Medico-social challenges of ex-serviceman and their spouse : a cross-sectional study in Punjab

Medico-social challenges of ex-serviceman and their spouse: a crosssectional study in Punjab Malhotra V.1*, Mohan Malhotra V.2, Kaur S.3, Cheema R.4 DOI: https://doi.org/10.17511/ijphr.2016.i4.01 1* Vishal Malhotra, Senior Resident, Department of Community Medicine, Govt. Medical College, Patiala, Punjab, India. 2 Varun Mohan Malhotra, Associate Professor, Department of Community Medicine, KIMS (Kamineni Institute of Medical Sciences), Nalgonda, Telangana, India. 3 Sharndeep Kaur, MBBS Intern, 8.Govt. Medical College, Patiala, Punjab, India. 4 Raina Cheema, MBBS Intern, Govt. Medical College, Patiala, Punjab, India.


Introduction
"Demographic transition" has produced pronounced results in form of population aging [1]. The life expectation at birth has shown an increase from "42 years in 1951-1960" to "58 years in 1986-1990" which is recently projected to "67 years by 2011 -2016 for males and 69 years for females" in India [2].
Aging has led to an increase in chronic conditions with advancing age from 39% in 60-64 year to 55% in those older than 70 year among Indian Population [3]. According to National Sample Survey organization (NSSO) report (2007)(2008), overall percentage of elderly in India is 7.5% and is expected to be 12.4% in 2026 [4][5].
Army people are generally considered mentally and physically well but they are more prone to psychosomatic and other chronic health problems due to arduous and hazardous nature of their duties in varied inhospitable terrain. Moreover after leading well regulated life away from main stream they need assistance for rehabilitation and resettlement.
Though literature on geriatric morbidity is available, however to best of author's knowledge, very few studies have been done on morbidity profile of ex army servicemen, so an attempt is made to find chronic disease profile of ex-serviceman and their treatment adherence. Hence, there is growing need for further research to know the health problems of ex-army servicemen, so that suitable and timely interventions can be taken and policies can be formulated to meet their requirements. Hence the main objective is to study social and health problems of ex-army servicemen and their spouse.

Results
Socio-demographic Characteristics: Table 1 shows that 75% of subjects fall in age group of 60-79 years and only 4% were 80 years and above. and re-employed (4.4%).
Life style habits of study subjects: Table 2 shows that 73% study subjects were vegetarian; females are more vegetarian as compared to males.
46% males drink alcohol and just 9% were current smoker.
Health problems of study subjects: Anemia, hypertension, musculoskeletal, mental disorders and cataract were more common in females. Table 5 shows that most of ex-servicemen have free availability of medical treatment (95.5%) and were adherent to treatment regimen (78.2%), and just 12.87% were non complaint to the treatment.

Treatment profile and adherence to treatment-
Compliance to treatment was less in females (19.6%), as compared to males (4.4%).
Reasons for feeling sad: Table 6 shows that 33.2% of respondents felt sad, and out of which 12% were sad due to neglect by their families, poverty (6.7%) and loneliness (4%). Other reasons for feeling sad were illness, alcoholic son/son in law, illness of spouse/children, no issue-no male issue, children staying away, death of spouse.
Since study subjects were ex-serviceman most of them have accessibility of medical treatment and were happy with their life.     Kumbhar et al. [11] also showed these two morbidities as commonest in ex-servicemen though with lower prevalence. Ocular disorders were third major morbidity and comparable results were reported in earlier studies [7, [12][13].
Diabetes was fourth most common morbidity, statistically significant in males than in females [6,9]. A much less prevalence of 7% was shown by study done in Sangli in Maharashtra [11]. Anemia, Acid Peptic Disease (A.P.D) and gallstones was statistically significant in females [11,6], though Kumbhar et al. [11] showed lower prevalence of A.P.D.
Mental health disorders with overall predominance of anxiety neurosis was significantly higher in females (8.9%), and was double than that reported from Maharashtra [11]. Other system problems like ENT, dental, genitourinary, skin and cancers were less than 10% [7, 11].    [14,15]. Around 7% subjects were sad because of poverty and 4% due to loneliness which is much less compared to other studies [10,.
The current study was done in ex-servicemen who probably because of nature of their job stayed away from their families and were better adapted to living alone compared to other studies done in civilians. Also better medical services and social security in form of pension make ex servicemen more equipped to deal with illness and poverty as reflected in current study where 70% of ex-servicemen were happy with their life.

Limitations
It is a cross-sectional study with relatively small sample size and study subjects were ex-army serviceman and their spouses attending mega camp with various health problems, study findings cannot be generalized to the community at large. Further Research involving bigger sample size and qualitative research is required to extrapolate the results and to explore the depth of health problems in ex-servicemen.

Conclusion
There is rising prevalence of chronic diseases in elderly population which will be major burden in future on health care services of country. Majority of Ex-army serviceman and their spouses were having multiple co-morbidities, hypertension and musculoskeletal disorders. Most of them were not involved in any productive job after retirement and have low income in spite of having pension, so there is increasing dependence on their children more so by females leading to a state of neglect in these exservicemen.
There should be periodic screening of ex-serviceman for diseases like hypertension and more such outreach camps be organized for health education regarding these chronic non-communicable diseases. The government should form some policy to provide re-employment to ex-army servicemen, so that they can live socially and economically productive life after retirement.