The present study revealed that females showed a higher prevalence of widowhood (67.5 vs. 33.0%) and illiteracy (80.5 vs. 45.0%) than males. Illiterates outnumbered the other categories in both the sexes (45.0% and 80.5%). All those not living with spouse / children (19.3%) were widows / widowers, totally neglected by their children. Subjects were categorized as financially ‘independent’ (getting pension or earning), ‘partially dependent’ (living with family with old age pension), and ‘totally dependent’ (no income). Less prevalence of economic dependency among subjects (53.0%) when compared with other studies,[6
] was because of the retired employees among them.
Regarding status in the family, the subjects were divided into ‘neglected’ (subjects living alone, totally neglected by children), ‘just looked-after’ (providing basic needs), ‘looked-after well’ (basic needs and medical care), and ‘respected and consulted’ (taking decisions or involving in family issues). Low prevalence of economic dependency was the reason for a lesser number of totally neglected subjects (13.75%) than in the studies by Elango S[7
] (38.0%) and Kishore S[11
] (55.8%). Financially, the totally dependent subjects were just looked after (15.8%), while the old age pensioners were being looked after well (41.2%). However, where only couples were present, the status was unaffected by economic dependency. Thus, economic dependency and living arrangements were the main factors deciding the status of the subject in the family.
The study showed a high prevalence of cognitive impairment (43.25%) than the studies by Singh et al
] (5.0%) and Goswami et al
] (18.03%), probably because of differences in the literacy status and composition of the subjects. Similar to Goswami et al
] (23.7 vs. 12.2%), a high prevalence of impairment among females (51.5%) was due to the high illiteracy rate and more number of females in the ≥ 80 age group. Similar to the study by Goswami et al
] (58.4%), prevalence and severity of impairment increased after 69 years of age (52.6%), especially in the ≥ 80 age group (42.9%), which showed higher prevalence than the two earlier age groups together (29.0%). High prevalence and severity of impairment associated with low literacy status was seen in illiterates (63.6 and 26.3%) rather than in literates (19.8 and 11.4%). The high prevalence (61.5%) and severity (29.8%) of impairment in the lower class as compared to the other class subjects was because of more illiterates in the lower class. The high prevalence of impairment in the upper class than in the middle class was because of few subjects in the upper class.
Similar to studies by Jain[6
] (45.9%) and Venkoba Rao et al
] (43.0%), high prevalence of depression was observed among the subjects (47.0%), as compared to the study by Singh et al
] (18.0%), which was due to the high prevalence of widowhood, illiteracy, economic dependency, and poor status of the family. Increased prevalence and severity of depression among females was due to high prevalence of poor health, widowhood, economic dependency, and poor status of the family in females, similar to the study by Singh et al
] (37.5 vs. 14.28%), Goswami et al
] (63.2 vs. 44.5%), and Jain et al
] (5.1±8.26). Subjects showed high prevalence of depression, especially after 69 years, as seen by an increase of 13.3% in the 70 to 79 age group, due to increased widowhood, dependency, and health deterioration with age. Illiteracy, economic dependency, and loneliness were reasons for higher prevalence of depression in the lower class (72.7%) than in all the other classes put together (54.9%) and in illiterates (58.9%) rather than in literates (48.8%). A lower prevalence of depression among the financially totally dependent subjects (41.7%) as compared to the partially dependent ones (63.3%) might be because of proper care and security. The burden of earning despite poor health, loneliness, and negligence by children (regarding those living alone), were the main reasons for depression among independent subjects. High prevalence of depression (80.0%) among physically dependent subjects might be because of poor health and status of the family.
Prevalence of a disturbed sleep pattern of the study subjects (36.0%) differs from the studies of Singh CP.[15
] (3.5%), Singh[16
] (28.66%), Jain[6
] (43.9%), and Goswami et al
] (58.36%) because of difference in the prevalence of factors responsible for depression, as was the case regarding the difference between male (33.0%) and female subjects (39.0%). A disturbed sleep pattern increased with age as shown by increase in its prevalence (19.0%) with age and with decreased social status (12.5 to 45.3%). Increased dependency and poor status of the family were reasons for this. Poor status of the family might be responsible for the disturbed sleep pattern among those living with family members. A normal sleep pattern in those living exclusively with spouse was because of security and good status of the family, the absence of which led to a disturbed sleep pattern among those living with others or living alone.