Rajiv Gandhi University of Health Science s1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

NAME OF THE Mr. NAGAVARMA P. CANDIDATE AND 1 I YEAR M Sc NURSING ADDRESS [IN BLOCK LETTERS] BGS COLLEGE OF NURSING,

KUVEMPUNAGAR,

MYSORE.

NAME OF THE BGS COLLEGE OF NURSING INSTITUTION KUVEMPUNAGAR,MYSORE 2.

COURSE OF THE STUDY, DEGREE IN MASTER OF NURSING

3. SUBJECT MENTAL HEALTH NURSING

4. DATE OF ADMISSION TO 29-7-2011 COURSE

5. Title of the Topic

“A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING ALZHEIMER’S DEMENTIA AMONG YOUNG ADULTS RESIDING IN SELECTED AREAS AT MYSORE.” 6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION:

“People don’t grow old; when they stop growing they become old”

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 Life was unnecessarily too long. The senior citizen is something of a social enigma .Ageing is a universal phenomenon, which is experienced by every human being across various cultures.1 The increase in the elderly population may pose tremendous problems in the days to come if proper measures are not taken.

Aging has been defined as a progressive decline in the physiological capacity leading to a decreased ability to adopt to stressors, or loss of adaptability of an individual organism over time .The term’ Elderly’ has been defined in many dimensions . Biologically ,the process of aging begins as early as puberty and is a continuous process through adult life .Socially, the characteristics of members of the society perceived as being old vary with the cultural setting ,and from generation to generation. Economically, especially in rural areas, the elderly are simply seen as being those who are too old to work and earn. Chronologically, numeric age has been traditionally used in defining the term ‘elderly’. Even though a single cut-off age which would define the elderly would vary between country and religion considering the biological, sociological and economical difference in their population, the United Nation in 1980 defined 60 years as the age of transition of people to the elderly segment of the population.2

Old age is a time of losses. It is the stage of life when an individual gradually or suddenly loses his physical vigour, physiological resources of body functions, occupation, friends, and spouse and may be independence. These life events keep on occurring continuously in the life of an old person. If and when theses stresses become too severe or too numerous they may affect the physical and or psychic equilibrium producing maladaptive patterns of adjustment including physical and mental disorders.3 The health problems of aged people are usually multiple which are compounded by underreporting and apathetic attitude of the relatives towards health problems of the elderly. Any system of the body can be affected by any disease in an aged person due to changes in the physical and chemical barriers of the body. Like changes in immune system, malnutrition, multiple drug abuse, psychological stress a callous attitude towards one’s own health.1

Neurodegeneration is the umbrella term for the progressive loss of structure or function of neurons, including death of neurons. Many neurodegenerative diseases including Parkinson’s, Alzheimer’s, and Huntington’s occur as a result of neurodegenerative processes. As research progresses, many similarities appear which relate these diseases to one another on a sub-cellular level. Discovering these similarities offers hope for therapeutic advances that could ameliorate many diseases simultaneously. There are many parallels between different neurodegenerative disorders including atypical protein assemblies as well as induced cell death. The most common causes of dementia in individuals older than 65 years of age are: Alzheimer’s disease.4

Alzheimer's disease (AD), the most frequent cause of neurodegenerative dementia in the elderly, is characterized by progressive cognitive decline and by its unique pathology. In 1907, Alois Alzheimer was the first to report a case of intellectual deterioration with the histological findings of senile plaques and

5 neurofibrillary tangles .

