1. INTRODUCTION:
“Memory
holds the whole of our past life and experience. Its loss is greater
than the loss of any of our senses”
Tom Gibsonns
“Getting older and
retirement both involves a change in lifestyle for most people and it’s
important to take care of yourself mentally as well as physically”
Ageing is a
universal phenomenon, old age is not in itself a disease, but is a normal part
of the human life span. Ageing is normal, universal, progressive, irreversible
process. It is an invitable physiological phenomenon.
1
As the risk of
dementia increases with increasing age, the number of persons with dementia in
the general population is also rising. In our ageing society the probability of
suffering from dementia increases with advancing age. Dementia predominantly
occurs in 2nd half our life, often after the age the age of 65-some
experts think that this is the ‘price society has to pay’ for our higher life
expectancy and therefore the the term ‘dementia’
activates similar fear and repression mechanisms as ‘cancer’ or ‘AIDS’. 2
The human life
span follows a recognized pattern from birth to death. A peak of human growth
and development is reached in the twenties. Then there is a gradual deteriorisation in physical and mental abilities. As the
ageing process progresses mental capabilities such as memory and physical
abilities further deteriorate. 3
Older adults face
special health problems many of the very old age people loss their ability to
live independently because of limited mobility, other physical or mental health
problems and require some forms of long term care.
About 20% of
elderly aged 55 or over suffer from mental disorders. Subsequently, global
statistics showed this to be an almost universal problem. Mental health
problems of older are under-identified by health care professionals and older
people themselves, and older people are often reluctant to seek help. 4
Dementia is one of
the most common and serious disorders of later life, affecting 5% of people
over the age of 65 years. 5
Dementia is not a
single, specific disease. It is a term used to describe a group of disease that
affect the brain and cause a progressive decline in the ability to think,
remember and learn. Although dementia is a condition that primarily affects
older people, it not a normal part of ageing. 6
Dementia is a
progressive brain dysfunction, which results in a restriction of daily
activities and in most cases leads to long time care. It is a general term that describes a group of
symptoms such as loss of memory, judgment, language, complex motor skills, and
other intellectual function caused by the permanent damage or death of the brain’s nerve cells or
neuron. One or more of several diseases, including Alzheimer’s disease can
cause dementia.7
Alzheimer’s
disease and other related dementia affect the health of the elderly population.
This causes disruptions in family routines
and wellness of the elderly. Hence, it is important to conduct awareness
program among the elderly.8
NEED FOR STUDY:
There is a rich
epidemiological evidence base on dementia in India which shows that this
neurodegenerative condition is an important public health problem, particularly
in the context of the rapid demographic transition in many parts of the
country. Research has shown that most people with dementia have significant
unmet health and social welfare needs. 9
Improving public
awareness of dementia would improve quality of life for people with dementia
and their families by putting them in a stronger, informed position to seek a
diagnosis, plan for the future and make more appropriate use of health and
social services throughout the course of their condition. 10
The global
publication share of the top 20 most protective countries in dementia research
varies from 0.91% to 33.59% during 2002 to 2011.
India is at 16th
position among the top 20 most productive countries in dementia. Research with it’s global publication share of 1.24% during 2002 to 2011.
India’s global publications share increased by 1.66% from the year 2002 to
2011.
Every 7 seconds
one or more person is being diagnosed with dementia all over the world. In
India there are approximately 3.2 million people affected with this disease. In
Bangalore there are 30,000 elders with dementia. As with all other major health
conditions, there is under-reporting of dementia due to lack of awareness
regarding the disease and a stigma associated with it.11
The prevalence of
dementia rises exponentially with age. The estimated prevalence of moderate to
severe dementia in a population aged 65 years or older is consistently reported
at approximately 5%. Within that age group, the exponential curve is
pronounced, so that the prevalence in the sub group aged 85-89 years, 20-22%. Dementia of the Alzheimer’s type is the most
common dementing disorder in the clinical and neuro pathological prevalence studies reported from north
countries.12
In India the
prevalence of dementia was 33.6 per 1000. Alzheimer’s disease was the most common
type (54%) followed by vascular dementia (39%), and 7% of cases were due to
causes such as infection, tumour and trauma. Family
history of dementia was risk factor for Alzheimer’s disease and history of
hypertension was a risk factor for vascular dementia. 13
The frequency of
people suffering from Alzheimer’s disease increases with age and it is
estimated that the occurrence is
Ř
0.5% per year in people aged from 65-69 years
Ř
1% per year from 70-74 years
Ř
2% per year from 75-79 years
Ř
3% per year from 80-84 years
Ř
8% per year in people over 85 year14
STATEMENT OF THE
PROBLEM:
“A study to evaluate effectiveness of
awareness program on Dementia among the elderly residing at selected old age
home of Belgaum, Karnataka.”
