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Introduction
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Potter and Perry (2005) 9 states that ageing is a life spanning process of growth and
development from Birth to death. Old age is an integral part of the whole, bringing
Fulfillment and self actualization. The ageing process occurs in every living species, as
also in human beings by graying of hair, wrinkling of skin, hardening of arteries, aches
and pains in joints and weakening of eye sight .The way that older adults adjust to the
changes of ageing depends on the individual. For some individuals adaptation and
adjustment are relatively easy, where as for other individuals coping with ageing changes
may require the Assistance of family, friends and health care professionals.
Decreasing strength is the general physical change in the elderly. The sociologic
issues of ageing are concerned with work, retirement, social security , health care and the
response to getting old age is related to life long habits ,diet and exercise patterns. Old
aged often becomes anxious if they live alone, lacking family support, poor income,
accommodation and insecurity which may lead to depression (Ann Z Swimmer, 2002)1
Depressive disorders are the most common affective illness found in old age.
Depression is a mood disturbance characterized by exaggerated feelings to sadness
despair,lowered self esteem, loss of interest in former activities and pessimistic thoughts.
The incidence of increased depression among the elderly is influenced by the variables
of physical illness,functional disability and cognitive impairement (C.Kockrow ,
2006).3
India is one of the South East Asian countries, in India by the year 2001 there were
around 76 million elderly people, who constituted seven point seven percent of the
countries population .Currently there is 9.8 percent elderly people in the country. It is
expected to increase further to fourteen percent by 2025. In Karnataka out of population
of 5.5 crores eighteen percent are elderly citizens (K.Park, 2007)7.
M.A. Boyd (2002) 6 States that the depression is so common that it is some times
difficult to identify risk factors .According to a study in 1993 the major risk factors
include prior episode of depression ,family history of depressive disorder lack of social
support, stressful life event, current substance use and medical comorbidity. Depression
comes in many shapes and forms. In some depression can persist at a low level for month
or even years. In others the symptoms are so strong that life grinds to a halt and suicide
can be a real call. Depression can be triggered or aggravated by personal and
interpersonal events ,hormonal changes and can even be triggered by lack of sunlight.
3
Morris (2006)16 states that Depression causes confusion and exacerbates
dementia. It reduces a person’s incentive to care for him, and lowers his energy level.
Untreated depression could cause irreversible brain damage and could lead to suicide. It
is one of the most common emotional and psychological disorders found in the elderly
and affects relational problems. Later life depression can have serious repercussions in
increasing mortality and disability, health care utilization and longer hospital stays,yet
63% older adults with a mental health disorder experience an unmet need for mental
health service. Deteriorating health, a sense of isolation and hopelessness and difficulty
adjusting to new life leads to depression and which in turn leads to suicide.
S.Nambi (2002) 10 states that we can minimize depression in elderly by regular and
periodic check up of physical health proper planning of retirement, low cost health
insurance schemes, encouragement of traditional values and joint family system and
advise to engage old people in religious activities and reading habits.
Ponnuswami (2005)7 states that the elderly have no other option but to live in old
age homes, often face loneliness, alienation and depression. In addition to losing most of
their worldly possessions and social support, they also lose their privacy and their sense
of self worth. They need others to meet their emotional and recreational needs. This
motivated the investigator to conduct study to assess the level of depression among the
elderly who are admitted in the old age home.
4
Today an increasing number of private elderly homes as well as the government
sponsored homes (which used to be reserved exclusively for elderly with no children and
no other means of support) are providing an alternative to familial elder care. However
these facilities are providing an alternative to familial elder care but these facilities are
still small in number, of varying standards and are often too expensive for many elderly
and their families. Community based long term care services for the elderly in India, both
informal and local government supported have also begun to emerge, especially in urban
areas. These efforts are serving various needs of the elderly and their family care givers,
including daily care, home maintenance and information and referral services
(Ponnuswami, 2005)7.
The lack of trained workforce in care giving to elderly is an important issue facing India
long term care delivery system .Some local government agencies ( such as the labour
union and the department of health) are training laid off workers to work in long term
care, but these training programs are short and cover only limited basic care giving skills
( I. Ponnuswami, 2005)7.
The investigator feels that depression may some times be hidden behind an array
of vague symptoms and it becomes necessary to carefully assess the elderly to identify
marked depression to treat the person holistically.This will enable health care
professionals in preventing the psychological problems and controlling the problems
related to depression .Mild levels of depression can be identified and treated in time to
prevent it before it becomes severe.
