1
PROFORMA FOR THE REGISTRATION OFSUBJECTS FOR DISSERTATION
DISSERTATION PROPOSAL
A DESCRIPTIVE STUDY TO ASSESS THE LEVEL OF DEPRESSION AMONG GERIATRIC OUT PATIENTS ATTENDING SELECTED GENERAL HOSPITALS AT TUMKUR.SUBMITTED BY :
MINI. S. GEORGE
I YEAR M.Sc NURSING
(PSYCHIATRIC NURSING)
SHRIDEVICOLLEGE OF
NURSING,TUMKUR.
2007-2008
RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR THE REGISTRATION OF
SUBJECTS FOR DISSERTATION
1. NAME OF THE CANDIDATE : MINI. S. GEORGE
AND ADRESS I YEAR M.Sc. NURSING
SHRIDEVICOLLEGE OF
NURSING,LINGAPURA,SIRA ROAD,TUMKUR.
2. NAME OF THE INSTITUTION : SHRIDEVICOLLEGE OF
NURSING.
3. COURSE OF STUDY AND: I YEAR M.Sc NURSING
SUBJECT PSYCHIATRIC NURSING
4. DATE OF ADMISSION TO
THE COURSE : 22-06-2007
5. TITLE OF THE TOPIC : A DESCRIPTIVE STUDY
TO ASSESS THE LEVEL OF
DEPRESSION AMONG
GERIATRIC OUTPATIENTS
ATTENDING THE
SELECTED GENERAL
HOSPITALS AT TUMKUR.
6. BRIEF RESUME OF THE INTENDED WORK
INTROUCTION:
“Ageing is a developmental issue. Healthy older persons are a resource for their families, their communities and their economy”
-WHO Brasilla declaration on healthy ageing,1996.
In a traditional Indian society, older people had a sense of honour and authority. They were revered for their experience and wisdom. The transition to modern society and the disintegration of joint family system led to the loss of traditional authority of older people.1 The elderly are considered to be a high risk group for multiple morbidity : physical, mental, social (Venkoba Rao, 1997). Owing to the hard work and poor nutrition, the health of older people declines. Poor eye sight, cataract, hearing impairment, cardio vascular disorders, and diabetes mellitus are common ailments. A host of other factors like illiteracy, I gnorance, non-availability of medical care and lack of personal attention also adds to the sufferings of aged in India.
Besides, older people are often the victims of mental disorders on account of their fear about death and feeling of dependency, anxiety, boredom, loneliness and helplessness.1 Depression is a common disorder that affects 12% of the older adults population at any one point in time (Copeland et al., 1999).3Geriatric depression is the most common diagnosis with a prevalence rate of 60/100 in the general population (Venkoba Rao and Madavan,1983).4
There are many reasons depression in the elderly is so often overlooked. Some assume seniors have good reasons to be down or that depression is just a part of ageing. The difficult changes that many elderly individual face can lead to depression, especially in those without a strong social system. Left alone, depression not only prevent older adults from enjoying life like they could be, it also takes a heavy toll on health.2
6.1. NEED FOR THE STUDY:
“Depression moods lead almost invariably to accidents. But when they occur, our mood changes again since the accident shows we can draw the world in our wake and that we still retain some degree of power when our spirits are low”.
-Jean Baudrillard,1929.
The World Health Organization stated that “Depression is the leading cause of disability and the fourth leading contributor to the global burden of disease in 2000. By the year 2020, depression is projected to reach second place of the ranking of disability adjusted life years, calculated for all ages and both sexes”.5 Nandi et al (1997), found depression to be the most common in old age with a rate of prevalence being 522/1000 population with
101 cases out of 112 in their study being diagnosed as depression.4
Sturn and Gresney (1999) have shown that the wealthiest 20% of the population in industrialized countries have a frequency of depression of 5%, the frequency of depression is as high as 15% in the poorest 20% of the population.5Shah,Panchal and Goswami(1995),in a study of geriatric medical inpatients found depressive symptoms in 40% of the subjects. Elderly medical inpatients and outpatients have found depression rates ranging from 15-45%(1988).Neilson and Williams(1983)reported that in a sample of 526 outpatients only 10%were diagnosed with depression by their physicians.4
The investigator is interested in this research because,although depression in the elderly is a common problem, only a small percentage gets the help they need. Elderly adults are often isolated, with few around to notice their distress. The treatment & diagnosis of psychological problems are not yet prioritized. Physicians are more likely to ignore depression in older patients, concentrating instead on their physical complaints.
Incorporating mental health components in the general hospital helps to achieve comprehensive health care. If a nurse learn how to spot the signs of depression and find effective ways to help, the geriatric patients can remain happy and vibrant throughout the golden years.2
6.2 REVIEW OF LITRETURE
Review of literature is defined as broad comprehensive, in depth systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual material and personal communication.
The purpose of this study is to asses the level of depression among the geriatric out patients. The purpose of review of litreture is to obtain comprehensive knowledge base and in depth of information of previous studies.
