A Descriptive study to assess the Knowledge regarding dementia in geriatrics among above the age group of 60 years in selected community area, Sakthikulangara, Kollam.

 

Ms Arya Roy¹, Mrs Sheeja S²

¹Fourth year B.Sc Nursing Students, Bishop Benziger College Of Nursing, Kollam

²Nursing Tutor, Department of Community Healthl Nursing, Bishop Benziger College of Nursing Kollam

 

ABSTRACT:

 

INTRODUCTION:

Aging (ie, pure aging) refers to the inevitable, irreversible decline in organ function that occurs over time ; in the absence of injury, illness, environmental risks, or poor lifestyle choices (eg, unhealthy diet, lack of exercise, substance abuse). Geriatrics refers to medical care for older adults, an age group that is not easy to define precisely. Gerontology is the study of aging, including biologic, sociologic, and psychological changes. Overall, women live about 5 years longer than men, probably because of genetic, biologic, and environmental factors. These differences in survival have changed little despite changes in women’s lifestyle (eg, increased smoking, increased stress) over the late 20th century and into the 21st.¹

^\

Diseases interact with pure aging effects to cause geriatric-specific complications (now referred to as geriatric syndromes), particularly in the weak-link systems-even when those organs are not the primary ones affected by a disease. Typical examples are delirium complicating pneumonia or urinary tract infections and the falls, dizziness, syncope, urinary incontinence, and weight loss that often accompany many minor illnesses in older adults. Aging organs are also more susceptible to injury; eg, intracranial hemorrhage is more common and is triggered by less clinically important injury in older adults.¹

 

Dementia is usually a disease of the elderly and is characterized by progressive loss of memory and other mental faculties such as language, judgment, and planning, impairment of daily activities, and deficiency in social interaction. Dementia impacts personal, family, and societal life. It reduces life span, induces caregiver's strain at family level, and utilizes health care facility, inflicting strain on national income. It is expected that the burden of dementia will be increasing in developing countries due to increase in longevity and increasing prevalence of risk factors such as hypertension and stroke and lifestyle changes. There are over 100 forms of dementia. The most well-known form of dementia is Alzheimer’s disease, which accounts for 50-60% of all cases.²

 

India has a unique situation characterized by rapid epidemiological transition leading to increasing aging population and higher prevalence and incidence of non-communicable diseases such as stroke and cardiovascular diseases, similar to other developing countries in the world.²

 

Dementia is not a specific disease. It is a descriptive term for a number of symptoms that can be caused by a number of disorders that affect the brain. Dementia patients have significantly impaired intellectual functioning that interferes with normal activities and relationships. They lose their ability to solve problems and maintain emotional control, and they also may experience personality changes and behavioral problems such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions were affected- such as memory, language skills, perception, or cognitive skills including reasoning and judgment are significantly impaired without loss of consciousness.³

 

There are many disorders that can cause dementia. In people aged 65 and olderAlzheimer's disease (AD) is the most common cause of dementia. Nearly all the brain functions, including memory, movement, language, judgment, behavior and abstract thinking are eventually affected. AD is characterized by two abnormalities in the brain: amyloid plaques and neurofibrillary tangles. Around 50-75% proportion of dementia cases in India are because of Alzheimer's disease. Vascular dementia is caused by brain damage from cerebrovascular or cardiovascular problems - usually strokes. It also may result from genetic diseases, endocarditis (infection of a heart valve), or amyloid angiopathy (a process in which amyloid protein builds up in the brain's blood vessels, sometimes causing hemorrhagic or "bleeding" strokes). In many cases, it may coexist with AD.³

 

Dementia refers to loss of cognitive function that affects memory along with the ability to think, solve problems and control emotions. Dementia itself is not a disease, but describes a group of symptoms caused by a brain disorder. When dementia becomes severe, It would say that is a complication. Sometimes patients may have severe paranoia, which can lead to psychosis, delusions and even aggression. Sometimes they become totally depressed and withdrawn, and if they aren’t eating and drinking properly, their body may become weak .⁴Other possible complications of dementia, regardless of its cause, include: loss of previous ability to function or care for self, loss of previous ability to interact with others, reduced lifespan, increased infections within the body.⁵

