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A STUDY TO ASSESS THE KNOWLEDGE OF
PERCEIVED HEALTH PROBLEMS AMONG ELDERLY PEOPLE &
FACILITIES PROVIDED TO THEM IN SELECTED OLD AGE HOMES
IN BANGALORE CITY.
By
Mona Prabhakar Londhe.
Dissertation submitted to theRajiv Gandhi University of Health Sciences,
Karnataka, Bangalore.
In Partial fulfillment of the requirements for the degree of
MASTER OF SCIENCES
In
MEDICAL SURGICAL NURSING.
Under the guidance of
Prof. SHEELA THANGAM Msc (N)
DEPARTMENT OF MEDICAL SURGICAL NURSINGNAVANEETHAM COLLEGE OF NURSING HORAMAVU
BANGALORE 43.
APRIL 2010.
I
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation/thesis entitled “A STUDY TO
ASSESS THE KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS
AMONG ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN
SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide
and genuine research work out by me under the guidance of Prof (Mrs)
Sheela Thangaym, Department of Medical Surgical Nursing, Navaneetham
College of Nursing, Hormavu, Bangalore 560043.
Date: - Signature of the CandidatePlace: - (Mona Prabhakar Londhe)
II
CERTIFICATION BY THE GUIDE
This is to certify that the dissertation entitled “A STUDY TO ASSESS THE
KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS AMONG
ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN
SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide
research work done by Mona Prabhakar Londhe in partial fulfillment of
the requirement for the degree of Master of Science in Medical Surgical
Nursing.
Prof (Mrs.) Sheela Thangam, Head of Department of Medical Surgical Nursing, Navaneetham College Of Nursing.
Place:-Bangalore
Date:-
III
ENDORSMENT BY THE HOD,
PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A STUDY TO ASSESS THE
KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS AMONG
ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN
SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide
research work done by Mona Prabhakar Londhe, under the guidance of Prof
(Mrs.) sheela thangam, Department of Medical Surgical Nursing,
Navaneetham College Of Nursing Hormavu Bangalore 560043.
Seal & Signature of the HOD. Seal & Signature of the Prof.Sheela Thangam. Principal, Msc (N) Prof. (Mrs) Indira.V Department of Medical Surgical NursingProfessor and Head, of Nursing. Department of Medical Surgical Nursing,Navaneetham College Of Nursing, Hormavu,Bangalore 43. Date: - Date:-
Place: - Place:-
IV
COPYRIGHT
Declaration by the Candidate
I here declare that the Rajiv Gandhi University of Health Science, Karnataka
shall have the rights to preserve, use and disseminate this dissertation in
print or electronic format for academic/research purpose.
Place: - Bangalore.
Date: - Signature of the candidate (Mona Prabhakar Londhe)
@ Rajiv Gandhi University of Health Sciences, Karanataka, Bangalore.
V
ACKNOWLEDGEMENT
“I have cared for you since you were born. Yes, I carried you before you
were born. I will be your God throughout your lifetime – until your hair
is white with age. I made you, and I will care for you. I will carry you
along and save you.” Isaiah 46:3-4.
First of all I Humbly Praise and Thank the Lord Almighty for his great
support, strength and Knowledge he has provided me to complete my study.
Gratitude can never be adequately expressed in words but this is only the
deep perception which makes the words flow from ones inner heart.
I express my sincere thanks to Mrs.Navaneetham Raju, for her continues
Love and Encouragement for me to complete the study.
I specially thank the chairman, Mr.Sampath Raj, and the Secretary, Mrs
Kavitha Sampth Raj, for their continues support to complete my study.
I would like to express my profound sense of gratitude and heartfelt thanks
to my esteemed teacher and research guide Prof. (Mrs) Sheela Thangam,
Head of Department of Medical Surgical Nursing, for her remarkable
teaching capabilities,expert guidance, valuable suggestions and support
throughout the period of this study. Her motivational effort, generous
assistance, clues to proceed further, have proved a great source of inspiration
to me in completing this study.
VI
I extend my whole hearted thanks to Prof. (Mrs) Indira.V, Principal, and
Navneetham College of Nursing for her motivation, expert valuable
suggestions, formations of ideas and thoughts and continuous and keen
interest in my dissertation work.
I extend my heartfelt thanks to Prof. (Mrs) Plantina David, Department of
Medical Surgical Nursing for her continues guidance and advice during
study.
I extend my whole hearted thanks Prof, (Mrs) Milka Madhale, Vice
Principal, KLES Institute of Nursing Science Belgaum, for her timely advice
for the successful completion of the study.
I especially thanks for the entire expert Professors for there valuable
suggestions and guidance for completion of study.
My sincere thanks to our Administrative Officer, Mr Bernadsha and other a
faculty members of Navaneetham College of Nursing.
I express my gratitude and heartfelt thanks Mr. Umapathy, Statistician, for
his guidance and co-operation to complete the study.
I especially thank to our librarian (Mrs) Jayanti for permitting and
facilitating me to make use of the reservoir of knowledge.
I extend my heart felt thanks to Mother Anntonet, The Superior of Little
Sister of the poor Home for the age Hosur road Bangalore. And all the
Sisters for there co-operation, love, and encouragement during my study.
VIII specially extend my thanks for all the Inmates from Little Sisters of the
Poor Home for the Age who gave me lots of love and co-operation during
my study period.
My special deep heartfelt and humble thanks for my beloved husband Mr.
Noel Rodgers who has supported me and the reason for all this hard work
His constant prayer, love, sacrifice, encouragement and support without
which this study would not have been possible.
My vocabulary fall short of right words to express my immense debts to my
father, mother, father-in-law, mother-in-law and all brother-in-laws,
who are the reason for all this hard work and study.
Last but not the least, my sincere gratitude and thankfulness to all well
wishers, friends and relatives for their prayers and best wishes which
helped me to carry out my study.
I extend my thanks to the faculty of Navaneetham College of Nursing for
there encouragement and support.
Place: - Bangalore. Mona Prabhakar Londhe.Date:-
VIIIRESEARCH ABSTRACT
A large percentage of today's aging population continues to live
independently despite a variety of chronic health problems. Both age and
disease related changes that affect the elderly's image of themselves; societal
values and life experiences also play a role. Health maintenance is an
ongoing challenge for these people, their families and health care providers.
Health care for a growing elderly population is also of concern throughout
the world. Individuals may have different views regarding ageing and
elderly, which reflect in the attitudes of people including aging person and of
health care providers.
Careful assessment of the aging person's perception of his or her health,
health practices, and knowledge of safety factors affecting their own health
is an important part of primary care in all settings, for especially family
practitioner (FPs) and nurses. Early detection of problems and early
intervention can prevent more serious complications and enable older adults
to maintain the highest possible level of wellness and function. Nurses and
FPs possess the knowledge, skill and caring to build a powerful
IX
understanding-communication with the seniors and to design, to implement
alternative cost-effective elder care environments or direct in old age home
and facility services.
Aim
The aim of this study was to assess the knowledge of perceived Health
Problems among elderly people and level of satisfaction of facilities
provided to them in old age homes.
Objectives Of the study.
1) To assess knowledge of perceived Health problems among elderly
people.
2) To assess the level of satisfaction with the facilities provided to the
elderly people in the old age homes as expressed by them.
Methods
The study was conducted at Little sisters of the poor Home for the
aged, Hosur Road Bangalore. The sample was selected by using purposive
sampling technique was utilized; Data collection was done for a period of
one month. Formal written permission from Little sisters of the poor home
for the aged authorities was obtained prior to data collection. data was
collected using structure interview schedule with a few open ended items
was designed to assess perceived health problems of elderly, and the
satisfaction with facilities provided to them in old age home. Data was
analyzed using descriptive and inferential statistics.
X
Results
The results of this study shows in the physiological, psychosocial and
financial situation among people aged 60 and above years or older, Health
conditions, quality-of-life measures (QOLM) and housing problems
affecting it are presented. Nearly one-third of the elderly people could not
read a newspaper with or without glasses, more than one-third had impaired
hearing, 47% had some sort of mobility problem (MP) and 66% reported
some form of sleeping problem (SP). 42% felt lonely sometimes or often and
65% were worried, in most cases about the risk of falling. In spite of this,
87% rated their health as good and 79% were content or rather content with
their situation. Even though eyesight and hearing problems were common in
this study, they did not affect perceived health to any large extent. Mobility
problems (MP) and sleeping problems (SP) had a greater impact. The most
important factors related to perceived health (PH) were activity score,
contentment and mobility problems. Contentment was affected by activity
score and loneliness and the latter was in turn affected by age and type of
dwelling. The practical implication of these findings is that perhaps more
attention should be focused on efforts to improve old people's satisfaction
with their life situation rather than on marginal improvements of their
medical situation.
XI
Interpretation and conclusion
Assessment of the perceived health problems (PHP) of elderly people
means to assess or to study the health problems which are related to age
factor.
For eg. In today’s life there are so many elderly people facing the health
problems such as hearing loss or impaired hearing nearly one third of elderly
people could not read a news paper with or without glasses
Some had some sort of mobility problem & some form of sleeping
problem ,some felt loneliness ,in most cases were worried about the risk of
falling ill in spite of their good health, the remaining were adjusting with
there situation, eventhough eyesight & hearing problem is common old age
is similar to child hood, children are treated by pediatrician &similarly the
aged are treated by geriatrician. Early diagnosis is always a better chance for
cure, prevention of the diseases& complications these assessments can help
to identify early sign & symptoms of diseases. It is good to assess there
physical, economical, emotional background, old age homes are a necessity
in the present day scenario as the younger generation do not have the time or
in many cases the resources to meet their needs (like medical expenses,
special food etc). But old age homes should be considered only as a
secondary option. Elders in the family are definitely an asset. It is they who
can impart the much needed ethical values and code of conduct in the
younger generation. Old age homes as an option should be considered only
for the betterment of the senior citizens (SC) by way of better physical and
mental status, greater possibility for social bonding etc. Under no pretext
XII
Should the aged be made to feel that they are a burden and hence turned
away. Builders can also consider allocating a few houses for the senior
citizens within an integrated township (at subsidized rates), so that the
feeling of isolation goes away while proximity to dear ones is maintained.
Key Words
Perceived health problems, Old age homes, senior citizens, social
bonding, and proximity.
XII
TABLE OF CONTENTS
Chapter No. Title. Page No.
1 Introduction
2 Objectives
3 Review of literature
4 Methodology
5 Results
6 Discussion
7 Conclusion
8 Summary
9 Bibliography
10 Annexure
XIV
LIST OF ABBREVATIONS USED
QOLM - Quality-of-life measures.
MP - Mobility Problem.
SP - Sleeping Problem.
PHP - Perceived Health Problem.
SC - Senior citizens.
OAG - Old Age Home.
XV
LIST OF FIGURESFigure
No.Title. Page No.
1 Conceptual frame Work.
2 Distribution of samples according to Age.
3 Distribution of samples according to Gender.
4 Distribution of samples according to the Education.
5 Distribution of samples according to the Marital Status.
6 Distribution of samples according to the Previous Occupation.
7 Distribution of samples according to the Duration of Stay.
8 Distribution of samples according to the Financial Dependency.
9 Distribution of samples according to the Self Care Activities.
10 Distribution of samples according to History of health illness.
11 Distribution of samples according to Dietary status.
12 To assess the knowledge of the elderly people on perceived health.
13 To identify the facilities provided for the elderly people in old age home.
14 Association between age and knowledge level of elderly people.
15 Association between gender and knowledge level of elderly people.
16 Association between Marital status and knowledge level of elderly people.
17 Association between education and knowledge level of elderly people.
18 Association between occupation and knowledge level of elderly people.
19 Association between previous occupation and knowledge level of elderly people.
20 Association between duration of stay and knowledge level of elderly people.
21 Association between financial dependency and knowledge level of elderly people.
22 Association between self care activities and knowledge level of elderly people.
23 Association between history of health illness and knowledge level of elderly people.
24 Association between dietary and knowledge level of elderly people.
25 Age Pyramid
XVI
LIST OF TABLES
Table No. Title Page No.1 Analysis of sample characteristics of elderly people
regarding demographic variables
2 To assess the knowledge of the elderly people on perceived health.
3 To identify the facilities provided for the elderly people in old age home.
4 To find the association between the knowledge of old age people on perceived health problems and demographic variables.
LIST OF ANNEXURES
Annexure No.
Title Page No.
1 Letter seeking permission to conduct the research study.
2 Letter requesting expert opinion to establish content validity.
3 Letter granting permission to conduct the research study.
4 Letter requesting opinions and Suggestions of experts for establishing content validity of the research.
5 Letter requesting participation of the elderly people in the study.
6 List of content validators of the of the prepared tool.
7 Letter of permission of Joint Director of Lal Bag for Flower Show for elderly people.
8 Photos of Researcher while assisting to elderly people in Little Sisters Of The Poor Home For The Aged.
XVII
1 INTRODUCTION
Need for the study
Assessment of the perceived health problems of elderly people means
to assess or to study the health problems which are related to age factor.
For eg. In today’s life there are so many elderly people facing the health
problems such as hearing loss or impaired hearing nearly one third of elderly
people could not read a news paper with or without glasses
Some had some sort of mobility problem & some form of sleeping
problem ,some felt loneliness ,in most cases were worried about the risk of
falling ill in spite of their good health, the remaining were adjusting with
there situation,eventhough eyesight & hearing problem is common old age
is similar to child hood, children are treated by pediatrician &similarly the
aged are treated by geriatrician.
