Rajiv Gandhi University of Health Sciences s140

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Ms. DHANYA GEORGE

First year M.Sc Nursing

Mental Health nursing

Year 2008-2009.

PADMASHREE INSTITUTE OF NURSING

NAGARABHAVI CIRCLE,

BANGALORE – 560072. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE Ms. DHANYA GEORGE CANDIDATE AND ADDRESS First year M.Sc Nursing,

Padmashree Institute of Nursing,

Nagarabhavi circle,

Bangalore- 560072.

2. NAME OF THE Padmashree Institute of Nursing, INSTITUTION Nagarabhavi circle,

Bangalore 560072

3. COURSE OF THE STUDY M.Sc (Nursing), AND SUBJECT Mental health nursing

4. DATE OF ADMISSION TO 30-06-2008 THE COURSE

5. TITLE OF THE STUDY Assessment of knowledge and attitude of family members regarding care of senior citizen.

2 6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Years wrinkle the skin, but

3 Worry, doubt, fear, anxiety

And self distress wrinkles the soul.”

The elderly are the setting sun who retreats in to the night after giving light and life during the day time. However no one knows when old age comes, it is said that nobody grows old merely living a certain number of years. Our knowledge about the aging process is incomplete. We don’t know how much about the disabilities incident to the aging process. Though the physical psychological needs of elderly do vary from those of the younger ones, dissatisfaction of the basic needs creates tension and frustration. They require sympathy acceptance and a spirit of tolerance from their dear ones.1

According to Mrs. Seneca,“old age is an incurable disease”. The appealing words by Sir. James Sterling Ross about old age is “you do not heal old age, you protect it, you promote it, you extent it”. Although we cannot eliminate all the problems of the aged, we can alleviate most of them through adequate care and concern. Maintaining autonomy should be the basic objective of care of elderly (WHO).2

In the year of 2002, there where an estimated 605 million old persons in the world of which 400 million are living in low income countries. By 2025, the number of elderly people is expected to rise more than 1.2 billion with about 840 million of these in low income countries. In India although the percentage of aged is low in comparison to the developed countries nevertheless, the absolute size of aged population is considerable, that is 11.9%. 3

Old age is a phase of life cycle characterized by its own developmental issues, many of which are concerned with loss of physical agility, mental acuity, friends, loved ones, status, and power. At the same time, old age is associated with the accumulation of wisdom and opportunity to pass that one to future generations. One of the task that informs Erik Eriksson’s view of healthy old age as a time of integrity and not a time of

4 despire. In contrast to this group of well old, these are the sick old persons with mental or physical disorders or both that impair their ability to function or even survive.4

Discoveries in medical sciences and improved social conditions during past few decades have increased the life span of man. The age structure of the population in the developed countries has so evolved that the number of old people is continually on the increase. These trends are appearing in all the countries. Where medical and social services are well developed and the standard of living is high.4

Most of the old age won’t be having any saving for their rainy days they are condemned to lead last year of life in privation and misery. They need love, emotional support, and care from their miserable plight. Care giving may be one of the most important roles that one will undertake in one’s lifetime. Typically it is not an easy role nor is it one for which most of us is prepared. As the family members are the primary caregivers for their elderly they should have adequate knowledge in identification of their problems and the best ways of solving it. 5

A person who provides support to an older adult, whether an emotional support, physical assistance, or financial assistance can become a care giver of him. A care giver may be providing many hours of direct care each week or perhaps providing mainly financial help because of distance. No matter what the care, there are some rules on the road. 6

6.2 NEED FOR THE STUDY

The most common mental health problems in older persons are depression, anxiety disorder and dementia. Mental health problems in elderly can be especially complex because of the complex coexisting medical problems and treatment. Many symptoms of

5 somatic disorder mask the psychiatric disorders such as fatigue may be related to anemia but it also may be symptomatic of depression.7

However older individuals are more likely to report somatic symptoms rather than psychological ones making identification of a mental disorder even more difficult. At least 30% of older people in acute hospitals and 40% of those in care homes meet the clinical criteria for depression. Overall, up to 60% of older people in acute hospitals experience mental health problems in some form. If tendencies continue, it is estimated that within the next 15 years, one in every 15 of the population will be an older person experiencing mental health problems.7

