BP KOIRALA INSTITUTE OF HEALTH SCIENCE College of Nursing Dharan, Ghopa

(Bishranti Mandir, Mulghat)

4th year Community Posting

Submitted To: Mrs. Angur Badu Associate Professor Head of Department Community Health Nursing College Of Nursing BPKIHS

Submitted By: B.Sc.Nursing 4th year Batch: 2008

S.N
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

TABLE OF CONTENTS CONTENTS

Acknowledgement Introduction Background Need Of the Study

Page No.
3. 4. 5.

Significance of the Study Literature Review Name List

7 4 4-6

Data Analysis Summary References

27 8-25 26

ACKNOWLEDGEMENT
First of all, we would like to express my sincere gratitude and thanks to College of Nursing, B.P. Koirala Institute of Health Sciences (BPKIHS) for providing us an opportunity and facilities to conduct this field work as a partial fulfilment of the Bachelor of Science Programme in Nursing. We run sort of words to express our great respect and deep sense of gratitude to our teacher Mrs. Angur Badhu, Additional Professor, Head of Community Health Nursing Department, College of Nursing, BPKIHS for her consistent encouragement,guidance, supervision and cooperation during the visit. We are deeply indebted to her as this field visit has only been completed with her scholastic ideas, critical evaluation and keen interest from the very beginning of this task till the final accomplishment of this work. With great respect and gratitude we express our deep acknowledgement to the tremendous contribution of Mrs. Mangala Shrestha, Chief College of Nursing, for her cooperation and help. We express our sincere thanks to coordinator of 4th year B. Sc. Nursing Programme, Mrs. Rosy Shrestha and Mrs. Dev Kumari Shrestha for helping by scheduling the field visit. We would also like to express our sincere gratitude to Mrs.Kamala Shrestha for providing us with valuable and all the necessary informations required for completion of our task. Our heartfelt gratitude goes to Mr. Laxman Adhikari, Mrs. Geeta and Mrs. Gyanu, College of Nursing for their kind support and cordial help. . Last but not the least, we are indebted to all the elderly people residing in Bishranti Mandir without whom the visit programme would not be successful.

THANK YOU ALL

INTRODUCTION
As per our curriculum, we B.Sc. Nursing 4th year were taken to Bisranti mandir, mulghat on 27th November 2011. This old age home is situated in Belhara VDC ,ward no-9 in Mulghat of Dhankuta district near the bank of Tammor river. Bisranti old age home was established in 1 st Asar ,2040 B.S. Initially this was established to provide free firewood for the funeral ceremony of dead people at the bank of river. But from 2042 B.S. it started to provide old age home services including free supply of firewood. Old age home was started initially with two geriatric people and at present it has been providing services to 34 people but the number ranges from 30-35.The people of age of 50 years to 90 years are residing in this old age home . After introducing ourselves with the Kamala didi and staffs of the bisranti mandir, we collected all the aged person residing there and each client were assessed individually by us in the mandir area. We collected demographic data via interview with old people. We did complete physical examination of the individual old people, assessed their current health problems or any diagnosed illness, their personal history and interviewed their cause of stay, their feelings based on the questionnaire. After the completion of the health assessment of all the old people there, we conducted biscuit distribution programme to all the old age people. The programme went successfully and the staffs of the bisranti mandir cooperated well in the programme. The elderly people were very happy and they thanked and blessed us. They were very happy to interact with us.

Background:
Geriatrics is a term of Greek origin from the word "geras" meaning "old age" and iatros meaning " healer" or "physician", and it means a branch of medicine that deals with the problems and diseases of old age and aging people. (Webster, 1985). The term was originated by Dr. I.L. Nascher, who was one of the country's first geriatricians. Lavinia L. Dock was one of the early nurse writers who wrote about the almshouses. 1 Gerontology is also derived from a Greek word, geron which means "old man" or "akin to old age": it is the study of old age.2 One other term used is "senescence", which was first used by the developmental psychologist G.S. Hall, who wrote a book with that title in 1922. Senescence is defined as "the state of being old".3 Ageing is a natural phenomenon and an inevitable process. Every living being born, develops, grows old and dies. Ageing population means an increase in the share of the elderly in the total population. It is closely related with the dynamic process of demographic and socio-economic transformation. Whether a population is young or old, or getting older or getting younger, it depends on the proportion of people at different age groups. In general, a population with more than 35 percent under age of 15 years is considered young and population with more than 10 percent aged 65 years and above is considered old. The population of Nepal is considered young as 39 percent of its total population is under 15 years of age and only 4.20 percent are above 65 years of age.4 In our country, age 60 and above are demarcated as elderly population. Ageing is a process of gradual change in physical appearance and mental situation that cause a person to grow old. The life expectancies are 59.7 and 59.1 years for male and female respectively in Nepal. Ageing and life expectancy are closely related. With the rise of life expectancy, the problem of ageing amplifies. Although the population is growing younger, elderly people are also facing many troubles.5 The ageing of population is an obvious consequence of the process of demographic transition. While the countries of the west have already experienced and have planned for their elderly population, it is only in the last one and half decades that countries in Asia too are facing a steady growth of the elderly, as a result of the decline in fertility and mortality, better medical and health care and improvements in the overall quality of life of people. Within Asia, as India and China are the two largest countries in the region, it is expected that they would have a significant proportion of the worlds elderly because of their large population base. In fact, the situation in India presents two different scenarios with certain states grappling with curbing their
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high fertility rates while others, which have controlled high fertility rates, are already experiencing or are poised to experience an increase in their elderly population.6

