Background:

Effective planning of health services depends on properly determining the risk factors. With the collaboration of state and non-governmental organisations; we tried to develop a pilot project of health and social services in the municipality for the elderly according to the requirements and demands of 65+ residents of a district. A cross-sectional study was planned and applied to the elderly who live in the Fatih Veledikarabas district of Istanbul.

The aim was:

• To define the social and economic concerns, health behaviours and their interactions with life quality measurments among citizens in Istanbul, of age 65+.
  
• To determine the risks and requirements.
  
• To develop effective, affordable and accessible elderly care by municipality services.

Materials & Method:

A district (Fatih Veledi Karabas district) was assigned in Istanbul. All contacted inhabitants who were sixty-five years old or more were included. The study group which consists of 250 seniors included 159 female (63.6%) and 91 male (36.4%) subjects (Table 1). After preparation of query documents in collaboration with Istanbul University and training of the staff, all subjects were visited at home. In addition to demographic data and detailed medical history, Activities of Daily Living scales (ADL and IADL), Health Related Quality Of Life Questionnaire Short Form 36 (SF 36), Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) were also performed for all subjects. Daily medicine consumptions (DMC) were also documented.Additionally , research was conducted pertaining to self evaluation of their social and economic circumctances including income, insurance, living conditions, home safety and hygiene, families, social relations, physical activities, nutrition status, expectations from Local Government. Emerged social and/or medical problems have been solved by municipality services during the study. All data was computed using SPSS. Measurements were compared among themselves with correlation while being compared with categoric data by means of Student's t-test. Categoric values were compared among themselves by means of crosstabs.

Table 1. Age dispersion According to sex

Results:

Mean age of the study group was 71,3 (SD=5,53) years. The age histogram was shown in Graphic 1. Population of the district was 11000. Out of the 550 registered elderly, only 250 could be reached. Subjects with Geriatric Depression Scores above fourteen numbered 129 (51.6) %). Cognitive dysfunction was suspected in subjects who achieved less than 26 points on MMSE. This was 115 subjects (46%). But not all these subjects needed psychiatric intervention. After re-evaluation by the family physician, 43 elderly have been referred to Dr. I B K. Only 13 had a psychiatric diagnosis and treatment was prescribed. There was a rather high rate of illiteracy (59%). The rate of those who were on medicines was 26%.

Rate of falls was 26,6% while there were several conditions that higher rates are associated with (Tables 1 to 5). Number of medicines consumed were not found to be correlated with falls. Certain parameters of SF 36 were found to be associated with falls. MMSE and GDS scores were also correlated with falls history; but only the latter was statistically significant. GDS was also higher among those with insufficient social relations as well as poor family relations (Table 6). Both conditions significantly worsened the GDS (p<0.0001). Defective social relationships have been found associated with poorer quality of life scores too (Table 7).

Family relations were found to be associated with quality of life scores also. Those with sufficient family relations have higher:
Bodily pain (BP),
Physical functioning (PF),
Role-social (RS),
Vitality (VT),
General health (GH),
Social functioning (SF),
Role-Emotional (RE), and
Mental Health (MH)scores (p=0,022 for the BP, and p=0,0001 for the others).

As female subjects were found to have some handicaps compared to males, linear regression analysis has been made with different models. Given the GDS as a dependent variable, female sex, and in another regression group, poor income, was found to be associated with higher GDS scores and falls (female sex and GDS: p=0.028, poor income and GDS: p=0.009, female sex and falls: p=0.003)
.
Table 2. Gender and falls (p=0,25)

Table 3. Education and falls (p=0,007)

Table 4. Social insurance and falls (p=0,002)

Table 5. Self-indulgence and falls (p=0,09)

Table 6. GDS and falls, social and family relations (**)

(**): p<0,0001 for all

Table 7. SF 36 scores and falls (*)

(*):Physical functioning (pf): p=0,03
General health (gh): p=0,026
Vitality (vt) p<0,0001
Social functioning (sf) p=0,017
Mental health (mh) p<0,0001

Table 8. SF 36 and social relations (***)

(***): Physical functioning (PF) p=0,001
Vitality (VT) p<0,001
Social functioning (SF) p=0,01
Role-Emotional (RE) p=0,022
Mental Health (MH) p<0,001

Discussion and conclusion:

Falls are a marker of frailty, immobility, and acute and chronic health impairment in older persons. By age 85, approximately two-thirds of all reported injury-related deaths are due to falls. Prevention of falls must span the spectrum of ages and health states within the older population and address the diversity of causes of falls without unnecessarily compromising quality of life and independence⁽¹⁾.

In the United States, National Health Interview Survey's 1984 Supplement on Aging has indicated that the rate of those who report falls in the previous year and who were 65-69 years was 18% for women and 15% for men. That ratio became 27% for women and 20% for men in the age interval of 80-84, and 29% for women and 26% for men among 85+ elderly. In addition to age and female sex, there is also strong evidence that depression and mobility impairment were associated with falls⁽¹⁾. In a study made in the capital of Turkey, in addition to being older than 65 years; gender was determined as a risk factor for falls in logistic regression analysis⁽²⁾. Those findings are consistent with ours.

Depression and anxiety lead to a serious impairment of daily functioning and quality of life. In frail elderly, the effects of depression and anxiety are especially deep and encroaching. Besides a deleterious effect on daily functioning and quality of life, a large number of studies demonstrate excess mortality, disability, handicap and service utilisation⁽³⁾. The Study of Osteoporotic Fractures suggests that depressive symptoms as assessed by the Geriatric Depression Scale (GDS) are a significant risk factor not only for falls but also for fractures in older Caucasian women⁽⁴⁾. In this study, GDS were found to be associated with falls and poorer social and family relations.

Findings obtained in this study are supporting the supposition that elderly with a history of falls were somewhat more exposed to socio-psychological inconveniences. During the primary care practices, falling elderly must be regarded as a high risk group of further deterioration. Depression, especially subsendromal types must be detected in first line health services for the elderly.

Geriatric assessment in rehabilitation and inpatient settings has demonstrated effectiveness in prolonging survival and reducing hospital and nursing home admissions; there is also some evidence it may improve functional status and prevent falls (1). Comprehensive geriatric assesment must be implicated widespread in the primary care settings in order to achieve early detection of the geriatric syndromes and to offer individualised preventive approach for senior citizens. Further studies are necessary to determine the risks for female sex.

References