Rajiv Gandhi University Ofhealth Sciences, Bangalore

RAJIV GANDHI UNIVERSITY OFHEALTH SCIENCES, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

BY,

MR. GIBEES THARAKAN

IST YEAR M.SC NURSING

PSYCHIATRIC NURSING

2011-2013 BATCH

SNEHA COLLEGE OF NURSING

BANGALORE – 43.

NAME OF THE CANDIDATE AND ADDRESS

Mr. GIBEES THARAKAN

BANGALORE – 43

TITLE OF THE TOPIC

MATERIALS AND METHODS :-

INTRODUCTION :-

Aging is an inevitable developmental phenomenonbringing along a number of changes inthe physical, psychological, hormonal and thesocial conditions.1

Birren and Renner define aging in terms ofthe biology, referring to “The regular changes thatoccur in mature genetically representativeorganisms living under representative environmentalconditions as they advance in chronological

age.”1

Old age has been viewed, as problematicperiod of one’s life and this is correct to someextent. The aged become increasingly dependent on others. As man grows, his reduced activities,income and consequent decline in the positionof the family and society makes his life morevulnerable. Chaudhary pointed out thatan old person begins to feel that even his childrendo not look upon him with that degree of respect,which he used to get some years earlier. The oldperson feels neglected and humiliated. This maylead to the development of psychology ofshunning the company of others. The elderly citizens are in need of urgentattention. They do not need our pity but theunderstanding love and care of their fellowhuman beings. It is our duty to see that they donot spend the twilight years of their life inisolation, penury and misery. Older people are,therefore, in need of vital support that will keepimportant aspects of their life-styles intact whileimproving their overall quality of life .1

The reduction in fertility level, reinforced by a steady increase in life expectancy, has produced fundamental changes in the age structure of the population. This, in turn, leads to the ageing population. The older population of India, which was 56.7 million in 1991, was 72 million in 2001 and is expected to grow to 137 million by 2021. Today, India is home to one out of every 10 senior citizens of the world. Since the number is big their problems are worth discussing.2

Senior citizens face three serious problems. They are poverty, disease and loneliness. An emotional and psychological problem tormenting the elders is loneliness. This is due to the growing “empty nest syndrome”. The children go away to far-off countries in search of economic betterment. Even if they live within the country, due to the spread of western ideas such as “spacing, privacy, individualism and non-interference,” the nuclear families are becoming the norm even in villages. Love marriages have further aggravated the breakup of the joint family system. Even within joint families, the elders feel lonely owing to the denial of due respect, concern and care by youngsters. The younger generation generally lacks sensitivity towards elders' need for emotional support. All these factors have contributed to the psychological trauma called “loneliness”.2

NEED FOR THE STUDY :-

The incidence of the emerging psychosocial problems among the senior citizens is wider in developing countries like India and still to be intervened at its best.

A study reveals estimated association between job insecurity and change over time in in the psychosocial aspect elderly men and women aged above 60yrs. Secondary analysis of longitudinal data collected from 190 senior citizens. And controlled for individual characteristics and baseline measures of outcome. Result showed that men who experienced job insecurity rated themselves in significantly poorer psychosocial well-being and women showed higher depressive symptoms and reported more hostility, loneliness and personal stress compared with women who don’t experience job insecurity and men who do. Financial insecurity due to job instability may be clinically significant in both elderly men and women and is a potentially important threat to the elderly psychosocial well-being.3

A study statesthe relationship of anxiety and insomnia in his study., Relationship of self reported anxiety to insomnia complaints were investigated among immigrants aged above 60yrs in Russia.61%reported insomnia complaints and 48%considered anxiety to be the major impairment.Logistic regression analysis showed that insomnia was the most important predictor of perceived anxiety.4

A study revealed stress in the oral histories of rural older women aged above 65yrs.Content analysis revealed that economic hardship, disruption of family life and fears and uncertainties were stressors associated with the day-to-day life. Implication to remove the stressors were discussed among the samples.5

According to a study on the effect of episodic memory loss on the psychosocial well-being of elderly.178 senior citizens aged above 60yrs were asked to drive through a particular environment. All the aspect of episodic memory were then assessed resulted in 70 older participants had less recollection of events such as what, when and why.6

Most of the senior citizens are uncomfortable discussing some illness. Others may agree to only those treatments that are acceptable in their culture. Ethnic cultural background may also have a major effect on how they deal with psychosocial problems. Women from some cultures do not feel comfortable exercising their problems in public. Due to this reason, most of the problems faced by the elderly go unnoticed.7

