INTRODUCTION:

“Age' is the acceptance of a term of years. But maturity is the glory of years”.

-- Martha Graham

Aging is a normal, universal and inevitable change which takes place even with the best of nutrition and health care. It is a time related change that occurs throughout life. Aging involves all aspects of the organism and largely characterized by a decline in functional efficiency and decreased capability to compensate and recover from stress.

As an individual advances from infancy to old age he accumulates a wealth of impression, skills and knowledge and develop his own life style”.²

Ageing is inevitable. It is irreversible, progressive and is associated with decline in functions. The individual gradually becomes dependent physically, functionally, socially and economically. Elders usually exhibit multiple health problems with complex interactions. The most common chronic conditions affecting older adults are cardio vascular diseases, cancer, diabetes, osteoarthritis, Alzheimer’s disease and psychiatric disorders, like depression and dementia.³

WHO Report on aging and Health reported that in developed countries approximately 1 to 3% of people aged over 65 suffer from severe depression with further 10–15% suffering milder forms of depression. Higher suicidal rates are associated with undiagnosed rates of depression. 25% completed suicides are above 65 years. Suicide rates for depression in men over 65 – 85 times higher than for younger men. Although the actual levels in developing countries are not known precisely since it requires age and culture relevant measures of depression.

In India the situation has reached alarming proportions from 25.6 million in 1961. The number of those over 60 years is expected to touch 340 millions in 2061. Between 1961 and 2061 while the total population would five times, the number of the elderly would soar 13 times. Today India is home to over 70 million older people. Of this around 34 million, are elderly women, more than half of them are widowed. The majority of older people resides in rural Indian and is denied the specialized and social services that may be available to their urban counter parts. While only 7 million older people belong to the organized sector, the rest are the part of the unorganized sector and as a result have no provisions made for old age. Further the aging issues are still not considered to be as important as issues like child labor or women’s development.⁵

NEED FOR THE STUDY:

The world’s elderly population in the last 50 years from 1950 to 2000 had increased from 8% to 9.9% of total population respectively. The geriatric population at present is 30.2% of total population of 313 million. The proportion of elderly population is expected to increase from 9.5% in 1955 to 14.6% in 2025.0f these more than 50% of them would be living in developing countries. It is estimated that by the year 2020, 700 million elderly will be in developing countries, currently there are around 671 million elderly in the world with China being the highest of them with the population of 12 million and Russian Federation with the lowest population of 3 million in the world scenario. It is also projected that by 2020 the Japanese population will be the oldest in the world with 31 % over 60 years of age followed by Italy, Greece and Switzerland.⁶

India is one of the South East Asian countries, in India by the year 2001 there were around 76 million elderly people, who constituted 7.7% of the country’s population. Currently there are around 82 million elderly people, who constitute 9.8% of country’s population with Kerala constituting the highest population of 3,33,668 which is 10.5% and Arunachal Pradesh with the lowest population count of 50,000 which is 4.5% It is expected to increase further to 14% which will be 171 million by 2025.⁷

In Karnataka out of the population of 5.5 corers (8%) are elderly citizens. In Belgaum the total population ranges from of 30-32 lacks out of which 82,346 people are elderly which is 36.43% with highest population in Gokak Taluka with 15171 (8.4%) and lowest with Khanapur Taluka i.e. 1036 (1.7%). ⁸

Depression will increase in magnitude as the elderly population increase year by year. Hence there is need for considering the emotional states of elderly when they treated for any of physical problem in the hospitals, homes, or in primary health centers. Later life depression can have serious repercussions in increasing mortality and disability, health care utilization and longer hospital stays, yet 63% older adults with a mental health disorder experience an unmet need for mental health service. Deteriorating health, a sense of isolation and hopelessness and difficulty adjusting to new life leads to depression and which in turn leads to suicide. Elderly have no other option but to live in old age homes, often face loneliness, alienation and depression. In addition to losing most of their worldly possessions and social support, they also lose their privacy and their sense of self worth. They need others to meet their emotional and recreational needs. Depression is the most common disturbance of mood experienced by elderly. It is a pathological mood disturbance characterized by feelings, attitudes and beliefs the person has about self and his environment, such as pessimism, hopelessness, helplessness, low self esteem and a guilt feeling.⁴

Hence investigator feels that depression may sometimes be hidden behind an array of vague symptoms and it becomes necessary to carefully assess the elderly to identify marked depression to treat the person holistically. This will enable health care professionals in preventing the psychological problems and controlling the problems related to depression. Mild levels of depression can be identified and treated in time to prevent it before it becomes severe.

