Assessment of the Effectiveness of Planned Teaching on Knowledge and attitude regarding the Dementia among Family Members of Elderly in selected Community Area

Ms. Sonali Waghmare¹*, Mr. Muniyandi. S²

¹Assistant Professor, Kasturba Nursing College, KHS, Sevagram

²HOD & Associate Professor, Kasturba Nursing College, KHS, Sevagram

*Corresponding Author Email: ms.sonujay@rediffmail.com

ABSTRACT:

PROBLEM STATEMENT:

Assessment of the effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of elderly in selected community area.

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding the dementia among family members of elderly.

2. To assess the level of attitude regarding the dementia among family members of elderly.

3. To assess the effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of elderly.

4. To determine the association between the knowledge regarding the dementia among family members of elderly with their selected demographic variables.

5. To determine the association between the attitude regarding the dementia among family members of elderly with their selected demographic variables.

6. To find out association between knowledge and attitude regarding the dementia among family members of elderly.

Research approach:

Present study was conducted with the primary objective of determining the effectiveness of planned teaching on knowledge and attitude regarding the dementia among the family members of elderly in a selected community area. Hence evaluative research approach was considered as appropriate. With this approach it would be possible to evaluate the knowledge and attitude regarding the dementia among the family members of elderly in a selected community area.

Research Design:

One group pre-test post-test design has been used to find the effectiveness of planned teaching on knowledge and attitude regarding the dementia among the family members of elderly in a selected community area and also to determine the association between knowledge and attitude of family members regarding the dementia with their selected demographic variables.

Setting of the study:

The study was conducted in selected community area. The rationale for selected this setting was an easy transport, familiarity with the setting, administrative approval, co-operation and availability of subjects.

Sample and sampling technique:

The sample consisted of 100 family members, who fulfilled the inclusion criteria.

Non probability convenient sampling method was used for the study.

Tool:

Knowledge questionnaire and Likert scale to assess attitude is used to gather information.

Validity and reliability:

The reliability was established by Split half method. So in split half method the KR-20 formula is applied to find out the reliability. The reliability coefficient correlation for structured knowledge questionnaire was r = 0.72. It is reliable to the instrument.

Investigator has an attitude Likert scale, so the Spearman-Brown formula used to find out the reliability value, the reliability value is 0.92 it’s highly reliable.

To obtain the content validity of the tool, the prepared tool with the synopsis, planned teaching on dementia, evaluators response sheet and content validity certificate were submitted to 11 experts in the field of psychiatric nursing and psychiatry. All validated tools were received back from the experts with their valuable suggestions and comments.

Pilot study:

The investigator conducted the pilot study in the month of December 2015. The duration of pilot study was 7/12/2015 to 13/12/2015. Permission from the Sarpanch of the village was obtained before conducting the study. The non probability convenient sampling technique was used for the selection of the sample. The pilot study was found to be feasible.

Data gathering process:

The data gathering process was from 04/01/2016 to 24/01/2016, after obtaining permission from the informed authorities total 100 samples were selected as per criteria. Investigator assessed knowledge by using structured questionnaire and attitude by 5 point Likert scale before and after administration of planned teaching. The data was analyzed in terms of the objectives of the study and presented in the form of tables and graphs.

Finding of the study:

The findings of the study includes, the analysis and interpretation of data collected from the family member of elderly in the selected community area. In this study, out of 100 subjects, most of the subjects 53 ( 53% ) were females, the age group of 44 ( 44% )subjects was 31 - 40 years, the educational qualification of most of the subjects 36 (36%) was higher secondary education, majority of the subjects 42 ( 42% ) were self employed, most of the subjects 60 ( 60% ) belongs to joint type of family, 51 ( 51% ) had annual income between rupees 10,001- 20,000 per month, 77 ( 77% ) subjects had no any previous knowledge about dementia, the source of information of 10 ( 10% ) subjects was newspapers and magazines.

In pre test, 13% subjects had poor knowledge, majority of the subjects i.e. 79% had significant knowledge, minority of the subjects 8% had good knowledge and nobody was in excellent group and only 19% subjects had unfavourable attitude and majority i.e. 81% of the subjects had moderately favourable attitude regarding dementia and nobody had favourable attitude.

While in post test, out of 100 subjects 4% of the subjects had good knowledge and 96% had excellent knowledge about dementia. And 10% of the subjects had moderately favourable attitude and majority of the subjects i.e. 90% had favourable attitude regarding the dementia.

The comparison between the mean of pretest and post test for knowledge showed that the mean of differences was 14.88, the calculated ‘t’ value was 39.199. It shows that there was a significant improvement in the knowledge of the family members of elderly regarding the dementia.

The comparison between the mean of pretest and post test for attitude showed that the mean of differences was 36.5, the calculated ‘t’ value was 35.07. It shows that there was a significant improvement in the attitude of the family members of elderly regarding the dementia, so, the null hypothesis H₀ is rejected and the research hypothesis H₁ is accepted.

The correlation index between knowledge and attitude related to dementia among family members of elderly are not significantly associated with each other.

CONCLUSION

The analysis of the study revealed that there was a significant improvement in the knowledge and attitude of the family members of elderly. The planned teaching proved to be effective in improving the knowledge and attitude of the family members of elderly in selected community area.

KEY WORDS:

Assessment, effectiveness, planned teaching, knowledge, attitude, dementia.

INTRODUCTION

“Memory is but the storage of fragmentary but relevant features”

Lewis Carol.

The ageing process is of course a biological reality which has its own dynamic, largely beyond human control. However, it is also subject to the constructions by which each society makes sense of old age. With the growing number of elderly persons in the world, the need for adequate health and social care will increase. Health and social service providers must develop policies and programs allowing the elderly to lead rich and independent lives as long as possible.¹

Family is a group consisting of parents and their children. They are related with each other by blood. Almost everybody have elderly people at their home. Elderly peoples are having many problems such as they are unable to hear, understand, remind and take care of themselves and so on. So the family members should have knowledge, information and skills to take care of the elderly.²

The term senility is used to refer to the period during old age when a more or less complete physical breakdown takes place and there is mental disorganization. Many people are afraid that growing old means losing the ability to think, reason or remember. They worry when they feel confused or forgetful that these feelings are the first signs of senility. In the past, doctors dismissed memory loss, confusion or similar behaviours as a normal part of ageing. However, scientists now know that most people remain alert and capable as they age. They also know that people who experience changes in personality, behaviour or skills may be suffering from brain disease called dementia.^3,4

Organic mental disorders are behavioural or psychological disorders associated with transient and permanent brain dysfunction. These disorders have demonstrable and independently diagnosable cerebral disease or disorder.

Dementia is defined by a loss of previous levels of cognitive, executive and memory function in a state of full alertness. Dementia is a progressive brain dysfunction of daily activities and in most cases, leads to the need for long term care. The WHO has defined dementia syndrome caused by disease of the brain usually of chronic functions, calculations, learning capacity, language and judgment. Impairment of cognitive function are commonly accompanied and occasionally preceded by deterioration in emotional control, social behaviour and motivation.⁴

Dementia is the term which is used to describe a group of conditions that affect the brain and cause a progressive decline in the ability to think, remember and learn. It is an issue of global, national and regional concern, since it is estimated that there are 36 million people worldwide living with dementia and that this will double to 66 million by 2030.⁵

Dementia is emerging as a major public health problem in India along with the demographic transition towards aging .The symptoms of dementia can be categorized into 3 major domains: cognition, behaviour and impairment in functioning related to activities of daily living behavioural disturbances are integral to the description of dementing disorders. Behavioural and psychological symptoms of dementia (BPSD) can be defined as a heterogeneous range of psychological reactions, psychiatric symptoms and behaviours occurring in people with dementia of any etiology.⁶

