Authors:
Dr J P, Majra (1)
Dr. Arpita Gur (2)

(1) MD (Community Medicine), MBA (Health Care Services),
Associate Professor,
Dept. of Community Medicine,
K.S.Hegde Medical Academy, Mangalore. India. 575018

(2) Dr. Arpita Gur,
Reader,
Dept. of Periodontology,
A.B. Shetty Memorial Institute of Dental Sciences
Mangalore, India 575018

Correspondence:
Dr J P, Majra
Email: jpmajra@hotmail.com
Phone no. 919480287990

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INTRODUCTION
The proportion of population of the elderly in most countries is increasing and India is no exception to this. According to the 2001 census, 7.7% of total population was above the age of sixty years. Population aging is both a medical as well as a social problem. The aged become increasingly dependent on others, their reduced activities, income and consequent decline in the position in the family and society makes their life more vulnerable(1). The Indian family (joint) has traditionally provided a natural social security for old people. However, in more recent times, the traditional role of the family is being shared by institutions such as old age homes(2). At present, besides government run old age homes, several voluntary organizations for social welfare and also the religious groups are running these homes. The present study was carried out to know the medico-social profile of the inmates of an old age home.

MATERIALS AND METHODS
The present study was carried out in two conveniently selected old age homes (A and B) in southern India. Due permission to conduct this study was obtained from the authorities of the old age home and the respondents. A pre-tested multiple choice questionnaire in the local language was used to collect the information by face to face interview. All of the inmates of the old age homes were included in the study. Contents of the questionnaire were explained to the inmates of the old age home and they were ensured that a total confidentially will be maintained. As the old age homes were being regularly visited by doctors from a medical college, therefore apart from general physical examination, medical records of the inmates were also used to get information on medical problems. WHO Oral Health Assessment Questionnaire(3) was used to assess the dental treatment needs of the inmates. Data so obtained was compiled and analyzed using appropriate statistical methods such as rates and proportions.

RESULTS
There were 76 inmates in old age home 'A' and 87 inmates in the old age home 'B'. Response rate was hundred percent. Out of a total 76 inmates, men and women were equal in number in old age home 'A' and there were 42 women and 45 men in the old age home 'B'. Sixty four (84.2%) of the inmates in the old age home 'A' were Christians and 12 (15.8%) were Hindus. Whereas, among the inmates of the old age home 'B' 68 (78%) were Hindus, 16 (18%) Christians and three (4%) were Muslims. Out of a total 163 inmates 116 (71%) inmates came from urban areas. The majority, 102 (62.3%) inmates, were educated up to tenth standard or above. The majority 88 (54%) of the residents were in the age group of 80-89 years, followed by 33 (20%), 23 (14%) and 19 (12%) in the age groups of 70-79, 60-69 and >90 years respectively. Average age at the time of joining was 73.6 years. A gradual decrease in the age at joining the old age home over the time was observed (Table 1). The average age at the time of joining was 77.7 years for those who joined the old age home more than ten years before, but it decreased to 74.8 years and 70.5 years for those who joined between the past six to ten years and during the past five years respectively. The majority, 122 (74%) of the inmates, were widows/widowers followed by 35 (22%) unmarried and six were married (three couples). One hundred and four (64%) of the elderly joined the old age home voluntarily and the rest of them were either compelled or left there by others. A good number 127 (78%) of inmates were being visited by their relatives/friends though at the most once in six months, but only a small proportion 21(13%) could visit their relations because of economic constraints as none of the inmates had any income and were totally dependant on the old age home. Thirty one (19%) of the inmates neither visited their relatives/ friends nor were visited by anyone. Most 104 (64%) of the inmates had adjusted to the old age home environment and so were happy but a sizable number 59 (36%) desired to return home if a congenial atmosphere was provided. Ninety one (56%) of the elderly cited 'Not to be a burden on their children' as the most important reason for joining the old age home. Whereas 46 (28%) mentioned negligence by the family members and want for basic needs as the reason for leaving their homes. For 26 (16%) of persons no one was there at home to take care of them.
Table 2 shows that 133 (82%) of the inmates were in need of dental treatment, dental decay and periodontitis being the major problems. All of the 163 inmates were suffering from one or another medical disorders of aging. Hypertension 82 (50%) was the most prevalent medical ailment among the inmates, followed by hearing defects 68 (42%), musculoskeletal disorders 60 (37%), visual impairment 46 (28%), Diabetes mellitus 45 (28%), respiratory illness 24 (15%) and anaemia 10 (6%).

Table 1. Average age at the time of joining old age home

Table 2. Morbidity pattern among the inmates of old age home

DISCUSSION
Population aging is a major issue in the process of demographic transition. Indian society provides a congenial set of conditions for a physically comfortable and emotionally satisfying old age. Elderly people enjoyed a superior status, considerable authority and control over family matters including family property. But the process of change such as modernization, industrialization, urbanization, secularization and changes in women's position has affected the status of the elderly people. It has been revealed that maximum percentage of the elderly were feeling insecure in their own house, neglected by family members and wanted to meet their basic needs. With the family increasingly nuclearized and with the progressive lengthening of the average life span, compounded by diminishing acceptance of family responsibilities towards one's elders, old age homes are being considered as a need of today's changing life styles. The present study reports that most of the elderly in the old age homes under study were suffering from multiple medico-social problems. It has been reported that institutionalized elderly exhibit significantly smaller social networks than non-institutionalized elderly5. It has also been observed that the overall institutional facilities had a positive significant correlation with attitude and health status of the elderly6. Therefore, in a developing country like ours where the social security system is not as developed as in the developed world and absolute number of the elderly being more than the total population of some of the developed countries, but family support system is still there though being weakened, and we have to choose what will be wiser for us, to go for old age homes, or protect our vital institutions like joint family. The matter needs urgent attention for this is our duty that those who have spent their lives for us do not spend the twilight years of their life in isolation, penury and misery. This is time to pay back.

CONCLUSIONS
Most of the elderly in the old age homes under study were suffering from multiple medico-social problems. They deserve a better deal than an old age home can offer.

ACKNOWLEDGEMENT
Our special thanks to authorities of the old age homes for granting permission to conduct this study and the elderly who participated in the study. We are also thankful to the group of interns who helped in collection of data.

REFERENCES
1. Chowdhry D Paul. Aging and the Aged. New Delhi: Inter India Publications; 1992.
2. Mishra Anindya Jayanta. A Study of Loneliness in an Old Age Home in India: A case of Kanpur. Indian Journal of Gerontology. 2003; 17:1-2. Available from: http://www.geocites.com/husociology/oldage4.htm?200718 [accessed on 18 December, 2009].
3. Oral Health Surveys: Basic Methods. Geneva: World Health Organisation; 1997.
4. Gangrade RD. Emerging conception of aging in India. A socio-cultural perspective. In: Bali Arun editor. Understanding graying people of India. New Delhi: Inter India Publications; 1999. p. 36-57.
5. Chadha NK, Kanwar P. Psychological determinants of institutionalized elderly. An empirical study. Indian Journal of Geronology. 1998; 12:27-39.
6. Saroj, Punia Shakuntala, Singh Chandra K, Balda Shanti. Psycho-social status of senior citizens and related factors. Journal of Hum Ecol.2007; 22:255-259.