A study to evaluate
the effectiveness of educational intervention among the caretakers of elderly
with cognitive impairment
Ms. Jayarani. N
Tutor, Holy Family Institute of Nursing Education,
Holy Family Academy, Premier Road, Kurla
West, Mumbai – 400070
*Corresponding Author Email: jayarani271@yahoo.com
ABSTRACT:
Background:
With 1095 million people over 65 years of age (2006 census) 5.8% belong to the
grey sector. Out of the projected figure of 1330 million people in 2025 more
than 12% will be those who have crossed the 60 years and above1
.Cognitive impairment is the result of abnormal functioning of the brain in
which memory, thinking, orientation and judgement
gets impaired. With increasing age, the incidence of cognitive impairment is
also increased in an individual.
Objectives
1) To identify elderly with cognitive impairment 2) To assess knowledge on
cognitive impairment among the care-takers of elderly 3) To determine the
effectiveness of educational intervention on knowledge regarding cognitive
impairment 4) To compare post-test knowledge of cognitive impairment between 7th
and 14th day with their selected socio-demographic characteristics
Materials and methods: A quasi experimental study, pre test and post test design
without control group approach was undertaken among caretakers of elderly with
cognitive impairment in Loni(Bk). The data were collected from
50 caretakers of elderly with cognitive impairment who are selected by simple
random sampling method, who met the inclusion criteria. Folstein’s
Mini Mental Status Examination (MMSE) was used to identify elderly with
cognitive impairment and self- prepared and content validated structured
questionnaire (for assessment of knowledge of caretakers) was used for data
collection, carried out in three phases , pre test was carried out before
implementation of the intervention. Followed by the educational intervention,
post test was conducted on 7th and 14th day. The
appropriate statistical analysis method was used wherever it is required.
Results:
The significant findings in relation to knowledge , overall pre test knowledge
score on cognitive impairment of group I
was (9.2+3.96) which is 51.04% group II was (11.46+3.86) which is
49.25%. It interprets that caretakers had ‘average knowledge’ on cognitive
impairment. The effectiveness of educational intervention on cognitive
impairment on for group I (7th day) was (11.46+3.86) which is (48.75%)
and on the Group II (15th day) was (15.7+3.89) which is
(62.59%).
Conclusion:
The study outcome revealed that educational intervention was found to be
effective in improving the knowledge of caretakers of elderly with cognitive
impairment. It should be emphasized that educating caretakers with educative
materials would thereby improve the knowledge and develop the competency in
providing care to elderly.
.
KEYWORDS: Evaluate,
Effectiveness, educational intervention, caretakers, elderly, cognitive
impairment.
INTRODUCTION:
Human
life refers to the Human condition or “condition human”.
It is a
characteristic that distinguishes objects that have life processes from that do
not. Life processes are the common essential processes or things that a living
thing has to perform for them to live or survive2.
Park K
(2013) quoted that “old age is an incurable disease”. Sir Sterling Ross
commented “You do not heal old age, you protect it, and you promote it, you
extend it.” Aging is a major life change which includes physiological,
psychological and mental changes and should be regarded as a normal inevitable
phenomenon.3
Kapoor B
(2008) commented that the old age is the age at which a person retires
from active employment and starts “living on the past” and also becomes
dependent physically and economically on others. It is not only a pattern of
changes in the structure and function of the body systems but also an
adjustment of a person to the changed environment4.
Sadock,
Benjamin J, Virginia A (2007) highlighted
that aging is a phase of the life
cycle characterized by its own developmental issues, many of which are
concerned with loss of physical agility and mental acuity, friends and loved
ones, status and power. At the same
time, old age is associated with the accumulation of wisdom and opportunity to
pass that on to future generations5.
National
Institute on Aging (2012) commented that By 2030 the
world is likely to have 1 billion older people accounting for 13% of the total
population. Between 2006 and 2030, the number of older people in less developed
countries is projected to increase by 140% as compared to an increase of 51% in
more developed countries6.
Stuart
GW, Laraia MT (2006) pointed that older adults with mental
health problems have relied on their primary care providers for management of
all their health needs. The occurrence of mental illness may be underestimated
in non-psychiatric setting, as symptoms may be attributed to cognitive
impairment, physical disorders, normal aging or the lack of age appropriate
diagnostic criteria7.
