Morbidity profile of elderly attended / admitted in Jeddah health facilities, Saudi Arabia

Ibrahim NK, Ghabrah TM, Qadi M

Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Kingdom of audi Arabia

Abstract A cross!sectional study "as conducted to determine morbidity profile and predictors of increased number of morbidities among ##$% elderly attended & admitted in Jeddah health facilities' !esults( About one!fourth of elderly reported poor self!perceived health, )*') + "ere dependent on others in their activities and )#', + utilized - ) drugs& day' Diminished vision "as the commonest complaint "hile the most prevalent diseases "ere diabetes mellitus, arthritis and hypertension' .he number of morbidities ranged from ,!$ "ith a mean of #',, / ,',$' 0n multivariate analysis, the predictors of increased morbidities "ere obesity 1234 ,'5)6 78 + C04 ,')*!#'%%9, feeling depressed 1234 ,'$%6 78 + C04 ,'#$!#',)9, advanced age, stop "or:ing and female gender' 0t is recommended that there is a great need 'for increasing elderly medical and social care

INT!"#$%TI"N 0n recent years, there has been a sharp increase in the number of older persons "orld"ide more old people are alive no"adays than at any time in history'
1#9 1,9

and

.he proportion of the

population aged $; and over, is also gro"ing each year' <y the year #;#8, the "orld "ill host ,'# billion people aged $; and over and rising to ,'7 billion in #;8;'
1)9

.he same trend is also

predicted in the =M36 "hile the proportion of the elderly population to total population "as 8'5 + in #;;; it e>pected to reach 5'* + by year #;#8 and ,8'; + by #;8;'1%9 .he demographic transition "ith ageing of the population is a global phenomenon "hich demands international, national, regional and local action' 1%,89 0n recent years there has been an increasing international a"areness of health issues relating to aging populations' 1$9 ' .raditional perceptions of old age have been challenged during the past fe" years and it is important that elderly people are not ta:en as a burden on society, but rather as an asset'18,$9 .he health problems of the elderly are complicated by social, economic and psychological interactions to a greater degree than younger people' Moreover, these problems are usually multiple and are often mas:ed by sensory and cognitive impairments so that special s:ills are re?uired to detect them' .hese factors contribute to a "orsening of morbidity and mortality' 1*9 Morbidity among elderly people has an important influence on their physical functioning and psychological "ell!being' Many elderly have several disorders at the same time' .he incidence of diseases increases "ith age'
159

.he importance of early surveillance of the health needs of

elderly people has been emphasized, Kno"ledge of the situation and circumstances of the elderly population is essential to the provision of cost! effective services and the planning of strategies for intervention and care' 1*9 @ittle is :no"n about the health needs of elderly population'
179

Assessment of the morbidity

profile "ill help in the application of interventions, to improve the health status and the ?uality of life of the elderly' .he obAective of this study "as to evaluate the morbidity profile and predictors of increased number of morbidities among the elderly patients attended & admitted in Jeddah health facilities'

MAT&!IA' ( M &T)"#S A cross sectional study "as conducted among all elderly 1aged $; years and above9 attended & admitted in health facilities "hich deliver health care for elderly in Jeddah governorate, during the study period of the year #;;8' All hospitals either governmental 1* hospitals9 or private 1#8 hospitals9 in addition to ,* randomly selected primary health care facilities from the total of )5 primary facilities "ere included in the study' .he data "ere collected through intervie"ing ?uestionnaire, revie"ing of records, and ta:ing some measurements' Inter*ie+in, -uestionnaire All elderly attended & admitted in the selected health facilities on the day of intervie" "ere recruited' A pre!designed ?uestionnaire "as used to collect information about personal and socio!demographic data, presence of a caregiver , personal habits and perceived health' Functional capacity of elderly "as in?uired by as:ing about the ability of elderly to conduct the basic activities as "al:ing, bathing, using the toilet, dressing, eating, and getting in and out of home "ithout need of help' .he main physical B psychological complaints "ere in?uired' 0n addition, diagnosed chronic diseases "ere in?uired by as:ing about the presence of chronic diseases diagnosed by physicians B & diseases "ritten in the patientsC record' !e*ie+in, of records A cross!chec:ing of medical records of intervie"ed patients "as done' .he clinical diagnosis "as ta:ing according to physician based report' .he main diagnosis, associated diagnosis "ere revie"ed' All investigations "ere also revie"ed' .he total numbers of morbidities "ere calculated according to the main and associated diagnoses' Measurements .he "eight B height "ere ta:en' .he body mass inde> 1<M09 "as calculated' 1<M0 4 Deight in :g& height in meter s?uare9' Statistical analysis .he statistical analysis "as conducted using t"o statistical pac:ages6 E version ,) and =pi!0nfo version $';%' Chi!s?uare, independent sample t! test and AF2GA tests "ere performed' Multivariate regression analysis using step"ise regression model "as done for controlling and adAusting of all confounding factors'

