Ageing is a natural, inevitable biological process characterized by a gradual decline in physiological functions and increased vulnerability to illness. The global demographic landscape is undergoing a major transformation, with the population aged 60 years and above expanding more rapidly than any other age group. As per the United Nations Population Division, the global elderly population is projected to more than double from 761 million in 2021 to over 1.6 billion by 2050 [1]. In India, this trend is similarly pronounced, with the elderly population expected to rise from 10.4% in 2022 to 20.8% by 2050. Notably, the proportion of individuals aged 80 years and above is also increasing significantly [2].

The Government of India, through its National Policy on Older Persons (1999), classifies individuals aged 60 years and above as senior citizens [3]. According to the Census of India 2011, the elderly constituted 8.6% of the total population, a figure projected to reach 19.5% by 2050 [4]. In Gujarat, elderly individuals accounted for 8.3% of the population, with a slightly higher proportion of females (9.0%) compared to males (7.6%) [5]. With rising life expectancy and declining fertility rates, the ageing population is poised to place considerable pressure on healthcare infrastructure, especially in rapidly urbanizing states like Gujarat.

Traditionally, the Indian joint family system played a key role in offering emotional, social, and financial support to the elderly. However, contemporary socio-economic transitions such as urbanization, internal migration, and the shift towards nuclear family structures have eroded these traditional support networks. As a result, many elderly individuals now face challenges such as social isolation, financial dependence, and deteriorating health [6,7]. Increasingly, elderly persons are seeking institutional care in old age homes—either voluntarily or due to compulsion—often stemming from neglect, abuse, loneliness, or the absence of family caregivers [8].

Old age homes have thus emerged as essential care institutions for elderly individuals who lack family support, face neglect, or are unable to manage independently. These facilities are designed to provide shelter, food, medical assistance, and emotional security. The need for such institutions is growing rapidly with the demographic shift and evolving family structures. According to HelpAge India, there are currently more than 1,000 old age homes in India, of which 99 are located in Gujarat and nearly 19 in Ahmedabad alone [9]. Many of these homes, however, vary greatly in quality and available services, and few provide comprehensive geriatric care that addresses both medical and psychosocial needs.

Despite their increasing relevance, research on the health status, morbidity burden, and psychosocial concerns of residents in these homes remains sparse—especially in urban Gujarat. In its 2012 campaign, "Good health adds life to years," the World Health Organization emphasized the importance of promoting both physical and mental well-being to help older adults remain active and socially connected [10]. In alignment with this vision, the Government of India implemented the National Programme for the Health Care of the Elderly (NPHCE), which aims to provide dedicated and holistic healthcare services for older individuals [11].

Despite the growing number of institutionalized elderly in urban Gujarat, there remains a significant gap in literature addressing their morbidity profiles, psychosocial challenges, and overall quality of life. Old age homes—once considered a last resort—are now becoming a necessary alternative for many elderly individuals. Yet, data on their health conditions, emotional status, and care quality remains insufficient. Ahmedabad, being one of the fastest urbanizing cities in the state, houses a considerable number of old age homes but lacks comprehensive, up-to-date evaluations of its elderly residents. Understanding their socio-demographic background, health needs, and psychosocial wellbeing is essential for improving institutional care services and framing effective geriatric health policies. This study seeks to fill this gap by evaluating the medical, social, and psychological problems of elderly individuals residing in selected old age homes of Ahmedabad district.

The primary aim of this study was to assess the medical and social problems among elderly individuals residing in selected old age homes of Ahmedabad district. The specific objectives included analyzing their socio-demographic profile, identifying common morbidity patterns, evaluating psychosocial concerns, and determining the factors affecting their quality of life. By systematically exploring these domains, the study seeks to generate evidence that can inform targeted interventions, enhance the standards of geriatric care within institutional settings, and support the formulation of policies aimed at improving the physical, emotional, and social well-being of the elderly population in Gujarat and beyond.

The present study was a community-based cross-sectional study conducted among elderly individuals residing in old age homes of Ahmedabad district, Gujarat. The study was carried out over a period of two years, from September 2020 to November 2022, encompassing both urban and peri-urban regions. All 19 functional old age homes listed in Ahmedabad were included in the study after obtaining permission from the respective authorities.

