DOI: 10.5958/j.2319-5886.2.2.

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International Journal of Medical Research & Health Sciences

www.ijmrhs.com
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Volume 2 Issue 2 April - June

Coden: IJMRHS
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Copyright @2013

ISSN: 2319-5886
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Received: 8 Feb 2013 Research article

Revised: 26 Mar 2013

Accepted: 31 Mar 2013

IMPACT OF AGEING ON DEPRESSION AND ACTIVITIES OF DAILY LIVINGS IN NORMAL ELDERLY SUBJECTS LIVING IN OLD AGE HOMES AND COMMUNITIES OF KANPUR, U.P. *Vanshika Sethi1, Vijeylaxmi Verma2, Udhbhav Singh2
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Assistant Professor, 2 BPT students Physiotherapy Department , Saaii College of Medical Science and Technology, Chaubeypur , Kanpur,U.P., India

*sethivanshika@gmail.com,sethi_vanshika@yahoo.co.in
ABSTRACT

Introduction: Ageing is a progressive, generalized impairment of functions resulting in loss of adaptive response to stress and increasing the risk of age related disease. Methodology: A sample of 200 elderly subjects i.e. 100 from the community (group A) and 100 from Old age home (group B) of sixty & above years of age were taken by the convenience sampling method. The subjects were collected through various old age homes and community which includes Vaikunth Dham Old Age Home, Ishwar Prem Ashram, Swaraj Ashram, Ramkrishna Mission old age home and nearby community located in the Kanpur and Varanasi. The subjects were assigned a number to maintain the confidentiality of the subjects and then the scales were used to assess the scores i.e., Geriatric Depression Scale (GDS) and Barthel index of daily livings were used to check the level of depression & ADLs and then the scores were compared. The results: The mean GDS scores for group A were 11.32 and for group B were 16.42 with a value of -6.981 with a p value of 0.00* and mean ADLs scores on the Barthel index for group A were16. 54 and 17.98 for group B within value of -2.898 with a p value of 0.004* which shows there is a significant difference. Conclusion: Elderly subjects living in Old age home are more affected in terms of depression and ADLs as compared to community dwelling elder subjects as old people living in their own homes were most able to cope in their homes. They received more support from relatives and friends than from health and social services Key words: Elderly, ADLs, Depression, Community, Old age home
INTRODUCTION

Age classification varied between countries and over time, reflecting in many instances the social class differences or functional ability related to the workforce, but more often than not was a reflection of the current political and economic situation. Many times the definition is linked to Vanshika et al.,

the retirement age, which in some instances, was lower for women than men. This transition in livelihood became the basis for the definition of old age which occurred between the ages of 45 and 55 years for women and between the ages of 55 and 75 years for men1.
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Elderly people are classified into: - 1) 60 yrs to 70yrs- Young old 2) 70 yrs to 80yrs- Middle old 3) 80yrs &above- Old old 2. The risk factors for reduced physical function in elderly people, as identified in longitudinal studies, relate to comorbidities, physical and psychosocial health, environmental conditions, social circumstances, nutrition, and lifestyle3 As the western population is increasingly ageing, problems connected with old age will dominate healthcare. Depression, one of the most prevalent psychiatric disorders, is expected to take an even more prominent position than presently, as the risk for developing depression increases with old age. Depressive symptoms are present in almost one third of the elderly populations and major depression may be present up to 4% Furthermore, once present, the prognosis for elderly with depression is poor4 There have always been elderly people, but what is new today that they now form the largest sector of the population in industrialized societies. However elderly are not preparing themselves for long life, nor are we receiving any information about the aging process at home, school, community in general. Society tends to exclude the elderly. They are considered incompetent and are denied any responsibilities. This is far removed from previous societies in which, given their experience, the eldest members enjoyed a much higher status. They considered wise, the teachers, and traditions. A great number of people in this sector are slightly depressed and tend to consider themselves less productive than they really are5 Between the year 2000 to 2050, the worldwide proportion of persons over 65 years of age is expected to more than double, from the current 6.9% to 16.4%. As healthcare facilities improve in countries, the proportion of the elderly in the population & the life expectancy after birth increase accordingly. This is the trend which has been in both developed & developing countries. It is commonly believed that the majority of the elderly population resides in developed countries. However, this is a myth, as about 60%

