Rajiv Gandhi Univerisity of Health Sciences, Karnataka, Bangalore

RAJIV GANDHI UNIVERISITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

BRIEF RESUME OF INTENDED WORK

Introduction

Aging isa complex process that can be described chronologically, physiologically, and functionally. Despite of some cultural changes, becoming old retains many negative connotations,people do not know enough about the realities of aging and because of ignorance they are afraid to get old.1

One of the major features of demographic transition in the world has been theConsiderable increase in the absolute and relative numbers of elderly people. This has been especially true in the case of developing countries like India, where ageing isoccurring more rapidly due to the decline in fertility rates combined by increase in lifeexpectancy of people achieved through medical interventions.2

According to 1991 census, India had 60 million elderly (60 years and above). This is about 6.7 percent of the total population, which is up from the 5.97 percent in 1971 and 6.32 percent in 1981 respectively. The percentage of elderly is much higher in rural (20.3percent) than in urban areas (1.97 percent). The number of elderly is likely to reach around 80 million by 2001 and 120 million by 2031 (EPW Research Foundation; 1994).The decadal rates of growth of the elderly population in India indicate that the elderly population has exploded in the 80 plus age range. This has resulted in emergence of emotional & psychological disturbance resulting in the deteriorated quality of life in elderly.3

6.1 Need for the study

The elderly are one of very importantvulnerable group of society which needs urgent attention. The recent statistics reveals Some 8.5 million people over age 70 have limitations either in activities of daily living (ADL) or instrumental activities of daily living (IADL). Although they are not disabled to the extent that they need institutional care, they do need some help to function in the community. As the population ages, millions more will need care. By 2030, 21 million elderly people may need help with activity limitations.4

Activities of daily living (ADL) include walking, dressing, eating, using the toilet, bathing, and getting into and out of bed. People who receive help, use equipment, or have difficulty with an activity of daily livinglimitations. Instrumental activities of daily living (IADL)like meal preparation, grocery shopping, making phone calls, taking medications, and money management are of great importence to the elderly. If the current rate of activity limitation remains unchanged, the number of elderly with activity limitations would increase more than twofold from 8.5 million to 21 million by 2030.By 2050, over 25 million elderly will be limited in their activities and need of care. Elderly will be limited in their activities and in need of care who would have a family member or friend available for future care needs.4

6.2 Review of literature

The study was conducted by Akitomo Yasunaga and Mikio Tokunaga, subjects of 202 elderly residents aged 70, living in their own home, to examine the relationships among exercise behavior, the ability to live independently as assessed by functional activities of daily living (ADL), and psychological health as measured by the PhiladelphiaGeriatricCenter morale scale. The results of this study demonstrated that elderly people's efforts to maintain and enhance their psychological health play important roles in their ability to live independently, and that regular exercise is necessary to an elderly person's ability to live independently.5

Dr. Iwasa conducted a study in (1993) on relationship between subjective well-being and maintenance of physical and psychological health in elderly. Between the age group of 52-72, with the sample of 1034 men and 1413 women living in an urban Japanese community.Hefound an intergender difference in subjective well-being, correlates of subjective well-being, and a subjective well-being–mortality association among middle-aged and elderly people, by Philadelphia Geriatric Center Morale Scale.6

Joshi, Rajesh Kumar and Avasthi (2003) conducted a cross-sectional

Survey of 200 subjects over 60 years old (100 each from the urban population of ChandigarhCity and the rural population of HaryanaState of India) was carried out using a cluster sampling technique. To examine the various socio-demographic characteristics. A clinical diagnosis was made by a physician based on reported illness, clinicalExamination and cross-checking of medical records and medications held by the subjects. Psychological distress and disability was assessed using the PGI (post graduate institution)Health Questionnaire-N-1 and the Rapid Disability Rating Scale-2, respectively. With Kruskal–Wallis H test, correlation coefficient, and multivariate analysis were used to assess the relationship and association of morbidity with other variables.7

