|Year : 2015 | Volume
| Issue : 5 | Page : 594-598
A cross-sectional study of gender differentials in disability assessed on World Health Organization Disability Assessment Schedule 2.0 among rural elderly of Maharashtra
Dattatraya Ramkrishna Sinalkar, Rajesh Kunwar, Renuka Kunte, Madhuri Balte
Department of Community Medicine, AFMC, Pune, Maharashtra, India
|Date of Web Publication||10-Sep-2015|
Dattatraya Ramkrishna Sinalkar
Department of Community Medicine, AFMC, Pune - 411 040, Maharashtra
Source of Support: Nil., Conflict of Interest: None declared.
Background: Disability is important public health problem especially among elderly. Gender difference between disability statuses of elderly is quite obvious. Very little information about disability in a rural area hinders the proper formulation of policies. Objectives: This study determines role of selected socio-demographic factors in explaining gender differences in disability among rural elderly. Materials and Methods: A community-based cross-sectional study was carried out from January 12 to December 12. 227 (Two hundred and twenty seven)(aged 60 years and above) were selected from a rural village of Pune, Maharashtra. Data collected using newly published World Health Organization Disability Assessment Schedule 2.0. Chi-square test and odds ratio used for determining the association. Results: The result confirms higher prevalence of disability among females than that of males. Disability was found to be statistically significant with gender. Marital status and education were effect modifier of disability. Disability in mobility was most common. In almost all domain disability was more common among elderly women. Conclusion: Greater prevalence of disability among aging women compared with men requires more attention to be given toward them for proper planning of scarce health services.
Keywords: Disability, gender differentials, Pune, rural elderly, World Health Organization Disability Assessment Schedule 2.0
|How to cite this article:|
Sinalkar DR, Kunwar R, Kunte R, Balte M. A cross-sectional study of gender differentials in disability assessed on World Health Organization Disability Assessment Schedule 2.0 among rural elderly of Maharashtra. Med J DY Patil Univ 2015;8:594-8
|How to cite this URL:|
Sinalkar DR, Kunwar R, Kunte R, Balte M. A cross-sectional study of gender differentials in disability assessed on World Health Organization Disability Assessment Schedule 2.0 among rural elderly of Maharashtra. Med J DY Patil Univ [serial online] 2015 [cited 2020 Jan 25];8:594-8. Available from: http://www.mjdrdypu.org/text.asp?2015/8/5/594/164975
| Introduction|| |
Disability is emerging as a public health problem. Ageing, emergence of chronic diseases and medical advances that preserve and prolong life results in the overall survival and the upward trend in the proportion of the elderly population and their disabilities. Disability among elderly is higher in developing countries (43.4%) than developed (29.6%) and higher among females. As per National Sample Survey Organization (2003), more than 25% of the Indian aged population is disabled. Of which around 59% were males and 41% were females.
Disability is related to many life areas and involves interactions between the person and his or her environment and hence is difficult to define and measure. According to the World Health Organization (WHO) "Disability is any restriction or lack (resulting from an impairment) of ability to perform in a manner or within the range considered normal for a human being." Approaches to measuring disability vary across countries and influence the results. There are various ways of assessing disability but widely used methods are London Handicap Scale, Medical Outcome Study 36-Item Short Form Health Survey, Nottingham Health Profile, Functional Independence Measure and Barthel's Index of Activities of Daily Living (BAL).,,,, Operational measures of disability vary according to the purpose and application of the data, the conception of disability, the aspects of disability examined - impairments, activity limitations, participation restrictions, related health conditions, environmental factors — the definitions, question design, reporting sources, data collection methods, and expectations of functioning.
International Classification of Functioning, Disability and Health (ICF) developed as a consensus framework by WHO takes each function of an individual — at body, person or society level -and provides a definition for its operational assessment, and defines disability as "a decrement in each functioning domain." However, the ICF is impractical for assessing and measuring disability in daily practice. To address this problem WHO recently provided a newer method of assessing disability, that is, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), a standardized way to measure health and disability across the cultures and globe.