OBJECTIVES:
1.
To assess the knowledge
regarding dementia among elderly people.
2.
To evaluate the effectiveness of awareness programme
on dementia among elderly people.
OPERATIONAL
DEFINITION:
1.
Knowledge – It is the level of
understanding regarding dementia among elderly people.
2.
Effectiveness – It refers to determine the
extent to which the information in the effective awareness programme
has achieved the desired outcome as measured by gaining knowledge score.
3.
Awareness – Awareness is the state of or
ability to be conscious of events or sensory pattern and in this level of
consciousness.
4.
Dementia -Dementia is an acquired global
impairment of intellectual, memory and personality but without impairment of
consciousness.
5.
Elderly people – Individuals whose age above
60 years.
Hypothesis:
H1: The
mean post test knowledge scores of subject exposed to effective awareness programme will be greater than the mean pre test knowledge
at 0.05 level of significance.
Assumptions:
1.
The elderly people may have some knowledge regarding dementia.
2.
There is an impact of knowledge of prevention of dementia.
3.
Awareness programme is an effective
method of teaching strategies to teaching elderly people regarding dementia.
Delimitations:
The study is
delimited to elderly people residing at shantai oldage home of Belgaum.
RESEARCH METHODOLOGY:
In this study it
refers to various logical steps that were generally adopted by the investigator
in studying the research problem.
The present study
is aimed at assessing the level of self esteem among dementia patients.
Research approach:
The selection of
research approach used in this study is evaluative research approach. This type
of research is beneficial contexts. Therefore, the evaluative research approach
was found to be suitable for the present study.
Research design:
A non experimental
cross sectional research design adopted to carry out the present study.
Symbolic
representation of one group pre-test and post-test
Pre experimental
design
|
Pre-test |
Treatment |
Post-test |
|
Measurement of knowledge
before administering treatment |
Treatment with awareness programme |
Measurement of knowledge after
administering treatment |
|
O1 |
X |
O2 |
O1: Measurement of
knowledge before administering treatment
X : Treatment with
awareness programme
O2: Measurement of
knowledge after administering treatment.
Variables:
The variables for
the present study are;
Independent variables:
Awareness programme on elderly people.
Dependent variables: Knowledge of the elderly people.
Attributed variables: Personal characteristics which
include age, sex, educational status, marital status, religion.
Research setting:
Setting are the
more specific places where data collection occurs based on the nature of the
research questions and the type of information needed to address it. Based on
the geographic proximity, feasibility to conduct the study and familiarity with
the setting, the investigator, selected old age home, Belgaum.
Population:
The population of
this study was elderly people in Shantai old age
home, Belgaum.
Sample:
Sample of this
study was elderly people who are staying in Shantai
old age home, Belgaum.
Sampling technique:
Non random
sampling procedure of convenient sampling technique was used to select the
sample of elderly patients.
Sample size:
The sample size
for the present study consists of 30 old age people from Shantai
old age home, Bamanwadi, Jamboti
Road, Belgaum.
Criteria for selection of the sample:
The sample for the
study was selected based on the following criteria:
Inclusion criteria:
1.
People of 60 – 85 years of age
2.
Both males and females people
3.
People who know to read and write kannada
and English
Exclusive criteria:
1.
Those who are sick at the time of data collection
2.
Those who are not available during the period of data collection
Description of the tool:
A structured
questionnaire was developed with the consideration of objectives and
consultation with experts. The tool had two parts:
Section A:- Socio demographic Performa
Section B:- Consist of 20 multiple choice questions to
assess the knowledge of elderly people regarding dementia disease. Each correct
response was given the score of “1” and incorrect answer the score given was
“0”.
Method of data collection
The data
collection was done on 10-6-2014 for pre-test, 10-6-2014 for effective
awareness programme and 17-6-2014 for post-test.
After getting permission from the Principal, Class co-ordinator and
Guides. All elderly people from the Shantai Old Age
Home Jamboti Road, Belgaum. Was gathered in the hall.
The investigator explains the purpose of the study and confidentiality of
information, obtained the consent from the each elderly people. The
investigators distributed the pre questionnaires to them and instructed to fill
it within 30 minutes. The response sheet collected individually and conducted
an effective awareness programme regarding Dementia.
