[Handicaps and needs of the elderly. A multifactor epidemiologic study under urban conditions]

As the number of old people increases, the need for a reliable statistical basis for socio-medical planning becomes more and more evident. Results of a representative survey in two cities of German-speaking Switzerland are presented, including correlations between the extent of need for assistance and predisposing factors. About half of the elderly are not disabled in everyday life, but 9.3% of the 66- to 75-year-olds and 46.1% of the over 85-year-olds are in need of regular daily assistance. In addition to age, male sex and being unmarried turned out to be independent predisposing factors for an increased need for help. Women were in the majority in some particular disturbances, but as a whole their need for assistance was less than among men. Socio-economic status was the most important risk factor for need for assistance. In comparison to those from higher social classes, elderly from the lowest class are round five times as often in nursing homes and ten times as often in residential homes. Their need for all forms of assistance is increased, and, in particular, they need much more daily household help than those in higher socio-economic groups. The number of admissions to institutions could be considerably reduced if more of these elderly persons could be offered ambulatory household assistance services. Furthermore, elderly of low socio-economic status tend to live more in unsuitable dwellings, eat food of lower quality, get less physical exercise, are less often of normal body weight, and have functional disturbances more often. Among the predominant factors associated with the need for nursing care are disturbances of orientation, incontinence and visual disturbances, whereas cardiovascular diseases and malignant tumors are of little importance in this context. The situation is different with respect to the need for household help, which is particularly frequent among persons with disturbances of the extremities. These in turn are about twice as frequent among elderly of lower social class than among those who are better-off. In the population under study about 40% of the elderly requiring daily nursing assistance are cared for in their homes, with their own family members providing most of the assistance. This is less often the case in the lower socio-economic groups. Our analyses make it possible, for the first time in Switzerland at least, to demonstrate clearly the important role social status, family situation and gender play in determining the level of disability and need for assistance among the elderly.(ABSTRACT TRUNCATED AT 400 WORDS)