Impact of Ageing on Depression and Activities of Daily Livings in Normal Elderly Subjects Living in Old Age Homes and Communities of Kanpur, U.P. SRJI Vol-2 Issue-2 Year-2013

7/28/2019 Impact of Ageing on Depression and Activities of Daily Livings in Normal Elderly Subjects Living in Old Age Homes

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IMPACT OF AGEING ON DEPRESSION AND ACTIVITIES OF DAILYLIVINGS IN NORMAL ELDERLY SUBJECTS LIVING IN OLD AGE

HOMES AND COMMUNITIES OF KANPUR, U.P.

Vanshika Sethi*, Vijeylaxmi Verma**, Udhbhav Singh***

ABSTRACT

INTRODUCTION: Ageing is a progressive generalized impairment of functions resulting in loss of adaptive

response to stress and increasing the risk of age related disease. METHODOLOGY: A sample of 200 elderly

subjects i.e. 100 from the community (group A) and 100 from Old age home (group B) of sixty & above years

of age were taken by the convenience sampling method. The subjects were collected through various old age

homes and community which includes Vaikunth Dham Old Age Home, Ishwar Prem Ashram, Swaraj Ashram,

Ramkrishna Mission old age home and nearby community located in the Kanpur and Varanasi. The subjects

were assigned a number to maintain the confidentiality of the subjects and then the scales were used to assess

the scores i.e., Geriatric Depression Scale (GDS) and Barthel index of daily livings were used to check the

level of depression & ADLs and then the scores were compared. THE RESULTS: The mean GDS scores for

group A were 11.32 and for group B were 16.42 with a value of -6.981 with a p value of 0.00* and mean

ADLs scores on the Barthel index for group A were16. 54 and 17.98 for group B within value of -2.898 with

a p value of 0.004* which shows there is a significant difference. Conclusion: Elderly subjects living in Old

age home are more affected in terms of depression and ADLs as compared to community dwelling elder

subjects as old people living in their own homes were most able to cope in their homes. They received more

support from relatives and friends than from health and social services16


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KEY WORDS: Elderly, ADLs, Depression, Community, Old age home

INTRODUCTION

Age classification varied between countries

and over time, reflecting in many instances the

social class differences or functional ability related

to the workforce, but more often than not was a

reflection of the current political and economic

situation. Many times the definition is linked to the

retirement age, which in some instances, was

lower for women than men. This transition in

livelihood became the basis for the definition of

old age which occurred between the ages of 45 and

55 years for women and between the ages of 55

and 75 years for men1.

Elderly people are classified into: - 1) 60 yrs

to 70yrs- Young old 2) 70 yrs to 80yrs- Middle old

3) 80yrs &above- Old old2

The risk factors for reduced physical function

in elderly people, as identified in longitudinal

studies, relate to comorbidities, physical and

psychosocial health, environmental conditions,

social circumstances, nutrition, and lifestyle3

As the western population is increasingly

ageing, problems connected with old age will

dominate healthcare. Depression, one of the most

prevalent psychiatric disorders, is expected to take

an even more prominent position than presently, as

the risk for developing depression increases with

old age. Depressive symptoms are present in

almost one third of the elderly populations and

major depression may be present up to 4%

Furthermore, once present, the prognosis for

elderly with depression is poor4

There have always been elderly people, but

what is new today that they now form the largest

sector of the population in industrialized societies.

However elderly are not preparing themselves for

long life, nor are we receiving any information

about the aging process at home, school,

community in general. Society tends to exclude the

elderly. They are considered incompetent and are

denied any responsibilities. This is far removed

from previous societies in which, given their

experience, the eldest members enjoyed a much

higher status. They considered wise, the teachers,

and traditions. A great number of people in this

sector are slightly depressed and tend to consider

themselves less productive than they really are5

Between the year 2000 to 2050, the

worldwide proportion of persons over 65 years of

age is expected to more than double, from the

current 6.9% to 16.4%. As healthcare facilities

improve in countries, the proportion of the elderly

in the population & the life expectancy after birthincrease accordingly. This is the trend which has

been in both developed & developing countries. It

is commonly believed that the majority of the

elderly population resides in developed countries.

However, this is a myth, as about 60% of the 580

million older people in the world live in

developing countries, and by 2020, this value will

increase to 70% of the total older population6

Depression is common in medically ill elderly

and associated with greater morbidity and

mortality, increased health service use and medical

costs. Studies have shown that antidepressant and

structured psychotherapy, alone or combined, are

effective in reducing depressive symptoms among

older adults7

Depression and anxiety lead to a serious

impairment of daily functioning and quality of life.


