assessment of geriatric depression and development
TRANSCRIPT
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ASSESSMENT OF GERIATRIC DEPRESSION AND DEVELOPMENT
OF LEISURE/ RECREATIONAL PACKAGE FOR GERON’S
1*
Namrata Jain and 2Vimla Dunkwal
1Ph.D Scholar, Department of Food and Nutrition, College of Home Science, Bikaner (Raj.).
2Professor, Department of Food and Nutrition, College of Home Science, Bikaner (Raj.).
ABSTRACT
Assessment of elderly depression and development of leisure/
recreational package was conducted in Bikaner city. Three hundred
elderly aged 60-70 years belonging to different economic groups were
selected purposely from following centers - Geriatric Research and
Care Centre P.B.M, Helpage India (N.G.O.), Senior Citizen Society,
Associated Group of Hospitals and a common site i.e.: “Vradh Jan
Bhraman Path” near Town hall, Bikaner. Information was gathered
from elderly through interviewing them using standardized tool known
as “geriatric depression scale” (GDS). Further a recreational
counseling package was developed to resolve the stress, loneliness,
boredom and also to uplift the mental health. Results of findings revealed that overall 45
percent elderly were satisfied with their life contributing percentage of male is more as
compared to female. Simultaneously explored the psychological information regarding
feeling of unoccupancy, boringness, helplessness, memory loss and emotional instability.
Data depicted that females reflected more depressive symptoms when compared to males
(12.04-29.35; 9.94-36.69; 8.90-22.93; 57.06-81.65 and 2.61-39.44) for the same parenthesis
respectively. Depression is widespread among elderly persons; overall 13% elderly are in
mild depression, 4.6% in moderate depression and 1% in severe depression. Data also
revealed that females are more depressed at every level. Scores obtained for the content of
this package was 4.7. Visual quality, organization & continuity and authenticity scored 4.6,
4.6 and 4.5 respectively. Overall mean score (4.7) was also rated in the range of good to
excellent category. The study concluded that recreational counseling package can be an
effective measure for bringing about favorable changes in elderly‟s lifestyle.
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 6.041
Volume 5, Issue 8, 762-774 Research Article ISSN 2278 – 4357
*Corresponding Author
Namrata Jain
Ph.D Scholar, Department
of Food and Nutrition,
College of Home Science,
Bikaner (Raj.).
Article Received on
06 May 2016,
Revised on 27 May 2016,
Accepted on 16 June 2016,
DOI: 10.20959/wjpps20168-7286
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Jain et al. World Journal of Pharmacy and Pharmaceutical Sciences
KEYWORDS: Geriatric depression scale, leisure/ recreational package.
INTRODUCTION
A grey wave is rapidly setting on the world with the rate of growth of aging population
exceeding that of the general population. According to world health organization, what was
an extra ordinary achievement for the last century will be one of the greatest challenges for
the present one- ensuring quality of life of an exceptionally large elderly population.
Ageing refers to a sequence of changes across a life span of an individual. Though ageing is
multidimensional process, old age is the closing period of the life of an individual. It is period
when people move away from their more desirable period or times of „usefulness‟. Ageing is
the progressive and generalized impairment of functions resulting in the loss of adaptive
response to stress and in increasing the risk of age related diseases. The overall effect of these
alterations is an increase in the probability dying, which is evident from the rise in age-
specific death rates in the population (Dey, 2008). Population ageing is a worldwide
phenomenon, and India is no exception. Indian population has approximately tripled during
the last 50 years, but the number of elderly Indians has increased more than four fold. Census
of 2001 has shown that the elderly population (60$) of India accounted for 77 million and
census of 2011 projections indicated that elderly population has crossed the 100 million
mark. It took more than 100 years for the aged population to double in most of the countries
in the world, but in India it has doubled in just 20 years. The life expectancy has also gone up
to over 70 years today. Better medical facilities, care and liberal family planning policies
made the elderly the fastest growing section of the society in India.
According to Erik Erikson‟s "Eight Stages of Life" theory, the human personality is
developed in a series of eight stages that take place from the time of birth and continue on
throughout an individual‟s complete life. Old age as a period of "Integrity vs. Despair",
during which a person focuses on reflecting back on their life. Those who are unsuccessful
during this phase feel that their life has been wasted and experience many regrets and left
with feelings of bitterness and despair. Those who feel proud of their accomplishments feel a
sense of integrity. These individuals attain wisdom, even when confronting death. Coping is a
very important skill needed in the aging process to move forward with life and not be 'stuck'
in the past (Erikson, 1968).
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It is also not well known that depression is the most common mental health problem of later
life. Although it is more readily treatable, it has received scant attention compare with
dementia. Depression in elderly is not an unitary entity (Beekman, 1996). Following
symptoms must have been presented in depressive illness like depressed mood most of the
day, nearly every day, as indicated feels sad or empty, appears tearful. Markedly diminished
interest or pleasure in all or almost all activities, significant weight loss when not dieting or
weight gain or decrease or increase in appetite nearly every day. Insomnia or hypersomnia
nearly every day, feelings of restlessness or being slowed down, Fatigue or loss of energy
nearly every day, feeling of worthlessness or excessive or inappropriate guilt, diminished
ability to think or concentrate, lastly recurrent thoughts of death, recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide. There
is considerable controversy over whether the general increase in life expectancy is associated
with the compression or expansion of morbidity in later life.