In Alzheimer’s disease, as in other types of dementia, increasing numbers of nerve cells deteriorate and die. A healthy adult brain has 100 billion nerve cells, with long branching extensions connected at 100 trillion points called synapses. At these connections, information flows in tiny chemical pulses released by one neuron and taken up by the receiving cell. Different strengths and patterns of signals move constantly through the brain’s circuits, creating the cellular basis of memories, thoughts and skills In Alzheimer’s disease, information transfer at the synapses begins to fail, the number of synapses declines and eventually cells die. Brains with advanced Alzheimer’s show dramatic shrinkage from cell loss and widespread debris from dead and dying neurons.6 Dementia is not being "out of one's mind." Dementia is the slow deterioration of mental capacities that is a direct result of a disease process in the brain. The first symptom of dementia, typically, is memory loss. Memory loss is frequently first noticed, not by the patient, but rather those close to him or her. Misplacing items, forgetting names and dates, and getting lost in familiar places are all signs of memory loss. This memory loss may also emerge as deterioration in an individual's ability to perform a familiar task, such as forgetting how to tie one's shoes or difficulties with conversation, such as forgetting words or repeating sentences. When these symptoms increase in frequency, considered a change in behaviour, dementia should be suspected.7

The most common cause of dementia is Alzheimer’s disease (AD). Symptoms include memory problems, a progressive deterioration in the ability to perform basic activities of daily living(ADL), and behaviour changes, mainly apathy and social withdrawal, but also behavioural disturbances. Alzheimer’s disease causes abnormal function and eventual death of selected nerve cells in the brain. The average survival period for patients following diagnosis eight to 10 years.8

6.1 NEED FOR THE STUDY

Demographic aging is a global phenomenon. It has picked up momentum in low income countries of Asia, Latin America and Africa. India’s population is undergoing a rapid demographic transition. Soon, there will be a sharp increase in the number of older people in our population. It is important to note that this rapid demographic change is happening along with fast paced social restructuring accompanied by economic development. Regions with more favourable health indicators seem to be ageing faster.9

India was home to more than 75 million people older than sixty years in2001. This age group, which was 7.5% of the population, is expected to grow dramatically in the coming decades. Analysis of the census data shows marked variations in the rate of demographic aging within India ranging from10.5% in Kerala to 4% in Dadra and Nagar Haveli. Other regions with elderly population above 8% include Himachal Pradesh (9%), Punjab(9%),Maharashtra(8.7%) , Tamil Nadu (8.8%), Orissa (8.3%), Goa (8.3%), and Pondicherry (8.3%). The demand for services will soon be evident in such places and will make the task of meeting the needs for the older people more challenging and urgent.9

According to the world health organization, India’s population of those aged over 65, which was 40 million in 1997.This is expected to increase to 108 million by 2025. This means a several-fold increase in age- related problems such as Dementia- a condition characterized by progressively declining memory and intellectual functions. The WHO, which estimates that two out of every three patients with dementia will soon be developing countries, appear to be a virtual dementia epidemic in India and the urgent need to prepare to face it.10

The elderly population is on the rise and will soon be of considerable size of the total population. Senior citizens should therefore exert their rights for their due place in the society. The elderly population in India which was 7.7 crore, as per Census 2001, is projected to be around 9.5 crore in 2011. It is projected to further go up to 17.3 crore in 2026. Rise in the share of elderly in total population poses multiple challenges. These challenges, however, also come with great opportunities, like for the younger generation, who can utilize the vast repository of knowledge that our elderly possess. Simultaneously, our senior citizens too have to think of ways to creatively and usefully occupy themselves.11

There is a growing realization that the care of older people with disabilities makes enormous demands on their care givers. Terms like dementia and Alzheimer’s disease are now better understood. However, this was not the case when the Alzheimer’s and Related Disorders Society of India initiated awareness programmes in 1992. Dementia remains a largely hidden problem in India, especially in those parts of India where poverty and illiteracy levels are high.9

In India life expectancy at birth has increased from 42yrs since independence to 65yrs at present and it is higher for women than men. Increasing life span of population worldwide has been accompanied by an increasing prevalence of age related disease such as Dementia and the number of people with dementia is predicted to exceed 80 million by 2040.12 The burden of disease is shared and reduces by increasing the awareness in of the disease. The disease of old age indeed constitute a major challenge for contemporary biomedical research.12

Providing appropriate help from medical and social welfare services may be hindered of people with dementia and their relatives are unaware of the help available, or if they perceive it as inappropriate for them. This lack of awareness hinders the analysis of prevalence of dementia research, well disseminated, can play an important role in increasing awareness at all level of society. Poor awareness is a key public health problem which has important consequences for the care giver and other member of the family. The burden of care on family remains to be a matter of concern along with the patient of dementia to understand the progression of the disease and its incidence, apart from strategies for caregivers.9

An individual can lead a normal happy life only if he has a sound intellectual capacity with a good memory. Any impairment to his/her memory will have a direct destructive effect on the quality of his living standards, thus this condition has been chosen for the present study.

