Shova Khanal, MIPH (Australia); MScPH (Nepal) Krishna M. Gautam, MSc Economics (Australia)

Abstract

This study explores the prevalence of chronic diseases and health care management practices in three old age homes in Kathmandu. The study showed that more than half of the residents were diagnosed with at least one chronic health problem. In general, females suffered more compared to males. All old age homes faced a lack of trained human resources and financial constraints. The study highlights the urgent need of developing fundamental guidelines to improve the care services.

Introduction

Nepal is a developing country experiencing a rapid increase in the elderly population. The total population in 2010 is estimated to be about 28 million of which nearly 8% are aged 60 and over. The percentage of the elders is estimated to double by 2017 (USAID, 2009). With the aim of delivering quality services to older people, a number of old age homes are registered, mainly in Kathmandu, with only one fifth of them actually in service. Older people are considered to be one of the most vulnerable groups in society, often suffering from a multitude of health problems, however, very few studies have been done to identify and manage their health care needs (Lions Club, 2009; Tiwari, 2010; GCN, 2010). In this context, this study aimed to assess the common geriatric health problems being faced by older people with a specific focus on the current health care facilities and disease management system in old age homes.

Methodology

The study included interviewing a total of 267 male and female residents, 60 years of age and above, living in three old age homes in Kathmandu. In order to collect more information, medical records of each resident were thoroughly reviewed covering a period of one year (from Nov. 2009 to Oct. 2010). In addition, health professionals and managers were interviewed to gain broad understanding of the health management system in the homes. Direct observations were made to assess the availability of physical resources and medical facilities required to provide a good quality service to the residents. The collected data and information were then analyzed using basic statistical tools available in Microsoft Excel.

The three selected homes were: Pashupati Old Age Home, Nishahaya Sewa Sadan and Aamako Ghar (Table 1). The Pashupati Old Age Home is a government funded care home with a capacity of 230, the latter two being run by NGOs. The occupancy rate is generally high in all homes ranging from 83% to 98%. Majority of the residents (54 %) belong to 70-79 years age group with 25% falling in 80 to 90 years group. Interestingly, the number of the famale residents was much higher compared to males (64% and 36 % respectively).This is probably due to the fact that in Nepalese society older women are traditionally a more neglected group. In addition, the occupancy of the homes was found closely linked with the ethnic caste system where most of the residents belonged to the so-called higher caste groups (such as Brahmin, Chhetri, Newar, etc). There were no residents who belong to the so-called lower castes – still considered “untouchable” people in Nepalese society.

Table 1: Type, capacity and occupancy in the study care homes


Assessment of health condition It was found that more than half of the residents had health related problems. The prevalence of poor health condition of the residents has been documented in other similar studies (Acharya, 2007). The residents were found suffering from a number of diseases with gastritis and hypertension most common. Female residents were found to be in poorer health as compared to males (Table 2).

Table 2: Prevalence of disease/disorders among the residents by gender




Almost 10% of the residents suffered with arthritis. An equal number of the residents were found affected by various infections that included eye, chest, urinary tract, cellulites and fungal infections. There were four cases of leprosy under treatment, one TB (cured) and one typhoid (under treatment). Other general problems that were observed included hernia, uterine prolapse, fracture, prostate enlargement, indigestion, fever, body-ache, joint pain, stomach pain, constipation, cough, allergies, pulmonary cancer, piles and varicose veins.

From a gender perspective, it was found that female residents suffered with single to multiple problems compared to males (Fig 1). This is consistent with a similar study conducted in five countries of South East Asia (Minh et al., 2005).

Fig.1: Diseases/ disorders by gender

Management of Geriatric Diseases

Each home had a volunteer doctor providing service for 2 to3 days a week. Each of the homes was found to be severely understaffed. The government standard ratio of health staff and residents is 1/10 (Tiwari, 2010). However, the ratio in the government-run home was found to be 1/112. On the top of that, no health professionals were deployed in other two homes. In addition, the care professionals serving in the old age homes had never attended any professional training.

Basic level health facilities such as first aid box, oxygen cylinder and drug store were available only in Pashupati home. None of the old age homes had any ambulance service. In addition, the lack of sick room for isolation may lead to disease transmission.

Health conscious activities such as Yoga were regular only in Nishahaya Sewa Sadan. Places for entertainment and religious activities were largely insufficient. Other activities such as recreation, religious talks and gatherings were not organized in a regular basis.

Practice of geriatric rehabilitation was not available, and this may be helpful to decrease the risk of various health conditions. None of the homes supported any patients with hypertension with low salt diet and diabetes cases with low calorie diet as required.

There was no provision of regular investigations of patients with specific diseases such as diabetes and heart disease. Each of the homes had a routine for shower and laundry services. However, sufficient water supply was available only in two homes.

Each home had to pay for medical bills of the residents. Only Pashupati received government budget in the range of 400,000 rupees annually for medical expenses. The other two homes had to manage the costs from charity and donations.

The availability of information was inconsistent in each home due to poor record keeping. This was identified as an obstacle for the planners, managers and others.

Conclusion

This study revealed that more than half of the residents in the old age home studied were suffering from at least one chronic illness. Hypertension, gastritis and arthritis were the most common diseases. Lack of trained human resources and financial constraints were the major issues for the efficient management of health problems. The study highlights the need to establish fundamental criteria and standards that will enable the government and operating agencies to provide improved health care services to older people.

References

Acharya P. ( 2007) Senior Citizens and The Elderly Homes: A Survey from Kathmandu. Dhaulagiri Journal of Sociology and Anthropology, Vol 2, 211-266.
GCN (Geriatric Centre Nepal) (2010) Status Report on Elderly People (60+) in Nepal on Health, Nutrition and Social Status Focusing on Research Needs. [Retrieved on Dec 4, 2010 from http://www.globalaging.org/health/world/2010/nepal.pdf]

Lions Club(2009). Lions Senior Citizens Home. Kathmandu Samakhushi. [Retrieved on Nov. 13, 2010 from http://www.lionsclubs.org.np/senior_citizen_home.php]

Minh H.V, Nawi Ng, Juvekar S. (2008) Self-Reported Prevalence of Chronic Diseases and Their Relation to Selected Socio-demographic Variables: A Study in INDEPTH Asian Sites, 2005Jan ; Preventing chronic diseases. Public health research practice and policy. 2008 July (53); A86. [Retrieved on 12th Oct.2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483549/]

Tiwari S. (2010) An Audit of five Old Age Homes in Nepal. A Thesis Submitted to University of Aberdeen, Department of Public Health for the Partial Fulfillment of Master Degree in Public Health.

USAID Country Health Statistical Report Nepal December 2009. [Retrieved on Nov. 12, 2010 form http://pdf.usaid.gov/pdf_docs/PNADR595.pdf ]