Early diagnosis is always a better chance for cure, prevention of the
diseases& complications these assessments can help to identify early sign &
symptoms of diseases. It is good to assess there physical, economical,
emotional background
In India about 7.5%of the population is above 60years and the life
expectancy is increasing gradually In India the aged prefer to live with their
children, sons consider it their duty to look after their aged parents they do
not allow them to be sent to old age homes the join family is the
predominant house hold from in rural and urban areas and even in the slums
but when elderly do not have family members to care for them old age
homes are their last resort .India is the second most populous country of the
world after china, at the turn of this century, the number of persons aged
60years and over was 12.1 million of these 5.5 million were male and 6.6
million were female and further to 75.9 million in 20011.
Old age was never a problem in India. Old age homes were alien in
concept and elder abuse was considered a Western problem. Not any more.
As life expectancy has increased from 41 years in 1951 to 64 years today,
hundreds of old age homes have sprung up in India. Neglect of parents has
become a big issue, so much so that the Indian government has passed "The
maintenance and welfare of parents and senior citizens bill 2006", which
makes it imperative for adult children to look after their parents. Healthy
ageing is not only related to the advances in medical technology but also to a
wide range of other factors like enabling the aged to lead a stimulating life,
being fully involved in society and having meaningful social relationships2.
Indian government is waking up to meet this challenge head on. At
present over 500 NGOs are given grant-in-aid to provide services like old
age homes, day care centers, medical facilities etc for the aged. The Delhi-
based International Federation on Aging has been campaigning for free
health care for senior citizens; decrease in the age limit for pension; a bigger,
respectable living allowance; change in the eligibility criteria so that even if
the combined family income is Rs.8,000 the senior citizen is entitled to
pension, creation and implementation of a social security scheme and so on.
Old age homes are a necessity in the present day scenario as the
younger generation do not have the time or in many cases the resources to
meet their needs (like medical expenses, special food etc). But old age
homes should be considered only as a secondary option. Elders in the family
are definitely an asset. It is they who can impart the much needed ethical
values and code of conduct in the younger generation. Old age homes as an
option should be considered only for the betterment of the senior citizens by
way of better physical and mental status, greater possibility for social
bonding etc. Under no pretext should the aged be made to feel that they are a
burden and hence turned away. Builders can also consider allocating a few
houses for the senior citizens within an integrated township (at subsidized
rates), so that the feeling of isolation goes away while proximity to dear ones
is maintained.
Help Age India is the leading advocate for Older People’s rights. We
speak up for India’s 90 million (current estimate) grey population to help
them live with dignity, independence & self-fulfillment3.
So the main Perceived health problems of the elderly people listed
below.
1. Hearing loss.
2. Impaired vision.
3. Impaired physical mobility, confusion, depression, & cognition.
4. Dementia.
5. Delirium.
6. Alzheimer’s disease.
7. Forgetfulness
8. Abnormal behavior.
9. Mentally ill.
10.Loneliness.
11.Hypertension.
12.Diabetes mellitus.
13.Acute myocardial Infarction.
14.Stroke.
15.Hyper & Hypothyroidism.
16.Chronic pulmonary problems
17.Atherosclerosis related diseases & urinary tract infection.
18.CRF and ARF.
So every elderly person likes to breath his last in dignity, This study
aims to detect the status of health of elderly people and providing proper
nursing care and health screening services in selected old age homes in
Bangalore city4.
Background of the Study.
Studies have described Home for the aged service as a frequently cited
unmet need, ours is the first to identify factors associated with the likelihood
of having unmet need for hospitalization service based on Our findings
suggested that equal use of hospitalization service for equal needs has not
been achieved, and that respondents with unmet need were mainly ‘lower-
educated’, ‘fewer enabling resources’ and ‘more needs’. Consequently, four
types of intervention aimed at reducing unmet need for Home for the aged
service are recommended.
1. Conduct health education: health education interventions can
increase seniors' knowledge of identifying symptoms of illness,
and provide the information about the availability of
hospitalization services. Accordingly, seniors with increased
knowledge and information can more effectively use
hospitalization service.
2. Create social support: because of the importance of the social
support in lowering unmet need for elderly home and
hospitalization service, health educators should work more closely
with the local community to design culturally appropriate methods
for health-promotion activities to reach the elderly population and
their families.
3. Promote community participation: the community should be
involved in the policy-making process. As India continues to
implement policies for reducing inequalities in healthcare, its
experiences should be closely monitored and evaluated.
Involvement of communities in policy evaluation is desirable to
really meet the need of the people. Especially, in the design of
allocation of health-care resources, the voices from the rural
population, especially the poor, need to be heard.
4. Promote inter-sectional cooperation: inter-sectional collaboration
and cooperation with other departments should be enhanced. In
India it is especially important to have harmonious coordination
between sectors because there are at least four departments
(including Departments of Health, Women's Federation,
Committee on Aging Population) at the community level that are
related to health issues of the aging population. For example, in
conducting health education, effective communication is needed
between the Departments of Health and Propaganda5.
This study, we used self-reports of diagnosed chronic disease as the
objective, professional evaluation of need. Respondents were asked
long-term conditions that had lasted or were expected to last 6 months
or longer and that had been diagnosed by a health-care professional.
Interviewers read a list of conditions and the number of positive
responses that respondents answered to the 30 specific conditions plus
an ‘other, specify’ option were summed and categorized as 0, 1, 2 and
3 or more. The 30 chronic conditions considered were: hypertension,
gastric ulcer, diabetes, gallstone disease, arthritis or joint conditions,
stroke, bone hyperplasia, osteoporosis, chronic faucitis,
intervertebraldisc disease, chronic bronchitis, chronic pulmonary heart
disease, pulmonary emphysema, asthma, coronary heart disease,
anemia, chronic hepatitis, hyperthyroidism, Alzheimer's disease,
depression, anxiety, cataract, prostate hyperplasia, womb flesh tumor,
cervical cancer, lung cancer, liver cancer, breast cancer, stomach
cancer and colorectal cancer6
2 OBJECTIVES
Statement of the problem
A STUDY TO ASSESS THE KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS
AMONG ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN SELECTED
OLD AGE HOMES IN BANGALORE CITY.
Objectives of the study.
1) To assess knowledge of perceived Health problems among elderly
people.
2) To assess the level of satisfaction with the facilities provided to the
elderly people in the old age homes as expressed by them.
Operational Definitions
Perceptions
Refers to the Elderly people’s faculty of awareness, understanding and
insight in to their health problems and the facilities provided to them in old
age homes.
Health Problems
Refers to the verbal responses of any difficulty experienced by elderly
people regarding physical, physiological, psychological economical and
spiritual as measured using a structured interview schedule and rating scale
with a few open ended items.
Elderly People.
Refers to male and female individuals over 60years of age residing in
the old age homes under the change of care givers.
Elder Abuse
Many types of abuse construe the definition of elder abuse. In general,
elder abuse may be defined as any physical, psychological, or material abuse
toward an elderly person. Additionally, violation of the elder’s right to
safety, security, and adequate health care constitutes elder abuse (Anderson,
Glanze, & Anderson, 1998, p. 2DE8).
Verbal/Psychological Abuse
Verbal abuse or psychological abuse is characterized by inflicting
mental anguish (Wolf, 1996). Humiliation, intimidation, yelling, and threats
are some of many examples of verbal abuse. Keeping an elderly person
isolated from others can also cause psychological distress and lead to more
serious issues such as depression
Financial Abuse
The illegal or improper exploitation and use of funds of an elderly
person denote financial abuse (Wolf, 1996). Theft, fraud, and taking
advantage of a cognitively impaired older person for profit or personal gain
constitute financial abuse. Financial abuse of the elderly tends to occur
overtime rather than a single, overt act such as robbery, purse snatching, or
car jacking.
Neglect/Self-Neglect.
Neglect by others or by oneself is characteristic of elder abuse.
Refusing or failing to fulfill care-taking obligations, aged adults were more
likely to perceive psychological abuse as being harmful to the victim than
younger adults.
Facilities
Refers to an environment with opportunities or means for necessities,
comfort and rest, that include food, living, care in health and illness and
recreational facilities.
Old age homes
Refers to institutions where the elderly people reside and are care for
Satisfaction
Refers to the extent of fulfillment or contentment with the facilities
provided to the elderly people residing in old age homes as measure using a
structured interview schedule.
Assumptions
1) The elderly people living in old age homes to have health needs.
2) The elderly people have varying self care abilities and functional
performance.
3) The elderly people participating in the study will be willing to
express their health problems and the level of satisfaction of
facilities provided to them in old age homes.
Hypothesis
H1) The elderly people living in old age homes to have health needs.
H2) The elderly people have varying self care abilities and functional
performance.
H3) The elderly people participating in the study will be willing to express
their health problems and the level of satisfaction of facilities provided to
them in old age homes.
Scope of the study
1) This study will provide a data base for planning and organizing health
services for the elderly.
2) The study will provide a baseline to find out the perceived health
problems of the elderly people and facilities provided to them.
3) The study will also motivate caregivers and significant others, to be
aware of the perceived health problems of the elderly people and be
able to render adequate care.
4) Identification of the perceived health problems and facilities,and
subsequent planning, implementation and evaluation will improve the
quality of care to the elderly people in old age homes.
Conceptual Frame Work.
For structuring the predictor variables of the study, we rely on the
behavioral model of health service use developed by Andersen as the
conceptual framework. This model suggests that people's use of health
services is a function of their predisposition to use services, factors which
enable or impede use, and their need for care. Predisposing variables were
demographic factors, social characteristics, and health beliefs. They
represent the sociocultural element of the behavioural model. The enabling
variables contain factors which make health services available and include
both personal/familial and community resources. First, people must have the
means and knowledge to get to those services and make use of them.
Second, health personnel and facilities must be available for individuals. The
need component is specified as the most immediate cause of health service
use, and involves both perceived and evaluated health status. Perceived need
included the amount of illness that an individual perceives and explains
individuals care-seeking and adherence to medical regimens, while
evaluated need is more closely related to the kind and amount of treatment
to be provided.
A conceptual frame work is a theoretical approach to the study of
problems that are scientifically based and emphasizes the selection
arrangement and classification of its concepts
Fig -1: Conceptual framework on the perceived health problems of the
elderly people and the facilities provided in old age homes based on the
health belief model.
Individual Modifying Likelihood of
Perception Factors Action
Age, Sex, Ethnicity,
Personality,Socioeconomic,
Knowledge
Perceived Benefits minus
Perceived Barrier
Perceived Susceptibility /
Perceived Severity
Perceived Threat
Likelihood of Behavior
According to the Health Belief Model, modifying variables, cues to action,
and self-efficacy affect perception of susceptibility, seriousness, benefits and
barriers and, behavior based on individual’s perceptions, modifying factors,
likelihood of action.23
Cues to Action
3 REVIEW OF LIERATURE
The task of reviewing research literature involves the identification
selection critical analysis and written description of existing information on
the topic of interest. When a general topic has already been selected readings
on that topic help to bring the problem in to sharper focus and aid in the
formulation of appropriate research questions. (Polit 1978)
For the readers understanding the reviewed, literature has been
presented under the following headings.
1) Literature related to Perceived Health Problems in Elderly People.
2) Literature related to Self care abilities of Elderly People.
3) Literature related to level of satisfaction with the facilities provided
to the elderly people in the old age homes.
Literature related to Perceived Health Problems in Elderly People
Growing older can be a frightening and stressful experience, especially for
those who feel lonely. Before continuing, allow me to make a distinction
between “being alone” and loneliness. Some older adults may prefer to
spend time alone, however feeling lonely (or experiencing constant
loneliness) is a different experience altogether On one hand, research has
shown that older adults tend to focus on relationships that make them
happier, while letting other relationships fade Feeling “lonely” is an
emotional reaction a person has when he or she has no one to talk to about
problems, and feels isolated and cut off from others Loneliness is different
for everyone, but life changes, such as retirement, losing a spouse, and
having friends and family move away can lead to isolation Also, as we age,
people have more health problems, which eventually begin to interfere with
mobility, making it harder for older adults to leave their homes24
It isn’t surprising that the combination of life changes and mobility problems
may lead to feelings of loneliness. Although research has shown that
loneliness is relatively stable over a person’s lifetime, in the later ages,
feelings of loneliness become a much greater possibility In fact, a recent
study found that for adults over the age of 65, 35% reported that they were
lonely, with 9% describing it as physically painful and another 6% saying it
was almost impossible for them not to feel lonely In this blog I will discuss
who is most likely to suffer from loneliness, the health effects of loneliness,
and how can we help to prevent loneliness in older adults. I will also provide
links to major press releases which provide more information when
possible.25
Hypertension, especially isolated systolic hypertension, is commonly found
in older (60–79 years of age) and elderly (≥80 years of age) people.
Antihypertensive drug therapy should be considered in all aging
hypertensive patients, as treatment greatly reduces cardiovascular events.
Most classes of antihypertensive medications may be used as first-line
treatment with the possible exception of α- and β-blockers. An initial blood
pressure treatment goal is less than 140/90 mmHg in all older patients and
less than 150/80 mmHg in the nonfrail elderly. The current paradigm of
delaying therapeutic interventions until people are at moderate or high
cardiovascular risk, a universal feature of hypertensive patients over 60
years of age, leads to vascular injury or disease that is only partially
reversible with treatment. Future management will likely focus on
intervening earlier to prevent accelerated vascular aging and irreversible
arterial damage. Hypertension is a highly prevalent disorder in older people.
