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Comparative study on old age care under institutional and non-institutional setting.

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  1. 1. DISSERTATION =============== “Comparative study on physical & mental health status of elderly in institutional & non- institutional setting - A case study of Delhi” This dissertation is a partial fulfillment of Post Graduate Diploma in Integrated Geriatric Care Course BY: GAUTAM CHOWDHARY. DPT. ND(CAL) GERIATRIC ANIMATOR GERIATRIC PHYSIOTHERAPIST Under project National Initiative on care for Elderly (NICE) Old Age Care Division National Institute of Social Defence, Delhi Autonomous Body Ministry of Social Justice and Empowerment Government of India.
  2. 2. Contents: - Page No Chapter Topics 1. Acknowledgement 2. Background 3. Research and Methodology. 4. Result and Discussion 5. Conclusion and suggestion 6. Bibliography 7. Case study 8. Appendix
  3. 3. Acknowledgement This “comparative study on physical & mental health status of elderly in institutional & non-institutional setting - A case study of Delhi” is one of several studies of the elderly in different states. This is the first exploratory study of Home – living rural and institutionalized elderly in Delhi. It is based on survey of 1). A random sample of 68 home-living elderly in rural, Delhi, and (2) 32 elderly living in homes, run by state government, Delhi,(2). Two homes. I deeply thankful to my respected sir Shri: R. Rahman, Project Director (NICE), encourage me and support also. I greatly thankful to Dr. Renu tyagi, to supervised and give me valuable advice to complete my study. I gave my heartiest thanks to Prof. Sanjay Kumar Singh, of Lal Bahadur Shastri Institute of management, Delhi to guide my study in proper way. I particularly thankful to librarian, old age care division, National Institute of social Defence, Delhi Min. of Social justice & Empowerment, Govt. of India. For support me by books. I thankful to State Govt. welfare officer Mrs. Saroj Rawat for her kind cooperation. I am really thankful to my wife Mrs. Uma sarkar (chowdhary) Advocate, Alipore Judge’s Court, Calcutta for her valuable advice and cooperation since one year. Also, I thankful to my Professors, Teachers, Md. Arif Khan and my classmates and CMIG, CALCUTTA, for their cooperation in this study. I thankful to all individuals’ officials of govt. depts.and other functionaries of the homes for the aged. I thank them all for their cooperation & assistance in arranging interviews with the elderly and care givers residing in their institution and thanks to all villagers of Hassanpur,Najafgarh, Delhi for their kind cooperation. Delhi 18.10.2004 Gautam Chowdhary.
  4. 4. INTRODUCTION: The world over, there has been a rapid increase in the number of elderly people, on India, the “aged “ population ( 60 years & elder) is the second largest in the world. It is estimated that the proportion of elderly people will increase from 7.7% in 2001 to about 11% in 2020.( AIIAMS,WHO AND UN- GUIDE BOOK on Older person,) With this demographic change, and increase in the population of the elderly, societies in developed and developing countries have to learn how to deal with a new set of health challenges. The elderly are prone to chronic non communicable diseases and disabilities. Many studies conducted in India and other developing countries reveal that a majority of elderly people are socially and economically dependent on their family members. They cannot afford to seek health care themselves. In India although physical, social and psychological health are separated out for convenience, each impinges can affect physical health, especially the environment in which they live. Hearing may cause physical problem, if rooms are not kept warm in winter. At best, chest conditions can exacerlected and at worse, hypothermia can occur in an individual. Education for the elderly on living in a warm environment may be more concerned with advice on social and voluntary services than with the physiology of degenerating temperature regulation. Physical help can be given on effective breathing, the availability of vaccination against influenza and rights to free prescriptions. There are difficulties in educating the elderly especially when finance is involved. Many would rather be cold then accept what to us in their right, but to them is charity. Further more, many will not discuses their finances and may exist on insufficient money when they are entitled to supplementary pension. It can also be that an elderly person will continue to live in the family home even through it is too big for one person and impossible to keep warm on limited funds. It is easy for the geriatric carer to see such a situation in a purely practical light where, in fact, social and psychological factors may also be involved.
  5. 5. It is known that the elderly people suffer from various types of problems, these are broadly speaking. Psychological, physical, economic and social. In coping with the changes which come with advanced age and the feeling of help less ness for various reasons, the cultural or the social norms other help them or push them into further desolation depending on the social norms of the culture these elderly people live in. the attitude towards life and surrounding is important if not the most important factor which may affect the intensity of various types of their sufferings. Bogardus (1931) defines attitude as “a tendency to act toward or against something in the environment, which becomes there by a positive or negative value”. Allport (1967) gives this definition as “An attitude is a mental and neural state of readiness organized through experience, exerting a directive or dynamic influence upon the individual’s response to all subject and situations with which it is related”. These definition hold good for the individuals. But when the social attitudes are considered, there are some important charatertics, some of there according to Joseph (1991) are, goal directed, they are shared by the members of a group, they may or may not be long lasting. Indian society so long was basically traditational, where aged people were respected, looked after and their opinions or advice were given importance. This attitude is changing with the growth of industries to considerable extent. One would expect the rural society in India is still adhering to the traditational social norms, while in the towns it may be in transitational stage and changing rapidly in the metropolis. The problem of ailing aged, therefore, may vary accordingly. The W.H.O.describes health as “a state of complete mental, physical, social, environmental wellbeing, and not merely the absence of disease or infirmity. This Description is all disease or infirmity”. This description in all embracing but it is difficult to measure. Kane (1994) suggests two ways to measure the health to examine the health situation of individual by collecting information on the types of illness & the age at which they are likely to die. Besides these suggestion, information on the mental peace & happiness may also throw some light on their state of health. The present study is directed to find out the physical health and mental health condition of the aged both males & females, the care they get from their family members and their