Dementia care may not be equivalent to other old age care and should be given attention separately from any other form of old age care. Indeveloping country like India the devalued field of care for elderly people, caring for those with dementia has been seen as an unrewarding job. Because of the rapid aging of India’s population, there has been proportionate increase in prevalence of the dementia leading to emergence of major socioeconomic challenges in dementia care and care giving. Lack of community awareness, rapid erosion of family support and poor government initiatives on these issues have been the well-recognized drawbacks of dementia care in this country. ⁶

 

NEED FOR THE STUDY:

Someone in the world develops dementia every 3 seconds. In worldwide there were an estimated 46.8 million people living with dementia in 2015 and this number is believed to be close to 50 million people in 2017. Over 9.9 million new cases of dementia in each year worldwide, implying one new case every 3.2 seconds.

 

A 2-phase survey was conducted in 2010 to assess the prevalence of AD and dementia in Kerala, South India, and effects of age, education and gender on it and 2466 individuals aged ≥ 55 years living in community. The method of assessment through instrumental activity of daily living scale for the elderly (IADL-E) and the Addenbrooke's cognition examination (ACE). Diagnostic-assessment (Phase II) was in 532 screen-positives and 247 (10%) screen-negatives. The Results shows that 93 (3.77%) ≥ 55 years and 81 (4.86%) ≥ 65 years of age had dementia. Age adjusted (against US-population in 2000) dementia (and AD) in age ≥ 55 years were 4.86% (1.91%) age and 6.44% (3.56%) in ≥ 65 years. Odds for dementia (and AD) were high with increasing-age 5.89 (15.33) in between the age of 75–84 years, 13.23 (25.92) ≥ 85 years, and in women 1.62 (2.95); and low 0.27 (0.16) if education was ≥ 9 years. The study summarizes that age and low education increases dementia and age and gender (female) increased AD. Prevalence of dementia and AD is higher than any reported from the subcontinent suggesting that dementia in Kerala in South India is not uncommon. Increasing age increased dementia and AD. Low-education is associated with dementia and female-gender with AD.⁷

 

Nearly 3.7 million people in India are suffering from dementia and this number is set to double over the next 20 years, according to the World Health Organization (WHO). India’s population of sufferers from Alzheimer’s disease and Vascular Dementia (the two major afflictions that denote this condition) is estimated to more than double by 2030 and then grow exponentially by 2050.

 

Worldwide, nearly 35.6 million people live with dementia as of 2010. By 2030 this number is expected to double about 65.7 million and more than triple by 2050 about115.4 million. Much of the increase will be in developing countries. Already in developing countries 58% of people lives with dementia, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, and their South Asian and Western Pacific neighbors. With a documented 3.7 million elderly people suffering from dementia, India currently ranks third, behind only China and the USA. Demographic ageing is a worldwide process that shows the successes of improved health care over the last century.³

 

According to the 10/66 Dementia study which was conducted in seven low and middle income countries in eleven sites which included both rural and urban India. The population trend projects to a rise from 5.63% of older adults in 1961 to 6.58% in 1991 reaching 7.5 per cent in 2001. Men and women between the age group of 75 - 79 years account to 5.7% (women) and 15.7% (men) of dementia sufferers respectively. This figure rises to 11% and 29.4% when the age group of 80 years and above is considered. The educational background, social status, urban / rural living, understanding of assessment process and validation of the assessment tools used are to be taken into account when diagnosing somebody with dementia. Large families living together for generations in the same house provide supportive care to the elderly they also are affected by the carer burden. This in turn has an effect on the negative economy due to lack of income generation by that member of family in addition to the psychosocial stress faced by them. India is currently spending INR 0.15 to 160 billion per year for care of people with dementia. It is predicted that the current number of people with dementia would double by 2030 (3.69 million to 7.61 million) and the immediate consequence would be that the cost of care would also double.⁸