1.Prakash O.etal.,(2007) conducted a study to assess the psychiatric disorders and life events in medically ill elderly people. The objective of this study was to study the psychiatric co-morbidity and life events among elderly medical outpatients. The study found 18% subjects had depression 11% had other mental disorders. This study concluded that mental disorders are common among medically ill elderly patients, but they are poorly recognized and
treated. Assessment of the psychiatric morbidity will help in strengthening psycho-geriatric services and thus ,improve the quality of life the elderly.6
2.Elsa Sanstombi et al.,(2007) conducted a study to determine the perceived depressive feelings among the elderly above the age of 60 years living with their family members in a selected area of Udupi district, Karnataka. The main objectives of the study was to determine the perceived depressive feelings of the elderly clients as measured by a structured questionnaire. This was followed by finding out the association between perceived depressive feelings and selected socio demographic variables. Among 100 elderly clients 55% were
moderately depressed, 37.5% had mild depression and 7% had severe depression. The study concluded that there was significant association between age, sex and education with perceived depressive feelings, but it was independent of occupation and socio economic status.7
3 .Urbina Torija JR.etal., (2007) conducted a study to estimate the prevalence of depressive symptoms in people older than 64 and to analyze their association with socio demographic factors, frailty markers, and disabling diseases.The prevalence of depressive symptoms was 19.7% and clinical depression was diagnosed in 5%.The prevalence of depressive symptoms is very high in the elderly,four times higher than the diagnosis of clinical depression. Social risk and comorbidity are associated with depressive symptoms.8
4.Khattri JB.etal.,(2006), conducted a study to the aim of the study is to stimate the prevalence of depression. According to Geriatric Depression Scale (GDS) and a study group of 100 elderly patients aged 65 years and above were randomly selected from the psychiatry, medicine and general practice outpatient departments of Tribhuvan University Teaching hospital ,Nepal.
53.25% of the samples were found to experience depressive illness according to GDS which includes 34.2% of mild and 19% of severe depression.This study concludes that significant number of elderly patients attending OPD of tertiary care hospital suffers from depression.9
5.G.Radhakrishnan (2006), conducted a study to asses the level of depression among geriatric outpatients attending selected general hospitals of Belgaum, Karnataka. He Concluded that around 17% of geriatric outpatients attending general have severe depression and 63% have mild to moderate depression. Losses of life partner have significant association with the level of depression.10
6.Da Canhota CM.etal.,(2005)conducted a study to identify the prevalence of depressive symptomatology in an elderly population using a screening scale. Using HAD cut-off score of >8.47% of the population studied were depressed ;with a HAD subscale score>11, 26.2%were depressed. Depression was detected more in women (59%) and being female was associated with depressive status (p=0.010). Not having some one willing to listen to their problems, difficulties and worries was significantly related with depression (p=0.041). Age (greater than 75 years) was also associated with being depressed, as not having some one to talk with (p=0.037), and from being low socio economic class (p=0.050). This study concluded that participants characteristics such as being over 75 years of age, being female and socially isolated were related to depression.11
7.Litcht-Strucnk E.etal., (2001) conducted study to know about the prevalence of depression in older patients consulting their general practitioner. The aim of this study was to estimate the prevalence of major and minor depression in older GP attendees. Depression was prevalent in 13.7% and minor depression in 10.2% of the patients. Depressed patients were older (mean difference 0.7 years p=0.037), more often female
(p>0.001) and lived more often in urban districts (p>0.001).The study concluded that
depression in older GP attendees is a very common health problem. Further research should focus on identifying those groups of patients with high risk of persistence of depression. This could help to focus the limited resources available in general practice to those patients in whom treatment is most urgently needed.12
STATEMENT OF THE PROBLEM
A descriptive study to assess the level of depression among the geriatricout patients attending selected general hospitals at Tumkur.
6.3.OBECTIVES OF THE STUDY:
- To asses the level of depression among geriatric out patients.
- To associate the level of depression with selected socio demographic variables.
- Assessment – it is organized, systematic and continuous process of collecting data from the geriatric out patients.
- Descriptive study- it is the study to describe and observe the phenomena.
- Depression – it is a state of mood in which individual is sad, worried losses interest in life, looses energy, feels helpless, hopeless and worthless.
- Geriatric – an aged person above 50yrs old.
- Out patient – a patient who is admitted to a hospital or clinic for
6.5.RESEARCH HYPOTHESIS:
H1 :- There will be statistically significant positive association between
the level of depression and the selected socio demographic variables.
6.6.ASSUMPTIONS:
The geriatric out patients attending the general hospital may have depression.
Early recognition of depression can avoid the consequences including illness, alcohol and prescription drug abuse, a higher mortality rate and even suicide.
6.7.DELIMITATIONS:
The study is limited to
1. 60 geriatric outpatients only.2. Those who understand Kannada or English.
6.8.PILOT STUDY:
Pilot study will be conducted with 8-10 samples. The purpose of pilot study is to find out the feasibility of conducting study and design on plan of statistical analysis.
6.9.VARIABLES :
Independent Variables – Age, Sex, Background, religion, education, type of Family, monthly income, spouse (Alive/Dead), health problem.
