Volume 27, Issue 1 (Winter 2020)                   Intern Med Today 2020, 27(1): 34-47 | Back to browse issues page

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Baghery Kakhki S, Basiri Moghadam M, Sadeghmoghadam L. The Prevalence of Disability and Its Relationship With the Demographic Characteristics of the Elderly in Gonabad City, Iran, in 2019. Intern Med Today 2020; 27 (1) :34-47
URL: http://imtj.gmu.ac.ir/article-1-3447-en.html
1- Department of Elderly health and Psychiatric nursing, School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran.
2- Social Development and Health Promotion Research Center, School of nursing, Gonabad University of Medical Sciences, Gonabad, Iran.
3- Department of Elderly health and Psychiatric nursing, School of Nursing, Social Development and heath Promotion Center, Gonabad University of Medical Science, Gonabad, Iran. , is_moghadam@yahoo.com
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1. Introduction
t present, 60% of the world’s elderly live in developing countries. This figure will increase by up to 80% by 2050. That is, in the next 30 years, 1.6 billion of the total world’s 2 billion older people will live in developing countries, such as Iran [1]. Aging is associated with decreased functional performance and mental, cognitive, physical, social, and economic disabilities. After midlife, the average physical and mental performance of a person reduces by 1.5% per year [2].
Disability is a general term used by the World Health Organization to describe impairments, activity limitation, and participation restriction caused by health conditions, whether due to a disability or a chronic illness [3]. Disability costs account for more than 3.6% of the UK gross national income and are projected to rise by 11% in 2030. A study in Iran has reported that the demand for health services in the elderly is more than three times the demand of the non-elderly population, and this demand increases with the age of the elderly [4].
Many problems that occur with age are considered potentially preventable and even reversible. We can minimize disability in old age and achieve successful aging goals. In this regard, we can reduce the cost of medical care for the elderly, which currently accounts for about 60% of total medical care costs. Achieving this critical goal requires recognizing the factors affecting the health of the elderly [5].
One of the essential indicators needed for any decision-making is a disability in the elderly of society [6]. Chronic diseases are among the most common problems in old age, which by creating physical disabilities often lead to reduced mobility of the elderly in terms of walking around, climbing stairs, bending, kneeling, etc. Therefore, the elderly have no choice but to use home care and hospitalization [7]. Besides, disability causes the elderly with chronic diseases suffer from premature aging and prolong the care process in these people [8, 9].
Haji Bagheri and Vafaei et al. have mentioned the relationship between gender, physical activity, lifestyle, and education with disability in the elderly [10, 11]. Also, in Mozaffari’s study [9], the relationship between the residence of the elderly and the prevalence of disability was investigated. It seems that a set of social, individual, and environmental factors determine the process of disability, and these characteristics are effective in reducing or increasing the disability of the elderly.
Studying the factors associated with functional disabilities in the elderly is essential for better planning and appropriate public health policy. One way to achieve these policies is to continuously study and collect epidemiological data regarding health status, disease, health behaviors, and access to services [11].
More than 12% of the total population of Gonabad City, Iran, were elderly, and this ratio was slightly higher than the country’s ratio [12]. On the other hand, a comprehensive study to examine the prevalence and factors related to the disability of the elderly in Gonabad had not been conducted so far. Accordingly, recognizing disabilities and related factors in each geographic area can help clarify the situation of the elderly and plan to support them better. Besides, this study can prevent an increase in disability and accidents for the elderly. In a nutshell, this study was performed on the elderly to determine the prevalence of disability and its related factors.
