INTRODUCTION:

“You do not heal old age, you protect it; you promote it; you extend it-- Sterling Ross

The dream of the people all over the world is to live longer in perfect health in each and every phase of life. According to WHO, it is estimated that there are 416 million senior citizen aged above 60yrs around the globe and by 2010 world’s 11.9% population will be above 60yrs.In India also the trend is the same,7.5% of the total population is above 60yrs and the life expectancy is increasing gradually, but whether with quality and productivity. Again this is related to the interaction of a wide range of psychological and social factors such as maintaining and enhancing physical and cognitive functions being fully involved in the society, leading a stimulating and self-motivated life, living in a stable social environment and having meaningful social relationships. Becoming older is a gradual process that ushers in some decline in physical, physiological, intellectual, cognitive, emotional and social aspect¹.

Individuals at the older age witness the flowering of seeds planted earlier in the prior phase of his or her life, ideally. And old age should be regarded as a normal ,inevitable, biological phenomenon which brings in changes in all the contexts in a massive way.² Elderly individuals usually face a higher risk of developing psychosocial problems due to lack of emotional support to sustain and bear the losses which include loss of work,s pouse, friends, along with the deficiency in motor abilities and intellectual process that leads to various psychosocial problems. This leaves the elderly vulnerable to various mental problems along with chronic physical disorders and sensory impairment which becomes a great psychosocial issues in their life.³

Memory functioning, intellectual functioning, learning abilities, adaptation to the task of aging, socio-cultural aspects, sexual aspects. Physical changes, economic status, dependency becomes the main psychosocial concern during old age. Aging individuals experiences many loss potentially leading to bereavement over-load. They are vulnerable to depression and feeling of low-self worth and suicide. Elder abuse is one of the subject of frequent discussion whether in institutions or community based.⁴

The elderly is vulnerable to depression and despair due to harassment, illtreatment, exploitation, desertion, separation from dear ones, living alone and none to help due to lack of family ties and social network. Psychosocial problems arising from this situation can have a reverse impact on the well-being, productivity and the quality of life. WHO report of 2008 states that 236 citizens per 10,000 suffer from mental illness due to various psychosocial problems without being helped. According to Warnick, getting over the psychosocial problems that accompany old age requires an individual is flexible and develops new coping skills to adapt to current phase in life.⁵

Today’s fast-forward world with diminishing family bond and various other social factors created a boom in emergence of old age homes globally which has become a system in India.35% of senior citizens aged above 60yrs live in old age homes, even if most of the elderly people consider home as a place where they can derive greatest emotional satisfaction.⁶

NEED FOR THE STUDY:

The incidence of the emerging psychosocial problems among the senior citizens is wider in developing countries like India and still to be intervened at its best. Kalil A estimated association between job insecurity and change over time in in the psychosocial aspect elderly men and women aged above 60yrs. Secondary analysis of longitudinal data collected from 190 senior citizens. And controlled for individual characteristics and baseline measures of outcome. Result showed that men who experienced job insecurity rated themselves in significantly poorer psychosocial well-being and women showed higher depressive symptoms and reported more hostility, loneliness and personal stress compared with women who don’t experience job insecurity and men who do. Financial insecurity due to job instability may be clinically significant in both elderly men and women and is a potentially important threat to the elderly psychosocial well-being.⁷

Butler. S states the relationship of anxiety and insomnia in his study. Relationship of self reported anxiety to insomnia complaints were investigated among immigrants aged above 60yrs in Russia.61%reported insomnia complaints and 48%considered anxiety to be the major impairement. Logistic regression analysis showed that insomnia was the most important predictor of perceived anxiety.⁸Dorman LT revealed stress in the oral histories of rural older women aged above 65yrs.Content analysis revealed that economic hardship, disruption of family life and fears and uncertainties were stressors associated with the day-to-day life. Implication to remove the stressors were discussed among the samples.⁹

Plancher C studied on the effect of episodic memory loss on the psychosocial well-being of elderly.178 senior citizens aged above 60yrs were asked to drive through a particular environment. All the aspect of episodic memory were then assessed resulted in 70 older participants had less recollection of events such as what, when and why.¹⁰

Most of the senior citizens are uncomfortable discussing some illness. Others may agree to only those treatment that are acceptable in their culture. Ethnic cultural background may also have a major effect on how they deal with psychosocial problems. Women from some cultures do not feel comfortable exercising their problems in public. Due to this reason, most of the problems faced by the elderly goes unoticed.¹¹