Dependent Variables – Level of depression among geriatric out patients.
7.MATERIAL AND METHOD OF STUDY (METHODOLOGY):
The study is designed to assess the level of depression among geriatric outpatients attending selected general hospitals at Tumkur.
7.1 SOURCES OF DATA:
The data will be collected from geriatric out patients attending selected general hospitals at Tumkur.
7.1.1 RESEARCH DESIGN:
Descriptive research design.
7.1.2 RESEARCH APPROACH:
Descriptive survey approach
7.1.3 STUDY SETTING:
Out patient department of selected general hospital at Tumkur.
7.1.4 POPULATIONS:
The target population of the study will be the geriatric out patients attending selected general hospitals at Tumkur.
7.2 METHOD OF DATA COLLECTION (Including Sampling Procedure):
The data collection procedure will be carried out for a period of 3 months. The study will be conducted after obtaining permission from the concerned authorities. The investigator will collect the data from geriatric out patients by using structured interview to asses the level of depression.
It consists of two parts. Part I and Part II.
PART I :- Items on demographic variables like age, sex, background, religion, education, type of family, monthly income, spouse (alive or dead), health problem.
PART II :- Items on the level of depression.
7:2.1 SAMPLING TECHNIQUE:
The geriatric outpatients will be selected by using non-probability simple convenient sampling.
7:2.2 SAMPLE SIZE:
The sample size of this study is 60 geriatric out patients.
CRITERIA FOR SAMPLE SELECTION:
7:2.3 INCLUSION CRITERIA:
- Geriatric patients aging 50 years and above.
- Patients who are willing to participate in the study.
- Both female and male patients are included in the study.
- Patients who do not understand Kannada or English.
- Patients who are critically ill.
Part I: Demographic data sheet.
Part II: Geriatric depression scale-15 developed by the university of Oxford.
7:2.6 DATA ANALYSIS:
The investigator will use inferential and descriptive statistical and other relevant study techniques to analyze the data.
Descriptive statistics:
1.Frequeny and percentage distribution is used to analyze demographic variables of Geriatric Outpatients.2.Mean and standard deviation to assess the level of depression
Inferential statistics:
1.Paired “t-test” will be used to compare the scores.
2.Chi square test to associate the level of depression with socio demographic variables.
7.3.Does the study requires any investigation or Intervention to be conducted on Patients or other Human or Animals?
Since the study is descriptive survey, interventions are not required.
7:4 Has Ethical Clearance been obtained from your Institution in case of 7.3?
The pilot study and main study will be conducted after the approval of research committee. Informed consent will be obtained from the concerned authority of the selected general hospitals. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality.
8. LIST OF RFERENCES (VANCOUVER STYLE FOLLOWED):
1.K.Pappathi, Sudhir MA.Psychological characteristics and problems of the
rural aged.Research and Development Journal.January 2005;11(3):16-18.
2.Jeanne Segal.Depression in older adults and the elderly[online].2007 April;Available from:URL:
3.Osvaldo.P.Almeida,Jon J. Paff.Depression and smoking amongst older general practice patients.Journal of Affective Disorders.February 2005;98(2):317-319. 4.Phoebe.S.Liebig, Irudaya Rajan S.Health status and health care services among older persons in India.An Ageing India:Newyork:The Haworth press;2003.p.92-93.
5.Brain.E.Leonard.Physical consequences of depression.Quarterly Journal of Mental Health.March 2006;1:27-29.
6.Prakash O,Gupta LN,Singh VB,Singhalak,Verma KK.Profile of psychiatric disorders and life events in medically ill eldely:experiences from geriatric clinic in Northern India.International Journal of Geriatric Psychiatry.March 2007;22(11):1101-1105.
7.Elsa Sanatombi, Neenu A, Anu R, Rosmary J, Anju B, Dalphina S. et al., Elderly and Depression.The nursing Journal of India.October 2007;98(10):221-223.
8.Urbina Torija JR,Flores Mayor JM,Garcia Salazar MP,Torres Buisan L, Torrubias Fernandez RM.Depressive symptoms in the elderly:Prevalence and associated factors.Gac Sanit.February 2007;21(1):37-42.
9.Khattri JB, Nepal MK.Study of depression among geriatric population in Nepal.Nepal Medical College Journal.December 2006;8(4):220-223.
10.G.Radhakrishnan.A descriptive study to assess the level of depression among geriatric outpatients attending the selected hospitalsat Belgaum.Nightingale Nursing Times.May 2006;2(2):29-32.
11.Da Canhota CM, Piterman L.Depressive disorders in elderly Chinese patients in Macau.Australian Journal of Psychiatry.June 2001;35(3):336-344.
12.Litcht-Strucnk E,Van der Kooij KG,Van Schaik DJ,Van Marwijk HW,Van Hout HP, DE Haan M. et al.,Prevalence of depression in older patients consulting their general practitioner in Netherlands.International Journal of Geriatric Psychiatry.November 2001;20(11):1013-1019.