Original Article

Social Factors Influencing Utilization of Old Age Homes by

Elderly in Urban Area of South Chennai, Tamil Nadu
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  Sujitha Pandian, Swetha Naik, Umadevi Ramachandran, Angeline Grace G, Gopalakrishnan S

Department of Community Medicine, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
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Abstract
Background: Currently, most old age homes in India are completely occupied. Nowadays, nuclear families are more than joint families,
and due to various factors such as urbanization, the elderly are deprived of essential care at home and are moved from their own homes to
old‑age homes. With the increasing geriatric population, this study explored the various social factors influencing the elderly to reside in old
age homes. Material and Methods: The study was conducted among 330 elderly in old age homes using simple random sampling. The study
population included elderly above the age of 60 years and residing in old age homes, who were willing to participate. A pretested structured
questionnaire with data on sociodemographic characteristics, family, financial support, and various other social factors was collected. Data
were analyzed using SPSS. Results: Among the respondents, 20.6% were supported by children financially and 18.5% had a pension. Almost
70% of the elderly were left unattended by friends and family. Care and support through means of calls, letters, and visits when analyzed
showed that 27.3% were provided care and support through children and 33.6% were left unattended. Conclusion: Family members, friends,
and relatives should be encouraged to give regular visits and spend time with the elderly so that the bonding will have a positive effect on
their mental health. Aging and geriatric health should be considered sensitively and should be made mandatory for schools and colleges to
arrange visits to old age homes, thereby keeping the younger generation aware of the issues.

Keywords: Geriatric, medical sociology, old age home

Introduction now becoming the need of present Indian society. From recent
data, we can see that multiple old age homes are coming up
Currently, India’s proportion of senior citizens has shown a
and currently, there are more than 1000 old age homes in
drastic increase from 5.6% in 1961 to 7.5% as of the 2011
South India.[9]
Census.[1] The elderly population living in rural areas of India
are maximum enrolled in unorganized agriculture work. With Non‑governmental organizations, private institutions, as well
the changing economic and social norms, geriatric health is as government, are contributing to the establishment of old age
facing weak care and support.[2] In India, the National Program homes. They are either free of cost or paid. The former ones
for Health Care of Elderly (NPHCE), which was initiated are generally for the abandoned and destitute who are devoid
recently aims to develop infrastructure and build the capacity of of familial support, finance, and healthcare. In such types,
healthcare providers for elderly healthcare around the world.[3] shelter, food, and healthcare are provided free of cost. In the
With industrialization and modernization, new lifestyles have latter type, all services are provided for a price.[10,11]
set in, resulting in transitional changes.
A single joint family is broken into many nuclear families. Address for correspondence: Dr. Sujitha Pandian,
Such changes in the family structure have put the elderly Sree Balaji Medical College and Hospital, CLC Works Road,
into a situation of shifting from their own homes to some Chromepet, Chennai ‑ 600044, Tamil Nadu, India.
institutions or old age homes (Doty, 1992, Hegde et al, E‑mail: [email protected]
2012, Kumar et al, 2012, 2013, Mishra, 2008 & Mudey et
al, 2011).[4-8] The concept of old age residence is developing This is an open access journal, and articles are distributed under the terms of the Creative
and in existence as a newer occupancy for the elderly and is Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit
Access this article online is given and the new creations are licensed under the identical terms.

Quick Response Code: For reprints contact: [email protected]

Website:
www.ijcm.org.in
How to cite this article: Pandian S, Naik S, Ramachandran U, Grace GA,
Gopalakrishnan S. Social factors influencing utilization of old age homes by
elderly in urban area of South Chennai, Tamil Nadu. Indian J Community
DOI:
10.4103/ijcm.ijcm_295_22
Med 2024;49:41-5.
Received: 05‑04‑22, Accepted: 31‑10‑23, Published: 12-01-24

© 2024 Indian Journal of Community Medicine | Published by Wolters Kluwer - Medknow 41

 Pandian, et al.: Various social factors influencing elderly on utilizing old age homes

Therefore, an attempt was made to explore various social Data collection method
factors responsible for influencing the elderly to utilize old Data were collected using a pretested, structured questionnaire.
age homes. With this background, this study was planned Information regarding sociodemographic characteristics and
to assess the social factors influencing the utilization of old various social factors and reasons that influenced them to
age homes by the elderly in an urban area of South Chennai, choose old age homes was collected.
Tamil Nadu.
Statistical analysis
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Data collected were entered into Microsoft Excel and analyzed

