RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES …



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

| | | |VELMIRA AVITA DIAS |

|1. |Name of the candidate and address | |FIRST YEAR M. Sc. NURSING |

| | | |UDUPI COLLEGE OF NURSING |

| | | |K. H. B. COLONY |

| | | |SHIVALLI |

| | | |MANIPAL |

| | | |UDUPI COLLEGE OF NURSING |

|2. |Name of the Institution | |K. H. B. COLONY |

| | | |SHIVALLI |

| | | |MANIPAL |

| | | |M. Sc. NURSING |

|3. |Course of study and subject | |MENTAL HEALTH NURSING |

| | | |22.06.2012 |

|4. |Date of admission to the course | | |

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|5. |Title of the study: |

| |A STUDY TO ASSESS THE PSYCHOLOGICAL PROBLEMS AND COPING STRATEGIES OF ELDERLY RESIDING IN THE SELECTED OLD AGE HOMES, UDUPI. |

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|6. |Brief resume of the intended work |

| |Introduction |

| |Age is information failure. The body loses fluency. |

| |- Jeanette Winterson (The Stone Gods) |

| |Ageing is a natural process and it is considered as a normal biological and an inevitable process. The process of ageing is |

| |classically depicted as one of constant and inexorable decline after reaching a peak of bodily function & efficiency around the |

| |second decade of life.1 |

| |“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 and you extend it”. Aging is a major life change includes physiological & psychological changes. Old age should be |

| |regarded as a normal inevitable biological phenomenon.1 |

| |But it is interesting that while the numbers have gone up, quality of life has gone down. Industrialization, migration, |

| |urbanization, westernization have severely affected value systems. The erstwhile joint family, natural support system has crumbled |

| |to the woes of the older person. 2 |

| |Ageing refers to a sequence of changes across a life span of an individual. The term ‘old age’ conveys the images of frustration and|

| |pity, sickness and poverty, despair and senility, warmth and responsibility. The aged feel a sense of social isolation because of |

| |the disjunction from various bonds viz., work relationships, and diminish of relatives and friends, mobility of children to far off |

| |places for jobs. The situation of the elderly still worsens when there is physical incapacity and financial stringency. Today in |

| |India elderly face the miserable conditions in their life.1 |

| |The general characteristics of old age are physical and psychological changes. It is common to associate old age with disability. |

| |The elderly people face number of problems and adjust to them in varying degrees in their old age. These problems range from absence|

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| |of ensured and their dependents, to ill-health, absence of social security, loss of social role and recognition, and the |

| |non-availability of opportunities for creative use of free time.3 |

| |Going by today’s standards, old age homes are not scandalous anymore! What was once considered as an unimaginable thought or action |

| |is now a most convenient reality. More and more people are thinking of and many are opting to put their aged parents in old age |

| |homes. It just seems the right thing to do, leaving couples free to pursue their careers, party around or go for vacations without |

| |the nagging thought of an aged parent at home.4 |

| |People favouring old age homes justify their decisions with several points. They say that the presence of old parents at home is too|

| |much trouble. There is no room for privacy. They have to constantly tend to them when they are sick. Bringing friends home becomes |

| |embarrassing. Going on a holiday becomes an impossible reality. So many problems just to have elderly parents around!4 |

| |6.1 Need for the study |

| |Today aging is a concern world over. Inadequate support from the care givers leads to lack of moral, emotional and physical support |

| |for elderly. When comparing the world scenario of elderly population, China is not alone with respect to extremely rapid populating |

| |aging among developing countries. The proportion of elderly in Korea will climb to a higher level with a large annual increase rate |

| |than in China. Mexico and India, two developing countries with large population sizes also will undergo very rapid population aging |

| |at annual increase rates of 2.6 and 2.1 per cent, although the proportion of elderly in 2050 will be substantially lower than in |

| |China. The annual increases in the proportion of the elderly between 1990 and 2050 in China, India, Korea and Mexico are all much |

| |higher than in European and North American countries. This fact deserves serious attention not only in those developing countries, |

| |but also from international organizations and developed countries.5 |

| |The world’s population is greying rapidly. The age 65 and older population is projected to triple from 516 million in 2009 to 153 |

| |billion in 2050, according to census bureau of 25th June 2009 fast growing group is age of 85 and older. This age group is expected |

| |to increase more than fivefold from 40 million to 219 million people. 2/3rd of 85 |