2. Materials and Methods
This cross-sectional analytical study was performed on 470 older adults in Gonabad City in 2019. The sample size was estimated to be 439 people based on calculating the formula  and considering a 7% of sample loss. Based on a similar study [13], the first type of error was considered 0.05, the estimation error 0.037, and the prevalence of disability 0.2. By obtaining permission from Gonabad University of Medical Sciences (Code: 130. 1397. REC. GMU. IR) and then by referring to the community health centers of Gonabad City, the sampling was performed by stratified random sampling method. For this purpose, each of the 3 community health centers in Gonabad City was considered a stratum. Initially, based on the elderly health record in the urban community health centers, an initial list was prepared. Based on the number of older people in each center, a proportion was allocated to that stratum. Then, by simple random sampling method, the required sample size was selected from within that stratum. Next, by inviting the elderly to the centers and explaining the study procedure, and obtaining written consent, the questionnaires were completed. In case of the inability of the elderly to refer to these centers, they were referred to the nursing home. This process continued until the desired sample size was reached.
The inclusion criteria were as follows: age 60 years or older, consent to participate in the study, living in Gonabad City, and ability to respond. The exclusion criteria were as follows: unwillingness to continue the study, lack of access to the elderly during the research (non-residence in Gonabad City), and failure to complete the questionnaire.
The data collection tool was a questionnaire consisting of two parts. The first part collected demographic characteristics such as age, gender, marital status, literacy level, number of children, economic status, and medical history. The second part included the standardized tools of the World Health Organization (WHO-DAS II). The questionnaire included 36 questions to assess the degree of disability in the areas of “understanding and communication”, “walking around”, “interaction with people”, life activities”, “self-employment”, and “participation in social activities”. It is scored on a 5-point Likert-type scale (by no means=1, mild=2, moderate=3, severe=4, I could not at all=5). Finally, each person could get a score between 0 and 144. Scores between 0 and 36 indicate severe disability, between 37 and 72 moderate disability, between 73 and 108 low disability, and between 109 and 144 very low disability. In the study of Haj Bagheri et al. the face validity and content validity of this questionnaire were confirmed, and the reliability of the instrument was obtained 0.97 using the Cronbach alpha coefficient [10].
Literate people completed the questionnaire themselves. For the illiterate ones, the researcher read the questions and entered the participants’ answers in the questionnaire. According to the results, the degree of disability of the elderly was classified into four levels: severe, moderate, low, and no disability. All ethical considerations were observed in different stages of this research. Individuals participated voluntarily in the study. The obtained data were analyzed in SPSS v. 14.5. First, the distribution of the studied variables for all samples was examined. Then the Chi-square test was performed to identify the factors associated with disability in the elderly. Finally, variables with a P value of less than 0.2 were analyzed using rank-ordered logistic regression.
3. Results
Of the total research samples, 43.4% were male, and 56.6% were female. About 51.3% of the elderly were in the age group of 60-74 years, 45.5% in the age groups of 75-90 years, and 2.3% were 90 years or older. More than two-thirds of the research units were married, and most of them had below-diploma or elementary literacy levels. A total of 50.3% of them lived with their spouse, 35.6% were located in very low strata, and the rest had different degrees of disability levels (low, moderate, and severe disability) (Table 1). 