STATEMENT OF PROBLEM:

A comparative study to assess depression between elderly residing at old age home and with families in Belgaum city, Karnataka.

OBJECTIVES:

The objectives of the study are:

1. To assess depression among the elderly residing at the old age home.

2. To assess depression among elderly residing with the families.

3. To compare depression between the elderly residing at the old age home and with the families.

4. To find the association between depression among the elderly residing at the old age home with demographic variables.

5. To find the association between depression among the elderly residing with the families with demographic variables.

OPERATIONAL DEFINITION:

1. Assess: In this study assess refers to a statistical measurement of depression among old age by using Beck’s Depression Inventory.

2. Elderly: In this study Elderly refers to men and women aged between 60-75 years.

3. Old age homes: - In this study an old age home is a multi-residence housing facility intended for the elderly.

4. Families: A group of people related in heredity or marriage and those living in the same household who are emotionally attached and interact regularly with each other.

HYPOTHESIS:

1. H₁: There will be a significant difference between depression among elderly residing at old age home and with families.

2. H₂: There will be a significant association between depression among elderly residing at old age home with selected demographic variables.

3. H₃: There will be a significant association between depression among elderly residing with families with selected demographic variables.

ASSUMPTIONS:

Old age people may be at risk for depression.

The environmental factors may play a major role in determining psychological well being of old age people.

The environmental factors may enhance positive or negative mental health among old age people.

DELIMITATION:

The study is delimited to elderly clients who are above 60 years of age.

RESEARCH METHODOLOGY:

Research Approach:

A comparative approach was adopted in this study.

Research Design:

A non experimental comparative research design was adopted to carry out the present study.

Research Setting:

Based on the geographic proximity, feasibility to conduct the study and familiarity with the setting, the investigator selected old age homes and families in selected areas of Belgaum City, Karnataka.

Population:

The population of the present study comprises the elderly residing in old age home and those staying with the families in selected areas of Belgaum City, Karnataka.

Sample and Sample Size:

Sample size of the present study consists of 100 elderly clients (50 elderly staying in old age home and 50 elderly staying with the families from selected setting) Belgaum, who are able to read, write and understand Kannada, Marathi and English.

Sampling Technique:

The sampling technique used for the present study is Simple Random sampling which is a type of Probability sampling technique and was considered appropriate for the study.

Description of Tool:

The tool used for gathering relevant data was a Standardized Beck’s Depression Inventory (BDI).

The final tool consists of two sections;

Section I	:	Demographic data
Section II	:	Standardized Beck’s Depression Inventory (BDI).

Beck’s Depression Inventory is made up of 21 multiple choice self report items to be completed over ten to twenty minutes, each reflecting a negative emotional symptom. Each of these is rated with scores ranging from 0-3 on the severity of the participants' experiences over the last week with the intention of emphasizing states over traits. These scores ranged from 0, meaning that the client believed the item "did not apply to them at all", to 3 meaning that the client considered the item to "apply to them very much, or most of the time". It is also stressed in the instructions that there is no right or wrong answers. The sum of the relevant 21 items for each scale constitutes the participants' scores for each of the emotions leading to Depression. The tool was translated in Kannada and Marathi and retranslated back to English by language experts.

PLAN FOR DATA ANALYSIS:

The data obtained was analyzed in terms of the objectives of the study using descriptive and inferential statistics. Experts in the field of nursing and statistics directed the development of data analysis plan which is as follows:

a. Organizing data on a master sheet.

b. Tabulation of the data in terms of frequencies, percentage, to describe the data.

c. Classifying the levels of depression, anxiety to Beck’s Depression Inventory (BDI) interpretation.