| |ages will be women because they live longer. It is census bureau of 227 countries and areas.6 |

| |In 1961, the population of the elderly in India was placed at 24 million; it increased exponentially to 43 million in 1981, 57 |

| |million in 1991 and about 77 million in 2001. The proportion of the elderly in the total population also rose from 5.63%. In 1961 to|

| |6.58% in 1991 and to 7.5% in 2001. UN report has predicted that India will have 198 million 60 plus people in 2030 and 326 million |

| |in 2050, Currently there are around 100 million senior citizens in India.7 |

| |According to the census conducted in 2001 population of senior citizens in Andhra Pradesh, Goa, Himachal Pradesh, Karnataka, Kerala,|

| |Maharashtra, Orissa, Punjab, Tamil Nadu, Uttarakhand and Ponducherry is more than national average 7.5%. In rural areas it is |

| |highest in Kerala and lowest in Andaman and Nicobar Islands. In the urban areas it is highest in Kerala and lowest in Arunachal |

| |Pradesh.8 |

| |For the past 50 years there has been a distinct change in the Indian family system. Joint families are turning into nuclear |

| |families. However, younger members of family are a product of a changed social system. This conflict in the value pattern makes |

| |elderly people, particularly those who are returned from service and other occupation, mentally isolated from the family. The |

| |feeling of loneliness along with the natural age related decline in physical and physiological functioning makes them prone to |

| |psychological disturbances. In some cases elderly members of relatively rich families or aged persons who has nobody to look after |

| |takes shelter in old age homes. The elderly live in these homes merely in terms of existence to complete the last phase of their |

| |lives.9 |

| |Eustis and associates (1984) identified the risk factors that appear to place the risk of requiring institutionalization. With the |

| |advent of the nuclear family, urbanization, influence of western culture and change life styles there is no space for the elders in |

| |the families and they may go for institutionalization. Whatever the reason for separation it means those elderly persons loose |

| |assistance from their children. This makes them physically and emotionally neglected and they may face number of psychological |

| |problems such as anxiety, depression, loneliness, feeling of insecurity and social isolation etc.10 |

| |In the study conducted in the elderly people were asked to list out from the 24 psychological problems about the presence or absence|

| |of the problem. It was found that almost all elderly were having one or the other psychological problems. The major psychological |

| |problems reported by elderly was anxiety followed by loneliness (58.5%), isolation (55.3%), stress (52.1%), feeling of guilt (51.1%)|

| |and of affection & irritation (50%).11 |

| |Yela (1996) reported that the greater the feelings of emotional exhaustion, the more likely these elders were to use strategies |

| |based on behavioural and mental disconnection from the situation, concentration on ones emotions which helps to decrease ones |

| |feelings when faced with difficult or stressful events. The clients will already be demonstrating some coping strategies which may |

| |be adaptive or non adaptive in nature.12 |

| |Initial out bursts as swearing or lashing out draw on the fight mechanism, giving an individual release of tension. Apart from this,|

| |the research literature has established that the physiological health and emotional well being of the elderly are enhanced by |

| |contact with animals, guided imagery, music therapy, meditation, religious activities, relaxation therapy, reality orientation |

| |etc.12 |

| |For a developing country like India, rapid growth in the number of older population creates issues that are hardly perceived yet; |

| |this must be addressed for social and economic development. Elders suffer from desires, psychological problems of usefulness and |

| |abundant. It should be noted that problems of the old age are highly individualistic in nature. The growing concern with the problem|

| |of ageing and constant development of services have brought about demands for professionalization of care of older people through |

| |man power development and training but still a lot of elderly population still suffer from both mental and physical illness.13 |

| |Gerontology is one of the neglected fields in India. Since institutionalization is a growing problem, the elderly facing |

| |psychological problems & need to cope with the situation. So the investigator felt the need to study the psychological problems & |

| |its coping strategies of elderly residing in the old age homes. This study will help the psychiatric mental health nurse or the care|

| |taker to know about the psychological ailments that the elderly faces in the institution and the coping that can be adopted to |

| |decrease these ailments. |

| |6.2 Review of literature |

| |Related literatures are organized under the following headings. |

| |Literature related to institutionalization of the elderly |

| |Literature related to psychological problems of the elderly |

| |Literature related to coping strategies of the elderly |

| |Literature related to institutionalization of the elderly |

| |Today, India is home to one out of every 10 senior citizens of the world. Senior citizens face three serious problems. They are |

