A STUDY TO “ASSESS THE KNOWLEDGE ON DEPRESSION AMONG GERIATRIC RESIDENTS OF SREE RAMAKRISHNA ASHRAM, PAVAGADA, TUMKUR DISTRICT IN A VIEWS TO DEVELOP AN INSTRUCTIONAL MODULE.”

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

MRS. C. MERCY MARY. COMMUNITY HEALTH NURSING.

MADHUGIRI SRI RAGAVENDRA COLLEGE OF NURSING MADHUGIRI, TUMKUR. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA. PERFORMA FOR REGISTRATION OF SUBJECTS \FOR DISSERTATION.

C.MERCY MARY, NAME OF THE 1 CANDIDATE AND M.Sc Nursing 1st year, ADDRESS Madhugiri Sri Ragavendra college of Nursing, Shankar Mutt Road, Ragavendra extension, Madhugiri, Tumkur, dist, Karnataka.

NAME OF THE Madhugiri Sri Ragavendra college of 2 INSTITUTION Nursing.

M.Sc Nursing 1st year, Community 3 COURSE OF THE STUDY AND SUBJECT Health Nursing.

4 DATE OF ADMISSION 10 June 2009 TO COURSE

A Study to “assess the knowledge on depression among geriatric residents of 5 Sree Ramakrishna Ashram, Pavagada, TITLE OF THE TOPIC Tumkur dist, in a view to develop an instructional module”

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The test of any civilization is the measure of consideration and care which it gives to its weaker members” - K. Park.

Ageing is a natural process that influences the individual, family and society in different ways. In old age, people seem to be depressed because of a variety of causes. They often find themselves deprived of the company of family members. The number of the elderly people is increasing in almost country. In last three decades, the elderly population has grown twice as fast as the rest of the population1.In India 3.8% of the population accounts for people above 65 years of age. It is expected that by 2030 elderly population will account for 21.8% of the total population2.

Depression is a complex syndrome that manifests in a variety of ways by the older ways by the older people showing that they are unhappy and disappointed. The process of ageing also tends to create psychological and social problems for the individual and for the society. The degree of adaptation to the fact of ageing is crucial to one’s happiness. The ageing individual’s adaptive coping strategies maybe seriously challenged by major stresses such as financial problems, physical illness, change in body functioning increasing awareness of disappearing death and numerous losses the individuals experience during the period of life2.

The life expectancy of the human is increased in both developed and developing countries due to advancement and improvement latest technology in medical field. About 13% national population is over age 65 although the elderly suffers from medical illness; there is a greater contribution to the mental health problems, especially the priority go to the depression. Depression is pervasive and can diminish the spark of life. Depression is a serious disorder that involves sadness, lack of interest and symptoms such as hopelessness and decreased energy for at last two weeks3.

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Ageing is a natural process. It as an incurable disease, but we can protect it promote it, extend it4. Reduce the depression by the way of built a trust relationship and listen or accept when he expresses5. Old age populations suffer both physical as well as mental changes in family structure and role, economic dependency all contributes to the mental health programs and physical health problems, among all those depression tend to be increasing in trend6.

The number of the elderly people is increasing in almost every country. In last three decades, the elderly population has grown twice as fast as the rest of the population it is not surprising that the societal attitude continually nurtures the feelings of low self dash esteem, helplessness and hopelessness that become more pervasive and intense with advanced age. The aging process typical experience increases isolation from family ties, personal and social relationship, and often suffers psychological effects from abrupt retirement at a fixed age2.

6.1. NEED FOR THE STUDY

Depression in the elderly is a common problem, only a small percentage gets the help they need. There are many reasons depression in order adults is so often overlooked. Elderly adults are often isolated, with few around to notice their distress, physicians are more likely to ignore depression in order patients, and 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 is important to watch for the warning signs and seek professional help7.

In an analysis of studies worldwide, the average prevalence was 13.3% for all depressive symptoms (major and milder depression) with rate of major depression average 18% many elderly and their families don’t recognize the symptoms of depression. Commonly mistaking them for a physical disorder. Clinical depression can be trigged by long term illness that is commonly in later life such as heart diseases, diabetes, chronic lung disease and arthritis. Depression found to occur at high rates in the old age homes and nursing homes with prolong illness depression unfortunately usually goes undetected and untreated3. 4 Hence the need to conduct a study on health motivation of elderly male and female individuals and to find its relationship with self related health status and health behaviour of elderly. It would provide basis for structuring health promotion and disease prevention programme for health elderly, prevention of deterioration of health in sick elderly and make aged people productive, happy and healthy in our society. The objective of geriatric care is to “add life to years” and not just years of life that is to reduce disability and improve the quality of life8.