SR.NO	SCORES	INTREPREATION
1.	1-10	These ups and downs are considered normal.
2.	11-20	Mild mood disturbance.
3.	21-30	Moderate depression.
4.	31-40	Severe depression.
5.	Above 40	Extreme depression.

RESULTS:

Findings related to socio demographic variables.

Table no 1: Frequency and percentage distribution of Elderly clients residing in old age home according to demographic variables. n=50

S No.	Socio-demographic variables	Frequency (f)	Percentage (%)
1	Age in years.
	a. 60-65 years.	15	30
	b. 66-70 years.	28	56
	c. 71-75 years	07	14
2	Gender.
	a. Male.	32	64
	b. Female.	18	36
3	Religion.
	a. Hindu.	34	68
	b. Muslim.	9	18
	c. Christian.	5	10
	d. Others.	2	4
4	Marital Status.
	a. Single.	10	20
	b. Married.	31	62
	c. Divorced.	07	14
	d. Widow/widower.	02	4
5.	Number of children.
	a. 0-1	12	24
	b. 2-3	33	66
	c. 4 and above	5	10
6.	Admission to old age home
	a. Voluntary.	34	68
	b. Involuntary	16	32
7.	Duration of stay in old age home.
	a. Less than 1 year.	12	24
	b. 1-2 years.	30	60
	c. 3-4 years.	5	10
	d. Above 4 years.	3	6
8.	Performance of activity.
	a. Independent.	13	26
	b. Partially dependent.	30	60
	c. Completely dependent.	7	14

The data presented in table 1 indicates that,

v Maximum Elderly clients 28 (56%) belonged to 66-70 years of age group and minimum 07 (14%) of them belonged to 71-75 years of age group.

v Majority of Elderly clients 32 (64%) were male and while a minimum 18 (36%) were female candidates.

v Majority of the Elderly clients 34 (68%) belonged to Hindu religion while minimum 02 (4%) belonged to the group of other religion.

v Majority of the Elderly clients were married 31(62%) while minimum 02(4%) belonged to the group of widow/widowers.

v Majority of the Elderly clients 33 (66%) had 2-3 children while the lowest group 05(10%) had above 4 children.

v Majority of the Elderly clients 34 (68%) were admitted to old age home on Voluntary basis while minimum 16(32%) were admitted on Involuntary basis to old age home.

v Majority of the Elderly clients stayed in old age home since 1-2 years 30(60%) while minimum of 03(6%) stayed in old age home above 4 years.

v Majority of the Elderly clients 30(60%) carried out their activities of daily living with partial dependence were as minimum of 07(14%) of them carried out activities with dependence.

Table no 2: Frequency and percentage distribution of Elderly clients staying with the family according to demographic variables. n=50

S No.	Socio-demographic variables	Frequency (f)	Percentage (%)
1	Age in years.
	a. 60-65 years.	13	26
	b. 66-70 years.	32	64
	c. 71-75 years	05	10
2	Gender.
	a. Male.	28	56
	b. Female.	22	44
3	Religion.
	a. Hindu.	41	82
	b. Muslim.	5	10
	c. Christian.	3	6
	d. Others.	1	2
4	Marital Status.
	a. Single.	12	24
	b. Married.	34	68
	c. Divorced.	03	6
	d. Widow/widower.	01	2
5.	Number of children.
	a. 0-1	15	30
	b. 2-3	31	62
	c. 4 and above	4	8
6.	Performance of activity.
	a. Independent.	13	26
	b. Partially dependent.	30	60
	c. Completely dependent.	7	14

The data presented in table 2 indicates that,

v Majority of Elderly clients 32 (64%) belonged to 66-70 years of age group and minimum 05 (10%) of them belonged to 71-75 years of age group.

v Maximum Elderly clients 28 (56%) were male and while a minimum 22 (44%) were female candidates.

v Majority of the Elderly clients 41 (82%) belonged to Hindu religion while minimum 01 (2%) belonged to the group of other religion.

v Majority of the Elderly clients were married 34(68%) while minimum 01(2%) belonged to the group of widow/widowers.

v Majority of the Elderly clients 31 (62%) had 2-3 children while the lowest group 04(8%) had above 4 children.

v Majority of the Elderly clients 33(66%) carried out their activities of daily living with partial dependence were as minimum of 06(12%) of them carried out activities with dependence.