  6. 6. attitude towards their families, from three different setting; rural, urban cities i.e. traditational, modern societies keeping the income level as a constant. AGEING SCENARIO OF INDIA: In the beginning of the last century 12 millions Indian where age 60 years or more. The number of the aged in doubled in the next sixty years to 24 millions. Since then there has been a large increase in the number of the elderly, to about 56 millions in 1991. The projected figures for the years 2001 and 2025 are 70 millions and 177 millions respectively. The expectancy of life has increase significantly in the last few decades. The expectancy of life at but has shown a rise of more than 10 years from 49.7 years during 1970 – 1975 to 60.3 years during the period 1991 – 95. Over this period of 25 years the life expectancy of life at 60 and 70 years has also shown a significant increase from 13.8 and 8.9 years respectively to 16.2 and 10.6 years.This trend is likely to persist in the coming years, and in next 50 years the expectancy of life at birth may well surpass 80 years in most countries of the world, including India. Old age all over the world is marked by poverty and social isolation. Most people enter old age in poor health as a result of life long exposure to health risks, deprivation, lack of knowledge and resources for health promotion poor access to health services. Forty-five percent of older Indians have chronic diseases and disabilities. The number increases to 95% among those who seek health screening. Information on acute health problem and service requirement is not available. The common diseases among the ambulatory elderly are hypertension, cateract, osteoarthritis, chronic obstructive pulmonary disease, ischemic heart disease, diabetes, benign prostates hypertrophy, dyspepsia, irritable bowel syndrome and depression, which account for 85% of the burden of ill-health. Among the very old patients, stroke, dementia, osteoporosis, heart failure and frailty and physical dependence are the usual problems. The commonest causes of death in the Indian elderly are bronchitis and pneumonia, ischemic heart disease, stroke, cancer and tuberculosis. In the next 20 years as per a recent WHO projection, over three quarters of the deaths in the developing world will be due to noncommunicable diseases, surpassing communicable diseases and injuries. This remarkable transformation in the profile of ill-health requires the provision of costly services for the disabling non communicable diseases while continuing
  7. 7. investment in the prevention of communicable diseases. The heavy load of non communicable degenerative diseases that produce considerable disability and require costly treatment, along with killer communicable diseases, will have to be learn by a health care system which is not geared to do so. In most developing countries including India most of the old people live in their communities and will continue to do so. They depend on community health services for most of their health problems. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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 tehological 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, chromic 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
  11. 11. 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
  12. 12. 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.
  13. 13. ● 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
  14. 14. 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:
  15. 15. 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.
  16. 16. LITERARY VIEWS IN MENTAL ABILITIES Shakespeare, made 132 references to the physical and behavioral changes accompanying old age. In describing senility he wrote:- Last scene of all. That ends this strange eventful history, Is second childishness and mere oblivious? Sans teeth, sans eyes, sans taste, sans everything. Like every other period in the life span, old age is characterized by certain physical and psychological changes. One cheerful literary reference to old age is provided by Browning: Grow old with me! The best is yet to be, The last of life for which the first was made. The common stereotype of the aged is that of men and women who are worn out physically and mentally. Who are unproductive, accident – prone, crotehety and hard to live with, and who because their days of usefulness are over, should be pushed aside to make way for younger people. According to this stereo type “young is beautiful and old is ugly” as Berry had explained. This unfavorable stereotype, it should be apparent, makes it difficult to see ageing as anything but a negative phase in the life span. Motivation likewise plays a very important role in decline. The individual who has little motivation to learn new things or to keep up to date in appearance, attitudes, or patterns of behavior will deteriorate much faster than one whose motivation to ward off ageing is stronger. The new leisure time, which comes with retirement or with the lessening of household responsibilities, often brings boredom which lowers the individual’s motivation. Age sixty is usually considered the dividing line between middle and old age. However, it is recognized that chronological age is a poor criterian to use in marking off the beginning of old age because there are much marked differences among individuals in the age at which ageing actually begins. Because of better living conditions and better health care, most men and women today do not show the mental and physical sign of ageing until the mid – sixties or even the early
  17. 17. seventies. For that reasons, there is a gradual trend towards using 65 – the age of retirement in many businesses to mark the beginning of old age. MENTAL HEALTH 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 ( see Venkaha Rao, 1979, 1986a, 1988, 1989). 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 (Venkaba Rao, 1979). There are, also certain psychological problems related to retirement (Channaleasavanna, 1987), psycho geriatrics is the area of research that deal with functional disorders of old age. It is a sub speciality in psychiatry and has developed recently. As in any new area of research, initial attempts in this subspecialty have been directed towards the assessment of the magnitude of the psychiatric morbidity in the older groups. REVIEW OF MENTAL ILLNESS:- Data from general epidemiological studies and community surveys on the elderly in India indicate a varied prevalence rate of mental illness or psychiatric morbidity ranging from 2.2 percent to 33.7 percent (Anantharaman,1975, Dube, 1970; Elnagar et.al. 1971; Nandi et.al – 1975,1979, Ramachandram and Sarda Menon , 1980; Ramachandram and Palaniappan, 1984; Sen. et al. 1984; Sharda Menon and Ahmed, 1971; Thacore, Gupta and Surya 1975; Thiagarajan, 1984, Venkoba Rao, Vasudevan and Madharani, 1982) Male dominance in the depressive illness of the old age has also been observed (Venkoba Rao and Madhavan, 1982; Ramachandran et.al. 1979,1981, 1982). Most of these surveys were conducted in gero – psychiatric clinics, mental health centre located in South Indian Towers, Calcutta and Agra, and also covered the older people from villages
