Physical Problems of Senior Citizens Attending Outpatient Department of Selected Hospitals of Chandigarh

 

Mrs. Rinku Mehmi¹, Mrs. Rashmi Chaudhary²

¹Lecturer, Medical Surgical Nursing, Mata Sahib Kaur College of Nursing, Mohali, Punjab

²Associate Professor, Medical Surgical Nursing, Mata Sahib Kaur College of Nursing, Mohali, Punjab

 

ABSTRACT:

An Exploratory Study was done to assess the Physical Problems of Senior Citizens. This study was conducted in medicine outpatient department of Government Multispeciality Hospital Sector 16 Chandigarh. The sample of present study consisted of 60 senior citizens. The investigator adopted convenient sampling technique to collect data. A review of the related literature enabled the investigator to develop a conceptual framework and select the methodology for the study. Analysis of data collection was done in accordance with the objectives of the study. The data collected were analyzed using descriptive statistics. Majority of senior citizens (45%) were in age group of 60-65years, 26.7% fell in the age of 66-70years and 28.3%  belonged the age group of 71-75years. 60%  were male and rests 40% were females. 50%  had normal weight, 40% were overweight, 8.3% were obese and one 1.7% were underweight. 75%  were living with their families while 21.7% were living with their spouses and just 3.3% were living alone. 31.7% senior citizens had primary education, 28.3% had secondary education, 25% were illiterate, and 11.7% had higher secondary education, while 3.3% were graduates. 36.7% senior citizens having income between Rs 11,000 – 20,000, 30% were earning less than Rs10, 000.  23.3% were earning in the range of Rs 21,000 – 30,000 while 10% were having income more than Rs 31,000. Mostly the senior citizens were suffered from Musculo-skeletal problems (29.83%). Problems related to cardiovascular system were also high (27.41%). Many of the senior citizens (16-27%) had problems related to sensory, gastrointestinal, and respiratory system. Problems related to neurologic, integumentary and endocrine system were found in 8-13 % of senior citizens. Only 6.09% of senior citizens were having problems related to genitourinary system.

 

 

 

INTRODUCTION:

A man's life is normally divided into five main stages namely infancy, childhood, adolescence, adulthood and old age. In each of these stages an individual has to find himself in different situations and face different problems. The old age is not without problems. In old age physical strength deteriorates, mental stability diminishes; money power becomes bleak coupled with negligence from the younger generation.¹

Aging and chronic illness have an enormous impact on the autonomy of the elderly. Ageing in humans refers to a multidimensional process of physical, psychological, and social change. Some dimensions of ageing grow and expand over time, while others decline. Old age may bring a lack of ability to concentrate, forgetfulness, inability to speak, to hear, to see etc. So the old individual gets used to sitting in a chair as pensiveness, vegetating, saying nothing. In humans, aging is associated with degenerative changes in the skin, bones, heart, blood vessels, lungs, nerves, and other organs and tissues.^2,3. In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates.

 

McCook Alison⁴ conducted a study in New York and said, 1 in 9 people aged 45-54 had hearing impaired. The researchers tested hearing in more than 2,800 adults between the ages of 21 to 84years. Over that large range, one in seven had lost some degree of hearing, and as expected, the rate of hearing loss increased with age. Almost all of those older than 80years of age about 90% had lost hearing, but the rate had already reached one in nine among adults 45 to 54 years old, the largest age group in the population Kobashi G et al ⁵ conducted a study on Health status and lifestyle issues of homeless people in Sapporo city. A total of 60 homeless people were consulted and examined, 40% had some dental problems, 28% suffered neck stiffness, and 27% back pain. The medical examination found 53% of them to be hypertensive and 26% to be diabetic. 25% had meals only once a day. 42% slept not more than 5 hours a day, 13% often drank alcohol in the daytime, and 83% were smokers.