| |poverty, disease and loneliness. An emotional and psychological problem tormenting the elders is loneliness. This is due to the |

| |growing “empty nest syndrome”. The children go away to far-off countries in search of economic betterment. Even if they live within |

| |the country, due to the spread of western ideas such as “spacing, privacy, individualism and non-interference”. Even within joint |

| |families, the elders feel lonely owing to the denial of due respect, concern and care by youngsters. As a consequence, the elderly |

| |are either left alone, or they are taken to old age homes. All these factors have contributed to the psychological trauma called |

| |“loneliness”.7 |

| |Study done in (2008) in Finland Institutionalization of older adults was more among older adults who had lost their spouse than |

| |among those living with their spouse. The risk of institutionalization was highest during the first month after spouse’s death more |

| |than 3 times among both sexes, stabilizing at approximately 20% - 50% higher over 1-5 yrs. Finland however the excess risk of |

| |institutionalization after death of spouse and it is long term. Another cause may be emotional stress following death of loved ones.|

| |However, Lusyne indicated that more educated persons in Belgium & Israel have relatively more excess mortality during the period |

| |immediately following the spouse’s death.14 |

| |The study was done in (2012) to examine the factors associated with institutionalization of older people in Canada. A |

| |cross-sectional study of 1258 institutional subjects and 9113 community dwelling older adults from the Canadian health |

| |and aging. The multiple logistic regression analysis showed that female gender being unmarried, absence of caregiver, presence of |

| |cognitive impairment, functional impairment, DM, Stroke, Parkinson’s disease were independently associated with being in term long |

| |term care & moved to old age institution.15 |

| |Literature related to the psychological problems of the elderly |

| |A study was conducted on effect of anxiety among the mental disorders, anxiety has a serious impact on their 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.16 |

| |A study was conducted on loneliness and social support among nursing home residents. Around 227 long term nursing residents 65 yrs |

| |and above. Data were obtained through face to face interviews social provisions scale and loneliness were analyzed using logistic |

| |regression. 56% experienced loneliness. Attachment was nearly significant (p=0.07) emotional closeness to significant others which |

| |derives a sense of security appears to be important for loneliness.17 |

| |A study was conducted in 2008 to assess the stress, coping strategies and quality of life of institutionalized and |

| |non-institutionalized elderly in Kottayam district, Kerala. Data used in this study were collected from an old age home and a |

| |village in Kottayam with sample of 150 respondents aged 60 or older The survey used different tools such as socio-demographic |

| |proforma for institutionalized and non-institutionalized elderly, stress rating scale, a coping inventory, and WHOQOL-BREF scale. |

| |The study reveals that institutionalized elderly have more stress and less quality of life compared to non-institutionalized ones.18|

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| |Literature related to coping strategies of the elderly |

| |A comparative study was conducted to assess the benefit of religiosity as a coping strategy to cope with physical and psychosocial |

| |demands of elderly in ashrams and those living with family members in Tirupathi. About 80 elderly people were interviewed by using a|

| |standardized questionnaire. Scores on motivational styles indicated that ashramite women were with higher a motivation and non self |

| |determined extrinsic motivation (x2=10.68) scores on coping style indicated that 80% of ashramites used religious coping while non |

| |ashramite preferred 40% for religious coping followed by 15% were active cognitive coping. Majority of ashramites used religious |

| |coping to familial problems and both the groups were found to use to some extent non religious coping also to health problems. |

| |Subjects in depressive states were found more motivated and used more of religious coping(66.56%),active behavioural |

| |coping(20.80%),avoidance of coping(8.32%) and active cognitive coping (4.14%) in comparison to non depressed states |

| |(37.44%,29.12%8.32% and 24.16% respectively).This study indicated the need for intervention to improve meaning of life of elderly |

| |people.19 |

| |Colombo G (2005) The aim of this study was to assess whether a pet therapy program had a favourable effect on the psychological |

| |status and perception of quality of life in institutionalized elderly. Seven elderly rest homes in Veneto Region of Northern Italy |

| |participated in the project, which was conducted on 144 cognitively intact elderly residents (97 females and 47 males). The |

| |participants were randomly divided into three groups: 48 subjects were given a canary, 43 subjects were given a plant, and 53 |

| |subjects were given nothing. The observation period (t0–t1) lasted for 3 months. At time t0 and t1 participants were administered |