The United Nation defines a country as aging when the proportion of people over 60 years reaches 7%. India exceeded that rate of proportion with 7.8% in 2001 and India comes under the purview of United Nation definition of “aging country”.8

A descriptive study conducted on administration on aging reveals that the older population continues to experience greater health problems and use more of the health care budget than other age groups. The hospitalization rates for the older adults and their average doctor’s visits are more than three times when comparing rates with younger age groups. A few hospital based studies have been made in India on the health status of the aged person, but such studies provide a partial view of the spectrum of illness in the aged. The overall data on the aged are scarce. The major problems of the elderly person which leads them to the geriatric clinics are visual problem, locomotive disorder, neurological complaints, gastrointestinal impairment and psychological problem, when viewed on a hierarchy bases. National academy on aging society in 2000 reports that 89% of the older adults have any one of the chronic medical condition and most of suffer from more than one in fact. 9

Caring of the elderly has become one of the important matters for discussion of today. For most of the person at the end of the life family members are the care givers,

6 who play a vital role in their life. They may do everything from assisting with the activities of daily living. Furthermore the family care giver often is the person who serves as a go between for the patient and the health care providers. Although the family member may find greater satisfaction in their caring role, they often experience stress and diminished physical health. 10

The attitude of people regarding the care and respects of the elderly is changing from the years to years. Cultural factors influence the attitude towards aging and giving care to older adults with in the family. Changes that have occurred over the past 50 years at times have created cultural barriers that subtly create misunderstanding and tensions between family members and bring up other variables that add to the cultural and generational conflicts in families. Various studies conducted in India and abroad have identified that majority of the elderly people consider home as a place where they can drive greatest emotional satisfaction. 11

To identify the barriers in giving care to the elderly from their own family members are very essential. The barriers may be lack of time, feeling of being unable to carry out her or his developmental task, feeling fatigue and diminished physical health, feeling role conflict, feeling of negative sense towards caring of old age. Most of them don’t want to experience the frustrations and tensions. More over older adults often experience difficulties in a culture that has values differing from their age. Some of these differences include decrease role opportunities because work for the young is valued over the work for the old, and decrease access to the health care because the economical factors many times weigh heavier than the health factor. 12

Elder abuse is one of the topics of serious discussion now a day. It may be physical emotional, financial neglect or sexual abuse. Some studies on the relationship between the elder abuses suggest that long term of abuse nature of the relationship between the care giver and the elderly may be an important factor in predicting instances in mistreatments. A common explanation for distress among elderly couples is the empty

7 nest syndrome; it showcases the stereotypes about their nature of parenthood and child care. The empty nest syndrome brings in depression in the face of their diminishing role in the family. 13

The investigator from her personal experience had seen many geriatric clients suffering from lack of care from their children and other family members. Despite of the socioeconomic status most of family members are unaware about the biological and psychological needs of their elderly. All these led the investigator to assess the knowledge and attitude of the family members to improve their levels.

6.3 STATEMENT OF THE PROBLEM

A study to assess the knowledge and attitude regarding care of senior citizen among their family members in selected urban community, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge regarding care of senior citizen among their family members.

2. To assess the attitude regarding care of senior citizen among their family members. 3. To correlate between knowledge and attitude regarding care of senior citizen among their family members. 4. To associate the knowledge and attitude regarding care of senior citizen among their family members with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

Knowledge

8 It refers to the awareness and understanding of the family members regarding care of senior citizen, in identifying their problems and the solution for their problems.

Attitude

Attitude is the way of thinking and the feeling expressed by the family members regarding care of senior citizen.

Care of senior citizen

Looking after and assisting in meeting the psychological needs of old age above 60 years.

Family members

Family members are refers to son or daughter taking care of the senior citizen aged between 25- 45 years and staying with their senior family member.

6.6 ASSUMPTIONS

1. The family members of senior citizen may have inadequate knowledge regarding care of senior citizen.

2. The family members of senior citizen may have an unfavorable attitude towards care of senior citizen. 3. The level of knowledge and attitude of family members regarding care of senior citizen may vary with selected demographic variables.

