PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

MS. GILCY GEORGE

1stYEAR M.Sc. (NURSING)

MEDICAL SURGICAL NURSING

YEAR 2011-2013

ST. PHILOMENA’S COLLEGE OF NURSING

#4 CAMPBELL ROAD, VIVEKNAGAR P. O

BANGALORE 560047

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MS. GILCY GEORGE
1ST YEAR M.Sc (NURSING)
ST.PHILOMENA'S COLLEGE OF NURSING #4 CAMPBELL ROAD, VIVEKNAGAR P.O
BANGALORE 560047
2. / NAME OF THE INSTITUTION / ST.PHILOMENA'S COLLEGE OF NURSING
3. / COURSE OF THE STUDY AND SUBJECT / 1st YEAR M.Sc (NURSING)
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO THE COURSE / 3rd MAY – 2011
5. / TITLE OF THE STUDY / A STUDY TO ASSESS THE EFFECTIVENESS OF CAMPHOR OIL ON JOINT PAIN AMONG ELDERLY IN A SELECTED OLD AGE HOME, BANGALORE.

6. BRIEF RESUME OF THE INTENDED STUDY

6.1 NEE D FOR THE STUDY

“Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment1.” (Will Rogers)

Pain is pain, but it is not all the same. It is complex and defies our ability to establish a clear definition. Pain is a complex dilemma of emotions, culture, experience, spirit and sensations. It blocks our sensations and pleasures. Pain, even if it is mild and if it is associated with joints, causes some restrictions to movements; it seriously affects the quality of life, as well as the activities of daily living.

Aging is a natural process. It is an inevitable developmental phenomenon that brings about a number of changes in the physical, psychological, hormonal and social conditions. The aged citizens become increasingly dependent on others. As man grows, his reduced activities, income and consequent decline in the position of the family and society makes his life more vulnerable.2

The world wide increase in the older population coupled with economic, social and other changes have inevitably affected the needs for health care. The recent Indian census (2011) shows that among 1.2 billion, 60 million are above the age of 65years3. Old age is the resting period of life after years of long tough journey; the body needs to have a calm and comfortable period of rest. But around 40 % of the geriatric population are suffering from different types of non- communicable diseases, in a gross reduction in the quality of life4.

The world - wide Statistics in 2008 shows that, among the total population, 40% of the people at the age of 60years, suffer from severe joint pain, 80% of the population have some degree of limitations of movement and 25% cannot perform daily activities5.

According to Indian Rheumatology Association statistics 2010, 49.8% of the total population is over the age of 60years, suffering from severe joint pain, 70% of the population have some degree of limitations of movement and 10% cannot perform daily tasks5.

As per 2010 statistics of arthritis organization, in Karnataka, among the total population, 28.4% of people over the age of 60years suffer from severe joint pain, among these 15% of the population have some degree of limitations of movement and 6% cannot perform daily activities.6

According to the survey conducted by The Hindu in Bangalore among the total population, 18% of people over the age of 70years suffer from severe joint pain, 33% of the population have some degree of limitations of movement and 3% cannot perform daily activities.7

A prospective observational cohort study was conducted to assess the prevalence of joint pain among elderly in UK (2011). The sample size was 1040 and the sampling technique was purposive sampling. The tools used for data collection was General Practice Record Review (GPRR) and Multi Dimensional Health Assessment (MDHA) conducted by trained research nurses in the participant’s own home/ institution. Among the participants, 62% of the cohorts were women and 99.6% were white. The results showed that among the total participants, 803 (63.1%) reported to have moderate to severe joint pain. Women reported pain more often than men.8

A cross- sectional descriptive study was conducted to assess the geriatric health problems and the socio- economic status in a rural community of Sreepur Thana, Bangladesh in 2007. The study population included those aged 50years or more. A total of 226 respondents were selected purposively and interviewed using a pre -tested questionnaire. The mean age of the respondents was found to be 62years. Mean family size and monthly family income were estimated to be 5.31 and 5.85 respectively. More than half (64.2%) of the respondents were illiterate. Results shown that 80% of them were unemployed and 67.3% were found to be dependent on their family members. Among these, most of them (65.5%) were found to be suffering from joint pains.9

A community based cross- sectional study to assess the morbidity among elderly in the rural service areas of Pondicherry, India was undertaken by Pondicherry Institute of Medical Sciences (PIMS) between October 1, 2002 to October 31, 2003. The sample was 320, all the persons above the age of 60years residing in 4 villages of the area were randomly selected for the study. They were interviewed and examined in their own houses using a predesigned and pretested questionnaire. A clinical examination and a set of basic laboratory tests including ECG were taken for each individual by a team of medical officers and field health staff. The results showed that the average illness per person was 2.77. Pain in the joints and Joint stiffness was the most common morbidity in 139 (43.4)%, followed by dental and chewing complaints in 135 (42)%, decreased visual acuity in 40, (14)%, diarrhoea in 38 (12)%, chronic cough in 37 (12)%, skin disorders in 38 (12)%,heart illness in 27 (9)%, diabetes in 26, (8.1)%, asthma in 19 (6)% & urinary complaints 18, (5.6)%.10

The most common distressing old age problems such as severe joint pain and impaired mobility necessitates the dependence on others. Usually health care professionals and family members neglect these problems as a part of old age wear and tear leading to severe reduction in the quality of life. Most of the analgesics may cause severe pyrosis and gastritis. Already food intake and appetite is decreased in old age. All these together may add other severe problems to old age leading to severe reduction in the quality of life.