Carita Nygren conducted the study at Swedenin (1990) about improved quality of geriatric rehabilitation. This was focused clients' perceptions of the rehabilitation process, dependence in activities of daily living (ADL), and subjective well-being in a one-year perspective. A study-specific questionnaire, a revised version of the ADL Staircase, and the Göteborg Quality of Life Instrument were administered, in 1996 (N = 278) and 1997 (N = 233). Even if 77% of the clients were content as regards rehabilitation quality. Most clients also reported a diminished contentment with the training provided during the period investigated. Most clients were dependent in activities of daily living, but in sub-groups independence in some activities diminished over the study period. In contrast, in some aspects sub-groups scored their subjective well-being lower on the second measurement than on the first. The results of this study were partly ambiguous. Still, since valid descriptions of variables at target for rehabilitation is one important key to the continuous process of quality development, this study produced information valuable for further studies following geriatric rehabilitation processes over time. The implementation of this study could be applicable in similar settings.8

Shu-Chuan Jennifer Yeh, PhD conductedstudy in Taiwan on to describe the characteristics of the elderly population living alone, and to examine how living alone relates to feeling lonely. Interviews were conducted with a stratified random sample of 4,859 elderly individuals living in Kaohsiung, Taiwan. Variables collected included demographic information, living alone or not, activities of daily living (ADL), instrumental activities of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), chronic conditions, perceived social support, and a subjective measure of feeling lonely. Using logistic regression, it was found that factors associated with living alone included gender, marital status, and occupation, source of income, religion, and IADL. Living alone is linked to physical and mental health problems, increasing social support and facilitating friendship should be factored into life-style management for communities of elderly.9

In 1995, a new national research institute of aging in Japan, the National Institute for Longevity Sciences (NILS) was established as a research facility in ChubuNationalHospital through Longitudinal Study of Aging. The samples were 2,267 males and females aged 40 to 79 years, randomly selected from the NILS area. Six to seven participants were examined every day at the NILS-LSA examination center. The aging process is assessed by detailed questionnaires and examinations including clinical evaluation, body composition and anthropometry, physical functions, nutritional analysis, and psychological assessments. The data from the study was used to investigate the causes of geriatric diseases and health problems in the elderly such as depression, mental disturbance, restriction of activities of daily living, low nutrition and physical activity, and also used to prevent these diseases and health problems in the elderly.10

6.3 Statement of the problem

“ASSESSMENT OF ACTIVITIES OF DAILY LIVING AND WELL-BEING STATUS OF ELDERLY BETWEEN THE AGE GROUP OF 60-85 YEARS WITH A VIEW TO PREPARE INFORMATION BOOKLET TO CAREGIVERS RESIDING IN A SELECTED COMMUNITY AT MANGALORE”

6.4 Objectives of the study

1) Toassess the activities of daily living as measured by activities of daily living status scale.

2)Toassess the well- being status of elderly as measured by well being scale.

3) To find out association between the activities of daily living status and well-being status in selected demographic variables.

6.5 Operational definitions

Elderly: -Elderly is the term used to describe persons who have achieved a certain chronological age (Clemenstone, 2002).In this study elderly refers to the persons who are in the age group between 60-85 years.

Wellbeing: -Astate of being healthy, happy (oxford dictionary 1992).In this study, subjective well-being status refers to the physical, psychological, mental and social well being of the elderly as measured by well-being scale.

Activities of daily living status: -Activities of daily living status are activities usually performed in the course of a normal day; they include ambulating, eating, dressing, bathing, brushing the teeth and grooming (potter and Perry 2000). In this study activities of daily living status refers to eating, dressing, bathing, brushing the teeth and grooming, as measured by activities of daily living status scale

Care givers:-A person who takes care of someone requiring close attention as a young child, adults, old age or an invalid (Webster’s new world dictionary 2004). In this study non-institutionalized care givers refers to significant members of the family taking care of elderly in thehome set up.