Life expectancy is increasing as a result of advances in medical science and the availability of better health care services: the proportion of elderly persons in the general population is therefore rising as the risk of dementia increases with increasing age, the number of persons with dementia in the general population is also rising .For example one of the study found that the cumulative incidence of dementia per 1000 in the USA rose from 3.5 in the 65-69 year age group to 72.8 in those aged 85 years and older, and the incidence per 1000 in another USA study were 2.2 in the group of 65-74 years and 26.0 in those aged 85 years and older.⁷

Aging of the brain is a continuous linear process that begins at conception. Two third of all people eventually experience some significant loss of mental lucidity and independence as a result of aging. People aged 60 years and older experience significant cognitive decline, including declines in memory, concentration, clarity of thought, focus and judgment with an increase in the onset of several neurological problems.⁸

According to World health organization, elderly are those at the age of 65 years and more. Many of the common diseases in this age are either chronic or progressive in nature and this makes these people dependant on their family and local health services. Some of the common neurological problems during old age are Alzheimer's disease, Parkinson's disease, stroke etc.^9,10

Caring for a person with dementia at home is a difficult task and can become overwhelming at times. Each day brings new challenges as the caregiver copes with changing levels of ability and new patterns of behaviour. Research has shown that caregivers themselves often are at increased risk for depression and illness, especially if they do not receive adequate support from family, friends and the community.¹¹

One of the biggest struggles caregivers face is dealing with the difficult behaviours of the person they are caring for dressing, bathing, eating basic activities of daily living often become difficult to manage for both the person with dementia and the caregiver. Having a plan for getting through the day can help caregivers cope. Many caregivers have found it helpful to use strategies for dealing with difficult behaviours and stressful situations.¹²

The potential for caregivers’ difficulty in providing home care to patients with dementia increases over time as the disease is self care functioning. Stressors include frustration because of impaired patient communication, anger at the patient’s bizarre behaviour fatigue or resentment from constant care responsibilities. If the caregivers grow increasingly frustrated, feelings of guilt may arise and the caregiver may feel as if the patient has been neglected.¹³

Since most of the aspects are neglected, it is the society of younger generations, other family members, social organizations and health care personnel to look into the matter and show concern. Nursing always has responded to the changes in the society’s health care needs. Nursing needs to identify practice and feasible clinical roles, which provides independent professional practice. Among the clinical specialization, geriatric nursing is a tangible area where the role of a nurse is accepted and approved. There is need for geriatric nursing care providers to meet the growing proportion of dementia population.¹⁴

NEED FOR STUDY:

The word dementia is an umbrella term, which describes serious deteriorations in the mental functions such as memory, language, orientation and judgment. Ultimately these problems results in alteration in individual’s function to work, social and family responsibilities and activities of daily living.⁴

A study was conducted to assess the experiences of care givers who provide care for family members with dementia. Results revealed ethno cultural and structural barriers that family care givers experienced including stigmatization of dementia in the community, a lack of knowledge about dementia and negative interactions with health-care providers. Researcher concludes that overcoming barriers and working with families and their community are needed to improve access and dementia service for clients and their families.¹⁵

The majority of Alzheimer's cases are sporadic and late-onset, developing after the age of 65 years. The causes of this disease type are not completely understood. Familial Alzheimer's disease is a rare form of the disease caused by certain gene mutations that affects less than 2 percent of Alzheimer's patients. Alzheimer’s disease disrupts the three processes that keep neurons healthy communication, metabolism and repair. The destruction of brain cells lead to memory failure, personality changes, and problems on carrying out activities of daily living.^16,17

The memory lapses are similar to those of someone in the earliest stage of Alzheimer’s, and some experts see it as a precursor to Alzheimer’s or other forms of dementia. People with mild cognitive impairment do develop Alzheimer’s at higher rates than the general population of older adults. But mild cognitive impairment is not the same as Alzheimer’s, nor does everyone with mild cognitive impairment develops Alzheimer’s. The early symptoms of Alzheimer's disease can be missed because they resemble signs that many people attribute to natural aging. These include increasing memory loss, starting with forgetting recent events and new information, and progressing to not recognizing friends and family members, difficulty to concentrate, coordination and gait disturbances, insomnia, incontinence, and restlessness.^18,19

A study was conducted to assess the family caregiver’s burden on caring for a relative with dementia. The result showed that 68.02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patients. Patient psychopathology and caregiver sex, income and level of education.²⁰

A study was conducted to improve the family member’s knowledge about dementia which has been associated with benefits for their well being. The research shows that education improved about dementia, as measured by increased scores on a dementia knowledge questionnaire. This study has important implication for public education about dementia and resources allocation for service providers.²¹

There are many myths surrounding dementia that can obscure our understanding of the issues facing our loved ones who suffer from dementia diseases.

People suffering from dementia usually do know what they want, they just have trouble communicating it properly. It may be useful to take notes on the behavior of a person with dementia to help determine the causes of distress or poor behavior. Dementia does not necessarily occur when a person ages, it is a medical condition, not inevitable. If it were a natural part of aging then everyone over the age of 65 would have it; however, it is estimated that dementia affects 5% of the population older than 65 with the rates increasing with increased age. Millions of people age into their 80s and 90s without much memory decline. Dementia can occur as a result of brain damage due to a head injury, stroke, alcohol abuse, or brain infection to name a few, causes that aren’t necessarily related to aging.²²

Alzheimer’s is the most common type of dementia in people aged 65 and older. There are no available treatment options for dementia, while it is true that most types of dementia don’t have a cure, there are treatment options to manage the symptoms of dementia and increase the quality of life for dementia patients. Anyone diagnosed with dementia is unable to make decisions; a dementia diagnosis does not indicate that your loved one is incompetent. As dementia progresses, it may be more difficult for your loved one to weigh options and understand the consequences involved in making major decisions, but those with mild dementia who are aware and comprehensive can be consulted before decisions are made on their behalf. As a caregiver, you are helpless; caring for a loved one suffering from dementia can take a toll on you physically, mentally and emotionally, but remember that you are making a difference. Learning about dementia, being present for doctor’s appointments and asking questions and finding resources for your loved one are all ways you can help your loved one.²³

The world dementia report 2009 had said that there would be 35 million people worldwide with dementia by 2010. That number is set to almost double every 20 years to 65.7 million in 2030 and 115.4 million in 2050. Scientists had earlier said that by 2020, around 10 million Indians above the age of 65 would suffer from dementia. By 2040, the number would increase to around 22 million.²⁴

The WHO report also focused on the impact of dementia physical, psychological and economic on caregivers. Statistics cited in the report suggested that 40-50% of caregivers had significant illness as a result of their care giving and 15-32% had clinically diagnosable depression. There may also be physical health consequences; strained caregivers have impaired immunity and a higher mortality rate. Caring is a full time job an average of around 8 hours per day for a relative with moderate to severe dementia require caregivers to take care of them.²⁵

The caregivers of patients suffering from dementia have inadequate knowledge of this disease condition. The studies have revealed that caregivers lack of knowledge, and they take the difficult decision to place their dear ones in home care, get no relief and undergo depression and anxiety and in fact suffer additional emotional trauma.²⁵

Many studies done in the relation has revealed that there are deficits in knowledge regarding the self care deficits of dementia patients. The studies emphasize that there is need for special education on self care deficits of clients. The care givers have to be skilled in knowledge of the care of these clients. Dementia includes a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. These symptoms are caused by changes in the brain as a result of physical diseases.⁷

It is estimated that 5.3 million people have Alzheimer's disease worldwide. Alzheimer's disease is the fifth-leading cause of death for those aged 65 years and older. There are 3.7 million elderly currently living with dementia in India of which 60- 70% are of Alzheimer’s type. Alzheimer’s disease is the most common cause of dementia in the United States. It will become even more common in the coming decades, as the number of elderly in the population increases.²⁷

