assessment of geriatric depression and development

www.wjpps.com Vol 5, Issue 8, 2016.

762

Jain et al. World Journal of Pharmacy and Pharmaceutical Sciences

ASSESSMENT OF GERIATRIC DEPRESSION AND DEVELOPMENT

OF LEISURE/ RECREATIONAL PACKAGE FOR GERON’S

1*

Namrata Jain and 2Vimla Dunkwal

1Ph.D Scholar, Department of Food and Nutrition, College of Home Science, Bikaner (Raj.).

2Professor, Department of Food and Nutrition, College of Home Science, Bikaner (Raj.).

ABSTRACT

Assessment of elderly depression and development of leisure/

recreational package was conducted in Bikaner city. Three hundred

elderly aged 60-70 years belonging to different economic groups were

selected purposely from following centers - Geriatric Research and

Care Centre P.B.M, Helpage India (N.G.O.), Senior Citizen Society,

Associated Group of Hospitals and a common site i.e.: “Vradh Jan

Bhraman Path” near Town hall, Bikaner. Information was gathered

from elderly through interviewing them using standardized tool known

as “geriatric depression scale” (GDS). Further a recreational

counseling package was developed to resolve the stress, loneliness,

boredom and also to uplift the mental health. Results of findings revealed that overall 45

percent elderly were satisfied with their life contributing percentage of male is more as

compared to female. Simultaneously explored the psychological information regarding

feeling of unoccupancy, boringness, helplessness, memory loss and emotional instability.

Data depicted that females reflected more depressive symptoms when compared to males

(12.04-29.35; 9.94-36.69; 8.90-22.93; 57.06-81.65 and 2.61-39.44) for the same parenthesis

respectively. Depression is widespread among elderly persons; overall 13% elderly are in

mild depression, 4.6% in moderate depression and 1% in severe depression. Data also

revealed that females are more depressed at every level. Scores obtained for the content of

this package was 4.7. Visual quality, organization & continuity and authenticity scored 4.6,

4.6 and 4.5 respectively. Overall mean score (4.7) was also rated in the range of good to

excellent category. The study concluded that recreational counseling package can be an

effective measure for bringing about favorable changes in elderly‟s lifestyle.

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 6.041

Volume 5, Issue 8, 762-774 Research Article ISSN 2278 – 4357

*Corresponding Author

Namrata Jain

Ph.D Scholar, Department

of Food and Nutrition,

College of Home Science,

Bikaner (Raj.).

Article Received on

06 May 2016,

Revised on 27 May 2016,

Accepted on 16 June 2016,

DOI: 10.20959/wjpps20168-7286


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KEYWORDS: Geriatric depression scale, leisure/ recreational package.

INTRODUCTION

A grey wave is rapidly setting on the world with the rate of growth of aging population

exceeding that of the general population. According to world health organization, what was

an extra ordinary achievement for the last century will be one of the greatest challenges for

the present one- ensuring quality of life of an exceptionally large elderly population.

Ageing refers to a sequence of changes across a life span of an individual. Though ageing is

multidimensional process, old age is the closing period of the life of an individual. It is period

when people move away from their more desirable period or times of „usefulness‟. Ageing is

the progressive and generalized impairment of functions resulting in the loss of adaptive

response to stress and in increasing the risk of age related diseases. The overall effect of these

alterations is an increase in the probability dying, which is evident from the rise in age-

specific death rates in the population (Dey, 2008). Population ageing is a worldwide

phenomenon, and India is no exception. Indian population has approximately tripled during

the last 50 years, but the number of elderly Indians has increased more than four fold. Census

of 2001 has shown that the elderly population (60$) of India accounted for 77 million and

census of 2011 projections indicated that elderly population has crossed the 100 million

mark. It took more than 100 years for the aged population to double in most of the countries

in the world, but in India it has doubled in just 20 years. The life expectancy has also gone up

to over 70 years today. Better medical facilities, care and liberal family planning policies

made the elderly the fastest growing section of the society in India.

According to Erik Erikson‟s "Eight Stages of Life" theory, the human personality is

developed in a series of eight stages that take place from the time of birth and continue on

throughout an individual‟s complete life. Old age as a period of "Integrity vs. Despair",

during which a person focuses on reflecting back on their life. Those who are unsuccessful

during this phase feel that their life has been wasted and experience many regrets and left

with feelings of bitterness and despair. Those who feel proud of their accomplishments feel a

sense of integrity. These individuals attain wisdom, even when confronting death. Coping is a

very important skill needed in the aging process to move forward with life and not be 'stuck'

in the past (Erikson, 1968).


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It is also not well known that depression is the most common mental health problem of later

life. Although it is more readily treatable, it has received scant attention compare with

dementia. Depression in elderly is not an unitary entity (Beekman, 1996). Following

symptoms must have been presented in depressive illness like depressed mood most of the

day, nearly every day, as indicated feels sad or empty, appears tearful. Markedly diminished

interest or pleasure in all or almost all activities, significant weight loss when not dieting or

weight gain or decrease or increase in appetite nearly every day. Insomnia or hypersomnia

nearly every day, feelings of restlessness or being slowed down, Fatigue or loss of energy

nearly every day, feeling of worthlessness or excessive or inappropriate guilt, diminished

ability to think or concentrate, lastly recurrent thoughts of death, recurrent suicidal ideation

without a specific plan, or a suicide attempt or a specific plan for committing suicide. There

is considerable controversy over whether the general increase in life expectancy is associated

with the compression or expansion of morbidity in later life.