A study on depression among elderly persons in a primary health centre area .Elderly are prone to psychiatric disorders through vicissitudes such as social isolation,malnutrition,economic and emotional depression. A cross sectional study was done to assess prevalence of depression among elderly persons aged above 60yrs and to study social factors influencing depression. Goldberg and Bridges scale was used to diagnose depression among 494 randomly selected study subjects.31.4%of elderly persons were having depression.37.1% among females, 37, 9% among illiterates, 55.8%among class v socio-economic status, divorced and unmarried.8

According to a study on correlation between loneliness and social relationship among elderly in China.Asample of 1144 elderly above 60yrs were surveyed using Loneliness Scale, The Social Support Rate Scale and the Family Adaptability,Partnership,Growth,Affection and Resolve Index. The study revealed that 80.94% of the elderly had moderate to high levels of loneliness with a mean score of 42.84 and a standard score of 53.55.Social support and poor family function were significant negatively associated with loneliness. Multiple regressions revealed that less social support and poor family function were associated with more loneliness.9

In the light of above facts and personal experiences, the researcher had felt that there is a need to assess and compare the psychosocial problems among the senior citizens of old age home and the rural old age people to decrease its magnitude. In turn the senior citizens to live a productive and dignified life in the society.

REVIEW OF LITERATURE :-

“Review of literature is a critical summary of research on a topic of interest often prepared to put a research problem in a context or as the basis for an implementation project”.

Review of literature is an essential part of the study. This helps the researchers to formulate hypothesis, aims and objectives of the study. It gives some idea how to assess the problem and toadapt suitable methodology.

A study on psychosocial adaptation status and health related quality of life among elderly Chinese.The objective of the study was to determine the association of psychological status with health related quality of life. In this cross sectional study, 167 samples above 65yrs were interviewed using structured questionnaires to assess their self-reported general health and psychological adaptation.30% of the samples reported that psychological adaptation plays a remarkable role in their health related quality of life. The study concluded that the psychological adaptation buffers the domain of social function, mental and general health and dependency.10

According to astudy on impact of family violence on psychological well-being of elderly African-American Women. Family violence among elderly women encompasses intimate partner violence and elder maltreatment; both linked to poor health status.150 African-American elderly women aged above 60yrs were interviewed in ambulatory clinics of a large public hospital. Family Violence Exposure was measured by the Family Violence against Older Women scale. Participants with top FVAOW scale score were 55% and considered to have higher family violence. Lower Income and poor medical facilities were associated with this. The study concluded that among 35.5% elderly women, lack of income and high level of family violence have worsened the psychological well and played in their current health status.11

Astudy on factors related to the social well-being among the elderly in Urban China. Predictive factors contributing to social well-being, focusing on multiple roles, among elderly Chinese subjects. A cross sectional survey was conducted among 356 senior citizens above 60yrs of age and who are retired from job. Participants completed a self-administered questionnaire and returned it by mail. Social well-being, the dependent variables was measured by the satisfaction with Life Scale. Variables included demographics, physical health, financial status, and self-efficacy. Gender-segregated multiple linear regression analysis were performed. The study resulted that for 23.3% males, the factors related to the social well-being were old age, absence of chronic diseases, better financial status, higher self-efficacy, absence of conflict with others and having grand children. For 33% females, absence of illness,absence of conflict with others, more contact with neighbors and engaging in more group activities .In conclusion, the results highlight predictive factors contributing to the social well-being of elderly.12

The study on suicide among the senior citizens in Mainland China. Suicide in Mainland China shows unique demographic patterns with age: the age over 65yrs has the highest rate of completed suicide, reaching 44.3-200 per 100,000,which is four to five times higher than Chinese general population. Rural suicide rates among the elderly are 38% higher than the urban population. The gender ratio of suicide in the elderly shows a reversal to those younger than 60yrs of age in China. In addition, suicide methods and causes of suicide among the elderly in China is different from the western countries.13