Elderly suffering from acute or chronic illness showed higher prevalence of depression, 61.5% geriatric patients with depression or more likely to have somatic complaints. Significant number of depressive syndromes may represent individuals with dementia. According to Venkoba Rao (1996) depression was became a public health problem. In an ICMR survey conducted in 1984-1985 of elderly persons over 60 years of age attending geriatric training in rural India. Psychiatric problem was founded to be 85 percentage about 6 % the population meets the criteria for major depressive disorders7.

The need for this study is to determine the depressive feelings of the elderly clients as measures by a structural questionnaire, and to find out the most significant depressive feeling among elderly, so that future intervention could be planned or recommended to improve the quality of life of the elderly population2.

6:2. REVIEW OF LITERATURE

6:2.1 A study was conducted on prevalence of undetected cognitive impairment and depression in residents of an elderly care home. A sample size of 167 people over 60 years of age living in a state run residential home in Malaysia selected through interview method validated assessment tools wear used to measure dependency, cognitive impairment the result of the study shows that the prevalence of depression is 67% with more depression in males and in the Indian population. The study was concluded with none of the identified cases had been investigated or treated for depression9.

5 6:2.2 A study focussed on residential status and depression among Korean elderly people: A comparison between residents of nursing homes and those based in the community. A sample size of 307 elderly living in nursing homes and 166 living in the community were selected by comparative study in Korea. The result of the study shows that a total of 39.3% of the sample in the community elderly showed symptoms of depression, higher than the rate found in the nursing home elderly. The study that concluded with there is a need to provide adequate health related care services for the elderly people in the community10.

6:2.3 A study was conducted on functional status and depressive symptoms among older adults from residential care facilities in the Czech Republic. The objective of this study was examined the relationship between functional status and depressive symptoms A sample size of 308 older adults from the residential care facilities in the Czech Republic were selected through questionnaire method . This study was used base line data from two randomized controlled trails testing the effect of dance and reminiscences the rapies on quality of life in order. Ref resident’s depressive symptoms were measured using the 15 item geriatric depressive scale. The result of the study revealed that suggest factors that may be important in efforts to improve psychological well being in this population11.

6:2.4. A study focussed on prevalence and symptomatology of depression in older people living in institutions in England and Wales. Sample sizes of 2,640 participants aged 65 and above, from five sites across England and Wales were selected through automated geriatric examination for computer – assisted taxonomy system. The result of the study shows that the prevalence of depression in those living institution was 27.1% compare to 9.3% in those living in home. The study was concluded with depressive symptoms might improve quality of life for people in institution12.

6:2.5. A study was conducted to collect information about the treatment of depression among older persons living in low-level residential care. The participants comprised 300 elderly residential care facilities from various suburbs in metropolitan Melbourne were selected through structured clinical interview method. The result of the study shows that the low treatment for currently depressed residents with less than half of those in the sample who were depressed receiving treatment. The study that concluded with there is high numbers receiving anti depressants who are not currently depressed13. 6 6:2.6. A study was conducted to determine the self care strategies and risk factors for depressive symptoms among residents of public elder care homes in Taiwan. A cross sectional design was used. Two of 18 public elder care homes were chosen by random sampling throughout Taiwan. Result of the study shows that nearly half of the participants were identified by the geriatric depression. The study was concluded with older persons tended to engage in activities and to interact with others to manage their depressive symptoms14.

6:2.7. An article focussed on motivation and depression in later life. The purpose of this research was specifically to study the relationships between the existences of four types of motivation. A sample size of 40 persons aged 60 or over who live in nursing homes was selected through questionnaire method. The result supported the hypothesis that motivational styles are related to important aspects of the life of elderly people. The study was concluded with high interest in research on aging and especially on the determinants of well-being in the elders15.

6:2.8. A study was conducted on losing faith and using faith: older African American discussed spirituality, religious activities and depression. A sample size of 47 older African, American primary care patients recruited from primary care practices in the Baltimore M.D Area were selected through interview method nearly 60 minutes. The result shows that the participants on these study held a faith based explanatory model of depression. The study was concluded that addressing spirituality in the clinical encounter may lead to improved detection of depression and treatment with patient’s beliefs and values16.