LITERATURE REVIEW

In a due course of making report, extensive literature review was done from various published, unpublished, national and international textbooks, journals and online websites. Ageing is the ultimate manifestation of Biological and Demographical activities in individual human being and population at large. Until recently very little attention was paid about the dynamics of ageing in human beings. However, continued increase in percentage of aged persons in the population is creating humanitarian, social and economic problems in many countries specially the developed ones. Thus, since last one decade, social scientists and demographers all over the world are trying to explore the dynamics of ageing. In Nepals case, though attention on social aspect of ageing has been paid since ancient time, no attention has been paid yet on its demographic aspect. Transition of Nepals population from its primitive stationary state during 1911 to present third state in 2001 on the way to its final stationary state has been changing age structure of the population in favor of elderly person by increasing proportion of elderly persons aged 65 and above years from 2.43% during 1911 to present 4.21% . Though,the increase is not so much as compared to those observed for developed countries ( as high as 13%), it indicates the starting of the ageing dynamics in Nepal, which will have adverse effects on Nepalese social structure and economy in the long run. According to the research work done by Sheela S in partial fulfillment of the requirement for the degree of M.Sc in Psycho Social Rehabilitation on the title Socio demographic profile and mental health status of elderly in old age home showed that there is high prevalence of psychological distress in the sample population, depression level was found to be moderate and the respondents were suffering from mild anxiety. Further, mental health of the elderly is affected by gender, occupation, marital status and unemployed children. The research design of the study was descriptive in nature. The universe for the study comprised of all elderly people in a voluntary organization called ASAKTHA POSHAKA SABHA. Sample was selected using random sampling techniques. It had a sample size of 60 elderly people who suited the inclusion criteria in which 30 were male and 30 female. Tools used for data collection were Sociodemographic sheet, GHQ, HAM-D and HAM-A. Data was analyzed in terms of means and Standard Deviation, comparisons were made between socio-demographic variables using ANOVA and correlation test was used to understand the correlation between all the three aspects of mental health. Another study was carried out to compare morbidity, disability (ADL-IADL disability) along with behavioral and biological correlates of diseases and disability of two elderly population groups (tea garden workers and urban dwellers)living in same geographical location. Two hundred and ninety three and 230 elderly from urban setting and tea garden respectively aged > 60 years were included in the study. Subjects were physical examined and activity of daily living instrumental activity of daily living (ADL-IADL) was assessed. Diagnosis of diseases was made
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on the basis of clinical evaluation, diagnosis and/or treatment of diseases done earlier elsewhere, available investigation reports, and electrocardiography. Hypertension was defined according to JNC-VI classification. BMI (weight/height2) was calculated. Logistic regression analysis was performed to see the impact of important background characteristics on non-communicable diseases (NCD) and disability.8 The result showed that Hypertension (urban - 68% and tea garden - 81.4%), musculoskeletal diseases (urban - 62.5% and teagarden - 67.5%), COPD and other respiratory problems (urban 30.4% and tea garden - 32.2%), cataract (urban 40.3% and tea garden - 33%), gastro-intestinal problems (urban - 13% and tea garden - 6.5%) were more commonly observed health problems among community dwellings elderly across both the groups. However in contrast to urban group, serious NCDs like Ischaemic Heart Disease (IHD), diabetes were yet to emerge as health problems among tea garden dwellers. Infectious morbidities, undernutrition and disability (ADLIADL disability) were more pronounced among tea garden dwellers. Utilization of health service by tea garden elderly was very low in comparison to the urban elderly. Both tea garden men and women had very high rates of risk factors like use of non-smoked tobacco and consumption of alcohol. On the other hand, smoking and obesity was more common in urban group.9 Most morbidities and disabilities were associated with identifiable risk factors, such as obesity, tobacco (smoked and non-smoked) and alcohol consumption. Educational status was also found to be an important determinant of diseases and disability of elderly population. Age showed a Jshaped relationship with disability and morbidity.10 In an article Common Geriatric conditions overlooked by Jennifer Warner on August 6, 2007 showed that half of the US adults over age 65 suffer from at least one common age-related condition, according to a new study. But researchers say these highly treatable geriatric health problems are often overlooked by health care providers. Researchers surveyed more than 11,000 adults aged 65 or older -- from both nursing homes and the community at large -- and found 50% had one or more geriatric health conditions, such as loss of mental sharpness, falls, incontinence, dizziness, and vision or hearing problems. The study also showed that common geriatric conditions were strongly associated with disability and difficulty in performing normal activities of daily living, such as bathing, dressing, eating, and going to the bathroom, even after adjusting for other chronic diseases. People with at least one geriatric condition were twice as likely to require assistance performing daily activities and those with three or more geriatric conditions were more than six times as likely to be dependent on assistance for activities of daily living.11 Older adults are encumbered by many of the same mental disorders as are other adults; however, the prevalence, nature, and course of each disorder may be very different. Many older individuals present with somatic complaints and experience symptoms of depression and anxiety that do not meet the full criteria for depressive or anxiety disorders. The consequences of these conditions may be just as deleterious as the syndromes themselves. Failure to detect individuals who truly have treatable mental disorders represents a serious public
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health problem (National Institutes of Health [NIH] Consensus Development Panel on Depression in Late Life, 1992). Detection of mental disorders in older adults is complicated further by high comorbidity with other medical disorders. The symptoms of somatic disorders may mimic or mask psychopathology, making diagnosis more taxing. In addition, older individuals are more likely to report somatic symptoms than psychological ones, leading to further under identification of mental disorders (Blazer, 1996b). In one study of primary care physicians, only 55 percent of internists felt confident in diagnosing depression, and even fewer (35 percent of the total) felt confident in prescribing antidepressants to older persons (Callahan et al., 1992). Physicians were least likely to report that they felt very confident in evaluating depression in other late-life conditions (Gallo et al., in press). Researchers estimate that an unmet need for mental health services may be experienced by up to 63 percent of adults aged 65 years and older with a mental disorder, based on prevalence estimates from the Epidemiologic Catchment Area (ECA) study (Rabins, 1996). Depression is strikingly prevalent among older people. As noted below, 8 to 20 percent of older adults in the community and up to 37 percent in primary care settings experience symptoms of depression. Depression is a foremost risk factor for suicide in older adults (Conwell, 1996; Conwell et al., 1996). Older people have the highest rates of suicide in the U.S. population: suicide rates increase with age, with older white men having a rate of suicide up to six times that of the general population (Kachur et al., 1995; Hoyert et al., 1999).

