Texila International Journal of Public Health

Volume 7, Issue 3, Sep 2019

Influence of Family Structure on Recent Trends of Ageing Process

Article by Ann Kavitha Mathew

Faculty, Dept. of Public health, School of Medical Education, Kerala, India
E-mail: [email protected]

Abstract
The demographic background of the elderly plays a pivotal role in the health and health related
aspects of the old age population. In India, where the family has an obligation to care for the elderly,
the consequences of rapid declines in fertility and mortality on elderly makes living arrangements an
important issue in the field of population and development. The study was conducted in the context of
Kerala with the purpose of finding out the influence of family structure on the health of the aged. The
data was collected through field work and it was a descriptive type of study. The analysis was carried
out with definite dependent and independent variables. The study shows that the family size plays an
important role in the deterioration health of the aged, the perception about their health condition, the
care during their illness. It was also clear from the study that feeling of loneliness and ability of
adjustment with the family members varies significantly with the family size. The analysis shows that
the disease structure particularly the prevalence of both communicable, non-communicable diseases
and occurrence of multiple diseases are more prone to those who belong to large families.
Keywords: Family structure, Ageing process, Geriatric health, Elderly, Old age, Living
arrangements.
Introduction
One of the major features of demographic transition in the world has been the considerable increase
in the absolute and relative numbers of elderly people. This has been true especially in the case of
developing countries like India, where ageing is occurring more rapidly due to the decline in fertility
rates combined by the increase in life expectancy of people achieved through medical interventions.
Geriatric health is influenced by many factors like age, gender, lifestyle habits, education, food habits,
residence, marital status, financial wellbeing, family size and structure, as well as cultural traditions
such as kinship patterns, the availability of social services and social support and the physical features
like housing structure and also that of local communities.
Methods
The main objective of the study was to understand the influence of family structure on the recent
trends of ageing process with special emphasis on health problems in Kerala context. The hypothesis
formulated was family size influences the occurrence of psychological problems among the aged.
Feeling of loneliness among the old is felt more among those with smaller family sizes. The study was
mainly extended over the relevant areas in the State of Kerala. Population of the study consists of
individuals 60 plus and who are permanent residents of Kerala both males and females. By way of
sampling procedure, systematic sampling method was adopted in the study. Sample item was selected
at random from different strata (districts) so as to have adequate representation from all areas with the
help of Census reports. Random number table was used for randomization. Sample size was suitably
fixed as 710.A pre-test was conducted among 53 items from among the population of the study based.
An interview guide was prepared for the purpose. The final interview schedule or research tool was
prepared on the basis of the observations obtained from the pre-test which was finally used for data
collection proper. Both primary and secondary were collected for the study. Primary data were
obtained from the sample items located for data collection proper. Secondary data was collected from
all available sources relevant to the problem of study like the already published work in the field,
reports, and official documents available as well as individual cases. The collected data is processed
with respect to definite dependent and independent variables identified for the study. The analysis is

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carried out to bring out the results of the study. Chi square test adopted for testing the hypothesis
selected.
Results
While considering the family size and general health condition, those who have a smaller family
size, higher is the perception about their health condition. It is 69.9% who are having a family size
less than 5 and 30.06% who are having a family size 5 and above. It is clear from the study that higher
the family size, higher is the deterioration of health among the aged. Observation on activities during
old age and family size reveals that those who belong to the smaller family size less than 5 (37.4%) go
for regular walks and only 6.7% are spending their time in conversing with others while those who
belong to the large family size of 5 and above 38.3% spend their time mostly for watching TV and
26.4% go to visit worship places / tourist places and relatives. On enquiring about the care during
illness during old age with respect to the family size it has been found that the majority (76.2%) of
those who belong to the larger family size of 5 and above are getting adequate care during their
illness. While examining the influence on the number of family members on the ability to adjust at
home it is seen that slightly less than the majority (48.37%) who family size is smaller than 5 are
always able to adjust well at home. Only 10.5% among those who are not able to adjust well at home
are having a larger family size of 5 and above. The feeling of loneliness is higher (77.5%) among
those who are having a smaller family size. Chi-square test also shows that the two variables are
significantly related. While assessing the influence of family size on the occurrence of diseases 96.7%
having diseases with the smaller family size of under 5 and 95.45% having diseases belong to the
larger family size of 5 and above. The communicable diseases are more among the old and those who
belong to the larger family size of above 5 (94.3%). In the smaller family group non, communicable
diseases are present among 96.7% of the study sample. The prevalence of multiple diseases is more
among (94.3%) with those who belong to the larger family size of above 5. In both cases the major
health problems present is cardiac / hypertension related followed by diabetes and gastro-intestinal
problems. It is 97.2%, 96%, and 90.2% respectively in the case of the sample whose family size of
less than 5. It is 88.7%, 87%, and 68.6% respectively in the case of the sample with the larger family
size of 5 and above.
Discussion
During the later years the number of members in the family affects many factors including health
and wellbeing. Here in the current study on examining the influence of family structure on the
perception of their own general health condition, among the respondents it was found that most of
them (63.12%), of those whose family size is less than 5 think that their general health is good and
only 19.2% among them perceive it as bad. While 48.5% of the respondents whose family size is
more than 5 reported that their general health is bad and 24.7% among them think of it as good. On
the other point of view those who perceive their health condition as good (43.09%), a great majority
(69.9%) having family size of less than 5. So, the study reveals that smaller the family size, higher is
the perception about their health condition as being better (Table 1).
Table 1. Family Structure & General Health
General Health
Good Average Bad Total
Family Size
214[63.12%] 60[17.7%] 65[19.2%] 339
Less Than 5
[69.9%] [37.7%] [26.5%] [47.7%]
92[24.7%] 99[26.7%] 180[48.5%] 371
5 And Above
[30.06%] [62.26%] [73.4%] [52.2%]
Total 306[43.09%] 159[22.39%] 245[34.5%] 710
While considering the relationship between number of family members and deterioration of health
among the aged, it was evident from the study that the majority 61.6% of the sample, whose family
size is less than 5 reported that there is no deterioration of their health condition while 12.6% reported
that their health is deteriorating. 46.9% of the sample whose family size is greater than 5 thinks that