Exercise training increases fitness, physical function, cognitive function, and positive behaviour in people with dementia and related cognitive impairments. Exercise was associated with statistically significant positive treatment effects in older patients with dementia and cognitive impairments. The meta-analysis results suggest a medium to large treatment effect for health-related physical fitness components, and an overall medium treatment effect for combined physical, cognitive, functional, and behavioural outcomes. The results provide preliminary evidence for the effectiveness of exercise treatments for persons with dementia and related cognitive impairments.²⁸

Improving public awareness of dementia would improve quality of life for people with dementia and their families by putting them in a strong 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. Without tackling the issue of a low level of awareness about dementia, stigma will continue to act as a barrier to people receiving the services they need. People are not aware of the range of symptoms associated with dementia. They are most likely to view memory loss as a symptom of dementia, rather than other symptoms such as confusion or behavioural changes .Family members often feel that memory problems are a natural part of aging, and may not see it as a medical problem .In one survey for example two-third (69%) of respondents believed that people fail to seek medical advice for memory problems because they think of it as a natural part of ageing, and more than a third (39%) felt that people do not consider memory loss to be a serious medical problem. Lack of awareness and misunderstanding can result in a considerable delay in people with dementia or their families consulting a doctor after recognizing symptoms.⁷

In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. India has become close to 80 million senior citizens. That number is larger than the entire population of United Kingdom. It is estimated that the number of older persons will grow to 137 million by 2021 in our country. These changes are due in part to the rising life expectations and in part to the changing demographic patterns.²

The investigator from her own experience during clinical posting and discussion with experts realized that dementia is a growing problem and family members are not prepared to care for persons with dementia. Very often family members prefer to place elderly people in institutions, departing from family.

The researcher observed that old people are at high risk for dementia. As the caregivers or family members were developing stress, conflict, frustrations because lack of knowledge and unfavourable attitude regarding dementia and its management, this researcher got interested to provide awareness regarding dementia and its management to the family members of elderly to help them to care for their elder ones with positive attitude.

PROBLEM STATEMENT:

Assessment of the effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of elderly in selected community area.

OBJECTIVES OF THE STUDY:

1. To assess the level of knowledge regarding the dementia among family members of elderly.

2. To assess the level of attitude regarding the dementia among family members of elderly.

3. To assess the effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of elderly.

4. To determine the association between the knowledge regarding the dementia among family members of elderly with their selected demographic variables.

5. To determine the association between the attitude regarding the dementia among family members of elderly with their selected demographic variables.

6. To find out correlation between knowledge and attitude regarding the dementia among family members of elderly.

OPERATIONAL DEFINITIONS:

Assessment:

It is the evaluation or estimation of the nature, quality, or ability of someone or something. (Oxford dictionary)

In this study, it refers to the organized, systematic and continuous process of collecting and analyzing the data related to knowledge and attitude regarding dementia among family members of elderly before and after implementation of planned teaching.

Effectiveness:

It refers to an act of producing intended results. (Oxford dictionary)

In this study effectiveness means improving the knowledge and attitude of family members of elderly regarding dementia by planned teaching which may result difference between pre-test and post-test scores.

Planned teaching:

It is a power point presentation which consists of demonstrations and multimedia clippings. (Oxford dictionary)

In this study, it refers to systematically developed teaching to provide information on different aspects of dementia.

Knowledge:

It refers to the information and skills gained through experience or education. (Oxford dictionary)

In this study, it refers to the sum of what is known regarding dementia among family members of elderly.

Attitude:

It refers to a manner of feeling, thinking or behaving that reflects a state of mind or disposition. (Oxford dictionary)

In this study it refers to the way the family members behave or think about dementia.

Family members:

It refers to a group of people affiliated by consanguity, affinity, or co-residence and/or shared consumption. Members of the family parents, brothers, sisters, sons, daughters, etc. (Oxford dictionary)

In this study, it refers to the members who are care givers of elderly between 18 to 55 yrs of age.

Elderly:

It refers to the people advanced in years. (Oxford dictionary)

In this study, it refers to the males and females above 60 yrs

Dementia:

A chronic or persistent disorder of the mental processes due to organic brain disease. (Oxford dictionary)

In this study, it refers to an acquired global impairment of intellect, memory and personality but without impairment of consciousness.

SCOPE OF THE STUDY:

Adequate knowledge regarding the dementia will help to reduce the mortality and morbidity among the elderly.

Planned teaching can be planned for family members in selected community area according to the needs of elderly and family members level of understanding

ASSUMPTIONS:

1. The family members of elderly may have inadequate knowledge and unfavorable attitude regarding the dementia.

2. Planned teaching may improve the knowledge of family members of elderly and they may develop favourable attitude regarding the dementia.

HYPOTHESIS:

H₀: There is no significant difference in knowledge and attitude of family members of elderly regarding the dementia after planned teaching measured at p<0.05 level of significance.

H₁: There is a significant difference in knowledge and attitude of family members of elderly regarding the dementia after planned teaching measured at p<0.05 level of significance.

LIMITATIONS:

· This study was limited to those family members only who were readily available in the selected community area

· Non probability convenient sampling was done which restrict the generalization of the study.

ETHICAL ASPECT:

1) Approval from the institutional ethical committee.

2) Prior permission from local community leader.

3) Informed consent from the participants.

CONCEPTUAL FRAMEWORK:

The theoretical framework of the study is based upon Imogene King Goal attainment theory. The major elementsof the theory of goal attainment are seen "in the interpersonal systems in which two people, who are usually strangers, come together in a health care organization to help and be helped to maintain a state of health that permits functioning in roles". The theory's focus on interpersonal systems reflects King's belief that the practice of nursing is differentiated from that of other health professions by what nurses do with and for individuals. Each of the individuals involved in an interaction brings different ideas, attitude and perceptions to the exchange. The individuals come together for a purpose and perceive each other; each makes a judgment and takes mental action or decide to act. Then each reacts to the other and to the situation (perception, judgment, action, reaction).According to this theory two people interact in some situation they interact then interpersonal system are formed, they perceive each other, make judgment about the others, take some mental action and react to each one of these. Since these behaviours cannot be directly observed, one can only make inference about the same. The next step in the process is interaction which can be directly observed. The step in this model is transaction which is dependent upon achievement of goals.

The investigator adopted King’s goal attainment theory as a basis for conceptual frame work, to find out these effectiveness and provision of planned teaching by assessing the family members knowledge and attitude before and after giving the planned teaching. The five major concepts of the phenomenon are described as follows.

Perception:

Refers to person’s representation of reality. It is universal hence highly subjective to each person. It is not observable but it can be inferred. Here the investigator perceived that the family members were having inadequate knowledge and unfavourable attitude regarding dementia. And the family members also perceived that they were having less knowledge dementia.

Judgement:

The investigator judged (felt the need) that the knowledge and attitude was inadequate among the family members regarding dementia and need to improve knowledge regarding dementia. The family members also judged the need to update the knowledge regarding dementia and develop favourable and positive attitude.

Action:

The nurse educator’s action is to prepare planned teaching regarding dementia. And to take consent that they are ready to receive planned teaching and participate in the study.

Mutual goal:

The nurse educator’s mutual goal is to involve family members of the elderly to gain adequate knowledge and favourable attitude towards dementia.

Reaction:

In this study investigator as a nurse’s reaction is setting mutual goal and plan for assessing the knowledge and attitude regarding dementia among family members of the elderly by conducting pre-test.

Interaction:

If individual goal directed pre-planned & commended.

In this study the investigator interacted with the family members by giving pre test followed by providing planned teaching.

SETTING OF THE STUDY:

Setting refers to the area where the study is conducted. It is the physical location and condition in which data collection takes place in a study. The selection of an appropriate setting for conducting a study is crucial for its successful completion. The study was conducted in selected community area. The rationale for selected this setting was an easy transport, familiarity with the setting, administrative approval, co-operation and availability of subjects.

