3
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms. JANLY GEORGE
FIRST YEAR M.SC (NURSING)
MENTAL HEALTH NURSING
YEAR 2011-2013
INDIAN ACADEMY COLLEGE OF NURSING
BANGALORE – 560 043
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRES / Ms. JANLY GEORGE1ST YEAR M.Sc (NURSING)
INDIAN ACADEMY COLLEGE OF NURSING,
HENNUR MAIN ROAD, HENNUR CROSS, BANGALORE – 560 043
2. / NAME OF THE INSTITUTION / INDIAN ACADEMY COLLEGE OF NURSING, BANGALORE-560043
3. / COURSE OF THE STUDY AND SUBJECT / 1ST YEAR M.Sc (NURSING),
MENTAL HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 25/09/2011
5. / TITLE OF THE STUDY / “A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF PRANAYAMA ON REDUCING DEPRESSION AMONG MARRIED AND UNMARRIED ELDERLY PEOPLE IN SELECTED OLD AGE HOMES AT BANGALORE.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“You do not heal old age. You protect it; promote it; you extend it”.
-Sir James Sterling Ross
Ageing is a universal phenomenon, which is experienced by every human being across various cultures. The experience of ageing is unique to every individual because of the individual differences in personalities, varying social support networks and differing according to the culture to which one belongs. Also aging involves many major life changes and is a psychological step, or a transition, that alters one’s relation to the world and demands new responses.1
The Indian family has traditionally provided natural social security to the old people. However, in more recent times, the traditional role of the family is being shared by institutions such as old age homes. Many of the elderly parents are compelled to leave their children and stay in old age homes. The old age homes, which were a rarity, have recently spread across the country, a fact that indicates the growing rift between the generations.2
Elderly depression can be quite common as ageing presents its own set of challenges - many elderly people have to face some very difficult situations where certain health conditions could be taking a toll on the person on the one hand and, on the other, failing health or death of a spouse could contribute heavily to depression in the elderly.3
Sometimes, people who have led a fairly independent life might be required to depend on another because of disabilities and coming to terms with these changes and challenges can be heart wrenching for the elderly. In such cases, it is only natural one begins to feel terribly lonely and in the absence of a support system in terms of spouse, family, and friends, elderly depression sets in during old age.4
Pranayama is a yogic tool that can function beyond treatment of depression to improve a person's overall wellbeing. People practicing pranayama learn to connect their mind and body by regulating their breath, which also serves as a foundation for meditation. Learning to manage the breath through pranayama leads to relaxation and better quality of life, which can reduce or eventually eliminate the persistent symptoms of depression.5
So the researcher is interested to compare the effectiveness of pranayama on reduction of depression among married and unmarried old age people because the prevalence rate was more among elderly persons. Pranayama will have greater impact on the improvement of the emotional status of old age persons and it will change the attitude of elderly persons to accept the old age a global phenomenon.4
6.1 NEED FOR THE STUDY
Demographic ageing is a global phenomenon. By 2025, the world's population is expected to include more than 830 million people at an age of 65. With a comparatively young population, India is still poised to become home to the second largest number of older persons in the world. Recent statistics related to elderly people in India,(according to census 2001), showed that as many as 75% of elderly persons were living in rural areas. About 48.2% of elderly persons were women, out of whom 55% were widows. A total of 73% of elderly persons were illiterate and dependent on physical labor. One-third was reported to be living below the poverty line, i.e., 66% of older persons were in a vulnerable situation without adequate food, clothing, or shelter.6
About 90% of the elderly were from the unorganized sector, i.e., they have no regular source of income. The socio-economic problems of the elderly are nowadays aggravated by factors such as the lack of social security and inadequate facilities for health care, rehabilitation etc. Living arrangements of older people are influenced by several factors such as gender, health status, and presence of disability, socio-economic status and societal traditions. To overcome these problems and to ensure a good, healthy and quality life, the elderly members of the society can move a long way with the support of the family members as well as the other society members. 7
Old people in India, like those in other countries, suffer from a range of problems.
However, of all the problems associated with an aging population, health care demands the top priority. Ageing is a time of multiple illness and general disability. Along with the changes in the biological compositions, life style factors are also important for disorders and diseases in old age. Old age diseases are not always curable, implying a strain on financial as well as physical health infrastructure resources. However, the feeling of well- being can still override actual physical discomforts if the surrounding environment is nurturing.7
According to WHO (2008), the prevalence of depressive disorders varies throughout the world. The lowest rates are reported in Asian and Southeast Asian countries. Percentages represent the lifetime chance that a person will experience a depressive episode that lasts a year or more. For example, Taiwan reports less than 2%, and Korea 3%. Western countries typically report higher rates, such as Canada 7%, New Zealand 11%, and France 16%. The United States has a rate of 6%. Also, countries plagued by protracted civil war, such as Bosnia and Northern Ireland, report higher rates of depression.8
The American Psychiatric Association estimates that 0.4% to 1.2% of adults experience Depression. This Depression affects women and men equally and is more common in higher socioeconomic groups. It can begin any time after adolescence, but onset usually occurs between ages 50 and 70; about 35% of patients experience onset between ages 60 and 70. Before the onset of overt symptoms, many patients with Depression have an energetic and outgoing personality with a history of wide mood swings.9
Depression recurs in 80% of patients; as they grow older, the episodes recur more frequently and last longer. This illness is associated with a significant mortality; 20% of patients commit suicide, many just as the depression lifts.
Worldwide Information
To say that depression and anxiety in the U.S. are a problem would be the understatement of the year.Whereas depression touches over 14 million adults every year, anxiety disorders clock in as the most common mental illness with 40 million (or 18 percent) of adults in the United States suffering the affects of this particular malady.10In world health organization reported that the incidence rate of Depression was 27.5%
In Canada the incidence rate of Depression 7.9-8.9 of adults will have Depression during their life time at least once.
