Mental Health and Health Status of Elderly Bengalis and Somalis in London Age and Ageing Ellen Silveira

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Mental Health and Health Status of Elderly Bengalis and Somalis in London
Age and Ageing
Ellen Silveira, Shah Ebrahim
November 1995

A semi-structured questionnaire on mental and physical health including a Life Satisfaction Index (LSI) and a scale of Symptoms of Anxiety and Depression (SAD) was administered in appropriate languages to 75 Bengalis and 72 Somalis aged 60 years and over living in Tower Hamlets, London. Data on prevalence of health problems and disability were sought to explore the relationships between health and socio-demographic determinants of anxiety and depression and life satisfaction. Prevalence of chronic health problems was correlated with SAD scores among Somalis (r = +0.31, p = 0.01) and Bengalis (r = +0.38, p = 0.001) and LSI scores among Somalis (r = -0.25, p = 0.04) but not Bengalis (r = -0.05). Disability in activities of daily living (ADL) correlated with LSI (r = -0.29, p = 0.01) and SAD scores (r = +0.39, p = 0.001) among Bengalis but not Somalis (r = -0. 11 and +0.08 respectively). Both age and chronic health problems were predictors of SAD scores among Somalis and health problems only predicted LSI scores. Among Bengalis, age and ADL disability were strong predictors of SAD scores whilst disability only predicted LSI scores. These findings emphasize the importance of aspects of physical health as determinants of psychological well-being among elderly people in different cultures. Differences observed between groups may reflect their concepts of disease, disability and well-being. A qualitative study to explore these possibilities is currently under way among Somalis and will allow further insights into the significance of these constructs.

Introduction and aims

Some empirical studies suggest that quality of life in old age is largely determined by health status [1-4]. The importance of good health to general well-being seems to be even greater among people in lower socioeconomic groups [5].

With the decline in physical abilities associated with old age, disability (particularly reduced mobility) rather than prevalence of chronic health problems tends to assume a more salient role in influencing well-being and may be a better indicator of subsequent mortality [6-8]. Physical health status and mental health are clearly linked but the relationship may be causally bi-directional. Increased prevalence of chronic health problems may inhibit people from interacting with friends or family members in leisure or work, restricting opportunities for boosting satisfaction within these life domains and producing depression. Negative emotions due to stressful life events may, on the other hand, lead to physical symptoms, feelings of hopelessness and predispose to physical illness through ill-understood mechanisms [9].

Among people aged 75+ in Britain, 62% of men and 72% of women are likely to report at least one long-term illness [10]. Elderly people from minority ethnic groups (60+) report even higher prevalence rates of long-term health problems. Data from the 1991 Census have revealed this to be the case particularly for Pakistanis, Bangladeshis and Afro-caribbeans compared with the white population of the same age [11, 12].

Epidemiological studies in Britain have shown higher prevalence rates of diabetes, hypertension, ischaemic heart disease and asthma among West Indians and people from the Indian subcontinent [13], higher consultation rates for general practitioner services [14, 15] and a high use of hospital beds among `Asian' elderly people, with increased discharge rates for cataract surgery, diabetes, gastrointestinal bleeding and asthma compared to a white group [16]. Rates of admission to psychiatric hospitals, particularly for schizophrenia, seem also to be related to ethnicity though lack of intercultural awareness is one of the complex issues involved in influencing such patterns [17-19].

The additional interplay of social difficulties such as poverty and poor housing is likely to exacerbate the relationship between ethnicity and health status. Although research in North London has revealed low levels of mental disorders among elderly Gujarati people [20] compared with the white population, it is hypothesized that the prevalence of mental disorders among elderly people living in impoverished areas will be high. Preliminary evidence suggested low health status and social circumstances of elderly people in the Somali and Bengali communities in Tower Hamlets [21, 22]. This study of elderly Bengalis and Somalis was carried out with two main aims: to examine levels of physical and mental health, and to study the relationship between them, focusing on the determinants of anxiety and depression and life satisfaction.

Methods

Subjects - Somalis: Seventy-two people were contacted, 60 men and 12 women. Names were drawn from a list of elderly Somalis receiving meals available from a Somali London Community Voluntary Organisation. The response rate was 100%. Participants were scattered through all wards in the borough but the majority were living in Poplar, Bow and Bethnal Green. Data were collected by a male Somali community worker from 1991 to 1992. Interviews were conducted in Somali.