 

According to the latest Dementia-India Report of Alzheimer's and Related Disorders Society of India (ARDSI), the projected prevalence of dementia among elderly, aged 65 years and above, in Kerala was 1.5 lakh in 2011. Kerala is estimated to have over two lakh dementia patients by 2021, said a report on the eve of World Alzheimer's Day, which is observed each year on September 21.⁹

 

People with dementia are frequently denied the basic rights and freedoms available to others. In many countries, physical and chemical restraints are used extensively in care homes for older people and in acute-care settings, even when regulations are in place to uphold the rights of people to freedom and choice.

 

An appropriate and supportive legislative environment based on internationally-accepted human rights standards is required to ensure the highest quality of service provision to people with dementia and their carers.

 

Home based support for caregivers of persons with dementia, which focus on the use of locally available, low-cost human resources, is feasible, acceptable and leads to significant improvements in caregiver mental health and burden of caring.

 

Dementia affects 50 million people worldwide, with every 3 seconds a new case of dementia occurring somewhere in the world. Dementia can also affect individuals under the age of 65 and it is called as young onset dementia. Greater awareness and understanding of dementia is important to challenge the myths and misconceptions that surround the condition.

 

This study is mainly focusing on the geriatrics and to assess the knowledge level of these regarding the dementia and make them and the family aware about dementia. It helps to improve the health status and can help the community from the occurrence of dementia. In this study the, in the particular area dementia cases were present and the geriatric population also greater.

 

OBJECTIVES OF THE STUDY ARE:

·       To assess the pretest knowledge regarding dementia in geriatrics among above the age group of 60 years

·       Find out the association between the demographic variables and knowledge regarding dementia in geriatrics among above the age group of 60 years.

 

RIVEW OF LITERATURE:

1.Literature related to the knowledge of dementia in geriatrics.

A population-based, cross-sectional study was conducted on public knowledge about dementia of 926 subjects, and living in Gwangmyeong City, Korea in between June and September 2014. A 12-item questionnaire with true/false responses was used to assess the knowledge about dementia. The data obtained were analyzed using quantitative methods. The result shows that, the mean score for the knowledge about dementia was 7.9862.5 points out of 12 points. The level of dementia knowledge was negatively associated with increasing age and positively with higher education level and People who have not connected to dementia information.¹²

 

Another cross sectional study was conducted to assess community health professionals' dementia knowledge, attitudes and care approach in China, 450 health professionals were recruited into the study using random sampling from community health service centers in Changsha, China. Their knowledge, attitudes and care approach were assessed utilizing the Chinese version of the Alzheimer's Disease Knowledge Scale, Dementia Care Attitude Scale and Approach to Advanced Dementia Care Questionnaire respectively. A total number of 390 participants werereturned the questionnaire (response rate 87%). Age, education, professional group and care experience were associated with knowledge scores, and overall dementia knowledge was poor. Attitudes were generally positive and it is influenced by age, professional group, gender and care experience. The experience of caring for people with dementia was positively associated with a person-centered care approach, although the participants tended not to use a person-centered care approach. A statistically significant association was found between knowledge and attitudes (r = 0.379, P < 0.001), and between attitudes and care approach (r = 0.143, P < 0.001). However, dementia knowledge has no relationship with a person-centered approach. The results suggest that a multifaceted approach which consisting of educational interventions for community health professionals, and policy and resource development to meet the demand for community dementia care services, is urgently needed in China.¹³

 