DESCRIPTION ABOUT EVENT:

The study was conducted in the selected area of community. Prior permission was taken from the competent authority. On day 1 the researcher visited the community and collected the people on the school ground. Consent was taken from the participants and pre-test papers were given. Planned teaching was given to them on dementia and thanks were given to all participants for participating in the study. After 7 days the post-test was conducted and the results were calculated.

POPULATION:

Population denotes the entire group of subjects under study. The population selected for the present study are family members of the elderly.

TARGET POPULATION:

The entire population in which the investigator is interested and in which they would like to generalize the research findings.

In this study, it includes the family members of elderly in selected community area.

ACCESSIBLE POPULATION:

The aggregate of cases that confirm to designated inclusion and exclusion criteria and that are accessible as subjects of the study.

In this study, it refers to family members of elderly in selected community area meeting the inclusion and exclusion criteria.

SAMPLE AND SAMPLING TECHNIQUE:

Sample:

Sample is the proportion or subset of population. A sample is the most basic unit, about which information is collected. In the study sample is the family members of the elderly who fulfil the inclusion and exclusion criteria.

Sampling technique:

Sampling is the process of selecting samples from the target population to represent the entire population.

Sampling technique used in the study is non probability convenient sampling. According to Polit and Beck non probability convenient sampling entails the selection of most readily available 100 individuals as subject in the study, it represents typical conditions and investigator’s knowledge about population and its elements can be used to select cases.

The investigator preferred to choose this sampling technique because of the constraint of time and in order to complete the data collection within the stipulated time.

Sample size:

It is the number of subjects being selected in the study.

100 family members were the sample size for this study as mentioned in the inclusion criteria.

SAMPLING CRITERIA:

Inclusion criteria:

The criteria that specify the characteristics that the population does have.

In this study the inclusion criteria was

- Family members of the elderly staying with them and willing to participate in this study.

- Family members of the elderly who knows Marathi/ Hindi languages

Exclusion Criteria:

The criteria that has a direct bearing on condition, intervention or results.

In this study the exclusion criteria was

Family members of the elderly who already had undergone similar training program.

TOOL FOR DATA COLLECTION:

A tool is an instrument or equipment used for collection of data.

The study was aimed at assessment of the effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of the elderly in selected community area. Hence, a self administered structured knowledge questionnaire and Likert scale to assess attitude was used.

The investigator developed the tool after updating the theoretical knowledge regarding the dementia. The investigators own experience, theoretical knowledge and guidance from the experts along with the review of literature helped in developing the tool necessary for the study.

DEVELOPMENT OF THE TOOL:

Based on the objectives of the study, a structured knowledge questionnaire was prepared to evaluate the knowledge and attitude of family members before and after intervention (planned teaching). After extensive and systematic review of literature the investigator developed this questionnaire and Likert scale. The sources of tool construction were; review of literature from textbooks, journals and online source reports, and other publications and thesis and discussion with the experts. Experts were in the field of psychiatric nursing and psychiatry which enlightened and refined the investigators idea about the tool preparation.

DESCRIPTION OF THE TOOL:

Section –A –Demographic data:

It comprised of 8 items seeking information on demographic data such as gender, age, educational status, occupation, type of family, annual income of the family, previous knowledge about dementia and the sources of information, if any.

Section –B –Questionnaire to assess the level of knowledge regarding the dementia

It consisted of structured questionnaire on knowledge regarding the dementia, which comprised of 30 items.

The knowledge questionnaire consisted of 30 multiple choice questions. Each question had 4 options in which one option was correct and others were incorrect. Every correct response was given the score 1and every unanswered and incorrect response was given 0. The maximum score on knowledge questionnaire was 30. Knowledge was graded from poor knowledge to excellent knowledge based on the scores. This grading was only for the purpose of the study. The different levels of knowledge were categorized as follows,

Table II- Categorization of level of knowledge

S.N.	SCORE	RANGE	LEVEL
1	1-7	1-7	Poor
2	8-15	8-15	Satisfactory
3	16-22	16-22	Good
4	23-30	23-30	Excellent

Section –C – Likert scale to assess the level of attitude about dementia

This section deals with the assessment of attitude regarding dementia by using modified Likert scale.

The scale consists of 25 statements measured in 5 response scale that is strongly agree, agree, undecided, disagree, strongly disagree. The response were measured on the basis of positive and negative form of questions from 1-5 and 5-1 respectively. The maximum score for attitude scale was 125 and minimum score was 25.

Table III- Categorization of the level of attitude

LEVEL OF ATTITUDE	RANGE
Unfavourable attitude	<50%
Moderately favourable attitude	50-75%
Favourable attitude	>75%

PLANNED TEACHING ON DEMENTIA:

The planned teaching was prepared for the people in the community

The steps adopted in the development of the planned teaching were thorough review of relevant published literature and websites and text books on various aspects of dementia.

FEASIBILITY OF THE STUDY:

Feasibility of the questionnaire was conducted on 10 family members of elderly in selected community area to check the clarity and ambiguity of the items. It took about 45-50 minutes to complete the questionnaire. The questionnaire was found to be unambiguous, feasible and understandable.

PILOT STUDY:

“A pilot study is a miniature run of the main study.”

Pilot study helps the investigator to assess the effectiveness of the data collection plan, identify the inadequacies of the plan and make due modifications as required, find out the feasibility of conducting the study and to determine the methods of statistical analysis.

The investigator conducted the pilot study in the month of December 2015. The duration of pilot study was 7/12/2015 to 13/12/2015. Permission from the Sarpanch of the village was obtained before conducting the study. The purposes of the usefulness of the study were explained to the concerned authorities before taking permission.

The investigator carried out the pilot study for the total 10 subjects. The non probability convenient sampling technique was used for the selection of the sample. On the first day of the study, pre-test was conducted, after giving prior instruction regarding context of the study and taken written consent from the samples to assess the level of knowledge and attitude regarding dementia. Questionnaire was administered, each sample required mean time of 45 minutes to complete the structured questionnaire. After the pre-test, planned teaching was conducted on dementia. The post-test was conducted with the same questionnaire on the 7^th day after planned teaching.

Data was analysed using descriptive and inferential statistics. Findings indicated that the planned teaching was effective in improving the knowledge and attitude of the family members regarding dementia.

RELIABILITY OF THE TOOL:

The reliability of a measuring instrument is a major criterion for assessing its quality and adequacy.

The reliability was established by Split half method. So in split half method the KR-20 formula is applied to find out the reliability. The reliability for structured knowledge questionnaire was r = 0.72. It is reliable to the instrument.

Investigator has an attitude Likert scale, so the Spearman-Brown formula used to find out the reliability value, the reliability value is 0.92 it’s highly reliable.

VALIDITY:

“Validity is the most critical criterion and indicates the degree to which an instrument measures what is supposed to be measured.”

Their suggestions were taken into consideration and the modifications were incorporated in the final preparation of the structured knowledge questionnaire, attitude scale and planned teaching.

DATA COLLECTION METHOD:

It is a precise systematic gathering of information relevant to the research purpose or the specific objective, or hypothesis of a study. The procedure for collecting data is not a mechanical process that can be carefully planned prior to initiation.

PROCEDURE FOR DATA COLLECTION:

Formal written permission was obtained from the selected community area. Data was collected from participants.

Data collection technique used was self reporting. The investigator personally approached subjects and explained the purposes of the study and how it would be beneficial for them, and confirmed their willingness to participate in the study, written consent was obtained from the study subjects and confidentiality of their response was maintained. The investigator collected a group of subjects, made them comfortable and oriented them to the study and administered questionnaire to them, instructed them not to interact with each other and their doubts were clarified. Once the questionnaire was completed, investigator collected them back. The subjects required mean time of 45 minutes to complete the structured questionnaire. After the pre-test planned teaching was conducted on the same day to enhance their knowledge. Post-test was conducted on the 7^th day with the same questionnaire.

The collection of data was performed within the stipulated time. After the data gathering process the investigator thanked all the study subjects as well as the authorities for their co-operation.