Thus present study is aimed to assess the depression of elderly and to develop leisure/
recreational package for elderly.
METHODOLOGY
1 Locale of the study and selection of sample
The study was conducted on elderly both male and female residing in Bikaner city., A total
number of 300 elderly aged 60-70 years belonging to different economic groups were
selected for the present investigation purposely from Geriatric Research and Care Centre
P.B.M, Helpage India (N.G.O.), Senior Citizen Society, Associated Group of Hospitals of
Bikaner City and a common site i.e.: “Vradh Jan Bhraman Path” near Town hall, Bikaner.
2 Assessment of mental Health
Assessment of mental health was done with the help of Geriatric Depression Scale (GDS).
Depression is common in late life, affecting nearly 5 million of 31 million Americans aged 65
and older. Depression is not a natural part of aging. Depression is often reversible with
prompt recognition and appropriate treatment. However if left untreated, it may result in the
onset of physical, cognitive, functional, and social impairment, as well as decreased quality
of life, delayed recovery from medical illness and surgery, increased health care utilization
and suicide (Blazer,2009).
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Tool
The Geriatric Depression Scale (GDS), first created by Yesavage, et.al, 1983 has been tested
and used extensively with older population. The GDS is a brief, 30-item questionnaire in
which participants are asked to respond yes or no in reference to how they felt on the day of
administration. Scores of 0-9 were considered normal; 10-19 indicated mild depression; over
20 were suggestive of severe depression.
Validity/Reliability
The GDS was found to have 92% sensitivity and 89% specificity when evaluated against
diagnostic criteria. In a validation study comparing the long and short forms of the GDS for
self rating of symptoms of depression, both were successful in differentiating depressed from
non depressed adults with high correlation (r = .84, p< .001) (Sheikh and Yesavage, 1986).
3. Leisure Profile
Stress in the elderly has many sources, including the loss of partner, financial stress, health
problems and lack of independence, which affect them both physically and psychologically.
Hence information is gathered from the subjects how they resolve their boredom and
loneliness and type of recreational activities through which they are most of the time
engaged.
4. Development of Recreational Counseling Package
Some elderly cope up with psychosocial changes, others experience extreme frustration and
mental distress. Many times negative traits like senile attitude, sad, hopelessness, loneliness,
timidness etc. develop in older adults, resulted in stress and mild depression. This package is
developed to educate about recreational and leisure activities to resolve boredom and
loneliness and information to uplift the mental health. Recreational counseling package
included different activities in which elderly can get engage to resolve loneliness, tips to
positive attitude and importance of social activeness.
5. Evaluation of the Package
The package was orderly arranged to maintain continuity and were evaluated by panel
members consisting nutritionist, medical and physical experts. They evaluated the package
for different quantitative and qualitative factors viz. content, authenticity, organization,
continuity and visual quality using modified version of evaluation form based on 5- point
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scale. On the basis of their suggestions further modification will be made in the package if
needed.
6. Analysis of Data
The data obtained from various analyses were organized and statistically analyzed by using
suitable statistics to find out significance of the results (Gupta, 1998).
RESULTS AND DISCUSSION
In the present study maximum number of overall elderly passes their leisure time by watching
T.V (78%) followed by reading (73%). More over males are more indulge in both activities
than females (81.67% and 71.55%) (83.24% and 55.04%). Further females enjoyed cooking
(44.03%), handy crafts (27.52%) and other activities (16.51%) more than males. Other
activities include religious prayers, social get together. In handy craft mostly stitching,
embroidery and knitting is done. Moreover in some leisure activities like music (12.56 and
11), writing (6.28 and 2.75) and gardening (23.56 and 24.77) both the counterparts spent
almost similar percentage (Table I).
Although the physical and psychological benefits of feeling in control are well-documented
in the research literature, the mechanisms that account for these effects have received less
attention. The present study was designed to examine the potential mediating role of
exercising and participation in nonphysical leisure activities, such as attending cultural
events, involvement in volunteer organizations, and so on, in the relation between perceived
control and well-being in seniors. The results indicated that an internal locus of control was
positively related to exercising and participation in leisure activities. Exercising and leisure
activity participation, in turn, were predictive of better perceived health and greater life
satisfaction. These findings point to the potential benefits of increasing seniors' sense of
control as a means to promote exercising and to increase leisure activity participation and,
consequently, to enhance well-being (Menec and Chipperfield, 1997).