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In frail elderly, the effects of depression and

anxiety are especially deep encroaching .The

number of elderly is rapidly growing. Almost a

third of elderly subjects in the community with sub

threshold depression or anxiety will develop a

major depressive or anxiety disorder in three years

8

The prevalence of major depressive disorder

at any given time in community samples of adults

aged 65-67 older ranges from 1-5% in larger scale

epidemiological investigations in the United States

and internationally, with the majority of studies

reporting prevalenceatthe lower end ofthe range.

Clinically significant depressive symptoms are

present in approximately 15% of the community-

dwelling older adults9

Major depressive disorder is one of the most

common forms of psychopathology, one that will

affect approximately one in six men and one in

four women in their lifetimes. It is also usually

highly recurrent, with at least 50% of those whorecover from a first episode of depression having

one or more additional episodes in their lifetime,

and approximately 80% of those with a history of

two episodes having another recurrence. Once a

first episode has occurred, recurrent episodes will

usually begin within five years of the initial

episode, and, on average, individuals with a

history of depression will have five to nine

separate depressive episodes in their lifetime10

Disability in Activities of Daily Living

(ADL) , which are the essential activities that a

person needs to perform to be able to live

independently , is an adverse outcome of frailty

that places a high burden on frail individuals,

health care professionals and health care systems .

Frail elderly people have a higher risk of ADL

disability compared to non-frail elderly people11

The model of the International Classification

of Functioning, Disability and Health can describe

the consequences of dementia that eventually lead

to deterioration in BADL and loss of autonomy. In

the context of this review, dementia (health

condition) has a negative influence on mobility,

endurance, lower-extremity strength and balance

(body functions and body structures). Those body

functions are important for BADL functioning

(activity). Depending on the quality of the BADL

performance, patients are less or more restricted in

their participation (participation). By training

physical components underlying ADL, or by a

direct influence of exercise on ADL, healthy

elderly subjects can stabilize or improve their

ADL score12

The mechanisms by which depression has an

effect on physical disability are not completely

understood. Both behavioral (depressed patients

may have poor lifestyle, such as nonadherence to

medication andself-care regiments) and biologicalmechanisms (depression may worsen medical

diseases through changes in hypothalamic-

pituitary-adrenal axis and the sympathetic nervous

and immunological system) have been proposed.

Each could lead to more disability13

One might expect that elevated body mass

index (throughout life) could also promote

impairments in ADL through other mechanisms

that include associations with diabetes and

possibly knee joint injuries in later life or

difficulties in walking around the house (more

common in Hawaii but unrelated to body mass

index in the current sample). It may be that

impairments in the ADL are more frequent in the

presence of subclinical frailty where weight loss is

a problem. Long-term follow-up of the effects of

body mass in middle adulthood on the risk of late-


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life ADL impairment might reveal a clearer

association14

In a study of patients with and without

depression during the immediate period after

stroke but with similar impairments in ADL

scores, we found, 2 years later, that the depressed

patients had significantly less recovery in their

ADL functions than the no depressed patients. The

recovery curves for ADL function were not

significantly different between patients with major

depression versus those with minor depression,

suggesting that both moderate and severe forms of

depression lead to impaired recovery in ADL

functions. Morris et al who used an abbreviated

version of the Barthel index, also reported that at

15 months after stroke, patients with major

depression and those with minor depression had a

significantly greater physical disability than no

depressed patients15

As in elderly people living in community &

old age home depression and impairment inperforming activities of daily livings are major

problem therefore assessing the prevalence of

depression and impairment in ADLs forms the

basis of the study.

MATERIALS & METHODS:

This study is a survey type of study which

intends to find changes in levels of depression and

activities of daily livings scores in elderly subjects

living in thecommunity and in old age home.

A sample of 200 elderly subjects i.e. 100 from

the community and 100 from Old age home of

sixty & above years of age were taken by the

convenience sampling method.

The subjects were collected through various

old age homes & which includes Vaikunth Dham

Old Age Home, Ishwar Prem Ashram, Swaraj

Ashram, Ramkrishna Mission old age home and

nearby community located in the Kanpur

&Varanasi.

All subjects signed consent forms & were

ready to take part in the study .The subjects were

given the instructions regarding the procedure &

the subjects who fulfilled the inclusion criteria &

were ready to actively participate, were selected.

Inclusion criteria

1. Normal elderly male & female with age of

60 years.

2. Able to understand verbal instructions &

completed 8-10 years of formal education.