The study population comprised geriatric individuals aged 60 years and above. Participants who were seriously ill or unable to provide consent were excluded. The sample size was calculated using the formula n = 4pq/L², considering an hypertension prevalence of 60% [12], with 10% allowable error and 10% non-response rate, arriving at a total sample size of 410 participants. Simple random sampling was used to select these participants from a total elderly population of 870 residing in the 19 old age homes.

Data was collected using a predesigned and pretested questionnaire, which included sections on socio-demographic characteristics, medical history, psychosocial aspects, and the Quality of Life (QOL) Questionnaire Version 2 – Indian scenario. A pilot study involving 25 elderly participants from an old age home in Gandhinagar district was conducted prior to data collection to validate the questionnaire.

Participants were interviewed face-to-face after obtaining written informed consent. Clinical examination was carried out for all subjects, including general and systemic examination, and a review of their medical records. Information was also gathered on medical facilities available within the old age homes, presence of support aids (e.g., walking sticks, spectacles), and health promotion activities.

Ethical approval was obtained from the Institutional Ethics Committee of GCS Medical College, Ahmedabad, before commencing the study. Confidentiality was maintained at all stages, and participation was entirely voluntary.

The collected data was entered into Microsoft Excel and analyzed using SPSS Version 20.0. Descriptive statistics (mean, standard deviation, proportions) were used for summarization. Chi-square test and Z-test were applied to assess associations between variables, with p-value < 0.05 considered statistically significant.

A total of 410 elderly residents from 19 old age homes across Ahmedabad district were included in this cross-sectional study. Of these, 225 (54.9%) were males and 185 (45.1%) were females. The most represented age group was 61–65 years (29.2%), and the overall mean age was 71.1 years for males and 69.0 years for females. Majority of participants were Hindus (75.6%) and urban residents (62.4%). Nearly one-fifth (15.3%) were illiterate, while 21.4% had completed higher secondary education. Most women (67.5%) had been homemakers, while men had more varied work backgrounds—business (30.6%), labour (28.8%), or professional jobs (24.0%). At the time of the study, 71.2% were not working, and only 7.1% reported receiving pensions.

As per socio-economic classification (Modified BG Prasad), 35.6% belonged to Class IV (lower-middle class), 30% to Class III (middle class), and 18.5% to Class V (lower class). A majority (63.4%) were married; however, only 11.2% were currently staying with their spouses, indicating high rates of separation or widowhood. A large proportion (88.8%) lived alone in the old age homes, and only 27.2% reported regular visits from family members.

In terms of health status, the most common morbidities included hypertension (43.1%), musculoskeletal disorders (41.4%), and visual impairment (39.3%). Other prevalent conditions were diabetes mellitus (17.5%), respiratory disorders (11.4%), and neurological complaints (6.8%). Multiple morbidities were common, and females showed a higher burden of musculoskeletal issues, while males had greater rates of cardiovascular and respiratory conditions.

With regard to nutritional status, BMI analysis showed that 50.4% had normal BMI, while 20.9% were underweight and 28.7% fell into the pre-obese or obese categories, more so among males. Addiction history revealed that 40% of the total sample had some form of substance use, with tobacco chewing (20.9%) and smoking (15.3%) being significantly more common among males, and alcohol use was exclusively seen in male participants (3.7%).

Psychosocial evaluation indicated that while many elderly found safety and routine in old age homes, a substantial number (42.6%) reported feelings of loneliness, and 28.9% expressed a desire to live with their families if possible. Emotional neglect and lack of social stimulation were prominent among residents with poor family contact. About 36% of participants reported no major health promotional activities in their homes, and access to medical care was found to be suboptimal in over one-third of the facilities.

Quality of Life (QOL) assessment revealed that only 14.8% of the elderly perceived their quality of life as “good,” while 38.6% rated it as “moderate,” and a concerning 46.6% perceived their QOL as “poor”. QOL was significantly associated with age, sex, presence of chronic illness, economic dependency, family contact, and participation in social or recreational activities.