 

SIGNIFICANCE OF THE STUDY:

Improvement in health and hygiene, control of infectious diseases, mass vaccinations, availability of drugs, and increased number of medical and paramedical manpower etc. have led to improved average lifespan. According to the United Nations Population Division India's population ages 60 and older is projected to increase dramatically over the next four decades, from 8 percent in 2010 to 19 percent in 2050. By mid-century, this age group is expected to encompass 323 million people⁶. The aging of India's population will lead to increases in the preva­lence of chronic conditions such as diabetes and hyperten­sion. By one measure, nearly one-half (45 percent) of India's disease burden is projected to be borne by older adults in 2030.⁷ Hypertension, cardiac problems, diabetes, joint pains, kidney infections, cancer, tuberculosis and eye problems are some ailments that generally affect senior citizens. These disorders require proper and in some cases prolonged treatment. Nearly 67% of old people suffer from: difficulty in falling asleep, waking up without being refreshed, brief stoppages of breathing or snoring etc. Nearly a third of all women crossing menopause suffer from short term insomnia.⁸   With advancing age, there is a significant increase in the number of health problems; at the same time, the complexity of the existing impairments increases. Health in old age is an important individual and societal topic today and in the future.⁹ Only government servants are entitled to pension. This means that literally 70% of the Indian population gets no pension, not even those who have worked in the corporate sector for 30 to 40 years. Most senior citizens are dependent on their savings or their provident fund, whose value is shrinking day by day. So the money available after retirement is further reduced because of the poor return from investments.¹⁰ Investigator also found during working in clinical area, there were more number of senior citizens who were admitted with numerous health problems. Thus the problems associated with aging are abundant.  Investigator felt that the older people are in need of vital support that will keep important aspects of their life style intact while improving their overall quality of life and planned to conduct study to identify the physical problems of elderly and their coping strategies.

 

OBJECTIVES OF THE STUDY:

To assess the physical problems of senior citizens attending outpatient department.

 

Assumptions:

The senior citizens do have physical problems which impair the normal functioning.

 

METHODOLOGY:

Research Approach:

Exploratory approach was used for assessing the physical problems of senior citizens attending outpatient department.

 

Research design:

A descriptive design was considered appropriate for the present study to assess the physical problems of senior citizens attending outpatient department.

 

Sociodemographic Variable:

Age, Gender, Basal Metabolic Index, Current Living Arrangement, Education, Income.

 

Study variables:

Physical Problems of the senior citizens

 

Population:

Population in the present study included senior citizens attending medicine outpatient department of Government Multispeciality Hospital Sector 16, Chandigarh.

 

Selection of field for study:

The study was conducted in the Government Multispeciality Hospital Sector 16 Chandigarh. The hospital is situated on Madhya Marg of the city, just 300 mtrs from the well known Rose Garden, Sector 16, Chandigarh. The hospital is 500 bedded.

 

Sample Size and Sampling Technique:

Sample of present study consisted 60 senior citizens attending medicine outpatient department of Government Multispeciality Hospital Sector 16, Chandigarh. The hospital is 500 bedded. This is a patient friendly hospital, known for prompt and efficient services Sample was selected by convenient sampling technique.

 

Inclusion criteria:

1.      Senior citizens attending medicine outpatient department

2.      Present at the time of data collection.

3.      Willing to participate in study

4.      Senior citizens in the age group of 60-75 years

 

Exclusion criteria:

1.      Senior citizens above 75 years

2.      Senior citizens attending other outpatient department

 

Development and description of the Tool:

The study was concerned to assess physical problems of senior citizens attending outpatient department. Structured checklist was developed for assessing physical problems. The present tool included four parts:

Part I: Includes sociodemographic variables such as age, gender, religion, basal metabolic rate, current living arrangement, educational status, income.

Pert II: Includes checklist for assessing physical problems. Problems from last six month were taken. It consists of 98 items.

 

Criterion Measure:

In present study part 1 dealt with sociodemographic data. Scoring key was prepared for part 2 and 3.