White et al., (2006) 17 conducted study on cognitive, emotional and quality of life
outcomes in patients with pulmonary arterial hypertension. Results shows that cognitive
sequelae occurred in 58 percent (27/46) of the pulmonary arterial hypertension
patient’s .Patients with cognitive sequelae had worse verbal learning delayed verbal
memory, executive function, and fine motor scores compared to patients with out
cognitive sequelae. 26 percent of patients had moderate to severe depression and 19
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percent had moderate to severe anxiety. Depression, anxiety and quality of life were not
different for patients with or without sequelae. Patients had decrease quality of life,
which was associated with worse working memory.
Andreoletti et. al., (2006)2 conducted a study on age differences in the relationship
between anxiety and recall. The results shows that a negative relationship between
cognitive-specific anxiety and memory, such that greater anxiety was related to poor
recall, but this was so only for middle aged and older results suggest that managing
anxiety may be a promising avenue for minimizing episodic memory problems in later
life .
Routaslo et. al., (2006)12 study conducted on social contacts and their relationship to
loneliness among aged people results declares that more than one third of the
respondents39.4suffered from loneliness. Feeling of loneliness was not associated with
the frequency of contacts with children and friends but rather with expectations and
satisfaction of these contacts. The most powerful predictors of loneliness were living
alone, depression, experienced poor understanding by the nearest and unfulfilled
expectations of contacts with friends.
Rajan et. al., (2004) 3 conducted a survey of elders in old age homes in
Pondicherry to find out problem of the aged reveals that a sizeable majority of the aged
suffer from loss of memory and no sleep. Psychologically maximum number of the aged
feels isolated, frustrated and depressed.
Hamada T et. al., (2003)5, conducted a study on abnormal nocturnal blood pressure
fall in senile-onset depression with Sub cortical silent cerebral infarction .Results suggest
that abnormal nocturnal blood pressure fall patterns appear to be Involved in the
development of Sub cortical cerebral infarction in senile-onset depression.
7
Hamalanien et. al., (2005) 6,conducted a study of major depressive episode related to
long unemployment and frequent alcohol intoxication study ,concluded that long time
unemployment is associated with increased risk of major depressive episode. Frequent
alcohol intoxication among long term unemployed individuals greatly increases the risk
of depression.
Stordal et .al., (2006)15, conducted study of recurrent unipolar major depression and
executive functions, concluded that there is little evidence that unipolar major depression
is uniquely associated with executive dysfunctions.
Suen and Dhar, (2006)16 stated that the prevalence of depression, which is common
in residential homes P=0.04), is not associated with the social support from outside the
home, and the feelings of belonging towards the institution and other residents are more
important than non- institutional support.
Gerard sana cora (2008)4 conducted study on link of major depression to increased
level of neurons in the brain, findings reveals that level of neurons in the brain with major
depression had about 30% more nerve cells in regions of the thalamus involved with
emotional regulation& the regions appeared larger in patients with major depression.
Stark Stein S. E. (2005)14 stated that the construct of minor and major depression
among seniors in long term residential care and found that twenty six percent of the
patients had major depression ,twenty six percent had mild depression and 48 percent
were not depressed.
Sherina M. S et. al., (2006) 13 the prevalence of depression among elderly in a tertiary
care center in Wilayah Persekutan.The results showed that 54 percent of the elderly
respondents were found to have depressive symptoms age ,sex, ethnicity, functional
disabilities in bathing, grooming, dressing, using the toilet, transferring from bed to chair
and back, mobility and climbing chairs were all found to be significantly associated with
depression among the elderly respondents.
Jakobsson U. (2006)8 conducted study on quality of life among older adults with
arthritis (n=168) had more pain functional limitations and lower quality of life
(physical\component than those with out osteoarthritis (n=246) .No significant
differences between the groups were found related to depressed mood and mental
components of quality of life. Quality of life was associated with pain, functional
limitations and depressed mood in both groups.
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Statement of problem
Assess the level of depression among elderly residing at selected old age homes of Rural
Bangalore, Karnataka.
6.3 Objectives of the study
1. Assess the level of depression among elderly residing at selected age homes
2. To associate the level of depression among elderly with their selected
demographic variables
Operational definitions
Assess: Statistical measurement of depression based on data collected by
observation rating scale among elderly residing at selected old age homes.
Elderly: Refers to old age men with depression residing at old age home between 55-74
years of age.
Level of depression: Grouping the depression scores obtained through observation rating
scale on depression .It is divided in to mild, moderate and severe.