| |the mini mental state examination (MMSE) to assess their cognitive status, the LEIPAD II-Short Version (LEIPAD-SV), to gauge |

| |subjective perception of quality of life in the elderly, and the brief symptom inventory (BSI), for self-evaluation of the presence |

| |of psychopathological symptoms. At the end of the 3-month trial, tests were re-administered, without removing the experimental |

| |condition. Even if the group that received a plant seemed to benefit from the experience, they did not achieve the same positive |

| |results on BSI and quality of life subscales exhibited by the group that received a pet. This study reinforces the hypothesis that |

| |pet therapy may have a beneficial effect on the psychological well being of institutionalized elderly, in particular on aspects |

| |related to depressive symptoms and perception of quality of life.20 |

| |Statement of the problem |

| |A study to assess the psychological problems and coping strategies of elderly residing in selected old age homes, Udupi. |

| |6.4 Objectives of the study |

| |The objectives of the proposed study are to: |

| |Assess the psychological problems of the elderly residing in old age home as measured by structured interview schedule. |

| |Assess various coping strategies used for psychological problems by elderly as measured by structured interview schedule. |

| |Find the correlation between the psychological problems and coping strategies adopted by the elderly people. |

| |Find the association between psychological problems and demographic variables. |

| |Find the association between coping strategies and demographic variables. |

| |6.5 Hypotheses |

| |The following hypotheses will be tested at .05 level of significance. |

| |H1: There will be significant association between psychological problems and demographic variables. |

| |H2: There will be significant association between the coping strategies and demographic variables. |

| |H3: There will be significant relationship between the psychological problems and coping strategies. |

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| |6.6 Operational definitions |

| |Psychological problems: In the present study the psychological problems include the problems such as anxiety, loneliness, stress |

| |experienced by the elderly. |

| |Coping strategies: Coping strategies refer to measures used by the elderly in order to cope with the corresponding problems as |

| |listed in the tool. |

| |Elderly: In this study an elderly is considered as a person above 60 years of age. |

| |Old age home: This term refers to an institution at Udupi, which gives care, shelter and food for the elderly people. |

| |6.7 Assumptions |

| |The study is based on the following assumptions |

| |Elderly people will cooperate in giving their responses. |

| |Ageing process brings about psychological problems among the elderly. |

| |6.8 Delimitations |

| |The sample will be limited to the elderly people who are available in the old age home during the time of study. |

| |Since the study method is restricted to the structured interview schedule the study is delimitated to the elderly who are able to |

| |hear, understand and respond verbally. |

|7. |Material and methods |

| |7.1 Source of data |

| |Data will be collected from the elderly people living at old age home. |

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| |7.1.1 Research design |

| |Descriptive research design with survey approach will be adopted to find out the psychological problems and coping strategies of |

| |elderly residing in old age homes. |

| |Variables |

| |Key variables: Coping strategies, Psychological problems |

| |Socio-demographic variables: Age, previous place of residence, educational status, religion, marital status, no of children, |

| |previous occupation, reason for stay, duration of stay, system of the family and spouse. |

| |7.1.3 Setting |

| |It will be conducted on the elderly in a selected old age homes at Udupi, Karnataka. |

| |7.1.4 Population |

| |The population in this study would comprise of the elderly residing in the old age homes during the period of data collection. |

| |7.2 Method of data collection |

| |7.2.1 Sampling procedure |

| |Convenience sampling technique will be used by lottery method to select the samples and the subjects will be substituted for the |

| |excluded ones. |

| |7.2.2 Sample size |

| |75 elderly residing in old age homes, who met the criteria for the selection of the sample were selected for this study. |

| |7.2.3 Inclusion criteria |

| |Elderly whose age is 60 and above. |

| |Those who were willing to participate in the study. |

| |Those who were able to hear, comprehend, and respond coherently. |

| |7.2.4 Exclusion criteria |

| |Those who are cognitively impaired. |

| |7.2.5 Instruments intended to be used |

| |Data will be collected by the investigator herself using structured interview schedule. |

| |Data collection method |

| |The investigator will obtain permission from the concerned authorities of the old age homes. Informed consent will be taken from the|

| |subjects and they will be assured of confidentiality. A total of 100 samples will be selected for the study. The investigator will |

| |administer structured interview schedule to assess the psychosocial problems and the coping strategies adopted by the elderly. |

