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Karapitiya Hospital study reveals five most common NCDs among elderly 

07 Mar 2022

  • Targeted interventions required to treat hypertension, diabetes mellitus, ischaemic heart disease, dyslipidemia, and bronchial asthma 
BY RUWAN LAKNATH JAYAKODY  Since hypertension (high blood pressure) was the most common non-communicable disease (NCD) among elders attending the medical clinics at the Karapitiya Teaching Hospital, as per a study, preventive measures such as encouraging them to consume more fruits and vegetables, get involved in regular physical activity, and avoid the use of tobacco, and reduce the consumption of alcohol, salt intake, and saturated fats and trans fats, need to be implemented among them. Also, since the majority of such elderly attendees had low or moderate levels of medication adherence and social support, and since a significant association was found between medication adherence and social support, medication adherence could be improved by enhancing the perceived social support by educating the significant other, the family and friends. These findings and recommendations were made by S. Fernando, W. Uluwattage and B. Sirisena (attached to the said hospital), and D. Rathish (attached to the Rajarata University) in an original research article on “NCDs, medication adherence and social support among elderly medical clinics attendees of the Teaching Hospital, Karapitiya” which was published in the Journal of the College of Community Physicians of Sri Lanka 27 (3) in November 2021. The elderly population, per the Asian Development Bank’s “Growing old before becoming rich: Challenges of an aging population in Sri Lanka”, is increasing with improvements in health and education. The global population of elders is expected to rise to 21.1% by 2050,  and the elders living in developing countries is expected to increase to 80% by 2050, per the United Nations’ (UN) “World population ageing”. E.L.S.J. Perera’s “Ageing population of Sri Lanka, emerging issues, needs and policy implications: Thematic report based on the Census of Population and Housing 2012” noted that Sri Lanka has the highest percentage (12%) in South Asia of those who are 60 years and above.  According to the UN’s “Ageing in the Asian and Pacific region: An overview” which noted that Sri Lankan life expectancies for males and females are 71.2 and 78.5 years, respectively, Sri Lanka will fast move from an ageing to an aged society by 2032. The above trend of population ageing in Sri Lanka would, as F. Kämpfen, N. Wijemunige and B. Evangelista’s “Ageing, NCDs, and old age disability in low and middle income countries: A challenge for global health” pointed out an increase in the prevalence of NCDs.  Moreover, the ageing population could, as explained by M.A. Kaplan and M.M. Inguanzo in “The social, economic, and public health consequences of global population ageing: Implications for social work practice and public policy”, lead to major socio economic consequences.  With the burden of NCDs, the geriatric population is dependent on a wide range of therapies, however, non-adherence to therapy could, as explained by J.G. Hugtenburg, L. Timmers, P.J.M. Elders, M. Vervloet and L.V. Dijk in “Definitions, variants, and causes of non-adherence with medication: A challenge for tailored interventions”, impedes the therapeutic goals. Medication non-adherence could, as B. Jimmy and J. Jose mentioned in “Patient medication adherence: Measures in daily practice”, lead to drug wastage, the progression of the illness, functional disabilities and the poor quality of life. Further, N.A. Chaudri emphasised in “Adherence to long-term therapies evidence for action”, that the lack of social support is associated with non-adherence to medication.  Social support for elders includes, per a Nigerian study, emotional support, access to information, companionship and financial support. Psychosocial wellbeing and social support show, per the Nigerian study, S. Unsar, O. Erol and N. Sut’s “Social support and health-related quality of life among older adults” and a US study, a significant association among elders.  Moreover, low perceived social support is associated with a low quality of life (S. Moser, W. Luxenberger and W. Freidl’s “The influence of social support and coping on the quality of life among the elderly with age-related hearing loss”, psychological abuse (a European study), financial exploitation (P.J. Liu, S. Wood, P. Xi, D.E. Berger and K. Wilber’s “The role of social support in elder financial exploitation using a community sample”) and mortality (D.G. Blazer’s “Social support and mortality in an elderly community population”). Hence, Fernando et al. conducted a descriptive, cross-sectional study at the Teaching Hospital, Karapitiya, in the Galle District of the Southern Province, which had a population of 1,063,334 by 2012 (the aforementioned Census), out of which, 155,996 (15%) were 60 years and above.  All patients attending the medical clinics, aged 60 years or older and who were permanent residents of the Galle District for at least five years were included in the study. Patients with cognitive impairment were excluded.  