A Study to Assess the Cognitive Impairment among Elderly People

 

Archana Jayakumar1, Bincy A.P.2

1Lecturer, Department of Mental Health Nursing, Amala College of Nursing, Thrissur, Kerala, India.

2Associate Professor, Department of Mental Health Nursing, Amala College of Nursing, Thrissur, Kerala, India.

*Corresponding Author Email: archanajayakumar747@gmail.com

 

ABSTRACT:

A descriptive study was conducted among 62 elderly people living in Tholur Panchayath, Thrissur to assess the cognitive impairment among elderly people. The objectives of the study were to assess the cognitive impairment among elderly people and to find the association between the cognitive impairment among elderly people with selected socio demographic variables. Total 62 samples were selected using a convenient sampling technique. The data was collected using self-structured sociodemographic questionnaire and Montreal cognitive assessment scale. The statistical analysis of the data shows that Majority of the subjects (45.2%) have severe cognitive impairment, 30.6% have moderate cognitive impairment and 24.2% had mild cognitive impairment and there is a significant association between cognitive impairment among elderly people with age (p=0.006) and literacy (p=0.0001) at p<0.05.

 

KEYWORDS: Elderly people, Cognitive impairment.

 

 


INTRODUCTION:

Ageing is a process of becoming older, it is a particular length or stage of life. It relates to humans, animals and plants. Globally the number of older people is increasing at a faster rate than all other age groups. This rapid aging demographic transition has resulted in greater levels of cognitive decline, which is a growing public health issue. About half of older people experienced a decline in cognitive function as a part of ageing process.1

 

Advanced ageing is associated with changes in cognitive ability. Dementia, which is the pathological extremity of cognitive impairment, is a major cause of morbidity and dependency among older adults. WHO in 2012 has identified dementia as a public health priority and has developed a global action plan on the public health response to dementia to reduce its impact on individuals and communities.2

 

Cognition is defined as the operation of mind includes all aspects of perceiving, thinking, and remembering and typically measured in research settings by a wide array of neuropsychological tests that vary from broad assessment to focused evaluations of specific cognitive domains.3 Cognitive decline is common as age past 65 years and progresses continuously. Cognitive impairment is when a person has trouble in remembering new things, concentrating, or making decisions that affect their everyday life.4 Your brain, like the rest of your body, changes as you grow older. It’s common to notice increasing forgetfulness as you age.it may take longer to think of a word or to recall a person’s name. But consistent or increasing concern about your mental performance may suggest cognitive impairment.5 With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers.6 Hence the researcher is motivated to do this study to identify the cognitive impairment in elderly so earlier and prevent the complications. A cross sectional study was conducted in Kerala to assess the prevalence of cognitive impairment among 65 aged individuals in a rural area Thiruvananthapuram. The result shows that the prevalence of MCI and dementia was 18.6% (95% confidence interval [CI] 14.7%–23.4%) and 6.8% (4.46%–10.1%), respectively, among the study participants. The prevalence of MCI was higher among the unemployed and those above 70 years of age.7 It is important to address any changes in an older person’s memory, language abilities, or personality as these may reflect a neurodegenerative disease process that may either be due to a reversible cause or become more serious. Whether memory or other cognition concerns are reported by the patient or a family member, or directly observed by you, the issues should be noted and followed up with a cognitive, behavioural or functional assessment.8

 

NEED AND SIGNIFICANCE OF STUDY:

Old people themselves fear cognitive decline, and experience ageism based in stereotypes concerning memory loss, difficulties in problem solving, and in the belief that any minor sign of cognitive impairment will progress to dementia. However, the progression of cognitive impairment to dementia is neither clear nor mandatory according to evidence from longitudinal studies. Cognitive impairment has a high prevalence in the elderly, especially in the oldest old, and it is a major concern for autonomous old people living in the community and their families. Any possible intervention will benefit from early detection of cognitive decline related signs.9 Your brain, like the rest of your body, changes as you grow older. It’s common to notice increasing forgetfulness as you age.it may take longer to think of a word or to recall a person’s name. But consistent or increasing concern about your mental performance may suggest cognitive impairment.10 With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. Hence the researcher is motivated to do this study to identify the cognitive impairment in elderly so earlier and prevent the complications.11 It is important to address any changes in an older person’s memory, language abilities, or personality as these may reflect a neurodegenerative disease process that may either be due to a reversible cause or become more serious. Whether memory or other cognition concerns are reported by the patient or a family member, or directly observed by you, the issues should be noted and followed up with a cognitive, behavioural or functional assessment.12

 

STATEMENT OF THE PROBLEM:

A study to assess the cognitive impairment among elderly people in a selected community at Thrissur district.

 

OBJECTIVES:

1.     To assess the cognitive impairment among elderly people.

2.     To find the association between the cognitive impairment among elderly people with selected socio demographic variables.

 

OPERATIONAL DEFINITIONS:

1. Assess:

In the study it considers a variety of factors, go through the information at hand, and draw a conclusion regarding something.