6.7 RESEARCH HYPOTHESIS

H1- There is a significant correlation between knowledge and attitude regarding care of senior citizen among their family members

9 H2- There is significant association between knowledge and attitude regarding care of senior citizen among their family members with the selected demographic variables.

6.8 REVIEW OF LITERATURE

The review of literature involves the systematic identification, location, scrutiny and survey of the written material that contain n information on research problem. 14

A descriptive study was conducted to assess the effectiveness of teaching regarding geriatrics and their problems among their family members from 150 participants 54.5% appreciated life experience and wisdom of seniors, 98.4% of family members were gained more knowledge regarding their physical psychological problems and 67.2% of family members reported after training they changed their attitude toward senior population. 15

A descriptive study was conducted to assess the problems and successes of old age care givers. A sample of 73 adult caregivers new to the role was interviewed. The findings provided an in-depth, theory based description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.16

A pilot study was conducted to assess how information and communication technology may contribute to health promotion among elderly spousal. The objective of this study was to explore whether use of information and communication technology by informal carers of frail elderly people living at home would enable them to gain more knowledge about chronic illness, caring and coping, establish an informal support network and reduce stress and related mental health problems. Carers reported more

10 social contacts and increased support and less need for information about chronic illness and caring.17

A study was done to assess the problems associated with care giving. The study concerns a questionnaire for the evaluation of care giving-related problems like the Family Strain Questionnaire. The questionnaire, which is composed by a structured interview and 47 dichotomous items, was administered to 409 caregivers of patients with different kinds of chronic diseases. Factorial analysis shows a structure of 5 factors they are emotional strain, social involvement and knowledge of the disease, family relationships and thoughts about death. The FSQ is sensible in discriminating different groups of caregivers.18

A study was conducted to assess the barriers and facilitators to senior’s independence and the perceptions of seniors, caregivers, and health care providers. They discovered four main themes characterized the barriers and facilitators to seniors' independence they are attitudes and attributes, service accessibility, communication and coordination, and continuity of care.19

An experimental study was conduced to evaluate a group program for spouses of frail elderly veterans. It examined the effectiveness of a multicomponent group program for spouses of frail aging veterans that included support, education, problem solving, and stress reduction. Compared with caregivers who received no intervention, those in the group program showed significant increases in use of active behavioral coping strategies, knowledge of community resources, perceived independence in the marital relationship, and personal changes in the care giving relationship. They also experienced significant decreases in subjective burden and the stress and severity of care giving problems. 20

A qualitative study was conducted to assess the level of participation in the care of elderly among the relatives. Interview data from 18 family members revealed that these

11 caregivers desire assistance from healthcare professionals regarding recommendations for appropriate and routine medical and social support and follow-up care. As the population ages and the incidence of chronic illnesses increases, the perspective of caregivers who make healthcare decisions becomes increasingly important. 21

A hospital based qualitative study was conducted to identify Jordanian family members attitudes towards older people and to consider whether the attitudes of the selected sample had any bearing on the care provided for this client group. 250 family members of older people enrolled in the study they displayed marginally positive attitudes toward older people. Adults and male had more positive attitudes toward this client group than their counterparts. The results of this study suggest that positive attitudes exist towards older people; despite this, it is clear that efforts are required to enhance them further. 22

A descriptive study was conducted to assess the caregiver competence to prevent the health problems in older adults. Interview data from the perspectives of 17 informants yielded a total of 68 clinical situations that allowed exploration of the scope and dimensions of caregiver competence to prevent health problems in old age. The factors most influential for effective caregiver prevention of illness were family support, an acceptance and ability to make role changes, teaching and role modeling from professionals, and long-standing values and family traditions. No single factor was sufficient to achieve effective care giving preventing illness, but the strength of one or two factors could compensate for the absence of others.23

A qualitative study was conducted to assess the knowledge used by caregivers when caring for older adults with chronic illnesses. Five focus groups were conducted with a total of 23 caregivers from both small and large families. Two categories of knowledge

12 were described, behavior-centered knowledge and person-centered knowledge. Behavior-centered knowledge focuses on strategies needed to manage behaviors, whereas person-centered knowledge focuses on the needs of the person exhibiting the behavior. Recommendations about the role of gerontological nurses and the training of caregivers in assisted living facilities are provided.24

7. MATERIAL AND METHOD

7.1 SOURCE OF DATA

The data will be collected from the family members aged 25-45 years of senior citizen residing in selected urban community, Bangalore.

