Abstract
Introduction: The oldest-old (aged 85 years and above) are a rapidly growing and particularly vulnerable subgroup, yet data on their health problems remain scarce in Nepal. This study aimed to describe the pattern of physical illnesses and depression among the oldest-old in a rural municipality of Palpa, Nepal, and to identify associated factors.
Methods: An observational, descriptive cross-sectional study was conducted among 125 oldest-old individuals in Ribdikot Rural Municipality, Palpa district, from October 2019 to March 2020. Participants were selected by simple random sampling using computer-generated random numbers. Data were collected using an interview schedule, and physical health problems were identified from self-reports and hospital medical records. Depression was assessed using the 15-item Geriatric Depression Scale. Chi-square and Fisher's exact tests were used to assess associations, with p < 0.05 considered statistically significant.
Results: Gastritis was the most prevalent physical illness (41.60%), followed by hypertension (40.00%), cataracts (34.40%), joint pain (29.60%), COPD (15.20%), and diabetes mellitus (8.80%). Depression was present in 32.80% of participants. Depression was significantly associated with living alone (p=0.025), low monthly family income (p=0.007), widowhood (p=0.001), and hypertension (p=0.029).
Conclusions: Physical illnesses and depression were highly prevalent among the oldest-old. Living arrangement, marital status, income, and hypertension were significant correlates of depression. Targeted screening and community-based interventions are needed to address the health needs of this vulnerable population.
References
1. United Nations Department of Economic and Social Affairs, Population Division. World Population Ageing 2023: Challenges and opportunities of population ageing in the least developed countries. New York: United Nations; 2024. Available from: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2024_wpa2023-report.pdf
2. World Health Organization. Ageing and health: fact sheet. Geneva: WHO; 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
3. Government of Nepal, National Statistics Office. National Population and Housing Census 2021. Kathmandu: Office of the Prime Minister and Council of Ministers; 2023. Available from: https://censusresults.nsonepal.gov.np/
4. Unal E, Ozdemir A. Old age and aging. 2019. Available from: https://www.researchgate.net/publication/336686689
5. Guo J, Huang X, Dou L, Yan M, Shen T, Tang W, et al. Aging and aging-related diseases: from molecular mechanisms to interventions and treatments. Signal Transduct Target Ther. 2022;7(1):391. PMID: https://pubmed.ncbi.nlm.nih.gov/36522308. doi: https://doi.org/10.1038/s41392-022-01251-0
6. Chen QF, Ni C, Jiang Y, Chen L, Liao H, Gao J, et al. Global burden of disease and its risk factors for adults aged 70 and older across 204 countries and territories: a comprehensive analysis of the Global Burden of Disease Study 2021. BMC Geriatr. 2025;25(1):462. PMID: https://pubmed.ncbi.nlm.nih.gov/40604507. doi: https://doi.org/10.1186/s12877-025-06095-1
7. Bista A, Joshi S. Health problems of elderly residing in urban areas, Kathmandu. J Inst Med Nepal. 2015. doi: https://doi.org/10.59779/jiomnepal.723
8. Qingwen G, Zerong L, Yuan Y, Li Y, Zheng L. Unraveling the link between hypertension and depression in older adults: a meta-analysis. Front Public Health. 2023;11:1302341. PMID: https://pubmed.ncbi.nlm.nih.gov/38074728. doi: https://doi.org/10.3389/fpubh.2023.1302341
9. Sapkota YD, Sunuwar M, Naito T, Akura J, Adhikari HK. The prevalence of blindness and cataract surgery in Rautahat district, Nepal. Ophthalmic Epidemiol. 2010;17(2):82-9. PMID: https://pubmed.ncbi.nlm.nih.gov/20302430. doi: https://doi.org/10.3109/09286581003624947
10. Dhungana RR, Pandey AR, Shrestha N. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension in Nepal between 2000 and 2025: A Systematic Review and Meta-Analysis. Int J Hypertens. 2021;2021:6610649. PMID: https://pubmed.ncbi.nlm.nih.gov/33747559. doi: https://doi.org/10.1155/2021/6610649
11. Shrestha N, Karki K, Poudyal A, Aryal KK, Mahato NK, Gautam N, et al. Prevalence of diabetes mellitus and associated risk factors in Nepal: findings from a nationwide population-based survey. BMJ Open. 2022;12(2):e060750. PMID: https://pubmed.ncbi.nlm.nih.gov/35193925. doi: https://doi.org/10.1136/bmjopen-2022-060750