Indian Information
The incidence rate of Depression was 31.2%, the annual incidence of Depression in slightly higher in male than in female. In National institute of Mental Health and Neurosciences reported that the incidence rate of Depression was 29.8%.
In the changing society, India is slowly grasping the western culture where the parents limit their company with their children and even children will have full freedom to live according to their needs. Old age was never a problem in India. As life expectancy has increased to around 65 today, hundreds of old age homes have sprung up in India.8
Basic reasons for neglecting old people in the families are:
- As the life is turning busy, there is no enough time to take care of elders in the family.
- Old life is burden and they need support of some one to be with for their needs.
- Children with a view that there won’t be freedom in the family if there is an old person. (Due to generation gap, variations in the thoughts.. etc.,)
- There won’t be any means of income for some elders. Here children may think that their parents or grand parents’ medical and food expenses are burden for them.
- Some people who prefer nuclear families rather than joint families are also one of the main reasons.
Whatever the reason is, the word neglect is definitely larger in this case, where the needy and the helpless seniors are getting avoided and left on their own without care and attention.10
Although depression in the elderly is a common problem, only a small percentage gets the help they need. There are many reasons depression in older adults is so often overlooked: Some assume seniors have good reason to be down or that depression is just part of aging. Elderly adults are often isolated, with few around to notice their distress. Physicians are more likely to ignore depression in older patients, concentrating instead on physical complaints. Finally, many depressed seniors are reluctant to talk about their feelings or ask for help.7
The consequences of this oversight are high. Untreated depression poses serious risks for older adults, including illness, alcohol and prescription drug abuse, a higher mortality rate, and even suicide. So it’s important to watch for the warning signs and seek professional help when you recognize it. The good news is that with treatment and support, depressed seniors can feel better.11
The researcher realized that there is an immense need of alleviating the stress of the elderly in order to maintain good physical and mental health. During the literature review the researcher found that pranayama provides good activity to all internal and external organs to reduce the stress hormones level, increases the circulation and relaxes the muscles. Hence the investigator felt that, it is necessary to assess the effectiveness pranayama to reduce the level of depression among married and unmarried elderly.
6.2 REVIEW OF LITERATURE
Review of literature is an important step in the development of any research project. It helps the investigator to analyze what is known about the topic and to describe method of inquiry used in earlier world including their success and short comings. It gives a broad understanding of the problem keeping those aspects in mind of the investigator. Probed in to available resource of the document, informations and studies related to pet therapy and its relation on depression among old age.
The review of the literature is an extensive systematic scrutinization of potential sources of previous study and work. This process helps in identification and selection of problem, back ground of the study, formation of the tool, choosing the methodology, formulating hypothesis. (Polit and Hungler 1990).
Review of literature of the present study was arranged under the following headings:
1. Literature related to prevalence and incidence of depression among old age people.
2. Literature related to management of depression among old age people.
3. Literature related to effectiveness of pranayama on reducing depression among old age people.
I. Literature related to prevalence and incidence of depression among old age people.
A T Beekman, (2000) conducted a study to assess the prevalence of depression in later life. The objective of the study was to assess the prevalence of late-life depression in the community. Systematic review of community-based studies of the prevalence of depression in later life (55+). This study concluded that there is consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances.12
Dyer CB, (2000) conducted a study to assess the prevalence and incidence of depression and dementia in neglected patients. The objective of the study was to describe the characteristics of abused or neglected patients and to compare the prevalence of depression and dementia in neglected patients. They selected Baylor College of Medicine Geriatrics Clinic at the Harris County Hospital District (Houston, Texas). Standard geriatric assessment tool has used./ this study revealed that there was a statistically significant higher prevalence of depression (62% vs 12%) and dementia (51% vs 30%) in victims of self-neglect compared to patients referred for other reasons.13
David C. Steffens,(2000) conducted a study to assess the Prevalence of Depression and Its Treatment in an Elderly Population. examined the current and lifetime prevalence of depressivedisorders in 4559 nondemented individuals aged 65 to 100 years.This sample represented 90% of the elderly population of CacheCounty, Utah. Using a modified version of the Diagnostic InterviewSchedule, we ascertained past and presentDSM-IVmajor depression,dysthymia, and subclinical depressive disorders. This study concluded that These estimates for prevalence of major depressionare higher than those reported previously in North Americanstudies. Treatment with antidepressants was more common thanreported previously, but was still lacking in most individualswith major depression. The prevalence of subsyndromal depressivesymptoms was low, possibly because of unusual characteristicsof the population.14
Patricia A. Parmelee, (2002) conducted a study Depression Among Institutionalized Aged: Assessment and Prevalence Estimation. Aged nursing home and congregate apartment residents were screened for symptoms of depression and cognitive impairment. Of 708 survey respondents, 12.4% met DSM-IIIR criteria (33) for major depression; about half this group also displayed significant cognitive deficits. Another 30.5% of the total sample reported less severe but nonetheless marked depressive symptoms. Such “minor” depressive syndromes were much more common among congregate housing than nursing home residents. Possible major depression was more prevalent among newly admitted residents of both housing components.15
K.Jongenelis, (2004), conducted a study Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. Prevalence and risk indicators of depression were assessed in 333 nursing home patients living on somatic wards of 14 nursing homes in the North West of the Netherlands. Depressive symptoms were measured by means of the Geriatric Depression Scale (GDS). This study showed that The prevalence of depression in the nursing home population is very high. Whichever way defined, the prevalence rates found were three to four times higher than in the community-dwelling elderly.16