6:2.9 A study was conducted to determine the prevalence of depression in elderly living in the shelter “Christ the redeemer”, in Magdalena the sample size of 55 elderly who answered the 30 questions of the scale of geriatric depression of Yeavage were selected through descriptive study with individuals aged 60 years or more. The result of the study shows that depression was identified in 25 individuals, 18 males and 10 females. The study was concluded with recommended the creation of new scale, simpler and easier to understand for patients with lower cognitive level17.

7 6:2.10 A study focused on depression in older nursing homes residents. A sample size of 65 older nursing homes residents were selected through interview method. The result shows that about half of all interviewers stated that they were either feeling depressed or experiencing negative effects, like loss of independence, feelings of social isolation and loneliness. The study was concluded with depression treatment the interviewers appeared to prefer nursing home programme that reduce their isolation over group or individual psychotheraphy18.

6:2.11. A study focussed on professional carers knowledge and response to depression among their aged- care clients; A sample size of 15 elderly people residing in high level or low level aged care facilities, and three elderly people who were receiving personal care in their home were selected through questionnaire method. The result shows that all participants described their cares in positive terms, they were critical of their knowledge and skills in recognizing depression. The study that concluded with training for personal cares in these areas, and efforts to change organizational culture are recommended19.

6:2.12. A study was conducted about he management of depressed elderly care recipients. A sample size of 15 family members of depressed age care recipients to determine their perceptions of the skills and knowledge of depression of professional careers were selected through interviews method. The result shows that cares are more likely to avoid than engage with their clients about depressive symptomatology and do not communicate their concerns with manager or general practitioners. The study was concluded with the implication of findings for health services planning and staff aere discussed20.

6:2.13. A study was concluded in community older people, its determinants have seldom been investigated in institutional settings. A cross sectional study was conducted in nursing homes and other geriatric facilities. A representative sample of 800 subjects 65 years of age and older living in 19 public and 30 private institutions of Madrid was randomly selected through stratified cluster sampling method the result shows that 669 interviewed residents, 55 % rated their health as good or very good. The study was concluded with chronic conditions functional status, depressive symptoms and socio economic factors were the main determinants of perceived health among Spanish institutionalized elderly persons21. 8 6.3 STATEMENT OF THE PROBLEM

A study to assess the knowledge on depression among geriatric residents of Sree Ramakrishna Ashram ,Pavagada, Tumkur district in a view to develop on instructional module.

6.4 OBJECTIVES OF THE STUDY

 To assess the knowledge on depression among geriatric.

 To find out the association between the knowledge of geriatric on depression with selected demographic variables.

 To develop an instructional module regarding management of depression among geriatric.

6.6 VARIABLES UNDER STUDY

Age, sex, family background, religion, educational status, type of family, source of income ,marital status, spouse(alive or dead), health problem, employment, retirement.

6.7 OPERATIONAL DEFINITIONS

1. ASSESSMENT

9 In this study it is an organized systematic and continuous process of collecting data from an elderly persons regarding depression.

2. KNOWLEDGE

Ii refers to the correct response from the respondent (elderly persons) on geriatric depression as elicited through instructional module.

3. DEPRESSION

It is a state of mood in which the individual is sad, worried, loses interest in life, loses energy, feels helpless, hopeless and worthless, as measured by geriatric depression.

4. GERIATRIC

The branch of medicine covering old age and the disorders arising from it.

5. INSTRUCTIONAL MODULE

It refers to systematically planned teaching programme designed to provide information regarding geriatric depression.

6.8 ASSUMPTIONS

 Old age people may be at risk of developing depression.  Instructional module will be enhance the knowledge regarding depression among geriatrics.

7. MATERIALS AND METHODS

7.1 7.1 SOURCE OF DATA: Data will be collected from geriatrics who are

10 Residing at Sri Ramakrishna Ashram, Pavagada, Tumkur.

o Research approach: Descriptive approach.

o Research design: A descriptive survey design was used.

o Research settings: A study was conducted at Sri Ramakrishna Ashram, Pavagada, Tumkur. o Populations: A population consists of geriatrics those who are residing at Sree Ramakrishna Ashram.

o Sample size: 100 Geriatrics.

o Sample technologies: Simple random sample.