In a recent population-based survey of adults aged 20–79 years in Canada,
hypertension, defined as a blood pressure of 140/90 mmHg or more or being
on antihypertensive medications, was present in 21.3% of the population
overall and 51.6% among those 60–79 years of age. Similar or even higher
age-dependent prevalence rates have been reported worldwide. Hypertension
is a major risk factor for cardiovascular and renal disease, and numerous
clinical trials including studies in older subjects have documented that
effective treatment improves survival and confers cardiovascular
benefits.current knowledge about hypertension in aging individuals. In this
article, older people aged 60–79 years are considered separately from the
very old or elderly, defined as 80 years of age or more. The presence of
comorbid conditions such as diabetes mellitus, chronic kidney disease or
previous cardiovascular disease, which increases with age, may affect the
epidemiology of hypertension and approach to treatment, especially in the
elderly.26
The Albertina Project is an epidemiological study of the medical, social and
economic situation among people aged 75 years or older in Uppsala,
Sweden. In this report, health conditions, quality-of-life measures and
housing problems affecting it are presented. A postal questionnaire was sent
to an 11% random sample (n = 959) of the eligible population out of which
706 (74%) persons responded. Nearly one-third of the elderly people could
not read a newspaper with or without glasses, more than one-third had
impaired hearing, 47% had some sort of mobility problem and 66% reported
some form of sleeping problem. Forty-two per cent felt lonely sometimes or
often and 65% were worried, in most cases about the risk of falling. In spite
of this, 87% rated their health as good and 79% were content or rather
content with their situation. Even though eyesight and hearing problems
were common in this study, they did not affect perceived health to any large
extent. Mobility problems and sleeping problems had a greater impact. The
most important factors related to perceived health were activity score,
contentment and mobility problems. Contentment was affected by activity
score and loneliness and the latter was in turn affected by age and type of
dwelling. The practical implication of these findings is that perhaps more
attention should be focused on efforts to improve old people's satisfaction
with their life situation rather than on marginal improvements of their
medical situation.27
Prevention of falling risk in elderly people: the relevance of muscular
strength and symmetry of lower limbs in postural stability. J Strength Cond
Res 25(2): 567-574, 2011-Falls are one of the major health problems
affecting the quality of life among older adults. The aging process is
associated with decreasing muscle strength and an increasing risk of falling.
The variables and techniques adopted to quantify muscular strength and
postural stability were different in each protocol; a great number of reports
analyzed the risk factors and predictors of falls, but the results appear still
uncertain. To date, there is no clear, definitive statement or review that has
examined the effect of the quadriceps strength on static balance
performances in different sensory conditions. This contribution aims to
provide an overview of experimental works to increase the comprehension
and prevention of falls and fall-related injuries in the elderly. Based on a
review of the literature, this work was designed to explore the relationship
among risk of falls, postural stability, and muscular strength of lower limbs
in older adults.28
Lack of social support increases the risk of mortality and supportive
relationships are associated with lower illness rates, faster recovery rates and
higher levels of health care behaviour (Dhar, 2001).
Falls and fracture are common in older women and men. Recurrent
falls due to intrinsic causes need complete evaluation of the underlying
medical condition and require preventive measures. Sedative use was most
commonly associated with falls. In order to improve the health status of the
elderly population it is important to carry out more studies in different areas
to identify various factors that are related to disability, which should lead to
efforts to develop effective programmes in fall prevention.29
As people age, the ability to interact with the outdoors may lessen. Frailty
and mobility problems create barriers to engaging in outdoor activities or
even experiencing the outdoors. The barriers are greater for people with
dementia. As the disease worsens to the point of institutionalization, access
to the outdoors may be completely barred and opportunities relinquished to
the determination of facility personnel. This article will review current
literature and some older seminal works on nature and nature-based stimuli
for people with dementia, especially those living in nursing homes.30
Dry mouth (salivary hypofunction, xerostomia) is a common problem
among older people. It causes significant oropharyngeal disorders, pain and
an impaired quality of life. Dry mouth has many causes, from local salivary
disorders to a plethora of medications and medical conditions. Treatments
are designed to correct the underlying cause and/or to enhance salivation
with topical and systemic stimulants. Early intervention for dry mouth
problems helps prevent the deleterious consequences of this disorder in
elderly people.Clinicians must be aware of dry mouth problems in older
patients, and they should be prepared to provide a diagnosis and administer
treatment to protect a patient's oropharyngeal health and quality of life.31
Literature related to Self care abilities of Elderly People.
To determine the concurrent influence of depressive symptoms, medical
conditions, and disabilities in activities of daily living (ADLs) on rates of
decline in cognitive function of older Americans.
Prevalent and incident depressive symptoms, stroke, and ADL disabilities
contribute independently to poorer cognitive functioning in older Americans
but do not appear to influence rates of future cognitive decline. Prevention,
early identification, and aggressive treatment of these conditions may
ameliorate the burdens of cognitive impairment 32.
Physical activity, a large proportion of older adults still lead a sedentary
lifestyle. Especially, for older residents of LTC institutions, ability and
resources for practising physical activity are more restricted than
community-dwelling older adults. They are very likely to encounter barriers
to physical activity. However, little is known about what factors impede
them from being physically active. To implement successful interventions,
more information is needed to address barriers to regular physical activity.
physical activity can be personal or environmental, including physical health
problems and physical frailty, fear of resultant injury or falling, past
sedentary lifestyle, insufficient understanding about physical activity and
environmental restriction33.
The findings advance knowledge of barriers that impede the institutionalised
older adults to perform physical activity. Participation in physical activity
was negatively influenced by these barriers. However, these barriers are
modifiable. Assessment and problem solving to overcome barriers could
result in positive outcomes.
Health care providers are in a unique position to influence older residents to
adopt regular physical activity. Health care providers should consider these
barriers to the development and maintenance of physical activity and to plan
effective individual interventions to reduce these barriers. In planning
physical activities, it is also important to provide a supportive environment34.
To explore the risk factors and management of falls in people with
intellectual disabilities and develop evidence-based recommendations.
Falling is a common cause of physical injury and impaired quality of life in
people with intellectual disability. Risk factors for falls and falls prevention
have been extensively researched in the general population but there is a
paucity of evidence specific to people with intellectual disabilities. Seven
articles met the inclusion criteria. Up to 57% of people with intellectual
disabilities experienced a fall. Falling was the cause of 50-62% of all
recorded injuries. Risk factors for falls in people with intellectual disabilities
may include older age, impaired mobility, epilepsy and behavioural
problems. There was a paucity of evidence for intervention strategies
identified.There is a lack of evidence for falls management in people with
intellectual disabilities. Findings suggest that falls are a common cause of
injury, institutionalisation and impaired quality of life in people with
intellectual disabilities. Environmental safety, careful medical management
and exercise interventions may play an important role in minimising fall-
related injuries. Further research is needed to explore risk factors for falls
and falls management in this vulnerable group.Early identification of the risk
factors and prevention of falls will inform nurses and other healthcare
professionals those who are at most risk and how to minimise injury in
people with an intellectual disability. A multi-model approach of
comprehensive assessment and tailored intervention are worthy of
endeavour35.
An estimated 19 million people (10.1%) reported some mobility difficulty.
The mean age of those with minor, moderate, or major difficulty ranged
from 59 to 67 years. Of those reporting major difficulties, 32% said their
problems began at aged 50 years or younger. Adjusted problem rates were
higher among women (11.8%) than men (8.8%), and higher among African
American (15.0%) than whites (10.0%). Persons with mobility difficulties
were more likely to be poorly educated, living alone, impoverished, obese,
and having problems conducting daily activities. Among persons with major
mobility difficulties, 30.6% reported being frequently depressed or anxious,
compared to 3.8% for persons without mobility difficulties36.
Reports of mobility difficulties are common, including among middle-
aged adults. Associations with poor performance of daily activities,
depression, anxiety, and poverty highlight the need for comprehensive care
for persons with mobility problems.
Diabetes presents many potential pathways for fatigue, but focused studies
on this symptom are rare. Furthermore, research on diabetes-related fatigue
is limited by fatigue's nonspecific symptoms and because fatigue researchers
have yet to agree on standardized definition, measurement, or diagnostic
criteria. Additionally, few diabetes randomized clinical trials included
measurement of patient-reported outcomes, such as symptoms or health-
related quality of life in their study designs, although one that did provided
some meaningful finding that symptom-focused education improved self-
management practices, Hb(A1c) levels, quality of life, and symptom
distress37.
Chronic pain in elderly patients referred to a Norwegian multidisciplinary
pain clinic. Confirm findings from a number of studies on main
characteristics of chronic pain conditions in the elderly. It is important that
regular general practitioners emphasize psychosocial factors when assessing
and treating chronic pain in the elderly. San Andrés-Torcal in Malaga, Spain
determines the needs of elderly individuals living alone and with some
degree of dependency for activities of daily live. The persons evaluated
showed numerous areas of dependency and there was a high proportion
whose basic needs were not suitably covered. Because of the multiple and
distinct problems identified, we believe that active screening should be
performed in this vulnerable population. In addition, special attention should
be paid to these individuals and the required help should be offered so that
they have information and access to the available health and social resources.
In the UK, population screening for unmet need has failed to improve the
health of older people. Those living alone were more likely to report fair or
poor health, poor vision, difficulties in instrumental and basic activities of
daily living, worse memory and mood, lower physical activity, poorer diet,
worsening function, risk of social isolation, hazardous alcohol use, having
no emergency carer, and multiple falls in the previous 12 months. After
adjustment for age, sex, income, and educational attainment, living alone
remained associated with multiple falls, functional impairment, poor diet,
smoking status, risk of social isolation, and three self-reported chronic
conditions: arthritis and/or rheumatism, glaucoma, and cataracts38.
Literature related to level of satisfaction with the facilities provided to
the elderly people in the old age homes.
In this article we explore the development of group homes for elders with
dementia in Japan since the inception of the long-term care insurance
program in 2000. We suggest that the combination of demographic and
policy trends in recent years have created a context in which entrepreneurial
activities related to elder care have increased significantly. By focusing on
one of the new institutions that has emerged, we show one way in which
social policy has had a significant influence on the lives of elders suffering
from dementia and their families. Finally, we point out some of the problems
that have arisen along with the growth of these new forms of care, such as a
lack of involvement by family members in visiting and caring for elders39.
Dutch GP's (General Practitioners) take care of people living in homes
for the elderly. The population of these homes is selected on the basis of
poor functioning on ADL (activities of daily living). We expected to find a
group of elderly people within these homes that need more complex primary
care. We describe the characteristics of care for an institutionalized elderly
population and compare these to the care provided to their independently
living peers. The design of this study is a matched case-control study in a
Dutch General Practice in the study period 1/1/1998 to 1/7/2004. Our main
results show that the rate of cognitive problems is two times, the prevalence
of depression even three times higher in older people living in a home for
the elderly than in those who live independently. Locomotory problems are a
frequent problem in homes for the elderly. Rates of chronic pulmonary
problems, atherosclerosis-related diseases and urinary tract infection are
higher, whereas no significant differences for CVA, diabetes and cancer
were found. Institutionalized older patients use more different types of
medication. GP's do not have more contacts with people living in a home for
the elderly than with older people living independently. We conclude that
people living in homes for the elderly have complex problems, and need
special attention for their specific vulnerability. Differences in care are not
primarily explained by chronic disease but by problems with mobility,
confusion, depression and cognition40.
Health Survey-Healthy Aging, 76% of Canadians in mid-life (45 to
64) and 56% of seniors reported good health in 2009. This is based on a
definition of health composed of: positive self-perceived general and mental
health, functional ability, and independence in activities of daily living.
Good health existed even in the presence of chronic conditions such as high
blood pressure, arthritis and back problems, all of which were common
among people aged 45 or older. Eight modifiable factors were associated
with good health: smoking status, body mass index, physical activity, diet,
sleep, oral health, stress, and social participation. Eighty-four percent of the
younger age group and 91% of seniors reported positive tendencies on four
or more of these factors. The more factors on which positive tendencies were
reported, the greater the likelihood of having good41.
In nursing homes, assessment and management of pain is often
problematic. Older residents in nursing homes often have several chronic
problems, such as cerebrovascular accidents, arthritis, and/or dementia
(Australian Pain Society, 2005). Physical and cognitive impairments often
make it difficult for such residents to report pain to the staff. Furthermore,
older residents often do not actively report pain, because of the stigma
associated with it or because of their own forbearance/stoicism (Hess, 2004).
The heavy workloads of nursing home staff may compound the problem,
making it difficult to identify pain among residents (Australian Pain Society,
2005). In addition, nurses tended to estimate severe pain and pain tolerance
significantly lower than patients (Bergh & Sjöström, 1999). Therefore,
nursing home staff needs to be aware of these problems and efforts should
be directed toward improving pain assessment and management.It is
important to manage pain for nursing home residents by providing
individually tailored care for each resident (Horgas & Miller, 2008). To
promote individually tailored care, it is essential to obtain all necessary
information about the pain, such as its causes, intensity, and other related
factors. Pain assessment and management should also be based on the best
available evidence from studies and tailored for the residents' circumstances
and needs (Herr, 2010). Although there are limited studies on the prevalence
of pain among nursing home residents in Japan, there is an increase in the
number of such studies worldwide that examine pain prevalence among
nursing home residents and explore the factors related to pain.
Therefore the aim of the present review was to identify studies on pain
prevalence among older residents in nursing homes and explore the factors
associated with pain in these prevalence studies. It was hoped that this paper
would serve as a basis for developing systems to manage pain and improve
the quality of life of nursing home residents42.