Methodology using the SPSS software, version 22.
The cross‑sectional study was carried out in old age homes
located in an urban area of South Chennai, Tamil Nadu. The
Results
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total land area was around 62.5 sq.km with 91,201 households.
The study population included elderly living in old age homes. The results of this descriptive cross‑sectional study are
presented as tables and graphs below:
Sample size and sampling technique
The sociodemographic characteristics of study respondents
The sample size for this study was calculated based on the
are presented in Table 1. Nearly 40.3% of the study
prevalence of a previous study conducted by Rakesh M Patel
participants belong to the age group between 71 and 80 years.
et al., in 2012, in Gujarat, which showed a prevalence of 25%
Among the 330 study participants, nearly half of them were
of elderly living in old age homes.[12] Taking this as a reference
female (50.9%). More than half (66.6%) of them had an
value and using the formula N = Zα²pq/[L] 2, the sample size
education qualification of middle school and above.
was calculated as follows.
Using the formula, Financial status of study participants
Various sources of income for study subjects are presented
N = Zα²pq/[L] 2 in Table 1. Among the study population, 31% had insurance
Where, Z = 1.96 at a 95% confidence interval coverage, 27.6% had personal savings, 20.6% were supported
by children financially, 18.5% had pension, 1.5% had assets in
p = prevalence of disease/event (referred value) their name, and the remaining 5.8% were getting rent.
q = 100 – P Care and support of the elderly
L = allowable error 5% Determinants of care and support of the elderly are presented
in Table 1. In aspects of frequency of visits from relatives,
Substituting it in the formula,
around 70% of them elderly, were left unattended by friends
[Z = 1.96, P = 25%, q = 75 (100‑25), L = 5] and family. Around 3.9% of the elderly were visited by friends
or family rarely. Nearly 13.3% had their relatives meet them
1.96 x1.96 x 25 x 75 once in 3 months, 5.3% monthly, 4.5% half‑yearly, and 2.7%
=N = 300
5*5 once a year. Care and support through means of calls, letters,
and visits, when analyzed, showed that 27.3% were provided
Accounting for 10% non‑response, the final sample size was care and support through children, 22.2% by relatives, and
calculated as 330 [N = 330]. 16.9% by friends. The remaining majority (33.6%) were still
left unattended.
Inclusion and exclusion criteria
Elderly individuals who were not chronically ill or not on any The decision taker for admitting the elderly in old age home
psychiatric medications were included in the study. Those not is presented in Figure 1. From the figure, we can see that for
willing to give informed consent and not willing to participate 30.3% of the older persons, the decision to stay in old age
in the study were excluded. homes was chosen by their relatives, whereas 27% of the
elderly made a self‑decision to live in old age homes. For
Sampling method 26.7% of residents, their children took the decision of staying
From the 31 old age homes in urban South Chennai, 10 homes at old age homes.
from which permission was obtained were chosen. From this
sampling frame, 330 participants were selected using the Psychological status
simple random sampling method. Satisfaction of residents regarding stay at old age homes
The satisfaction of the study respondents regarding their stay
Ethical approval
at old age home is presented in Figure 2. Among our elderly
The proposal for this study was presented before the
study population, the majority of the respondents (76%) were
Institutional Ethics Committee and approval was obtained
satisfied with their stay at an old age home. The remaining
before beginning the study.
minimum of 24% was not satisfied with staying at an old age
IEC number: 002/SBMC/IHEC/2018/1178 home. Their options to stay are presented in Table 1. Of the

42 Indian Journal of Community Medicine ¦ Volume 49 ¦ Issue 1 ¦ January-February 2024

 Pandian, et al.: Various social factors influencing elderly on utilizing old age homes

Table 1: Frequency distribution of various characteristics Others 16.1%

of respondents
Children 26.7%
Sociodemographic variable Frequency Percentage
(n=330) Self 26.9%
Age
Relatives 30.3%
60‑70 122 36.9
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71‑80 133 40.3 0 5 10 15 20 25 30 35

Above 80 75 22.7 Percentage
Sex
Female 168 50.9 Figure 1: Decision makers responsible for admitting elderly in old age
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Male 162 49.1 home (n = 330)