PLAN FOR DATA ANALYSIS:

It is the plan to analyse the data by using descriptive and inferential statistics on the basis of objectives and hypothesis of the study. To compute the data, a master data sheet was prepared by the investigator.

Data collected was analysed in the following steps.

· Data were organised in master sheet

· The frequencies and percentage for the analysis of demographic variables

· Mean, mean score percentage and standard deviation for pre-test and post-test score

· Paired ‘t’ test to determine significance of difference between mean pre-test score and mean post test score. Mean gain of knowledge score before and after administration of structured teaching

ANALYSIS AND INTERPRETATION:

Organization and presentation of the data:

The raw data collected were entered in the master sheet. The analysis and interpretation of the observations were done by using descriptive and inferential statistics. The data were organised and presented under the following headings.

Section I-

Data on demographic variables among family members of elderly

Section II-

Assessment of knowledge regarding the dementia among family members of elderly

Section III-

Assessment of attitude regarding the dementia among family members of elderly

Section IV-

Effectiveness of planned teaching on knowledge and attitude regarding the dementia among family members of elderly.

Section V-

Association between the knowledge regarding the dementia among family members of elderly with their selected demographic variables.

Section VI -

Association between the attitude regarding the dementia among family members of elderly with their selected demographic variables.

Section VII-

Correlation between knowledge and attitude regarding the dementia among family members of elderly.

Frequency and percentage distribution of family members of elderly with regard to their demographic variables n=100

Sr. no	Demographic variables		Frequency (n)	Percentage (%)
1	Sex
	a	Male	47	47%
	b	Female	53	53%
2	Age
	a	18 to 30	23	23%
	b	31 to 40	44	44%
	c	41 to 50	23	23%
	d	51 to 60	10	10%
3	Education status
	a	Primary education	13	13%
	b	Secondary education	31	31%
	c	Higher secondary education	36	36%
	d	Graduation	20	20%
4	Occupation
	a	Housewife	31	31%
	b	Self employed	42	42%
	c	Professionals	27	27%
5	Type of family
	a	Nuclear	37	37%
	b	Joint	60	60%
	c	Extended	3	3%
6	Annual income
	a	Less than Rs. 10,000/month	9	9%
	b	Rs. 10,001 – 20,000/month	51	51%
	c	Rs. 20,001 – 30,000/month	34	34%
	d	More than Rs. 30,001/month	6	6%
7	Previous knowledge about dementia
	a	Yes	23	23%
	b	No	77	77%
8	If yes, the source of information is
	a	Newspaper / Magazines	10	10%
	b	T.V / Internet	5	5%
	c	Health professional	4	4%
	d	Family	3	3%
	e	Friends	1	1%

SECTION II

ASSESSMENT OF KNOWLEDGE AND ATTITUDE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF ELDERLY

Table V- Frequency and percentage distribution of family members according to level of knowledge. n=100

Sr. no	Level of Knowledge	Pre test		Post test
Sr. no	Level of Knowledge	Frequency n	Percentage %	Frequency N	Percentage %
1	Poor (1-7)	13	13%	0	0%
2	Satisfactory (8-15)	79	79%	0	0%
3	Good (16-22)	8	8%	4	4%
4	Excellent (23-30)	0	0%	96	96%

Table VI- Frequency and percentage distribution of family members according to level of attitude n=100

Sr. no	Level of Attitude	Pre test		Post test
Sr. no	Level of Attitude	Frequency n	Percentage %	Frequency N	Percentage %
1	Unfavourable ( < 50%)	19	19%	0	0%
2	Moderately favourable ( 51-75%)	1	81%	10	10%
3	Favourable ( >75%)	0	0%	90	90%

SECTION III

EFFECTIVENESS OF PLANNED TEACHING ON KNOWLEDGE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF ELDERLY.

Table VII- Mean, standard deviation, mean of differences in scores and ‘t’ value for knowledge regarding the dementia.n=100

Sr no	Test	Mean	Standard deviation (S.D)	Mean of differences in score (M.D)	‘t’ value
1	Pre test	10.84	3.024	14.88	39.199*
2	Post test	25.72	1.52	14.88	39.199*
P < 0.05 level *significant

SECTION IV

EFFECTIVENESS OF PLANNED TEACHING ON ATTITUDE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF ELDERLY.

Table VIII- Mean, standard deviation, mean of differences in scores and ‘t’ value for attitude regarding the dementia.n=100

Sr no	Test	Mean	Standard deviation	Mean of differences in score	‘t’ value
1	Pre test	67.52	6.00	36.5	35.07*
2	Post test	104.07	7.32	36.5	35.07*
P < 0.05 level *significant

Figure 11. Pre-test and post test knowledge regarding the dementia

Figure12. Pre-test and post test level of attitude regarding the dementia

Figure 13. Comparison of mean pretest and post test knowledge and attitude score regarding the dementia among family members of elderly

SECTION V

ASSOCIATION BETWEEN THE KNOWLEDGE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF ELDERLY WITH THEIR SELECTED DEMOGRAPHIC VARIABLES.

Table IX- Association between knowledge with their selected demographic variables n=100

Sr. no	Demographic variables	Knowledge score			Chi square (²)
Sr. no	Demographic variables	Poor	Satisfactory	Good	Chi square (²)
1	Sex
	a. Male	6	41	0	c²=7.85* df=2
	b. Female	7	38	8	c²=7.85* df=2
2.	Age in years
	a. 18 - 30	5	15	3	c²=10.66^NS df=6
	b. 31 - 40	8	32	4
	c. 41 - 50	0	22	1
	d. 51 - 60	0	10	0
3	Educational status
	a. Primary education	1	11	1	c²=9.6569^NS df=6
	b. Secondary education	4	26	1
	c. Higher secondary education	7	27	2
	d. Graduation	1	15	4
4	Occupation
	a. House wife	5	21	5	c²=5.522^NS df=4
	b. Self employed	6	34	2
	c. Professionals	2	24	1
Sr. no	Demographic variables	Knowledge score			Chi square (²)
Sr. no	Demographic variables	Poor	Satisfactory	Good	Chi square (²)
5	Family type
	a. Nuclear	3	31	3	c²=7.67^NS df=4
	b. Joint	9	46	5
	c. Extended	1	2	0
6	Annual income
	a. a. Less than Rs.10,000/month	2	4	3	c²=19.356* df=6
	b. b. Rs.10,001-20,000/month	9	40	2
	c. c. Rs.20,000-30,000/month	2	31	1
	d. d. More than Rs.30,001/month	0	4	2
7	Previous knowledge about dementia
	a. a. Yes	2	15	6	c²=13.342* df=2
	b. b. No	11	64	2	c²=13.342* df=2
8	If yes, the source of information
	a. a. Newspaper / Magazines	1	6	3	c²=68.898* df=8
	b. b. T.V / Internet	1	3	1
	c. c. Health professional	0	3	1
	d. d. Family	0	2	1
	e. e. Friends	0	1	0

*significant

NS- non significant

df-degree of freedom

SECTION VI

ASSOCIATION BETWEEN THE ATTITUDE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF THE ELDERLY WITH THEIR SELECTED DEMOGRAPHIC VARIABLES.