Probably the main point of controversy is to clearly define the role of
residential facilities, that is whether they should be conceptualized as
intensive treatment programmes, or merely as ordinary homes or living
settings for people who participate fully in treatment and psychosocial
programmes provided by local mental health services. These contrasting
objectives may actually lead to different characteristics of their functioning
and to diverse typologies of care processes, although the scientific literature
usually refers to residential facilities as a unitary concept43.
Related to this point, there is the need to develop a clear taxonomy of
residential facilities, based on specific operational criteria. This taxonomy
should spell out acceptable ranges of available residential facilities, staffing
levels, optimal size, satisfactory environmental features and activities
needed to fill residents' weekly time, and in particular weekends, evenings,
and so on. Precise patients' inclusion criteria should be developed; all
patients that are candidates for residential facility admission should receive
careful, multidimensional assessments, highlighting not only clinical
characteristics but also impairments in social and vocational roles.
Management plans and related organizational frameworks should match
residents' typologies and their various needs and requests. Patients'
rehabilitation plans should be carefully monitored with appropriate
instruments. Avoiding an indistinct case mix (i.e. aged patients mixed up
with young, treatment-resistant patients) in residential facilities is a
prerequisite for the development of tailored treatment plans and for
transforming residential facilities into effective rehabilitation settings for
those patients with realistic prospects of rehabilitation. This strategy also
implies the selection of staff with specific characteristics, and a reasonable
staff turnover should be foreseen to prevent burnout.Specific facilities,
management plans and trained staff should be available for the residential
treatment of specific patient populations, in particular patients at high risk of
violence, with dual diagnoses and with severe personality disorders (and all
these conditions are often associated).Finally, outcome research should
refrain from generic questions (e.g. 'Does residential care work?') and should
address specific questions, such as 'What kind of residential care appears to
be most effective for what kinds of residents by what type of outcomes and
in what kind of social and service context?' (Shepherd, personal
communication). Addressing these important points in research and clinical
practice will enable the whole field of residential care to progress so that it
can respond to the complexities of modern mental health care44.
4 RESEARCH METHODOLOGY
This chapter presents the methodology adapted for the study including
research approach, Research design and steps taken in the development of
the tool. Further, this chapter describes the setting, sampling techniques,
pilot study and plan for data analysis.
Research Methodology is a way to systematically solve the research
problem, in it we study the various steps that are generally adopted by a
researcher in studying her research problem along with the logic behind
(Kothari 1990)
This study was conducted with the main purpose of assessing the
health problems of the elderly as perceived by them and the facilities
provided to them in old age homes.
Research Approach
Descriptive research was used to study the research problem. Descriptive or
exploratory research studies collect detailed descriptions of existing
variables and use the data to justify and assess current conditions. (Wood
1990).It deals with the relationship between variables. the testing of
hypothesis and the development of generalizations, principles or thesis that
have universal validity (Best 1992)
Research Design:
Descriptive design to assess the knowledge of perceived health problems
among elderly people.
Setting of Study:
The setting is where the population or the portion of it that is being studied
is located and where the study is carried out.
One private old age home run by religious congregations in
Bangalore, which are well known for their care and accommodation were
selected for the purpose of the study, people above the age of 60 years reside
in this homes. This old age home had approximately 140 elderly inmates are
present. there are 70 women and 70 men’s respectively, there were both
single rooms and dormitories, more space for outdoor games, better medical
and nursing care, facilities Opportunities for Spiritual growth like retreats
and gospel meetings, physiotherapy facilities ,participation in making
handicraft, gardening, The elderly in the bigger old age home were more
social and outgoing in there behavior when compaired to the elderly of the
smaller old age home where facilities were must restricted.
Variables under Study
Variables are a concept that has measurable changing attributes.
Dependent Variables.
It is the variable which is measured or observed following the action
of the independent variable. In the present study it refers to the perceived
health problems of the elderly people.
Independent Variable.
It is the variable that precedes the dependent variable and is observed
in non experimental research (Roberts1989).In this study; it refers to the
facilities provided to the elderly people in the old age homes.
Extraneous Variables.
It is the variable which can account for change in the dependent
variables here it refers to the selected variables such as Age, sex, marital
status, Educational status, Previous Occupation, Duration of stay in old age
home, Financial dependency History of health& illness, Dietary status and
Self care activities.
Population
The target population consists of the total membership of a defined set
of subjects from whom the study subjects are selected and to whom the data
will be generalized (Adbellah 1986)
In the present study, the population consisted of the elderly people
above 60 years of age in the old age homes of Bangalore.
Sample and Sampling Technique
The set of sampling units chosen for the study is called the Sample.
Sampling
It is process of selecting a portion of the population to represent the
entire Population (polit 1995)
Here the study Sample comprised of the elderly people above 60 years
in the old age homes, fulfilling the Sampling Criteria, The purposive
Sampling Technique will be used to collect data from the available group
falling under inclusion criteria.
Criteria for selection of the sample
1) The elderly people who are 60 years and above
2) The elderly people who are able to express their problems verbally.
3) Subjects who are available at the time of the study.
4) Subjects who are residents of the old age homes.
5) Subjects who are able to understand and communicate in English.
Exclusion Criteria
1) Subjects who are unconscious or handicapped.
2) Subjects who are not able to understand English.
3) Subjects who are not willing to participate in the study.
Selection and development of study tools.
Data collection tools are the procedure or instruments used by the
researcher to observe or measure the key variables in the research problems
(Robert 1989)
The following steps were adopted in the development of the tool.
1) Review of literature provided adequate content area for the tool
preparation.
2) Personal consultation and discussion with nursing experts and
psychologists.
3) Content validity of the tool helped to frame the appropriate
statements.
4) Discussion with the personal working in the old age homes.
5) Observational visits to old age homes prior to the preparation of the
tool.
All these procedures helped in framing the appropriate tools suitable for the
study.
Description of the tool
A structured interview schedule with a few Open-ended items were
utilized for this study.
The tool consisted of 3 parts.
Part-I Demographic Data.
Part-II Tool to assess the Knowledge of Perceived health problems among
elderly people.
Part-III Level of satisfaction of the facilities provided in the old age homes.
Section A- Demographic Data (Annexure 6)
It consisted of 10 items on personal and demographic data of the
subjects in relation to their Age, Sex Educational Status, Marital status,
Previous Occupation, Duration of stay, Financial dependency Self care
activities, Hostory of health illness, Dietary status by criteria of BMI.
Section B- Assess the knowledge of perceived health problems among
elderly people.
Assessment of the perceived health problems was divided in to 3 categories,
1) Physical -----------------17 items.
2) Physiological-----------27 items.
3) Psychological------------16 items.
Section C- Level of satisfaction of facilities provided in the old age
homes.
These are subdivided in to 4 categories.
1) Food Facilities----------8 items.
2) Living Facilities----------10 items.
3) Care in Health and Illness--------5 items.
4) Recreational Facilities------------5 items.
Content Validity of the Tool.
Content validity of the tool refers to the degree an instrument
measures what it is supposed to be measured (Polit1978)
The tool was validated by Nine experts six Medical Surgical Nursing
experts, One statician, one psychologist, and one Physician, Based on their,
Suggestions and Opinions, the tool was Reformed.
Reliability of the tool
The reliability of a measuring instrument is a major criterion for
assessing its quality and accuracy.
Reliability of an instrument is the degree of consistency with which it
measures, the attributes it is supposed to be measuring. (Polit 1976)
To check the internal consistency of the tool, the investigator
interviewed eight elderly people from one of the old age home and split-half
technique was carried out.
The reliability of the half test was found out using Karl Pearson’
product.
Moment Correlation formula.
r = N ∑ XY – (∑X. ∑Y)
√(N∑X2 – (∑X)2) (N∑Y2 – (∑Y2))
The reliability of fullest was calculated using Spearman’s Brown
prophecy formula as shown below.
r11 = 2 r 1/2.1/11 1 + 1 1/2 1/11
Were,
r11 = Reliability quotient of the whole test
r1/2 1/11=Reliability quotient of the half test (Gasset 1981)
The reliability quotients obtained were 0.83 & 0.87 which was considered to
be reliable and adequate.
Pilot Study
Pilot and Hungler (1978) defined pilot study as a small scale version
or trial run of the major study. Its function is to obtain information of
improving the project or for assessing its feasibility.
The Main focus is the assessment of the adequacy of Measurement.
The pilot study was conducted in the Little Sisters of the Poor Home
for the Aged, from Nov 15th to 30th a formal permission was obtained from
the authorities.
Ten elderly people fulfilling the criteria for sample selection were
interviewed. The purposive Sampling Technique was used to select the
Samples.
From the old age home the elderly men and women 5 were selected
from sampling frame.
Certain problems were encountered during the pilot study were found
to be lengthy. Certain items were irrelevant and some items pertained to
problems which were uncommon, subjects had to be interviewed for 1&1/2
Hours, which made them tired, therefore, certain items were deleted as
suggested by the experts.
The Main Findings
Data analysis was done using descriptive and inferential Statistics.
The elderly people staying in old age homes have higher mean (72%) in
physical activities compared to physiological (67%) and (64%)
psychological problems.
The elderly people were somewhat satisfied with the facilities
provided in the old age home. They were very satisfied with the facilities
given during health and illness They were best satisfied with the food
facilities there was no significance association between the health problems
and duration of stay and there was a significance association between
physical and psychological problems.
Method of Data Collection
Written permission were obtained from the Mother Superior, of the
old age home, They were made aware of the nature of the study ad were
assured that the study would not interfere with the daily routine activities of
the elderly people.
The data was collected from Dec 10th to Jan11th 2011 .The
investigator collected the required information in the old age home.
Prior to the actual interview the investigator familiarized herself with
the subjects and explained the purpose of the study to them, She requested
the participants for their full Co-operation and prompt answers. She also
ensured the confidentiality of the subjects’ responses and the importance
sensed by their answers .An informed consent was taken from the subjects
willing to participate in the study The subjects were made to assume a
comfortable position the investigator was seated facing the subjects. The
questions listed in the schedule were read out clearly at a pace
understandable to them. No unnecessary explanation or suggestion to
answers were given.
Interviewer in the structured interview was 35-40 min. keeping in
mind the rest periods of the elderly people the interview was conducted
between 10am to 12 noon and 2:30pm to 4pm.After completion of the
interview process the investigator thanked the respondents for their
participation in the study.
Plan for data analysis
The analysis of data involves the translation of information collected
during the course of a research project in to an interpretable and manageable
forms, it involves the use of statistical procedures to give organization and
meaning to data. Descriptive and inferential statistics will be used for data
analysis in terms of frequency percentage and mean score, chi-square tests
and students t-test for the testing of hypothesis, The various categories of
analysis the numerical data based on the objectives of the study are given
below.
Projected Outcome.
Personal data will be analyzed using frequency, percentage mean score.
The perceived health problems will be analyzed in terms of frequency,
percentage and mean score.
Chi-square test would be adopted to find out the association between
perceived health problems and demographical variables in old age home.
Student’s t-test would be used to find out the difference between the
mean satisfaction score of the facilities provided to the male and female
elderly people.
5 RESULTS
This chapter deals with the analysis and the interpretation of the data
collected in order to assess the knowledge of the perceived health problems
among elderly people and facilities provided to them in selected old age
homes in Bangalore city.
The data obtained by organized in master sheet for tabulation. The
analysis of the data is organized and presented under following sections.
Objectives of the study.
1) To assess knowledge of perceived Health problems among elderly
people.
2) To assess the level of satisfaction with the facilities provided to the
elderly people in the old age homes as expressed by them.
Organization of findings
Section 1: Analysis of sample characteristics of elderly people in old age
homes regarding demographic variables
Section II: To assess the knowledge of the elderly people on perceived
health problems.
Section III: To identify the level of satisfaction of the facilities provided for
the elderly people in old age homes.
Section IV: To find the association between the knowledge of old age
people on perceived health problems and demographic variables.
Section 1: Analysis of sample characteristics of elderly people regarding
demographic variables
This section deals with description of demographic variable of sample
characteristics. The 50 elderly people were drawn from the selected old age
home in Bangalore. The data on sample were analyzed using descriptive and
inferential statistics. The data obtained from the samples are presented in
terms of age, gender, education, previous occupation, marital status,
financial dependency, self care activities, duration of stay, history of health
illness and dietary status.
a) Analysis of sample characteristics of elderly people regarding
demographic variables
Table 1
Sl. No.
Demographic Data
Frequency Percentage
1 Age60-65years 1 265-70years 13 26>70 years 36 72
2 GenderMale 15 30Female 35 70
3 Educational qualificationPrimary 16 32Secondary 17 34Higher Secondary 14 28Degree 3 6
4 Marital statusMarried 15 30Unmarried 3 6Widow 31 62Divorce 1 2
5 Previous Occupation Professional 17 34Any other 33 66
6 Duration of Stay 3-5years 26 525& above years 24 48
7 Financial Dependency Self 10 20On family members 2 4Old age homes 38 76
8 Self Care Activities Independent 22 44Partially Dependent 24 48Fully Dependant 4 8
9 History of Health Illness Diabetes Mellitus 3 6Hypertension 10 20Bronchial Asthma 2 4Any Other 35 70
10 Dietary Status by Criteria of BMIWell Nourished 9 18
Moderately Nourished 32 64Poorly Nourished 8 16
FIG:1 Distribution of samples according to Age
72%
26%
2%
0
5
10
15
20
25
30
35
40
60-65years 65-70years >70 years
Age
Among the elderly people, 2% were from age group of 60- 65 years, 26%
were from age group of 65- 70 years and 72% were from age group of > 72
years.
