Volume 75, No.1: 2023 Siriraj Medical Journal

https://he02.tci-thaijo.org/index.php/sirirajmedj/index

Riya Halder, MBBS*, Bobby Paul, MD (PSM), DCH**, Ankush Banerjee, MBBS, M.D.***, Ranjan Das, MD

(PSM)**, Trina Sengupta, MBBS*

*MD Community Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India, **Department of Preventive and Social Medicine,

All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India, ***All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India.

Functional Status of the Elderly and their

Rehabilitation Needs: A Mixed-Method Study in

a Slum of Kolkata, West Bengal

ABSTRACT

Objective: A comprehensive understanding of the requirements of elderly is necessary to preserve their “functional

capacity”, an important indicator of their health status. is study aimed to assess the functional status of the elderly

and their rehabilitation needs.

Materials and Methods: A mixed-method study was conducted from November 2021 to June 2022 at a health centre

in Chetla, West Bengal, India. Quantitative data, collected from 172 elderly persons using a pretested questionnaire,

were analyzed by logistic regression analysis. Qualitative data, collected via focus group discussions, were analyzed

thematically.

Results: Overall, 11.62% and 66.86% participants were functionally dependent in one or more activities of daily

living (ADL) and instrumental activities of daily living (IADL), respectively. Signicant association of age ≥70 years

(AOR = 4.06, 95% CI= 1.13-14.63), male gender (AOR= 5.21, 95% CI= 1.57-17.28) and assistive device use (AOR=

6.92, 95% CI= 1.85-25.83) was found with ADL limitations. Increasing age (AOR= 1.29, 95% CI= 1.13-1.50), female

gender (AOR= 13.97, 95%CI= 3.61-54.00), residence in joint family (AOR= 3.95, 95%CI=1.47-10.61), without

spouse (AOR= 3.59, 95% CI= 1.12-11.44) and daily intake of multiple medications (AOR= 4.99, 95%CI= 1.45-

17.13) were factors signicantly associated with IADL limitations. Major identied needs of the elderly were related

to development of peer support groups, transportation systems and delivery of services from the health system.

Conclusion: Rehabilitative services like providing assistive devices to the needy, developing elderly support groups,

undertaking household visits for bedridden and those with restricted mobility, and building supportive environments

within families and communities should be ensured.

Keywords: Activities of daily living; elderly; functional status; instrumental activities of daily living; rehabilitation

(Siriraj Med J 2023; 75: 20-28)

Corresponding author: Trina Sengupta

E-mail: ghoto1995@gmail.com

Received 22 September 2022 Revised 27 October 2022 Accepted 4 December 2022

ORCID ID:http://orcid.org/0000-0003-4864-8159

http://dx.doi.org/10.33192/Smj.2022.4

All material is licensed under terms of

the Creative Commons Attribution 4.0

International (CC-BY-NC-ND 4.0)

license unless otherwise stated.

INTRODUCTION

e unprecedented increase in human longevity

in the 20

century has led to a global rise in the elderly

population. India is soon destined to become home to the

second-largest number of elderly persons in the world.

e Census data has demonstrated a steady increase in

the proportion of older people from 7.7% of the total

population in 2001 to 10.1% in 2021, which is estimated

to reach 300.96 million by 2051.

Over the past decade, ‘Healthy aging’ has emerged

as an important concept concerning health issues of the

elderly. It has been dened as “not only the mere absence

Halder et al.

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of a disease but the process which enables older people to

continue to do the things that are important to them”.

Data provided by the United Nations has shown that

more than 46% of the global elderly population (≥60

years of age) live with disabilities.

Disabilities are the

negative aspects of the interaction between the individual

and the environment, i.e., decits, limitations in the

activity and restrictions in his/her social participation.

us, maintenance of functional capacity becomes an

important indicator of health status in the elderly.

Activities of daily living (ADL) are considered as those

activities that are essential for an independent life while

instrumental activities of daily living (IADL) are more

complex tasks that involve decision making and greater

interaction with the environment.

Studies conducted

previously across dierent countries have assessed the

functional capacity of the elderly and have demonstrated

varying prevalence of limitations in activities of daily living

(ADL) ranging from 17.3% to 34.6% while limitations

in instrumental activities of daily living (IADL) ranged

from 35.75% to 59.3%.