7.2 METHOD OF DATA COLLECTION

i Research design

Non experimental descriptive correlational design

ii. Variables

Study variable Knowledge and attitude regarding care of senior citizen among their family members.

Extraneous variable It consists of demographic variable of family member of senior citizen, such as age, sex, education, occupation, income, religion, habitat, any physical illness of senior citizen and any psychiatric illness of senior citizen.

iii. Setting

The study will be conducted in selected urban community, Bangalore.

13 iv. Population

All the family members of the senior citizen who are residing in selected urban community, Bangalore.

v. Sample

The family members of senior citizen who fulfill the inclusive criteria are the sample and the sample size is 100.

vi. Criteria for sample selection

Inclusive Criteria: The study includes, 1. Son or daughter who is living with senior parent. 2. Son or daughter of senior citizen aged between 25 – 45 years. 3. Son or daughter of senior citizen who are able to read either English or Kannada. Exclusive Criteria: The study excludes,

1. Son or daughter of senior citizen who are not willing to participate in the study.

2. Son or daughter of senior citizen who are not available at the time of data collection.

vii. Sampling technique

Non Probability convenience sampling technique.

viii. Tool for data collection

14 The tool for data collection include following sections

Section A: Demographic data which gives baseline information obtained from the family of senior citizens such as age, sex, education, occupation, income, religion, habitat, any physical illness of senior citizen, any psychiatric illness of senior citizen.

Section B:

A Structured questionnaire to assess the knowledge regarding care of senior citizen among their family members.

Section C:

Likert scale to assess the attitude regarding care of senior citizen among their family members.

ix. Method of data collection

After obtaining formal permission from the concerned authority of selected community and informed consent from the sample, the investigator will collect data from the sample about the knowledge regarding care of senior citizen by using structured questionnaire. Likert scale will be used to assess the attitude of family members regarding care of senior citizen.

x. Plan for data analysis

The data analysis will be done by using descriptive and inferential statistics.25

15 Descriptive statistics

Frequency, percentage distribution, mean and standard deviation will be used to analyze the knowledge and attitude of family members regarding care of senior citizen.

Inferential statistics

Correlation coefficient will be used to analyze correlation between the knowledge and attitude of family members regarding care of senior citizen and chi square test will be used to analyze the association of the knowledge and attitude with selected demographic variables.26

Xi. Projected out come

The result of the study will enable investigator to know the level of knowledge and attitude of family members regarding care of senior citizen. Based on the collected data the investigator can plan an education to improve the knowledge and attitude regarding the care of senior citizen among their family members.

7.3 Does the study require any investigation or intervention to the patients or other human being or animal?

No, there is no active manipulation of the subject

7.4 Has ethical clearance obtained from your institution?

Permission will be obtained from the consent authority of the community area and informed consent will be taken from the subject to conduct the study. Confidentiality and privacy of data will be maintained.

8. LIST OF REFERENCES

16 1. K.Park. Text book of preventive medicine: Geriatric problems. Jabalpur: Banarsidar Bhanot publishers; 2007. P. 475-78

2. Meridian L Mass, Kathleen C Buckwalter, Mary D Hardy. Nursing care of older adult’s diagnosis, outcome, and interventions: Geriatric care. Missouri: Mosby publications; 2001. P. 3, 93, 416.

3. Kaplan, Sadock. Synopsis of psychiatry behavioral science and clinical psychiatry: Geriatric statistics. Philadelphia: Wloter’s kluwer publications; 2007. P. 1348-50.