A study conducted to assess the knowledge of the family members of elderly regarding Alzheimer's disease in a selected urban community at Mangalore. A preexperimental research design of one group pretest and posttest with an evaluative approach was adopted for the study. Analysis revealed that the mean posttest knowledge (20.78 ± 3.31) was higher than mean pretest knowledge scores (12.90 ± 2.43). Significance of difference between pretest and posttest was statistically tested using paired "t" test and it was found very highly significant (t = 40.85, P <0.05). Majority of the variables showed no significant association between pretest and posttest knowledge score and with demographic variables. The findings revealed that the planned teaching program is an effective strategy for improving the knowledge of the subjects.¹⁴

 

1.     Literature related to the management of dementia.

An interpretative study was conducted to understand the experiences of people with dementia and their caregivers in engaging in dementia diagnosis in China. In total, 23 participants contributed to the interviews or focus group. The aim of the study was to understand the experiences of people with dementia and their caregivers in engaging in dementia diagnosis. An interpretative study design informed by Gadamer's hermeneutic principles was applied to the present study to achieve the aim of the study. The study was strengthened by applying a social ecological framework to the study design.Thematic analysis was applied to data analysis.4 themes were determined from data and described as: capabilities to detect the memory loss in an early stage, perceptions and beliefs of dementia in the community, different journeys toward the diagnosis and expectations of a smooth journey for others. The study findings illuminate a social ecological perspective of improving early detection and diagnosis of dementia in the community settings. And thisstudy findings have implications for policy, resource, and practice development. Consumers expect that government subsidized dementia care services in primary care and specialist care settings are needed in order to enable consumer-driven timely diagnosis and dementia management in home care settings.¹⁵

 

A study was conducted in Bangalore to assess the cost of dementia care in India. The study result shows the total expense was similar to that reported by individual households. The annual household cost of caring for a person with dementia in India, depending on the severity of the disease, ranged between INR 45,600 to INR 20,2450 in urban areas and INR 20,300 to INR 66,025 in rural areas. Costs increased with increasing severity of the disease process. In therural or urban area, the costs of informal care contributed to nearly half of the total costs. Thus with increasing severity, proportion of medical costs decreased while social cost increased. Medical costs in rural areas were nearly one-third of the total costs as against less than one-fifth in urban areas.¹⁶

 

Arandomised controlled trial from Goa, India. It measured caregiver mental health (General Health Questionnaire), caregiver burden (Zarit Burden Score), distress due to behavioral disturbances (NPI-D), behavioral problems in the subject (NPI-S) and activities of daily living in the elder with dementia (EASI). Outcome evaluations were masked to the allocation status. Analyzed each outcome with a mixed effects model. Eighty-one families enrolled in the trial, were 41 randomly allocated to the intervention. 59 completed the trial and 18 died during the trial. The intervention led to a significant reduction of GHQ (-1.12, 95% CI -2.07 to -0.17) and NPI-D scores (-1.96, 95%CI -3.51 to -0.41) and non-significant reductions in the ZBS, EASI and NPI-S scores and also observed a non-significant reduction in the total number of deaths in people with dementia in the intervention arm (OR 0.34, 95% CI 0.01 to 1.03).¹⁷

2.     Studies related to the incidence and prevalence of dementia.

A systematic search of studies published in Italy between 1980 and April 2014 aims to investigating the prevalence of dementia and AD and then evaluated the quality of the selected studies. A systematic search were performed using PubMed/Medline and Embase to identify the Italian population-based studies on the prevalence of dementia among people aged ≥60 years. The quality of the studies was scored according to the Alzheimer’s Disease International (ADI) criteria.About sixteen articles on the prevalence of dementia and AD in Italy were eligible and 75 % of them were published before the year 2000 and only one study was a national survey, whereas most of the studies were locally based (Northern Italy and Tuscany). Overall, the 16 studies were attributed a mean ADI quality score of 7.6 (median 7.75). Full implementation of a Dementia National Plan is highly needed to better understand the epidemiology of the disease and monitor dementia patients.¹⁸

 