of the 580 million older people in the world live in developing countries, and by 2020, this value will increase to70% of total older population 6 Depression is common in medically ill elderly and associated with greater morbidity and mortality, increased health service use and medical costs. Studies have shown that antidepressant and structured psychotherapy, alone or combined, are effective in reducing depressive symptoms among older adults7 Depression and anxiety lead to a serious impairment of daily functioning and quality of life. Frail elderly, the effects of depression and anxiety are especially deep encroaching .The number of elderly is rapidly growing. Almost a third of elderly subjects in the community with sub threshold depression or anxiety will develop a major depressive or anxiety disorder in three years8 The prevalence of major depressive disorder at any given time in community samples of adults aged 65-67 older ranges from 1-5% in larger scale epidemiological investigations in the United States and internationally, with the majority of studies reporting prevalence at the lower end of the range. Clinically significant depressive symptoms are present in approximately 15% of the community-dwelling older adults 9 Major depressive disorder is one of the most common forms of psychopathology, one that will affect approximately one in six men and one in four women in their lifetimes. It is also usually highly recurrent, with at least 50% of those who recover from a first episode of depression having one or more additional episodes in their lifetime, and approximately 80% of those with a history of two episodes having another recurrence. Once a first episode has occurred, recurrent episodes will usually begin within five years of the initial episode, and, on average, individuals with a history of depression will have five to nine separate depressive episodes in their lifetime10 Disability in Activities of Daily Living (ADL) , which are the essential activities that a person needs to perform to be able to live independently
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, is an adverse outcome of frailty that places a high burden on frail individuals, health care professionals and health care systems . Frail elderly people have a higher risk of ADL disability compared to non-frail elderly people11 The model of the International Classification of Functioning, Disability and Health (ICF) can describe the consequences of dementia that eventually lead to deterioration in BADL(Basic activity of daily living) and loss of autonomy. In the context of this review, dementia (health condition) has a negative influence on mobility, endurance, lower-extremity strength and balance (body functions and body structures). Those body functions are important for BADL functioning (activity). Depending on the quality of the BADL performance, patients are less or more restricted in their participation (participation). By training physical components underlying ADL, or by a direct influence of exercise on ADL, healthy elderly subjects can stabilize or improve their ADL score12 The mechanisms by which depression has an effect on physical disability are not completely understood. Both behavioral (depressed patients may have poor lifestyle, such as nonadherence to medication and self-care regiments) and biological mechanisms (depression may worsen medical diseases through changes in hypothalamic-pituitary-adrenal axis and the sympathetic nervous and immunological system) have been proposed. Each could lead to more disability13 One might expect that elevated body mass index (throughout life) could also promote impairments in ADL through other mechanisms that include associations with diabetes and possibly knee joint injuries in later life or difficulties in walking around the house (more common in Hawaii but unrelated to body mass index in the current sample). It may be that impairments in the ADL are more frequent in the presence of subclinical frailty where weight loss is a problem. Long-term follow-up of the effects of body mass in middle adulthood on the risk of

late-life ADL impairment might reveal a clearer association14 In a study of patients with and without depression during the immediate period after stroke but with similar impairments in ADL scores, we found, 2 years later, that the depressed patients had significantly less recovery in their ADL functions than the no depressed patients. The recovery curves for ADL function were not significantly different between patients with major depression versus those with minor depression, suggesting that both moderate and severe forms of depression lead to impaired recovery in ADL functions. Morris et al who used an abbreviated version of the Barthel index, also reported that at 15 months after stroke, patients with major depression and those with minor depression had a significantly greater physical disability than no depressed patients15 As in elderly people living in community & old age home depression and impairment in performing activities of daily livings are major problem therefore assessing the prevalence of depression and impairment in ADLs forms the basis of the study. MATERIALS & METHODS This study is a survey type of research which intends to find changes in levels of depression and activities of daily livings scores in elderly subjects living in the community and in old age home. A sample of 200 elderly subjects i.e. 100 from the community and 100 from Old age home of sixty & above years of age were taken by the convenience sampling method. The subjects were collected through various old age homes & which includes Vaikunth Dham Old Age Home, Ishwar Prem Ashram, Swaraj Ashram, Ramkrishna Mission old age home and nearby community located in the Kanpur &Varanasi. All subjects signed consent forms & were ready to take part in the study .The subjects were given the instructions regarding the procedure & the
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subjects who fulfilled the inclusion criteria & were ready to actively participate, were selected. Inclusion criteria 1. Normal elderly male & female with age of 60 years. 2. Able to understand verbal instructions & completed 8-10 years of formal education. 3. Subjects with stable medications Exclusion criteria 1.Any neurological problems such as Parkinsonism, stroke, cerebellar disorders, balance disorders, myopathy, myelopathy which can influence the psychological status of the subjects. 2.Any cardiovascular or orthopedic problems which affect their day to day routine activity & further may become the cause of depression. 3. Significant hearing & vision impairment. 4. Uncontrolled hypertension. 5. Any speech deficit interfering the survey. 6. Unstable seizure / disorder affecting the psychological status of subjects. 7. Smoking or alcohol intake. Procedure Subjects were introduced to the study followed by the signing of consent forms, general assessment regarding of socio-demographic data ( name, gender, age), education level, past