The post test was conducted on after 7 days.
Data analysis plan:
The data obtained
were analyzed in terms of the objectives of the study using descriptive and
inferential statistics. The plan of the data analysis was developed under the
excellent direction of the experts in the field of nursing and statistics. The
plan of the data analysis was as follow
1.
Organized the data on master sheet
2.
Computer frequency, percentage, means, standard deviation and
range to describe the data.
3.
Classify the knowledge scores as follows
a.
Good – X + S.D
b.
Average – X - S.D
c.
Poor – X - S.D to X + S.D
4.
Use of inferential statistics to draw the conclusions.
This
chapter on research methodology has thus described about data various
activities carried out and planned by the research investigators during the
course of our project.
RESULTS:
This chapter deals
with the analysis and interpretation of data obtained from 30 old age people in
order to assess effectiveness of Awareness programme
on knowledge and attitude regarding Dementia in Shantai
Old age home of Belgaum.
Descriptive and inferential statistics are
used to analyze the collected data. The
data findings have been organized, finalized and presented under the following
sections.
The objectives of the study:
To assess the level of knowledge regarding
Dementia among elderly.
Organization of the findings:
The analysis of
the data are organized and presented under the following headings
Section - I: Demographic variables of the
Elderly people.
Section - II Knowledge scores of
Respondents on Dementia.
Section 1: Findings related to the
socio-demographic variables
Table
1: Distribution of samples by Age
n=30
|
Age in years |
Frequency |
Percentage |
|
a) < 65 years |
14 |
46.7% |
|
b) 66 – 75 years |
6 |
20% |
|
c) 76 – 85 years |
6 |
20% |
|
d) > 85 years |
4 |
13.3% |
Table
1 shows that majority 14(46.70%) of were
in the age group of below 65 years, 6(20%) were in the age group of 66-75
years, 6(20%) were in the age group of 76-85 years and 4(13.30%) were in the
age above 86 years.
Table 2: Distribution of samples by Gender n=30
|
Gender |
Frequency |
Percentage |
|
a) Male |
10 |
33.30% |
|
b) Female |
20 |
66.70% |
Table 2 shows that among 30 samples 20(66.70%) were females and 10(33.30%)
were male
Graph 1: Distribution of the samples by
Educational status n=30
Graph 1
depicts that majority 9(30%) elderly were having primary education, 8(26.70%)
elderly were having secondary education, 7(23.30%) were illiterate, 4(13.30%)
were having PUC education and 2(6.70%) had graduate degree.
Table 3: Distribution of samples by marital
status n=30
|
Marital status |
Frequency |
Percentage |
|
a)Married |
5 |
16.70% |
|
b)Unmarried |
11 |
36.70% |
|
c)Widow |
10 |
33.30% |
|
d)Divorced |
4 |
13.30% |
|
Knowledge Level |
Classification of Respondents |
|||
|
Pre test |
Post test |
|||
|
Number |
Percent |
Number |
Percent |
|
|
Poor
Knowledge |
08 |
27% |
04 |
13% |
|
Average
Knowledge |
21 |
70% |
17 |
57% |
|
Good
Knowledge |
1 |
03% |
09 |
30% |
|
Total |
30 |
100% |
30 |
100% |
Table 4
showing that majority 11(36.70%) were unmarried, 10(33.3%) were widow, 5(16.7%)
were married and 4(13.3%) were divorced.
Section - II: Overall Knowledge scores of
Respondents on Dementia
Table – 4 Classification of respondent’s
knowledge level on Dementia n=30
The above table reveals that in pre test, 70% of the
respondents possess average knowledge, 27% of the respondents possess poor
knowledge and remaining 3% respondents possess good knowledge. Whereas in post
tests 57% of the respondents possess average knowledge, 30% of the respondents
possess good knowledge and 13% respondents possess poor knowledge.
Table 5:
Mean, Median, Mode, Standard deviation, range of knowledge scores of
subject regarding Dementia among elderly people. n=30
|
Area of Analysis |
Mean |
Median |
Mode |
Standard deviation |
Range |
|
Pre-test |
4 |
4 |
4 |
0.911 |
4 |
|
Post-test |
13 |
13 |
13 |
1.264 |
5 |
|
Difference |
9 |
9 |
9 |
0.35 |
1 |
While evaluating
the effectiveness of awareness programme for elderly
people on knowledge regarding Dementia, the pre-test and post-test data
analysis revealed that the mean, median, mode post-test knowledge score(13) was
higher than the mean, median, mode pre-test knowledge score(4).