A Study conducted on the Prevalence of Dementia in Migrant, Urban, Rural, and Tribal Elderly Population of Himalayan Region in Northern India.The aim of the study was to generate data on the prevalence of dementia and to generate a hypothesis on the differential distribution across populations.The settings identified for the purpose of this study which included a migrant, urban, rural, and tribal. This study was conducted in two phases: 1) A screening phase and 2) a clinical phase. Sample size is 2,000 individuals above 60 years of age. Out of 2,000 samples ;500 individuals were approached from each site. Nobody refused to participate. A total of 32/2,000 (1.6%) elderly individuals were classified as demented. No case of dementia was reported from tribal population. Sex differential reveals that majority (21/32; 66%) of individuals identified as demented were females. As age advancedwith elders above 80 years showing decreased lowest scoreson cognitive screen. Out of 32, 56% (18) of patients classified as demented were more than 80 years of age. The findings of this study are in agreement with previous studies which point towards differential distribution of dementia across populations.¹⁹

 

A community-based epidemiologic study of dementia in a rural community in Kerala India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia. Andoor to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had undergone a detailed neuropsychological evaluation by CAMDEX-Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX-Section H to confirm the history of deterioration or impairment in social or personal functioning.5% of those whose screening was negative were randomly selected and evaluated during each stage. Out of 2067 persons aged 60 ,sixty-six cases of dementia were identified, a prevalence rate of 31.9 per thousand.Fifty-eight percent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD-10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group. Dementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.²⁰

 

MATERIALS AND METHOD:

Methods:

A quantitave approach is used in that the research design is adopted for the study is non experimental descriptive design. The setting will be Sakthikulangara community area situated at kollam. The populations in the study include residents in selected villages at kollam. Convenience sampling used in this study.

 

Tools / instruments:

The instruments used for the present study are demographic proforma and structured questionnaire which were validated by the experts.

 

Data collection:

The data collection was conducted from the setting for the study was Community area of Sakthikulangara at Kollam. The data collected after obtaining administrative approval and permission from authorities of community Centre. The subjects were collected based on inclusion and exclusion criteria. The household members of who are residing Sakthikulangara areas were selected. A total of 30 samples were selected using convenience sampling technique. The investigators introduced them to the subjects and purpose of the study was explained to them. Confidentiality was assured and a written consent was obtained. Structured questionnaire was used to find out the knowledge regarding dementia. After conducting the study pamphlets was given to household members to increase knowledge regarding dementia and its management. The data collection was completed by thanking the respondents for their cooperation. The data collected were compiled for analysis.

 

Data analysis:

The researcher will analyse the data by using descriptive and inferential statistics based on the objectives and hypothesis of the study. To compute the data, a master data sheet was prepared by the investigator.

 

FINDINGS OF THE STUDY:

SECTION A

Description of demographic data of geriatrics regarding dementia.

This section deals with the percentage wise distribution of demographic variables.

 

SECTION A

Description of sample according to their demographic variables.

This section deals with the percentage distribution of demographic variables

 

Figure 1: Bar diagram showing frequency and percentage distribution of samples according to their Age.                 N=30

 

The data presented in the figure shows that 46.66% are 60-70 years of age, 40% are between 71-80 years of age and 13.33% are between 81-90 years of age group.

 

Figure 2: Bar diagram showing frequency and percentage distribution of samples according to their Sex.                     N=30

 

The data presented in the figure 2 shows that 70% were males and 30% were females.

 

Figure 3: Bar diagram showing frequency and percentage distribution of samples according to their Education.               N=30

 

The data presented in the figure 3 shows that 43.33% had primary education, 46.66% had high school education and 10% were graduates.

 

Figure 4: Bar diagram showing frequency and percentage distribution of samples according to their Religion.          N=30

 

The data presented in the figure 4 shows that 60% were Hindus, 33.33% were Christians and 6.66% were Muslims.

 

Figure 5: Bar diagram showing frequency and percentage distribution of samples according to their marital status.      N=30

 

The data in presented in the figure 5 shows 96.66% were married and 3.33% were unmarried.

 

SECTION B:

Analysis of knowledge of samples regarding dementia.