Part 2 included checklist which consisted “yes” or “no” options

1 score was awarded for every yes

0 score was awarded for every No.

Maximum = 98, Minimum = 0

 

Content Validity of the tool:

Tool was submitted to 10 nursing experts of Mata Sahib Kaur College of Nursing, Mohali and after that tool was submitted to 10 experts in the field of nursing. 

 

Ethical consideration:

Permission of conducting Research study was taken from Ethical and research committee of Mata Sahib Kaur college of Nursing, Mohali. Written permission was taken from the medical superintendent of Government Multispeciality Hospital Sector 16, Chandigarh. Informed Verbal consent was taken from the participant’s of the study.

 

Reliability of research tool:

The reliability of the tool was checked by split half method by cronbach alpha.. Reliability of the tool is  0.80

 

Data collection procedure:

Data was collected during the month of January 2012. Sixty senior citizens attending medicine outpatient department of Government Multispeciality Hospital Sector 16, Chandigarh were selected. Investigator introduces herself to the subjects. Subjects were explained about the purpose of the study and they were ensured that confidentiality will be maintained under all circumstances. Investigator spent 30-40 min with each subject.

 

Data analysis:

Data was analyzed by using descriptive statistics.

 

RESULTS:

The analysis showed majority of senior citizens (45%) were in age group of 60-65years, 26.7% fell in the age of 66-70years and 28.3% belonged the age group of 71-75years.

60% were male and rests 40% were females.50% had normal weight, 40% were overweight, 8.3% were obese and one 1.7% were underweight. 75% were living with their families while 21.7% were living with their spouses and just 3.3% were living alone. 31.7% senior citizens had primary education, 28.3% had secondary education, 25% were illiterate, and 11.7% had higher secondary education, while 3.3% were graduates.36.7% senior citizens having income between Rs 11,000 – 20,000, 30% were earning less than Rs10, 000, 23.3% were earning in the range of Rs 21,000 – 30,000 while 10% were having income more than Rs 31,000.

 

Table: 1 Socio demographic characteristics N=60

Characteristics	Frequency	Percentage
Age 60-65 66-70 71-75 Gender Male Female BMI Under weight Normal weight Over weight Obese Current living arrangement Alone Spouse Family Education Illiterate Primary Secondary Higher secondary Graduation and above Income < 10,000 11000-20000 21000-30000 >31,000	27 16 17   36 24   1 30 24 5   2 13 45   15 19 17 7 2   18 22 14 6	45.0 26.7 28.3   60.0 40.0   1.7 50.0 40.0 8.3   3.3 21.7 75.0   25.0 31.7 28.3 11.7 3.3   30.0 36.7 23.3 10.0

 

Table: 2.1 Frequency distribution of Physical Problems of Sensory System faced by  Senior Citizens N=60

System	Symptoms	Yes		No
		n	%	n	%
Sensory system	Blurring of vision	48	80	12	20
	Swelling in eyes	03	05	57	95
	Double vision	05	08	55	92
	Pain in eyes	19	32	41	68
	Dryness in eyes	9	15	51	85
	Redness in sclera	10	17	50	83
	Discharge from eyes	22	37	38	63
	Difficulty in night vision	25	42	35	58
	Short sightedness	46	77	14	23
	Long sightedness	42	70	18	30
	Hearing difficulty	23	38	37	62
	Tinnitus in ears	02	03	58	97
	Discharge from ears	04	07	56	93
	Pain in ears	04	07	56	93
	Itching	07	12	53	88
	Discharge or bleeding from nose	00	00	60	100
	Frequent cold	03	05	57	95
	Changes in the taste	02	03	58	97

 

Table 2.1 analyzes the various sensory system problems among the senior citizens. 80% subjects were having blurring in vision, 77% reported short sightedness while 70% said they were having long sightedness. Difficulty in night vision was common among 42% subjects, 37% were having regular discharge from eyes and pain in eyes was reported by 32% subjects. 38% subjects also reported hearing problems.  17% subjects said they had redness in sclera, 15% were having dryness in eyes and 12% were facing itching problems. In the range of 7 – 8 % subjects reported problems like double vision, discharge from ears and pain in ears.