Thus present study is aimed to assess the depression of elderly and to develop leisure/

recreational package for elderly.

METHODOLOGY

1 Locale of the study and selection of sample

The study was conducted on elderly both male and female residing in Bikaner city., A total

number of 300 elderly aged 60-70 years belonging to different economic groups were

selected for the present investigation purposely from Geriatric Research and Care Centre

P.B.M, Helpage India (N.G.O.), Senior Citizen Society, Associated Group of Hospitals of

Bikaner City and a common site i.e.: “Vradh Jan Bhraman Path” near Town hall, Bikaner.

2 Assessment of mental Health

Assessment of mental health was done with the help of Geriatric Depression Scale (GDS).

Depression is common in late life, affecting nearly 5 million of 31 million Americans aged 65

and older. Depression is not a natural part of aging. Depression is often reversible with

prompt recognition and appropriate treatment. However if left untreated, it may result in the

onset of physical, cognitive, functional, and social impairment, as well as decreased quality

of life, delayed recovery from medical illness and surgery, increased health care utilization

and suicide (Blazer,2009).


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Tool

The Geriatric Depression Scale (GDS), first created by Yesavage, et.al, 1983 has been tested

and used extensively with older population. The GDS is a brief, 30-item questionnaire in

which participants are asked to respond yes or no in reference to how they felt on the day of

administration. Scores of 0-9 were considered normal; 10-19 indicated mild depression; over

20 were suggestive of severe depression.

Validity/Reliability

The GDS was found to have 92% sensitivity and 89% specificity when evaluated against

diagnostic criteria. In a validation study comparing the long and short forms of the GDS for

self rating of symptoms of depression, both were successful in differentiating depressed from

non depressed adults with high correlation (r = .84, p< .001) (Sheikh and Yesavage, 1986).

3. Leisure Profile

Stress in the elderly has many sources, including the loss of partner, financial stress, health

problems and lack of independence, which affect them both physically and psychologically.

Hence information is gathered from the subjects how they resolve their boredom and

loneliness and type of recreational activities through which they are most of the time

engaged.

4. Development of Recreational Counseling Package

Some elderly cope up with psychosocial changes, others experience extreme frustration and

mental distress. Many times negative traits like senile attitude, sad, hopelessness, loneliness,

timidness etc. develop in older adults, resulted in stress and mild depression. This package is

developed to educate about recreational and leisure activities to resolve boredom and

loneliness and information to uplift the mental health. Recreational counseling package

included different activities in which elderly can get engage to resolve loneliness, tips to

positive attitude and importance of social activeness.

5. Evaluation of the Package

The package was orderly arranged to maintain continuity and were evaluated by panel

members consisting nutritionist, medical and physical experts. They evaluated the package

for different quantitative and qualitative factors viz. content, authenticity, organization,

continuity and visual quality using modified version of evaluation form based on 5- point


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scale. On the basis of their suggestions further modification will be made in the package if

needed.

6. Analysis of Data

The data obtained from various analyses were organized and statistically analyzed by using

suitable statistics to find out significance of the results (Gupta, 1998).

RESULTS AND DISCUSSION

In the present study maximum number of overall elderly passes their leisure time by watching

T.V (78%) followed by reading (73%). More over males are more indulge in both activities

than females (81.67% and 71.55%) (83.24% and 55.04%). Further females enjoyed cooking

(44.03%), handy crafts (27.52%) and other activities (16.51%) more than males. Other

activities include religious prayers, social get together. In handy craft mostly stitching,

embroidery and knitting is done. Moreover in some leisure activities like music (12.56 and

11), writing (6.28 and 2.75) and gardening (23.56 and 24.77) both the counterparts spent

almost similar percentage (Table I).

Although the physical and psychological benefits of feeling in control are well-documented

in the research literature, the mechanisms that account for these effects have received less

attention. The present study was designed to examine the potential mediating role of

exercising and participation in nonphysical leisure activities, such as attending cultural

events, involvement in volunteer organizations, and so on, in the relation between perceived

control and well-being in seniors. The results indicated that an internal locus of control was

positively related to exercising and participation in leisure activities. Exercising and leisure

activity participation, in turn, were predictive of better perceived health and greater life

satisfaction. These findings point to the potential benefits of increasing seniors' sense of

control as a means to promote exercising and to increase leisure activity participation and,

consequently, to enhance well-being (Menec and Chipperfield, 1997).