NEED FOR STUDY:
Aging
is the accumulation of changes in a person over time. It refers to a
multidimensional process of physical, psychological and social change. It is a
natural process and it is considered as a norm biological and inevitable
process. The process of aging is classically depicted as one of the constant
and inexorable decline after reaching a peak of the bodily function and
efficiency around the second decade of
life8.
Townsend
Mary C (2005) pointed that concept of the “Elderly” has changed drastically
over the years. Our prehistoric ancestors probably had a life span of 40 years with an average
life span of around 10 years. An improvement in the standard of living was not
truly evident until about the middle of the 17th century. Since that
time assured food supply, changes in the food production, better housing
condition and more progressive medical and sanitation facility have contributed
to population growth , declining mortality rate and substantial increase in
longevity9.
WHO Facts
File (2012) pointed that the world population between 2000 and 2050 the
proportion of the world’s population over 60 years will double from about 11%
to 22%. The number of people aged 60 years and over is expected to increase
from 605 million to 2 billion over the same period. The number of people aged
80 and older will quadruple in the period 2000 to 2050. By 2050 the world will
have 400 million people aged 80 years or older. By 2050, 80% of older people
will live in low and middle-income countries10.
Times
of India (2009) reported that India and China account for one third of the
world’s population older than 65 years of age .The 65-and-older population in
China and India alone outnumbered 166 million in 2008, nearly one-third of the
world’s total. Issues related to population aging in the world’s two most
populous nations will be gradually increasing
in the coming decades as the absolute number climbs to 551 million in
2040 (329 million in China and 222 million in India11.
National
Institute on Aging (2009) observed that
the oldest old constitute 7% of the world’s 65 and over population: 10% in more
developed countries and 5% in less developed countries. On a global level, the
85-and-over population is projected to increase 151% between 2005 and 2030
compared to a 104% increase for the population age 65 and over and a 21%
increase for the population under age 6512.
STATEMENT OF THE
PROBLEM:
A study to evaluate the effectiveness of educational
intervention among the caretakers of elderly with cognitive impairment.
OBJECTIVES:
1 To
identify elderly with
cognitive impairment.
2 To
assess knowledge on cognitive impairment among the care-takers of elderly.
3 To
determine the effectiveness of educational intervention on knowledge regarding
cognitive impairment.
4 To
compare post-test knowledge on cognitive impairment between 7th and
14th day with their selected socio-demographic characteristics.
ASSUMPTIONS:
Incidence
of cognitive impairment among elderly is high
Caretakers
of elderly have inadequate knowledge about cognitive impairment.
There may be significant difference in knowledge on
cognitive impairment before and after educational interventions.
There may be significant association between knowledge on
cognitive impairment with selected socio-demographic characteristics.
DELIMITATIONS:
The study will be limited to the caretakers, who are,
·
Above the age of 18
years.
·
Able to take care of
elderly at home.
·
Able to understand and
speak Marathi.
·
Willing to participate
in the study.
·
Available during the
period of data collection.
SCOPE OF THE STUDY:
This
study helps us to understand the need of the elderly care and the various
problems faced by the caretakers of elderly. It focuses on the impact of
educational interventions on the caring ability of the caretakers.
ETHICAL ASPECT:
The
study proposal has been sanctioned by the Institutional ethics committee of the
college.
Written
Permission obtained from the concerned authority Sarpanch
of Loni (Bk) village.
Information
about the study is given to participant
Informed
consent has been taken from the participants.
RESEARCH DESIGN AND APPROACH:
The research design selected for the present study is
Quasi-experimental study, pre test post test design without control group
approach to assess the effectiveness of
educational intervention on knowledge among the caretakers of elderly
with cognitive impairment.
R
0 1--------X------- 02
The
symbols used are,
R: Randomisation
01: Pre test- Assessment of knowledge among the caretakers of
elderly with cognitive impairment before educational intervention.
02: Post-test- Assessment of knowledge among
the caretakers of elderly with cognitive impairment after educational intervention on 7th
and 14th day.
X: Educational
Intervention.
VARIABLES:
INDEPENDENT VARIABLE:
In the
present study, independent variable was educational intervention, which
includes education on meaning
of cognitive impairment, symptoms, management and care of elderly
with cognitive impairment.