6.6 Assumptions

1. Aging process brings about bio psychosocial, physiological changes in the individuals.

2. Elderly clients are capable of expressing their well being status

3. Participants will give free and frank responses

6.7 Delimitations

1. Studyis limited to the elderly who can speak Kannada, English.Languages

2. Study is limited to those who are willing to participate in the study

3. Study is limited to the age group of 60-85 yrs.

4. Study is limited to elderly people, who are residing in selected community atMangalore only.

6.8 Projected outcomes / Hypothesis

All hypotheses will be tested at 0.05 level of statistical significance

H1: There will be significant association between activities of daily living and demographic variables

H2: There will be significant association between well-being status and demographic variables

H3: There will be an association between activities of daily living and well-being of elderly.

Material and method

7.1 Source of data

Activities of daily living and well-being status of elderly people, residing in selected community atMangalore,is collected using checklistand structuredquestionnaire.

7.1.1 Research design

Descriptive study design is planned since the present study explores the activities of daily living and well- being status of the elderly living with family members.

7.1.2 Setting

The setting for the study is selected acommunity where there is an access of elderly people and their care givers.

7.1.3 Population

Elderly age group of 60-85 years and their care givers who meet the inclusive criteria

7.2 Method of data collection

7.2.1 Sampling procedures

Convenient sampling will be used to select the population

7.2.2 Sample size

100 samples

7.2.3 Inclusive criteria for sampling

1. Elderlywith the age group of 60-85 years

2. Able to speak Kannada, English languages

3. Able to respond to the questions asked by the interviewer

4. Not previously sensitized through the research studies. / Awareness program

5. Care givers and elderly clients who are willing to participate in the study.

7.2.4 Exclusion criteria for sampling

1. Elderly who are above the age limit of 85 years

2. Elderly who are not ableto hear.

3. Those who do not wish to participate in the study

4. Previously sensitized

7.2.5 Instruments intended to use

Instruments intended to be used is observational checklist, & structured questionnaire which will be validated by experts before conducting the study.

7.2.6 Data collection method

Step 1:-Community areas are selected based on availability of permission to conduct the study.

Step 2:- Introduction to study subjects & explaining the need for the study.

Step 3:- Informed consent will be taken prior to study

Step 4:- Data will be collected through a structured questionnaire technique

Step 5:-Distribution ofinformation booklet to care givers about the activities of daily living and well-being status.

7.2.7 Data analysis plan

1. After the data collection process analysis of data will be based on objectives, hypothesis and using descriptive and inferential statistical methods.

2. Findings will be presented using tables and figures

7.3 Does the study require any investigation / intervention to be conducted?

Yes, the guide sheet will be given to the care givers regarding daily activities and well- being of elderly in order to improve the standardized care.

7.4 Has ethical consideration been obtained from our institution in case of 7.3?

Yes, ethical clearance has been obtained

References

1. Hoffman GW.Basic Geriatric Nursing.2nd ed;Mosby: A times Mirror Company: 1999,4-150
2. Bold, 2001 “Health status elderly in India” International Institute of Aging, United Nations, Malta, 10-11
3. Visalia 2001”Demographics of ageing in India” Economic and Political Weekly, 36, 1967-1975
4. Lee Shirey and Laura Summer,” Challenges for the 21st century, Gerontological Society of America, 2000, 7, 1-6
5. Akitomo Yasunaga and Mikio Tokunaga, Journal of physiological anthropology and applied human science, 20, 2001, 339-343.
6. Dr.Hajime Iwasa, (1993).Research team for promoting independence of the elderly. Journal of gerontology, 35(2), 173-175.
7. Joshi K, Rajeshkumar and Avasthi A, Morbidity profile and disability among elder people in Northern India, International Journal of Epidemiology 2003:32:978-987.
8. Carita Nygren, Susanne Iwarsson, Ake Isacsson,”Rehabilitation”, vol. 8, (3), September 2001, 148-156.
9. Shu-Chuan Jennifer Yeh,”Social Behaviour and Personality”, International Journal, 2004, 32: (2),129-138
10. Hiroshi Shimokata, MD, PhD, Gerontology, Geriatrics and Epidemiology, 1993, 13:1-20.
11. Clemenstone.S.McGuire’s. & Eigsti.D.G. (2002).Comprehensive community health nursing.Philadelphia: Mosby Company, 203-204
12. Potter P.A., &Perry A.G. (2000) Fundamentals of Nursing. India: Harcourt Private Limited.34-35