4. Adrianne Dill Linton, Helen W Latch. Gerotological nursing concepts and practice: Family care giving. USA: Elsevier; 2007. P. 125,198, 726

5. Kasthuri sunder Rao. An introduction to community health nursing: care of old age. Chennai: BI publications; 2004. P. 323-25

6. Gail W Stuart, Michele T Laria. Principles and practice of psychiatric nursing: Geriatric mental health problems. Missouri: Mosby publications; 2005. P. 810- 12.

7. Marry Ann Boyd. Psychiatric nursing Contemporary practice: geriatric psychiatric problems. Philadelphia: Wloter’s kluwer publications; 2008. P. 682.

17 8. Old age India. Available from URL:http\\oldage.in

9. Dr.J Suhara Beevi. Morbidity status of elderly women in institutions and non institutions. The health action. HAFA publishers. 2008october10(21)20-24

10. Mental health problems in old age. Available from URL:http\\communitycare.co.uk

11. Karen Devereaux Mellio, Susan Croker Houde.Geropsychiatric and mental health nursing: morbidity rate of elderly. Sudbery: Jones and Bartlett publishers; 2005. P.3-19.

12. Fear of old age. Available from URL:http\\living.oneindia.in

13. Lack of energy in old age linked to health problems. Available from URL:http\\andhranews.net .

14. Denis F Polit, Chery Tanto Beck. Nursing research: review of literature. New Delhi: Wolters Kluwer. 2008.P. 134-37.

15. Shaji KS, Smitha K, Lal KP, Prince MJ. Caregivers of people with chronic disease: a qualitative study from the Indian 10/66 Dementia Research Network. Gerontological nursing. 2007 September;20(9):29-34.

16. Pierce LL, SteinerV, Govoni A, Thompson TC, Friedemann ML. Two sides of a care giving story. Gerontological Nursing. Rehabilitative nursing. 2007 September;33(9):30-6.

18 17. Snitz BE, Morrow LA, Rodriguez EG, Huber KA, Saxton JA. A pilot study of how information and communication contribute to health promotion among elderly spousal careers in Norway. Journal on Internet Neuropsychology. 2008 November;14(6):1004-13.

18. Rossi Ferrario S, Baiardi P, Zotti AM. Assessment of problems associated with care giving: the family strain questionnaire. Journal on Internet Neuropsychology. 2008 November;14(6):1004-13.

19. Brown JB, McWilliam CL, Mai V. Barriers and facilitators to seniors' independence. Perceptions of seniors, caregivers, and health care providers. Gerontology and Biological Science. 2008 October;63(10):1069-1075.

20. Toseland RW, Labrecque MS, Goebel ST, Whitney MH. An evaluation of a group program for spouses of frail elderly veterans. Dementia and Geriatric Cognitive Disorders. 2008 October 22;26(5):407-415.

21. Rasin J, Kautz DD. Participation in an elderly care evaluation program: perceptions of family members. Neuroscience Nursing. 2005 April;37(2):92-6.

22. Hweidi IM, Al-Obeisat SM. Jordanian family member’s attitudes toward the elderly Nurse Education Today. 2006 January;26(1):23-30.

23. Horvath KJ, Hurley AC, Duffy ME, Gauthier MA, Harvey RM, Trudeau SA, Cipolloni PB, Smith SJ. Caregiver competence to prevent health problems in elderly Rehabilitative Nursing. 2005 Sep-October;30(5):189-96.

19 24. Hsieh HF, Wang JJ, Yen M, Liu TT. Knowing the resident with chronic illness: perspectives of assisted living facility caregivers. Advanced Health Science Education and Theory Practice. 2008 May 319(6):59-62.

25. B.T. Basabathappa. Nursing research: Data analysis and interpretation. New Delhi: Jaypee brothers; 2003.P.108.

26. Veer Bala Restogi. Fundamentals of biostatistics: Inferential statistics; New Delhi: Anne book India. 2006. P. 198

20 9. Signature of the Candidate :

10. Remarks of the guide :

11.1 Name and Designation of the Guide:

11.2 Signature :

11.3 Co-guide :

11.4 Signature :

11.5 Head of the Department :

11.6 Signature :

12.1 Remarks of the Principal :

12.2 Signature :