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Volume 7, Issue 3, Sep 2019
their health is deteriorating, but only 35.5% of them think that there is no deterioration. Again a closer
look at the data suggest that those who reported that there is no deterioration in their health condition,
the majority 61.2% belongs to those who are having family sizes of less than 5 and those who
reported that deterioration is higher, the majority 80.2% belongs to those whose family size is greater
than 5. So higher the family size, higher is the deterioration to their health among the aged. (Table 2).
Table 2. Family structure & deterioration of health

Deterioration
Of Health To Some
No Very Much Total
Extent
Family Size

209[61%] 87[25.%] 43[12.6%] 339

Less Than 5
[61.2%] [57.2%] [19.8%] [47.7]
132[35%] 65[17.%] 174[46.%] 371
5 And Above
[38.7%] [42.7%] [80.2%] [52.2]
Total 341[48%] 152[2%] 217[30.%] 710
On enquiring about the care, they are receiving during their illness in their old age with respect to
the family size it was observed that 67.74% of the respondents who reported that the care they are
getting during illness is adequate, 58.8% belongs to the larger family sized group. So higher the
family size, higher is the care they are getting during their illness. (Figure1)

300

200

100

0
LESS THAN 5 5 & ABOVE

INADEQUATE ADEQUATE

Figure 1. Family structure & care during illness

During old age, factors like social isolation, low income and depression affect their health.
Loneliness is a common problem in old age and leads to health-related problems. Table 3 explains the
various activities that they are engaged during their free time. During this time, it becomes all the
more important for seniors to take on some activity that occupy their time. Study based on the
activities during old age and family structure revealed that among the lower family sized groups,
37.4% are going for regular walks, 33.03% are visiting such as worship, tourist places or their
relatives, and 22.7% spend their time watching TV and only 6.7% spend their time conversing with
others. While those who belong to the larger family size the majority 38.3% spend their time watching
TV, 26.4% by visiting worship, tourist places or relatives, 19.4% spend their time in conversations
with others, and 15.9% of them by going for walks. (Table 3).

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Table 3. Family Structure & Activities
Visiting Total
Conver-
Activities Worship
Going For Watching Sation
Places / Tourist
Walks Tv With
Family Size Places /
Others
Relatives
339
112[33.03%] 127[37.4%] 77[22.7%] 23[6.7%]
Less Than 5 [47.7
[53.3%] [68.3%] [35.1%] [24.2%]
%]
142[38.3% 371
98[26.4%] 59[[15.9%] 72[19.4%]
5 And Above ] [52.2
[46.6%] [31.7%] [75.7%]
[64.8%] %]
219[30.8%
Total 210[29.57%] 186[26.19%] 95[13.4%] 710
]
On examining the degree of feeling of loneliness based on the present study, it is seen that feeling
of loneliness is far higher (77.5%) in the smaller family size and only a far smaller percentage (4.4%),
of those with a smaller family size do not have any feeling of loneliness. Among those who feel
loneliness very much, the majority (67.6%) belongs to the smaller family size and those who are not
at all feeling loneliness; the majority (82.7%) belongs to the larger family size. So higher the family
size, the lower is the feeling of loneliness among the aged. The chi-square test also shows that the
observation on feeling of loneliness and the family size of the respondents are significantly related.
(Table 4) (Chi-square value = 138.6, Degrees of Freedom=2, Table value at 5% level=5.99).
Table 4. Family Structure & Feeling of Loneliness

