The term "elderly" has varied over time and in response to geographical differences in life expectancy. Anyone over the age of 65 is considered elderly in most developed nations, although the age is 60 in underdeveloped ones. In all parts of the world, life expectancy has increased significantly, more than doubling in the last century. Because of continuing advancements in health and improvements in living conditions (1).

Aging is a natural part of life. This stage of life must be experienced at one's own time and speed. Aging is a reflection of all the changes that occur over one's life. Middle age is when the elderly begin to notice age-related changes such as greying hair, wrinkled skin, and some physical decline. Even the healthiest and most attractive people are not immune to these changes. Physical impairment and functional disability occur slowly and steadily, resulting in increased dependency as people age. (2).

Sensory alterations, muscular weakening, diminished mobility, and fat changes are all part of normal ageing. As a result, chronic diseases such as hypertension, cardiovascular disease, diabetes, and a variety of neurological disorders are becoming increasingly common in the elderly. There are various functional changes in the respiratory system of the aged, including a decrease in vital capacity, an increase in residual volume, and a decrease in gas exchange. There is also a decrease in the number of functioning glomeruli and renal blood flow. There is also a drop in basal metabolism, as well as changes in the gastrointestinal and hypothalamic-pituitary-adrenal systems (3).

Chronic diseases are more common in the elderly around the world. Chronic diseases are defined by geriatric physicians as illnesses that last a year or longer and necessitate continuing medical care and/or restricted activities of daily living. The phrase "chronic diseases" is the subject of heated controversy. Heart disease, hypertension, type 2 diabetes, and obesity, for example, are all classified as chronic diseases by the Centers for Disease Control (CDC). Depression and cardiovascular illnesses, to mention a few, are among the 19 chronic conditions listed by the Centers for Medicare and Medicaid Services (4).

Chronic diseases are usually incurable, necessitate ongoing medical care, and have a significant impact on a person's everyday life. According to statistics, 80–92% of the elderly have at least one chronic disease, and 50–77% have two or more. The most common chronic diseases in the elderly are cardiovascular disease, chronic obstructive pulmonary disease, and diabetes. One of the most common causes of impairment is diabetes. It's the biggest cause of kidney failure, amputations of lower limbs, and new cases of blindness in the elderly. Chronic diseases are also said to account for roughly 63 percent of all fatalities worldwide, causing significant economic harm to all countries, particularly developing countries (5).

The World Health Organization (WHO) created a global monitoring framework to measure progress in preventing and controlling major chronic diseases such as cardiovascular disease, chronic lung disease, and diabetes on a worldwide scale. Nine global targets and 25 indicators are included in the framework, which will be up for endorsement by member states during the WHO assembly in May 2013. Member states are urged to consider developing national chronic illness targets and indicators based on the global framework once it has been adopted. The nine voluntary international targets are targeted at reducing global mortality from the four chronic diseases while also speeding up action against the top risk factor (6).

Nurses, who make up the majority of health-care employees, may make a big difference when it comes to dealing with chronic diseases in the elderly. To improve client outcomes, an emphasis on preventive self-management, organizational reform, and political change is required. To achieve these adjustments, nurses will need to have specialized expertise. Nurses are increasingly needed to work with communities and other sectors to intervene early in the prevention of chronic diseases in the elderly. Nurses must use evidence-based practice (EBP) that has been shown to have favorable effects in order to do this effectively. Not just in the manner of direct client care, but also in the mode of indirect client care (7).

Significance of study:

Chronic diseases are widely acknowledged as one of the primary causes of disability, morbidity, and mortality. They have a long duration and a gradual progression. Cardiovascular disease, chronic respiratory illness, and diabetes account for 82% of all chronic disease-related deaths globally. In 2012, more than 40% of these deaths were premature (before the age of 70), with low and middle-income countries accounting for 82% of these deaths.We can define the behaviour of epidemiological indicators and guide the design of prevention and control measures if we understand the multifactorial complexity of chronic diseases in each geographical area (8).

The elderly represent a large sector of the population everywhere. Around 8.5 percent of the world's population is 65 or older. Given this situation, we propose describing the status of chronic disease indicators and key risk factors among this large group of people aged 60 and up in order to assist governments and other stakeholders in accelerating action, reducing exposure to common chronic disease risk factors, and allowing national health systems to respond effectively (9).

The number of elderly people in Egypt is 5.28 percent of the total population. There is a gradual increase in the absolute and relative numbers of elderly people. This trend is expected to continue over the next decades to be 9.2% by the end of 2021 and is expected to reach 20.8% by 2050, so special attention should be given to elderly people, as they have a right to live and do an effective role and to be productive members of the community (10).

Aim of the study:

• The aim of this study was to assess selected health indicators among elderly people with chronic diseases at Beni-Suef through.