  18. 18. and slums areas. Moreover, in most cases prevalence rates of mental illness in the aged included the illness that started at younger age and continued into old age. It may be noted that these prevalence rates are not comparable and representative due to varied operational definitions of psychiatric morbidity, sampling technique, socio-demographic variables, and the age groupings. As reliable generalization in this respect cannot be made for the aged in India. It has, however, been observed that there is a general tendency of psychiatric morbidity to rise with advancing years; mental illness in the elderly is characterized by multiplicity and chronicity (Mohan, Praveen lal, Dube, and Sunderram, 1986). And that physical illness abounds among the elderly and the combined physical and psychiatric morbidity is appallingly higher. Moreover, for most of the elderly population, these problems can be subsumed within a general problem of poverty. (Sharma and Dak (ed) 1987) Although less in number and restricted in scope, such surveys of the mental health problems of the elderly, nevertheless, brought into focus the need for conducting interdisciplinary studies (both clinical and non – clinical on the geriatric population). A number of general articles monograph have been published that deal with varied aspects of ageing in India including the social need for a planed, integrated system of services for individuals and community level interventions and training medicos in geriatric medicine (e.g. Bhatia, 1983; Chacko, 1986; Doshi, 1989; Kaslival 1986, Mohan 1988, Moudgil, 1986, Ranade, 1985; Sharma and Dak, 1987; Venkoba Rao, 1988, 1989).One way of classifying studies on the psychiatric morbidity or mental ill health of the elderly in India can be the settings in which these were conducted. These settings can be community at large or clinical/hospital where geriatric groups sought professional assistance. -Venkoba Rao & Madhavan (1982) studied a large sample of individuals aged sixty years and above (N=686, Men – 291; Women – 395) who resided in and around Tiruppuvanam. Depression alone contributed 67 percent if total psychiatric morbidity. This figure was higher than that reported in earlier clinical studies (e.g. Nandi et. al. 1975; Ramachandran and Sarada Menon, 1980). Moreover, there could be a large segment of invisible depression which escapes detection in the community and the evidence of depression in the aged could be higher than what has been observed (Ramachandran and Sarada Menon, 1980). In this respect Venkoba Rao, (1986b) Argued
  19. 19. that depressive illness in the community is invisible due to factors like community tolerance, mistaking the withdrawal features of the older person to the process of ageing itself failure to preserve the depression as an illness by the rural population. Venkoba Rao and Madhavan (1982) also observed that 57 percent of the psychiatric group suffered physical morbidity and 83 percent from sensory handicaps. They further found that OBS organic Brain Syndrome constituted 10 percents of their total sample while schizophrenia, anxiety state, and alcoholism accounted for 23 percents. The major mental health problems of older persons reported by providers and researchers Liptzin (1986), Quslander (1982), Harper (1987), Gurland (1982) and matteson and Meconnell (1988) include the following: 1. Delirium 2. Dementia 3. Depression 4. Agitation 5. Crying Spell 6. Irritability 7. Facing 8. Wondering 9. Assaultiveness 10. Apathy 11. Emotional problems associated with poor physical health. 12. Expressions of feeling of unworthiness, hopelessness 13. Diminished memory, orientation and judgment. 14. Suicidal impulses and or attempts 15. Loneliness 16. Paranoid delusions 17. Demanding behavior
  20. 20. 18. Anxiety disorders 19. Alcohol abuse 20. Short attention span 21. Impaired concentration 22. Tendencies to hoard personal items 23. Stress incontinence 24. Disorientation Emotional reactions to hospitalization or entry into a long – term care facility are significant in all age groups but may be more intense in older adults. Anxiety, depression agitation and disorientation are emotional reactions that can results from fears of hospitalization, diagnostic testing, the outcome of diagnostic testing and treatment, as hospital routine. OBJECTIVES: The present study was carried out with the major objective of assessing the health status of the elderly in Delhi. The specific objectives of the study were: 1. To develop a profile of elderly on their physical and mental health as observed by themselves and by caregiver also. 2.To study mean difference, if any between self and others observation on the physical and mental health elderly..
  21. 21. Method of Study: - Selection of the Place – Old age Home (state Govt) & Rural area of Najafgarh, Delhi. (MCD area –Municipal Corporation, Delhi). The survey was conducted in Delhi & it suburbs, including the survey & old age homes run by state government. Delhi is a cosmopolitan city and capital of India. So, various types of cultures are included in its daily life leading citizens of Delhi. Delhi- National Capital Territory- Area= 1,500 sq. km (Approx) capital –Delhi, Language- Hindi, Punjabi, Urdu, population =9,420,614; Males: 5,120,733; Females: 4,249,742; Density = 6,319 (person/Km2); Sex Ratio =830; Literacy= 76. 09% Males: 82.63 Females: 68.01. (Manorama, 2002) The territory forms an enclave inside the eastern frontier of Haryana in North India. Extreme dryness with an intensely hot summer & cold winter is the Characteristics of the climate. The Delhi city was founded in the 11th century A.D. Rajput – Chieftain of the Tomara clan. The chauhans obtains possession of the city from the Tomaras. Prithviraj, the chauhan rular of Ajmer & Delhi; made the city of Delhi famous by his heroic valour & romantic adventures. Delhi under Pritviraj & Kanauj under Jai chand were the principal Kingdoms of North India at that time. The first invansion of India by Muhammad Ghori was beaten back by prithvi raj in the first battle of Tarain in (1191). Ghori came back to average his defeat and in the battle of tarain (1192) the Rajput army was routed. Prithviraj was captured & put to death. Delhi thus passed into the hands of muslim rulers for the next six centuries. Under the Mughal Empower, Delhi became a world famous city. 1857, British deposed the titular Emperor Bahadur shah, & formally annexed Delhi. In 1912, the capital of British India was transferred from Calcutta to Delhi. A new city- New Delhi of imposing dimensions laid out by the side of the old city-old Delhi by the British Indian Government. Independence India has retained their historic capital. Delhi became a Union territory on November 1,1956. in December, 1991 Delhi gat a Legislative assembly comprising to seats along with a 7 member council of Ministers headed by a Chief Minister. The territory is made up of three census towns. Delhi, New Delhi & Delhi cantonment. And 214 village; the territory is covered by 3 local bodies. Delhi Municipal Corporation; New Delhi Municipal Corporation & Cantonment Board. The rural area of the territory falls within the jurisdiction of the Municipal Corporation of Delhi. The survey was conducted by visiting old age homes and rural areas where the aged persons live in. All interactive sessions, interviews of the aged were done in their respective household, which in our unit of observation. Elderly persons of both sexes had been selected from those areas respectively. The cut-age of the respondent was 60years. A total of 100 (65male, 35 female) elderly persons in the respective areas were surveyed.