DEPENDENT VARIABLE:
Dependent
variable for the present study was knowledge of caretakers.
EXTRANEOUS VARIABLE /CONFOUNDING VARIABLE:
Extraneous
variable for the present study was Socio demographic variables like age, sex,
religion, education, income, occupation .
SETTING OF THE STUDY:
The study was conducted in Loni
(Bk) village; it’s a rural village under Tal. Rahata, District-Ahmednagar,
approximately around 170 km away from Pune city, 84
km from Nasik and 20 km near to Shirdi. The samples were taken from Musle vasti and Vittal nagar areas of Loni (Bk) village.
POPULATION:
The
population for the present study was elderly above 65 years of age residing in Loni (Bk).
SAMPLING:
SAMPLE:
The
sample for the present study
will be the care-takers of elderly with cognitive impairment who are residing
in Loni (Bk) village and
available during data collection period.
SAMPLING TECHNIQUE:
Probability
method; simple random sampling technique was used for the selection of
participants who meet the purpose of study on the basis of inclusion
criteria. Numbers 1- 97 was put on small
similar looking pieces of paper. The papers were folded similar for all. It was
mixed and put in a box and a third party was asked to draw 50 paper from the box.
SAMPLE SIZE:
The
sample size comprised of 50 caretakers of elderly with cognitive impairment,
who fulfilled the inclusion criteria of the study.
DATA COLLECTION METHODS:
Pre
test was conducted before implementation of educational intervention by using
the structured questionnaire to assess the knowledge on cognitive impairment.
Immediately after the pre test, educational intervention was implemented by the
researcher with lecture cum demonstration method. The duration of the
educational intervention was for 45 mins. Post test was carried
out on 7th and 14th day after the implementation of
educational intervention.
For data analysis, the descriptive and inferential
statistics were applied wherever required. The collected data was tabulated and
analysed by using descriptive statistics. i.e., Mean,
Standard Deviation and Mean %. The inferential statistics like paired “t” test
was used to assess the effectiveness of educational intervention on cognitive
impairment. The Chi – square test was used to test the association between
knowledge with their selected demographic variables.
RESULTS:
Demographic data of elderly:
Highest
percentage (38%) of elderly were in the age group of
76-80 years. Highest percentage (56%) of elderly were
females and (44% ) were males. Distribution of educational status shows
that highest percentage (31%) had primary education. As per present occupation
of elderly highest percentage (52%) were unemployed whereas lowest percentage
(4%) of them were businessman. Source of income of elderly shows that the
highest percentage (42%) were having income from
children’s source and lowest (12%) were having source of income from pension.
Demographic data of caretakers of elderly
with cognitive impairment:
Highest
percentage of caretakers (68%) were in the age group
of 41-50 years. Maximum percentage (82%) of caretakers of elderly were
married. Majority (56%) of caretakers of elderly were housewife by occupation.
Most (68%) of caretakers of elderly were children’s and daughter-in-laws.Highest percentage (42%) of caregivers had been in caregiving role for 1-2 years. Majority (54%) of caretakers
spent 1-2 hours in caregiving. Most (74%) of elderly
were staying in their children’s house.
Assessment of the knowledge regarding
cognitive impairment among caretakers of elderly before implementation of
educational intervention:
The
overall pre test mean score for group I was (9.2+3.96) which is 51.04%
and of group II was (11.46+3.86) which is 49.25% shows that caretakers
had average knowledge on cognitive impairment.
Assessment of the effectiveness of
educational intervention on cognitive impairment
In post
test the overall mean knowledge score of caretakers was Group I (18.44+3.59)
which is (74.32%) and Group II was (15.7+3.89) which is (62.59%) indicates that the
difference in the mean % of the knowledge scores was (11.73%).
Comparison of post test knowledge on 7th
day and 14th day with selected demographic variables of caretakers
of elderly:
Comparison
of post test mean knowledge scores of
caretakers to their age group shows that highest mean score (19+1.73)
which is 76% for group I and (17.5+4) which is 70% for group II .
