Health Seeking Behaviour,

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Graying population is one of the most significant characteristic of twentieth century. Recent demographic trends have shown a considerable increase in elderly population all over the world. In 1950 there were about 200 million people over 60 years throughout the world. In the year 2000, this number increased to 550 million, and by 2025 there will be about 1.2 billion. The rate of growth of older population is highest in developing countries. The world population of people over 60 increased by more than 12 million in 1995, and 80% of the increase occurred in developing countries (UN Population Division, 1996). In India elderly population has doubled from 24.7 million (5.6% of total population) in 1961 to 56.7 million (6.8% of total population) in 1991 and is expected to be 70.6 million (6.97%) in 2001 and approximately 113 million (8.94%) by 2016 (Registrar General of India, 1991, 1996).

As age advances, lot of physical, mental and social changes take place. Physical condition may restrict movements, social changes may force dependency and mental conditions may lead to depression and anxiety. To worsen the situation, health problems, especially age-related, may lead to major disabilities. Health care of the elderly has not received adequate attention from policy maker in developing countries, like India as they were pre-occupied with maternal and child health, communicable diseases, malnutrition, and increasing population. One of the possible reason for this could be lack of data on health problems of elderly.

Majority of the India's elderly (78%) population lives in rural areas (Registtrar General of India, 1991). Considering this, the present study was planned with the objective of finding out the prevalence of Self-reported health problems among elderly and the health seeking behaviour of the aged.

This study was conducted in Intensive Field Practice Area (IFPA) of Comprehensive Rural Health Services Project (CRHSP) Ballabgarh in district Faridabad (Haryana). This is a rural field practice area of Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi. This period of data collection was January 1998 to December 1999. Twenty eight villages with a population of 69995 were covered by IFP. Health services are provided by two Primary Health Centres (PHC) Dayalpur and Chhainsa, Covering 8 Sub-Centres (SC) which included two PHC subcentres. The demographic data of all the population is stored electronically in a database, which is updated annually. The sample was selected using stratified random cluster sampling. To take a representative sample, Sub-centres were stratified on the basis of availability of health facility i.e. PHC (Sub-centre (2) and Non PHC sub-centres (6). Sample sub-centres were selected randomly by draw of lots i.e.

–    One sub centre out of the 2 PHC sub-centre

–    One sub centre out of the 6 non PHC sub-centres.

All the villages in selected two sub-centres were included in the study. Each village served as a cluster and all the aged people in the village were studied. This was a cross-sectional study of people, who had completed 60 years of age and had been resident of area for at least six months. A computerized list of eldelrly was obtained from computer data base of study area. Additional cases were identified with the help of health workers and personally by the researchers. If elderly were found to be absent on one visit, another visit was made within 7 days. If they could not be contacted despite two visits, then they were excluded from the study. Personal interviews were conducted in their local language by the researcher in the homes of respondents. An informed verbal consent from each participant was taken. When necessary, subjects were referred for further examination/ investigation and treatment. The approval of the ethics committee was taken for conducting of this study.

The data was collected using semi-structured interview schedule adapted from standardized schedules (Pareek, 1981; Andrews, 1992). Detailed information were collected regarding basic demographic-characteristics, current and past health problems, living conditions, health care practices, and use of medication and health care needs. Recall period for self reported health problems was of one month and of chronic health problems was the last one year. Problems were recorded on the basis of self report or history or examination or records available. Dependency was assessed and categorized into three groups i.e. independent, partlly dependent and dependents. All the interviews and measurement were performed by single investigator.

The data was analyzed using Epi Info 6.04 and SPSS version 7.5 Software. For comparison of proportions, chi-square test was used.

Results

The present study was conducted in 7 selected villages with a total population of 17795. There were, 1,117 aged (>60 years) in this population, comprising 6.3% of the total population. Out of these 1,117 people, 987 (88.4%) could be interviewed and examined. Only 12 (1.1%) people refused to co-operate and rest 118 (10.5) could not be contacted, the reason being, either they had moved away or had died since inclusion in the database of the 987 subjects included in this study, 49.6% were males. Majority of the aged were illiterate (81.6%), living in joint families (82.9%), belonging to lower socio-economic status (48.8%), living with spouse and children (56.0%), presently head of the house-hold (40.1%), not working (64.5%) and fully dependent (71.1%). In general females were more likely to be illiterate (99.0% vs 63.9%), widowed (49.7% vs 20.4%), living alone (4.2% vs 1.0%), having son as head of house-hold (51.3% vs 27.8%), not working (74.4% vs 54.5%), and fully dependent (88.1% vs 53.9%).