prevalence of multiple chronic
conditions among elderly patients. There was a high
level of morbidity, with two chronic conditions experienced
by 11.7%, three conditions by 18.0% and four or more
conditions by 70.4% of the elderly patients. The number
of elderly chronic conditions ranged from 2-8 with a
mean of 4.62 ±1.62.
Table 2: Prevalence of multiple chronic conditions
among elderly patients registered in EHBPC in Dubai
Table 3 reveals that, a total
of 30 diseases were reported in this study; the most
prevalent disease was hypertension (67.5%), followed
by dementia (57.8), diabetes mellitus (52.4%), osteoarthritis
(45.6%) and cerebrovascular accident (38.8%). Diseases
of the neurological system were more prevalent among
elderly males. Osteoarthritis and osteoporosis were
more common among elderly females (48.2% and 25.9% respectively)
in comparison to elderly males (40.3% and 10.4% respectively).
The least prevalent diseases were colon cancer (0.5%),
thyrotoxicosis (1.0%) and breast cancer (1.5%).
Table 3: Distribution of diseases among elderly patients
registered in EHBPC in Dubai according to sex
Concerning the prevalence of
impairments, Figure 1 displays that, more than two thirds
of the elderly patients had mobility impairment and
urinary incontinence. Moreover, one third of the elderly
patients had visual impairment and almost one in five
had hearing impairment.
Figure 1: Prevalence of impairments among elderly
patients registered in EHBPC in Dubai
Figure 2 summarizes the distribution
of elderly patients registered in EHBPC in Dubai according
to Activities of daily life (ADLs). The figure demonstrated
that only 5.8% of elderly patients were independent.
Figure 2: Distribution of elderly patients registered
in EHBPC in Dubai according to Activities of daily life
(ADLs)
Discussion
The United Arab Emirates like most countries
in the world is facing the challenge of an ageing population.
Elderly Primary home care service is a vital source
of health care for the aging population which helps
maintain elderly patients in their own homes with a
multi-disciplinary team approach. The recent increases
in the proportion of elderly has raised attention to
issues concerning the morbidity profile of this potentially
vulnerable age group. The Physical functioning and psychological
wellbeing of elderly are influenced by their morbidities.
(10)
In this study, it was observed that the average number
of morbidities among elderly patients
was 4.62 ±1.62, which
is lower than an Indian study (2000) (10) but higher
than other studies in Korea (2003) (11) and Saudi Arabia
(2011) (9) where the mean number of morbidities among
the elderly was 1.62 ± 1.35, 3.7 ± 1.70
and respectively.
The differences in morbidity
can be partly explained by the differences in the racial
and ethnic origin of the study population. Moreover,
in this study, morbidity was assessed by a physician
which could partly explain the reason for higher morbidity
as physician assessment generally tends to be more comprehensive.
In the current study, hypertension
was the most common chronic disease among the elderly.
The finding is consistent with previous studies in India
(1999) (12) , Korea (2003) (11) and Saudi Arabia (2011).
(9) A systematic review of the overall worldwide prevalence
of hypertension, showed no gender difference. (12) This
study further supports this finding.
Diabetes mellitus is a public health concern in the
United Arab Emirates. The increasing prevalence of diabetes
mellitus is well documented. The risk of developing
diabetes increases as the age increases. A study was
conducted among the elderly population in the UAE by
Margolis et al and reported that the prevalence of diabetes
was high.(14) This finding is in accordance with the
present study which revealed that diabetes mellitus
was among the top most common chronic diseases among
elderly patients.
The rapid urbanization and social modernization in the
United Arab Emirates has brought transformation in the
family structure from the extended family towards the
nuclear family. This change has brought breakdown in
the framework of family support and social isolation
leading to a host of psychological illnesses among the
elderly. Furthermore, impairments and disabilities among
the elderly increase the likelihood of physiological
illness. It has been documented that the elderly are
more prone to psychological problems and depression
is the commonest geriatric psychiatric disorder.(15,16)
In view of this fact, the current study showed that
38.3% of the elderly patients had depression.
The prevalence of depression
is comparable with previous studies in the UAE (2004)(17),
Jordan (2004)(18), Sudan (2010)(19), and India (2010).(20)
Depression in the elderly is an illness that should
be diagnosed and treated early in order to speed up
remission rates, prevent relapse and improve the elderly's
quality of life.
Visual impairment among the elderly is a major health
problem. With advancing age, the normal function of
eye tissues decreases and there is an increased incidence
of ocular pathology. Visual impairment was the single
most important cause of preventable impairment among
the elderly aged 60 years and above as reported by Venkatorao
et al in India study.(21)
In this study, one third of the elderly patients had
visual impairment. This emphasises the urgent need to
screen for visual impairment among the elderly population
as elderly patients may not complain of or recognize
that their vision is impaired.
ADLs refer to a basic set of everyday activities or
tasks that an individual should be able to perform in
order to live independently. ADLs are widely used in
developed countries as predictors for the need for long-term
care either in the community or in institutional settings.
(22) In the current study, 39.8% of the elderly patients
were dependent. This finding is higher than studies
in Saudi Arabia (1995)(23) and Oman (2010)(24) where
18.8% and 25.2% of the elderly were respectively dependent.
This could be explained by this study being conducted
among elderly patients and not among the general elderly
population.
Conclusion
This study provides a valuable insight into the magnitude
of disease, impairment and disability among elderly
patients. It revealed that the prevalence of multiple
chronic conditions is high. This emphasises the need
for high quality care programs, focused on managing
multiple chronic conditions and preventing impairment
and disability in order to improve health and quality
of life of elderly.
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