1)   What is the impact of chronic diseases on quality of life among studied elderly people?

2)   What is the level of independence in activities of daily living among studied elderly people with chronic disease?

3)   What is the level of depression among studied elderly people with chronic disease?

4)   What are the determinants of health affected by chronic disease among studied elderly people?

Research design:

A descriptive research design was utilized to conduct the study.

Setting: The setting of the study was conducted in two outpatient clinics (medical and chest clinics) at Beni-Suef University Hospital. The hospital has 26 clinics serving around 800 to 1000 patients every day. There is no special clinic for elderly people.

Subjects: A convenience sample was included from the pre-mentioned setting. The total number of studied samples was 100 elderly patients who had already been diagnosed with one of the following chronic diseases: diabetes, hypertension, or chronic obstructive pulmonary disease for at least 3 months, fully oriented to place, people, and time. They also must have full insight and judgment, both sexes, of older adults with the age group of 60 years old or more.  

 Tools of data collection: The current study employed two tools used to collect data:

I: Structured Interviewing Questionnaire: It was developed by the investigator, under the supervision of staff, based on reviewing related literature and expert opinions and written in a simple Arabic language. It comprised six parts to assess the following:

Part1: Socio demographic characteristics of the elderly people it consists of 7 items closed ended questions (Question No 1-7) about (gender, age, residence, marital status, work, salary, and educational level).

Part 2: Elderly medical history of chronic diseases consisted of 3 items closed ended questions (Question No 8-10) about (history of the following diseases: hypertension, diabetes, and COPD).

Part 3: Older People’s Quality of Life Questionnaire (OPQOL) (Moradi et al., 2020). (11)

To assess the quality of life for elderly people, which consists of 9 domains including a total of 34 items These domains cover areas such as: life overall, health and functioning, social relationships, independence, control over life, freedom, home and neighborhood, psychological and emotional wellbeing, financial circumstances, leisure and social activities, and religion and culture.  

 Part 4: Katz Index of Independence in Activities of Daily Living (ADL) (Bonilla et al., 2020) (12):

To assess functional status as measurement of the studied elderly people ability to perform activities of daily living independently it consists of six items (bathing, dressing, toileting, transferring, continence and feeding) 

Part 5: Determinants of health (as BMI, risk factors and life style) (Buyl et al., 2020) (13).

This tool, modified by the researchers and approved by the supervisors to assess elderly determinants of health, is composed of two parts:

A: To assess elderlylifestyle behavior and risk factors for chronic diseases. The questionnaire form consists of 15 close-ended questions emphasizing personal hygiene, meals, correctly using vegetables, fruits, protein, fat, dairy, exercise, sleep health, smoking, social activities, general examination, and consumption of food supplements. 

B: Body Mass Index (BMI) is a simple calculation using a person's height and weight. The formula is 

BMI = kg/m² 

Where kg is a person's weight in kilograms and m2 is their height in meters squared.

Part 6:  Health system indicators (health care access, cost, quality and use of immunization and follow up (Braithwaite et al., 2017) (14).

This part was modified by the investigator under the guidance of supervisors based on reviewing textbooks, related articles, and research studies to assess health system indicators in terms of health care access, cost, availability, and effectiveness of services. It includes four statements The first statement is to assess the accessibility of general, the second statement to assess the affordability or financial accessibility, the third statement to assess the cost of services, and the last statement to assess the effectiveness of health care services.

  Tool II: Hamilton depression rating scale (HAM -D) (Nixon et al., 2020) (15):

Intended to assess the degree of depression in persons over the age of 65 who have chronic diseases. Depressed mood, guilt, suicide, sleeplessness, work and interests, retardation, agitation, anxiety, weight loss, insight, diurnal change of his symptoms, depersonalization, derealization, paranoid symptoms, and obsessional symptoms are just few of the symptoms he may experience.

Field work: The researcher conducted the study for the studied sample in the selected settings at medical and chest clinics at Beni-Suef University Hospital in Beni-Suef governorate over a six-month period, beginning in January 2020 and ending in June 2020.The researcher visited the selected hospital from 10 am to 12 mid-day, two days a week, to collect patients’ data. The average time needed for the sheet was around 30-45 minutes. The average number interviewed individually was four elderly people per week, depending upon the understanding and response of the interviews. The elderly and nurses were informed about the study's goal, purpose, and significance.Nurses in the hospital cooperated with me in data collection.  

Administrative Design:An official letter from Beni Suef University's nursing faculty was delivered to the director(s) of the intended study setting (Beni-Suef University hospital).A full explanation of the aim of the study was explored with him. Official permission to conduct the study was obtained from the responsible authorities. Oral consent was obtained from each elderly patient before conducting the interview. The title, objectives, study technique, and tools were illustrated for cooperation. If the patient is not able to read and write or is physically impaired, the researcher helped him to clarify each point accordingly.     