| |7.2.7 Data analysis plan |

| |Descriptive statistics: Percentage, mean & standard deviation will be used to describe the variables. |

| |Inferential statistics: Chi-square test will be used to find the association between psychological problems and demographic |

| |variables. Further same test will be suitable for finding the association between the coping strategies & demographic variables and |

| |also planned to use Karl Pearson coefficient of correlation to find the correlation between the psychological problems and coping |

| |strategies. |

| |7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? |

| |Yes, the study requires investigation to be conducted on the elderly people regarding psychosocial problems and the coping |

| |strategies. |

| |7.4 Has ethical clearance been obtained from your institution? |

| |Yes, the ethical clearance will be obtained from concerned authorities and consent will be taken by elderly people before data |

| |collection. |

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|8. |References |

| |Park K. Textbook of preventive and social medicine. 17th ed. Jabalpur: Banarsidas Bhanot Publishers; 1991. |

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| |Tolkein JRR. Retirement and old age. [online]. 2010 Aug. Available from: |

| |URL: |

| |Townsend MC. Essentials of psychiatric mental health nursing. 5th ed. Philadelphia: F. A. Davis Company; 2006. |

| |Fowles. A profile of older Americans. Washington: American Association; 2001. |

| |Branden E. Census Bureau: Worlds 65 And Older Population Will Triple By 2050. [online]. 2009 Jul. Available from: |

| |URL: |

| |Population ageing: an area of darkness. The Hindu. [online]. 2001 Sep 22. Available from: |

| |URL:

| |df |

| |Know your rights elderly. National Human Rights Commission of India. [online]. 2011. Available from: URL: |

| |Ghosh AB. Psychiatry in India. Need to focus on geriatric psychiatry. Indian J Psychiatry 2006;48:49-50. |

| |Eustis, Greenberg, Patton. Long term care for older persons. Washington: Brooks/Cole Publishing Co.; 1984. |

| |Agharwal MM. To work the cause and care of disadvantaged aged persons and to improve their quality of life. Available from: |

| |URL: |

| |Wong Y. Socioeconomic and health implication. Asia Pasafic Population Journal 1996;2(3). |

| |Census Bureau Population Division. World population prospects. London: Nicholas Brealey Publishing; 2003 |

| |Nihtila E, Martikainen. Institutionalization of older adults after the death of spouse. AMJ Public Health 2008;98(7):1228-34. |

| |Factors associated with institutionalization of the older people in Canada: Testing a multi factorial definition of frailty. J A M |

| |Geriatrsoc 1996 May;4(5):578-82. |

| |US Public Health Service. The Nursing Journal of India 2000 Apr;LXXXXL(3):64- 5. |

| |Draquse J, Kirkevold M. Loneliness and social support among nursing home residents without cognitive impairment: a questionnaire |

| |survey. Burgen University College, Norway 2011 May;48(5):611-9. |

| |Mathew MA. Stress, coping strategies and quality of life of institutionalised and non-institutionalized elderly. Indian Journal of |

| |Gerontology 2009;23(1):79-87. |

| |Ushasree S, Basha SA. Religiosity as a contributor to meaning in life. Indian J Gerontol 2003;17:85-98. |

| |Colombo G, Buono MD, Smania K, Raviola R, De Leo. Pet therapy and institutionalized elderly. Arch Gerontol Geriatr 2006 |

| |Apr;42(2):207-16. |

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|9. |Signature of the candidate | |

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|10. |Remarks of the guide |Feasible and practicable to conduct. |

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|11. |Name and designation of (in block letters) |

| |11.1 Guide |MR. ARUN S. NATH |

| | |ASSOCIATE PROFESSOR AND HOD |

| | |MENTAL HEALTH NURSING |

| | |UDUPI COLLEGE OF NURSING |

| | |MANIPAL. |

| |11.2 Signature | |

| |11.3 Co-guide (if any) | |

| | | |

| | Signature | |

|12 | Head of the department |MR. ARUN S. NATH |

| | |ASSOCIATE PROFESSOR AND HOD |

| | |MENTAL HEALTH NURSING |

| | |UDUPI COLLEGE OF NURSING |

| | |MANIPAL. |

| |12.2 Signature | |

|13. |13.1 Remarks of the Chairman and Principal |

| |The methodology adopted is feasible to conduct as a study. |

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| |13.2 Signature |

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