 

Table: 2.2 Frequency distribution of Physical Problems of Gastro-Intestinal system faced by Senior Citizens                                N=60

System	Symptoms	Yes		No
		n	%	n	%
Gastro-Intestinal	Oral ulcers	7	12	53	88
	Difficulty in chewing	33	55	27	45
	Bleeding gums	19	32	41	68
	Dental carries or tooth pain	26	43	34	57
	Excessive thirst	07	12	53	88
	Frequent dryness in mouth	08	13	52	87
	Heart burn	36	60	24	40
	Dysphasia	05	08	55	92
	Loss of appetite	15	25	45	75
	Abdominal pain	09	15	51	85
	Abdominal distension	09	15	51	85
	Diarrhea	04	07	56	93
	Constipation	32	53	28	47
	Hemorrhoids	06	06	54	90
	Fecal incontinence	00	00	60	100
	Formation of gas	16	27	44	73

 

Table 2.2 analyzes the various Gastro-Intestinal problems among the senior citizens. 60% subjects reported heart burns, 55% were having difficulty in chewing and 53% were having constipation problem. 43% subjects were having tooth pain and 32% Subjects had bleeding gums. 27% subjects also reported the formation of gas while 25% subjects said they have lost their appetite. The subjects in the range of 12 – 15% reported the problems like abdominal pain and distension, frequent dryness in mouth and excessive thirst. Also 7 – 10 % subjects reported hemorrhoids, dysphasia and diarrhea.

 

Table: 2.3 Frequency distribution of Physical Problems of Respiratory  system  faced  by  Senior Citizens  N=60

System	Symptoms	Yes		No
		n	%	n	%
Respiratory	Dyspnea on rest	05	08	55	92
	Chest pain associated with breathing	13	22	47	78
	Breathlessness with exertion	26	43	34	57
	Hemoptysis	01	02	59	98
	Persistent cough	06	10	54	90

 

Table 2.3 analyzes the various respiratory problems among the senior citizens.  The responses were in terms of yes or no towards the physical problem. Among the respiratory problems, 43% reported breathlessness with exertion, 22% subjects reported chest pain associated with breathing, 8 – 10% subjects reported problems like persistent cough and Dyspnea on rest. Hemoptysis was reported by 2% subjects.

 

Table: 2.4 Frequency distribution of Physical Problems of Cardio – vascular system faced by Senior Citizens                                   N=60

System	Symptoms	Yes		No
		n	%	n	%
Cardio vascular	Chest pain on rest	11	18	49	82
	Chest pain on exertion	19	32	41	68
	Sudden or continuous chest pain	09	15	51	85
	Radiating jaw or arm pain	09	15	51	85
	Heavy sensation in the upper chest	20	33	40	67
	Palpitations	22	37	38	63
	Pain in calf muscles	22	37	38	63
	Edema	06	10	54	90
	Distended neck vein	00	00	60	100
	Bluish discoloration	01	02	59	98
	Frequently fatigued	39	65	21	35
	Alteration in blood pressure	39	65	21	35

 

Table 2.4 analyzes the various cardio - vascular problems among the senior citizens.65% subjects were reporting frequently fatigue and alteration in blood pressure. Again 37% subjects were complaining about palpitations and pain in calf muscles. 32 – 33% range of subjects also reported about the heavy sensation in the upper chest and chest pain on exertion. 18% subjects also said they experience pain in chest while resting. 15% subjects were experiencing sudden or continuous chest pain and radiating jaw or arm pain. 10% said they had edema while 2% reported bluish discoloration.