!&S$'TS .he total number of elderly in the study amounted to ##%$ persons' ."o! thirds of elderly "ere recruited from governmental health facilities 1hospitals and primary care facilities9 "hile one third of the sample "as recruited from private hospitals' About one! fifth of the elderly 1#,'$ +9 "ere inpatients "hile the rest "ere recruited from outpatient clinics' .able 1,9 portrays personal and socioeconomic characteristics of elderly' Males represented $#'* + of the sample' .he age of elderly ranged from $; ! ,;% years "ith a mean of $*'7 / *'*, years, about t"o fifths of the sample aged *; years B above' About three! fourths "ere audi' Dido"ed elderly represented about one! fifth 1#,'5 +9 of the sample' .he maAority of elderly 1*5'% +9 had less than secondary education' Almost all geriatric subAects in the present study lived "ith their families and "ere cared for by family members 17)'$+9, "hile only $'%+ lived alone .able 1#9 sho"s that )7 '; + of elderly perceived their health as good, "hile about one fourth 1#)'8 +9 of the sample rated their health as poor' .he percentage of females "ho perceived their health as poor "as higher 1),'# +9 than males 1,7'; +9' .he differences bet"een both se>es has a highly statistical significant difference 1 X2 4 $$'5, p4;';;;;9'.he table also sho"s that about t"o!fifths 1)*') +9 of elderly "ere dependent on others in their usual daily activities6 #)'8 + "ere dependent in ,!) of daily activities and ,)'5 + for more than ) of their activities' .he number of utilized drugs by elderly patients ranged from ;! ,; drugs "ith a mean of #'75 / #'#*' About one third 1)#', +9 of elderly "ere on more than three medications' Females utilized e>cessive number of drugs compared to males "ith a high statistical significant difference 1X2 4 #,')7, p4;';;;9'.he number of elderly morbid conditions ranged from ,! $ diseases "ith a mean of #',, / ,',$' About t"o! fifths 1)7'% +9 of the elderly had one disease "hile $;'$ + had t"o or more morbid conditions' .able 1)9 demonstrates physical and psychological complaints of elderly' Diminished vision "as the most fre?uent physical complaint 1$,'8 +9 "hile diminished hearing "as encountered among );'$ + and #8'$ + of elderly complained from dementia' 3egarding psychological complaints6 rapidly angry "as the commonest one 1$,'% +9' .he table also

portrays that females sho"ed higher percentages of all physical and psychological symptoms than males' 3egarding physical complaints, they "ere more susceptible to repeated falling 1234 #',;6 78+ C0( ,'$$!#'$%9, urinary incontinence 1234 ,'*%6 78+ C0( ,')% !#'#$9' 3egarding psychological complaints females "ere more than t"o times more prone to feeling of depression 1234 #'),6 78+ C0( ,'7)!#'**9 and insomnia 1234 #';;6 78+ C0( ,'$* !#'**9' .able 1%9 sho"s the morbidity profile of the elderly, it is apparent from the table that diabetes mellitus "as the commonest elderly disease 18)'$ +9, follo"ed by arthritis 18#',#+9 and hypertension 18;'%+9' Females "ere at higher ris:s of having many types elderly diseases compared to males' .he highest ris: "as for osteoporosis 1234 %'5#6 78 + C04 )'7)! 8'7)9, follo"ed by arthritis 1234 #',$6 78 + C04 ,'5,! #'879 and psychological problems 1234 #',%6 78 + C04 ,'85! #'7;9' 0n addition, females "ere also at higher ris:s of having bronchial asthma, cancer, C2ED and eye diseases' 2n the other hand, they "ere slightly less susceptible to diabetes mellitus and renal diseases' .able 189 illustrates the relationship bet"een the numbers morbidities and the studied variable' Higher number of morbidities "as observed among females compared to males "ith a highly statistical significant difference 1t4 8'%,, p4 ;';;;9' Age!"ise, higher mean morbidities "as noticed "ith advancing age and a highly statistical significant difference "as present 1F4 ,#'8), p4 ;';;;9' @o"er morbid conditions "ere observed among married elderly compared to others' <ased on <M0, lo"er morbidity "as found among non obese elderly' Fon practicing e>ercise "as associated "ith higher numbers of morbidities compared to those "ho practicing e>ercise' <ased on psychological condition of elderly, those "ho "ere still "or:ing, those having no family or social problems and "ho didnIt feel loneliness or depression encountered less number of morbid conditions compared to others' 1pJ;';;;;9 Multivariate regression analysis 1.able $9 sho"s that the first predictor of increase number of morbidity "as obesity6 obese elderly "ere at ,'5) times increased ris: of multiple morbidities compared to non!obese' .he second predictor "as feeling depressed6 participants "ho felt depressed "ere ,'$% times more liable to increased morbidities' .he follo"ing predictor is advanced age, elderly aged *; years and above "ere ,'$, times more prone to multiple

