Rajiv Gandhi University of Health Sciences, Karnataka
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidate
MS.RINTU MOL P.R
Diana College of nursing
2. Name of the institution
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
Assess the level of depression among
5.Title of the topic
elderly residing at selected old age
homes of Rural Bangalore,
Karnataka.
1
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
2
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.
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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
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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
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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
6
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
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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
8
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.
9
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.
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.
Radha Krishnan, (2006)10
assessed depression among geriatric out patients
attending selected hospitals at Belgaum, Karnataka concluded that 63% of the geriatric
out patients had mild to moderate depression &17% of them had severe depression
according to GDs 15 and there is significant association between the level of depression
and loss of spouse.
Statement of problem
Assess the level of depression among elderly residing at selected old age homes of Rural
Bangalore, Karnataka.
10
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.
Depression: Refers loss of interest in pleasurable activities feeling of worthlessness and
excessive guilt of elderly residing in selected old age homes.
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.
Assumptions
 Demographic variable have some influence on level of depression
 As the age increases the level of depression in elderly increases
7. Material and methods
11
The data will be collected from elderly
7.1 Source of data
residing in selected old age homes between
the age group of 55-74 years.
7.2 Method of data collection
Non experimental descriptive design will
Research design
be selected to assess the level of depression
among elderly.
Selected old age homes at Rural Bangalore,
Setting
Population
Sample
Karnataka
Population for the study will be old age.
Men suffering from depression between 55
to 74 years of the age residing at selected
old age homes.
90 elderly men suffering from depression
Sample size
will be the sample size..
The investigator will use the convenient
Sampling technique
sampling technique to select the elderly
residing at selected old age homes.
The study will be limited to the elderly;
Inclusion criteria
1.Men between 55 to 74 years
2.Men residing at selected old age homes
3.Men who will give consent to participate
in the study
4. Men who will be available at the time of
data collection.
The Observational rating scale will be used
Tools
to assess the level of depression among
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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.
7.3 Does the study require any investigation or intervention to be conducted on
Patients or other humans or animals? If so describe briefly.
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
7.4 Ethical committee
13
Assess the level of depression among
Title of the topic
the
elderly residing at selected old age homes of
Rural Bangalore, Karnataka
Name of the candidate
Course and subject
Ms. RintuMol P.R
Master of science in nursing
Psychiatric Nursing
Name of the guide
Ethical committee
Prof. Mrs. Kalai selvi. S.
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
Approved
14
Members of ethical committee
1. Prof. Veda vivek
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.
4. Prof. Vasantha chitra.
Head of the Department.
Department of medical surgical nursing.
Diana college of nursing, Bangalore-64.
5. Prof. Mrs. Kalai selvi. S.
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
6. Prof Surendra.
Biostatistician,
GKVK, AirPort Road, Bangalore
15
8. List of references
Books
1. Ann J Zwimmer. Basic psychology for nurses in India.1st edition. New Delhi:
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.
3. Christensen kockrow .Foundations and adult health nursing .1st edition.
Philadalphia: Mosby company;2006.p1082,1088.
4. Gulani K K.Community health nursing principles and practices.1stedition .New
Delhi:
Kumar Publishing House;2005, p.469-471.
5. Karensaucer ,Sharyn Janes,K.s.Lundy.Essentials of community based nursing.
1st edition. Canada: Jones and Barlett publishers ;2003.p502, 504,509,525.
6. Mary ann boyd .Psychiatric nursing contemporary practice. 2nd edition.
Philadalphia: Lippincott company .2002.p921.
7. Park K. Text book of preventive and social medicine.18th edition. Jabalpur,
India: Banarasidas Bhanot Publication.2007 p.382.
8. Polit& Hungler. Nursing research principles and methods. 5th edition.
Philadalphia :Lippincott company .1999.p69-70.
9. Potter and Perry. Fundamentals of nursing. 5th edition. N.Delhi: Harcourt pvt
ltd; 2005.p246.
16
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.
2. Andreoletti .C ,et al. ,Age differences in the relation ship between anxiety and
recall, Ageing mental health 2006; 10 (3) : 265-71.
3. E.M.Rajan ,T . Sarachandraraj,Problem of the aged in Pondicherry,social
welfare 2004; vol.51 no.7,p 16-18..
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.
6. Hamalanien j et al, Major depression relationship with long term
unemployment and frequent alcohol intoxication ,Archives of General
psychiatry 2005; Jun;62 (6): 617-27.
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.
17
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.
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.
15. Stordal et al . Association between unipolar major depression & executive
functions, journal of the American medical association 2006 ; Jun-18;288
(25):3095 –105.
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. White J et al . cognitive emotional and quality of life outcomes in patients
With pulmonary arterial hypertension. RespirRes 2006 ; mar 31; 7 :55.
18
9. Signature of the candidate:
The research topic selected for this candidate
10. Remarks of the guide
is significant and feasible. The study is related
to level of depression among elderly residing
at selected old age homes. . Hence, there is a
need to assess the level of depression among
elderly.
11. Name and designation of guide
Prof. Mrs. Kalai selvi. S.
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
Signature
HOD
Prof. Mrs. Kalai selvi. S.
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
Signature
12.Remarks of the
The study is relevant and researchable and
forwarded for needful action.
Chairman &Principal
Signature
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