12. Adhikari TB, Neupane D, Karki A, Hansen MRH, Drews A, Cooper B, et al. Prevalence of COPD in Nepal: findings from a community-based study. Eur Respir J. 2020;56(Suppl 64):2605. doi: https://doi.org/10.1183/13993003.congress-2020.2605
13. Poudyal A, Bista B, Gyanwali P, Karki S, Bhattarai S, Sharma S, et al. Prevalence and factors associated with joint pain in Nepal: findings from a countrywide cross-sectional STEPS survey. BMJ Open. 2021;11(10):e051536. PMID: https://pubmed.ncbi.nlm.nih.gov/34615678. doi: https://doi.org/10.1136/bmjopen-2021-051536
14. Zenebe Y, Akele B, Selassie M, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Ann Gen Psychiatry. 2021;20(1):55. PMID: https://pubmed.ncbi.nlm.nih.gov/34922595. doi: https://doi.org/10.1186/s12991-021-00375-x
15. Thapa DK, Visentin D, Kornhaber R, Cleary M. Prevalence of mental disorders among older people in Nepal: a systematic review. Kathmandu Univ Med J. 2018;16(62):181-90. PMID: https://pubmed.ncbi.nlm.nih.gov/30636762
16. Ministry of Health and Population, Nepal. Geriatric Health Service Standards, 2078 (2021). Kathmandu: Government of Nepal; 2021. Available from: https://mohp.gov.np
17. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol. 1986;5(1-2):165-73. doi: https://doi.org/10.1300/J018v05n01_09
18. Acharya S, Ghimire S, Jeffers EM, Shrestha N. Health care utilization and health care expenditure of Nepali older adults. Front Public Health. 2019;7:24. PMID: https://pubmed.ncbi.nlm.nih.gov/30828573. doi: https://doi.org/10.3389/fpubh.2019.00024
19. Franceschi M, Di Mario F, Leandro G, Maggi S, Pilotto A. Acid-related disorders in the elderly. Best Pract Res Clin Gastroenterol. 2009;23(6):839-48. PMID: https://pubmed.ncbi.nlm.nih.gov/19942162. doi: https://doi.org/10.1016/j.bpg.2009.10.004
20. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: assessment, management, and challenges. Clin Cardiol. 2020;43(2):99-107. PMID: https://pubmed.ncbi.nlm.nih.gov/31825114. doi: https://doi.org/10.1002/clc.23303
21. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: assessment, management, and challenges. Clin Cardiol. 2020;43(2):99-107. PMID: https://pubmed.ncbi.nlm.nih.gov/31825114. doi: https://doi.org/10.1002/clc.23303
22. Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet. 2023;401(10374):377-89. doi: https://doi.org/10.1016/S0140-6736(22)01874-4
23. Fazleen A, Wilkinson T. Early COPD: current evidence for diagnosis and management. Ther Adv Respir Dis. 2020;14:1753466620942128. PMID: https://pubmed.ncbi.nlm.nih.gov/32664818. doi: https://doi.org/10.1177/1753466620942128
24. Kalyani RR, Egan JM. Diabetes and altered glucose metabolism with aging. Endocrinol Metab Clin North Am. 2013;42(2):333-47. PMID: https://pubmed.ncbi.nlm.nih.gov/23702405. doi: https://doi.org/10.1016/j.ecl.2013.02.010
25. Karki R, Paudel B, Chaudhary A, Bhatta R, Shah SK, Khanal J. Prevalence of geriatric depression and associated factors in Kalika Rural Municipality of Rasuwa District, Nepal. Int J Health Sci Res. 2022;12(1):188-94. Available from: https://www.semanticscholar.org/paper/Prevalence-of-Geriatric-Depression-and-Associated-Karki-Paudel/e030268697f3db386c6f663f36df8d7b987132bc
26. Yadav UN, Thapa TB, Mistry SK, Pokhrel R, Harris MF. Socio-demographic characteristics, lifestyle factors, multi-morbid conditions and depressive symptoms among Nepalese older adults. BMC Psychiatry. 2020;20(1):261. PMID: https://pubmed.ncbi.nlm.nih.gov/32456611. doi: https://doi.org/10.1186/s12888-020-02680-3
27. Gaire D, Gahatraj NR, Yadav RK, Shah G, Baral S. Study among geriatric people residing in urban and rural area and associated factor with depression in Nepal. Int J Community Med Public Health. 2021;8(9):4167-73. doi: https://doi.org/10.18203/2394-6040.ijcmph20213514
28. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-37. PMID: https://pubmed.ncbi.nlm.nih.gov/25910392. doi: https://doi.org/10.1177/1745691614568352
29. Sasson I, Umberson DJ. Widowhood and depression: new light on gender differences, selection, and psychological adjustment. J Gerontol B Psychol Sci Soc Sci. 2014;69(1):135-45. PMID: https://pubmed.ncbi.nlm.nih.gov/23811294. doi: https://doi.org/10.1093/geronb/gbt058
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Deelip Kumar Karki, Samata Nepal, Laxmi Prasad Sapkota, Krishna Bahadur GC