Previous occupation
Skilled worker and semi‑skilled worker 154 46.6 Level of Satisfaction
Unskilled and unemployed 176 53.4
Education status
Middle school and above 220 66.6
Below middle school 110 33.4
24%
Marital status
Married 26 7.9
Not married/single/widowed 304 92.1 Satisfied
Type of family
Nuclear 53 16.1
Not Satisfied
Joint 14 4.2
Destitute 145 43.9
76%
Abandoned 118 35.8
Religion
Hindu 300 90.9
Christian 20 6.06
Figure 2: Study participants satisfied with stay at old age home (n = 330)
Muslim 10 3.04
Source of financial income
Insurance 102 31 Discussion
Savings 91 27.6
Our study assessed various social factors that have been
Children support 68 20.6
influencing senior citizens to utilize old‑age homes. With
Pension 61 18.5
an increase in life expectancy, the proportion of elderly is
Rents 19 5.8
increasing in our country. It has been reported that the elderly
Assets 5 1.5
Determinants of care and support
population is more than 100 million and is expected to rise to
Visit
300 million by 2050, thereby making India the leading country
Once a month 17 5.3 with elderly when compared to Japan.[13,14]
Quarterly 44 13.3 There are very little data on the total number of old age homes
Twice a year 15 4.5 in India. It is reported that there are approximately 700 old age
Once a year 9 2.7 homes in India, of which nearly 46% (325) of old age homes
Rarely 13 3.9
are free of cost, whereas the remaining are on a pay‑and‑stay
None 232 70.3
basis. There are 728 old‑age homes in India today. Detailed
Care and support
information on 547 homes is available. Out of 28 states in
None 111 33.6
India, Kerala has 124 old age homes, which is the maximum.[15]
Children 90 27.3
Friends 56 16.9 A study conducted by Samuel et al.[16] in Chennai compares
Relatives 73 22.2 the prevalence of the elderly population residing at home with
Preferred company to stay those residing at old age homes. With recommendations of
Children 52 15.7 “National Policy on Older Persons” under the Maintenance
Relative 27 8.3 and Welfare of Parents and Senior Citizens Act 2007,”
No 251 76 The Ministry of Health and Family Welfare (MOHFW)
launched the National Programme for Healthcare of the
24% who were not satisfied with their stay at old age homes, Elderly (NPHCE) in 2010‑2011 targeting all elderly people
15.7% wished to stay with their children, and the remaining above the age of 60 years. This program covers the entire
8.3% desired to stay with their relatives. county and its aims are to provide separate, specialized, and

Indian Journal of Community Medicine ¦ Volume 49 ¦ Issue 1 ¦ January-February 2024 43

 Pandian, et al.: Various social factors influencing elderly on utilizing old age homes

comprehensive healthcare to senior citizens at various levels. Conclusion

These services are provided in an integrated manner aiming to
From this study, various social factors are identified as reasons
provide promotional, preventive, curative, and rehabilitative
for choosing old age homes. With the increasing elderly
services at various government health facilities.
population and urbanization, steps need to be taken to accept
It has been noted that the majority of the old age home residents the changes. Residents should be encouraged to participate in
were forced to leave to old age homes, but currently, they are domestic activities in the old age homes. Depending on their
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satisfied with their stay. From our study, of the 24% who were activity of daily living, they can be allotted some mild work.
not willing to stay in old age homes wished to stay either with Some participants were found to get pensions. Authorities of
their children or relatives. Maximum study respondents (31%) the old age home should make arrangements for the pension
had financial support through insurance, whereas other sources to reach the elderly directly. Family members, friends, and
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of financial income were children support, savings, pension, relatives should be encouraged to give regular visits and spend
etc., From a study conducted by Rajput M et al. it has been time with the elderly so that the bonding will have a positive
noticed that elderly require long-term care and follow-up for effect on their mental health. Aging and geriatric health should
chronic conditions and even a small amount of user fees raises be considered sensitively and should be made mandatory
concern in them. In the absence of health insurance and poor for schools and colleges to arrange visits to old age homes,
home care in rural areas, other low‑cost alternatives to hospital thereby keeping the younger generation aware of the issues.
care such as mobile services, special camps, and ambulance Through such visits, the residents get to spend quality time
services have been suggested.[17] with children. Motivational talks among schoolchildren on
their responsibility to respect, honor, and protect the elderly
From a study conducted by Dhananjay et al, lack of family care
should be encouraged.
has been a main reason for the elderly to shift from their own
homes to old age homes. Other studies conducted by Bharathi Financial support and sponsorship
in 2006 and Mishra in 2008 discuss various reasons such as a Nil.
change in family structure, insufficient housing, and economic
hardship for the elderly to move to old age homes.[18,19] Conflicts of interest
There are no conflicts of interest.
A study conducted by Smith presents “misbehavior of
children” (29.8%) as the most common factor for residing in
old‑age homes. Similarly, a study conducted by Lalan in 2014
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