 

Figure 6: Bar diagram showing frequency and percentage distribution of samples according to their marks rewarded. N=30

 

Figure 7 shows that 6.66% were gets marks between 0-6, 90% were gets marks between 7-14 and 3.33% were gets marks between 15-20.

 

SECTION B: Assessing the knowledge regarding Dementia in geriatrics among above the age 60 years in selected community area at Kollam.

 

Table 1: Frequency and percentage distribution of score on knowledge regarding Dementia in geriatrics among above 60 years.

Score	Score range	Frequency	Percentage
0-6 7-14 15-20	Inadequate Moderate Adequate	2 27 1	6.66% 90% 3.33%

 

The data presented in table 1 shows that 6.66% have inadequate knowledge, 90% have moderate knowledge and 3.33% have adequate knowledge.

 

SECTION C: Association between knowledge regarding Dementia and selected demographic variables.

TABLE 2: Association between knowledge and selected demographic variables.

Sl no	Variables	Knowledge				Chisquare value	Level of Significance
		Inadequate	Moderate	Adequate	df
1.	Age in years 60-70 71-80 81-90	1 0 1	12 12 3	1 0 0	4	4.226	NS
2.	Sex Male Female Transgender	2 0 0	19 8 0	0 1 0	2	3.192	NS
3.	Education Primary High school Degree and above	2 0 0	11 13 3	0 1 0	4	3.846	NS
4.	Religion Hindu Christian Muslim	1 1 0	16 9 2	1 0 0	4	1.025	NS
5.	Marital status Married Widow Unmarried	2 0 0	26 0 1	1 0 0	2	0.115	NS

 

Table 2: The association was computed by using chi square test. It was inferred that the present study showed no significant association between the knowledge, age, sex, religion, education, marital status (calculated value is greater than tabulated value at 0.05 level of significance).So there was no significant association between the demographic variables and knowledge at 0.05 level of significance.

 

CONCLUSION:

Out of 30 samples 46.66% are in between 60-70 years of age, 40% are in between 71-80 years of age and 13.33% are in between 81-90 years of age. In the study 70%of samples were males and 30% were females. Among the samples 43.33% have primary education, 46.66% have high school education and 10% were graduates and among the samples 60% were Hindus, 33.33% were Christians and 6.66% were Muslims. Samples of 96.66% were married and 3.33% were unmarried.

 

Out of 30 samples 6.66% have inadequate knowledge, 90% have moderate knowledge and 3.33% have adequate knowledge.

 

RECOMENTATION:

Based on the findings of the study is recommended that

·       A similar kind of study can be conducted for adult

·       The same study can be conducted for large group

·       A structured teaching programme can be planned for a large group.

 

REFERENCES:

1.          https://www.msdmanuals.com/professional/geriatrics/approach-to-the-geriatric-patient/introduction-to-geriatrics

2.          Shyamal K Das, Sandip Pal, Malay K Gopal. Dementia: Indian scenario, Publication of the Neurological Society of India, 2012.

3.          Available from. http://www.neurologyindia.com/article.asp? issn=0028-3886;year=2012;volume=60;issue=6;spage=618; epage = 624; aulast=Das

4.          Available from http://nopr.niscair.res.in/bitstream/123456789/ 15701/4/ALIS%2059%284%29%20280-288.pdf introduction

5.          Available from https://www.sharecare.com/health/dementia Available from https://www.healthline.com/health/dementia-complications#general-complications

6.          PC Das, Prakash Kumar, Amarendra Amar, A B Dey. Dementia care in india Issues and prospects, February 2014. Available from https://www.researchgate.net/publication/259962052_Dementia_care_in_India_Issues_prospects

7.          Pacagada S. Mathuranath, Perumpillichira J Cherian, Robert Mathew, Suresh Kumar. Prevalence and influence of age, educationand gender I Kerala, South India. International Journal of Geriatric Psychiatry 25(3):290-297. Available from https://www.researchgate.net/publication/229684850_Dementia_in_Kerala_South_India_Prevalence_and_influence_of_age_education_and_gender