  22. 22. The elderly persons also represented both old age home rural dwellers. Thus the population represent more or less a cross-section of the elderly pollution of the Delhi cosmopolitan. Considering the duration of the proposed survey and the variety of information to be collected, It has done a total enumeration in the respective homes & locality. As a result no such sampling frame was adopted for the present survey. But as the aged are not a homogenous population the care was taken for an appropriate representation of the following two markers namely; a). Different age groups, b). Gender to obtain a presentable number of elderly persons. There is another survey on caregiver. It was done a total enumeration be collected in the respective homes & locality. As a result care giver also represented both old age home & rural areas. Then care giver represent more or less a cross-section of the elderly care provider of Delhi. Rapport:- Establishing rapport with respondent with respondent is integral part in any kind of sociological survey. Full Co-operation was received through out the period of data collection by govt. of Delhi, social welfare Dept. and Najafgarh Municipal Corporation. The purpose of data collection & clarification were received well by them with a spirit of co-operation. For the present survey attitude response scales made all enquiries. A series of statements are rated in the following five point scale-strongly agree, agree, undecided, disagree, strongly disagree. Before going to start he survey work it was conducted a pilot survey get an idea about the response of the aged. Data collected by face- to- face interview and direct observation methods. In order to understood the general inter-personal behavior with the aged, the care provider, observation method was very much useful. This enabled me to take note of the type of respect pr neglect extended to the aged by their caregivers of family members. Types of data:- I Respondent (elderly person) A) ‘ physical health status covered by the normal health, chronic health problem, allergies immobility, physical problem, surgical intervention faced by the elderly respondents. B) “Mental health status” covered by the- Consciousness, emotion, perception disturbance, abstract reasoning, personality disorder faced by the elderly respondents. C). “ Socio-Demographic status ‘ covered by the age, gender, married status, Religion, education level. D). “ Economic status” covered by the earning status, property ownership.
  23. 23. II. Care giver A). ‘ Social status ‘ covered by age, gender, relation. B). “ Health Status on physical’ on their feeling & observation covered by-chronic Disease, disability with ageing, Healthy life style; Diabetes mellitus, loss & Sensor motor stimulation. C). “Mental Health status” of elderly on care given feeling & observation covered By- wandering, consciousness, perception, construction ability of talking, Mental illness with high income. Data Processing:- The respondent were free to answer without reservation all statement, put to them, and also to express their statements put to them, and also to express their opinion or attitude regarding socio-demographic, economic, physical & mental health status, care giver attitude regarding physical & mental health status. The information thus collected have been codified for classification into categories & these coded response data subsequently have been used for analyses. The confidentiality of individual information is maintained. The sample of the study in 150. 32 Respondent aged 60 yrs and care givers (8) chosen from two old age homes different status groups on the basic of their economic capabilities to stay free of cost or paid. In order to find out the condition of the old people at their own homes. 68 more respondents &42 more caregiver from the nearby village were interviewed. Old age homes are selected because they are only for the aged people. In this study health in not considered purely as a biological disturbance but viewed in terms of physical & mental activities. To be healthy is be active. To be healthy facilities provide by the home as follows:- 1. Even though meal are provide two times a day, no special care is taken for the nutritive value of the diet. Neither do they offer any supplementary food. 2. The home has arrangement for a visit of govt. doctor, once in 7 days for check-up of the inmates. For simple ailment like fever, cold and pain, medicines are readily available at the institution itself and for other health problems they have to approach other hospitals according to their home preferences. As this type of visit by the doctor is not sufficient to meet their health problems, the inmates go to government hospitals whenever it is necessary. 3. Sanitary conditions & other facilities are not so good. Separate rooms are not available for their members. The rooms walls are not white washed and floors not cleaned properly. 4. However the home has a television set and subscribes to a few magazines & newspapers. The inmates seem to be quite. Content with their facilities and pass their time chatting quarreling. A kind of self-imposed isolation and withdrawal from the external world indicates their disengagements.
  24. 24. 5. Unfortunately, the Govt. programmes for the aged welfare have not reached there. The inmates complain that the service provide by the management is not sufficient on taken care of by the institution. An analysis of the life history of each respondent makes it clear that our senior citizens have a spectrum of problems ranging from physical problem to widowhood. Each case furnishes a unique problem. A careful analysis shows that many cultural aspects function at a negative ride for the old. Lack of economic facilities of the older person with dealing health, makes their plight awful. In order to highlight there aspects a few cases are given below. Case No. 1 Mr. A.G. is 75 yrs. Old. He is a widower & has daughter. When he 62, he lost his partial mobility, then he was burden daughter’s family. Frequent conflicts disturbed the peace of the home and the family members decided to send him off. He was admitted to their home for the aged. His daughter visits him once in a month. Main worry being ill health. Case No. 2 Mr. G is 72 yrs old. He is from Bombay and ex-Govt. employee, He is a widower & his son settled abroad. Then he came to this home for the aged. He is very co- operative; enjoy his life with other members of the Home. He sings well. He has depth of knowledge but there is no way to use knowledge, however, a school also attached with that old age Home. Case No. 3 Mr. K. is 93 old. He bachelor in perfect, He is Helpful to all inmate, He has joined the home on his own as he disliked the idea living alone. 1. the analysis of the cases above discloses two different & extreme kinds of problems for the senior citizens owing to ill-health & economic inability. On the other side old people get themselves admitted to home because they have no family at all to care for them. Therefore, two things are clear, one in that elderly people want some security & prefer to be under the care of an institution and secondly due to unsound economics position the family considers the old as a burden & send them to Homes. Therefore, economic security is a crucial one in the life of aged. 2. Except for one respondent all the other inmates are found to withdraw themselves from their social contacts. It is self imposed lethargy leading to a condition of possibility, true that they require money and good health for social activities, but the respondents are found to be lacking in private activities like reading, hobbies & visiting temples, except one member who shows interest in gardening. But home has not any income generation programmed to spent inmates time in work.
  25. 25. The needs, problems & the healthy behavior differ among the old according to the place in which they stay. Institutionalized older persons are just one group among the old population in India. There is another picture of old living outside the institutions. The second half of the study analyses the health condition of the aged living in rural areas under non- institutional setting. The data has been collected from Najafgarh, Hasanpur, a village in Delhi. The entire respondents belong to the lower income group. In rural areas the problem is different from the urban centers. In rural areas, against the common belief of strong joint family living, 80% of the elderly respondents are found to be living separately. Joint living may be convenient for the rich agricultural families. Whenever, in the lower income group, the sons, a few years after marriages, construct separate huts and stay to some one come out their own living and themselves have to someone come out their own living and themselves are not in a position to take care of their parents. Hence there is a compulsion for the parents to accept their lot. They regret and accept that their sons had to toil in the field from morning till night and it is their own fate to remain all alone uncared. 62% of the respondents including women do some work & earn their Livelihood & have their own property. Case No. 4 Mrs. G. 81 yrs. Old widow, has two sons & two daughters. Sons are working as laborers and are just unable to look after her. Sometimes she may not see them for days. All that she wants just enough food and clothing. Case No. 5 Mr. H. lives with his wife. As he has some disability, his wife goes to work and looks after him. Their three sons & two daughters’ are of no help to them. Their is need is just care and clothing. His wife health is better than her Husband, earns by some works. Now, we consider elder care, it is the second & third generational. Who may act as care givers? Therefore, the views or a valueless perception of adult children and grand children of the aged name become critical determinants of quality care. Two decade ago, in 1984, a study was carried out with objective of assessing various elder care issues. It brought to light that the joint family system was dwindling, yet a majority of adult and young children viewed elder care as part of their adult life (Rammorit & Jamuana, 1986). In view of their observation the present study was planned to reexamine the views of adult children, younger persons& also elderly to know whether time had brought any significant change in the perceptions & expectation with regard to few important aspects of eldercare issues. Here it found that to know perceptions/ expectations of the caregiver from generations’ regarding- a). old age as problem in physical health. b). old age as problem in mental health. c). Institutional care is good. d). Non- institutional is best.