 

2. Cognitive impairment:

In the study, cognitive impairment refers to when a person has trouble in remembering, learning new things, concentrating, or making decisions that affect their quality of life.

 

3. Elderly people:

In this study, it refers to elderly people who are at the age of 60 years and above.

 

Assumption: Elderly people will have cognitive impairment.

 

Hypothesis:

H1: There will be a significant association between cognitive impairment among elderly people with selected socio demographic variables.

 

METHODS AND MATERIALS:

Research approach: Quantitative research approach

Research Design: A descriptive research design

The setting adopted for the study: Tholur pancahayath, Thrissur.

Population: Elderly people

Sample: 62 Elderly people living in Tholur Panchayath, who met the inclusion criteria.

Sample size: 62

Sampling Technique: Convenient sampling technique

 

Sampling Criteria:

 

Inclusion criteria:

1.     Elderly people who are at age of 60 years and above.

2.     Elderly people lives in Tholur panchayath, of both genders.

3.     Those who have given consent to participate in the study.

 

Exclusion criteria:

1.     Those who are unavailable during data collection.

2.     Those who are not willing to participate in the study.

3.     Those who are handicapped.

 

Tools and instruments:

Tool 1: A self-structured questionnaire to assess the socio demographic variables such as age, gender, literacy, habits, Occupation, Type of family, Marital status, Support system.

 

Tool 2: Montreal Cognitive Assessment to assess the cognitive impairment in elderly. Montreal cognitive assessment (MOCA) is a screening test used to detect cognitive impairment. It consists of questions and tasks that test a person's short-term memory, orientation to time and place, language, abstraction capabilities, attention span, problem solving, and visual-spatial abilities. Administered by healthcare professionals, it typically takes about 10 to 15 minutes and has a maximum score of 30.

 

Scoring Category:

Mild cognitive impairment: 18-25

Moderate cognitive impairment: 10-17

Severe cognitive impairment: <10

 

Reliability of tool:

Reliability is the degree of consistency and accuracy with which an instrument measures the attributes which it is designed to measure.16 It is then concerned with consistency, accuracy, precision, stability, equivalence, and homogeneity. The tool can be considered reliable if it measures an attribute with similar results in repeated use. Reliability of the MOCA scale is 0.96(95% cl:0,91-0.98) (Crobachs alpha). Thus, the tools were found to be reliable and amenable to use.

 

Data collection process:

1.     Formal permission is obtained from the Tholur Panchayath President.

2.     Purpose and need of the study will be explained to the participants and informed consent were obtained for assuring their confidentiality.

3.     The data were collected using self-structured questionnaire to assess socio demographic variables and Montreal Cognitive Assessment Scale to assess the cognitive impairment.

 

 

Plan for data analysis:

1.     All the categorical variable will be summarized using frequency and percentage, Continuous variable will be using mean and standard deviation if the data follows normality.

2.     Association between selected socio demographic variables and cognitive impairment among elderly will be assessed using Chi square test and Fisher Exact test. P<0.05 will be considered as statistically significant and the entire analysis will be done through spss software.

 

RESULTS AND DISCUSSION:

Section I: Distribution of the Elderly people according to the sociodemographic variables:

In terms of age, most of the subjects (50%) belongs to the age group of 60-70 years. In terms of gender, majority of subjects (56.5%) were females. Considering literacy, 72.6% were illiterate. According to type of family, 62.2% were living in nuclear family. In terms of habits, 64.5% were not having any bad habits such as smoking and alcoholism. According to marital status, 59.1% were widows. Considering support system, 71% of them were supported by their family members.

 

Section II: Distribution of elderly people according to the level of cognitive impairment.

Figure 1: Distribution of elderly people according to the level of cognitive impairment.     (n=62)

 

Figure 1: Depicts that majority of the subjects (45.2%) have severe cognitive impairment, 30.6% have moderate cognitive impairment and 24.2% have mild cognitive impairment.

 

Section III: Analysis of the association between cognitive impairment among elderly people with selected socio demographic variables.

The Fisher's Exact Test and Chi square test were used to identify the association. A statistically significant association was found between the cognitive impairment among elderly people with age and literacy with p < 0.05. There is no association with other socio-demographic variables such as gender, Type of family, habits, occupational status, marital status and support system.

 

CONCLUSION:

The results shows that majority of elderly people have severe cognitive impairment. There is a significant association between cognitive impairment among elderly people with age and literacy.

 

RECOMMENDATIONS:

1.     Similar study can be conducted among large number of samples.

2.     Similar study can be conducted among adult people.

3.     The study can be conducted in a large community setting.

 

LIMITATIONS:

1.     Study is limited to 62 elderly people.

2.     Study only considered elderly people living in a selected community.

3.     Interventional studies will be more effective to improve their cognitive impairment.

4.     Study doesn’t consider handicapped elderly people.

 

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Received on 16.05.2024         Revised on 12.08.2024

Accepted on 01.10.2024         Published on 12.12.2024

Available online on December 30, 2024

Asian J. Nursing Education and Research. 2024;14(4):295-298.

DOI: 10.52711/2349-2996.2024.00057

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