7-10

Although laudable eorts have

been made by the researchers for assessing the functional

status, the issue of social and healthcare needs of the

elderly required for healthy ageing has been largely

overlooked. erefore, a comprehensive understanding

of the requirements of our elderly population is needed

to preserve their functional capacity and promote healthy

aging so that they can continue to make their positive

contributions towards the society. With this backdrop,

this mixed method study was undertaken to assess the

functional status of the elderly residing in an urban slum

in West Bengal and to explore their unmet needs from

the health system for rehabilitation

MATERIALS AND METHODS

is cross-sectional study with convergent parallel

mixed method design (QUAN+QUAL) was conducted

from November 2021 to June 2022 among the elderly

persons (age≥60 years) attending the non-communicable

disease (NCD) clinic at Urban Health Unit and Training

Centre, Chetla, Kolkata, West Bengal. Participants who

did not give written informed consent were excluded

from the study.

Sampling

For the quantitative strand of the study, considering

the prevalence of ADL disability and IADL disability

among the study population to be 53.6%

and 48%

respectively and relative error of 20% with a condence

level of 95%, the sample size was calculated separately

using the standard Cochran’s formula.

It came to be

84 and 105 respectively. Taking into account the larger

value, that is 105, the nal sample size was estimated by

adding a design eect of 1.5 and 10% non-response rate

allowance which came to be 172.

Data collection was performed on 1 day per week.

So, for estimated sample size of 172, it took approximately

12 weeks for data collection. Study participants were

selected by systematic random sampling technique

for the quantitative strand. Approximately 30 elderly

persons attended the NCD clinic per day. Study piloting

revealed that only 15 patients could be interviewed per

day. erefore, taking sampling interval of 30/15= 2, every

patient attending the NCD clinic was interviewed.

Separate days were taken to conduct Focus group

discussions (FGDs) for collecting data for the qualitative

strand of our study. Data was collected till the point of

data saturation which was reached aer conduction of

2 FGDs. Each FGD constituted 6 members who were

recruited purposively from the patients visiting the NCD

clinic.

Study Tools and Parameters Used

Medical records were checked and face-to-face

interview technique was performed using pre-tested,

pre-designed structured questionnaire to collect data

for the quantitative strand of our study. Pretesting was

done on 15 elderly patients diagnosed with NCDs in a

dierent setting who were not included in the study.

Reliability of the scales used within the questionnaire

was checked with Cronbach’s alpha along with inter-item

correlation. Face & construct validity of the scales used

was checked by public health experts. e questionnaire

consisted of the following domains:

(a) Independent variables

i. Socio-demographic variables: age, religion, caste, gender,

marital status, living arrangement, education, employment

status, nancial status, socioeconomic status, availability

of medical insurance

ii. Physical health status: body mass index (BMI), pain

on visual analog scale (VAS), number of chronic diseases

(from medical records), number of daily medicine intake

(from medical records)

iii. Environmental characteristics: presence of assistive

technology (handrails, grab bars, hearing aid, glasses, walker

wheelchair etc.), home modications (widened doors,

lowered cabinets) and material adjustments (removing

throw rugs, rearranging furniture etc.)

iv. Multidimensional scale of perceived social support

(MSPSS): It was assessed via a 12-item tool for measuring

perceptions of support from 3 sources: family, friends,

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and signicant others. [Cronbach’s alpha= 0.87].

mean score of 1-2.9 meant low support, 3-5 indicated

moderate support and 5.1-7 indicated high support.

v. Geriatric depression scale 15 (GDS 15) consisted of

a 15-item preliminary screening tool for depression in

elderly [Cronbach’s alpha= 0.71].

Scores of 0-4 were

considered normal, 5-8 indicated mild depression; 9-11

as moderate depression; and 12-15 indicated severe

depression.

(b) Dependent variable

i. Katz Index of Independence in Activities of Daily Living

(ADL): It assessed the client’s ability to independently

perform six activities of daily living i.e bathing, dressing,

toileting, transferring, continence, and feeding.

Participants

were given 1 point if they required no assistance in

performing their daily activities and 0 point if they

required help, personal assistance or total care for the

same. (Cronbach’s alpha=0.79). Study participants were

categorized into two groups according to their summary

scores:

1. Independent (score of 6, needed no assistance

in any of the activities)

2. Dependent (score 0-5, assistance needed in some

or the other activity)

ii. Lawton- Brody Instrumental Activities of Daily Living

Scale (IADL): It measured the client’s ability to perform

independent living skills, measured across 8 domains.