  Ethical Considerations: All ethical consideration was issued; oral consent was being obtained from each elderly patient before conducting the interview and given them a brief orientation to the purpose of the study. They were also reassured that all information gathered would be in a confidential manner and used only for the purpose of the study. No names were required on the forms to ensure anonymity and confidentiality. They were also informed about their right to withdraw at any time from the study without giving any reasons.

Statistical Analysis: The Statistical Software Package for Social Science (SPSS) version 20 was used to analyze the data. Numbers, percentages, means, and standard deviations were used to express qualitative data. Person correlation (r) was used to detect associations between quantitative variables.

Table (1): Percentage distribution of studied sample according to their sociodemographic characteristics (n=100)

Table 1: shows that 56% of the studied samples were males. Furthermore, 78% of the studied samples reside in urban areas, and 42% of them had enough monthly income. In addition, 48% of them were illiterate.

Figure (1): Percentage distribution of studied sample according to their medical history (n=100

Figure (1): Reveals that 91% of the studied sample had a history of hypertension, 65% had diabetes, and 15% of them had a history of COPD.

Table (2): Percentage distribution of studied sample according to total Quality of Life (n=100).

Table (2) shows that97% of the studied sample was satisfied with their lives in general, 94% believed in their culture or religion, and 87% engaged in leisure and social activities. Furthermore, 83% of the studied sample have excellent health and functioning, while 52% are dependent and have no control over their lives/freedom. And 46% of them have financial strain.

Figure (2); Percentage distribution of studied sample according to Total Independence in Activities of Daily Living (n=100).

Figure (2): shows that 77% of the studied sample was completely independent in all daily activities, while 23% were completely dependent on all daily activities.18% of the totally dependent have moderate functional impairment.

Figure (3): Percentage distribution of total awareness of healthy lifestyle (n=100).

Figure (3) shows that 65% of the studied sample had insufficient awareness regarding healthy lifestyle and risk factors, while 35% of them had sufficient awareness of healthy lifestyle and risk factors.

Figure (4): Percentage distribution of studied sample regarding their Body mass index (n=100).

Figure (4) shows that 83% of the studied sample had a body mass index of 18.5 to 24.9, and 14% of them had a body mass index of 25 to 29.9.

Table (3):Percentage distribution for health system indicators for studied sample (n=100)

Table (3) shows that 45% of the studied sample faces moderate barriers, and 43% of them face difficulty accessing health care services. 33% of the studied sample has financial barriers to receiving care. While 52% of the studied sample agree that health care costs are covered by the healthcare system, and 57% of them travel to other locations to receive appropriate care.

Figure (5); Percentage distribution of studied sample according to total severity of depression.

Figure (5) shows that 28% of the studied sample experienced very severe depression, 25% of them were classified as moderate depression, and 23% of them had severe depression.

Table4: Relation between Socio-demographic characteristics awareness on healthy lifestyle among studied subjects.

X² Chi Square test

^FE Expected cell count less than 5, Fisher’s Exact test was used.

* Statistically significant at p<0.05

** Highly statistically significant at p<0.01

Table 4 demonstrates a highly statistically significant difference between awareness of a healthy lifestyle and age, place of residence, income, and educational level. Furthermore, among the elderly adults investigated, there was a statistically significant difference in awareness of a healthy lifestyle and occupation.

Table 5 Relation between body mass index and older people’s quality of life, independence in activities of daily living, severity of depression and awareness on healthy lifestyle among studied subjects.

X² Chi Square test

^FE Expected cell count less than 5, Fisher’s Exact test was used.

** Highly statistically significant at p<0.01

Table 5 shows a highly statistically significant difference between body mass index and older people's quality of life, independence in activities of daily living, severity of depression, and awareness of healthy lifestyle choices during aging among studied elderly people.

Table6: Relation between chronic diseases and older people’s quality of life among studied subjects.

X² Chi Square test

^FE Expected cell count less than 5, Fisher’s Exact test was used.

** Highly statistically significant a

Table 6 demonstrates a highly statistically significant difference between older people's quality of life and chronic obstructive pulmonary diseases among studied elderly people. In addition, there was no significant relation between hypertension and diabetes with older people's quality of life.

Table (7): Relation between total quality of life, independence in activities of daily living, severity of depression and awareness on healthy lifestyle and risk factors among studied subjects.

* Statistically significant at p<0.05

** Highly statistically significant at p<0.01

Table (7) demonstrates that there is a very statistically significant relationship between the tested sample's freedom in daily activities and their overall quality of life. Furthermore, there was a statistically significant relationship between the study sample's awareness of a healthy lifestyle and their overall quality of life.