There is very little information about gender disparities in disability and its association with socio-demographic variables among the rural elderly. Proper planning of health services has not been possible because of lack of proper data on the number, extent and magnitude of the problem in the rural area. Hence the study was conducted in rural area of Pune district using newly published Disability Assessment Schedule.
| Materials and Methods|| |
This was a community-based cross-sectional study carried out over a period of 12 months from January 12 to December 12. The study was conducted in the Kasurdi village which is a rural field practice area of college. Kasurdi is located approximately 45 km from Pune in Taluka Daund and covers a population of about 4500.
The study population comprised individuals in the geriatric age group, which included 60 years and above age group. Individuals with age 60 years and above as on January 1, 2012 were considered. Electoral voter identity card was used for deciding the age of the individual. All willing and permanent resident were surveyed so that inbuilt comparison group was available for determining the differences in disability in both gender. Total 396 elderly constituted the sampling frame in the current study. Of these, 48 elderly were not located, 27 were dead, and 21 not participated in the study while 35 were not permanent residents of the village. Those with severely hearing impairment (22), unable to comprehend (16) were excluded.
Disability was assessed using WHODAS 2.0 Questionnaire Interviewer Administered 36-Item Version). WHODAS 2.0 (36-item) is a self-reported scale covering six disability domains (i.e., cognition, mobility, self-care, getting along with people, life activities and participation in society, and self-care). Respondents were asked to state the level of difficulties experienced in these domains of life during the last 30 days. Respondents responses are scaled as in a 5-point Likert format (1: None; 2: Mild; 3: Moderate; 4: Severe and 5: Extreme or cannot do). Manual for WHODAS 2.0 was referred for question-by-question specifications in questionnaire and for domain details. We followed three steps as mentioned in manual for WHODAS 2.0. These are:
- Step 1 — Summing of recoded item scores within each domain
- Step 2 — Summing of all six domain scores
- Step 3 — Converting the summary score into a metric ranging from 0 to 100
- Step 4 — Summary score were coded using ICF disability categories namely:
- No disability (0-4%)
- Disability present (>4%)
The data collected were tabulated and analyzed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM corporation). Findings were described in terms of proportions and percentages. Chi-square test was carried out to test the differences between proportions. P < 0.05 was considered as significant. Ethical clearance was obtained from the Medical Ethics Committee of Medical College as this study was conducted in rural field practice area of college.
For the purpose of study, participants were classified according to the highest educational standard up to which they had gone to school, that is, primary school (up to 5th class), middle school (up to 8th class), high school (up to 10th class) and above (11th class onwards). Illiterate were those who could not read and write with understanding any one language.
| Results|| |
The age of study population ranges from 61 to 94 (mean 68.33 ± 7.47). Maximum numbers (68.7%) were in the age group 60-65 years. Of total 118 (52.0%) were females and 109 (48.0%) were males [Table 1]. There were no significant difference between females and males in respect of age (t-test = 0.2953). Maximum were illiterate in both females (79.7%) and males (43.1%). About 91.8% of males were married while 33.1% of females were widow [Table 2]. The overall prevalence of disability was found to be 70.04%. Disability was higher among females (76.27%) than that of males (63.3%) and it was found to be significant (χ2 = 4.54, P = 0.03) [Table 3].
|Table 2: Distribution of study population as per selected demographic characteristics|
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|Table 3: Gender differences in prevalence of disability among study population|
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Stratifying by age, education and marital status, we calculated different measures. Odds ratios in all the above variables after stratification were different across strata and hence these variables act as an effect modifier and not as confounders.
Females (68.24%) in <70 year's age groups have significantly higher disability compared to males (45.07%) in similar age group while such association was not observed in study subjects above 70 years. Disability was more common in illiterate females as compared to in illiterate males. Even literate females (83.33%) have significantly higher disability compared to literate males (56.45%). Disability prevalence was significantly higher among females even if they stayed with spouse (82.61%) than males staying with spouse (62.0%). There was no difference in disability among singles [Table 4].