6.2 REVIEW OF LITERATURE

A study was conducted to examine the knowledge about Alzheimer’s disease among 794 people by using knowledge questionnaire. The study result showed that the Knowledge about Alzheimer’s disease was lower for dementia care givers, older adults, senior centre staff and undergraduate students. Across groups, respondents don’t know about risk factors and prevention of Alzheimer’s disease. The study concluded that the awareness program is necessary to the public about Alzheimer’s disease.13

A cross sectional study was conducted in Sao Paulo, whichgnette to investigate the public’s attitude towards help seeking and preferences for treatment of Alzheimer’s disease. Data was collected from 500 household residents over 18 years old by face-to-face interviews depicting AD and a structured questionnaire. The study result showed that public opinion rests firmly in the lay support system, Many alternative treatments (such as vitamins, physical exercise, vacation) were often rated as helpful. The study concludes that the attitudes and belief systems have an important impact on help-seeking and treatment recommendations.14

A cross sectional study was conducted to investigate public stigma (stereotype, prejudice, discrimination) relating to Alzheimer’s disease. The data was collected by interview from 500 people aged between 18-65yrs living within the community. The study results showed that the 41.6% of the participants expressed stereotype; 43.4% prejudice, and 35.5% discrimination. The study concluded that dimension of stigma were highly prevalent in relation to Alzheimer’s disease and more interventions are needed to reduce effect of stigma.15

A cross sectional study was conducted to investigate the recognition of dementia and beliefs regarding prognosis, cause and risk reduction in the Australian public. Data was collected from 2,000 adults by telephone interview. The study results showed that 82% of the samples identified “dementia” or Alzheimer’s from a vignette and there were no differences in recognition rates between describing mild or moderate dementia symptoms. The study concludes that public awareness campaigns need to increase accurate knowledge of factors consistently found to be associated with dementia.16

A study was conducted to assess the racial differences in knowledge and attitudes about Alzheimer’s dementia among adults .Data collected from 1176 adults aged 35 years and over (48.6% White, 25.7%Black, and 25.8% Hispanic) obtained through telephone interview. The result showed that Compared with White and Black respondents, Hispanics were more likely to report feeling well-prepared for handling a diagnosis of Alzheimer’s disease in a family member. The study concluded that misconceptions about Alzheimer’s dementia remain among large segments of the population and continued efforts are needed to educate the public about this disease.17

A study was conducted to assess relationships between knowledge about symptoms of Alzheimer's disease and help seeking intention among the lay public. Data was collected from 150 persons aged over 45, who did not have a close relative diagnosed with Alzheimer’s disease. Knowledge about 11 warning signs of Alzheimer's disease as described in the information provided by the Alzheimer's Association, and four non- Alzheimer's disease symptoms was assessed, together with intentions to seek help from professional and non-professional sources. The result showed that higher knowledge about Alzheimer's disease symptoms was associated with increased intentions to seek help from professional sources. The result concludes that, Efforts to increase knowledge about Alzheimer's disease symptoms should be expanded, with special attention to risk groups. 18

A study was conduct to investigate the incidence of Alzheimer’s dementia among US population. The data was collected from 150 persons at least 90 years old in 2003. The study result showed that the incident rate of dementia increased exponentially, from 12.7% per year for 90 to 94 year olds, to 21.2% per year for 95 to 99 year olds, to 40.7%per year for persons aged 100 years and older.19