  26. 26. Here, it was found 50 men & women as sample from old age home & household areas of Delhi. The household & old age home cases where all three generations were living together. i.e. (20-29) young generations; (30-39) Middle age group; (40-55) old age group; The rule sects were individuals contacted & the purpose of the study was explained to them. Then the questionnaire which was used in caregiver role in society. The response were analyses & percentages of responses were calculated. To realize the first objectives, the respondents were asked to indicate their views an-whether old age problem in physical health. There was a disporting in the views among three generations (young, middle & old). It is noteworthy that age or problem in physical age. (Table: As a second step, the respondents were asked to indicate as to who would take care of the mental health problem? The responses showed that by & large, the view of Caregivers were about same. (Table. Nextly, eldercare in old age homes as important substitutes to care of the disable elderly. Next, when it comes to non- Institutional care the young, middle & old age care giver viewing some or less equally that care giving by sons & daughters wee due to their emotional attachment to their aged parents. Eldercare by family members ( other than spouse) will become more of a problem in the coming decades in view of selective migration of children from rural to urban areas. Rapid growth of dual career families and a tendency toward more individualistic life style loosen family ties their increasing intergenerational distance. Therefore, it is time that we should be thinking of alternative strategies of sharing the care giver border. In view of our National priorities some of the possible strategies of elder care managements are: 1. Community car services like (Geri homes) & caring Network services like (Geana-homeNet) rather than the formal family care services must be encourage in the society by family care provider. 2. Greater emphasis an self care, spouse care & the greater provision for home Help services in rural areas for the disabled.
  27. 27. Result and Discussion:- Table : 1: Mean & S.D. value on 6 Dimensions of physical Health of three group Of elderly in Old Age Homes, Delhi. Gr. I Gr. II Gr. III X S.D X S.D X S.D Normal Health 3.75 .433 4.00 .707 3.16 .897 (10) Chronic health 2.62 .487 2.80 .979 2.66 .745 (11) Immobility (12) 3.06 .242 2.70 .640 3.50 .500 Allergies (13) 2.56 .540 2.40 .330 2.66 .745 Physical Problem 3.50 .612 2.70 .781 3.50 .935 (14) Surgical 2.75 .701 2.40 .489 3.16 .687 Intervention (15) Table.1 shows on the whole it may be said that all the three groups of elderly of Old age homes, Delhi have favorable perception towards their normal health. At the same time they are also opinioned that they do not have any kind of problems related to chronic disease and allergies. But the elderly belongs to group I. & III do experience that they do have physical problem as well as problem associated with immobility, whereas such kind of perceptions towards the problem just mentioned have not been observed for the elderly belonging to Group II. Finally, the Table.1 also indicates that elderly belonging to Group II and I do not have any kind of surgical Intervention so far but the elderly belonging to Group III have had surgical intervention. Therefore, on the basis of the findings of the study, different policies and programmed used to be device and implemented by Government working in area of old age, so that the elderly people of the Old age homes, Delhi can be help to live better live.
  28. 28. Table: 2: Mean S.D value on 6 dimensions of mental health of three groups of elderly in Old age homes, Delhi. Gr. I Gr. II Gr. III X S.D X S.D X S.D Consciousness (22) 3.18 .634 3.20 .871 3.16 .687 Emotional status 3.00 .500 3.40 .800 2.83 .687 (23) Perception 2.81 .634 2.80 .871 2.66 .745 Disturbance (25) Abstract reasoning 2.81 .526 2.80 .806 3.00 .372 (26) Poor 2.68 .583 2.80 .748 3.00 .577 Concentration (27) Personality 2.68 .463 2.50 .651 2.83 .372 Disorder (28) Table.2 presents the mean and standard deviation of all three groups of the elderly of Old age homes, Delhi have favourable perception towards their mental health. At the same time they are also opinioned that they do not have any problem related Consciousness, perception disturbance, abstract reasoning, poor concentration, and personality disorder.
  29. 29. Table :-3, Mean and Standard Deviation on 6 dimensions of physical Health of elderly in rural areas, Delhi. Statement Group –I (60-70) Years Group-II (71-80) Years Group-III (81+) Years No. Mean S.D Mean S.D Mean S.D Normal 4.53 .498 4.22 .974 4.66 .471 Health (10) Chronic 1.93 .725 2.05 .779 1.33 .471 Health (11) Allergies (12) 1.93 .665 2.22 .916 1.66 .471 Immobility 2.14 .798 2.27 .869 1.33 .471 (13) Physical Problem (14) 2.45 .917 2.44 1.06 3.00 1.41 Surgical Intervention 2.17 .752 2.38 1.01 3.00 1.41 5 Norm al Health (10) 4 Chronic Health (11) 3 Allergies (12) 2 Im m obility (13) 1 Physical Problem (14) Surgical Intervention 0 Table.3 present mean and standard deviation of the perception on physical health status of elderly of rural areas of Delhi in their own family setting. As their own perception on their own physical health status shows normal on all dimensions.
