Prevalence Of Cognitive Impairment In Elderly Population Residing In An Urban Area

Abstract

Background and Objectives Ageing is a natural process. The ageing population should be seen as one of the great success stories of the 20th century. Life expectancy at birth has continued to increase globally over the years. With the increase in life expectancy the proportion of elderly in the country is increasing. In recent years, a great deal of interest has been generated around the concept of boundary or transitional state between dementia and normal ageing. This condition has been termed as Mild Cognitive Impairment (MCI). Cognitive Impairment (CI) is emerging as an important health problem of elderly population in India. CI is no longer considered a normal and inevitable change of ageing, it occurs when problems with thought process occur. Hence the present study was undertaken with the objectives of knowing the prevalence of cognitive impairment among elderly residing in an urban area and to assess the burden among cognitively impaired elderly on caregivers. Methods A cross sectional study was carried out amongst the elderly population residing in the field practice area of Ashok Nagar, Urban Health Centre. The study was conducted from 1st January to 31st December 2012. A total of 783 elderly were interviewed using a predesigned and pretested questionnaire. Participants were screened for CI using Mini Mental State Examination (MMSE) (for literates), Hindi Mini Mental State Examination (HMSE) (for illiterates).Instrumental Activity of Daily Living (IADL) scale was used to assess the functional activities of elderly. Among the caregivers of cognitively impaired elderly, caregiver burden was assessed using Zarit Caregiver Burden Scale. Results: Among 783 elderly studied, majority (68.45%) were between 60 – 69 years age group, and a few (0.77%) participants were above 90 years of age. Males were 42.01% and rest were females. Out of the total elderly studied majority (66.79%) were Hindus, rest were Muslims and Christians reflecting the population distribution of the study area. Most (91.82%) of them, were literates, with a larger proportion (55.56%) being housewives, with respect to occupation 16.60% were retired and 90.80% belonged to nuclear families. Majority (75.47%) were married and living with their spouse but 21.08% were widows/widower. Most of them (76.76%) belonged to class III and IV socio-economic status according to Modified B.G.Prasad classification. Among the total elderly, 624 (79.70%) had a history of forgetfulness during their daily routine, 109 (13.90%) had difficulty to perform daily routine and 80 (10.20%) elderly did depend on the relatives for daily routine. Out of the total elderly, 28.36% were currently chewing tobacco and 18.26% were currently smokers. The present study revealed that 51.46% had family history of hypertension, 48.02% had Diabetes Mellitus and 5.61% elderly had family history of dementia. As regards to Body Mass Index (BMI) majority (63.30%) of the elderly participants had grade I obesity and (8.20%) had grade II obesity. With regards to number of morbidities, 97.70% were suffering from one or the other morbidities and 44.00% had more than one morbidity. The major morbidities noted in our study were: Iron deficiency anaemia (66.92%), Hypertension (55.94%), Diabetes Mellitus (50.32%), joint pain and muscle aches (24.31%), vitamin B-12 deficiency (12.67%) and acute lower respiratory tract infection (12.41%). The prevalence of cognitive impairment was 7.02% in our study area. Among them, 6.38% had mild cognitive impairment and 0.64% had moderate cognitive impairment. The prevalence of cognitive impairment increased with age (p<0.001) and was more among females, probably attributed to the high life expectancy among women and this was statistically significant (p=0.003). The percentage of cognitive impairment was inversely related to literacy and socio-economic status (p<0.001). The association between marital status and a positive family history of dementia among study participants with cognitive impairment was statistically significant (p=<0.001). Most of the cognitively impaired study participants could not perform daily routine tasks like using telephone (p<0.001), do shopping (p<0.001), meal preparation (p<0.001), housekeeping (p=0.001), laundry (p<0.001), difficulty in travelling (p<0.001), difficulty to take their own medications (p<0.001) and difficulty in handling finances (p<0.001). Out of 55 cognitively impaired elderly, 43.64% of the family members felt that the upbringing of children was affected and 27.27% families had marriage prospectus affected due to the presence of a cognitively impaired person at home. Among the elderly who were more than 65 years of age 80.68% were getting pension and 4.13% faced difficulty in getting the pension allowances. In the present study a major proportion (60.00%) of the caregivers were females, with 52.72% in the age group of 31-40 years,41.83% of them were daughters and 40.00% of them were sons of the cognitively impaired elderly. Among the caregivers 43.63% were educated up to pre-university and 36.36% were working in a private sector. In our study a good number of caregivers (29.09%) had a Zarit Caregiver Burden Scale score of 21 to 40 and experienced mild to moderate burden, majority (69.09%) had a score of 41 to 60 and experienced moderate to severe burden, a few (1.82%) had a score of 61-88 and experienced severe burden. Caregivers experienced emotional, financial, social and occupational burden. Conclusion and interpretation The present study revealed that the prevalence of cognitive impairment was considerably high. A strong positive family history of dementia, low socio-economic status and low level of educational status were related to cognitive impairment among the elderly studied. Regarding the caregivers of cognitively impaired elderly, majority of them experienced a lot of physical, emotional, psychological stress and strain and they were overtaxed with responsibilities and felt that all responsibility fell on one caregiver.