 

Table: 2.5  Frequency distribution of Physical Problems of Genitourinary and Reproductive System faced by Senior Citizens   N=60

System	Symptoms	Yes		No
		n	%	n	%
Genitourinary and Reproductive	Pain during urination		05	57	95
	Dribbling of urine	02	03	58	97
	Frequent urination	10	17	50	83
	Hesitancy during urination	00	00	60	100
	Hematuria	01	02	59	98
	Oliguria	03	05	57	95
	Urinary incontinence	02	03	58	97
	Burning on urination	03	05	57	95
	Suprapubic or pelvic pain	00	00	60	100
	Nocturia	03	05	57	95
	Perineal itching	13	22	47	78

 

Table 2.5 analyzes the various Genitourinary and Reproductive problems among the senior citizens.22% subjects were having perineal itching, 17% were reporting frequent urination while less than 5% of the subjects were reporting problems like pain during urination, Oliguria, burning on urination, Nocturia, dribbling of urine, urinary incontinences and Hematuria.

 

Table: 2.6 Frequency distribution of Physical Problems of Musculoskeletal system faced by Senior Citizens                    N=60

System	Symptoms	Yes		No
		n	%	n	%
Muscularskeletal	Joint pain at rest	09	15	51	85
	Stiffness of joint during movement	38	63	22	37
	Backache	38	63	22	37
	Swelling over the joint	05	08	55	92
	Tenderness over the joint	00	00	60	100
	Decreased range of motion	18	30	42	70

 

Table 2.6 analyzes the various Musculo-skeletal problems among the senior citizens. 63% each subject was having problems of backache and stiffness of joint during movement. 30% reported decreased range of movement, 15% said they had joint pain while resting and 8% were having swelling over joints.

 

Table: 2.7 Frequency distribution of Physical Problems of Neurologic faced by  Senior Citizens  N=60

System	Symptoms	Yes		No
		n	%	n	%
Neurologic	Dizziness	01	02	59	98
	Fainting	02	03	58	97
	Confusion	05	08	55	92
	Headache	17	28	43	72
	Par aesthesia	01	02	59	98
	Difficulty in walking	17	28	43	72
	Difficulty in speaking	01	02	59	98
	Loss of balance	13	12	53	88
	Take more time to respond	03	05	57	95
	Risk of fall	13	22	47	78
	Weakness of the upper extremities	10	17	50	83
	Weakness of the lower extremities	26	43	34	57
	Difficulty in forming words	03	05	57	95
	Impaired ability to concentrate	00	00	60	100

 

Table 2.7 analyzes the various Neurologic problems among the senior citizens. 43% subjects reported weakness of the lower extremities, 28% each subjects reported headache and difficulty in walking, 22% subjects reported risk of fall, 17% reported weakness of upper extremities. Also less than 5% subjects reported problem like take times to respond, difficulty in forming words, fainting, dizziness, Paraesthesia and difficulty in speaking. 8% said they were confused. Nobody reported impaired ability to concentrate.

 

Table: 2.8 Frequency percentage of Physical Problems of Integumentary system faced by  Senior Citizens N=60

System	Symptoms	Yes  n    %	No n  %
Integumentary	Bed sores	01     02	59    98
	Bruises	03     05	57    95
	Patechiae	01     02	59    98
	Generalized Redness on the skin	05     08	55    92
	Dry skin	12     20	48    80
	Purities	08     13	52    87

Table 2.8 analyzes the various Integumentary problems among the senior citizens. 20% subjects reported problem of dry skin, 13% reported purities, 8% said they had redness on skin and less than 5% reported that they had bad sores, Patechiae and bruises.