|Table 4: Association of disability and selected socio-demographic variables among study population|
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Among the study subjects with various disabilities; most common domain affected was mobility. On further analysis of each disability domain with gender as seen in [Table 5], it was observed that proportion of the elderly having disability is much higher for women than for men in almost in all domains (cognition: 44.1 vs. 43.1; mobility: 70.3% vs. 63.3%; household activities: 50% vs. 37.6%; work activities: 60.5% vs. 38.1% and participation 54.2% vs. 45.9%) except in self-care (27.9% vs. 28.4%) and getting along with people (22.03% vs. 36.7%). More males had disability in getting along with people as compared to females, and this association was found to be statistically significant. Significant number of females affected in work activity domain as compared to males. However, no association of disability was found with mobility, cognition, self-care, household activities and participation (P > 0.05) in this study [Table 5].
|Table 5: Gender wise distribution of disability in each domain in percentages|
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| Discussion|| |
This study is among the few population-based surveys reporting disability prevalence assessed according to WHODAS 2.0 framework. Our results provide a novel view of disability among the elderly population in rural India.
As the well documented studies to determine the prevalence of disability and its epidemiological features among the geriatric population using WHODAS 2.0 were scarce, comparisons were made with disability studies among elderly using a different methodology. Some studies had taken only the physical disability and some others mental disability.
Our study showed a higher prevalence of disability among the geriatric population in comparison to other studies. Recent National Sample Survey Organization report in India showed the prevalence of disability among the geriatric population as little as 6.4%. The widely differing prevalence of disability found in these studies was due to a wide difference in definitions and in methodologies used for disability.
In our study, overall prevalence of disability was found to be 70.04%. Study conducted in Chandigarh by Joshi et al. in 2003 showed a higher prevalence 87.5% than our study. Study conducted in a rural community of district Coimbatore in Tamil Nadu by Ashokkumar et al. showed that 53.1% were disabled in one or more physical activity which was lower than our study.
Mobility domain (67%) was most commonly affected and least was the self-care domain (28.2%). These findings are consistent with the study conducted in Spain in 2005 by Virués-Ortega et al. in which mobility was affected in about 70% of elderly. Furthermore, study by Patel in 2009 revealed that locomotor disabilities are the most prevalent type of disabilities affecting elderly in India.
Study showed a significant association between disability and gender. Females were more disabled as compared to males. Hirve et al. in their cross-sectional survey in Pune District, India showed that males had significantly better overall health than their female contemporaries. However, in a study among elderly (≥65 year) of Bengaluru city, Karnataka by Srinivasan et al. using ICF disability showed no similar association.
Association of age with a disability was found to be statistically significant and disability increases as age advances. A study in Tamil Nadu also showed that the likelihood of disability increases significantly with an increase in age.
We have not found association between education and disability which was similar to the study by Srinivasan et al. among elderly of Bengaluru city, Karnataka, India where level of education was not associated with disability while Hirve et al. showed that disability in all domains increased with decreasing levels of education.
In the present study, no significant association was found between marital status and disability. This finding was similar to the study conducted by Ashokkumar et al. which showed that 95% of the disabled were married, and only 5% of them were unmarried. The difference was not found to be significant with marital status. In contrast to this finding, the study conducted in Tamil Nadu showed an association of marital status with disability.
| Conclusion|| |
The study has some positive points. Homogeneity of this population with regard to age was served as a built-in control and also helped in drawing inferences from the gender comparisons. Although a number of studies assessing disability in various settings have used the ICF system and the WHODAS 2.0, they have been rarely used as the basis for assessment in a population-based study on the prevalence of disability and gender differences with respect to education and marital status. This approach may be superior to more classical means of determining functional status. Data were gathered through a population-based survey by resident community medicine himself increasing reliability of information and use of the standard way suggested by WHO for collecting and analyzing data, that is, WHODAS 2.0. This was a cross-sectional study and hence due to inherent limitations of this type of study, our study cannot depict the true picture of disability among elderly. Furthermore, variations in the prevalence may occur due to the location of the area and other factors. There is also the possibility of recall bias.
Increased age, gender plays an important role in disability among rural elderly. Future longitudinal study with a large sample may be conclusive for identifying different socio-demographic variables and for the prevention of disability. Policymakers should consider these factors for future planning of gender sensitive geriatric friendly health and social care services in order to prevent disability and to improve the quality of life of geriatric population in rural India.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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