30%
70%
0
10
20
30
40
Male Female
Fig 2: Distribution of samples according to the Gender
Among the elderly people, 30% were male and 70% were female
32%
34%
28%
6%
0
2
4
6
8
10
12
14
16
18
Primary Secondary Higher Secondary Degree
Fig: 3 Distribution of samples according to the Education
Among the elderly people, 32% had primary education, 34% had secondary
education, 28% had higher secondary education and 6% had graduation.
Fig 4: Distribution of samples according to the Marital Status
2%
30%
6%
62%
0
5
10
15
20
25
30
35
Married Unmarried Widow Divorce
Among the elderly people, 30% were married, 6% were unmarried, 62%
were widows and 2% were divorced.
34%
66%
0
5
10
15
20
25
30
35
Professional Any other
Fig 5: Distribution of samples according to the Previous Occupation
Among the elderly people, 34% were professionals and 66% were non
professionals.
52%
48%
23
23.5
24
24.5
25
25.5
26
3-5years 5& above years
Fig: 6 Distribution of samples according to the Duration of stay
Among the elderly people, 52% stayed from 3- 5 years and 48% were
staying more than 5 years.
20%4%
76%
0
10
20
30
40
Self On family members Old age homes
Fig: 7 Distribution of samples according to the Financial dependency
Among the elderly people, 20% were self depended for finance, 4% were
dependent on family members and 76% were dependent on old age homes.
44%48%
8%
0
5
10
15
20
25
Independent Partially Dependent Fully Dependant
Fig 8: Distribution of samples according to the Self care activities
Among the elderly people, 44% were independent for self care activities,
48% were partially dependent and 8% were fully dependent.
6%
20%
4%
70%
0
5
10
15
20
25
30
35
Diabetes Mellitus Hypertension BronchialAsthma
Any Other
Fig 9: Distribution of samples according to History of Health illness
Among the elderly people, 6% had diabetes mellitus, 20% had hypertension,
4% had bronchial asthma and 70% suffered from other illness.
Fig 10: Distribution of samples according to Dietary status
Well Nourished18%
ModeratelyNourished
66%
Poorly Nourished16%
Among the elderly people, 18% were well nourished, 66% were moderately
nourished and 16% were poorly nourished.
Section II: To assess the knowledge of the elderly people on perceived
health problems.
Table: 2
N= 50
Maximum Range Mean S.D StatementsMax. score Mean%
Knowledge of Perceived Health problems among elderly people
Physical Questionnaire 50 18 -50 35.8 9.04 17 50 72%
Physiological Questionnaire 45 15 -45 30.1 7.01 27 45 67%
Psychological Question 52 15 -52 33.1 9.16 16 52 64%
Fig: 11
58%
60%
62%
64%
66%
68%
70%
72%
Mean %
PhysicalQuestionnaire
Physiological Questionnaire
Psychological Question
The above table and diagram depicts that, the elderly people staying in old
age homes have higher mean % in physical activities compared to
physiological and psychological problems.
Section III: To identify the facilities provided for the elderly people in
old age homes.
Table: 3
Maximum Range Mean S.D StatementsMax. score Mean%
Facilities provided to Elderly peopleFood Facilities 32 8 -32 19.1 4.89 8 32 60% Living Facilities 40 19 -40 28.5 6.81 10 40 71%
Care in Health and Illness 28 10 -28 14.9 4.58 5 28 53%
Recreational Facilities 24 10 -24 14.4 4.18 5 24 60%
Fig: 12
0%
10%
20%
30%
40%
50%
60%
70%
80%
Mean %
FoodFacilities
LivingFacilities
Care inHealth and
Illness
RecreationalFacilities
The above table and diagram depicts that, of the elderly people staying in
old age homes, more than 60% were dissatisfied with food facilities, > 70%
were dissatisfied with living facilities, 53% were dissatisfied with care in
health and illness and 60% were dissatisfied with recreational facilities.
Section IV: To find the association between the knowledge of old age people on perceived health problems and demographic variables.
Table 4
Demographic Variables Category
Respondents knowledgeTotal
χ2 value
p valueInadequate Moderate Adequate
n % n % n %
Age
60-65years 1 100% 0 0% 0 0% 1
65-70years 1 8% 4 31% 8 62% 13
>70 years 2 6% 17 47% 17 47% 36 12.80 0.01
GenderMale 3 20% 5 33% 7 47% 15 Female 1 3% 16 46% 18 51% 35 4.29 0.12
Educational qualification
Primary 0 0% 6 38% 10 63% 16
Secondary 2 12% 11 65% 4 24% 17
Higher Secondary 2 14% 3 21% 9 64% 14 15.32 0.03
Degree 0 0% 1 33% 2 67% 3
Marital statusMarried 3 12% 12 46% 11 42% 26 Unmarried 1 4% 9 38% 14 58% 24 1.71 0.43
Previous Occupation
Professional 3 18% 5 29% 9 53% 17
Any other 1 3% 16 48% 16 48% 33 10.21 0.04
Duration of Stay 3-5years 3 12% 12 46% 11 42% 26 5& above years 1 4% 9 38% 14 58% 24 1.71 0.43
Financial Dependency
Self 1 10% 1 10% 8 80% 10 On family members 0 0% 1 50% 1 50% 2 5.53 0.24Old age homes 3 8% 19 50% 16 42% 38
Self Care Activities
Independent 3 14% 5 23% 14 64% 22 Partially Dependent 0 0% 13 54% 11 46% 24 10.97 0.03Fully Dependant 1 25% 3 75% 0 0% 4
History of Health Illness
Diabetes Mellitus 1 33% 2 67% 0 0% 3
Hypertension 2 20% 5 50% 3 30% 10 15.88 0.01Bronchial Asthma 1 50% 0 0% 1 50% 2
Any Other 0 0% 14 40% 21 60% 35
Dietary Status by Criteria of
BMI
Well Nourished 1 11% 4 44% 4 44% 9 Moderately Nourished 3 9% 13 39% 17 52% 33 13.15 0.05Poorly Nourished 0 0% 4 50% 4 50% 8
The above table depicts the demographic variables like age, education,
previous occupation, self care activities, history of health illness and dietary
status are significant with knowledge of elderly people and other
demographic variables are not significant.
Fig 13: Association between age and knowledge level of elderly people.
100%
8% 6%
0%
31%47%
0%
62%47%
0%10%20%30%40%50%60%70%80%90%
100%
60-65years 65-70years >70 years
Age
%
Inadequate Moderate Adequate
The association between age and knowledge levels is significant (χ2= 12.80)
at 5% level of significance.
Fig 14: Association between gender and knowledge level of elderly people.
20%
33%
47%
3%
46%51%
0%
10%
20%
30%
40%
50%
60%
Male Female
Gender
Inadequate Moderate Adequate
The association between gender and knowledge levels is not significant (χ2=
4.29) at 5% level of significance.
Fig 15: Association between marital status and knowledge level of elderly people.
12%
4%
46%
38%
42%
58%
Married
Unmarried
Mar
ital
sta
tus
Inadequate Moderate Adequate
The association between marital status and knowledge levels is not
significant (χ2= 1.71) at 5% level of significance.
Fig 16: Association between education and knowledge level of elderly people.
20%
33%
47%
3%
46%51%
0%
38%
63%
12%
65%
24%
14%
21%
64%
0%
33%
67%
0%
10%
20%
30%
40%
50%
60%
70%
Male Female Primary Secondary HigherSecondary
Degree
Education
Inadequate Moderate Adequate
The association between education and knowledge levels is significant (χ2=
15.32) at 5% level of significance.
Fig 17: Association between previous occupation and knowledge level of elderly
people.
18%
29%
53%
3%
48%
48%
0%
10%
20%
30%
40%
50%
60%
Professional Any other
Previous Occupation
Inadequate Moderate Adequate
The association between previous occupation and knowledge levels is
significant (χ2= 10.21) at 5% level of significance.
Fig 18: Association between duration of stay and knowledge level of elderly people.
12
%4
%
46
%
38
%
42
%
58
%
0% 20% 40% 60% 80% 100% 120%
3-5years
5& above years
Du
rati
on
of
sta
y
Inadequate Moderate Adequate
The association between duration of stay and knowledge levels is not
significant (χ2= 1.71) at 5% level of significance.
Fig 19: Association between financial dependency and knowledge level of elderly
people.
10% 10%
80%
0%
50%50%
8%
50%
42%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Self On family members Old age homes
Financial Dependency
Inadequate Moderate Adequate
The association between financial dependency and knowledge levels is not
significant (χ2= 5.53) at 5% level of significance.
Fig 20: Association between self care activities and knowledge level of elderly
people.
14%
23%
64%
0%
54%46%
25%
75%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Independent Partially Dependent Fully Dependant
Self Care activities
Inadequate Moderate Adequate
The association between self care activities and knowledge levels is
significant (χ2= 10.97) at 5% level of significance.
Fig 21: Association between history of health illness and knowledge level of elderly
people.
33
%
20
%
50
%
0%
67
%
50
%
0%
40
%
0%
30
%
50
%
60
%
0% 20% 40% 60% 80% 100% 120%
Diabetes Mellitus
Hypertension
Bronchial Asthma
Any Other
His
tory
of
he
alt
h il
lne
ss
Inadequate Moderate Adequate
The association between history of health illness and knowledge levels is
significant (χ2= 15.88) at 5% level of significance.
Fig 22: Association between dietary status and knowledge level of elderly people.
11%
44%44%
9%
39%
52%
0%
50%50%
0%
10%
20%
30%
40%
50%
60%
Well Nourished ModeratelyNourished
Poorly Nourished
Dietary status
Inadequate Moderate Adequate
The association between dietary status and knowledge levels is significant
(χ2= 13.15) at 5% level of significance.
6 DISCUSSION
Various criteria are used to assess a person's level of health. Objective
measures can be noted and counted by a trained observer, while subjective
measures of health depend exclusively on a person's self-evaluation.
Objective measures include the presence of a disease or disorder, measuring
of blood pressure, days spent in bed or in the hospital, or observation of the
ability of the person to perform daily activities. A subjective measure of
assessed health can be collected by simply asking a person if his or her
health is excellent, good, fair, or poor. Both objective indicators and the
subjective measure of self-rated health are designed to capture the health
status of an individual, and there is a moderately strong relationship between
the two measures. Most people report an evaluation of their health that
matches or comes close to the objective indicator of a physician's diagnosis.
In general, those with more functional disabilities are likely to rate their
health less favorably. In addition, those with specific chronic conditions,
such as heart disease, chronic lung problems and diabetes also report worse
health.
Objectives of the study
1) To assess knowledge of perceived Health problems among elderly
people.
2) To assess the level of satisfaction with the facilities provided to the
elderly people in the old age homes as expressed by them.
Hypothesis
H1) The elderly people living in old age homes to have health needs.
H2) The elderly people have varying self care abilities and functional
performance.
H3) The elderly people participating in the study will be willing to express
their health problems and the level of satisfaction of facilities provided to
them in old age homes.
Sample Characteristics.
Among the elderly people, 2% were from age group of 60- 65 years, 26%
were from age group of 65- 70 years and 72% were from age group of >
72 years.(Table-1)
Among the elderly people, 30% were male and 70% were female (Table-
2).
Among the elderly people, 32% had primary education, 34% had
secondary education, 28% had higher secondary education and 6% had
graduation.(Table-3)
Among the elderly people, 30% were married, 6% were unmarried, 62%
were widows and 2% were divorced.(Table-4)
Among the elderly people, 34% were professionals and 66% were non
professionals.(Table-5)
Among the elderly people, 52% stayed from 3- 5 years and 48% were
staying more than 5 years.(Table-6)
Among the elderly people, 20% were self depended for finance, 4% were
dependent on family members and 76% were dependent on old age
homes(Table7)
Among the elderly people, 44% were independent for self care activities,
48% were partially dependent and 8% were fully dependent. (Table-8)
Among the elderly people, 6% had diabetes mellitus, 20% had
hypertension, 4% had bronchial asthma and 70% suffered from other
illness. (Table-9)
Among the elderly people, 18% were well nourished, 66% were
moderately nourished and 16% were poorly nourished. (Table-10)
Description of the Knowledge of perceived health problems in Elderly.
Among elderly people staying in old age homes have higher mean %
in physical activities(72%) compared to physiological(67%) and
psychological(64%) problems.(Table-2)
Description of Level of Satisfaction of the facilities provided to Elderly
people.
Among the elderly people staying in old age homes, more than 60%
were dissatisfied with food facilities, > 70% were dissatisfied with
living facilities, 53% were dissatisfied with care in health and illness
and 60% were dissatisfied with recreational facilities.(Table-2)
Association between the knowledge of old age people on perceived
health problems and demographic variables.
The demographic variables like age, education, previous occupation, self
care activities, history of health illness and dietary status are significant with
knowledge of elderly people and other demographic variables are not
significant.
The association between age and knowledge levels is significant (χ2=
12.80) at 5% level of significance.
The association between gender and knowledge levels is not
significant (χ2= 4.29) at 5% level of significance.
The association between marital status and knowledge levels is not
significant (χ2= 1.71) at 5% level of significance.
The association between education and knowledge levels is significant
(χ2= 15.32) at 5% level of significance.
The association between previous occupation and knowledge levels is
significant (χ2= 10.21) at 5% level of significance.
The association between history of health illness and knowledge
levels is significant (χ2= 15.88) at 5% level of significance.
The association between dietary status and knowledge levels is
significant (χ2= 13.15) at 5% level of significance.