According to Table 2, the highest disability of the studied elderly was in the areas of “understanding and communication” and “walking around”, and the lowest disability was in the area of “self-care”. 

In the elderly with older age and lower level of education, disability increased significantly (P<0.001), and disability in women was significantly higher than men (P=0.007) and in married elderly less than the single elderly (P<0.001). Also, disability in the elderly with the underlying disease was significantly higher than the elderly without underlying disease (P<0.001). There was no significant relationship between the disability of the elderly and the number of children (P=0.46) (Table 3). 

Table 4 presents the results of rank-ordered logistic regression. 

The results showed that age (P<0.001), gender(P=0.03), illiteracy(P<0.001), below-diploma education (P=0.02), and history of the underlying disease (P<0.001) are significant predictors of disability in the elderly. For each year of aging, the chances of being in the upper strata of disability increased by 2.36 times (OR=2.36). The chance of being in the upper strata of disability in women was 1.27 times higher than men (OR=1.27). The chances of being in the upper strata of disability in the illiterate elderly were 2.36 times (OR=2.36) and in below-diploma elderly 1.58 times (OR=1.58) higher than in the elderly with an associate degree or higher. The chance of being in the upper strata of disability in the elderly with the underlying disease was 1.68 times higher than the elderly without underlying disease (OR=1.68).
4. Discussion
In this study, although the mean disability score was in low disability, the results showed that at older ages, the mean of severe disability and moderate disability increased. These results were consistent with some other studies [7, 14]. Although in our country the trend of disability of the elderly has been less addressed, considering that the growth rate of the elderly population in the last two decades has increased from 1.7% to more than 3% [15], it can be expected that the number of disabled people increases in the near future. The results of the present study showed that the highest rate of disability was related to “understanding and communication” and “walking around”, and the lowest rate of disability was related to “social and family activities” and “self-care”. In this study, the “inability to move” seems to have created the most problems for the elderly. In the study of Haj Bagheri et al. [10], the lowest rate of disability was related to “understanding and communication”, and the highest rate was related to “life activities” in Nejatie’s study, problems related to physical activity and the inability to play physical roles were the most problematic for the elderly [16].
In this study, although the elderly showed less disability in the area of “self-care”, in some other studies, about 20%-80% of the elderly over the age of 70 showed some degree of disability in performing daily activities (such as bathing, dressing, going to the toilet, urinary and fecal control, eating, and transfer from chair to bed) [17]. It is possible that the difference in the results of our study was related to the greater number of older people aged 60-74 years (who are considered young elderly), and the ability of this group to take care of themselves was higher than other groups.
The results of the present study showed that the lowest rate of disability was related to “social and family activities”. It seems that living in the heart of society and traditional neighborhoods and close contact with each other in terms of physical proximity can be an essential factor in reducing the communication problems of the elderly. At the same time, to create and expand the necessary support from family members, neighborhoods, and communities to help the elderly in carrying out life activities, measures should be taken to improve the construction of buildings, sidewalks, and other social environments to reduce the problems of the elderly regarding walking indoors and outdoors [10, 18].
In this study, there was a significant relationship between gender and the degree of disability, which was consistent with the results of the study of Haj Bagheri et al. on the elderly in Kashan [4] and also the study of Taş et al. [19]. In both studies, the rate of disability in women was higher than that in men. Other studies in the country have reported that physical problems that lead to the demand for treatment and reduced quality of life are more pronounced in women. This could be due to more chronic debilitating diseases in older women or to their physiological and endocrine differences with men (such as less lung capacity, less muscle mass and strength, less bone mass, and faster emaciation of these systems in women). Furthermore, more disability in women can be due to the sedentary lifestyle of women in our society [20, 21].
The lifestyle and commitment of the older women in the study population to be more at home, prioritizing the needs of other family members over their desires, and tolerating pain and illness and attributing it to aging are some of the factors that make the results similar to studies in other cities of the country where women also had more disabilities for other reasons.
Due to the voluntary participation in the study, the number of female participants was more than men. This may have interfered with the clarity of the samples.
Other results showed that the elderly with higher education had less disability. These results were consistent with the study of Noei et al. [7]. It seems that there is a connection between the level of education and disability. As education increases, the elderly acquire more information about a healthy lifestyle, and therefore the likelihood of their disability decreases. These results, on the one hand, show the need for special attention of society and government to the health of women (which is at a lower level than the health of men) and the elderly, and on the other hand, the need to strengthen educational programs at higher levels. The results of logistic regression on age, gender, and history of an underlying disease and the significant relationship between these factors and disability, are used as predictors of disability level. The regression results for the number of children and marital status did not predict the degree of disability. This is probably due to social support for the elderly in rural areas and small towns. In these societies, everyone is somehow a relative or friend of each other. If the elderly are alone and without a spouse or children, the rest of the big family support them, and as a result, these older people report less disability. Such a result was not obtained in Mozaffari, Vafaee, and Shahbazi studies [9, 11].
5. Conclusion
Because of the growing trend of the elderly population, it is necessary to consider health, reduce disabilities, and identify factors related to disability in the elderly. The severity of disability in women and illiterate people requires more attention to these vulnerable groups. The present study was the first research conducted in Gonabad City to examine the disability of the elderly. For this reason, it is suggested that similar research be conducted in different parts of the country to get an overview of the disability of the elderly. The use of other study methods, including qualitative methods, is also suggested in this field. Even a comparison of the results of different research studies can identify different dimensions and factors affecting disability. Also, because of the diversity of variables affecting disability, it is suggested that an investigation be performed on elderly disability using multiple regression analysis.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of the University of Gonabad University of Medical Sciences, No. 130. 1397. REC. GMU. IR. All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

This article is extracted from Saleh Bagheri Kakhki’s Master’s thesis at the Department of Geriatrics, School of Nursing, Gonabad University of Medical Sciences and Health Services.

Authors' contributions
Writing – original draft, and Writing – review & editing: Saleh Bagheri Kakhki; Methodology, Leila Sadegh Moghadam; Data collection and Data analysis: Mehdi Basiri Moghaddam.

Conflicts of interest
The authors declared no conflict of interest.

We would like to thank Dr Khosravan, Vice-Chancellor for Research and Technology of Gonabad University of Medical Sciences, and the officials of Gonabad Community Health Centers.

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Type of Study: Original | Subject: Basic Medical Science
Received: 2019/12/18 | Accepted: 2020/06/24 | Published: 2020/12/30

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