Kamble SV done a study on depression among elderly persons in a primary health centre area .Elderly are prone to psychiatric disorders through vicissitudes such as social isolation, malnutrition, economic and emotional depression. A cross sectional study was done to assess prevalence of depression among elderly persons aged above 60yrs and to study social factors influencing depression. Goldberg and Bridges scale was used to diagnose depression among 494 randomly selected study subjects.31.4%of elderly persons were having depression.37.1% among females, 37.9% among illiterates, 55.8% among class v socio-economic status, divorced and unmarried.¹²

Wu ZQ studied on correlation between loneliness and social relationship among elderly in China. A sample of 1144 elderly above 60yrs were surveyed using Loneliness Scale, The Social Support Rate Scale and the Family Adaptibility, Partnership, Growth, Affection and Resolve Index. The study revealed that 80.94% of the elderly had moderate to high levels of loneliness with a mean score of 42.84 and a standard score of 53.55.Social support and poor family function were significant negatively associated with loneliness. Multiple regression revealed that less social support and poor family function were associated with more loneliness.¹³

Wang C W conducted a study on psychosocial adaptation status and health related quality of life among elderly chinese. The objective of the study was to determine the association of psychological status with health related quality of life. In this cross sectional study, 167 samples above 65yrs were interviewed using structured questionnaires to assess their self-reported general health and psychological adaptation. 30% of the samples reported that psychological adaptation plays a remarkable role in thier health related quality of life. The study concluded that the psychological adaptation buffers the domain of social function, mental and general health and dependency.¹⁴

Rajkumar AP et al conducted a study on nature, prevalence and factors associated with depression among the senior citizens in a rural community south Indian community. Depression in old age is an important public health problem causing considerable morbidity and disability worldwide. This study is aimed to establish the nature, prevalence and factors associated with elderly depression .1000 participants aged above 65yrs were recruited from Kanyakumkari block, Vellore, India. Socio-demographic profile, psychological morbidity, cognitive functioning and disability status using the Structured Assessment Tools. A case control framework to study the factors was adopted to study the factors associated with depression in elderly. The study showed that prevalence of depression in the elderly was 15.5% and it is prevalent in South India.9% of the cases are due to poverty and physical ill health which plays the risk factors for depression among elderly.¹⁵

Paranjpe et al conducted study on impact of family violence on psychological well-being of elderly African-American Women..Family violence among elderly women encompasses intimate partner violence and elder maltreatment, both linked to poor health status.150 African-American elderly women aged above 60yrs were interviewed in an ambulatory clinics of a large public hospital. Family Violence Exposure was measured by the Family Violence against Older Women scale. Participants with top FVAOW scale score were 55% and considered to have higher family violence. Lower Income and poor medical facilities were associated with this. The study concluded that among 35.5% elderly women, lack of income and high level of family violence have worsened the psychological well and played in their current health nstatus.¹⁶

Chen J et al conducted study on factors related to the social well-being among the elderly in Urban China. Predictive factors contributing to social well-being, focusing on multiple roles, among elderly Chinese subjects. A cross sectional survey was conducted among 356 senior citizens above 60yrs of age and who are retired from job. Participants completed a self-administered questionnaire and returned it by mail. Social well-being, the dependent variables was measured by the satisfaction with Life Scale. Variables included demographics, physical health, financial status, self-efficacy. Gender-segregated multiple linear regression analysis were performed. The study resulted that for 23.3% males, the factors related to the social well-being were old age, absence of chronic diseases, better financial status, higher self-efficacy, absence of conflict with others and having grand children. For 33% females, absence of ill-ness, absence of conflict with others, more contact with neighbours and engaging in more group activities. In conclusion, the results highlight predictive factors contributing to the social well-being of elderly¹⁷

Span J Psychol conducted a study on daily activities and life satisfaction in senior citizens living in old age home in London. The study is aimed at exploring daily and desired activity pattern in a sample of male senior citizens aged above 60yrs as well as at examining the effect of some influential factors and their relationship with life satisfaction. The samples were 250 retired individuals from 12 old age homes. Data gathered through interview technique included daily activities and life satisfaction.58% of samples reported that daily activity pattern including the leisure activity plays a remarkable role in the life satisfaction which adds to the social well-being.¹⁸

Li X et al conducted the study on suicide among the senior citizens in Mainland China. Suicide in Mainland China shows unique demographic patterns with age: the age over 65rys has the highest rate of completed suicide, reaching 44.3-200 per 100,000,which is four to five times higher than Chinese general population. Rural suicide rates among the elderly are 38% higher than the urban population. The gender ratio of suicide in the elderly shows a reversal to those younger than 60yrs of age in China. In addition, suicide methods and causes of suicide among the elderly in China is different from the western countries.¹⁹