3. Subjects with stable medications

Exclusion criteria

1. Any neurological problems such as

Parkinsonism, stroke, cerebellar disorders,

balance disorders, myopathy, myelopathy

which can influence the psychological

status of the subjects.

2. Any cardiovascular or orthopedic problemswhich affects their day to day routine

activity & further may become the cause

of depression.

3. Significant hearing & vision impairment.

4. Uncontrolled hypertension.

5. Any speech deficit interfering the survey.

6. Unstable seizure / disorder affecting the

psychological status of subjects.

7. Smoking or alcohol intake.

Procedure

Group MeanStandard

DeviationT P

Community

(gp A)

11.32

4.29

-6.981

0.000*

Home

(gp B)

16.42

5.90


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Subjects were introduced to the study

followed by the signing of consent forms ,general

assessment regarding of socio-demographic data (

name, gender, age), education level, past medical

history, personal history, family history were

gathered from the participants assessment forms.

The subjects were collected from community &

various old age homes & were divided into two

groups a (community) and b (old age home) for

comparison. Total 200 numbers of subjects data

was collected, 100 for Group A(community) and

group B (old age home).The subjects were

assigned a number to maintain the confidentiality

of the subjects and then the scale was used to

assess the scores i.e., Geriatric Depression Scale

(GDS) and Barthel Index (BI) was used to check

the level of depression and impairment in ADLs

and then the scores were entered in the data

collection form.

RESULTSReading on GDS and BI were taken during

first interview contact with the subject and were

tabulated as data.

The mean value of GDS for the old age

home (group B) was 16.42 with standard deviation

5.90 and mean value for subjects living in

community (group A) was 11.3 with SD 4.29 and

p value was 0.000 which shows there is a

significant difference in the score hence level of

depression is more in elderly people living in an

old age home town community.

Table 1: Analysis of GDS score in group A and

group B

*Significant difference

The mean value of the Barthel index for the old

age home was 16.54 with standard deviation

4.001and mean value for subjects living in the

community was 17.98 with SD 2.947 and p value

was 0.004 which shows there is a significant

difference in the scores hence Activities of daily

livings are more affected in elderly people living

in an old age home town community.

Table 2: Analysis of Activity Of Daily Living

by Barthel index between group A & group

B

*Significant difference

DISCUSSION

As results of the study shows that depression

level is more in elderly living in an old age home

than in community. It is supported by a study

which suggests that urbanization promotes

nucleation of the family system and a decrease in

care and support for the elderly. Depression and

physical illness often coexist in the elderly as they

both occur commonly in old age. There is a close

relation between depression and physical illness.

Depression may be caused by a specific physical

disorder possibly as a direct consequence of the

cerebral organic effect of these conditions.

Therefore strategies to decrease depression should

be utilized for persons living in an old age home.

The literature shows the institutionalized

participants were more likely to report depressed

Group MeanStandard

DeviationT P

Community

(gp A)16.54 4.001

-2.898 0.004*

Home

(gp B)17.98 2.947


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mood, crime, wishing to be dead, future looking

bleak and staying away from others. Therefore the

persons living in an old age home should be

encouraged to intact with the society and family

members to cope up depression.

Literature shows that older people living in

their own homes were most able to cope in their

homes. They received more support from relatives

and friends than from health and social

services3.Result of the present study also shows

that elderly people living in an Old age home were

more affected in terms of ADLs than elderly

people living in the community.

Relevance to clinical practice:

This research study may serve as a basis for

development and implementation of a new

rehabilitation program to cope up depression and

to improve daily living skills for subjects living in

an old age home and in community by whichfurther their level of dependency and depression

can be reduced.

Future research:

1. This study is a survey type study in whichno training was given to the improvement

of ADLs and to decrease the depression

hence in a future training program can be

administered and its after effects may be

noted down.

2. As sample size was small hence largesample size may be taken to generalize

the results.

3. Task orientedgoals/activities/training/may be used to

improve the efficiency of subjects living

in an old age home and community.

4. Group involvement and interaction withsociety may be suggested for subjects

living in an old age home as loneliness

may be the factor affecting ADLs and

depression.


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CORRESPONDENCE

* Assistant Professor, Physiotherapy Dept., Saaii College of Medical Science and Technology, Kanpur, U.P.

** B.P.T. Student, Saaii College of Medical Science and Technology, Kanpur, U.P.

*** B.P.T. Student, Saaii College of Medical Science and Technology, Kanpur, U.P.

Documents

Impact of Ageing on Depression and Activities of Daily Livings in Normal Elderly Subjects Living in Old Age Homes and Communities of Kanpur, U.P. SRJI Vol-2 Issue-2 Year-2013