Table (I) Distribution of elderly according to passes their leisure time
S.No Hobbies Male(191)
(%)
Female(109)
(%)
Overall(300)
(%)
1 Reading 159(83.24) 60(55.04) 219(73)
2 Writing 12(6.28) 3(2.75) 15(5)
3 Music 24(12.56) 12(11) 36(12)
4 Cooking 9(4.71) 48(44.03) 57(19)
5 Gardening 45(23.56) 27(24.77) 72(24)
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6 Watching T.V 156(81.67) 78(71.55) 234(78)
7 Handicraft 0 30(27.52) 30(10)
8 Other 27(14.13) 18(16.51) 45(15)
Note- figures in parenthesis indicates percentage of subjects
Assessment of Mental Health
Depression in older people is frequently undiagnosed or misdiagnosed because symptoms are
confused with other medical illness. Untreated depression has serious side effects on older
adults. It diminishes the pleasure of living; including eating. It exacerbates other medical
conditions and it can compromise immune function. It is associated with decreased appetite,
weight loss and fatigue (Mahan, et al., 2012). Assessment of mental health would be done
with the help of Geriatric depression scale (GDS). The GDS is widely recommended for
clinical use and is included as a routine part of a comprehensive geriatric assessment. It is
also increasingly being used in research on depression in the elderly (Gallo, et al., 1995).
Table (II) Distribution of subjects with respect to psychological information
S.No Psychological
information
Male(191)
(%)
Female(109)
(%)
Overall(300)
(%)
1 Satisfied with life 89(46.59) 46(42.20) 155(45)
2 Feel unoccupied 23(12.04) 32(29.35) 55(18.53)
3 Get bored 19(9.94) 40(36.69) 59(19.16)
4 Feel helpless 17(8.90) 25(22.93) 42(14)
5 Memory loss 109(57.06) 89(81.65) 198(66)
6 Full of energy 99(51.83) 42(38.53) 141(47)
7 Frequency feel like
crying 5(2.61) 43(39.44) 48(16)
8 Make decision 128(67.01) 69(63.30) 197(65.66)
Note- figures in parenthesis indicates percentage of subjects
Table (II) unfolds the psychological information of elderly and data revealed that overall 45
percent elderly were satisfied with their life in which percentage of male was more as
compared to female. Further view explored psychological information regarding feel
unoccupied, get bored, feel helpless, memory loss and frequently feel like crying percentage
depicted females reflected more depressive symptoms when compared to males (12.04-29.35;
9.94-36.69; 8.90-22.93; 57.06-81.65 and 2.61-39.44). Whereas male elderly (51.83%) were
more full of energy as compared to female elderly (38.53%). Also 67% males were more
capable in taking own decision while, (63.3%) females take advise while taking any decision.
Over all data showed that males were stronger enough to withstand against age related
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depression as compared to females. This might be due to the fact that females have fear for
their life and they are more dependent on the spouse.
Table (III) Distribution of elderly according to the level of depression
S.No Category Male(191)
(%)
Female(109)
(%)
Overall(300)
(%)
1 Mild depression 12(6.2) 27(24.77) 39(13)
2 Moderate
depression 4(2.09) 10(9.17) 14(4.6)
3 Severe depression 1(0.52) 2(1.83) 3(1)
Note- figures in parenthesis indicates percentage of subjects
Depression is widespread among elderly persons, affecting one in six patients treated in
general medical practice and even higher percentage of those in hospitals and nursing homes.
Older people have the highest suicidal rate of any group, and many medical problems
common to older people may be related to, or intensified by a depressive disorder (Sadavoy,
et al., 1997). Table (III) revealed that overall 13% elderly are in mild depression, 4.6% in
moderate depression and 1% in severe depression. Data also revealed that females are more
depressed at every level.
Jongenelis, et al., 2004 studied the risk indicators of depression in elderly depressive
symptoms were measured by means of GDS results revealed the prevalence of major
depression was assessed to be 8.1% and the prevalence of minor depression was 14.1%,
while a further 24% of the patients suffered from sub-clinical depression. Similar study by
Bordy, et al., 2001 concluded Depressive disorder is a significant problem for the elderly
afflicted with advanced macular degeneration. Further research on psychopharmacologic and
psychotherapeutic interventions for depressed AMD patients is warranted to improve
depression and enhance functioning. Over and above depression, visual acuity aided in
predicting vision-specific disability. Treatment strategies that teach patients to cope up with
vision loss should be developed and evaluated. Package was designed to achieve the
objectives of the study. For the evaluation of the package, relevant information was organized
and evaluated on 5 point rating scale by 10 panel members comprised of subject matter
specialists, medical and physical experts. On the basis of their suggestions further
modifications were incorporated in the content and language, new information was added,
unnecessary information was deleted, and some illustrations were replaced.
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Table (IV) Mean Scores of evaluation packages
Mean and Standard Deviation
Leisure/ Recreational Package: Table (IV) reported that the scores obtained for the content
of this package was 4.7. Visual quality, organization & continuity and authenticity scored 4.6,
4.6 and 4.5.Overall mean scores (4.7) was also rated between good and excellent category.
Package Visual
quality Content
Organization &
Continuity Authenticity Overall
Leisure/
Recreational
Package
4.6±0.49 4.7±0.68 4.6±0.37 4.5±0.55 4.7±0.04
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