Table X- Association between attitude with their selected demographic variables. n=100

Sr. no.	Demographic variables	Attitude score				Chi square (c²)
		Unfavourable			Moderately favourable
1	Sex
	a. Male	12			35	c²=2.4579^NS df=1
	b. Female	7			46
2	Age in years
	a. 18 – 30	5			18	c²=4.46^NS df=3
	b. 31 – 40	10			34
	c. 41 – 50	1			22
	d. 51 – 60	3			7
3	Educational status
	a. Primary education	4			9	c²=4.06^NS df=3
	b. Secondary education	4			27
	c. Higher secondary education	5			31
	d. Graduation	6			14
4	Occupation
	a. House wife	5			26	c²=1.101^NS Cont…df=2
	b. Self employed	10			32
	c. Professionals	4			23
Sr. no.	Demographic variables	Attitude score				Chi square c²)
		Unfavourable			Moderately favourable
5	Family type
	a. Nuclear	6			31	c²=1.15^NS df=2
	b. Joint	13			47
	c. Extended	0			3
6	Annual income
	a. Less than Rs.10,000/month	3			6	c²=5.99^NS df=3
	b. Rs.10,001-20,000/month	5			46
	c. Rs.20,001-30,000/month	9			25
	d. More than Rs.30,001/month	2			4
7	Previous knowledge about dementia
	a. Yes		6	17		c²=0.972^NS df=1
	b. No		13	64
8	If yes, the source of information
	a. Newspaper / Magazines		4	6		c²=70.36* df=4
	b. T.V / Internet		1	4
	c. Health professional		1	3
	d. Family		0	3
	e. Friends		0	1

*significant

NS- not significant

df- degree of freedom

SECTION VII

CORRELATION BETWEEN KNOWLEDGE AND ATTITUDE REGARDING THE DEMENTIA AMONG FAMILY MEMBERS OF ELDERLY.

This section deals with the correlation between knowledge and attitude regarding the dementia among family members of elderly.

Table XI- Correlation between knowledge and attitude regarding the dementia among family members of elderly. n=100

Sr no	Test	Mean	Standard deviation (S.D)	‘r’ value
1	Pre test (knowledge)	10.84	3.01	- 0.79^NS
2	Pre test (attitude)	25.72	19.89	- 0.79^NS
r < 0.05 level *significant

The data in above table shows correlation between the pre-test level of knowledge and attitude of the family members of elderly regarding dementia. Product moment correlation Karl Pearson’s correlation is applied to find out the correlations between knowledge and attitude. The calculated value of correlation index is - 0.79, which is much smaller than the tabulated value that is 0.16 at degree of freedom 98. So the correlation index between knowledge and attitude regarding the dementia among family members of elderly are not significantly correlated with each other. So the hypothesis is rejected.

V. SUMMARY, MAJOR FINDINGS, DISCUSSION, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS:

This chapter presents the analysis and interpretation of data collected from the family member of the elderly in the selected community area. In this study, out of 100 subjects, most of the subjects 53 (53%) were females, the age group of 44 ( 44% ) subjects was 31 - 40 years, the educational qualification of most of the subjects 36 (36%) was higher secondary education, majority of the subjects 42 (42%) were self employed, most of the subjects 60 ( 60% ) belonged to joint type of family, 51 (51%) had annual income between rupees 10,001- 20,000 per month, 77 (77%) subjects had not any previous knowledge about dementia, the source of information of 10 (10%) subjects was newspapers and magazines.

While in post test, out of 100 subjects 4% of the subjects had good knowledge and 96% had excellent knowledge about dementia and 10% of the subjects had moderately favourable attitude and majority of the subjects i.e. 90% had favourable attitude regarding the dementia.

The comparison between the mean of pre-test and post test for attitude showed that the mean of differences was 36.5, the calculated ‘t’ value was 35.07. It shows that there was a significant improvement in the attitude of the family members of elderly regarding the dementia, so, the null hypothesis H₀ is rejected and the research hypothesis H₁ is accepted.

The correlation index between knowledge and attitude regarding the dementia among family members of elderly are not significantly correlated with each other

DISCUSSION:

The findings of the study were discussed with reference to the objectives stated in chapter I and with the findings of the other sections. The present study was undertaken as, “Assessment of the effectiveness of planned teaching programme on knowledge and attitude regarding the dementia among the family members of elderly in selected community area.”

Distribution of subjects according to the demographic variables shows that, out of the 100 subjects 47 (47%) subjects were males and 53(53%) were females. 23 (23%) subjects were between the age group of 18 – 30 years, 44 (44%) of 31- 40 years, 23 (23%) of 41- 50 years and 10 (10%) of the age group of 51- 60 years. 13(13%) subjects had taken primary education, 31(31%) completed secondary education, 36(36%) completed higher secondary education and 20 (20%) were educated up to graduation. 31(31%) subjects were house wives, 42(42%) self employed and 27(27%) were professionals by occupation. 37(37%) subjects were living in a nuclear family, 60(60%) in joint family and 3 (3%) were in extended family. 9(9%) subjects had annual income less than Rs. 10,000/ month, 51 (51%) had 10,001 to 20,000/month, 34(34%) had 20,001 to 30,001/month and 6 (6%) had annual income more than Rs.30,001/month. 23(23%) subjects had previous knowledge about dementia while 77(77%) did not have any knowledge about dementia. The source of information of 10(10%) subjects was newspapers / magazines, while 5 (5%) had T.V / Internet as a source of information, 4 (4%) got information from health professionals, 3 got information from family and 1 subject got information from friend.

The findings of the study shows that the mean pre-test score was 10.84 with the standard deviation of 3.024, whereas in post test it was 25.72 with the standard deviation of 1.52. The mean difference in pre-test and post test scores was 14.88. The calculated ‘t’ value was 39.199. It shows that the calculated ‘t’ value was much higher than the tabulated ‘t’ value. It shows that there was a significant improvement in the knowledge of family members of elderly after planned teaching.

The mean pre-test score was 67.52 with the standard deviation of 6.00, whereas in post test it was 104.07 with the standard deviation of 7.32. The mean difference in pre-test and post test scores was 36.5. The calculated ‘t’ value was 35.07 whereas the tabulated ‘t’ value was 2.021, it shows that the calculated ‘t’ value was much higher than the tabulated ‘t’ value. It shows that the planned teaching was effective in significantly improving the attitude of family members of elderly regarding the dementia.

Thus the null hypothesis ( H₀) i.e. “There is no significant difference in knowledge and attitude of family members of elderly regarding the dementia after planned teaching measured at p<0.05 level of significance” is rejected and the research hypothesis (H₁),” There is a significant difference in knowledge and attitude of family members of elderly regarding the dementia after planned teaching measured at p<0.05 level of significance”, is accepted.

A descriptive study was conducted to systematic review and partial meta-analysis of physical activity interventions in people with dementia in United Kingdom. The sample size was 896 participants. The information was collected by searching eight databases for English language papers and reference lists of relevant papers. Studies compared the intervention with a non-active or a no-intervention control and reported at least one outcome related to physical function, quality of life or depression. The study concluded that three of six trials that reported walking as an outcome found an improvement, as did four of the five trials reporting timed get up and go tests. Only one of the four trials that reported depression as an outcome found a positive effect.

An epidemiological study was conducted in Pune on dementia under the aegis of mental health program. The data was collected from 2145 people over 65yrs by door to door survey. The study results showed that the prevalence of dementia was 4.1%. The study concluded that poor awareness was a key public-health problem. The withdrawal of the elderly from the previous societal role, reduction in all types of interaction that is shift of attention from outer world to the inner world, reduction in the power and prestige of the elderly enhance aging process.

A comparative study was conducted to know the awareness of cognitive deficits in adults with cognitive impairment no dementia. This study examined whether community volunteers with cognitive impairment no dementia and reduced awareness had worse cognitive performance and cognitive decline over 18 months than cognitive impairment no dementia participants with intact awareness or healthy controls. The data was collected from 92 participants with cognitive impairment no dementia and 91 healthy controls with their respective informants. The study concluded that reduced awareness of deficit may be uncommon in community volunteer samples with cognitive impairment no dementia. In addition, self-report of cognitive complaints may be at least as useful as informant report when screening community-dwelling older adults at risk of cognitive decline and dementia.