A studywas conducted on preventing social isolation and loneliness among older people. Preventing and alleviating social isolation and loneliness among older people is an important area for policy and practice, but the effectiveness of many interventionshas been questioned because of the lack of evidence. A systematic review wasconducted to determine the effectiveness of health promotion interventions that

target social isolation and loneliness among older people. Quantitative outcomestudies between 1970 and 2002 in any language were included. Articles wereidentified by searching electronic databases, journals and abstracts, and contactingkey informants. Information was extracted and synthesized using a standardform. Thirty studies were identified and categorized as ‘group’ (n=17) ; ‘one-tone’(n=10) ; ‘ service provision’ (n=3) ; and ‘community development ’ (n=1).Most were conducted in the USA and Canada, and their design, methods, qualityand transferability varied considerably. Nine of the 10 effective interventions weregroup activities with an educational or support input. Six of the eight ineffectiveinterventions provided one-to-one social support, advice and information, orhealth-needs assessment. The review suggests that educational and social activitygroup interventions that target specific groups can alleviate social isolation andloneliness among older people. The effectiveness of home visiting and befriendingschemes remains unclear.14

A study on socio-economic, psychological and health problems of senior citizens was conducted.The present study was an attempt to probe into the socio-economic, psychological and health problems of senior citizens: A study of urban male citizens. The study was conducted in two colonies of Faisalabad. A sample of 120 male senior citizens was randomly selected from two colonies. According to this study, majority i.e., 89.2 percent of the respondents reported that they were respected. A huge majority. i.e., 97.5 percent were in favor of the view that welfare homes should be established for the aged person. A vast majority i.e.. 97.5 percent of the respondents said that special services were needed for the aged persons.15

A study on effects of ageism on individual and health care providers’ responses to healthy aging.Ageism has been described as “thinking or believing in a negative manner about the process of becoming old or about old people” Society’s attitudes and beliefs about aging are culturally embedded and can have a profound effect on how people view themselves and others who are aging. Unfortunately, negative stereotypes about aging are still quite prevalent . Health care providers are not immune to these insidious stereotypes. This article reviews a number of ageism stereotypes in society generally and in the health care field. The aim is to demonstrate that ageism can negatively affect health care providers’ professional training and service delivery and, ultimately, their clients’ behavior and health outcomes.16

For many years service providers used the World Health Organization definition of health. The concept of health was a radical departure from the traditional model that saw health only as the absence of disease. WHO recognized that psychosocial well-being is an important component of health. However, health remained an abstract concept and, therefore, an ideal difficult to achieve. More recently, Achieving Health for All defined health in terms of “quality of life” and included in the definition the opportunity to make choices and to gain satisfaction from living despite functional limitations. This document suggested that health is a dynamic process of interaction between communities and individuals. Health involves freedom of choice: Communities including health care providers and individuals choose to take deliberate action to make the changes necessary for healthy aging.16

Unfortunately, ageism can often affect the choices people are presented with and the decisions they make about those choices. If people believe that some of the “inevitable deterioration” of aging is preventable, they are likely to be more active in their own self-care. If health care providers believe that elderly people are valuable, equal members of society, then this belief should be reflected in professional training and service provision. Consequently, confronting ageism by enhancing positive beliefs about aging is a vital component of health promotion training and programming.16

A study on The Prevention of Substance Abuse And Misuse Among the Elderlywas conducted. The Washington State Division of Alcohol and Substance Abuse has identified the prevention ofsubstance abuse and misuse among the elderly as a priority area for attention and action. Abuse isdifferentiated from misuse in that substance abuse is deliberate and intentional; misuse is inadvertentand may be perpetuated by another, often by a health care provider. Among the elderly alcohol is thesubstance typically associated with abusive use whereas misuse involves prescription and proprietarydrugs. Both abuse and misuse are related to undesirable physical, social, and psychological consequences,result in increased risks of development of other problems, and contribute significantly tohealth care costs. They also are factors in reduced quality of life. Older adults aged 65 and over makeup 12% of the population of the state, with projections for further proportionate increases in thefuture. In light of these facts, efforts to prevent abuse and misuse in this segment of the populationtake on increased importance.17

According to study onwidowhood, it is an inevitable life event for many older women has an impact on their psycho-social status. Consequent upon widowhood many older widows are vulnerable to the development of psycho-social problems and low self-esteem. This study is an attempt to investigate the psycho-social factors contributing to self-esteem of widows. The sample consists of 320 community dwelling elderly widows from the age groups of 60-89 years living in rural and urban areas of Chittoor and Cuddapah Districts. The results indicate that the economic status, age and psychological health were the significant contributions to self-esteem of widows. Implications of the findings in the context of intervention for the betterment of older widows are indicated.18