A study was conducted to assess the Knowledge of Alzheimer's Disease among Patients, Carers, and Non carer Adults. The data was collected by using a modified version of the Alzheimer's disease Knowledge questionnaire from 13 carers, 20 non carer older adults, and 10 people with Alzheimer’s dementia. The result showed that the knowledge about Alzheimer’s disease was lower for patients and non carers’ adults’.20

A study conducted to estimate the Prevalence of Alzheimer's type dementia in an elderly Arab population. The data was collected from 821 persons (362 males) (459 females) aged 60 years or older by using a semi structured questionnaire. The results showed that the prevalence increased steeply with age, from 8% among those younger than 70 years to 33% among those aged 70–79 and 51%among those 80 years or older. The study concluded that Alzheimer’s dementia was more prevalent among females than males.21

In Israel a study was conducted to determine Social distance against towards a persons with Alzheimer's disease. The data was collected from 206 adults (mean age =59.7) by face to face interview. The results showed that pro social feelings were found to decrease the behavioral discrimination against the person with Alzheimer’s disease, whereas feelings of rejection increased the discrimination. The study concluded that the government should take initiatives to provide the lay public with accurate knowledge about the disease, its symptoms, and treatments.22

An epidemiological study was conducted in pune on dementia under the aegis of mental health program. The data was collected from 2145 people over 65yrs by door to door survey. The study result shows that the prevalence of dementia was 4.1%. The study concludes that poor awareness is a key public-health problem. The withdrawal of the elderly from the previous societal role, reduction in all types of interaction that is shift of attention from outer world to the inner world, reduction in the power and prestige of the elderly enhance aging process.12

A survey was conducted in Germany to assess the knowledge and attitudes towards Alzheimer’s dementia in general population. The data was collected from 1245 people between 14 and 99 years. The result shows that Only 13%mentioned memory disturbances, e.g. forgetfulness, as hallmarks of Alzheimer’s dementia; 54% knew that age was a major risk factor; In case of developing Alzheimer’s dementia, more than 70% wished to be informed together with a close relative or friend; 7% felt that nobody else should know about their problem; and many more than 50% expected information on treatment, course, symptoms and causes. The study concludes that there is a remarkable lack of relevant information on Alzheimer’s Dementia in the general population, and that most individuals wished to be informed about a potential diagnosis of Alzheimer’s dementia together with their family and friends.23

6.3 PROBLEM STATEMENT A study to assess the effectiveness of self instructional module on knowledge regarding Alzheimer’s dementia among young adults residing in selected areas at Mysore.

6.4 OBJECTIVES 1) To assess the pre test level of knowledge regarding Alzheimer’s dementia among young adults.

2) To assess the post test level of knowledge regarding Alzheimer’s dementia among young adults.

3) To assess the effectiveness of self instructional module on knowledge regarding Alzheimer’s dementia among young adults.

4) To associate the level of knowledge regarding Alzheimer’s dementia among young adults with their selected demographic variables

6.5 OPERATIONAL DEFINITIONS

1) Assess: Assessment refers to the process of documenting the knowledge on Alzheimer’s dementia among young adults.

2) Effectiveness: It refers to determining the extent to which the Self Instructional Module had achieved the desired effect in terms of gain in post test knowledge score regarding Alzheimer’s dementia among young adults.

3) Knowledge: It refers to young adult’s awareness regarding Alzheimer’s dementia as measured by scores obtained according to the response to the items on the structured questionnaire.

4) Self instructional module: It refers to the self contained written material prepared by investigator to promote self learning in young adults regarding Alzheimer’s dementia.

5) Young adults: In this study young adults refers to both males and females within the age group of 19-40 years.

6) Alzheimer’s dementia: Alzheimer’s type of dementia is an irreversible disease marked by global, progressive impairment of cognitive functioning, memory and personality. 6.6 CONCEPTUAL FRAMEWORK:

In this study, Pender’s Health promotion model theory will be used as a conceptual frame work.