 

Table: 2.9 Frequency percentage of Physical Problems of Endocrine system faced by  Senior Citizens  N=60

System	Symptoms	Yes n  %	No n  %
Endocrine	Increased appetite	10     17	50    83
	Bulging eyes	04     07	56    93
	Excessive mass on the back	02     03	58    97
	Heat intolerance due to hyper- thyroidism	06     10	54    90
	Cold intolerance due to hyper- thyroidism	02     03	58    97
	Weight gain	12     20	48    80
	Weight loss	04     07	56    93
	Alteration in thyroid level	11     18	49    82
	Hyperglycemia	12     20	48    80
	Hypoglycemia	03     05	57    95

 

 

Table 2.9 analyzes the various Endocrine problems among the senior citizens.  20% each subject reported problems like weight gain and Hyperglycemia. 18% reported that they had increased appetite and alteration in thyroid level. 10% said they had heat intolerances due to hyper thyroidism while 7% each subjects reported bulging eyes and weight loss problem. Less than 5% said they had Hypoglycemia, excessive mass on back and cold intolerance due to hyper thyroidism.

 

Table: 2.10 Mean percentage of problems of all the body systems faced by senior citizens  N=60

Systems	Total no of problems n	Mean %	SD
Sensory	18	25.44	26.63
Gastrointestinal	16	24.18	19.00
Respiratory	05	17.00	16.24
Cardiovascular	12	27.41	21.65
Genitourinary and reproductive	11	06.09	6.97
Musculo- skeletal	06	29.83	27.52
Neurologic	14	12.64	13.10
Integumentary	06	08.30	7.06
Endocrine	10	11.00	7.02

 

Table 2.10 showed mean percentage and standard deviation of problems of all the body system wise analysis of various problems. Higher the mean percentage, higher was the problems.  Mostly the senior citizens were suffered from Musculo-skeletal problems (29.83%). Problems related to cardiovascular system were also high (27.41%).  (16-27%) senior citizens had problems related to sensory, gastrointestinal, and respiratory system. (8-13 %) senior citizens had problems related to neurologic, Integumentary and endocrine system. Only (6.09%) of senior citizens were having problems related to genitourinary system.

 

DISCUSSION:

Findings of the studies were discussed according to the objectives. Physical problems were assessed in each body system and data were collected. The findings are in agreement with the some studies: The findings of the study revealed that  80% patients were having blurring in vision, 77% reported short sightedness while 70% said they were having long sightedness. 38% patients also reported hearing problems. McCook Alison⁴ found that 1 in 9 people aged were had hearing impaired. One in seven had lost some degree of hearing, and as expected, the rate of hearing loss increased with age. Almost all of those older than 80years of age about 90% had lost hearing. Law NM et.al¹¹ determined that the prevalence rates for blindness and visual impairment in the elderly were 3.0% and 15.2% respectively. The prevalence rates for cataract, age-related macular degeneration, glaucoma and diabetic retinopathy were 78.6%, 27.0%, 5.7% and 5.1% respectively.  60% patients reported heart burns, 55% were having difficulty in chewing and 43% patients were having tooth pain and patients with bleeding gums were 32%.  Kobashi G et al⁵ analyzed that 40% had some dental problems. Among the respiratory problems, 43% reported breathlessness with exertion, 22% patients reported chest pain associated with breathing. While Ruben FL¹² revealed that Respiratory infections were most frequent 52% of the patients. 63% each patient was having problems of backache and stiffness of joint during movement. 30% reported decreased range of movement, 15% had joint pain while resting and 8% had swelling over joints. Whereas Machado GP et al¹³ assessed prevalence of arthritis was of 25.3% Whereas Kobashi G, et al ⁵ analyzed that 28% suffered neck stiffness, and 27% back pain, 53% of them to be hypertensive  20% each patient reported problems like weight gain and Hyperglycemia. 18% reported alteration in thyroid level. Less than 5% had Hypoglycemia, excessive mass on back and cold intolerance due to hyper thyroids. Martinez-Weber C¹⁴ analyzed thyroid autoantibodies were present in 44% of the study group. Ten women (13.3%) had elevated TSH levels.  Whereas Kobashi G, et al ⁵ analyzed that 26% patients were diabetic.