DATA ANALYSIS A) DEMOGRAPHIC DATA

a)Age
12

10

6 10 4 7 5 2 4 3 5

0 <60 yrs 60-65 yrs 65-70 yrs 70-75 yrs 75-80 yrs >80 yrs

10

b)Sex

Female 7%

male 93%

C)Marrital status
18 16 14 12 10 8 6 4 2 0 married unmarried widowed 4 1 seperated 13 16

11

12

4)Previous occupation
10 9 8 7 6 5 9 4 3 5 2 1 0 Farmer Business Housewife labour Service unemploye 2 1 3.5 5

5)ADDRESS
7 6 5 4 3 5 2 1 0 4 2 2 1 2 1 5 6 6

13

6)Duration for stay

>6yrs 6%

<6 month 27%

6 mth-6yrs 67%

7)Reason For Stay

no family members 6%

Sales

self/religion 47% ignorance by child 47%

14

8)Religion

Baishnav 9%

kirat 6%

Hindu 85%

9)Number of children
No children 5%

<or equal2 32%

>orequal2 63%

15

10)Any medical illness

no 13%

yes 87%

16

If yes,specify (one may have more than one problem)

10 9 8 7 6 5 4 3 2 1 0 4 1 1 2 2 6 9 9

8 5 3

11)On medication

no 20%

yes 80%

17

12)Blood Pressure
hypertensive (>140/90) 5% hypotensive (100/60) 15%

normotensive 80%

13)sleep Pattern

normal 18%

disturbed 82%

18

14)Leisure
25

activities

20

15

10

20

5 2 reading books

10

6 3

chat with

gardening

nap

involve in media(radio) puja/bhajan

cooking

15) Problem faced during stay

yes 6%

no 94%

19

16) Family visit

frequent 29% never 47%

infrequent 24%

17) Communication with others

poor 24%

good 76%

20

18) Staying with spouse

yes 24%

no 76%

21

SUMMARY OF GERIATRIC HOME VISIT

We students of B.Sc. Nursing 4th year ,Batch 2008 had a visit to `BISHRANTI BRIDRASHRAM` Mulghat , Dhankuta. We 20 students along our supervisor Mrs. Angur Badu and 2 students of M.Sc. Nursing reached over there at 11am . Beginning with the introduction we stated them about our objectives to visit. Then we had general physical assessment of total 34 clients , 14 male and 20 female. The age range is from 60 to >80 year. Among them 13 were married , 16 widow , 4 unmarried and 1 separated. The duration of stay was <6 months : 6 , 6 month to 6 year : 15 and > 6 year : 13.The reason for stay of 10 of 34 clients was self wish and religious cause. The 10 others had stayed because of ignorance from family and remainig 14 had no family members. Among 34 clients 29 were Hindu , 2 were Kirat and 3 baisnav.The medical illness was found among 22 clients after general physical assessment .The common medical illness found after assessment were dental(4),mental(6),vision problem(9),joint pain(8),edema(1),bed ridden(1),hypertension(8),hearing loss(5),hemorrhoid92),asthma(2) and gastritis(3).Among them 13 were under medication.Their preference on leisure time were reading books,chating,gardening,religious activities,nap,cooking etc.The 2 of the client among 34 stated that they faced problem during the stay.the family visit from their family were frequent for 10 clients, infrequent for 8 clients and never visited for 8 clients. After the assessment of the each of the client we gather detail information from the management committee(detail in the previous page).The overall visit was fruitful and effective.