Table 1: Demographic and Socioeconomic Profile of Elderly (n = 410)

Table 2: Morbidity and Health Profile of Elderly (n = 410)

Table 3: Quality of Life and Psychosocial Indicators (n = 410)

Table 4:  Multiple Logistic Regression for Poor Quality of Life among Elderly (n = 410)

In the present study, multiple logistic regression analysis was performed to identify independent predictors of poor quality of life among elderly residents of old age homes. Several socio-demographic and health-related variables showed statistically

significant associations.

Elderly individuals aged 75 years or more were found to have significantly higher odds (AOR = 2.15; 95% CI: 1.32–3.51; p = 0.002) of experiencing poor quality of life compared to those younger than 75 years. Female gender was also associated with poorer outcomes (AOR = 1.74; 95% CI: 1.10–2.74; p = 0.017), indicating that elderly women are more vulnerable to psychosocial distress in institutional settings.

Participants from rural backgrounds had 1.6 times higher odds of reporting poor quality of life (AOR = 1.62; 95% CI: 1.03–2.56; p = 0.039), possibly due to greater adjustment difficulties in urban institutional environments. The presence of two or more chronic morbidities emerged as the strongest predictor (AOR = 3.21; 95% CI: 2.01–5.12; p < 0.001), highlighting the burden of co-existing illnesses on the physical and emotional well-being of the elderly.

Elderly who did not receive family visits were significantly more likely to have poor quality of life (AOR = 2.56; 95% CI: 1.67–3.92; p = 0.001), underlining the critical role of emotional support in geriatric care. Similarly, those not engaged in any form of work or activity were nearly twice as likely to report poor quality of life (AOR = 1.88; 95% CI: 1.12–3.15; p = 0.015), suggesting the importance of purposeful engagement. Lastly, participants from lower socioeconomic class (Class V) had significantly higher odds of poor quality of life (AOR = 2.91; 95% CI: 1.75–4.85; p < 0.001), pointing towards the intersection of economic deprivation and social vulnerability.

These findings underscore the multifactorial nature of poor quality of life in institutionalized elderly populations and emphasize the need for targeted interventions focused on chronic disease management, family reintegration, psychosocial support, and economic upliftment.

Figure 1: Morbidity Patterns Among Elderly Living in Old Age Homes

Figure 2: Forest Plot of Predictors of Poor Quality of Life

T In this study conducted among 410 elderly individuals residing in 19 old age homes of Ahmedabad district, the majority were males (54.9%) and aged between 61–70 years (42.2%). Most participants belonged to urban areas (62.4%) and were currently not working (71.2%). Although 63.4% were married, only 11.2% were living with their spouse, suggesting a high degree of social isolation. These patterns are consistent with a cross-sectional study by Brahmbhatt and Shah [12] in 2019, which reported that 51.2% were widowed and nearly 60% had minimal or no family interaction, emphasizing similar trends of emotional and social detachment among institutionalized elderly in Ahmedabad and Gandhinagar. Similarly, studies from Tamil Nadu and Maharashtra also noted more than half of residents living alone and having limited contact with children [13,14].

In terms of morbidity, hypertension (43.1%), musculoskeletal disorders (41.4%), and visual impairment (39.3%) emerged as the most common health issues. This aligns closely with findings from Brahmbhatt and Shah [12], where hypertension affected 39.2%, visual problems were seen in 34.6%, and musculoskeletal complaints in 36.4% of residents. Medhi et al. from Assam reported hypertension in 48% and chronic pain in 45% of institutionalized elderly, again reinforcing the high prevalence of non-communicable diseases in this setting [15]. A Kerala-based study by Nair et al. also showed that musculoskeletal and vision-related morbidities predominated among residents, with nearly 70% of elderly suffering from at least one chronic condition [16].

The burden of multimorbidity (51.4%) in this study reflects complex care needs. In the Brahmbhatt and Shah study [12], 49.1% of participants had more than one chronic illness, corroborating the compounded impact of coexisting health issues on elderly well-being. ICMR's multicentric survey further warned of limited access to specialist care in old age homes, especially for managing chronic diseases, leading to functional decline and disability [17].