 

CONCLUSION:

Mostly the senior citizens were suffered from Musculo-skeletal problems (29.83%). Problems related to cardiovascular system 27.41% were also high. 16-27 % senior citizens had problems related to sensory, gastrointestinal, and respiratory system. 8-13 % senior citizens had problems related to neurologic, Integumentary and endocrine system. Only 6.09 % of senior citizens had problems related to genitourinary system. 55% of senior citizens had high level of functioning, 36.7% had moderate level of functioning. Only 8.3% had low level of functioning and none of the subject had very low level of functioning. 

 

RECOMMENDATIONS:

The following recommendations were made on the basis of the study:

1.      A similar study can be conducted on large population to validate and generative its findings.

2.      A similar study can be done on other outpatient departments

3.      A similar study can be done on old age home.

4.      Impact of sociodemographic variables on functional assessment of activities of daily living can be analyzed.

5.      A similar study can be done in a community setting.

6.      A similar study can be done to assess other problems like psychosocial, financial etc

 

REFERENCES:

1.     AZAD India Foundation. The problems of old age in India [internet]. 2010. Accessed from: http://www.azadindia.org/social-issues/problem-of-old-age-in-india.html.

2.       Encyclopedia. Aging [internet]. 2012. Accessed from http://en.wikipedia.org/wiki/Ageing

3.       Columbia Encyclopedia. Aging [internet]. 2011  Accessed from; http://crosswords911.com/aging.html.

4.     Alison McCook. 1 in 9 people aged 45-54 is hearing impaired [internet]. 2011. Accessed from : http://www.reuters.com/article/2011/02/21/us-1-9-people-aged-45-54-hearing-impaire-id USTRE71K5RO201102.

5.       HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kobashi%20G%22%5BAuthor%5D"Kobashi G, Ohta K, Nagano S, Kisa K, Kasai S, Haga K, et al. Health status and lifestyle issues of homeless people [internet]. 2001.  Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/11676095.

6.       Scommegna Paola.  India’s aging population [internet]. 2012. Accessed from: http://www.prb.org/Reports/2012/india-older-population.aspx

7.       Chakrabarti Debi. Well-being of the elderly residing in old Age Home Vs those in Family setting. Nursing Journal of India 2009; (10):224-225.          

8.       Vyasamoorthy P V. Sleep problems of Senior Citizens [internet] 2008. Accessed from: http://vyasa-kaaranam-ketkadey.blogspot.in/2008/12/sleep-problems-of-senior-citizens.html

9.       Sass AC, Wurm S, Scheidt-Nave C. Health and old age [internet].2010. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/20437022

10.    Rai Usha. Growing Old. The Hindu Online edition of India's National Newspaper; [internet]. 2003 July 13. Accessed from http://www.hindu.com/thehindu/mag/2003/07/13/stories/2003071300090400.htm.

11.    Law NM, Goh LG, Yoong T . Eye diseases in the elderly  [internet]. 1997. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/9269393

12.    Ruben FL, Dearwater SR, Norden CW, Kuller LH, Gartner K, Shalley A, et al .Clinical infections in the noninstitutionalized geriatric age group [internet]. 1995. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/7817970

13.    Machado GP , Barreto SM, Passos VM, Lima-Costa MF. Health and aging study: prevalence of chronic joint symptoms among the elderly [internet]. 2004. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed?term=prevalence%20of%20chronic%20joint%20symptoms%20among%20the%20elderly%20by%20Machado%20GP

14.    Martinez-Weber C, Wallack PF, Lefkowitz P, Davies TF .Prevalence of thyroid autoantibodies in ambulatory elderly women [internet].  1993. Accessed from: http://www.ncbi.nlm.nih.gov/pubmed/8469246

 

 

 

Received on 17.10.2014                Modified on 28.10.2014

Accepted on 05.11.2014                © A&V Publication all right reserved