Women were scored on all 8 areas of function; whereas,

for men, the areas of food preparation, housekeeping,

laundering were excluded [Cronbach’s alpha= 0.82].

Participants were given 1 point if they required no

assistance in performing the activities and 0 point if

they required help, personal assistance or total care for

the same. Study participants were categorized into two

groups according to their summary scores:

For females: 1. Independent (score of 8, needed no

assistance in any of the activities)

2. Dependent (score of 0-7, assistance

needed in some or the other activity)

For males: 1. Independent (score of 5, needs no

assistance in any of the activities)

2. Dependent (score 0-4, assistance needed in some

or the other activity)

For the qualitative part of the study, two FGDs were

conducted among the study participants to nd out their

expectations from the health system with respect to their

healthcare needs, using a predesigned FGD guide, audio

recorder and eld notes.

Data analysis

Quantitative data was analysed using Microso

Excel 2016 and Statistical Package for Social Sciences

soware (version 16). Descriptive statistics were shown

by frequency table, mean, median and interquartile range.

Aer excluding multicollinearity (variance ination

factor>10), factors were analyzed by test of signicance

(p-value< 0.05) at 95% condence interval via univariate

regression model. All the biologically plausible signicant

factors in the respective univariate analysis where then

included in the nal multivariable model.

For qualitative data, thematic analysis approach

was undertaken. e recorded statements from the FGD

were rst transcribed in verbatim format and translated

back to English language. Simultaneously, eld notes

were reviewed. Appropriate codes were then generated

from the transcripts. Similar codes were put together

to generate subthemes followed by the generation of

appropriate themes.

Ethical approval

Permission was taken from Institutional Ethics

Committee of All India institute of Hygiene and Public

Health, Kolkata. All the ethical principles as per Declaration

of Helsinki were strictly adhered to. Informed written

consent was taken from each participant before data

collection. Condentiality was maintained throughout

the process.

RESULTS

Among the 172 study participants, 118 were females

and 54 were males with a median age of 62.50 years

(IQR =61.00- 67.75). Majority of the male participants

were married (81.5%) whereas only 36.4% females were

married. Around 30.8% of the participants had two

children. 47.1% of elderly were living with ‘spouse and

other members’. Almost 55.2% of the participants had

no formal education and considered themselves to be

nancially dependent on their family members. Around

one-fourth (25.6%) of the study participants were formally

retired. More than half (60.5%) of the study participants

belonged to class V of B.G Prasad’s socioeconomic scale.

e median per capita income was Rs 1,000/-. More than

half of the participants (52.3%) were covered under

state government nanced medical insurance schemes

like ‘Swasthya Sathi’.

With regard to their health status, as many as 56.9%

of individuals suered from multiple chronic diseases

and 55.8% were taking multiple medicines daily. Around

44.8% individuals reported to be suering from moderate

pain on Visual Analogue Scale (VAS).

On the part of environmental modications, only 0.6%

and 5.8% of participants had special equipment attached

to their home structure and did material adjustments

Halder et al.

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respectively, for unhindered movement. Assistive devices

were used by 24.4% of the elderly. None of the participants

had the interior of their homes modied as per their

necessity of old age.

Almost 65.7% of the elderly received moderate

social support (friends, family and signicant other

combined) with median score of 4(IQR= 3.44-5.04).

Majority (82.6%) of study participants were suering

from some or other form of depression with a median

score of 6(IQR= 5-9) as measured by GDS 15.

Functional Status of the elderly:

e respondents reported at least one problem with

IADL (66.86 %) more frequently than with ADL (11.62

%). Among the female participants 7.6% and among

males 20.4% were dependent in one or more ADL while

80.5% of females and 37% of males were found to be one

or more IADL (Fig 1 & 2).

e most frequent problem in ADL was related to

transferring (6.4%) followed by continence (4.7%) and

toileting (4.7%). e most frequent problem associated

with IADL was food preparation (61.9%) among the

females and shopping in males (52.3%).

Factors associated with functional limitations among

the study participants

Signicant factors associated with functional limitations

in ADL were age of ≥70 years {Adjusted odds ratio (AOR)

= 4.06, 95% CI= 1.13-14.63}, male gender (AOR= 5.21,

95% CI= 1.57-17.28) and use of assistive devices (AOR=

6.92, 95% CI= 1.85-25.83) (Table 1).