A population based study was conducted among elderly Japanese American men living on the island of Oahu, Hawaii. Data for this study were from the dementia prevalence survey. A total of 21% of family informants failed to recognize a problem with memory among subjects subsequently found to have dementia. Among subjects with very mild dementia, 52% of family informants failed to recognize a significant memory problem compared with 13% among more severely demented subjects. Of the subjects with dementia whose family informants did recognize a memory problem, 53% failed to receive a medical evaluation for this problem. The study concluded that unrecognized dementia was common in our population, especially among mild cases. Cognitive screening programs for the elderly and public education policies designed to increase awareness of early signs of dementia are needed if interventions for individuals with potentially treatable dementias are to be implemented.

CONCLUSION:

After the detailed analysis, this study leads to the following conclusion.

Planned teaching on dementia was found to be effective in improving the knowledge and attitude of family members of the elderly. Family members of elderly had a significant gain in knowledge and improvement in attitude regarding the dementia.

An association was found between sex, annual income of family members, previous knowledge about dementia and sources of information with knowledge score and sources of information with the attitude score. Rests of the demographic variables did not show any association with the knowledge score and attitude score.

Hence, based on the above findings, it was concluded undoubtedly that the written prepared material by the investigator in the form of planned teaching helped the family members of elderly to improve their knowledge and attitude regarding the dementia.

IMPLICATIONS OF THE STUDY:

The findings of the present study have implication not only in the field of nursing but also in allied areas. The information obtained could be utilized by the educators, curriculum planners and administrators in order to integrate dementia programs into the educational as well as training Programme as dementia remains a national priority and major problem. More research work needs to be conducted in this area in order to identify the problems related to dementia. The findings of the study may be helpful for the future studies.

Nursing Service:

· Regular health education program should be carried out by hospital Nurse, in community areas.

· The mental health educators can assess needs of the family members regarding various aspects of dementia and provide services to them through organizing health check up camps at village level.

· Family members to provide the elderly with a secure & healthy environment to avoid dementia and related complications.

· Organize health camps to identify high-risk elderly for dementia in the community areas.

· Mental health nurses can suggest and organize the planned teaching to follow life style measures like exercise, stress management and yoga, which will promote healthy lifestyle.

· Mass health education campaigns should be organized regularly by the health teams to provide education on dementia.

Nursing Education:

· Nurse educators need to lay emphasis on dementia which should include- causes, effects, treatment and preventive aspects.

· Nurse educators need to lay emphasis on dementia which should include- teacher should be taught regarding the various aspects of dementia using various A-V aids etc. Charts, puppet shows, flip charts and the actual devices so that they can educate the students in the schools, colleges and community people by motivating them to give awareness programmed to the peoples regarding dementia.

· Conducting in service education program for Nurses & health workers regarding, various aspects of dementia.

Nursing Administration:

· Nurse administrators should take the initiative in organizing continuing education programs for Nurses regarding various aspects of dementia.

· Appropriate teaching / learning material needs to be prepared and made available for Nurses.

· Helping in early identification of dementia in the elderly from other settings by providing proper tools and aids.

Nursing Research:

Research should be conducted to assess the knowledge and attitude of family members regarding the dementia and associated problems. So that we can develop health education packages related to dementia during old age. More research is needed to find out the causes and factors predisposing to dementia. It can also help in finding out better alternatives for the elderly at risk and at the time when they are on the verge of becoming victims of dementia.

LIMITATIONS:

This study is limited to those family members only who are readily available in the selected community area.

Non probability convenient sampling was done which restrict the generalization of the study.

RECOMMENDATIONS:

· Formal education Programme should be conducted in all primary schools regarding dementia.

· The study can be replicated on a large sample; and on various settings, so that findings can be generalized to a large population.

· Such studies can be carried out using other teaching strategies like planned teaching, computer-assisted instruction on dementia etc.

· Comparative surveys can be carried out to ascertain the knowledge of dementia among family members of the elderly between urban and rural area of the community.

· Similar studies can be conducted on to evaluate the effectiveness of self instructional module on dementia.

referEnce:

1. who.info/healthinfo/survey/ageingdefolder

2. cda-adc.ca/jcda/vol66/issue-6/320.html

3. Hurlock. B. Elizabeth, developmental psychology, a life span approach, 5^th edition, New Delhi: 1995; p 390-403.

4. Heitkemper, Dirkesen Louis, Text book of Medical-surgical Nursing, 10^th edition. 2000. p 1583-86.

5. McManus M, Devine P. Dementia: Public knowledge and attitude .2011 [cited 2011 Oct 7]. Available at: URL:http://www.ark.a.c.uk [accessed on Aug 2013].

6. Shaji S, Bose S, Kuriakose S. Behavioural and psychological symptoms of dementia: A study of symptomatology. Indian J Psychiatry 2009;51(1):38-41.

7. Andrade C, Radhakrishnan R. The prevention and treatment of cognitive decline and dementia. An overview of recent research on experimental treatments. Indian J Psychiatry 2009;51(1):12-25.

8. Effects of aging. 2009 Apr; Webindia123.com

9. Old age. 2009 Nov 1; en. Wikipedia. Org

10. Common elderly diseases.2007; Babyboomercaretaker.com

11. Williams Rawlins, Beck, Mental health Nursing. A holistic life cycle approach. 3^rd edition; Mosby publication, Sydney. p 649-68.

12. Gail Stuart, Sudden Sandra J, Principles and practice of psychiatric Nursing, St. Louis: Mosby year book. 1991. p 568-91.

13. Cissk M, Wilczed Ruzycka E, Gnibek A. Zdanowska. Presentation of the family care to the patient with Alzheimer’s disease, American Journal of Alzheimer’s disease 2000, 59; p 200-03.

14. Jha. S, Patel R, Some observations on the spectrum of dementia. Neural India. (serial online) 2004, Nov (cited 2003); 1(1): (1 screen) and available from: URL: http://wwwcdcdem/org.

15. Zhan.L. caring for family members with dementia; perspective form Chinese-American caregivers, School of health and environment, University of Massachusetts-Lowell-USA, J Gerontol Nurs. 2004 Aug; 30(8):19-29.

16. Black M Joyce, hawks Jane Hokanson. Medical surgical nursing. 7^th ed. St. Louis: Saunders an imprint of Elsvier. 2005. 2161- 2170.

17. Smeltzer C Suzanne, Bare Brenda G. Text book of Medical surgical Nursing. 10^th ed. Philadelphia: Lippincott Williams& Wilkins. 2004.

18. Gill Jaffe Ellen, Kemp Gina. Memory loss and aging causes treatment and help for memory problems. 2009 Jan 12; http://www.helpguide.org.

19. Bhat Smitha Pandey. Alzheimers Disease Clinical Features Diagnosis and Treatment. Article alley. 2010 Aug 11; http://www.articlealley.com.

20. Siman B.R, “Burden of caregivers and strategies to cope with stressors (serial online) 1999, Feb-Mar (cited 2000 Dec), 1(1) [12screens]. http://www.avert.org/aidesindia.htm.

21. Sullivan K, O conor F; “proving education about dementia care”. School of sychology and counseling, Quesland University of technology, carseldine, Australia, aging ment health, 2001 Feb: 5(1); 5-13

22. Ellen woodward potts co-author, a pocket guide for alzheimer’s caregiver, myths about dementia, December 6, 2011. http://dementiadynamics.com/myths-about-dementia//

23. http://www.brookdale.com/regional_posts/five-common-misconceptions-dementia

24. Kounteya Sinha, By 2020, India will have 10m dementia patients. Breaking news, times of India. TNN22, September 2009, 02:05 AM IST.

25. Clara C Pratt, Vicki I Schmall. Burden and coping strategies of caregivers to dementia. (serial online) 1985 (cited 1980); 1(1) available from URL: http://den/nim/2225678/alz.org.

26. Marco De Bob. Alzheimer’s disease facts and figures. The Alzheimer’s reading room 2010 Mar 9; http:// www.alz.dis.readingroom.com.

27. Active lifestyle for Alzheimer’s patients. India Times 2010 Nov 29.

28. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: A Meta-Analysis. Arch Phys Med Rehabil 2004 ;85.

