Study on Factors Associated with Depression among Elderly and Comparison of Two Scales Used for Screening

Background:

Depression is one of the most frequent illnesses found among the elderly. ICD-10 scale and Geriatric Depression Scale (GDS) are used commonly for screening and hence it is important to identify the scale which can be used more effectively in community settings.

Objectives:

(1) To analyze the factors responsible for the elderly depression and (2) to compare two scales used for the screening (ICD-10 and GDS).

Materials and Methods:

A cross-sectional house-to-house survey was carried in Sayla taluka of Surendranagar district by directly questioning the subjects after oral and written consent. The selection of taluka was done using simple random sampling and sample size was calculated on the basis of estimated geriatric population. 306 subjects were interviewed using a predesigned, pretested, and validated questionnaire.

Results:

GDS showed the prevalence of 16% whereas ICD-10 showed 22%. The factors associated with depression were physical health, poor economical situation, and avoidance by family members. The agreement between the 2 scales using Cohen's kappa statistic showed excellent agreement.

Conclusion:

Community-based multiphasic screening programs is needed for early diagnosis of geriatric depression. ICD-10 having lesser number of questions can be used in the 1^st phase of screening and those found positive can then be tested by GDS.

Does the social status of the elderly impact morbidities among them? – A cross sectional Study in a district of Gujarat

Background: The aging population is both medical & sociological problem for the country and they suffer with high rates of morbidity and mortality. So Social factors lay a significant impact on the health practices and this study will help us to understand and evaluate their health problems of elderly. Aims and Objective: 1. To assess the social status of elderly population. 2. To associate the findings with morbidities of elderly Methods: A cross sectional study was carried out in urban and rural area of Surendranagar district among 611 elderly, using a predesigned and pre tested questionnaire by directly questioning the subjects with oral and written consent. For selection of the area, in both areas, the sampling units were enumerated and samples were collected by using simple random sampling, data was entered and analyzed using MS excel 2007. Result: Nearly 60 % of the subjects were currently unemployed and the predominant family system was 3 generation family. Majority of the families in the urban areas were from social class 4, whereas in the rural areas were from social class 5. Having poor social score had a statistically significant association with presence of morbidity in elderly both areas. Conclusions: Majority of elderly in both urban and rural areas had a poor social status. Role of the family and social structure on the health of the elderly can be clearly established. However, support structure must be developed in our social system in a way that the destitute and dependent elderly are taken care of by either government system or social organizations like NGOs and old age home.

Epidemiology of animal bites and rabies cases in India. A multicentric study

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.