With respect to IADL limitations, increasing age

(AOR= 1.29, 95% CI= 1.13-1.50), female gender (AOR=

13.97, 95% CI= 3.61-54.00), participants residing in

joint family (AOR= 3.95, 95% CI= 1.47-10.61) without

spouse (AOR= 3.59, 95% CI= 1.12-11.44) and taking

multiple medicines daily (AOR= 4.99, 95% CI= 1.45-17.13)

were the factors that came to be statistically signicant

(Table 2).

e models examining the inuences of factors on

ADL and IADL explained 16.6%-32.3% and 39.7%-55.1%

of the variance respectively.

4( 4.1%)

5 (25.0%)

75 (76.5%)

20 (100.0%)

<70 yrs ≥70 yrs

Number of females

Age groups

Dependent in ≥1 ADL Dependent in ≥1 IADL

5 (11.9%)

6 (50.0%)

10 (23.8%) 10 (83.3%)

<70 yrs ≥70 yrs

Number of males

Age groups

Dependent in ≥1 ADL Dependent in ≥1 IADL

Fig 1. Multiple bar diagram showing

functional status of female participants

across age groups (n=118).

Fig 2. Multiple bar diagram showing

functional status of male participants across

age groups (n=54).

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TABLE 1. Factors associated with functional limitation in ADL among study participants: Univariate and

Multivariable logistic regression analysis (n=172).

Parameters Total number Dependent in Unadjusted OR Adjusted OR

 (n) ≥1ADL(%) (95%CI) (95%CI)

Age

<70 yrs 140 9(6.4) 1(Ref) 1(Ref)

≥70 yrs 32 11(34.4) 7.62(2.82-20.60) 4.06(1.13-14.63)

Gender

Female 118 9(7.6) 1(Ref) 1(Ref)

Male 54 11(20.4) 3.09(1.19-8.00) 5.21(1.57-17.28)

Number of chronic diseases

<2 74 4(5.4) 1(Ref) 1(Ref)

≥2 98 16(16.3) 3.41(1.09-10.68) 0.57(0.09-3.61)

Number of medicines taking daily

<2 76 4(5.3) 1(Ref) 1(Ref)

≥2 96 16(16.7) 3.60(1.15-11.26) 3.04(0.52-17.83)

Use of assistive devices (hearing aid, wheelchair, walker etc)

Absent 130 8(6.2) 1(Ref) 1(Ref)

Present 42 12(28.6) 6.10(2.29-16.24) 6.92(1.85-25.83)

Material adjustments at residence (removing through rugs, rearranging furniture, adjusted lighting etc.)

Absent 162 16(9.9) 1(Ref) 1(Ref)

Present 10 4(40.0) 6.08(1.55-23.85) 0.81(0.12-5.35)

Hosmer-Lemeshow test statistic=0.669, Cox and Snell’s R

=0.166, and Nagelkerke’s R

=0.323.

Qualitative exploration of the unmet needs of the

elderly from the health system for rehabilitation

e FGDs revealed three major themes: (I) need to

cater to service issues (II) need to cater to transportation

issues (III) need for development of peer support group.

Under the rst theme the major sub themes identied

were ‘Homebased services’, ‘Supplies and logistics’, ‘Social

protection schemes’ and ‘Other health services’.

Under the ‘Homebased services’ subtheme, the

need for domiciliary visits at least once every month

by trained healthcare workers for routine health check-

ups was identied. In this context P4 (60 years, female)

reiterated:

“If it was possible that once or twice in a month

the health workers come and visit us in our house and

do a checkup of our sugar, pressure it would have been

very very helpful.”

e major ‘Supplies and logistics’ need identied

was ensuring the availability of medicines and assistive

devices such as glasses, hearing aids etc. from the health

centre, better if free of cost. P3 (61 years, female) said

in this regard:

“Sometimes they ask us to buy medicines from

outside but we cannot buy them due to our economic

constraint. So, we miss the dose for that month.”

Under the ‘Social protection schemes’, the need

for old age pension, increase in pension amount, and

health insurance schemes were identied. P2 (62 years,

female) said in this respect:

“I get old age pension of ₹1,000 per month. But

you tell me, in these days does ₹1,000 have any value?”

e study participants also highlighted the need

for provision of ‘Other health services’ such as dental

facility, ophthalmology, psychiatry, otorhinolaryngology

and investigations such as thyroid prole from the PHC.