  30. 30. Table –4.Mean and S.D values on 6 dimensions of mental health of elderly in Rural area, Delhi. Statement Group –I (60-70) Years Group-II (71-80) Years Group-III (81+) Years No. Mean S.D Mean S.D Mean S.D Consciousness 3.89 .682 3.38 .755 3.00 .816 Emotional 3.76 .749 3.50 .687 2.66 .471 Status Perception 2.19 .733 2.61 .755 2.33 .942 Disturbance Abstract 2.21 .565 2.68 .463 2.66 .471 Reasoning Poor 2.21 .741 3.06 .805 3.33 .471 Concentratio n Personality 2.25 .626 2.50 .600 2.33 .942 Disorder 4 3.5 Consciousness 3 Em otional Status 2.5 Perception Disturbance 2 Abstract Reasoning 1.5 1 Poor Concentration 0.5 Personality Disorder 0 Table.4 present mean and standard deviation of the perception on mental health status of elderly live at rural areas, Delhi as perception of their own mental health status. Here on consciousness and emotional status shows high but Group III has low perception on emotional status.
  31. 31. Table –5: - Mean & S.D. Value on 5 Dimensions of physical and mental health status as observe by care giver of old age home, Delhi Physical Health Mental Health Statement Statement Mean S.D Mean S.D Chronic Disease 3.37 .727 3.87 .330 Wandering Disability 3.87 .599 3.87 .330 Consciousness Healthy life style 3.75 .433 3.87 .330 Perception Disturbance Diabetes Mellitus 3.50 .500 3.87 .330 Construction Ability Loss Sensory 3.62 .484 3.75 .433 Mental Illness with Motor Stimulation High Income Group The result in Table.5 present on that caregivers staying at Old age homes, Delhi have their own perception on elderly physical and mental health status. It says that both health status on old age home’s elderly likely to be same. Table –6:- Mean & S.D. Value on 5 Dimensions of physical and mental health status as observe by care giver of Rural area, Delhi. Physical Health Mental Health Statement Statement Mean S.D Mean S.D Chronic Disease 3.83 .651 3.97 .407 Wandering Disability 4.07 .642 3.61 .485 Consciousness Healthy life style 3.97 .555 3.64 .526 Perception Disturbance Diabetes Mellitus 3.83 .613 3.88 .624 Construction Ability Loss Sensory 3.71 .824 3.52 .499 Mental Illness with Motor Stimulation High Income Gr. The Table.6 present on that caregivers perception on elderly physical and mental health status. It says that the rural elderly are suffering from chronic disease, Disability with ageing, Diabetes Mellitus, Loss sensory motor stimulation but contradict on healthy life style lead by elderly of rural area.
  32. 32. Table 7: Mean Difference between self and caregivers perception and observation on physical health of elderly person in old age Home, Delhi. Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Normal Health (10) Healthy Lifestyle (10) 3.63 3.75 Chronic Health (11) Chronic Disease (8) 2.69 3.37 Immobility (12) Disabilities with 3.08 3.87 Ageing (9) Physical Problem Loss sensory motor (14) 3.23 3.62 stimulation (16) The result in Table.7 present difference in perception towards physical health problem of elderly by themselves and other caregivers. It says that both elderly and caregiver are the opinion that the elderly have normal health but some kind of physical problem such as loss sensory motor stimulation. But for the chronic health and Allergies, elderly people say that they do not have any kind of such problem whereas the caregivers contradict them while saying that the older person does suffer from problem associated with chronic health. Therefore, it only on the chronic health problem/ chronic disease that difference in perception on the part of gray person and caregiver have been noticed. So that some kind of efforts in terms of research is required to see why is this difference in perception towards chronic health problem between gray person and caregiver are there.
  33. 33. Table 8: Mean Difference between self and caregivers perception and observation on physical health of elderly person in Rural Area, Delhi. Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Normal Health (10) Healthy Lifestyle (10) 4.47 3.97 Chronic Health (11) Chronic Disease (8) 1.77 3.83 Immobility (12) Disabilities with 1.91 4.07 Ageing (9) Physical Problem Loss sensory motor (14) 2.63 3.71 stimulation (16) Table.8 presents the result on difference in perception towards physical health status of elderly at rural area, Delhi by themselves and caregivers. It says that both elderly and caregiver are the opinion that the elderly have normal health but some kind physical problems as such as chronic health problem, Immobility, Physical problem of elderly perception are less suffer. But for the caregiver perception contradict the elderly perception on those above dimension. Therefore, some kind of efforts in terms of further study is required to see why this difference in perception toward physical health status between elderly and caregiver are there.
  34. 34. Table 9: Mean Difference between self and caregivers perception and observation on physical health of elderly person in old age Home, Delhi. Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Consciousness 3.18 3.87 Consciousness Personality Disorder 2.67 3.87 Wandering Perception 2.75 3.87 Perception Disturbance Disturbance Poor Concentration 2.82 3.87 Construction Ability In Table.9 on the whole it may be said that all difference of elderly and caregiver perception towards consciousness of mental health status of Old age homes on favourable. At the same time they are suffering from Wandering, perception disturbance, and construction ability as caregiver’s perception but elderly perception do normal.
  35. 35. Table 10: Mean Difference between self and caregivers perception and observation on physical health of elderly person in Rural Area, Delhi. Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Consciousness 3.42 3.61 Consciousness Personality Disorder 2.36 3.97 Wandering Perception 2.37 3.64 Perception Disturbance Disturbance Poor Concentration 2.86 3.88 Construction Ability In Table.10 shows result in differences in perception towards mental health status between elderly and caregiver from rural area. It says that both elderly and caregiver are the opinion that the elderly have normal consciousness.
  36. 36. CONCLUSION In the brief study on the compared of elderly which will arising between physical and mental health status of elderly as to develop a profile on their observation by themselves and by caregiver also. This study shows some new findings that denote that there some problem in the care for the elderly in society as well as in Old age homes. In geriatric caregiver is new angle, no caregiver available till the project “NICE” was started. now caregiver is professional like other field i.e. Medical Practitioner, Physiotherapist, Occupational therapist, speech therapist, psychotherapist, nursing and other professionals. The data highlight that this geriatric care giver (geriatric animator) should have right for recognition as service provider, registration for licensing and scale for payment and security on housing, education to their children, medical reimbursement, EPF and CPF facilities.