29. Vas CJ, Pinto C, Panicker D, Deshpande N, Kulkarni L, Sachdeva S. Int Psychogeriatric.2001 Dec; 13(4):389-93.

30. Siman B.R, “Burden of caregivers and strategies to cope with stressors (serial online) 1999, Feb-Mar (cited 2000 Dec), 1(1) [12screens]. http://www.avert.org/aidesindia.htm.

31. Buckwatter KC, Gerdner L. “A Nursing intervention to decrease depression in family caregivers pf persons with dementia”, Arch Psyciatr Nurse 1999, Apr; 13(2): 80-88.

32. Ocarles C. coping strategies influence caregiver outcomes among Asian family caregivers of person with dementia, International journal of Alzhimer disease [serial online] 5^th august 2010] [cited 2010 December 10] 24(4). P:311 Available from URL http://journals.iww.com./alzheimer journal/pages/currenttoc.aspx

33. Oqayhagen MP, Oqayhagen M. Alzhemier’s stress : coping with the care giving role., the Oxford journal [serial online]1988 [cited 2010 December 10] 28(3) p:391 Available from URL http://gerontologist.Oxfordjournals.org/ content/28/3/391:.abstract

34. Karlikaya G, Yukese G, Varlibas F, Tireli H, Caregivers burden in dementia. A study in the Turkish population, the Internet journal of neurology .[serial online] 2004 November 2 [cited 2010 December 10] 4(1) p:21-25 Available from URL http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ ijn/vol4n2/dementia.xml#h1-0

35. Hinricnsen AG, Niederehe G. Dementia management strategies and adjustments of family members of older patients, The oxford journal [serial online]1994 December 06 [cited 2010 December 05] :34(1) p:95-102 Available from URL http:// geronologist Oxford journal.org/content /34/1/102:abstract

36. Hooker k, Frazier L D, Deborah J, Monahan M. Personality and coping among caregivers of souses with dementia, the oxford Journal [serial online]1994 December 6,[Cited 2010 December 06],34(3) p:386-392.Avilable from URL

http:// spouses wit dementia+gerontologist.mht

37. Bull AM, losses in families affected by dementia coping strategies and service issue. Journal of family studies, [ serial on linen ] 1998 October, [cited 2010 December 06] 4(2) :p:187-199. Available from URL http//www.family studies.mht

38. logsdon G R,Teri L, Vitiello M, Sleep disturbances in caregivers of person with Dementia. PubMed central [serial online ]2007 February 6,[cited 2010 december06,]11(2);p:143-153 Available from URL http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1861844/

39. Mitrani BV, Lewis E J, Feaster J D, Ezaya J S, Eiszofer C, Schulz R.etall. The role of family functioning in the stress process of Dementia caregivers, the Oxford journal [serial online]2005 July 29,[cited 2010december 10] 46(1):p:97-105 Available from URL http://gerontologist.oxfordjournals.org/content/ 46/1/97.abstract?relatedurls=yes&legid=geront;46/1/97

40. Tremont A, Unique contribution of family functioning in caregivers of patient with mild to moderate Dementia. dementia and geriatric cognitive disorder.[serial online]2006 January 3 [cited 2010 December 11] 21(3) :p:5 Available from URL http://content.karger.com/produktedb/produkte.asp? typ=pdf&file=DEM2006021003170

41. Tansen L, forbes DA, Markle-Reid M, Hawranik P, Kinngston D, et al “ Formal care Providers perceptionsof home and community-based services-informing dementia care quality”. Home health care serv Q.2009; 28(1):1-23.

42. Rasin J. Kautz DD, knowing the resident with dementia: perspectives of assisted living facility caregivers; widener university, chester, USA, J. Gerontal Nurs, 2007 sep : 33(9):30-6.

43. Li X, Fang W, Su N, Liu Y, Xiao S, Xiao Z. Survey in Shanghai communities: The public awareness of and attitude towards dementia. Available from: URL:http://www.pubmed.com/edaada [accessed on Aug 2013].

44. Tan WJ, Hong SI, Luo N, Lo TJ, Yap P. The lay public’s understanding and perception of dementia in a Developed Asian Nation. Dement Geriatr Cogn Dis Extra 2012 Jan;2(1):433-44.

45. Arai A, Arai Y. Advance care planning among the general public in Japan: association with awareness about Japan. Nihon Ronen Iqakkai Zasshi 2008 Nov;45(6) 640-6.

46. Livingston G, Leavey G, Manela M, Livingston D, Rait G, Sampson E . etall.. Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK., PubMed [serial online ]2010 august,[cited 2010 december 06,] Avilable from URL http://www.ncbi.nlm.nih.gov/ pubmed/20719843

47. Sullivan, Karen A, Muscat, Tracey M, Mulgrew, Kate E. Knowledge of Alzheimer's disease amongst patients, carers, and non-carer adults. Geriatric Rehabilitation. 2007 mar 30; 23(2): 148-159.

48. Braul L Kathryn, Takamura C Jeanette, Forman M Sheila, Sasaki A Latricia, Meinenger Laurie. Developing and testing outreach materials on Alzheimer’s disease for Asian and Pacific Islander Americans. The gerontologist. 1993 Nov 15; 35(1): 122- 126.

49. Schwalen S, Forstl H, Alzheimer’s disease knowledge and attitudes in a representative survey. Neuropsychiatry. 2008; 22(1): 35- 37.

50. Tsolaki M, Paraskevi S, Degleris N, Karamavrou S. Attitudes and perceptions regarding Alzheimer's disease in Greece. Am J Alzheimer’s Dis Other Demen. 2009 Feb-Mar; 24(1):21-26.

51. Anderson LA, Day KL, Beard RL, Reed PS. The public's perceptions about cognitive health and Alzheimer's disease among the U.S. population. Gerontologist. 2009 Jun; 49(1): 3- 11.

52. Zhan.L. caring for family members with dementia; perspective form Chinese-American caregivers, School of health and environment, University of Massachusetts-Lowell-USA, J Gerontol Nurs. 2004 Aug; 30(8):19-29.

53. Shaji KS, Smitha K, Lal KP, Prince MJ, “caregivers of people with dementia of Alzheimer’s disease”, Department of psychiatry, medical college, Thrissur, Kerala, India, Int J Geriatric psychiatry, 2003 Jan; 18(1): 1-6.

54. Wright dorer J. “researching the qualities of Alzheimer’s care Nurses, Journal of Alzheimer’s Care. Vol-4(4), October 2002, P210-216.

55. Hutchison S, Leger-Krall S, Skodal Wilson J, Gerontaical Nursing, 2002, Apr 4; (6): 534-536.

56. Sullivan K, O conor F; “proving education about dementia care”. School of sychology and counseling, Quesland University of technology, carseldine, Australia, aging ment health, 2001 Feb: 5(1); 5-13

57. Carolyn K Clevenger, Shileah Cantey, Mary Ellen Quinn. Teaching Primary Prevention of Alzheimer’s Disease. Journal of Primary Care & Community Health. 2010 July 26; 1(2):2134-2138.

58. Mahoney DF, Tarlow BJ, Jones RN, Sandire J. Effects of a multimedia project on user’s knowledge about normal forgetting and serious memory loss. J Am Med Inform Assoc. 2002 Jul- Aug; 9(4): 383- 394.

59. Thompson Dolores Gallagher, Haynie Dee, Takagi A Kellie, Valverde Irene, Thompson W Larry. Impact on Alzheimer’s disease education programme. Gerontology and geriatrics education. 2000 June; 20(3): 25- 40.

Received on 27.12.2016 Modified on 16.01.2017

Int. J. Nur. Edu. and Research. 2017; 5(3): 241-260.

DOI: 10.5958/2454-2660.2017.00052.7

Group	Pre test	Intervention						Post test
		Planned teaching
		Days
Experimental group	Q₁	1	2	3	4	5	6	Q₂
		X	-	-	-	-	-