P1 (64 years, male) & P2 said in this regard:

“I hear less in one ear. If facility for ear check-up

was present over here I would go for the same.”

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TABLE 2. Factors associated with functional limitation in IADL among study participants: Univariate and

Multivariable logistic regression analysis (n=172).

Parameters Total number Dependent in Unadjusted OR Adjusted OR

 (n) ≥1IADL(%) (95%CI) (95%CI)

Age(↑)* 1.14(1.05-1.24) 1.29(1.13-1.50)

Gender

Female 118 95(80.5) 7.20(3.43-14.36) 13.97(3.61-54.00)

Male 54 20(37.0) 1(Ref) 1(Ref)

Type of family

Joint 99 78(78.8) 3.61(1.85-7.03) 3.95(1.47-10.61)

Nuclear 73 37(50.7) 1(Ref) 1(Ref)

Marital Status

No spouse 83 70(84.3) 5.26(2.55-10.85) 3.59(1.12-11.44)

Married 89 45(50.6) 1(Ref) 1(Ref)

Education

No formal education 95 70(73.7) 2.06(1.07-3.96) 0.79(0.28-2.17)

Educated (any form) 73 42(57.5) 1(Ref) 1(Ref)

Socioeconomic status †

Class V 104 83(79.8) 4.44(2.26-8.73) 0.87(0.31-2.41)

Class IV & below 68 32(47.1) 1(Ref) 1(Ref)

Pain

Severe pain 27 24(88.9) 4.74(1.36-16.51) 5.56(0.93-33.18)

Less than severe pain 145 91(62.8) 1(Ref) 1(Ref)

Number of chronic diseases

≥2 98 73(74.5) 2.22(1.16-4.24) 0.60(0.16-2.23)

<2 74 42(56.8) 1(Ref) 1(Ref)

Number of medicines taking daily

≥2 96 75(78.1) 3.21(1.66-6.22) 4.99(1.45-17.13)

<2 76 40(52.6) 1(Ref) 1(Ref)

Multidimensional scale of perceived social support

Lower support 131 96(73.3) 3.17(1.53-6.56) 0.71(0.23-2.11)

High support 41 19(46.3) 1(Ref) 1(Ref)

Hosmer-Lemeshow test statistic=0.095, Cox and Snell’s R

=0.397, and Nagelkerke’s R

=0.551.

*Continuous variables, OR=odds ratio, CI=condence interval

† According to Revised B.G Prasad Scale for January 2021 based on labour bureau statistics of November 2020

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“I have pain in my gums and teeth but no dental

facility is available here”.

Under the second theme, the distant location of

tertiary care hospitals, poor access to accessible, comfortable

and reliable transport services were reported to cause

hindrance to patients’ journey to hospitals for specialized

care. Notable verbatim by P7 (61 years, female) in this

aspect is:

“Sometimes we are said to go to specialized hospitals

since all the treatment is not available here. But our old

age and restricted mobility prevent us from going there

and getting better treatment”

e third theme highlighted the ‘need for development

of peer support groups’. e elderly valued peer support

as an important source of happiness, information and

companionship as stated by P8 (65 years, male):

“It feels good to talk among your friends and relieve

your mental burden. You can hear their side of their

stories as well as you can express your concerns.”

DISCUSSION

e study ndings revealed the overall prevalence

of ADL and IADL limitations among the elderly to be

11.62% and 66.86% respectively, which is comparable to

the ndings from other studies. A study done in Nepal

by Chalise et al.

showed around 30% & 52% elderly

aged 65 yrs and older were having functional limitation

on at least one ADL and IADL respectively. In a study

done in India by Patel et al. 22% & 48% of the older

adults reported some form of ADL and IADL disability

respectively.

Increasing age showed signicant association with

functional limitations, both ADL and IADL in elderly

proving that it can be the most important risk factor for

the deterioration of the functional state in the elderly.

e current study showed that males were more

dependent in ADL than females which is in contrast

to other studies that showed female gender to be more

predisposed to functional limitations in ADL.

7,19,20

is

may be attributed to the fact that there were more older

male participants (22.2%) compared to females (6.9%)

in this study.

With respect to IADL limitations and gender dierences,

this study is in line with ndings from other studies that

showed that female elderly are signicantly more dependent

in one or more IADL.

7,19,20

is can be explained by the

fact that in an Indian society, which is predominantly

male dominated, women are traditionally bound to do

household work whereas their male counterparts do work

outside and are mainly responsible to handle nances.

