Rajiv Gandhi University of Health Sciences, Karnataka
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidate/ MS.RINTU MOL P.R
2. Name of the institution
/Diana College of nursing
No. 68, Chokkanahalli, Jakkur
Post, Bangalore-64
3.Course of study and subject/ Masters of science in Nursing
Psychiatric Nursing
4.Date of admission to course /28.06.08
5.Title of the topic / Assess the level of depression among
elderly residing at selected old age
homes of Rural Bangalore,
Karnataka.
6. Brief resume of the work
Introduction
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
6.1 Need for the study
Ageing is inevitable. It is irreversible, progressive and is associated with decline in functions. The individual gradually becomes dependent physically, functionally, socially and economically. Elders usually exhibit multiple health problems with complex interactions.The most common chronic conditions affecting older adults are cardio vascular diseases ,cancer ,diabetes, osteoartheritis ,alzheimer’s disease and psychiatric disorders, most commonly depression and dementia (Karen Saucer,2003)5.
The world elderly population in the last 50 years from 1950 to 2000 had increased from 8 to 9.9percent of total population. The geriatric population at present is 30.2 percent of total population. The proportion of elderly population is expected to increase from 9.5 percent in 1955 to 14.6 percent in 2025.Of these more than fifty percent of them would be living in developing countries. It is estimated that by the year 2020, 700 million elderlies will be in developing countries, currently there would be around 671 million elderlies in the world. It is also projected that by 2020 the Japaneese population will be the oldest in the world with 31 % over 60 years of age followed by Italy, Greese and Switzerland (Gulani, 2005).4.
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.
Depression is the most common disturbance of mood experienced by elderly. It is a pathological mood disturbance characterized by feelings, attitudes and beliefs the person has about self and his environment, such as pessimism , Hopelessness Helplessness, low self esteem and a guilt feeling ( Bimla Kapoor, 2005)2.
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.
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.
Alexopoulos (2005)1 compared different causes of depression as well as diagnosis, prevention and management of depression in elderly. And concluded that the available treatments were effective for treatment for depression in the elderly as they were in young individuals, but late life depression is often under recognized and under treated. Depression now demands the aggressive level of research in the next quarter of a centaury that smoking, cancer and heart disease have received in the past quarter of a centaury.
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.
Depression will increase in magnitude as the elderly population increase year by year. Hense there is need for considering the emotional states of elderly when they treated for any of physical problem in the hospitals,homes,or in primary health centers. This motivated the investigator to conduct the study to assess the level of depression among the elderly who are admitted in the old age home with different types of alignment.
6.2 Review of literature
Review of literature is the important step in the development of a research project. It involves the identification, location, security and the summary of written material that contain information on research problems (Polit&Hungler,1999)8.
The literature arranged under the following headings
1. Review of literature related to old age
2. Review of literature related to depression
3. Review of literature related to depression among old age
1. Review of literature related to old age
Reddysubramaniyam G. (2005)11 stated that global population ageing is an important challenge and action has to be taken by virtually all countries .The geriatric population was about 600 million in 2000.It is expected to raise up to 1.2 billion in 2025 and 2 billion in 2050.About two thirds of all older persons are living in the developed countries this figure, by 2025 will be about 75%. In developing countries like India these figures have changed the nature of demands on the health care system. Health delivery system has to accommodate the needs of the older population.
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 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.
2. Review of literature Related To Depression
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.
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.
3. Review of literature related to depression among old age
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.
Wilson K (2006)18 conducted a study reveals that a prevalence rate of 21 percent and an annual incidence of 12.8 percent (Geriatric depression score of five or more ) were found Risk factors associated with prevalence depression include not living close to friends and family ,poor satisfaction with living accommodation and poor satisfaction with finances.Subsequent development of clinically significant depressive symptoms was associated with base line increased scores in depression.
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.
Nguyen H. and Zimmerman (2006)9 conducted a study reveals the relationship between the age aspects and depression. Results indicate a reasonable degree of stability among adults under 70 years of age .However there were significant age- related increases in somatic symptoms and lack of well-being after approximately 70 years of age Where as symptoms related to depressed affect the interpersonal problems and remained stable. The addition of co morbid physical illness to the analysis did not reduce the association between age and depressive symptoms.