morbidities compared to those aged $;! $8' 1234,'$,6 78 + C0( ,'#$! #',)9' 2n the other hand males, elderly "ho "ere still "or:ing "ere favorable of decrease morbidity number compared to females and those "ho stop "or:ing' #IS%$SSI"N Health status is an important factor that has a significant impact on the ?uality of life of an elderly population' .he maAor elements of health status are perceived health, especially psychological "ell!being, chronic illnesses, and functional status' 159 Almost all geriatric subAects in the present study lived "ith their families 17)'$+9 this result agrees "ith result of a study from Abha city' 1*9 3esults of the present study revealed that poor perceived health "as reported by #)'8 + of elderly6 ,7'; + by males and ),'# + by females' .hese rates are much better than those reported by Kadava et al, 0ndia, their corresponding figures "ere )*+ and *;+ among both se>es respectively' 1,;9 .hese differences may be attributed to differences in socioeconomic level and health care delivered to elderly patients in both audi Arabia and 0ndia' 2n the other hand, )7'; + of elderly in the present study rated their health as good "hich is lo"er than rates reported from a panish study 1%7'8 +9 1,,9 and a ingaporean study 15# +9' 1,#9 Eresent results sho"ed that )*') + of elderly "ere dependent on others on conduction of their activities' 3esults obtained from a study conducted in Ale>andria, #;;), revealed that about one fourth of elderly cancer patients "ere dependent on others on more than one of daily functions'
1,)9

A@ L Doghether et al , #;;%, 1,%9 reported that ,7 + of ,;; elderly attended one EHC in 3iyadh governorate, audi Arabia, "ere on more than three drugs, "hile the corresponding figure from the current study "as )#', +' .hese differences may be because elderly in the present study "ere recruited from both hospitals and EHC facilities, and hospitalized elderly 1especially inpatients9 usually utilize more number and have more severe form of diseases and accordingly they consumed e>cessive amount of drugs than EHC attendance, or the difference 'may be due to difference in sample size in both studies High rates of co!morbidity present a challenge in providing care to elderly' A@ L

Doghether et al, 1,%9 reported that 8$ + of elderly had t"o or more diseases' A slightly higher finding 1$;'% +9 "as obtained from the present study' 3egarding elderly complaints, more than t"o! thirds of elderly in the present study complained from diminish vision "hich agrees "ith result of 0ecovich et al , #;;), 1,89 "ho found that the maAority of elderly in their study reported visual problems' Eresent results sho" that #8'$ + of elderly complained from dementia "hich coincides "ith the percentage reported among elderly in Hong Kong 1#*';+9' 1,$9 3esults of the present study revealed that female subAects encountered more physical complaints compared to males' Urinary incontinence "as ,'*% more prevalent among females and this coincides

"ith results a study reported from Ale>andria, #;;;' 1,*9 Esychological symptoms "ere also more encountered among females6 feeling of depression among females "as #'), times higher than males' .his goes on line "ith results from Abha city6 female geriatric subAects "ere #'$ times more li:ely to suffer from depression than males' 1*9 .he audi Arabia is a rapidly developing country "ith changes that influence life!style of people to"ards urbanization "ith more progression to"ards epidemiological transition' Diabetes is present in epidemic proportions throughout concentrated in urban areas'
1,59

audi Arabia "ith e>ceedingly high rates

3esults of the present study revealed that diabetes mellitus "as

the most common chronic disease 18)'$ +9 diagnosed among elderly patients' Al! Fozha et al, #;;%,
1,59