Participants residing in joint family reported to have

more dependency in IADL in our study. is nding

substantiates the fact that those who live with others

have the opportunity to depend on them for shopping,

food preparation, housekeeping etc., than those who

live alone.

Signicant association between functional limitation

of IADL and absence of spouse can be explained by the

fact that loss of signicant other in the extreme of age

has a huge emotional impact on the surviving elderly to

the extent that it can lead to depression. Many previous

studies have also found a positive correlation between

depression and worsened mobility in elderly.

21,22

As disability and mobility problems increase with

age, use of assistive devices such as canes, crutches, and

walkers, increase a patient’s base of support, improves

balance, increased activity and independence, proving that

signicant association between functional dependency

in ADL and assistive device use among the elderly may

exist, as found in our study.

Signicant association between dependency in IADL

and intake of multiple medicines has been found in our

study which can be ascribed to the fact that advancing age

brings increased number of comorbidities and thereby

increasing number of daily medicines intake.

e ndings from the qualitative part of our study

also substantiates our quantitative ndings (Table 3).

Subjective needs assessment is required for addressing

the complexity of needs of dependent older people. Due

to limitations in mobility and economic constraints, older

people cannot access health facilities located far away

from home or buy medicines from outside. ere is a

paramount need for provision of various rehabilitative

and healthcare services like home visits, ensuring all-

time supply of medicines and logistics, service delivery

nearer to homes, easy availability and accessibility of

social protection schemes and development of peer

support groups.

CONCLUSION

is study revealed that emotional health is as

important as physical health of the elderly. With advancing

age there is not only an increasing limitation in the

functional capacity of the elderly but also an increasing

requirement of meaningful relationships and experiences.

Declining agility and unsteadiness may result in falls

and devastating injuries among the aged population.

Similarly feeling of loneliness, isolation and lack of self-

worth may result in depression among elderly. Health

care administrators and policy makers should take into

note the physical and emotional needs of the elderly

while implementing strategies for their rehabilitation.

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TABLE 3. Joint Display of health care needs of elderly with respect to their functional status.

Themes Subthemes Qualitativeresults(Codes) Quantitativeresults

Service issues Need for home domiciliary visits by health 11.62% & 66.86% elderly are

based services workers for health check up dependent in ADL & IADL

respectively, hindering their regular

visit to health centre.

15.7% participants reported severe

body pain

Need for supplies ensure availability of 56.9% and 55.8% participants

and logistics medicines, insulin supply, respectively, were having ≥2

supply of hearing aids, chronic diseases and taking ≥2

glasses, cane medications daily.

24.4% elderly required assistive

devices in their daily activities.

Need for Social provision of government More than half of the study

Protection health insurance scheme, participants (55.2%) were nancially

Schemes (SPS) increment in amount of old age dependent and belonged

pension schemes, nancial to lower socio-economic group

dependence on children (60.5%).

47.7% were not covered by any

medical insurance.

Other services dental facility, psychiatry, 17.4% elderly had visual

Eye and ENT doctors, impairment, 6.4% had impaired

thyroid prole test hearing, 1.2% had dental problems,

1.2% had thyroid disorder.

Transportation inconvenient and distant 11.6% were found to be dependent

issues location of tertiary care hospitals on ‘mode of transportation’ item of

providing specialized care and Lawton Brody IADL Scale.

treatment

Peer support isolation & neglect of family, 82.6% suffered from some form of

groups loss of spouse, feeling of burden depression in GDS 15 scale

on children, no one to share 8.7% participants reported to have

emotional feelings low social support in MSPSS scale.

Tailor-made interventions are the need of the hour for

holistically addressing the rehabilitative needs- both

physical and emotional, of our elderly. Availability of

various services such as mental health clinics, dental

clinics, ophthalmology and otorhinolaryngology services

etc, provision of assistive devices to the needy, developing

elderly support groups, undertaking household visits for

bedridden elderly, counseling about improved care-seeking,

and increasing supportive environment in families and

community should be ensured at the primary care level.

Limitations

is study was done in an outpatient clinic and

hence elderly who are bedridden, too sick to attend OPD

could not be interviewed. While most of the responses

were recall-based, bias might be possible.

Conict of interest : Nil

Funding: Nil

Volume 75, No.1: 2023 Siriraj Medical Journal

https://he02.tci-thaijo.org/index.php/sirirajmedj/index

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