7 CONCLUSIONS
On the basis of findings of the study following conclusions were made:-
Majority of the elderly people 72% belong to age group of above 70
years.
More than half of the elderly people 70% were female.
Approximately half of the elderly people 34% had studied up to
secondary school.
Most of the elderly 62% were married.
Majority elderly people 66% were had previous occupation.
52% of elderly people were duration of stay.
76% of elderly people were financial depend on old age home.
Most of the elderly people 48% were taking self care.
Majority of elderly people 70% were suffering with other perceived
health problems.
In dietary status 64% of elderly people were moderately nourished.
72% of elderly people were suffering with physical health problems.
67% of elderly people were suffering with physiological health
problems.
64% of elderly people were suffering with psychological health
problems.
The facilities provided for the elderly people in old age Home.
The elderly people staying in old age homes, more than 60% were
dissatisfied with food facilities, > 70% were dissatisfied with living
facilities, 53% were dissatisfied with care in health and illness and
60% were dissatisfied with recreational facility.
Nursing Implications
The study findings have several implications in nursing. They can be
categorized under nursing Practice, nursing education and nursing research.
Nursing Practice:
Nursing service includes preventive, promotive, Curetive and
rehabilitative Services, Nurses have important role in the prevention of
perceived health problems increase in chronic and degenerative problems
will cause a high degree of disability, which will require aid and support
from qualified professionals. As a specialty, Geriatric Nursing has
developed recently and is based on knowledge of the aging process for
thebio-psycho-social-cultural and spiritual valuation of elderly people.s
needs. Service organization and theoretical concepts guide practice, data
collection, nursing diagnosis,planning and maintenance of care,
intervention,assessments, multi-professional collaboration, research, ethics
and professional development as its standards of quality. Therefore, the
usage of Nursing Care Systematization (NCS) is a worldwide need for the
quality of its practices. The interest in discovering the main nursing
diagnosesfor elderly inpatients originated from clinical practice during the
first year of the residence specialization coursein Geriatric Nursing, and
from the need to standardize the NCS in order to facilitate, promote and
elaborate proper health care for elderly users.
Nursing Diagnosis in elderly people.
1. Risk of infection
2. Impaired Physical Mobility
3. Altered nutrition: less than corporeal needs
4. Self-care deficit
5. Impaired skin integrity
6. Intolerance to activity
7. Pain
8. Sensorial/Perception changes
9. Risk of injury
10. Constipation
11. Diarrhea
12. Impaired verbal communication
13. Confusion
14. Urinary Incontinence
15. Risk of impaired skin integrity
16. Impaired gaseous exchange
17. Risk of ineffective respiratory patterns
18. Anxiety
19. Risk of caregiver weariness
20. Decreased peripheral tissular perfusion
21. Risk of Imbalanced liquid volume
22. Sleeping patterns disturbs
Nursing Intervention for elderly people
Applicable to elderly people.
* Promoting daily bathing.
* Monitoring fluids and electrolytes.
* Promoting vaccination.
* Controlling exposition to communicable diseases.
* Offering nutritional intake.
* Observing the aspect of the skin.
* Monitoring vital signs.
* Moving immobilized elderly carefully.
* Promoting passive exercise.
* Adequate positioning in bed or chair.
* Promoting body mechanics.
* Promoting fluid balance.
* Fractioning the diet.
* Controlling swallowing disorders.
* Observe weight gain.
* Care for users who receive diet through forced or parenteral nutrition.
* Controlling hypoglycemia or hyperglycemia.
* Performing or helping with bathing.
* Performing oral, eye, ear, hair and intimate hygiene.
* Controlling pain.
* Helping with dressing.
* Assisting and helping with fluid and food ingestion.
* Encouraging the user to perform self-care.
* Reducing bleeding.
* Easing pressure.
* Moisturizing the skin.
* Promoting suitable nutritional intake.
* Preventing pressure ulcers.
* Treating pressure ulcers and existing wounds.
* Stimulating circulation.
Nursing diagnoses have been examined and represent one of the main
steps in the NCS (Nursing care system) because they contribute to the
identification of the user’s problems and subsequent elaboration of the
nursing interventions. The interventions, when linked, permit a better
solution of the identified problem, making nursing tasks easier and
maintaining individual care. The classification of nursing diagnoses and
interventions in line with taxonomy is used to standardize and guide nursing
activities. We believe that considering the interventions developed in this
classification for the most frequent nursing diagnoses in elderly inpatients
hospitalized in geriatric wings and comparing them to our reality will
contribute to the strengthening of professional practice.
Nursing Education: - Assessing elderly people (continuing nursing
education).
Nurses are increasingly likely to be involved in assessing the health
status of elderly people in a number of care settings. It is important that the
assessment is relevant and useful, not only for the primary health care team,
but also for the elderly person and any involved carers created and is
maintained by RNs dedicated to optimizing a family’s access to valid
information and credible services about senior care and housing options. The
goal of nursing education is to educate families about the types of care
options available in order to help them to better understand what might be
the best choice for their aging loved ones. Access to their on-line databases
facilitates the difficult search for home care, assisted living, retirement
homes, nursing homes and other long-term care facilities.
Nursing Research: - Nursing Research has a major contribution in meeting
the Health and welfare needs of the people One of the aim of nursing
research is to expand and broaden the scope of nursing.\
Assessment and Care Strategies Three strategies to assess for a typical
presentation of illness include: (1) Vague Presentation of Illness; (2) Altered
Presentation of Illness; and (3) Non-presentation (under-reporting) of Illness.
(1) Vague Presentation of Illness;
Non-specific Symptoms
Confusion
Self-neglect
Falling
Incontinence
Apathy
Anorexia
Dyspnea
Fatigue
(2) Altered Presentation of Illness
Altered Presentation of Illness in Elderly Persons Illness Atypical
Presentation Infectious diseases
Absence of fever
Sepsis without usual leukocytosis and fever
Falls, decreased appetite or fluid intake, confusion, change in
functional status
"Silent" acute abdomen Absence of symptoms (silent presentation)
Mild discomfort and constipation
Some tachypnea and possibly vague respiratory symptoms
"Silent" malignancy Back pain secondary to metastases from slow growing breast masses
Silent masses of the bowel
"Silent" myocardial infarction Absence of chest pain
Vague symptoms of fatigue, nausea and a decrease in functional
status.
Classic presentation: shortness of breath more common complaint
than chest pain
Non-dyspneic pulmonary edema May not subjectively experience the classic symptoms such as
paroxysmal nocturnal dyspnea or coughing
Typical onset is insidious with change in function, food or fluid
intake, or confusion
Thyroid disease Hyperthyroidism presenting as "apathetic thyrotoxicosis," i.e. fatigue
and a slowing down
Hypothyroidism, presenting with confusion and agitation
Depression Lack of sadness
Somatic complaints, such as appetite changes, vague GI symptoms,
constipation, and sleep disturbances
Hyper activity
Sadness misinterpreted by provider as normal consequence of aging
Medical problems that mask depression
Medical illness that presents as depression
Hypo- and hyper- thyroid disease that presents as diminished energy
and apathy
(3) Non-presentation (under-reporting) of Illness.
Hidden" Illness in Elderly People
Depression
Incontinence
Musculoskeletal stiffness
Falling
Alcoholism
Osteoporosis
Hearing loss
Dementia
Dental Problems
Poor nutrition
Sexual dysfunction
Osteoarthritis.
The expanded role of a professional nurse emphasizes those activities which
promote health maintenance behavior among the Elderly people.The present
study is only conducted to assess the perceived health problems and level of
satisfaction of facilities in old age home. Further research can be conducted
including other aspects among elderly.
Limitations.
The study will be limited to,
The elderly people who are 60years and above.
The elderly people who are willing to participate in the study.
Those elderly people who are able to express their problems verbally.
The elderly people who are available at the time of the study residing
in old age home.
The elderly people who can understand English.
Reduce adverse drug events in older adults.
Suggestion
Respect (deference) to older patients in culturally appropriate ways helps to
establish a trusting relationship. Many older adults from different ethnic
backgrounds are more responsive to calmness and humility. Speed and self-
assertion or directness can create barriers to the interaction. Specific
strategies to foster the development of trust may include:
Consult informed persons as to what is culturally appropriate.
Generally, acknowledge and greet older persons first. Generally, use
formal title such as "Mr." or "Mrs." to address the patient, at least
initially. Find an appropriate time to ask the patient's how she/he prefers
to be addressed by the provider.
Consider use of informal conversation prior to formal assessment. It
may not be respectful to ask business oriented questions without first
acknowledging the patient in a more personal way.
For example, to begin a conversation with questions such as "How is
your family?" or "Did you have to travel long to come here?" before
they wish to respond to more formal questions such as "What brings
you here today?" or "How can I help you today?" When an older person
inquires about you, be ready to share something personal about
yourself.
Despite the increasing pressure of limited time for patient care in
clinical settings, an attitude of sincere concern usually helps to put the
ethnic older person at ease.
Avoiding the "invisible patient syndrome". Older patients need to be
talked to and with, rather than talked about. Talking to someone else in
the room as if the patient weren't there (or is incapable of
understanding) demonstrates disrespect.
Acknowledge the importance of ethnicity and ask for the patient's help
as a cultural expert in understanding the current situation and
incorporating salient cultural components in the plan of care.
Facilities of old age homes should improve more so Elderly can enjoy
their life.
Recommendations
Based on the findings of the present study, the following recommendations
were offered for the future study.
Similar study can be conducted on a larger sample.
Comparative study can be conducted with control group.
A descriptive study can be conducted to assess the knowledge of
perceived health problems among elderly people.
If interested in Geriatric care can open home for the Aged so elderly
can enjoy there life.
8 SUMMARY
Research Methodology gives a bird eye view of the entire process of a
talking a research problem in a scientific ,systematic manner, In this study
the dependant variable refers to the perceived health problems of the elderly
people, the Independent variable refers to the facilities provided in the old
age home.
This chapter has been of permanent use in the development of the
analysis and interpretation,
AGEING AS PHENOMENON: It is probable that ageing occurs through
the process of natural selection. Survival after the reproductive era is not
beneficial to the propagation of species because it leads to over-crowding
and competition for resources for survival. Ageing is beneficial in the
weeding out of species not engaged in active reproduction, if it survives
predatory elimination, accidents, environment hazards and disease. Thus,
ageing is not physiological but a natural phenomenon mediated by genes.
Principals on the science of health care of the elderly as based include
individuals gradually become more heterogeneous or dissimilar as they age.
Ageing does not produce an abrupt decline in organ function but disease
always does. Ageing process is accentuated by disease and attenuated by
modification of risk factors such as smoking, sedentary lifestyle and obesity.
Healthy old age can be attained with different levels of prevention and
health promotion.
AGEING IN THE MUSCULAR SYSTEM Decreasing muscle mass,
decreasing elasticity of tendons and ligaments, decreasing amount of
stored sugar, decreasing endurance and agility, Decreasing Blood flow,
Increasing variability of muscle tonicity, Increasing variability of nerve
conduction and irritability, Increasing amount of muscle spasms,
increasing amount of waste products. (Lactic acid, Co2 retained).
AGEING IN THE SKELETAL SYSTEM: Decreasing hardness of
bones, decreasing activity of bone marrow, decreasing elasticity of joints
and ligaments, decreasing mobility of joints increasing shift of mineral
salt, bones to blood, Increasing postural and foot changes. Age changes
in the skeletal system predispose the elderly in developing osteoporosis,
damage to the joints, falls, fractures, and walk.
AGEING IN THE URINARY SYSTEM Decreasing number of cells in
kidneys, decreasing blood flow to kidney, decreasing elasticity of
bladder, decreasing muscle tonicity of urethra, increasing variability in
irritability and neural condition to urethra. There is a decline in the
efficiency of homeostatic mechanisms, urinary urgency and frequency.
Prostates enlargement in male elderly which is part of normal ageing,
may lead to urinary retention and infections of water soluble medications
occurs due to altered glomerulus’s filtration rate. There is a decrease in
interval between the signal of the need to void and the actual emptying of
the bladder. In women pelvic floor weakness as a part of ageing may
produce urinary incontinence.
AGEING IN THE NERVOUS SYSTEM:- Decreasing number of cells
and endings, decreasing rate of venous returns, decreasing irritability and
conduction, decreasing rate of arterial flow, increasing variability in
perception, equilibrium, motor coordination, increasing variability in
reception, integration and response to external and internal stimuli. The
nervous system shows gradual ageing changes which may lead to
progressive decline in short term memory, forgetfulness, impaired
Judgment, wandering behavior and shower processing of information.
AGEING IN THE RESPIRATORY SYSTEM:- Decreasing elasticity
of alveoli, decreasing tonicity of intercostals muscles and diaphragm,
decreasing vital capacity, decreases blood flow, increasing variability in
reception, integration and response to external and internal stimuli
increasing desiccations of respiratory mucous membranes increasing
carbon dioxide. These age related changes of the respiratory tract,
decrease the efficiency of gas exchange and increases susceptibility to
lower respiratory infections. There is reduction in the immunity which
may lead to severe problems like pneumonia. Mouth breathing,
diminished coughing, increased use of accessory muscles, more energy
expanded for respiratory functioning, lead to diminished efficiency of gas
exchange, decreased vital capacity, slight decrease in overall efficiency
and increased susceptibility to lower respiratory infection.