The number of medical clinic attendees in 2017 was, according to the said hospital’s “Annual report”, 93,623. Fernando et al. assumed that from among them, around 50% would be elders, and therefore roughly 160 patients were expected to attend the hospital’s medical clinics daily. Fernando et al. collected data from every eighth elderly patient on clinic days (all days of the week except on Sundays) for a month. A self-administered questionnaire was used to collect data from the selected subjects.  Out of the 465 subjects who participated in the study, six were omitted from the analysis due to missing data. Most of the study participants were females (459), Buddhists (97%), unemployed (73%), having a monthly income of over Rs. 50,000 (99%), educated up to or below the primary level (56%), married (60%) and not living alone (95%). The mean (average) age of the participants was 70.5 years with a range of 61 to 94 years, and 459/11% being below 80 years. The mean number of years residing in Galle was 65.7 years with a range of five to 94 years. All patients attending the medical clinics had at least one NCD. Hypertension (76%) showed the highest prevalence among the overall participants. P. Katulanda, P. Ranasinghe, R. Jayawardena, G.R. Constantine, M.H.R. Sheriff and D.R. Matthews’s “The prevalence, predictors and associations of hypertension in Sri Lanka: A cross sectional population-based national survey” reported hypertension among 65% of adults aged below 70 years. Also, 47% had at least three NCDs.  The mean, median (the middle most number or centre value in a data set) and mode (the value that is repeatedly occurring in a data set or the one that appears most often) of the total number of medications utilised per day by the participants were 8.4 (3.5), eight (six – 11) and eight, respectively, with a range of one to 20. The distribution of medication adherence was asymmetric. High, moderate and low medication adherence was found in 24%, 59% and 17%, respectively. While medication adherence was positively correlated with age and negatively correlated with the number of drugs per day, it however did not have a significant correlation with age or with the number of drugs per day.  The distribution of perceived social support was asymmetric. The overall high, moderate and low perceived social support was found in 20%, 78% and 2%, respectively. Medication adherence had a positive and significant correlation with perceived social support. Perceived social support had a negative, non-significant correlation with age. The high, moderate and low perceived social support from the significant other was found in 40%, 58% and 2%, respectively. The corresponding values were 24%, 74% and 2% for social support from the family and 7%, 77% and 16% from a friend. A significant difference was found between the perceived social support from the significant other and the family. Also, a significant difference was found between the perceived social support from the significant other and friends, and from the family and friends. Medication non-adherence among elders is a well known issue. A.F. Yap, T. Thirumoorthy and Y.H. Kwan’s “Medication adherence in the elderly” proposed that clinicians consider the patient, the medication, the healthcare provider, the healthcare system and socioeconomic factors in order to find personalised solutions to overcome the issue. The assessment of medication adherence among elders should also involve, per E.J. MacLaughlin, C.L. Raehl, A.K. Treadway, T.L. Sterling, D.P. Zoller and C.A. Bond’s “Assessing medication adherence in the elderly: Which tools to use in clinical practice?”, the caregiver.  Moreover, the aforementioned Nigerian study has shown a significant association between social support and psychosocial wellbeing among elders. Satisfaction with emotional support among elders is associated with better self reported health status, as found in the aforementioned US study. Also, per Unsar et al., social support and the quality of life of elders are positively correlated. Of the public health implications of the study, Fernando et al. observed that hypertension, diabetes mellitus (a disorder in which the body does not produce enough insulin or responds normally to insulin, causing blood sugar/glucose levels to be abnormally high), ischaemic heart disease (heart problems caused by narrowed heart arteries as a result of which less blood and oxygen reaches the heart muscle, which can ultimately lead to a heart attack), dyslipidemia (an abnormal amount of lipids in the blood) and bronchial asthma (a medical condition which causes the airway path of the lungs to swell and narrow and due to this swelling, the air path produces excess mucus, in turn making it hard to breathe, which results in coughing, short breath, and wheezing) were the top NCDs seen among the elders. Therefore, Fernando et al. recommended that these should be the main focus of health interventions in this target group. Since high levels of medication adherence and social support were seen only in a small proportion of the participants, and a significant association for medication adherence was found with social support, a greater emphasis should therefore be placed on enhancing social support and medication adherence, Fernando et al. elaborated.


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