An Analysis of the Morbidity Pattern and Its Financial Dynamics of Treatment Among Geriatric Patients

INTRODUCTION

As the global population ages, understanding geriatric patient morbidity patterns and financial dynamics is increasingly important. The morbidity patterns of geriatric patients are characterised by multiple chronic conditions, which frequently co-exist. These conditions can include hypertension, diabetes, cardiovascular diseases, musculoskeletal problems, and mental health issues. The prevalence of these conditions increases with age, and older adults often suffer from multiple pathologies.^[1,2]

Due to the decreasing fertility rate and increasing life expectancy, India is experiencing a significant demographic shift, with the proportion of elderly individuals steadily growing.^[3] The percentage share of the elderly population in the overall population of India is projected to increase from 8 percent in 2015 to 19 percent in 2050, accounting for around 300 million older adults and 34 percent by the end of the century.^[4] This demographic shift presents unique challenges for the healthcare system, as older individuals typically require more frequent and specialised medical attention.

The National Programme for Healthcare of the Elderly (NPHCE) aims to provide accessible and affordable healthcare services to older adults. However, inadequate funding to address the extensive healthcare needs of the elderly population, the limited reach of the program’s coverage, lack of awareness about the NPHCE and its benefits among the elderly and their families, and the shortage of healthcare professionals with expertise in geriatric care are some of the key factors that limit the scope of this government initiative.^[5]

A cross-sectional study in a rural area of Dakshina Kannada highlights a high prevalence of multimorbidity among the elderly in rural Dakshina Kannada. Key morbidities include visual impairment, hypertension, and joint problems, with notable gender differences in specific conditions.^[6] Many elderly individuals in India do not have health insurance coverage, and the percentage of policy purchases among senior citizens in India stands at 15% between April to December 2020.^[7] This might be due to a variety of reasons, such as a lack of awareness or the increased rate of premiums of the insurance policies. Lack of insurance access leads to out-of-pocket expenditures, which can be burdensome for elderly individuals, especially those living on fixed incomes, as it can lead to financial strain. The Indian government has also introduced social welfare schemes like the National Social Assistance Program, which provides financial assistance to vulnerable groups. However, the financial support provided may be inadequate to meet the basic needs and living expenses of the beneficiaries, thus ruling out its importance in healthcare funding.^[8]

With increasing age, the prevalence of non-communicable diseases rises significantly. Managing and treating these chronic conditions can be expensive, necessitating adequate financing mechanisms to ensure seniors can access the required healthcare services.^[9]

Geriatric care often involves long-term management of multiple health issues and frequent visits to the healthcare setting, leading to higher healthcare expenses. As seniors may have reduced earning potential and increased reliance on savings, pensions, or support from family, financing their healthcare becomes a vital concern. As the elderly population grows, the demand for healthcare services increases, leading to higher costs for both patients and healthcare systems. The financial implications of geriatric morbidity patterns include increased healthcare expenditures due to the need for multiple treatments and medications, higher hospitalisation rates, longer lengths of stay, increased risk of readmission, complications, and decreased functionality and quality of life.^[10]

This study analysed the financial implications of geriatric morbidity patterns, including the costs associated with healthcare services. The study underscores the significant impact of financial dynamics on the health-seeking behaviour and morbidity patterns of older adults, highlighting the need for improved financial support systems to manage healthcare expenses effectively.

MATERIAL AND METHODS

A cross-sectional study was conducted at a 1000-bed tertiary care hospital in Mangalore from April to June 2024 to evaluate the health and financial status of geriatric patients, focusing on morbidity patterns and associated economic impacts. The study population comprised geriatric patients aged 60 years and older who visited the Outpatient and Inpatient Departments of the hospital during this period, aligning with the World Health Organization’s definition of ‘elderly’ or ‘older persons.’ Convenience sampling was used to select participants, as this non-probability sampling method is cost-effective and feasible in a hospital setting, allowing easy access to patients presenting for care.

The required sample size was determined based on the expected prevalence of multimorbidity among older adults. For the purposes of adequate data representation and ensuring statistical validity in detecting significant health patterns and financial dynamics, the sample size was set at 148 [Supplementary S1]. This number was calculated to balance the precision of the study findings with the logistical constraints of the study setting.

This was calculated using the formula.

$n=\frac{z^2\frac{\alpha }{2}pq}{d^2}$

Where Z represents the standardised normal deviate (typically 1.96 for a 95% confidence level), p is the expected proportion (set at 0.5 to maximise variability and sample size), q is the complement of p (q=1−p), and d denotes the precision or margin of error (set at 8%, or 0.08).

Participants aged 60 years and above who visited the hospital’s outpatient and inpatient departments and were capable of giving informed consent were included in the study. Patients residing in institutional homes, such as nursing homes or old age homes, were excluded to avoid bias stemming from potentially different levels of care availability. Data collection was carried out using a structured questionnaire, which was developed and validated with input from relevant experts to ensure it effectively captured detailed information on health conditions, socioeconomic status, and healthcare utilisation.