AGEING IN THE DIGESTIVE SYSTEM Decreasing capacity for
biting and chewing, decreasing capacity for smelling and testing,
decreasing production of digestive enzymes, decreasing gastric and
intestinal mobility, decreasing thickness of the gastro – intestinal lining,
decreasing number of liver cells and liver functions, increasing variability
in swallowing reflex, increasing variability in peristalsis, increasing
variability of the amount of bile flow, increasing incidence of indigestion,
abnormal distention, flatus, increasing variability in bowel habits,
increasing variability in nutritional status. The elderly loose the ability to
enjoy the food and eat less because of absence of teeth, less efficient
chewing and decreased taste sensation. There is also decreased
absorption of vital elements leading to multiple deficiency states. The
show mobility of the Gastro intestinal tract leads to constipation and
problems associated with it. Decreased absorption of iron, folic acid,
vitamin B12 malnutrition and dehydration lead to subsequent cognitive
impairments.
AGEING IN THE CARDIOVASCULAR SYSTEM Decreasing
muscle tonicity; decreasing cardiac output, decrease elasticity, decreasing
venous return decreasing body fluids, decreasing blood cell production,
increasing heart size, increasing arterial resistance to passage of blood,
(B.P – increase) increasing variability of neural conduction and
irritability, increasing time required for the heart to return to the resting
stage. The heart and blood vessels are under going age changes leading to
stiffening of the vasculature, hypertrophy of left ventricular wall,
increased peripheral resistance, postural hypotension, development of
blood pressure, increased susceptibility for heart diseases, arrhythmias
etc.
AGEING IN THE ENDOCRINE SYSTEM Decreasing number if cells
and size of gland, decreasing amount of secretions, decreasing basal –
metabolic rate, cessation of menses (female), decreasing capacity for
tissue repair, decreasing capacity to maintain Na +, K+ and fluid balance,
increasing variability of adapting to stress, increasing variability of
calcium metabolism, increasing variability glucose metabolism,
increasing variability of the inflammatory response, increasing variability
of the tolerance to temperature and atmospheric changes, increasing
regression of secondary sex characteristics. The consequences of age
related changes of the endocrine organs lead to alterations in
thermoregulation in the form of either hypo or hyperthermia. Withdrawal
of the estrogen during menopause may lead to osteoporosis and
technological disturbances. There is a decreased amount of secretions of
the endocrine organs which may produce mild endocrine regression of
secondary sex characteristics.
AGEING IN THE SKIN: Decreasing number of cells, decreasing
amount of subcutaneous fat, decreasing number of nerve cells and
endings, decreasing amount of blood flow, decreasing elasticity,
decreasing amount of blood flow, decreasing elasticity, decreasing
amount of secretions of sweat glands and sebaceous islands, increasing
areas of pigmentation, increasing amount of dryness and thickening of
nails and hair, increasing variation in hair growth, increasing variability
of maintenance of body temperature, increasing susceptibility to infection
trauma. Ageing skin and appendages may lead to wrinkles, dry skin,
delay in wound healing, increased susceptibility to burns, injury,
infections, increased incidence of cracks and injury occurring to the nails.
Decreased sweating and shivering leads to increased susceptibility to
hypothermia and hyperthermia, skin cancer is also more common in the
elderly.
AGEING IN SEXUAL AND REPRODUCTIVE SYSTEM: Social
norms have traditionally interpreted the normal changes of ageing as
indications that is no longer necessary or even appropriate to engage in
sexual intercourse. Even in elderly males, beyond 65 years of age.
Morning erections are not uncommon. it is many of the other diseases
such as diabetes, chronic kidney or liver diseases and some of the drugs
such as those taken for hypertension of other ailment that lessen an
elderly’s sexual urge. Many women, on the other hand, equate the
beginning of post-menopausal period with ‘no-sex’. This is not a fact,
because of absence of some of the sex-hormones, heralds’ attendant
changes in sex organs that may lead to delayed onset of sexual desire, but
none the less, the desire is there. Older people, unless otherwise contra-
indicated, may continue having sex relations with their partners, so long
as the desire is there.
AGEING IN THE SENSORY SYSTEM: Ear Decreasing elasticity of
eardrum, decreasing number of sensitive cells in the cochlea, increasing
rigidity of the small bones in the middle ear, increasing rate of time for
the passage of impulses in the auditory nerve, increasing rate of time for
fluid to drain in the semicircular canals. Age related changes leads to
impaired hearing and diminished ability to hear high pitched sounds.
Diminished sensory input and impaired social interaction. Eye
Decreasing eye muscle tonicity, decreasing peripheral vision, decreasing
elasticity of lens, decreasing ability of pupil to change size, is decreasing
ability to adjust to night vision, decreasing depth and colour perception.
Decreasing moisture on cornea and conjunction, increasing changes in
blood vessels, increasing time required for fluid to drain from eye
chambers. Increasing eyelid droop, increasing tearing. There is decreased
ability to focus on near objects, increased sensitivity to glare, diminished
depth of perception, altered colour perception, difficulty in night driving
and slower processing of visual information.
CHANGES IN THE BODY DUE TO AGEING: The changes that
occur in the body may be categorized as: (1) External i.e. those that are
visible; (2) Internal, i.e. those which occur in the internal organs of the
body .2 (3) In the sense organ perceptions. External changes are seen
most obviously in the hair, face, skin, stature, posture, bony joints, and
mobility. One of the most obvious features of an older person is the
graying of the hair which also tends to become sparse. Wrinkles and
creases in the face result from the loss of fat and elastic fibers, (loss of
teeth progressively, leads to resumption of bone from the upper jaw &
the lower jaw.) When advanced, this produces marked shrinkage in the
lower portion of the face, an increased in folding of the mouth &
shortened distance between the chin & nose. Many elderly persons, in
addition to the bending of the trunk, undergo postural changes, among
which slight flexion at the knees and at the hips, tend to contribute further
to diminished stature. An older person has less energy and is not so agile.
A general slowing up of movement is the rule. The gait becomes stiff and
the steps tend to be short. The nervous system, in the joints and in the
muscles. In the nervous system, the loss of cells from the brain and spinal
cord, leads to a slowing and diminution of co-ordination in bodily
movements. There is a greater tendency to fall. It is very important to
know and recognize the changes occur, normally, with aging, because
this knowledge helps one to distinguish a particular symptom, sign or
result of a test in an older person as normal due to aging, or abnormal due
to a disease. Furthermore, it helps in proper understanding of the
behavior and response of an aged person.
COMMON FEATURES OF ILLNESS IN OLD AGE: When an older
person falls ill, there are some features which are more often met because
of the age and not because o a particular disease. These have to be
recognized and sorted out from the particulars feature of a disease, so as
to manage the patient as best as possible.
MULTIPLE PATHOLOGY- In old age, it is a rule rather than the
exception for the patient to suffer from several diseases at a time. In an
acute illness, it is actually clear which disease is dominant, but some
account must be take of the others, a patient with a brain stroke, for
example, may well be handicapped also by cataract which limits his
vision, heart disease which limits his capacity for effort, an urinary
infection which increases the risk of incontinence and osteoarthritis of the
hips or knees which further limits his mobility. All this as well as the
stroke demand treatment, and influence his rehabilitation.
TENDENCY OF CONFUSION – In an older patient, the stability of the
brain is precariously balanced probably because of the brain is readily
upset by any kind of bodily disturbance, and a sudden onset of confusion
is one of the commonest indication of physical illness in old age.
LESSER SENSIBILITY TO PAIN- An older patient has admonished
sense of pain. This makes life less uncomfortable for him, but it increases
the risk that he may injure himself. For example, he may burn his skin by
sitting too close to the fire. Hot water bottles are a special danger. Even
serious injurious like fractures may not be obvious. An old person, who
breaks the neck of the femur, may have only mild discomfort even
though he cannot walk. In acute abdominal conditions such as acute
appendicitis, there may be little pain or tenderness until the disease is far
advanced and the patient is gravely ill.
DIMINISHED TEMPERATURE REGULATION – The regulation of
body temperature is less efficient in the older patient and fever is less
obvious and less severe. Thus an illness which would provoke a sharp
rise in temperature in a young patient may in the elderly cause only a
small rise are none at al. If an old person seems unwell, there can be no
assurance in the fact that his temperature is normal. The pulse and
respiration is often a better guide to his condition.
LOSS OF APPETITE – If the illness is of a toxic or feverish nature, old
patients lose their appetite completely. Appetite is probably the last thing
to recover.
SPECIAL HAZARDS OF ILLNESS IN OLD AGE – Young people
overcome their illness because of ample bodily reserves them to fight
their illness that are not usually expected in your younger individuals.
Thus, a young person may be immobilized for long periods without
coming to any harm, but an older person deteriorates fast in general
mobility and capability, in vigor and even in spirit if he cannot move
about. This happens more so in those who are already arthritic or have
disorders of mobility. Confinement to bed for older people is a harbinger
of more problems to come. Those commonly seen are constipation,
incontinence farces and urine, pressure sores, contractures of the joints,
and thrombo-embolism.
USE OF DRUGS IN OLD AGE – Ageing causes an changes in the
body with regards to drug absorbed distribution & action, it is important
to understand this an changed behavior of the leody towards drugs so that
a proper response in obtained, and ride –effects eliminative. It may lead
to poor compliance, with the potential of either under-dosin. Many
factors influence drug response. Some of the important ones are,
ABSORPTION: - following their absorption, al drugs pass in the portal
(abdominal) cireulayion to the liver where some undergo substantial
metabolism before entering the general circulation. A reduction in liver
metabolic activity is likely to occur in order people leading to increased
systemic bio-availabity following oral administration of the drug.
EXCRETION: - for some drugs, namely antibiotics like vetreptomycim
& elimination. Changes in renal function association with aging have
important implications for such drugs. The elderly are at risk of reduced
elearmes and resulting accumulation of the parent drug & the active
metabolites.
MENTAL HEALTH is the balance development of the individual’s
personality and emotional attitudes which enable him to live
harmoniously with the fellow men. Characteristic of mentally healthy
person – Mentally healthy person has 3 characteristic – (1). Feel
comfortable about himself and feel secure at home. Neither under
estimate nor over estimates his own ability accepts his limitation and has
self – respect. (2). Feel right towards other so that he is able to be
interested in others and to love them he has friendship that are long
lasting and satisfied. (3). the mentally healthy person is able to meet the
demands of his life. He is able to take independent decision in life.
MENTAL HYGIENE: Mental Hygiene means the science of the
preservation of mental health. Purpose : The main purpose of mental
hygiene of health but also to make the person feel secure, loved at his
home and developing positive habits so that he may have harmonious
development of his/her personality. ●Mental Changes in Old Age:
LEARNING – Older person are more cautious about learning, need
more time to integrate their responses, are less capable of dealing with
new earlier experiences, and are less accurate than younger people.
REMINISCING: The tendency to reminisce about the past becomes
increasing more marked with advancing age. How much the individual
reminisce depends mainly on how pleasant or unpleasant the elderly send
their living condition now.
REASONING: There is a general reduction in the speed with which the
individual reaches a conclusion in both inductive and deductive
reasoning. This is partly the result of the tendency to become increasingly
cautious with age.
SENSE OF HUMOR: A common stereotype of the elderly is that of
humorless people. While it is true that their comprehension of the comic
tends to decrease with advancing age, their appreciation for the comic
that they can comprehend increases.
VOCABULARY – Detoriation in vocabulary is very slight in old age
because elderly people constantly use words most of which were learned
in childhood or adolescence. Learning new words in old age is more
infrequent than frequent.
MENTAL RIGIDITY – Mental rigidity is far from universal in old age,
in contradiction to the stereo – type of the elderly as mentally rigid, age it
tends to become more prenounced with advancing age partly because the
elderly learn more slowly and with more difficulty than they did earlier
and partly because they believed that old values and ways of doing things
are better than new ones. This is not mental rigidity in the strict use of the
term but a carefully reasoned decision.
CREATIVITY – Older people tend to talk the capacity for, or interest in
creative thinking. Thus, significant creative achievements are less
common among older people than among younger ones.
MEMORY - Old people tend to have poor recent memories but better
remote memories. This may be due partly to the fact that they are not
always strongly motivated to remember things, partly to lack of
attentiveness, and partly to not hearing clearly and distinctly what others
say.
RECALL - Recall is affected more by age than recognition, many older
people use cues, especially visual, auditory and kinesthetic one’s to aid
their ability to recall.
PROBLEM WITH OLD AGE: The longevity of the individuals in
India is gradually increasing with improving standards of public health
care. Unfortunately, studies on the health problems of the geriatric
population in India are far less the desired number such studies are
needed since psychiatry of the aged cannot be divorced from cultural,
social, family, economic, philosophical, and spiritual dimensions
Moreover, it is worthwhile to find out whether increased geriatric
population means more mental health problems. It is, however, a
common observation that the elderly are prone to psychiatric disorders
through economic and emotional deprivation, malnutrition, and social
isolation. Living to a longer age no doubt means greater liability for
senile psychosis and other degeneration disorders. There are, also certain
psychological problems related to retirement psycho geriatrics is the area
of research that deals with functional disorders of old age.
MAJOR FINDINGS OF THE STUDY
Majority of the elderly people 72% belong to age group of above 70
years.
More than half of the elderly people 70% were female.
Approximately half of the elderly people 34% had studied up to
secondary School.
Most of the elderly 62% were married.
Majority elderly people 66% were had previous occupation.
52% of elderly people were duration of stay.
76% of elderly people were financial depend on old age home.
Most of the elderly people 48% were taking self care.
Majority of elderly people 70% were suffering with other perceived
health problems.
In dietary status 64% of elderly people were moderately nourished.
72% of elderly people were suffering with physical health problems.
67% of elderly people were suffering with physiological health
problems.
64% of elderly people were suffering with psychological health
problems.