6.7 HYPOTHESIS:

At the level of point 0.05 level of significance

 There will be significant difference between mean pre test & mean post test knowledge score regarding Alzheimer’s dementia among young adults

 There will be a significant association between pre test level of knowledge scores regarding Alzheimer’s dementia among adults with selected demographic variables.

6.8 ASSUMPTIONS:

The researcher assumes that

 Young adults may not have adequate awareness about Alzheimer’s dementia.

 The young adults may willingly participate in the study.

 Self Instructional Module may positive influence the knowledge regarding Alzheimer’s dementia among young adults

6.9 DELIMITATION:

 The study is limited to young adults residing in the selected areas at Mysore.

 The study is limited to young adults age group of 19-40yrs.

7 MATERIALS AND METHODS

7.1 source of data:

Data will be collected from Young adults in selected areas at Mysore. 7.1.1 Research design:

Pre experimental (One group pre and post-test design)

Pre-test Intervention Post- test

O1 X O2

O1- Administration of structured knowledge questionnaire to the young adults.

X –Administration of self instructional module.

O2-Administration of structured knowledge questionnaire after7 days of administration of self instructional module

7.1.2 Research approach

In this study educative and evaluative approach will be used.

7.1.3 Research Variables:

 Dependent variable: In this study dependent variable is knowledge on Alzheimer’s dementia.

 Independent variable: In this study independent variable is Self instructional module.

7.1.4 Setting: Setting consists of selected areas at Mysore.

7.1.5 Population:

Young adults residing in Mysore.

7.2 METHODS OF DATA COLLECTION

Data will be collected from Young adults in selected areas at Mysore.

7.2.1 Sampling technique:

Non probability convenient sampling technique.

7.2.2 Sampling size:

In the study sample size is 50

7.2.3 Inclusion criteria:

 Young adults within the age group of 19-40 years.

 Young adults who are available during the data collection period.

 Young adults who are willing to participate in the study.

7.2.4 Exclusion criteria:

 Young adults who are not able to read kannada.

 Young adults who are physically challenged.

 Young adults who are working in health sectors.

7.2.5 Instruments used:

Tool for data collection:

Tool 1-Part A: Proforma for collecting demographic data such as age, education, family background.

Part B: Structured knowledge questionnaire regarding Alzheimer’s dementia.

7.2.6 Data collection method:

Data will be collected by interview method using structured knowledge questionnaire regarding Alzheimer’s dementia and demographic Proforma.

7.2.7 Plan for data analysis:

In this study pre and post test scores of knowledge will be analyzed through the following technique.

Descriptive statistics: Mean, standard deviation, range and mean score percentage will be used to measure the level of knowledge before and after self instructional module.

Inferential statistics: Paired ‘t’ test will be used to examine the effectiveness of self instructional module by comparing the pre test and post test score.

Chi-square test will be worked out to determine the association of socio-demographic factors of people with pre test knowledge.

7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals, if so please describe briefly?

Yes, the investigator is giving self instructional module to young adults.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, the ethical clearance has been obtained from our college that is BGS College of nursing consent will be obtained from particular subjects. 8. BIBLIOGRAPHY

1. Sukkran. Old age problems. 2011. Available from:URL: http://www.squidoo.com/old-age-problems.

2. Aravind kasthuri.Travails of a graying nation. june 2007

3. Niruj Agrawal,Jhingan HP. Life events and depression in elderly. Indian Journal of Psychiatry 2002; 44(1): 34-40.

4. Rubinsztein DC. The roles of intracellular protein-degradation pathways in neurodegeneration2006oct;443 (7113):780–6. Available from:URL:n.wikipedia.org/wiki/Neurodegeneration.

5. RoyYaari, JodyCorey-Bloom. Alzheimer's Disease Seminars in Neurology [Cited2011Dec6];27(1):32-41. Availablefrom:URL: http://www.medscape.com/viewarticle/5532566

6. Alzheimer’s Association. Alzheimer’s Disease Facts and Figures2009:5(3):7-9.

7. Nathan E, Lavid M D.Neuro science Applied to clinical and forensic psychiatry.2002-2011;Availablefrom:URL: http://www.nathanlavidmd.com/psychiatric_descriptions/dementia.html

8. Leishman W. Organic Psychiatry: The Psychological Consequences of Cerebral Disorder. 2nd ed. Oxford: Blackwell Science 1987.

