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A comparative study of morbidity pattern in elderly of rural and urban areas of Allahabad district, Uttar Pradesh, India

At the moment, there is no United Nations standard numerical criterion, but the UN agreed cut off is 60+ years to refer to the older population. 1 Populations are growing older in countries throughout the world. While the population of more developed countries have been aging for well over a century, this process began recently in most less developed countries, and it is being compressed into a few decades. 2 The number of elderly people residing in the world was estimated about 841 million in the year 2013, which is four times higher than the 202 million that once lived in 1950.

The demographic transition with ageing of the population is a global phenomenon which demands international, national, regional and local action.
Over the next four decades, India's demographic structure is also expected to shift dramatically from a young to an aging population resulting in 316 million elderly persons by 2050. 4 The percentage of the elderly population in India increased from 5.4 per cent in 1950 to 6.1 per cent in 1990 and is expected to be about 8.7 per cent in 2015, 11.1 per cent in 2025, 12.4 per cent in 2030 and 19.6 per cent in 2050. 5 Several forces are driving India's changing age structure, including an upward trend in life expectancy and falling fertility.
A WHO report states that non communicable disease's account for at least 32% of all deaths in India with a word of caution that this could be an under and inadequate estimation.
The impact should be higher in the geriatric population. According to Government of India statistics, cardiovascular disorders account for one-third of elderly mortality. Respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%.
Neoplasm accounts for 6% and accidents, poisoning, and violence constitute less than 4% of elderly mortality with more or less similar rates for nutritional, metabolic, gastrointestinal, and genito-urinary infections. 7 A study conducted in the rural area of Pondicherry reported decreased visual acuity due to cataract and refractive errors in 57% of the elderly followed by pain in the joints and joint stiffness in 43.4%, dental and chewing complaints in 42%, and hearing impairment in 15.4%. Other morbidities were hypertension (14%), diarrhea (12%), chronic cough (12%), skin diseases (12%), heart disease (9%), diabetes (8.1%), asthma (6%), and urinary complaints (5.6%). 8 Over the past decades, India's health program and policies have been focusing on issues like population stabilization, maternal and child health, and disease control.
However, current statistics for the elderly in India also gives a prelude to a new set of medical, social, and economic problems that could arise if adequate initiative in this direction is not taken by the program managers and policy makers.
There is a need to highlight the medical and socioeconomic problems that are being faced by the elderly people in India. 9 To formulate policies and programmes and for them to function effectively, good approximate measure of morbidity status of elderly should be studied which will provide with such information that are lacking. So, based on above facts the present study was carried out with the objective to compare the morbidity pattern in rural and urban areas of Allahabad district.

METHODS
For setting and study design it was a cross-sectional study carried out on elderly aged 60 years and above selected from rural and urban areas of Allahabad district, by multistage random sampling.
A sample size of 400 was calculated from the research adviser 2006 based on target population of 5,06,123 elderly in Allahabad district, with 95% of confidence interval and 5% margin of error. 10,11 For the data collection informed consent was obtained from the study subjects after explaining the purpose and objective of the study. Data was collected by house to house visits. The study subjects were interviewed and examined. The collected information was recorded on a pre-designed, pretested, semi structured questionnaire. Morbidity was assessed by taking history, doing a clinical examination, reviewing past medical records and medicines taken by the study subject.
The data was analyzed using statistical software, SPSS Version 16. Chi-square tests and Z-test were used to test the associations between the different variables. P value less than 0.05 was considered as significant.

RESULTS
A total 200 elderly each from rural and urban areas were selected. Out of which majority in both groups belonged to age group of 60-70 years followed by 70-80 years. The mean age of the elderly in rural was found to be 68.96 years (SD 7.48) and in the urban area, the mean age was 68.97(SD 7.45).
In rural more than half (64.5%) were living in joint families, followed by (18%) living in third generation families, while among urban elderly, about half (53.5%) were living in joint families, and about (28%) in nuclear families. Majority (70.55%) in rural and (79.5%) in urban were married at the time of study.
More than half (62%) elderly in the rural were found to be illiterate as compared to (25.5%) in urban group. Most elderly in both the group i.e. (53.0%) were either retired from service or were not working at the time of study. More of elderly in rural areas were engaged in agricultural activities (22.5%), followed by (8.5%) who were laborer, while in urban area the proportion of elderly engaged in service and semiskilled work were 7.5% and 5% respectively. The body mass index shows more of rural elderly (38.5%) were underweight, whereas prevalence of overnutrition i.e. (overweight and obesity) were more in urban elderly (27.5%) and (7.5%) respectively. This difference was also found to be statistically significant (Table-1).

DISCUSSION
In the present study more of urban elderly (70.5%) had ocular disease as compared to (66.5%) of rural elderly. Refractive error followed by cataract was most common ocular morbidity observed out of which prevalence of cataract was more common among rural area. Kanfade M et al in a study conducted on elderly in urban area of Nagpur found prevalence of eye disease around 74% and Mahesh C and et al found the prevalence of ocular diseases among elderly around 60% which is nearer to present finding. In the present study, more of urban elderly (61%) had musculoskeletal problems as compared to (58.5%) of rural elderly which is similar to the study conducted in rural area by Sharma D et al and Shankar R et al (58% ) which is again similar to our rural finding. [12][13][14][15] In present study the prevalence of anaemia among rural elderly (43%) was found to be higher than urban elderly (33%), Hakmaosa A et al in rural areas of Assam found prevalence of anemia among elderly around 40% which is similar to our rural finding. 16 In the present study more of urban elderly had hypertension (39%) as compared to (27.5%) of rural elderly, which was also statistically significant.  20 Similar finding was seen in study done in rural and urban area of Pune by RP Thakur & et al where higher proportion of elderly in rural were underweight as compared to urban elderly and overweight and obesity was more common in urban area. In our study more proportion of urban elderly (23.5%) were found to be diabetic as compared to (06%) of rural elderly. 21 Hakmaosa A et al in rural areas of Assam found prevalence of diabetes among rural elderly around 07% which is comparable to our rural finding. 16

CONCLUSION
The present study highlighted that prevalence of certain diseases such as diabetes, hypertension, obesity, and psychological problems were more in urban elderly which could be due to sedentary lifestyle and lack of physical activities whereas the prevalence of anemia, under-nutrition, respiratory and skin problems are more in rural elderly which could be attributed to lower socioeconic status of elderly in rural areas and more involvement in outdoor activities. Comprehensive care including imparting health education and promoting the healthy lifestyle, creating awareness regarding the various geriatric welfare scheme will further enable the elderly to improve their quality of life. The present study will further help in creating felt need health services for the elderly which will enable to decrease the common