  37. 37. Bibliography 1.Das, N.G, 2000, Statistical Methods, Das Publication, Calcutta. 2.Kothari.C.S.,1997, Research Methodology,Wiswa Prakasan, Delhi. 3.Phipps, Simmons, 1997-98, Primary data-methods of collection, sampling methods, survey methods and questionnaire design. The Chartered Institute of Marketing. Butterwerth – Heinemann, Oxford 4.Jamuna.D, 1997, Public perception in care giving, an evaluation, CMIG, Calcutta. 5.Chakraborty, Indrani, 1997,Life in Twilight years,Kwality Book, Calcutta 6. Ramamurty.P.V. and Jamuna.D and Reddy.L.K. 1992, Psychological aspects of care giving and disability among elderly in India. 7. Hogstel.Mildred.O, (1995), Geropsychiatric Nursing, 2nd edition 8. Harlok, Elizabeth, (1982), Developmental Psychology a life span approach, 9. Siva Raju, S, (2002), Health Status of the Urban Elderly, B.R.Publication, Delhi 10. Kausalya. S., Geriatric Nursing, Help Age India, 2002 11. Prakash.I.J. Ageing – An Indian Perspective, Bangalore University,2001 12. Dey.A.B. Health guide for the older persons, AIIMS, WHO, United Nations,2002
  38. 38. Appendix UNITED NATIONS WORLD ASSEMBLY ON AGEING United Nations is preparing for the Second World Assembly on Ageing scheduled for the 2002. In this process technical committee was formed and this committee has already formulated certain strategies with priority issues and objectives for the welfare of the elderly. It is right time for the social gerontologists in India to examine the issues and strategies formulated by the UN and in appropriate way the same may have to be included in our own agenda. The UN priority issues are as follows: Priority Issue 1: Poverty Alleviation Objective : ● In accordance with the already agreed International Development Goals, reduce poverty among older persons by 50 percent by 2015 and further targets for the reduction of poverty thereafter. ● Prevent poverty in old age through the appropriate areas of income security, employment, family and community support. Priority Issue 2: Income Security and Social Protection Objectives: ● Established social protection programmes all workers, including those engaged in informal sector, to acquire the right to basic social protection, including an old – age pension. ● Institute and expand pension systems and social assistance schemes. ● Guarantee sufficient minimum income for older persons. Priority Issue 3: Access to Knowledge, Education and Training Objective:- ● Ensure that older persons, without discrimination by reason of age,
  39. 39. enjoy equality of opportunity and treatment with regards to continuing education, training, retraining as well as vocational guidance and placement services. ● Utilize the potential and expertise of older persons in the different Areas of the economy and society. ● Ensure that methods appropriate to older persons are used in skills Training. Priority Issue 4: Work and Social Productivity (observers from ILO and ISSA would prefer to revert to “labour market” rather than “work”) Objective ● established the conditions, which enable active participation in the labour market, (ISSA suggests adding, “this would include not only increasing the participation of older workers, but just as importantly, also that of the unemployed women, persons with disabilities and other marginalized groups in the labor marker). ● Promote a realistic understanding of the older worker’s productivity based on their expertise and potential. ● Assist older persons already engaged informal sector activities to improve their income, productivity and working conditions. ● Assist older persons by engaging them in self – employment. Priority Issue 5: Active Participation in Development and Society Objectives: ● Recognize the social, political and economic potential and contribution of older persons. ● Include older persons in decision – making processes. ● Clarify, quantity, support and recognize contribution of older persons to development through, inter alia, their role of carers of HIV/AIDS infected children and grandchildren, as well as their role as surrogate parents to orphaned grand children. Acknowledgement that these roles of
  40. 40. older persons reflect their essential contribution to the development of future labour force. Priority Issue 6: Intergenerational Solidarity Objective: ● Achieve and sustain intergenerational solidarity. ● Contribute to positive images of ageing by focusing on societal resources of older persons by using the expertise of elder workers in the labor market and by fostering the mutual exchange between the generations. Priority Issue 7: Rural Development Objective: ● Alleviate isolation and marginalization of older persons in rural areas. ● Improve life conditions and develop/extend infrastructure in rural unities in order to diminish out migration of younger persons to urban Areas. Priority Issue 8: Migration and Urbanization Objective: ● Support late life migrants to avoid their alienation and marginalization and cognize the hardships created by displacement and late life migration. (Note: issues of refugees, emergency situations and forced migration need be addressed here). ● Assist and support older persons affected by urbanization. Priority Issue 9: Health Promotion and Development Across the Life Course Objective:
  41. 41. ● Increase the prevalence of factors that protect health and well- being throughout the life course, including the later stages of life. ● Foster health development and health promotion across the life course to maximize healthy ageing. ● Develop disease prevention policies. ● Reduce prevalence of risk factors associate with major diseases in the ageing process. Priority Issue 10: Universal and Equitable Health Care Services Vital to Development. Objective: ● established a range of services to meet the diverse health needs of older People to maximize their health and functional abilities. ● Ensure fair access to health care. Priority Issue 11: Primary Health Care Objective: ● Develop and strengthen primary health care to meet the needs of older people. ● Provide primary care workers with knowledge, training and the necessary resources to meet the needs of older persons. Priority Issue 12: Impact of HIV/AIDS on older Persons and Society Objective: ● Clarify, through research and accurate data collection, the impact of HIV/AIDS on the health of older persons, both for those who are infected suffers training, medical care and social support. ● Ensure that older persons who are affected by HIV/AIDS, both sufferers and carers, receive adequate support in areas such as information, care s skills training, medical care and social support. Priority 13: Training of Health Care Providers Objective:
  42. 42. ● Introduce specific and appropriate knowledge of ageing to all health and social service providers. ● Prepare specialists in gerontology and geriatrics who are also skilled in interdisciplinary areas. ● Create awareness in the population at large regarding the special needs and caring for the elderly. Priority Issue 14: Mental Health, Cognitive and Affective Needs of Older People Objective: ● Ensure that appropriate care is provided to older persons with mental cognitive disorders, including their emotional needs. ● Promote early detection, diagnostic and measurement. ● Create a network of informal and formal care providers. Priority Issue 15: Older Persons and Disabilities Objective: ● Prevent disabilities and reduce its prevalence in old age while reducing disabling consequences through life course. ● Provide appropriate care, rehabilitation and community – based support services for older disabled persons, as well as for persons with disabilities reaching old age, so as to ensure fulfillment of their rights to appropriate services and to integration into society without any discrimination based on age and disability. ● Obtain knowledge and information and conduct evaluation projects on older persons with disability and on effective policies, practices and technologies, enabling their habilitation and integration into society. Priority Issue 16: Well – being and Self-fulfillment in Old Age Objective:
  43. 43. ● The attainment of full participation of older persons in economic, social and political affairs in the community and society. ● Provide opportunities and services for self – actualization. ● Promote holistic care for older persons, taking into account the interdependence of physical, mental, social, spiritual and environment factors. Priority Issue 17: Housing and Living Environment Objective: ● Strengthen support for interdependent living (and ageing in place) in the community, with regards given to individual preferences. ● Ensure that housing and environment design cater for the needs of ageing persons. [OR: that environmental conditions and human settlements be ● adapted to an ageing society] Ensure the availability of accessible and affordable transportation for older persons. ● Ensure equitable allocation of public housing for older persons. Priority Issue 18: Care Objective: ● Ensure the provision / availability of community – based – care – not to substitute, but to support family care. Ensure minimum care standards and regulation of residential care and all other forms of care. ● Recognize the burden of care falling on older women [in situations of AIDS, etc]. ● Promote holistic care for older persons, taking into account the interdependence of physical, psychological, social spiritual and environment factors. Priority Issue 19: Abuse and Violence
  44. 44. Objective: ● Eliminate all forms of abuse against older persons Priority Issue 20: Intergenerational Relations Objective: ● Strengthen intergenerational ties in family and community ● Ensure that policy and services support (harmonious) intergenerational family relations. Priority Issue 21: Positive Images of Ageing Objective: ● Promote public awareness of the positive contribution and resources of older persons, including older women and older persons with disabilities. ● Eliminate negative stereotypes of older persons in the mass, media, particularly older women. Priority issue 22: Emergency Situations Objective: ● Ensure that appropriate attention is paid to older persons in emergency situations. Priority Issue 23: Well _ being and self – fulfillment in Old Age Objective: ● The attainment of full participation of older persons in economic, social and political affairs in the community and society ● Provide opportunities and services for self- actualization.