in a Fational Community <ased urvey in the audi Arabia found that the prevalence

of diabetes among elderly population aged $;!*; years "as )$'8 + and other ,%'7 + sho"ed impaired glucose tolerance' .he higher figures obtained from the present study may be because the age of elderly in present study ranged from $;!,;% years and not Aust elderly $;!*; and as it is :no"n there is an increase in the rates of diabetes "ith advanced age, or the difference may be because the present study conducted among elderly patients not among the general elderly population' .he stri:ing high figures of elderly diabetes obtained from these t"o studies "ere

higher than may parts of the "orld

1,7 !#,9

may indicate that there is dramatic increase in rate of

diabetes especially "ith advanced aging and indicates that the ris: factors of increased diabetes in increasing in audi Arabia' 1,59 A study from the U A reported that arthritis "as the most prevalent 1%5'7 +9 chronic condition among elderly M $8 years, follo"ed by hypertension 1%;') +9' 1##9 0n the present study, Arthritis "as the second most common disease 18#',# +9 among elderly patients follo"ed by hypertension 18;'% +9' .he lo"er figures reported from the U A are probably the reflection of their community based study' 0n ingapore study, %$ + of elderly in a population based study had hypertension' 1,#9 0n the present study, psychological problems "ere more encountered among females and this agrees "ith results of Hafez et al, #;;)'1#)9 3esults of the current study sho"ed that 0HD "as more encountered among males compared to females and ##'* + of elderly had these diseases' 3esults from the Fational Community <ased urvey in the audi Arabia revealed that male gender "as a ris: factor of 0HD and the

prevalence among elderly aged $;!*; years "as lo"er 17') +9' 1#%9 .his difference may be due to differences in the age group or the type of the target population' .he mean number of morbidities among elderly in the present study "as #',, /,',$, and it "as significantly higher among females 1#'#5 / ,'#;9 compared to males 1#';; / ,',#9' .hese results approach those of Fuchs et al
1#89

"ho found that the mean morbidity number among 2n the other hand, the reported mean

females "as #'% /,'$ and ,'7 /,'% among males'

morbidities from the 0ndian study "as much higher in both males and females'159 0t "as noted from the present study that the number of morbid conditions increased among those "ith poor self rated health' A study conducted in #;;# among ,;; elderly in =l! Minia governorate 1=gypt9 sho"ed that there "ere positive relationship bet"een functional health status and perceived health status'
1#$9

0t is clear from the present study that morbidity

number increased among elderly e>periencing family or social problems "hich agrees "ith results of Kadava et al' 1,;9 0n the elderly, obesity contributes to the early onset of chronic morbidity and functional

impairment and is related to premature mortality'

1#*9

2besity significantly increases the chance

of developing diabetes, coronary artery disease, and stro:e' 1#59 0n the present study, obesity "as the first predictor of increased morbidities among elderly' .here is an implicit assumption that disease and deterioration of ill!health are inevitably associated "ith chronological ageing'
1*9

.he results of the present study sho"ed that increase

number of morbidities "as associated "ith advanced aging "hich agrees "ith results of under et al 1#79 "ho observed that multiple morbidities "ere more common "ith advanced age' Johsi et al 159 reported that the age "as among factors "hich predict increased morbidity'

%"N%'$SI"N AN# !&%"MM&N#ATI"NS About one!fourth of elderly in the present study reported poor self!perceived health and the number of morbidities among elderly ranged from ,! $ "ith mean of #',, /,',$ diseases' .here is an alarming high rate of diabetes mellitus and hypertension among elderly' 2besity "as the most important modifiable ris: factor for increase number of morbidity, females and those felt depression "ere more susceptible' De recommend that there is a need for promotion of healthy lifestyles and behavioral changes through conduction of community!based health education program' .he program should insist on modifying ris: factors especially those causing obesity' .his in tern leads to tac:ling the chronic health problems among ageing population by decrease the prevalence of many morbidities and also decreasing co! morbidities' creening programs for chronic diseases, especially for diabetes and hypertension, is highly recommended among elderly population' .here is also a need for satisfactory living condition for elderly6 satisfy psychosocial needs, increase recreational activities for elderly involvement of elderly in doing useful activities'

Ac.no+led,ment .he authors "ould li:e to than: all persons "ho participated and help in accomplishing this "or: and also "ould li:e to than: all the elderly' pecial than:s to fourth year medical students in Family and Community medicine department , King Abdul!Aziz University, Jeddah'

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