Old age homes: Refers to a shelter care facility provided to old age people residing in
selected old age home.
Hypothesis
H1: There will be significant association between level of depression among elderly
residing at selected old age homes and their selected demographic variables.
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Assumptions
Demographic variable have some influence on level of depression
As the age increases the level of depression in elderly increases
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elderly suffering from depression.
Prior to the data collection written
permission will be obtained from the
Data collection concerned authorities of old age homes.
Further the data will be collected by the
investigator her self by using observational
rating scale.
The investigator will use discriptive and
inferential statistics. Mean, median, mode,
Data analysis , Presentation and standard deviation, chi-square test and
Interpretation relevant statistics analysis will be used. The
analyzed data will be presented in the form
of tables, diagrams and graphs.
Yes, study will be conduct among elderly between 55-74 years of age residing in selected
old age homes.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
- Yes informed .consent will be obtained from concerned subjects and authority
of institution.
- Privacy, confidentiality and anonymity will be guarded.
- Scientific objectivity will be maintained with honesty and impartiality
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Assess the level of depression among the
Title of the topic elderly residing at selected old age homes of
Rural Bangalore, Karnataka
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Principal and HOD
Department of community health nursing.
Diana college of nursing,Bangalore-64.
2. Prof.Elizabeth Dora
Head of the Department.
Department of child health nursing.
Diana college of nursing,Bangalore-64.
3. Prof Kalaivani
Head of the Department.
Department of obstetric and gynaecological nursing.
Diana college of nursing,Bangalore-64.
8. List of references
Books
1. Ann J Zwimmer. Basic psychology for nurses in India.1st edition. New Delhi:
14
B.I.Publications pvt ltd ;2002.p193.
2. Bimla kapoor .Text book of psychiatric nursing. 1st edition. New Delhi: kumar
publishing house;2005,p272-275.
9. Potter and Perry. Fundamentals of nursing. 5th edition. N.Delhi: Harcourt pvt
ltd; 2005.p246.
10. S.Nambi . Psychiatry for nurses. 1st edition. N.Delhi :Jaypee Brothers
company; 2002 .p153.
Journals
1. Alexopolous. Stress, social engagement and psychological wellbeing in
institutional settings: evidence based on the minimum data set 2.0. canadian
journal on ageing,19 (supple.2) 2005 ; 50-66.
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2. Andreoletti .C ,et al. ,Age differences in the relation ship between anxiety and
recall, Ageing mental health 2006; 10 (3) : 265-71.
4. Gerard sana cora, Link of mojor depression to increase level of neurons in the
brain, medicine,the journal of gerontology Washigton 2008; 56 B ,5, 285
5. Hamada T.et al, abnormal nocturnal blood pressure fall in senile onset
depression with sub cotrical silent cerebral infarction .Neuro psychology
2003; 47 (4): 187-191.
7. Illango Ponnuswami , “Ageing world wide trends & challenges for care
giving”;social welfare 2005; vol.51 no.7, P 26-39.
8. Jakobsson .U. and Hallberg . I.r Quality of life among older adults with osteo
arthritis : an explorative study. J Gerontol Nurs 2006 ; 32 (8): 51-60.
9. Nguyen , H.T and Zonderman .A.B , relationship between age and aspects of
depression : consistency reliability across two longitudinal studies . Psychol
ageing 2006; 21 (1) : 119-26 .
10. Radha Krishnan. A study to assess depression among geriatric out patients
attending selected general hospitals at Belgaum,Karnataka, Nightingale
Nursing Times 2006; vol .2, issue -2 ,p 29.
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11. Reddy .S .G. Geriatric society of India. G.S.I News 2005 ; july vol.1 Ix no.2
12. Routasalo .P.E .et al , social contacts and their relation ship to loneliness
among aged people – a population based study . Gerontology 2006; 52 (3) :
13. Sherina M.S ,et al . The prevalence of depresion among elderly warded in a
tertiary care centre in Wilayah Persekutan . Medical journal of Malaysia 2006
; 61 (1) : 15-21.
14. Stark stein .S.E et al . The construct of minor and major depression in
Alzhemier' s disease Am j Psychiatry 2005; 162 (11) : 2086-93.
16. Suen L.J and Morris .D.L .Depression and gender differences : focus on
Taiwanese American older adults . J gerontol nursing 2006 ; 32(4): 28-35.
17
Prof. Mrs. Kalai selvi. S.
Head of the department
11. Name and designation of guide
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
Signature
Prof. Mrs. Kalai selvi. S.
Head of the department
HOD
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
Signature
Signature
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