9. Shaji.ks,Jotheeswaran AJ, Girish egis of mental N, Srikala bharath, Amit dia. Meerapattabiraman. The Dementia India Report. The report prepared for the Alzheimer’s and related disorder society of india. New Delhi; 2010

10. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglon IL, Ganguli M, et al. Global prevalence of dementia; A Delhi consensus study. Lancet 11. Nagashwar k, Srilaxmi. Old age population on the rise 2011 Available from:URL:http://indiacurrentaffairs.org/old-age-population-on-the-rise/

12. Saldanha D, Maj Raghunandan mani, Srivasthav kalpana, Goyal sunil, Bhattacharya D. An epidemiological study of dementia under the aegis of mental health program. Maharashtra. Pune chapter. Indian journal of psychiatry 2010 P 131-132.

13. Carpenter BD, Zoller SM, Balsis S, Otilingam PG, Gatz M Demographic and contextual factors related to knowledge about Alzheimer's disease.Am J Alzheimers Dis Other Demen. 2011 Mar;26(2)15

14. Blay SL, Furtado A, Peluso ET .Knowledge and beliefs about help-seekin behaviour and helpfulness of interventions for Alzheimer's disease. 2008 Sep;12(5):577-86.

15. Blay SL, Toledo Pisa Peluso E. Public stigma: the community's tolerance of Alzheimer disease.Am J Geriatr Psychiatry. 2010 Feb;18(2):163-71.

16. .Low LF, Anstey KJ. Dementia literacy: recognition and beliefs on dementia of the Australian public. 2009 Jan;5(1):43-9.

17. Connell CM, Scott Roberts J, McLaughlin SJ. Public opinion about Alzheimer disease among blacks, hispanics, and whites: results from a national survey. 2007Jul- Sep;21(3):232-40

18. Werner P. Knowledge about symptoms of Alzheimer's disease: correlates and relationship to help-seeking behaviour. 2003 Nov;18(11):1029-36.

19. Lynda A. Anderson, Kristine L. Day, Renée L. Beard, Peter S. Reed, Bei Wu. The Public's Perceptions about Cognitive Health and Alzheimer's disease Among the U.S. Population:ANational Review. Available from : URL: http://gerontologist.oxfordjournals.org/content/49/S1/S3.short

20. Sullivan, Karen A. Muscat, Tracey M & Mulgrew, Kate E. Knowledge of Alzheimer's disease amongst patients, carers, and non-carer adults: Misconceptions, knowledge gaps, and correct beliefs. Topics in Geriatric Rehabilitation,2007; 23(2): 148-159. 21. Bowirrat A, Treven, Friedland Prevalence of Alzheimer’s type dementia in an elderly arab population. European journal of neurology 2001 8(2):119-123

22. Werner P. Social distance towards a person with Alzheimer's disease. 2005 Feb;20(2):182-8.

23. Schwalen S, Förstl H. Alzheimer's disease knowledge and attitudes in a representative survey. 2008;22(1):35-7.

9 Signature of the candidate 10 Remarks of the guide Study is recommended since it create awareness among adults about Alzheimer’s Dementia and it may help them to recognise their role in care of elderly with the same 11 Name and designation of (in block letters) 11.1 Guide Mr. BALACHANDAR S. ASST PROFESSOR BGS COLLEGE OF NURSING, MYSORE. 11.2 Signature

11.3 Co-guide(if any)

11.4 Signature

12 12.1 Head of the department Mr. BALACHANDRAN S. HOD MENTAL HEALTH NURSING BGS COLLEGE OF NURSING, MYSORE

12.2 Signature

13 13.1 Remarks of the chairman and Principal

13.2 Signature