Psychosocial distress was prominent in this study, with 42.6% reporting loneliness and 29.0% expressing a desire to return to family life. These findings echo Lena et al., who found 40–50% of elderly feeling neglected due to infrequent visits from children [18]. In Brahmbhatt and Shah's study [12], 47.3% reported emotional isolation, and nearly 35% said they felt abandoned by their families, confirming the emotional burden faced by elderly residents.

When quality of life (QOL) was assessed, this study found that 46.6% rated it as poor, 38.6% as moderate, and only 14.8% as good. In contrast, Brahmbhatt and Shah [12] reported 40.9% with poor QOL, showing slight regional variation, but generally highlighting the inadequate focus on holistic elderly care. Institutional studies from Delhi and Karnataka also demonstrated that older age, female gender, financial insecurity, and illness were strongly correlated with poor QOL [19,20]. In the present study, additional barriers such as lack of health promotion activities (36%) and inadequate medical access (34.6%) were reported—gaps also noted by Brahmbhatt and Shah [12], where 32.8% complained of irregular medical services.

The multiple logistic regression in this study confirmed that age ≥75 years, female gender, rural background, multiple morbidities, non-working status, lack of family contact, and lower socioeconomic class were significant predictors of poor QOL. These findings are consistent with national geriatric health surveys and also resonate with Brahmbhatt and Shah [12], where multimorbidity, financial dependence, and emotional neglect were independently associated with poor QOL in institutional settings.

The present study highlights the complex interplay of medical, social, and emotional challenges faced by elderly individuals residing in old age homes. A significant proportion of the participants suffered from chronic morbidities such as hypertension, musculoskeletal disorders, and visual impairment, with more than half experiencing multiple co-existing conditions. Despite institutional shelter, many residents reported poor quality of life, influenced by advanced age, female gender, rural origin, economic dependency, lack of family support, and absence of meaningful engagement.

The findings underscore that while old age homes provide basic living arrangements, they often fall short in addressing the broader spectrum of geriatric health care, particularly psychosocial and preventive aspects. There is a pressing need for structured interventions in these institutions—integrating regular medical care, health promotion activities, mental health services, and family reintegration efforts—to enhance the well-being and dignity of the ageing population. These results can inform policymakers and healthcare planners in designing comprehensive geriatric care programs tailored for institutionalized elderly.

This study has certain limitations that must be acknowledged. As a cross-sectional study, it does not allow for the establishment of causal relationships between identified risk factors and poor quality of life. The findings are restricted to elderly individuals residing in registered old age homes within Ahmedabad district, which may limit the generalizability to those in unregistered institutions or community-dwelling elderly. Additionally, the data were largely self-reported, introducing potential recall bias and social desirability bias. The study also did not include standardized tools to assess cognitive impairment or mental health disorders, possibly underestimating the true burden of neuropsychiatric conditions in this population

Based on the study findings, several recommendations are proposed to improve the well-being of elderly residents in old age homes. Regular comprehensive health screenings should be institutionalized, with a focus on the early detection and management of chronic diseases and mental health issues. Structured recreational, social, and spiritual engagement activities should be integrated to reduce loneliness and enhance psychosocial health. Efforts must be made to encourage family reintegration through planned visitation programs and emotional support initiatives. Capacity-building of caregivers in geriatric care and basic counselling should be prioritized. Furthermore, policy-level reforms are needed to ensure minimum standards of care and periodic audits of old age homes, supported by collaboration between government agencies and non-governmental organizations. Future multi-centric longitudinal studies are also recommended to capture the evolving needs of the institutionalized elderly.

I sincerely thank Dr. Viral Dave, Professor and Head, and Dr. Umesh Oza, former Associate Professor, Department of Community Medicine, GCS Medical College, Hospital and Research Centre, Ahmedabad, for their continuous guidance, insightful suggestions, and steadfast support throughout this project. Their expertise and motivation were instrumental in shaping the study and bringing it to successful completion.

CONFLICT OF INTEREST: Nil

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