The facilities provided for the elderly people in old age Home.
The elderly people staying in old age homes, more than 60% were
dissatisfied with food facilities, > 70% were dissatisfied with living
facilities, 53% were dissatisfied with care in health and illness and
60% were dissatisfied with recreational facility.
Association between the knowledge of old age people on perceived
health problems and demographic variables.
The demographic variables like age, education, previous occupation, self
care activities, history of health illness and dietary status are significant with
knowledge of elderly people and other demographic variables are not
significant.
The association between age and knowledge levels is significant (χ2=
12.80) at 5% level of significance.
The association between gender and knowledge levels is not
significant (χ2= 4.29) at 5% level of significance.
The association between marital status and knowledge levels is not
significant (χ2= 1.71) at 5% level of significance.
The association between education and knowledge levels is significant
(χ2= 15.32) at 5% level of significance.
The association between previous occupation and knowledge levels is
significant (χ2= 10.21) at 5% level of significance.
The association between history of health illness and knowledge
levels is significant (χ2= 15.88) at 5% level of significance.
The association between dietary status and knowledge levels is
significant (χ2= 13.15) at 5% level of significance.
The elderly people staying in old age homes have higher mean (72%)
in physical activities compared to physiological (67%) and (64%)
psychological problems.
The elderly people were somewhat satisfied with the facilities
provided in the old age home. They were very satisfied with the facilities
given during health and illness They were best satisfied with the food
facilities there was no significance association between the health problems
and duration of stay and there was a significance association between
physical and psychological problems.
9 BIBLIOGRAPHY
Textbooks:-
1. Abdellah, F.G.& Eugene.L.Better patient care through nursing
Research.London. The MacMillan Company, 1971.
2. Bahaduri A and Mary F.Fealth Research A community based
approach. New Delhi.WHO.Regional publication south East
Asia.1981.
3. Burnside IM.Nursing and the aged New York MC Graw-Hill
Company 1976.
4. Christ M.A.Faith J.H.Gerontological Nursing –A study and learning
tool. Pennsylvania, Springhouse Publishing Company 1988.
5. Care of the Ageing New York Churchill Livingston 1981.
6. Ebersole and Hers Towards Healthy Aging Human Needs and
Nursing Response (IInd) 103-636.
7. Ebersole and Hers Supporting Physiologic needs of the patient
towards of healthy Aging.103-193.
8. Need for protection safety and security.197-314.
9. Self esteem status and self respect towards healthy aging (IInd
edition) 401-521.
10. Park .J.E.AND Park .k.text book of preventive and social Medicine
VII, Edition Jabalpur, M/S Banasari Das 1979.
11. Polit Denise and Hungler, Nursing Research, Principles and Methods
Philadelphia, J.B.Lippincott Co-1978.
12. Shrivastava R.S.Aged and the socity,New Delhi,Citizen Develpoment
Socity 1983.
13. Mosby, Driksen Medical – surgical Nursing- Older Adult. Page no.
58-80.
Journals:-
14 Barbara, B.February 1991.The Aging Process, Health Action.Vol.3
(2), 7-8p.
15 Celia.L.H.The effect of early nursing home placement on student
attitudes towards the elderly, Journal of nursing education Vol.34 (3),
128p.
16 Graene J. February 1991”The blind Man’s association –Steps in
development for elderly people health action Vol.3 (2)17-18p.
17 Muriel.S.February 1991Infections in old age, Health Action Vol.3 (2),
9-10p.
Dissertations:-
18. Tai Chi and Perceived Health Status in Older Adults Who Are
Transitionally Frail.
19. “Comparative study on physical & mental health status of elderly in
institutional & non- institutional setting - A case study of Delhi” BY:
GAUTAM CHOWDHARY. DPT. ND (CAL) GERIATRIC ANIMATOR
20. Harmony- AGEING IN INDIA IN THE 21ST CENTURY: A RESEARCH
AGENDA.
21. Elderly Community Residents' Reactions tothe Nursing Home: An
Analysis of Nursing Home-Related Beliefs, Paula J. Biedenharn,
MA2 and Janice Bastlin Normoyle, PhD.
22. Being old does not always mean being sick perspectives on conditions
of health as perceived by British and American elderly Hanneke
M.Th. van Maanen RN DrNSc MPH M, Associate Professor of
Nursing, Faculty of Nursing, University of Toronto, Toronto, Ontario,
Canada
23. Health Belief Model Chapter 4 by Jones and Bartlett publishers on
line.
24. Loneliness and Older Adults Physical Health,Michael Steinhour.
23 Mobility in aging,
24 Hypertension in Aging Patients, Alexander G Logan.
25 Factors related to perceived health among elderly people: the
Albertina project
26 Prevention of falling risk in elderly people: the relevance of muscular
strength and symmetry of lower limbs in postural stability,Pizzigalli
L, Filippini A, Ahmaidi S, Jullien H, Rainoldi A.
27 Attitudes of primary care team to diagnosing dementia.Thomas H,
Older Persons Services, Glanrhyd Hospital, Bridgend.
28 The importance of getting back to nature for people with
dementia.Bossen A
29 Dry mouth and its effects on the oral health of elderly people.Turner
MD, Ship JA.Department of Oral and Maxillofacial Surgery, New
York University College of Dentistry, New York City, USA.
31. Depressive Symptoms, Chronic Diseases, and Physical Disabilities as
Predictors of Cognitive Functioning Trajectories in Older
AmericansJoshua Chodosh, MD, MSHS; Dana Miller-Martinez, PhD;
Carol S. Aneshensel, PhD; Richard G. Wight, PhD; Arun S.
Karlamangla, PhD, MD
32. Perceived barriers to physical activity among older adults residing in
long-term care institutions.Chen YM.China Medical University,
School of Nursing, Taichung, Taiwan, ROC.
ymchen@mail.cmu.edu.tw
33 Review of risk factors and preventative strategies for fall-related
injuries in people with intellectual disabilities.Willgoss TG,
Yohannes AM, Mitchell D.Department of Health Professions,
Elizabeth Gaskell Campus, Manchester Metropolitan University,
Manchester M13 0JA, UK. t.willgoss@mmu.ac.uk
34 Mobility Difficulties Are Not Only a Problem of Old Age,Lisa I
Iezzoni, MD, MSc,1,3 Ellen P McCarthy, PhD,1,3 Roger B Davis,
ScD,1,3 and Hilary Siebens, MD2
35 Fatigue in patients with diabetes: a review.Fritschi C, Quinn
L,Department of Biobehavioral Health Science, College of Nursing,
University of Illinois at Chicago, IL 60612, USA.
36 Article in Norwegian Chronic pain is a serious and frequent health
problem in elderly people.
37 In the UK, population screening for unmet need has failed to improve
the health of older people.
38 Explore the development of group homes for elders with dementia in
Japan since the inception of the long-term care insurance program in
2000.
39 Dutch GP's (General Practitioners) take care of people living in homes
for the elderly.
40 Health-promoting factors and good health among Canadians in mid- to
late life,Ramage-Morin PL, Shields M, Martel L,Health Analysis
Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.
Pamela.Ramage-Morin@statcan.gc.ca
41 Literature Review of Pain Prevalence Among Older Residents of
Nursing Home,Yukari Takai, DNSc, RN; Noriko Yamamoto-Mitani,
PhD, RN; Yuko Okamoto, PhD, RN; Keiko Koyama, PhD, MD;
Akiko Honda, PhD, RN
42 Residential Facilities and Long-Term Psychiatric Care: A review of the
most recent literature has helped identify at least some of the most
relevant problems in the field of residential care, which we will briefly
summarize.
43 Web Sites
www.geriatricnursing.com
www.greonotology.com
www.helpage.com
www.ageandaging.com etc.
ANNEXURE-1
Letter requesting permission to conduct, Pilot Study on senior citizens.
To, Sr Antoinette, Mother Superior,
The little sisters of the poor, Home for the Aged, No 26, Hosur Road, Bangalore.560025
Subject: - Letter requesting permission to conduct, Pilot Study on senior citizens
Dear Mother Antoinette, Mona Prabhakar Londhe is a final year student , for Master of Nursing course in our College of Nursing Hormavu Bangalore5600 43 She has selected the following topic for her research Project to be submitted to the Rajive Gandhi University of Health Science Bangalore in partial fulfillment of the University requirement for the Master of Nursing Degree.Topic: - A study to assess knowledge of perceived health problems among elderly people and facilities provided to them in selected old age homes in Bangalore city. She needs your esteemed help and co-operation, as she is interested in conducting her project study at your home for the aged, while she is doing her voluntary services for the aged. I am requesting you to kindly grant her permission & provide necessary facilities for her work on the proposed project. On completion of her project work,. I once again request you to please give her a letter (To Whom So Ever It may Concern) that Mona Prabhakar Londhe final year student of Navaneetham College of Nursing Bangalore 560043 was
permitted to be a volunteer in our Home for the Aged. & for her requirement of study on Elderly Senior Citizens.
Thanking you,
Yours Sincerely,
Principal,
Navaneetham College of Nursing. Bangalore 43.
ANNEXURE-2
Letter of permission granted for pilot study in Little sister of the poor Home for the
aged by Mother Superior
ANNEXURE-3
Letter seeking expert’s opinion in validating tool and information regarding topic.
From
Mona Prabhakar Londhe.
IInd year Msc Nursing Student,Navaneetham College of Nursing,Horamav Bangalore 43.
TO,
Forwarded through the Principal,
Subject: - Request for validation of Research tool.
Respected Madam / Sir,
I, Ms. Mona Prabhakar Londhe, am a 2nd. year Msc. nursing student - Medical Surgical Nursing - at Navaneetham College of Nursing, and as a part of my academic requirement of Rajiv Gandhi University of Health Science, have undertaken to do a research project on,
“Assessment of the knowledge related to perceived health problems among elderly people and the facilities provided to them in selected senior citizen’s (old age) homes in Bangalore city. With a view to develop information.
I humbly request you to kindly give your expert opinion and suggestions on the above subject, its scope, and the need for modification or deletion, by using the evaluation criteria checklist enclosed.
Thanking you in anticipation,
Yours Sincerely,
{Mona Prabhakar Londhe.}
Please find attached herein below the following documents for your kind reference
1) Blue print of the tool.
2) Tool.
a) Demographic Data-Part-I
b) Structured Interview schedule with Questionnaire Part-II
c) Structured Interview schedule with Questionnaire Part-III
3) Scoring Key.
4) Criteria check list for tool validation.
5) Information of the Topic.
6) Criteria rating scale for validation of the knowledge of perceived health problems amoung elderly people and facilities provided to them in old age home.
7) Content Validity certificate.
Forwarded By,
Principal,
ANNEXURE-4
CONTENT VALIDITY CERTIFICATE
This is to certify that tool for “A study to assess knowledge of perceived health problems among the elderly people and facilities provided to them in selected old age homes in Bangalore city.a view to develop information and above topic prepared by Mona Prabhakar Londhe, IInd year Msc Nursing Student of Navneetham College of nursing Hormav, all content of tool is found to be valid.
Signature of expert.
Name:-
Designation:-
Address:-
Date:-
ANNEXURE-5
CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL.
Instruction:
Kindly review the items in the tool. If you are agree with the criteria, place a tick mark in Relevant column otherwise place a tick mark in need modification column or not relevant and give your comments in the ‘Remarks ‘Column.
PART-I Demographical Data:
SL.NO. Relevant Needs Modification
Not Relevant Remarks.
1
2
3
4
5
6
7
8
9
10
PART- II Knowledge Questionnaire:
SL.NO. Relevant Needs Modification
Not Relevant Remarks.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
PART-III
Facilities provided in old age home questionnaire:
SL.NO. Relevant Needs Modification
Not Relevant Remarks.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Signature of Expert.
ANNEXURE-6
PART-I DEMOGRAPHIC DATA RESPONSE1 Age
a) 60-65yearsb) 65-70yearsc) 70years & above.
2 Sexa) Maleb) Female
3 Educational Status a)Primary b)Secondary c)Higher Secondary d)Degree
4 Marital Statusa) Marriedb) Unmarriedc) Widowd) Divorce
5 Previous Occupation a)Professional b)Any other
6 Duration of Staya) <3 yearsb) 3-5years
c) 5& above years7 Financial Dependency
a)Self b)On family member c) Old age homes d) Any other
8 Self Care Activitiesa) Independentb) Partially Dependentc) Fully Dependant
9 History of Health Illness a)Diabetes Mellitus b)Hypertension c)Bronchial Asthma d) Any Other
10 Dietary Status by Criteria of BMIa) Well Nourishedb) Moderately Nourishedc) Poorly Nourished.
ANNEXURE-7
List of Validators.
1. Mrs.Thangam Sheila Rosalen.
HOD.of Medical Surgical Nursing
Navaneetham College of nursing.
Bangalore.
2. Mrs. Prabha Thomas.
HOD.of Medical Surgical Nursing
Krupanidhi College of Nursing
Bangalore.
3. Mrs. Milka Madhale
HOD.of Medical Surgical Nursing
k.L.E College of Nursing.
Belgaum.
4. Mrs.M.Sumitra.
HOD.of Medical Surgical Nursing
Chinmaya Institute of Nursing
Bangalore.
5. Mr.Umapathy.
HOD of Statistics.
R.V.College of Commerce Bangalore.
ANNEXURE-8
Letter of Joint Director of Horticulture Lal Bag Bangalore for Free Entry Pass
for Flower Show.
ANNEXURE-9
Pix of candidate who is assessing the elderly people in Home for the Aged in
Bangalore.