Section III: Analysis and Interpretation of depression scores of elderly residing in old age home and with family.

Table 3: Mean median, mode, standard deviation and range of depression scores of elderly residing in old age home and with family n = 100

Area of analysis

Mean

Median

Mode

Standard deviation

Range

Residing in Old age home.

Residing with Family.

Difference

30.74

20.88

9.86

31.52

21.24

10.28

3.04

2.00

1.04

Table 3 reveals that mean difference is 9.86, median is 10, mode is 10.28, standard deviation is 1.04 and range difference is 0.

Analysis and Interpretation of data to find out an association between depression scores of elderly residing in old age home with demographic variables.

Table 5: Association between depression scores of elderly residing in old age home and demographic variables. n=50

S.No

Socio demographic variables

Good

Average

Poor

χ^{2 CAL.VAL}

χ^{2 TAB
VAL}

Age in years.

a. 60-65 years.

b. 66-70 years.

c. 71-75 years.

9.82

9.49

Gender.

a. Male.

b. Female.

0.52

5.99

Religion.

a. Hindu.

b. Muslim.

c. Christian.

d. Others.

2.29

12.592

Marital Status.

a. Single.

b. Married.

c. Divorced.

d. Widow/widower.

4.32

12.592

Number of children.

a. 0-1.

b. 2-3.

c. 4 and above.

0.73

9.49

Performance of activity.

a. Independent.

b. Partially dependent.

c. Dependent

0.19

9.49

Admission to old age home.

a. Voluntary.

b. Involuntary.

0.35

5.991

Duration of stay in old age home.

a. Less than 1 year.

b. 1-2 years.

c. 3-4 years.

d. Above 4 years.

1.46

12.59

χ²-chi square, df – degrees of freedom

Table 6: Mean difference (d), standard error of difference (SED) and un- paired ‘t’ values of depression scores of elderly residing in old age home and with the family n = 100

Mean (X₁) =30.74

Mean(X₂)= 20.88

Standard error(S²)

Un-Paired ‘t’ Values

Calculated

Tabulated value at 98 degrees of freedom

6.62

19.33^*

1.960

*(p<0.05)

Table 6 reveals that the calculated Un-paired ‘t’ value (t=19.33) is greater than tabulated value (t=1.960). Hence H₁is accepted.

Table 7: Association between depression scores of elderly staying with the family and demographic variables. n=50

S.No

Socio demographic variables

Good

Average

Poor

χ^{2
CAL.VAL}

χ^{2 TAB VAL}

Age in years.

a. 60-65 years.

b. 66-70 years.

c. 71-75 years.

4.51

9.49

Gender.

c. Male.

a. Female.

0.02

5.99

Religion.

a. Hindu.

b. Muslim.

c. Christian.

d. Others.

3.51

12.592

Marital Status.

a. Single.

b. Married.

c. Divorced.

d. Widow/widower.

6.68

12.592

Number of children.

a. 0-1.

b. 2-3.

c. 4 and above.

3.24

9.49

Performance of activity.

a. Independent.

b. Partially dependent.

c. Dependent

7.56

9.49

The findings of table 5 reveals that the variables age in years, gender, religion, marital status, number of children, admission to old age home, duration of stay in old age home and performance of activities of daily living among elderly residing in old age home are independent of each other. The chi-square calculated value is less than the chi-square table value, reject the hypothesis. Hence there is no association between depression scores and demographic variables.

Analysis and Interpretation of data to find out an association between depression scores of elderly staying with the family with demographic variables.

H₃: There will be a significant association between depression among elderly residing with families with demographic variables.

The findings of table 7 reveals that the variables age in years, gender, religion, marital status, number of children, and performance of activities of daily living among elderly staying with the family are independent of each other. The chi-square calculated value is less than the chi-square table value, reject the hypothesis. Hence there is no association between depression scores and demographic variables.