medical history, personal history, family history were gathered from the participant assessment forms. The subjects were collected from community & various old age homes & were divided into two groups a (community) and b (old age home) for comparison. Total 200 numbers of subjects data were collected, 100 for Group A (community) and group B (old age home). The subjects were assigned a number to maintain the confidentiality of the subjects and then the scale was used to assess the scores i.e., Geriatric Depression Scale (GDS)17and Barthel Index (BI)18was used to check the level of depression and impairment in ADLs and then the scores were entered in the data collection form.
RESULTS

Reading on GDS and BI were taken during first interview contact with the subject and were tabulated as data. The mean value of GDS for the old age home (group B) was 16.42 with standard deviation 5.90 and mean value for subjects living in community (group A) was 11.3 with SD 4.29 and p value was 0.000 which shows there is a significant difference in the score hence level of depression is more in elderly people living in an old age home town community.

Table:1. Analysis of GDS scores in group A and group B GROUP MEAN STANDARD DEVIATION 11.32 4.29 Community (Group A) Old age home (Group B) *Significant difference The mean value of the Barthel index for the old age home was 16.54 with standard deviation 4.001and mean value for subjects living in the community was 17.98 with SD 2.947 and p value 16.42 5.90

T -6.981

p 0.000*

was 0.004 which shows there is a significant difference in the scores hence Activities of daily livings are more affected in elderly people living in an old age home town community.

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Table:2 Analysis of Activity Of Daily Living by Barthel index between group A & group B GROUP MEAN STANDARD t P DEVIATION Community Old age home *statistically significant DISCUSSION 17.98 16.54 2.947 4.001 -2.898 0.004*

As results of the study shows that depression level is more in elderly living in an old age home than in community. It is supported by a study which suggests that urbanization promotes nucleation of the family system and a decrease in care and support for the elderly6. Depression and physical illness often coexist in the elderly as they both occur commonly in old age. There is a close relation between depression and physical illness. Depression may be caused by a specific physical disorder possibly as a direct consequence of the cerebral organic effect of these conditions. Therefore strategies to decrease depression should be utilized for persons living in an old age home. The literature shows the institutionalized participants were more likely to report depressed mood, crime, wishing to be dead, future looking bleak and staying away from others. Therefore the persons living in an old age home should be encouraged to intact with the society and family members to cope up depression. Literature shows that older people living in their own homes were most able to cope in their homes. They received more support from relatives and friends than from health and social services3.Result of the present study also shows that elderly people living in an Old age home were more affected in terms of ADLs than elderly people living in the community. Relevance to clinical practice: This research study may serve as a basis for development and implementation of a new rehabilitation program to cope up depression and to improve daily living skills for subjects living in an old age home and in community by which

further their level of dependency and depression can be reduced. Future research: 1. This study is a survey type study in which no training was given to the improvement of ADLs and to decrease the depression hence in a future training program can be administered and its after effects may be noted down. 2. As sample size was small hence large sample size may be taken to generalize the results. 3. Task oriented goals/activities/training/may be used to improve the efficiency of subjects living in an old age home and community. 4. Group involvement and interaction with society may be suggested for subjects living in an old age home as loneliness may be the factor affecting ADLs and depression.
CONCLUSION

Functional status, that is an individuals ability to perform daily tasks routinely, is an integral component of mental health care. It enters into a diagnostic decision as axis V of the DSM-IV and is particularly useful in gauging the severity of illness, the effectiveness of psychiatric interventions(pharmacological, psychotherapeutic, behavioral), and the need for supporting services (e.g., meals-on-wheels, chore services). From the perspective of patients, the ability to carry out daily living activities directly influences their ability to live independently in the community and their quality of life. Hence, the accurate assessment of functional status is of paramount importance because an overestimation places patients at risk, while an underestimation

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increases they depend beyond that warranted by their functional status16 In summary, the evidence clearly shows that there are multiple therapeutic alternatives including somatic and psychotherapeutic approaches each with efficacy for treating depression in later life. Because Depression in later life, even at subsyndromal levels is associated with increased physical Impairment, treatment of depression may provide an opportunity to improve physical function, clinical trial of depression intervention for older adults have begun to evaluate functioning as an outcome measure.
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