A correlative study was conducted to assess the prevalence of suicidal ideation and attempts in patients with major depressive disorder and find the correlation between the two among 60 patients attending a psychiatric OPD of Institution of Medical Sciences, Varanasi, by administering the Hamilton Rating Scale. The results revealed that the incidence of suicidal attempts was 16.6% with suicidal ideation. A value of P<0.005 was statistically considered significant. There was a positive correlation between suicidal attempt and severity of depression. The study concluded that all patients with depression having severe suicidal ideation with agitation are more likely to attempt suicide.²⁰

An experimental study was conducted to evaluate the efficacy of two internet interventions for community dwelling individuals with symptoms of depression among 525 individuals with increased depressive symptoms using randomised controlled trial method. Cognitive behaviour therapy and psychoeducation was given. The results revealed reduction in score on depression scale 3.2 (95% confidence interval 0.9 to 5.4). Depression literacy significantly improved participants’ understanding of effective evidence-based treatments for depression (P<0.05). The study concluded that both cognitive behaviour therapy and psychoeducation are effective in reducing symptoms of depression.²¹_.

A survey was conducted to assess the rates of major depression and suicidal attempts across various ethnic groups within US. Data was gathered as part of Epidemiologic Catchment Area study from 3555 Mexican Americans, 907 Cuban Americans and 1353 Puerto Ricans aged 20-74 years. The results revealed that rates of major depression ranged from 9.3% (Puerto Ricans) to 3.24% (Cuban Americans). Similarly suicidal attempts rate ranged from 9.1% for Puerto Rican to 1.9% for Cuban Americans. The study concluded that the impact of migration process and socioeconomic status may underlie the difference in major depression and suicide attempt rates across ethnic groups.²²

A study was conducted to assess major depressive disorder influences intent to die in violent suicide attempters among 502 patients admitted in a hospital at France following a suicidal attempt. Beck Suicide Intent Scale was used to assess the last suicide attempt before admission. The results revealed that suicidal intent for both, the last suicide before admission and violent suicide attempts were higher in those with history of major depressive disorder (P=0.03 and P=0.04 respectively). The study concluded that violent suicide attempters constituted a heterogeneous group in terms of suicidal intent.²³

A comparative study was conducted to assess the rates of suicidal behaviour during and after discontinuation of treatment with antidepressants among 521 patients attending clinics in the US by reviewing charts from clinical records. The results revealed that there was greater than fivefold increase in risk for suicidal behaviour after discontinuation of antidepressant treatment (P<0.0001). The study concluded that the suicidal behaviour in unipolar depressed patients treated with antidepressants increases substantially after medication discontinuation.²⁴

WHO predicts that within 20 years, 90% of people will be affected by depression than any other problems⁵. Suicidal risk may increase during periods of rapid changes of depressive state²⁵. The incidence of depression is around 120 million worldwide and nearly a million people commit suicide every year, more common in women than in men at a ratio approximately 2:1, highest at middle ages. In Karnataka the incidence of suicide is 30.0 per 1000 population.

A study was conducted to assess the prevalence of suicidal ideation among ninety-three alcoholic depressed patients attending a selected hospital at Hubli. A simple enquiry regarding the suicidal ideation was recorded along with other potential causes. The result revealed that among 47 (50.53%) patients having suicidal ideation, 12 (25.53%) were alcoholic depressed patients and rest 35 (74.46%) were non-alcoholic depressed patients. A value of P<0.01 was considered as statistically significant. The study concluded that suicide is one huge social hindrance that definitely needs quick attention²⁶.

A cross-sectional survey was conducted to assess the patients’ ethnicity and perceptions of families and friends regarding depression and it’s treatment among 355 (N=314) family members of depressive patients through visits at a community in Philadelphia by interview technique. The results revealed that black patients were less likely to be rated as needing depression treatment by their family and friends compared to white patients. Eighty-eight percent responses were given by black patients’ and 95% by white patients’ families. The study concluded that ethnicity also influences the family members’ or friends’ perceived need for depression and its treatment.²⁷

The investigator, from her personal experience in nursing profession has witnessed many patients who were diagnosed as having depression, making suicidal ideation and attempts. The above studies reveal that psychosocial deviations and depression are major cause for suicide in senior citizens. Hence, the investigator was motivated to take up this study.

STATEMENT OF PROBLEM:

A Cross-sectional study to assess the psychosocial deviations and depression among the senior citizens of selected rural community of Gurdaspur, Punjab.

OBJECTIVES:

1: To assess the level of psychosocial deviations among senior citizens.

2: To assess the level of depression among senior citizens.