Table (I) Distribution of elderly according to passes their leisure time

S.No Hobbies Male(191)

(%)

Female(109)

(%)

Overall(300)

(%)

1 Reading 159(83.24) 60(55.04) 219(73)

2 Writing 12(6.28) 3(2.75) 15(5)

3 Music 24(12.56) 12(11) 36(12)

4 Cooking 9(4.71) 48(44.03) 57(19)

5 Gardening 45(23.56) 27(24.77) 72(24)


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6 Watching T.V 156(81.67) 78(71.55) 234(78)

7 Handicraft 0 30(27.52) 30(10)

8 Other 27(14.13) 18(16.51) 45(15)

Note- figures in parenthesis indicates percentage of subjects

Assessment of Mental Health

Depression in older people is frequently undiagnosed or misdiagnosed because symptoms are

confused with other medical illness. Untreated depression has serious side effects on older

adults. It diminishes the pleasure of living; including eating. It exacerbates other medical

conditions and it can compromise immune function. It is associated with decreased appetite,

weight loss and fatigue (Mahan, et al., 2012). Assessment of mental health would be done

with the help of Geriatric depression scale (GDS). The GDS is widely recommended for

clinical use and is included as a routine part of a comprehensive geriatric assessment. It is

also increasingly being used in research on depression in the elderly (Gallo, et al., 1995).

Table (II) Distribution of subjects with respect to psychological information

S.No Psychological

information

Male(191)

(%)

Female(109)

(%)

Overall(300)

(%)

1 Satisfied with life 89(46.59) 46(42.20) 155(45)

2 Feel unoccupied 23(12.04) 32(29.35) 55(18.53)

3 Get bored 19(9.94) 40(36.69) 59(19.16)

4 Feel helpless 17(8.90) 25(22.93) 42(14)

5 Memory loss 109(57.06) 89(81.65) 198(66)

6 Full of energy 99(51.83) 42(38.53) 141(47)

7 Frequency feel like

crying 5(2.61) 43(39.44) 48(16)

8 Make decision 128(67.01) 69(63.30) 197(65.66)


Table (II) unfolds the psychological information of elderly and data revealed that overall 45

percent elderly were satisfied with their life in which percentage of male was more as

compared to female. Further view explored psychological information regarding feel

unoccupied, get bored, feel helpless, memory loss and frequently feel like crying percentage

depicted females reflected more depressive symptoms when compared to males (12.04-29.35;

9.94-36.69; 8.90-22.93; 57.06-81.65 and 2.61-39.44). Whereas male elderly (51.83%) were

more full of energy as compared to female elderly (38.53%). Also 67% males were more

capable in taking own decision while, (63.3%) females take advise while taking any decision.

Over all data showed that males were stronger enough to withstand against age related


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depression as compared to females. This might be due to the fact that females have fear for

their life and they are more dependent on the spouse.

Table (III) Distribution of elderly according to the level of depression

S.No Category Male(191)

(%)

Female(109)

(%)

Overall(300)

(%)

1 Mild depression 12(6.2) 27(24.77) 39(13)

2 Moderate

depression 4(2.09) 10(9.17) 14(4.6)

3 Severe depression 1(0.52) 2(1.83) 3(1)


Depression is widespread among elderly persons, affecting one in six patients treated in

general medical practice and even higher percentage of those in hospitals and nursing homes.

Older people have the highest suicidal rate of any group, and many medical problems

common to older people may be related to, or intensified by a depressive disorder (Sadavoy,

et al., 1997). Table (III) revealed that overall 13% elderly are in mild depression, 4.6% in

moderate depression and 1% in severe depression. Data also revealed that females are more

depressed at every level.

Jongenelis, et al., 2004 studied the risk indicators of depression in elderly depressive

symptoms were measured by means of GDS results revealed the prevalence of major

depression was assessed to be 8.1% and the prevalence of minor depression was 14.1%,

while a further 24% of the patients suffered from sub-clinical depression. Similar study by

Bordy, et al., 2001 concluded Depressive disorder is a significant problem for the elderly

afflicted with advanced macular degeneration. Further research on psychopharmacologic and

psychotherapeutic interventions for depressed AMD patients is warranted to improve

depression and enhance functioning. Over and above depression, visual acuity aided in

predicting vision-specific disability. Treatment strategies that teach patients to cope up with

vision loss should be developed and evaluated. Package was designed to achieve the

objectives of the study. For the evaluation of the package, relevant information was organized

and evaluated on 5 point rating scale by 10 panel members comprised of subject matter

specialists, medical and physical experts. On the basis of their suggestions further

modifications were incorporated in the content and language, new information was added,

unnecessary information was deleted, and some illustrations were replaced.


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Table (IV) Mean Scores of evaluation packages

Mean and Standard Deviation

Leisure/ Recreational Package: Table (IV) reported that the scores obtained for the content

of this package was 4.7. Visual quality, organization & continuity and authenticity scored 4.6,

4.6 and 4.5.Overall mean scores (4.7) was also rated between good and excellent category.

Package Visual

quality Content

Organization &

Continuity Authenticity Overall

Leisure/

Recreational

Package

4.6±0.49 4.7±0.68 4.6±0.37 4.5±0.55 4.7±0.04


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assessment of geriatric depression and development

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