Feeling of
Loneliness Very Much To Some
Family Not at All Total
Extent
Size
263[77.5%] 61[17.9%] 15[4.4%] 339
Less Than 5
[67.6%] [26.1%] [17.2%] [47.7%]
126[33.9%] 173[46.6%] 72[19.4%] 371
5 And Above
[32.3%] [73.9%] [82.7%] [52.2%]
Total 389[54.7%] 234[32.9%] 87[12.25%] 710
On an examination of the influence of the family on the ability to adjust well at home it was found
that 48.37% of the respondents whose family size is less than 5 reported that they are always able to
adjust well at home and only 24.7% reported they are having difficulty adjusting while for the larger
sized families 49.8% of them were having difficulties adjusting and only 10.5% reported they are well
adjusted. On examining those who are always well adjusted, the majority 80.7% belongs to the family
size of less than 5. So, the study reveals that the sample which belongs to the lower family size is able
to adjust better at home than those who are living with a larger sized family. (Table 5).
Table 5. Family Size &Ability for Adjustment

Ability to
Adjust Well
at Home
Always Some-Times Never Total

Family Size

164[48.37%] 91[26.8%] 84[24.7%] 339

Less Than 5
[80.7%] [38.2%] [31.22%] [47.7%]
39[10.5%] 147[39.6%] 185[49.8%] 371
5 And Above
[19.2%] [61.7%] [68.7%] [52.2%]

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Volume 7, Issue 3, Sep 2019

Total 203[28.59%] 238[33.5%] 269[37.88%] 710

On examining the disease pattern, it was seen that 96.7% of those having diseases belong to the
smaller family sized group and 95.4% of those having diseases belong to the larger family size. (Table
6).
Table 6. Family structure & disease
Disease
Present Absent Total
Family Size
339
Less Than 5 328[96.75%] 11[3.2%]
[47.7%]
371
5 And Above 354[95.41%] 17[4.5%]
[52.2%]
Total 682[96.05%] 28[3.9%] 710
Among those who are having family size less than 5, non- communicable diseases are present
among 96.7% of the sample and in the larger family size of 5 and above it is 95.4%. But in the case of
communicable disease it is higher among the larger family size 94.3%. (Table 7).
Table 7. Family Structure & Disease (Communicable & Non- Communicable)

Disease Communic
Non-Communi No
able Total
Family Size cable Disease Disease
Disease
Less Than 5 299[88.2%] 328[96.7%] 11[3.2%] 339[47.7%]
5 And Above 350[94.3%] 354[95.4%] 17[4.5%] 371[52.2%]
Total 649[91.4%] 682[96.05%] 28[3.9%] 710
The study shows that multiple diseases are more prevalent (94.3%) among those who belong to the
larger family size compared to those who have small family size (88.2%). Multiple diseases are absent
among 11.7% in the case of the smaller family sized group and only 5.6% in the case in the larger
family size. It is evident from the study that higher the number of members in the family, the greater
the risk of getting multiple diseases. (Figure 2).

400

200

0
less than 5 5 and above
present absent

Figure 2. Family Structure & Multiple Diseases

Furthermore, it was observed that among those that were having family size less than 5, 97.2% are
having cardiac / hypertension related problems, 96% are having diabetes and 90.2% are having
gastrointestinal problems. But in the case of those who are having larger family size, 88.7% are
having cardiac or hypertension related problems, 87% are having diabetes and 68.6% are having
gastro- intestinal problems. Among those who are having family size less than 5, 86.5% are having
respiratory problems, 80.1% are having metabolic / hormonal complaints, 75% are having urology
related complaints, 61.8% are having neurological ailments and 12.5% are cancer patients. Among
those who are in the larger family size, 52.25% have respiratory illness, 51.6% are having
neurological problems, 44.9% are having urological problems 41.2% are having metabolic / hormonal
problems and 7.3% are cancer patients, in all these cases, the higher prevalence is among those who
have family size less than 5. (Table 8).

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ISSN: 2520-3134

Table 8. Family Structure & Types of Diseases

Disease Sub- Gastro- Metabo- Cardiac/
Res- Urolo- Neuro- No
Inte lic/Hor Hyper- Diabetes Cancer Total
Total piratory gical logical Disease
Family Size stinal monal tension
Less Than 5 328[96.75] 284[86.5] 296[90.2] 246[75] 203[61.8] 263[80.1] 319[97.2] 315[96.03] 41[12.5] 11[3.2] 339[47.7]
5 And
354[95.4] 185[52.25] 243[68.6] 159[44.9] 183[51.6] 146[41.2] 314[88.7] 308[87.01] 26[7.3] 17[4.5] 371[52.2]
Above
Total 682[96.05] 469[68.76] 539[79.03] 405[59.4] 386[56.59] 409[59.9] 633[92.8] 623[91.34] 67[9.8] 28[3.9] 710

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Volume 7, Issue 3, Sep 2019

Conclusion
This study is mainly focused on the health problems including physical and mental abilities in the
context of Kerala with special emphasis on the influence of family structure. It revealed that the
variables selected for the study has significantly related with the health status of elderly. As family
plays an important role in maintaining health condition, the lack of awareness among the family
members regarding the changing behavioral pattern of the elderly leads to their life more problematic.
So, it is the duty of the members to understand their needs and concerns thus ensuring their good
health and also by providing emotional support makes them jovial which is inevitable an ideal way to
make their life happy.
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