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REFERENCES:
1. Bhanman, T.R. (2006). Promotion of Spiritual Health for the Elderly, EMPOWERMENT, Year 5 Vol. 1 Issue 8 April May 2006, A journal of Ministry of Women, Children and Social Welfare, Government of Nepal, Kathmandu, Nepal (pp 368) 2. GEWON (2007). The Senior Citizens and the Elderly Homes around Kathmandu; A survey, an unpublished report, Geront World Nepal, Kathmandu, Nepal 3. MWCSW, Government of Nepal (2002). Senior Citizens Policy and Working Policy, Kathmandu, Nepal 4. Poudel, Nirakar (2004). Problems of Elderly Population: www.nepalnews.com Shrestha, Menaka Rajbhandari (2004). Problems and Questions of Ageing Population; Nepal University Teacher's Association (NUTA) journal, Vol. 3 No. 3, December 2004, Kathmandu, Nepal (pp 112-122) 5.Swar, Sushila (2002). Speech of Government of Nepal in International Conference on Ageing, Second World Assembly on Ageing, 9th April, Madrid, Spain Tenth Plan, Government of Nepal 6.UNO/MWCSW (2002). Madrid International Plan of Action 7.Burnside Irene M., Nursing & The Aged, A self-care approach, 3rd edition, Mc Graw Hill Book Company, 1988, Page No. 39-50 8.Ebersole Priscilla, Hess Patricia; Toward Healthy Aging Human Needs & Nursing Response, 4th edition, Mosby, 1994, Page No. 3-20 9.Esberger Karen Kay et.al, Nursing Care of The Aged, 1989, Publishing Division Of Prentice Hall, Page No. 1-20 10.Will Connie A., Eighmy Judith B.; Being A Long Term Care Nursing Assistant, 3 rd edition, Brady Regents/Prentice Hall, 1983, Page No. 2-6. 11.In an articles on Problems of Elderly Population:By Nirakar Poudel, Nepal news.com,Nepal, July 8 2005.

12Das, N.P. and Urvi Shah 2001. The Social and Health Status of the Elderly in India: Evidence from Recent National Level Data. A special report prepared as a part of the research initiative at the Population Research Centre, Baroda for the MOHFW, New Delhi.

13.Sheela. S Sociodemographic profile and mental health status of elderly in Old Age Homes[serial online] accessed on May 14, 2011
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14.Yadava KN, Yadava SS, Vajpeyi DK. Study of aged population and associated health risks in rural India. Health Policy Plan 1994;9:331-6.

15. Kumar KV, Sivan YS, Reghu JR, Das R, Kutty VR. Health of the elderly in community in transition: a survey in Thiruvananthapuram City, Kerala, India. Int J Aging Hum Dev 1997;44:293-315

15. Gupta HL, Yadav M, Sundarka MK, Talwar V, Saini M, GargP. Study of Health Problems in Asymtomatic Elderly individuals in Delhi. J Assoc Physicians India 2002;50:792-5.

16. Warner Jennifer, Common Geriatric Conditions Overlooked, Study Shows Many Health Problems in Older Adults Are Often IgnoredAccessed on May 14, 2011.

17. USAID Country Health Statistical Report Nepal December 2009. [Retrieved on Nov. 12, 2010 form http://pdf.usaid.gov/pdf_docs/PNADR595.pdf.

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