title: Determinants of disability among the elderly population in a rural south Indian community: the need to study local issues and contexts.
abstract: BACKGROUND
  Disability among the elderly is a cause of significant burden. There is dearth of relevant research from low- and middle-income countries. We aimed to establish the nature and factors associated with disability among the elderly in a rural south Indian community.
  
  
  METHODS
  We recruited 1000 participants aged over 65 years from Kaniyambadi block, Vellore, India. We assessed their disability status, sociodemographic profile, psychiatric morbidity, cognitive functioning and anthropometrics using the following structured instruments: WHO Disability Assessment Scale II, Geriatric Mental State, Community Screening Instrument for Dementia, and Neuropsychiatric Inventory. We employed appropriate multivariate statistics to study the factors associated with a higher level of disability and to determine the population attributable fractions for various modifiable risk factors.
  
  
  RESULTS
  Advanced age, illiteracy, hunger, poor nutrition, arthritis, hearing impairment, gastro-intestinal and respiratory diseases, dementia and travel costs to primary health facilities increased the risk of disability significantly. Hypertension, diabetes and depression were not associated with disability. Modifiable social determinants and medical diseases together contributed to disability in this population.
  
  
  CONCLUSIONS
  Locally relevant social determinants combine with prevalent medical diseases to produce the disability burden among elderly. There is a need to focus on local contexts and modifiable risk factors to design locally appropriate public health policies and interventions.
authors.affiliation: Department of Psychiatry, Christian Medical College, Vellore, India.
authors.forename: A S
authors.initials: AS
authors.lastname: Duba
authors.forename: A P
authors.initials: AP
authors.lastname: Rajkumar
authors.forename: M
authors.initials: M
authors.lastname: Prince
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011584:Psychology; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors