RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING

GERIATRIC CARE AMONG CLIENTS IN A OLD

AGE HOME AT KGF, KOLAR DISTRICT,

KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms. GUNASUNDARI .S

AE & CS PAVAN COLLEGE OF NURSING

KOLAR-563101(KARNATAKA)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1. |NAME OF THE CANDIDATE |Ms. GUNASUNDARI .S |

| |AND ADDRESS |1ST YEAR M.Sc NURSING |

| | |AE & CS PAVAN COLLEGE OF NURSING , KOLAR-563101 |

| | |KARNATAKA. |

|2. |NAME OF THE INSTITUTION |AE & CS PAVAN COLLEGE OF NURSING , KOLAR-563101 |

| | |KARNATAKA. |

|3. |COURSE OF STUDY AND |M.Sc. (NURSING) |

| |THE SUBJECT |MEDICAL SURGICAL NURSING |

|4. |DATE OF ADMISSION TO |06-07-2010 |

| |COURSE | |

|5. |TITLE OF THE TOPIC: |

| |A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING GERIATRIC CARE AMONG CLIENTS IN A OLD AGE|

| |HOME AT KGF, KOLAR DISTRICT,KARNATAKA. |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“The golden age is before us not be hind us”

St. John.

Ageing is a natural process in the words of “SENECA”, old age is an incurable disease but more recently “Sir. James Sterling Ross” commented you do not heal old age, you protect it, you promote it, you extend it, it is not the fact that growing old should be a time of dismay and withdrawal from everything around, in fact most people growing old is a time to be enjoyed.1

Dates on the calendar denote only the passing of time but ageing denotes the declining level of physical activity and response to it.2

As physical change or disease affects ageing parents, some or all of their independent function may be lost, this is distressing for the family members as well as for elderly themselves.3

Even with the best resource in terms of health care facilities, financial support, social support and emotional support, all organisms lose adaptability with the passage of time.4

The change in ageing process, the loss of adaptability leads the organism to increase vulnerability to internal and external environmental change.4

Ageing population has serious implication both as the macro and the household level especially as the transition has been accompanied by changes in society and economy, the proportion of elderly persons in the country has raised from 5.6% in 1961 to 7.1% in 2001.5

In absolute terms in the year 1991 saw 55 million elderly persons in the country and will touch 76 million by 2025, 40% of elderly live below the poverty line, 90% of them are from the unrecognized sector with no benefits at all, 55% of all women over 60 are widows many without any support, 80% of them are from rural areas and 73% of them are illiterates and have to depend on labor to sustain themselves.5

As Advances in Medical technology have lengthened lifespan and cracks have developed in traditional support system like the joint family and the village community, problems of the uncared elderly have been impinging on the welfare agenda of the state.5

Life expectancy in India today is 62 yrs, but there are great variations between state and most of the countries accept 65 yrs and UN agree 60 yrs and above is the definition of old age.

Ageing process is flower a biological reality which as its own dynamic, largely beyond their control.6

Since ageing is a universal phenomenon inevitable in the life cycle, it brings about certain anatomical, physiological, psychological, changes in life.

Medical treatment and socio economic factors such as education, income, better nutrition and living condition as well as technological advancement extends the lifespan.

Ageing also refer to decline in the functional capacity of the organs of the human body which occurs mostly due to physiological transformation, but senior citizens constitute a precious human resources .7

The needs motivate one to acts for there fulfillment the physical needs to nurture our human body in a state of health , the psychosocial ones which promotes stable personality and maintain harmonious relationship with our brethren, spiritual one which contribute to vertical and horizontal peace and love dissatisfaction of the basic needs treated tension and fruition, in old age, people need to be protected from accident, infection and disabilities as the oblige advance certain changes take place skin gets wrinkled memory is impaired cessation of menstruation in women, In men sexual activity diminishes emotion irritability jealousy and dependency can be noticed.

Older people often suffer from illness such as bronchitis, arthritis A-vitaminosis, gastro intestinal disorder and depression restricting their social activity, one feels isolated and a liability on may others, doubts gods love and worries about death and life after death.

Many of the aged are reluctant to go to institutions for the care of the aged thus family case is encouraged. The knowledge is directed inwards primary care is provided for prevention of disease or injury and promotion of positive health, elders are encouraged to participate in the activities is to avoid injuries, early detection of signs of ill health and timely intervention and care and encourage individual to return to independent existence as for as possible.

Care of the aged is very important for the care givers, is to gain knowledge, nursing skills and right attitude in order to give skilled nursing care to the people, should assess the immediate and long term needs or problems of the aged and their families always face, supporting, advising and guiding and plan with family in providing the total care including rehabilitation.

Suggestion of care givers on various aspects of elderly decide where and how to lead the remaining life, continue to have supportive, close, warm relationship with the spouse or close relatives to have safe and comfortable dwelling according to ones economic status, maintain a high degree of heath, physical and emotional by getting regular health examination and needed medical and dental care, eating balanced diet and maintain good personal hygiene, maintain contact with children, grand children and other kinsmen, finding emotional satisfaction with them work out for significant, philosophy of life, finding comfort in a philosophy or religion, adjust living standards to retirement, income, supplement income with remunerative activities.

With a rise in the number of elders in the community, very little is being done in planning and providing care for the ageing population.8

6.1. NEED FOR STUDY

As the life expectancy is rising the population of the aged people is also increasing steadily, the world population prospectus released by united nation in 1998 reveals the population of the aged as global level is 9%, in under developed countries is 6.7% and 15% in developed countries.9

Though the proportion of elderly population is more in developed countries, majority of the old people live in developing countries in absolute numbers such of about 530 million people above 60yrs living in the world, about 355 ( 61.2%) million people live in developing countries.9

By the year 2020 the world population of the people would be about 1000 million of which about 700 million (70%) would be living in developing countries resulting in increasing the burden of disease associated with old age.9

Today 19 of the worlds 20 oldest countries that with the largest percentage of elderly people (65 or older) are in Europe, in Italy the worlds oldest country by these standard over 19% of the population is elderly, this figure is expected to reach 28% by 2030.

Japan and Europe particularly in Asia and Latin America are slowly creeping up in elderly population, in china elderly population will increase from 88 million to 349 million by 2010.UN experts state that the vast majority of people 65yrs and older will leave in developing countries.

In Japan 1 in 4 people will be elderly by 2015, current population is 128 million but expected to be 95 million by mid century, since Japan had high life expectancy upto 108 yrs from 1984 it was youngest in 2005, it became elderly country by soon it will become first elderly country.

According to UN experts demographic transition of elderly will be slower in middle east Africa particularly sub Saharan Africa because of increased fertility which keeps elderly population for 4% until decade to come.

India and china have one third of worlds population over 65 yrs and older population of 166 million in 2008 by “ageing world report” in coming decade climes to 551 million in 2040 that is 329 million in china and 222 million in India.

The availability of improved medical service better awareness regarding health and nutrition and comparatively better overall standard of living have resulted in the delayed onset of ageing and associated problems with an ultimate increase in life expectancy consequently the population of the elderly has been increasing over the years.10

In India the population of older persons (60+) in the total population of India was around 5.5% which increased to nearly 6% in 1971 and above 7.5% in 2001 in absolute terms the magnitude of such population has increased from nearly 2 cores in 1951 and 7.2 cores in 2001 and expected to be 8% in the next decade.10

The Indian scenario of ageing population bring to light that India’s population of just over one billion in the year 2000 continues to grow at above 1.5 % per annum and is expected to exceed one and half billion by mid century. 11

It is found that 56% of the males and 55% of the females continue to work beyond 60 yrs of age even after 80yrs 20% of the males and 13% of the females in India continue to work.11

Around 70.6% of elderly females in rural and about 75.7% elderly females in urban of fully dependent, where as 31.3% of elderly male in rural and 29.7% of elderly male in urban areas are dependent.11

I n rural areas the proportion of elderly males who are fully dependent on others is highest in Karnataka (42.7%) and lowest in Jammu and Kashmir (21.2%) whereas females is highest in west Bengal (88.3%) and lowest in Uttar Pradesh ( 1.2%).11

In urban area fully dependent elderly males being 38% in Kerala and lowest being 2.8% in Haryana but for females in urban is 90.5% in Assam and lowest of 48.7% in Himachal Pradesh.11

Majority of the economically dependent elderly are supported by their children in India around 78% of economically dependent is supported by their own children and 3% by grand children.11

The Indian aged population is currently the second largest in the world, the first being china with more than 150 million.

According to recent statistic related to elderly people in India (2001 census) it was observed that as many as 75% of elderly persons were living in rural areas about 48.2% of elderly persons were women out of whom 55% were widows, a total of 73% of elderly persons were illiterate and dependent on physical labor, 1/3rd was reported to be living below the poverty line that is 66% of older persons were in a vulnerable situation without adequate food, clothing or shelter.11

Until the 1980’s Mumbai had only a handful of homes for the elderly, most of these being run by Christians. In 2003 there was 40 old age home in Mumbai. This 40 have 1200 and 1500 residents acts as a shelter for elderly.

An Indian council of medical research (ICMR) report on the chronic morbidity profile in elderly states hearing impairment is the most common morbidity followed by visual impairment.

A study conducted in the rural area of Pondicherry reported decreased visual acuity due to cataract and refractive errors in 57% of elderly followed by pain in the joints and joint stiffness in 43.4% dental and chewing complaints in 42% and hearing impairment in 15.4%, other morbidities were hypertension ( 14%), diarrhea (12%), chromic cough (12%), skin diseases (12%), heart disease (9%), diabetes (8.1%), asthma (6%) and urinary complaints (5.6%).12

A study conducted on prevalence of Locomotor disability among elderly in rural and urban areas, all types of disabilities was found in elderly among rural areas was 2.8% and in urban area it was 2.9%.

A survey was conducted in New Delhi regarding psychological stress among elders over 81% of the elderly confessed to having increasing stress and psychological problems in modern society, while 77.6% complained about mother-in –law or daughter- in -law conflicts being on the increase.

The late of growth of the population of elderly has been higher than the overall growth rat of the total population. As well the needs and problems of elderly is also more hence the investigator have taken the study to improve the knowledge on self care of elderly.

6.2. REVIEW OF LITERATURE

“Review of literature is a key step in research process”.

According to Polit and Hungler (1991) review of literature is an important step in the research project it involves systematic identification and scrutiny of written material that contain information on research problem.13

THE RELATED LITERATURE IS ORGANIZED AND PRESENTED UNDER THE FOLLOWING HANDINGS

Section A : Studies related to common geriatric problems.

Section B: Studies related to knowledge regarding geriatric care .

Section C: Studies related to general geriatric care of elderly person.

Section D: Studies related structured teaching programme regarding geriatric care.

Section A : studies related to common geriatric

problems.

A descriptive study was conducted to determine the perceived depressive feelings experienced in Udupi District in which 100 clients participated. The study results showed that majority of clients had moderate depression ( 58%) and about 19% of them had severe depression it was a subjective feeling of depression and represents that there is a significant relationship between family, friend relationship and depressive feeling of aged person, the study concluded that care all health professionals to go deeper into society to bring about issues and problems faced by older population and to bring about changes that can fulfill the needs of the elderly.14

A study was conducted on loneliness of elderly, it results showed that presence of perceived loneliness contributed strongly, to the effects of depression on mortality and if concluded that the oldest old depression is associated with mortality only when feeling or loneliness are present. 15

A comparative study was conducted an depression in elderly by using centre for epidemiologic studies, depression scale and geriatric depression scale in primary care institution and the depression is screened for 130 patients by using scales,. The results showed that CESD- 21% in which 92% sensitivity and 87% specificity and GDS shows sensitivity 100% specificity 84% both scales have excellent properties for use of screening.16

A study was conducted on effect of anxiety among the mental disorders, anxiety has a serious impact on there society of life due to the lack of evidence, the study result shows that anxiety affects 7% of elderly as compared with depression which affects only 3% of them, 11.4% of late adults suffer out of anxiety non specific anxiety rates are reported to be up to 17% in elderly men and 21% in elderly women and concluded that despite its prevalence anxiety remains one of the most undiagnosed and untreated condition in this population.17

A study was conducted on old age and its related problem considered from an elderly perspective in a group of elderly in Turkish with participants of 1261. The study result sowed that majority of elderly indicated that their health status was bad or not bad and satisfied with place of residence 72.8%, remaining with family members 64.4% and 42.3% residential care homes. And frequently reported problem was hypertension (26.1%) hence the study concluded that ageing population all over the country has not brought only with it, new and serious issues, but has also become a national and international health matter to be dealt with as in our country.18

A longitudinal study was conducted on the prevalence of chronic respiratory morbidity and related epidemiology factors among elderly in spinning mill workers involved 462 and the study results showed that 25.3% chronic respiratory morbidity, byssinosis (11.7%), chronic bronchitis (5.85) bronchial asthma (4.5%), tuberculosis (1.5%), obstructive disease (1.7%), advancing age, duration of exposure, non usage of protective devices and smoking were seen as major determinants of chronic respiratory morbidities.19

A cross sectional study was conducted on morbidity pattern among geriatric population in an urban area of udaipur, the sample of 310 elderly participated in the study the study result showed that 29.3% belong to socio-economic class V and 14.6% belong to II and I class, 48% had hypertension, 63% chronic bronchitis, 11.5% bronchial asthma, 18.6% neurological problem, 60% cataract feeling of loneliness 21.85% the study concluded the recognition of the importance of care of elderly problems.20

A descriptive study was conducted on prevalence of sleep problem and its relation to physical and mental problem, in Sweden, 641 subjects participated in the study and the result revealed that 1/3rd of subjects were identified with sleep problem, Poor self rated health depression and pain were related to presence of sleep problem, among person with sleep problem and depression, 19.2% antidepressants, 46.2% hypnotics, 63.2% analgesics, 47.8% sedatives used drugs for sleep and the study concluded that sleep problems were common is older persons and suggested the importance and careful assessment of complaints of older person regarding sleep problem.21

A longitudinal study on urinary incontinence and related symptoms in older men and women the result showed around 17% prevalent in male and 48% prevalent in females there was increase in urge incontinence among men and women some increase the prevalence of weak stream in men.22

A study conducted on appetite and constipation in advanced life, America, the study result shows that in 20% of male and 36.8% of females suffer from constipation which is brought by loss of appetite, and the study concluded that important to bring up the nutritional needs of elderly.23

A study conducted on difficulties is mobility among elderly people and their association with socio economic factors 2 random samples 800 persons are taken for the study, the results shows 52% reported difficulties, 23% least frequently difficulty in mobility, it concluded that difficulty in mobility among elderly people especially elderly women should be reduced more actively either women should be reduced more actively either by improving their physical activity or by developing compensation strategy for their own use.24

A study on Parkinson disease in elderly states the role of common genetic risk variants in recent identification is associate two fold increase in risk of Parkinson disease, it facilitates the development of clinical, bio imaging, genetic, biological biomarker useful in monitoring and neutroprotect therapy assisting individuals.25

Section B : Studies related to knowledge regarding

geriatric care.

A study conducted on nurses regarding the knowledge and attitude about nutrition in elderly in Maulabi care service, 600 nurses participated and the result of study shows that vast majority (91%) of the participant elderly in their practice, nurses with bachelor degree had better attitude than registered nurses about importance of nutrition in elderly 80% pointed to the importance of feeding at the end of life. The study concluded that the community nurses recognized the importance of proper nutrition on elderly patients health but need more training in screening for nutritional problem in India.26

A cross sectional study conducted on knowledge and perception of erectile dysfunction among the elderly diabetic and non diabetic patients in Unners 200 individuals of diabetic and non diabetic patients involved in the study, the results showed that 63.7% of diabetic patients had total knowledge of erectile dysfunction and 53.8% maximum score of non diabetic had knowledge of erectile dysfunction, there score significantly lower regarding perception towards sexual active 65% in diabetics and 70% in non diabetics, the study concludes that health care professional should be more practice in dissemination health information about erectile dysfunction to the public in order to increase knowledge and assessment on the diabetic.27

A descriptive study conducted on a model of care to prevent functional decline in hospitalized elderly clients, 240 patients were taken for study, successfully implemented on 4 units, 93% in general clarification of elderly, 41% managements of immobility, 41% management of bladder and bowel problems, 25% prevention of pressure ulcer, 25% confusion evaluation, 18% adjustment of medication, overall 68% of specify recommendation were documented. The study concluded an innovative model of care in which guide nursing care was integrated as a part of nursing care.28

A study conducted on short term geriatric assessments in general hospital, Queba, 64 managers enrolled for study, they did assessment in hospital admission 9% focused geriatric assessment and audit care management, 23% offered rehabilitation care, it concluded that the standardized geriatric assessment on prevention of functional decline must be applied throughout all hospital words.29

SECTION C : Studies related to common geriatric

care

A Descriptive and comparative nature of study was conducted on well being among elderly couple living in the joint family in chinerkuppam 40 elderly couples participated in the study the results showed that there was a significant difference between the level of well being (0.001) even there was significant association between the level of well being and the number of children at (p ................
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