3: To ascertain the correlation between psychosocial deviations and depression among senior citizens.

4:To determine the association of psychosocial deviations and depression among senior citizens with selected socio demographic variables.

5:To prepare and distribute the guidelines on prevention of psychosocial deviations and depression among senior citizen.

MATERIAL AND METHODS:

The aim of the study is to assess prevalence of psychosocial deviations and depression among senior citizens of selected rural community. A non-experimental research approach along with Cross-sectional descriptive research design was used. Research study was conducted in selected rural community of Gurdaspur, Punjab. Non-Probability sampling technique purposive sampling technique was used for data collection. The study was delimited to senior citizens residing in selected rural community. It was assumed that the senior citizens may or may not have any psychosocial problems and depression. Socio-demographic variables were age, gender, education, income, self efficacy, employment, years of retirement, life partner alive or expired. Likert scale on psychosocial deviations of senior citizens and Modified Beck’s depression inventory was used to assess depression among senior citizen of selected rural community of Gurdaspur , Punjab. The reliability of the Likert scale on psychosocial deviations of senior citizens was 0.7 and modified Beck’s depression inventory was r=0.9.The tool was administered to 100 elderly persons of selected rural community. The permission for research was taken from the authorities of selected village. Data for study was collected by door to door visit in selected community. Chi square was employed to determine association of collected data.

ETHICAL CLEARANCE:

The permission for research was taken from the selected village authorities. Before collecting data, investigator gave brief introduction about self, purpose of the study and information regarding tools. Informed consent was taken from each study subject.

RESULT:

According to age of the senior citizen out of 100, majority were in age group of 66-70years (26%). As per educational status most of senior citizens were un-educated (47%). Distribution of study sample according to employment in which maximum were homemakers (74%). Regarding monthly family income majority (52%) had family income Rs upto 2000/- .Distribution of study subjects according to self efficacy (61%) of senior citizens belonged to group not self efficate. Regarding gender most of study subjects were male; (59%). Pertaining to years of retirement counted maximum in 1-3 year group (46.%). According to life partner alive or expired maximum (53.%) were living with their life partners.

CONCLUSION:

Hence, it may be concluded that out of 100 study subjects, majority were in age group 66-70 years, were homemakers ,un-educated with monthly family income upto 2000/-. It shows that a significant association was found between psychosocial deviations and depression with age , income, self efficacy, years of retirement, life partner alive or expired.

Objective 1: To assess the level of psychosocial deviations among senior citizen.

Out of 100 subjects (57%) of the subjects had medium level of psychosocial deviations and overall mean was 33.33.

Objective 2: To assess the level of depression among senior citizen.

It was found that there (24%) severe level of depression. The overall mean of depression was 16.66.

Objective3: To ascertain the correlation between psychosocial deviations and depression among senior citizens.

It shows that mean ± SD for psychosocial deviations was 33.33± 5.9 and for depression was 16.66± 3.02. The coefficient of correlation of psychosocial deviations and depression among senior citizens was calculated by using Karl Pearsons method which was found moderately positively (r=+0.63) correlated at p <0.001***.

Objective4: To determine the association of psychosocial deviations and depression among senior citizens with selected socio demographic variables.

It shows that a significant association was found between psychosocial deviations and depression with age, income, self efficacy, years of retirement, life partner alive or expired.

DISCUSSION:

Objective 1: To assess the level of psychosocial deviations among senior citizen.

Out of 100 subjects (57%) of the subjects had medium level of psychosocial deviations and overall mean was 33.33. Findings were similar to study conducted by Wang C W¹⁴

Objective 2: To assess the level of depression among senior citizen.

It was found that there (24%) severe level of depression. The overall mean of depression was 16.66. Findings were similar to study conducted by Rajkumar AP et; al¹⁵

Objective3: To ascertain the correlation between psychosocial deviations and depression among senior citizens.

Objective4: To determine the association of psychosocial deviations and depression among senior citizens with selected socio demographic variables.

It shows that a significant association was found between psychosocial deviations and depression with age, income, self efficacy, years of retirement, life partner alive or expired. Chen J et; al ¹⁷conducted a smilar study in which demographics variables included were, physical health, financial status, self-efficacy. Gender-segregated multiple linear regression analysis were performed. The study resulted that for 23.3% males, the factors related to the social well-being were old age, absence of chronic diseases, better financial status, higher self-efficacy, absence of conflict with others and having grand children.

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Received on 09.09.2015 Modified on 21.09.2015

Asian J. Nur. Edu. and Research. 2016; 6(3): 401-406

DOI: 10.5958/2349-2996.2016.00075.6