DISCUSSION:

The results were supported with the study by Dr. G. Radha Krishnan, A study to assess depression among general out patients attending selected general hospital. This study reveals that 86.8% of the subjects fell in the age range of 61.43 were married 25.72 from urban background.⁵ Another study by Ather M Taqui, Ahmed Itrat, Waris Qidwai, et al. Depression in the elderly: Does family system play a role? A cross-sectional study showed that 65 to 74years, 78% were male, 21.2 were married.⁶

In the present study revealed that among 50 elderly clients residing in old age home, 28 (56%) had severe level of depression and 22 (44%) had moderate level of depression. Among 50 elderly clients staying with the family, 28 (56%) had moderate level of depression and 22(44%) had mild level of depression. The results were supported with the study by Bekaroglu M, Uluutku N, Tanriover S, Kirpinar I, revealed that around 41% of the elderly clients residing in the old age institutions had severe depression were as compared to elderly residing in the home 29% had mild depression.⁷ The results were also supported with the study by M C Dougall FA and Matthews FE, revealed that around 27.1% elderly residing in old age home had depression were as compared to the elderly staying with the family 9.3% had low level of depression.⁸

CONCLUSION:

The nurses play an important role in prevention of geriatric depression. Nurses enhance peoples’ ability to deal with the multiple factors that influence their health status and health care needs. The goal of nursing is to promote health, prevent illness, restore health and alleviate suffering. The nurses have an impact on the health and life of societies in every imaginable situation providing solutions and touching the human heart.

The study showed varied levels of depression, among elderly residing in old age home and with the family. The results of the study will help the nurses to understand the level of depression. The investigator as a mental health nurse felt that the nurses are ideally placed to implement proactive strategies to prevent depression, to promote early detection of symptoms and to ensure access to effective treatment in older people. Mental health nurse have a key role to play in providing the appropriate psychological, spiritual, social and physical support that can lead to improvement in quality of life for the older people.

This study will enable the nurses to prepare teaching guidelines for prevention and management of depression. Thus, nurses can build good health of the community by providing information which will help them to manage depression among elderly clients and also prevent occurrence of depression.

REFERENCES:

1. Christensen Kockrow. Foundations and adult health nursing. 1^sted. Philadalphia: Mosby Company; 2006.Pg.no:1082, 1088.

2. Lessy. F. Jarvic. Aging into the 21^st century. New York: Garner Press; 1988. Pg.no:231.

3. Karensaucer , Sharyn Janes, K..Lundy Essentials of community based nursing. 1^sted. Canada: Jones and Barlett publishers. 2003. Pg no: 502, 504,509,525.

4. WHO Report on Aging and Health; 2003.Pg.no:19 to 21.

5. Gulani K K. Community health nursing principles and practices. 1^st ed. New Delhi. Kumar Publishing House. 2005. Pg no: 469-471.

6. Park K. Text book of preventive and social medicine. 8^thed. Jabalpur, India. Banarasidas Bhanot Publication. 2007. Pg no: .382.

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9. Toukala M. The General System model of Lindwig Von Bertalanffy. Available at: http//www. (nekos.org/engjournals/ The general system model of Lindwig Bertalanffy.doc .

10. Radha Krishnan. A study to assess depression among general out patients attending selected general hospital at Belgaum, Karnataka, Nightingale Nursing times 2006 2(2). Pg.no: 29-32.

11. Ather M Taqui, Ahmed Itrat, Waris Qidwai et al. Depression in the elderly: Does family system play a role? A cross-sectional study. BMC Psychiatry. 2007 Oct 25; 7: 57 Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2194680/

12. Bekaroglu M, Uluutku N, Tanriover S, Kirpinar I. Department of psychiatry, Faculty of medicine, Karadeniz Technical University, Trabzon, Turkey. Acta Psychiatric Scand. 2001 Aug; 84 (2). Pg.no: 174 – 178.

13. M C Dougall FA and Matthews FE. Prevelance and symptomatology of depression in older people living in institutions in England and Wales. Age aging 2007. Sep 36(5). Pg.no: 562-568.

Level of depression	Score range	Frequency	Percentage (%)
Ups and downs are normal.	1-10	0	0
Mild mood disturbance	11-20	0	0
Moderate depression	21-30	22	44
Severe depression	31-40	28	56
Extreme depression	Above 40	0	0