  45. 45. QUESTIONNARIE No. ……………… Following are the statements that reflect upon how you feel/experience about yourself and the world around. Read each statement carefully and do register your reply the response alternative immediately. There is no right/wrong answer to any of the question in this questionnaire. 1. Name …………………………… 2. Age……………………………… 3. Sex……………… 4. Martial status……………… Married/unmarried/Discovered/widow 5. Religion Hindu/ Muslim/Christian/Buddha/Jain 6. Qualification….. Illiterate/ Primary/ Secondary/University 7. Property…… Yes /No; 8. Occupation……. Employment/Rtd/professional. 9. Income = >50,000 p.a >72,000 p.a >1, 00,000 p.a 10. I think that my health is normal:-
  46. 46. a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 11. I have chronic health problem:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree; 12. I have immobility:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 13. I have allergies (food/Medicine, if any) a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 14. I have physical problem:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 15. I have surgical intervention:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 16. I take care of myself:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 17. I have loss of appetite:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 18. I am abused by family members:- a). Strongly Agree; b). Agree; c) Undecided; d) Disagree; e) Strongly disagree; 19. I am well in my family:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree; 20. I feel dissatisfaction with life:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree;
  47. 47. 21. I have alertness and good orientation:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 22. My level of consciousness is good:- a). Strongly Agree; b). Agree; c).Undecided; d) Disagree; e). Strongly disagree; 23. My emotional status is fine – a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 24. I have no problem with construction ability of talking:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). strongly disagree; 25. I have perception disturbances:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree: e). strongly disagree; 26. I have abstract reasoning, insight, jugdement:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 27. I have poor concentration:- a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 28. I have suffered from personality disorders:- a). Strongly Agree; b). Agree; c) Undecided; d) Disagree; e). Strongly disagree
  48. 48. INTERVIEW SCHEDULE N0………………. Your answers to the questions will help me in our research. I am interested in how you are feeling generally in your role here. Caregiver Name__________________________ Age____________ Sex______________ Elderly Name____________________________ Age____________ Sex______________ Address________________________________________________________________ __ _______________________________________________________________________ __ Relation with the elderly___________________________________________________ Type of problem: Physical/Mental Health. 1. I think that older person’s age will be 60yrs. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 2. I give total response to older person. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 2. I feel uncomfortable with elderly.
  49. 49. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 3. I spent my time with daily activities of elderly person. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 4. Older persons make trouble. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 5. I have seen wandering behaviors in older adults a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 6. I suggest supportive counseling to wanderers. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 7. I think that older person suffer chronic disease. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 8. Older persons are facing disabilities with ageing. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 9. Older persons lead healthy lifestyle. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 10. Maximum older persons facing Diabetes Mellitus. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 12. I believe older adults have lived long life and promote less care or no care. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 13. I think that legal provision for geriatric care giver right is very important. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 14. ‘Relocation’ one of the major factors that leads to stress in older adults. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 15. ‘Group-meeting’ in activity room promoting “self-esteem”.
  50. 50. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 16. Older adult loss sensor motor stimulation. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 17. I feel strain with elderly care for inadequate support service. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 18. Older adult loss their consciousness level. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 19. Older adults have perception disturbances. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 20. Older adults have problem with construction ability of talking. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 21. Older adults take help with instrumental daily activities like-computer operating, telephone a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 22. Older persons favour Govt. hospital & modern medicine, more. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree; 23. Mentally illness more affect high income group elderly. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;
  51. 51. APPENDIX ‘B’ SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE (SPMSQ) Instruction: Ask question 1-10 in this list and record all answer. Ask question 4A only if patient does not have a telephone. Record total number of errors based on ten questions. 1. What is the date today? + _ 2. What day of the week is it? 3. What is the name of this place? 4. What is your telephone number? 4a What is your street address? (Ask only if patient does not have a telephone) 5. How old are you? 6. When were you born? 7. Who is the pradhan / councelor now? 8. Who is the pradhan / councelor before him?
  52. 52. 9. What was your mother’s maiden name? 10. Subtract 3 from 20 and keep subtracting each new number all the way down. Total Number of Errors To be completed by Interviewer. Patient’s name Date Sex: Male Female Years of education: 1. Primary school. 2. High school. 3. beyond High School. Interviewer’s Name: 0-2 errors intact intellectual functioning. 3-4 errors Mild intellectual impairment. 5-7 errors Moderate intellectual impairment. 8-10 errors High intellectual impairment.