8.          Farooq Khan. Dementia in India: it's high time to address the need. Available from http://medind.nic. in/aag/t11/i2/aagt11i2p64.pdf

9.          Available from https://www. news18.com/ news/india/kerala-may-have-over-2-lakh-dementia-patients-by-2021-509778.html

10.        Anbu, Text book of Psychiatric Nursing, EMMESS publications, 2nd edition, page number:254-261.

11.        Javed Ansari, Examination Master: Medical Surgical Nursing-II, Peevee publications, page number :5.

12.        Sung mi-Ra. Public knowledge about dementia, Yong-in City, South Korea. Available from https://www. alzheimersanddementia.com/article/S1552-5260(15)00994-2/pdf

13.        Wang Y, Xiao LD, Luo Y, Xiao SY, Whitehead C, Davies O. Community health professonals’ dementia knowledge, attitude and care approach: A cross-sectional survey in Changsha, China. BMC Geriatrics 18(1). December 2018. DOI: 10.1186/s12877-018-0821-4. https://www.researchgate.net/publication/325369067.

14.        Lavina Rodrigues, Thereza Mathias, Effectiveness of planned teaching program on knowledge regarding Alzheimer′s disease among the family members of elderly in a selected urban community at Mangalore. Indian Journal Of Psychiatry 58(1):44. January 2016. DOI: 10.4103/0019-5545.174370

15.        Yan Lian, Lily Dongxia Xiao, Fan Zeng, Xianmu Wu. The Experiences of People with Dementia and Their Caregivers in Dementia Diagnosis. Journal of Alzheimer’s disease: JD 59(4):1-9. January 2017, DOI: 10.3233/JAD-170370

16.        Girish N Rao, SrikalaBharath, Cost of dementia care in India: Delusion or reality, Indian Journal of Public Health, 2013. Volume : 57, Issue: 2, Page: 71-77.http://www.ijph.in/article. asp?issn=0019-557X; year=2013; volume=57; issue=2;spage=71; epage=77;aulast=Rao

17.        Dias A, Dewey ME, D'Souza J, Dhume R, Motghare DD, Shaji KS, Menon R, Prince M, Patel V.The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India.PLoS One. 2008 Jun 4:3(6):e2333. Doi:10.1371/ journal. pone.0002333

18.        GianlucaBruti, ElisabettaCavallucci, SandroSorbi. A systematic review of the quality of studies on dementia prevalence in Italy. Published in BMC Health Services Research 2016, DOI:10. 1186/s12913-1741-7.https://www.semanticscholar.org/paper/A-systematic-review-of-the-quality-of-studies-on-in-Bruti-Cavallucci/6f57dcd5504576c08f8c758173815802e8af2d0b

19.        Sunil Kumar Raina, SujeetRaina, VishavChander, Ashoo Grover.Is Dementia Differentially Distributed? A Study on the Prevalence of Dementia in Migrant, Urban, Rural, and Tribal Elderly Population of Himalayan Region in Northern India., North American Journal of Medical Sciences 6(4):172-7 . April 2014, DOI: 10.4103/1947-2714.131243. https://www.researchgate. net/publication/262539210_

20.        Shaji S , Promodu K, Abraham T, Roy KJ, Verghese A. An epidemiological study of dementia in a rural community in Kerala, India. US National Library of Medicine National Institute of Health. Br J Psychiatry 1996 Jun:168(6):745-9. https://www.ncbi.nlm.nih.gov/pubmed/8773818

21.        Suresh K Sharma. Literature Review. In: Dr Lalith Singh, Varun Gupta, Mr Nithin Valecha, Mr Subodh, editors. Nursing Research and Statitics 2nd ed. Elsevier Publications 2014.

 

Received on 23.01.2020          Modified on 11.02.2020

Accepted on 28.02.2020   © A&V Publications all right reserved