* Sample criteria: (A) Inclusion criteria

 Geriatrics those are willing to participate in the study.  Geriatrics who can understand Kannada and English.

(B) Exclusion criteria

o Geriatrics those are not willing to participate in the study. o Geriatrics those are not able to understand Kannada and English. o Geriatrics with severe pschychiatric problem, hearing and vision problem.

7:2.8 Method Data collection tool : Structured interviewed schedule. Section A- Performa for collecting demographic data. Section B- Interview schedule.

11 7:2.9 Duration of the study: 6 week.

7:2.10 Data analysis and Interpretation 1. Descriptive statistics o Frequency and percentage distribution were used to analyze democratic variables of geriatrics. o Mean and standard Deviation to identify the level of depression.

2. Inferential statistics o Chi-square test for associating level of depression with association with socio demographic variable.

7.3 does the study require any or other interventions to be concluded on patients or Other human or animals?

- No - 7.4 has the ethical clearance been obtained from your institution? Yes, Ethical Clearance will be obtained from, o The institutional authorities, principal and director of Sree Ragavendra College of Nursing, Madhugiri, Tumkur. o The authorities of Sree Ramakrishna Ashram, Pavagada, Tumkur. o The informed concerned from the candidates willing to participate in the study.

8. LIST OF REFRENCE

1. The nursing journal of India, vol 5 may 2007 page no 106.

12 2. The nursing journals of India, vol 10 October 2007 page no 221.

3. Nightingale Nursing Time vol 4, issue 8, November 2008 page no 31.

4. K. Park text book of “preventive and social medicine, 18th edition” page no 434.

5. T.P. Prema K.F. Gracy “principles and practice of psychiatric nursing”, page no 241.

6. Nightingale Nursing Time vol 2 issue 2 may 2006 page no 29.

7. www.wikipedia .com

8. The Nursing Journal of India vol no 1 January 2008 page 5.

9. AI- Jawad M, Rashid AK, ‘prevalence of undetected cognitive impairment and

depression in residents of an elderly care home’, 2007 December; 62(5): 375-9.

10. Chung S; “Residential status and depression among Korean elderly people; a comparison

between residents of nursing home and those based in the community”. 2008

July;16(4):370-7.

11. Vankova H, Holmerova 1, “functional status and depressive symptoms among older adults

from residential care facilities in the Czech Republic”, 2008 may;23(5): 466-71.

12. Mc Dougall FA, Mathews FE, ETAC prevalence and symptomatology of depression in

order people living in institutions in England and Wales”, 2007 September; 36(5): 562-8.

13. Gerge K, Moore K, ETAL “Treatment of depression in low-level residential care facilities

for the elderly”; 2007 December; 19(6): 1153-60.

14. Tasi YF, “self-care management and risk factors for depressive symptoms among

Taiwanese Institutionalized older persons”; 2007 March-April; 56(2): 124-31.

15. Altintas E, Gurriena; ETAL motivational orientation and depressive symptoms in the

elderly”: 2009 march: 24(3): 402-7.

16. Wittink MN, Joo JH; “losing faith and using faith”; “older African Americans discuss

spirituality religious activities, and depression”. 2009 March; 24(3) 402-7.

17. De Vasconcelo SDT, Duarte GC, ETAL “analysis of depression in elderly living in the

shelter”. 2009 January – February; 14(1): 253-9. 13 18. Choi NG, Ransom S,” Depression in older nursing home residents:” 2008 September;

12(5): 536-47.

19. Mellor D, Davidson T, “professional carer’s knowledge and response to depression among

their aged-care clients”; 2008 may; 12(3): 389-99.

20. Mellor D, Davidson T, ETL” the management of the elderly care recipients: family

perspectives on the skills of professional carers. 2008 January- March; 25(1): 44-61.

21. Damian J, Pastor-Barriuso R, “factors associated with self-rated health in order people

living in institution. 2008 February; 8:5.

9. SIGNATURE OF THE CANDIDATE:......

10. REMARK OF GUIDE: 14 11. NAME AND DESIGNATION:

11.1. GUIDE NAME AND ADDRESS:

11.2. SIGNATURE OF THE GUIDE:......

11.3. NAME OF HOD:......

11.4. SIGNATURE OF HOD:

12. REMARK OF PRINCIPAL:

12.1 SIGNATURE OF PRINCIPAL:......

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