A placebo controlled double blind cross over study to assess the effectiveness of topical application of camphor oil in relieving joint pain in patients suffering from severe joint pain conducted in UK (1993). The study was conducted on 60 samples (30 – experimental and 30 – control group). The topical application of camphor oil is given to experimental group and placebo to the control group. The assessment was done by Visual Analogue Scale. The duration of study was 20 days and the results showed that the average duration of pain relief was significantly greater with the camphor oil than placebo oil. Pain free body movement was reported after 24 hour of treatment in 44% of camphor application cases compared with none of the placebo applications.11

The aim of this study is to reduce the dependence of elderly on the Over The Counter (OTC) medications to reduce joint pain by introducing the home remedies, thereby reducing the side effects of the Over The Counter drugs and to improve the quality of life. The easy availability of camphor, it’s medicinal properties to relieve pain and it’s low cost with less side effects in topical application makes camphor as an adjuvant therapy in reduction of pain among elderly with joint pains.

During my clinical experience in geriatric ward, I had come across many patients suffering from severe joint pain as well from the side effects of Over The Counter medications. From these experiences the researcher wishes to search for an alternative route of treatment (topical) which can be non - invasive, safe and effective. Through this study the researcher aims to evaluate the effectiveness of topical application of camphor oil on joint pain among elderly.

6.2 REVIEW OF LITERATURE

The literature can be grouped under 3 domains. They are:

6.2.1 Literature related to joint pain among elderly.

6.2.2 Literature related to effectiveness of camphor oil on joint pain.

6.2.3 Literature related to effectiveness of camphor oil on other pains.

6.2.1 Literature related to joint pain among elderly

A longitudinal study was conducted to assess the prevalence of joint pain among elderly in UK in 1998. The sample size consisted of 4804 elderly over the age of 75years and the sampling technique used was simple random sampling. The tools used were postal questionnaires and rating scales. The response rate to the postal questionnaire was 77%, providing 4804 patients, with a mean age of 80.7 yr in 1998; the proportion of females was 58%. All respondents completed the questionnaires on joint pain. The results showed that 83% of the participants reported to have joint pain. This was mainly related to old age, mobility and female gender. The percentage reporting of any degree of pain was 83%. The prevalence of constant pain was 26%, and was higher in women (χ2 = 80, P<0.001) and in the over-85s (χ2 = 21, P<0.001): 20% of men under 85 and 24% of men over 85; 28 and 34% of women respectively.12

A cross sectional study was conducted to estimate the burden of musculoskeletal disorders in the community was done in 1998 in US. An age and sex stratified sample of 6000 adults from the two practices (Allopathy & Ayurveda) were mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment Questionnaire- MHAQ). The response rate was 78.5%. The results showed that the most common sites of joint pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability and joint pain in the community rose with age. It was the highest in those with multiple joint problems, but was also high in those with isolated back or knee pain.13

A descriptive study was conducted to assess the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic joint pain in the hip or knee and of a reference group without pain. The sampling technique was simple random sampling and the sample size was 306. A Visual Analogue Scale was used to assess global QOL. Physical as well as psychosocial disability was assessed with the Sickness Impact Profile (SIP). Coping with problems in general was assessed with the Utrecht Coping List. As expected, a significantly lower QOL was found in people with more chronic joint pain (p = 0.045). The difference in QOL between the group with chronic pain and a reference group without pain was 10%. 14

A cross sectional survey was carried out to estimate the morbidity, co -morbidity & patterns of treatment seeking and to determine relationship of morbidity with disability, psychological distress and sociodemographic variables among the elderly population from the urban population of Chandigarh city and the rural population of Haryana, India in 2000, by using a cluster sampling technique. The sample size was 252.Various socio demographic characteristics were recorded at base line. A clinical diagnosis was made by physician based on reported illness, clinical examination and cross checking of medical records and medications held by the subjects. The results showed that out of total samples 88.9 % reported illness based on their perception and of these 43.5% were diagnosed as having 4 – 6 morbidities. The mean of number of morbidities among elderly people was 6.1 (SD- 2.9). A total of 87.5% had minimal to severe disabilities and 66% of elderly people were distressed physically, psychologically or both. The most prevalent morbidity was anaemia followed by joint pains, immobility, hypertension and COAD (Chronic Obstructive Airway Diseases). Morbidity was significantly associated with age. (b value- 0.06, 95%, Cl 0.01, 0.012),Sex (b- value 1.03, 95%, Cl 0.02, 2.05) and occupation (b value 0.20, 95%, Cl 0.07, 0.33)15

A cross sectional observational, community based study was conducted to assess the disability among geriatric females in rural area of West Bengal, India in 2006 by house to house visits, clinical examination, observation and interview with a predesigned pretested proforma. The results showed that among 261 samples 130 (49.8%) suffering from severe joint pains due to Osteoarthritis and have impaired physical mobility.16

A cross sectional study was conducted to assess the geriatric morbidity pattern & depression in relation to the family support in aged population of Kashmir Valley in 2003. The study was conducted on 210 aged people (samples) above the age of 60 years, out of 210 aged persons 122 were female and 88 males with mean age of 70.53 (SD 7.32) of the population. The mean age of females was 69.75 (SD 7.43) and that of male was 71.6 (SD 7.12). The study results showed that majority of the population above 60 years of age, 51.81% were suffering from joint pain and 58% of the elderly were having moderate to severe depression, 26% of the samples were having mild – moderate level of depression and 14% of the samples were comfortable with their family support.17