The questionnaire was developed through a literature review and expert validation. The tool had three sections: demographic details, morbidity assessment (7 questions), and financial dynamics (37 questions). It captured information on health conditions, mental health symptoms, surgical history, medication use, healthcare access, barriers to treatment, and awareness of government health schemes. Financial aspects such as health insurance, service utilisation, out-of-pocket expenses, and family financial burden were also assessed.

To ensure the clarity and relevance of the questionnaire items, a pilot test was conducted with a small subset of 15 participants representative of the target demographic. This pilot test enabled the researchers to gather preliminary data on participants’ understanding and interpretation of the questions, helping to identify any ambiguities or areas of confusion. Feedback from the pilot group was instrumental in refining the questionnaire, as participants provided insights into which questions were clear and which needed rephrasing or additional context.

Data was entered into MS Excel, cleaned, and analysed using SPSS version 29. Descriptive statistics summarised frequencies, percentages, means, and standard deviations, while chi-square tests examined associations between morbidity patterns and financial dynamics.

RESULTS

DISCUSSION

The study offers a critical examination of morbidity patterns and financial dynamics among geriatric patients at a tertiary care hospital, revealing a complex health landscape. Chronic diseases such as diabetes mellitus and hypertension are highly prevalent in the geriatric population, affecting 34.5% and 33.1% of participants, respectively. This prevalence is consistent with broader research, such as the findings by Smith et al.,^[11] which show similar rates of chronic conditions in elderly populations across various healthcare settings, emphasising the widespread nature of these health issues.

The burden of these chronic diseases is compounded by the presence of other significant health conditions such as heart diseases and cancer, reported at 19.6% and 13.5% respectively in our study. These conditions underscore the critical health challenges faced by this demographic, necessitating regular medical interventions and comprehensive disease management strategies. Studies like those conducted by Johnson and Lee^[12] highlight the global impact of these diseases on mortality and morbidity rates among the elderly, stressing the need for enhanced healthcare protocols and preventive measures.

Additionally, the study identified high rates of urinary incontinence and liver diseases, which affect the daily lives and overall well-being of the elderly. High cholesterol and anaemia were each reported by 7.4% of participants, indicating prevalent metabolic and haematological issues that require ongoing medical attention. The complexity of treating these conditions is often intensified by multimorbidity, which Green et al^[13] suggest is a growing concern that complicates medical care and patient management in geriatric medicine.

Mental health emerges as a significant concern from the study, with symptoms of fear and anxiety prevalent among participants. These mental health challenges are often exacerbated by physical health issues and social factors such as isolation and financial stress, as indicated in the research by Kapoor and Sharma.^[14] Addressing mental health in conjunction with physical health is thus essential for providing holistic care to the elderly, a stance supported by the comprehensive care models discussed in Thompson and Diaz’s study.^[15]

Undiagnosed conditions such as visual disturbances, hearing loss, and chronic pain also significantly impact the quality of life and independence of elderly individuals. The need for early detection and intervention in managing these conditions is critical to prevent further deterioration, a view supported by Walters et al.^[16] who emphasise the benefits of early diagnostic screenings in improving long-term health outcomes for the elderly.

Turning to the financial dynamics of healthcare, the study highlights significant challenges, especially concerning health insurance coverage and out-of-pocket expenditures. Most participants (58.1%) did not have health insurance, which is a substantial barrier to accessing necessary healthcare services. Those who did have coverage were predominantly under government-sponsored plans, which are often limited in scope, leading to considerable out-of-pocket expenses. This finding aligns with the study by Harish et al.,^[17] which notes that inadequate health insurance coverage contributes significantly to the financial strain experienced by elderly patients.

Participants with health insurance reported varying maximum insurance claim amounts, with most claims capped at 5 lakhs (35.1%). However, the complexity of the claim process and the limited coverage result in substantial out-of-pocket expenses even for insured individuals, a situation that mirrors findings by Philip et al.,^[18] who discuss the limitations of health insurance schemes in adequately covering elderly healthcare needs. These financial challenges are further illustrated by the high frequency of healthcare utilisation and the considerable costs associated with both inpatient and outpatient services.

The correlation between lack of insurance and higher morbidity rates is particularly stark, underscoring the critical role of health insurance in mitigating the financial impact of healthcare expenses. Naveena and Venkatesh^[19] highlight similar findings, where uninsured individuals face more significant financial burdens and health disparities, pointing to the urgent need for policy reforms to expand and improve health insurance coverage for older adults.

CONCLUSION

The study highlights a pressing need for systemic changes to address the health and financial challenges encountered by older people. Key policy interventions should focus on expanding health insurance coverage, simplifying claims processes, and broadening the scope of services covered. Moreover, adopting integrated care models that address both physical and mental health needs is essential for delivering comprehensive support to older people. Future research should aim to build on these findings through broader, longitudinal studies that offer deeper insights into the evolving healthcare and financial needs of this demographic. Such research would better inform the development of effective healthcare strategies and policy reforms.