Comparison
of post test mean knowledge scores of group I and Group II with regard to their
gender shows that males of group I had marginally highest scores (19+1.41)
which is 76% and females of group II had highest score (18.8+1.79) which
is 75.2%:
DISCUSSION:
The
study outcome reveals that the post
test knowledge scores between group I and Group II shows that the effectiveness
of educational intervention on the 7th day was (18.44+3.59)
which is (74.32%) and on the 15th day was (15.7+3.89) which
is (62.59%) indicates that the
difference in the mean% of the knowledge scores was (11.73%).
It was observed
from the study outcome that there was a statistically significant association
between the knowledge score and variables like years of caregiving
(X2 =3.98) and hours of caregiving (X2 =4.32) at p<0.05 level.
However, it was noticed that there was positive co-relationship (r = 0.328)
found between the knowledge scores.
CONCLUSION:
From
the study findings it was evident that before educational intervention
caretakers of elderly have average level of knowledge on cognitive impairment.
While after the educational intervention it was observed that there was
significant improvement in knowledge.
The
major conclusion drawn from the research work was that educational intervention
was found to be effective in improving the knowledge of caretakers. Hence, it
should be emphasized that having educational intervention would improve the
competencies in providing care for elderly at home. Thus, it significantly contribute in reducing the mortality and morbidity rate,
minimum long-term hospitalization and treatment cost of chronically ill
elderly.
NURSING
IMPLICATIONS:
NURSING SERVICE:
Elderly
constitute a large proportion of population. Due to decrease in the mortality
rate and increase in the life expectancy, the population of elderly has also
increased. Elderly are likely to have multiple physical and psychological
problem that contribute to the need of long-term hospitalization or care. Thus,
it is essential for nurses to practice holistic approach while rendering care
to the elderly population.
As emphasized
through the study findings, providing education to caretakers of elderly with
cognitive impairment will enhance the knowledge and skill for caring of
elderly. Thereby, providing quality care to elderly with
cognitive impairment.
Nurses
play a vital role in health care system, thus nurse directed educative programs
does play a significant role in reduce long-term hospitalization and mortality rate due to chronic
illness.
As a
primary caregiver geriatric nurse must be proficient enough in assessing the cognitive , affective, functional , physical and behavioural status of the elderly.
Educational
intervention will help the different cadres of nursing professionals and other
health care team members in the different health care settings by reinforcing
their knowledge on cognitive impairment.
Educational
intervention by nurses will impart awareness and skill among the caretakers ,thus improve the competency in providing care to
elderly with cognitive impairment.
NURSING EDUCATION:
Since
aging is a growing problem more emphasis should be given to geriatric nursing
in the curriculum.
Community
awareness regarding the problems related to the aging has to be planned for the
students to find out the needs and problems of the elderly residing in
community.
Training
to the community health workers, NGO’s, formal caretakers and family members
regarding the identification of health problems and taking necessary steps to
solve them can be of great asset in organizing health programs for the elderly.
Initiate
specialty in geriatric nursing for the post graduate education courses so as to
prepare nurses competent in providing education to caretakers.
NURSING RESEARCH:
The
systemic reviews showed that these research studies were conducted mostly in
developed countries. In developing countries like India, the growth of elderly population
is at a faster rate. Thus these kind of research work
should be carried out on a larger scale.
The
study helps the nurse researcher to develop insight on development on various
training sessions for caretakers of elderly in the community setting.
Extensive
research is needed in this area so that nurse researchers can understand the
psychological needs of the old age population.
RECOMMENDATIONS:
Based
on the study finding the following recommendations have been made,
Similar
kind of study with large sample size can be carried out for the generalization
of the study findings.
The
study may be conducted as an experimental study with control group.
A study
may be replicated as knowledge, attitude and practice (KAP) of cognitive
impairment among caretakers.
Similar
study may be carried on health care professionals
knowledge about cognitive impairment.
As the
retention of knowledge reduces with time, reinforcement should be done with follow-up.
Study
may be conducted on factors influencing knowledge and skill of caretakers of
elderly.
A
longitudinal study may be carried by increasing the duration of intervention
and feedback at regular intervals.
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Received on 26.02.2015 Modified on 18.04.2015
Accepted on 05.05.2015 © A&V Publication all right reserved
Asian
J. Nur. Edu. and Research 5(3): July-
Sept.2015; Page 366-372
DOI: 10.5958/2349-2996.2015.00074.9