DISSERTATION===============

“Comparative study on physical & mental health status of elderly in institutional & non-institutional setting - A case study of Delhi”

This dissertation is a partial fulfillment of Post Graduate Diploma in Integrated Geriatric Care Course

BY: GAUTAM CHOWDHARY.

DPT. ND(CAL) GERIATRIC ANIMATOR

GERIATRIC PHYSIOTHERAPIST

Under project

National Initiative on care for Elderly (NICE) Old Age Care Division

National Institute of Social Defence, Delhi Autonomous Body Ministry of Social Justice and Empowerment Government of India.

Contents: -

Page No

Chapter Topics

1. Acknowledgement

2. Background

3. Research and Methodology.

4. Result and Discussion

5. Conclusion and suggestion

6. Bibliography

7. Case study

8. Appendix

Acknowledgement

This “comparative study on physical & mental health status of elderly in

institutional & non-institutional setting - A case study of Delhi” is one of several

studies of the elderly in different states. This is the first exploratory study of Home –

living rural and institutionalized elderly in Delhi. It is based on survey of 1). A random

sample of 68 home-living elderly in rural, Delhi, and (2) 32 elderly living in homes, run

by state government, Delhi,(2). Two homes.

I deeply thankful to my respected sir Shri: R. Rahman, Project Director (NICE),

encourage me and support also. I greatly thankful to Dr. Renu tyagi, to supervised and

give me valuable advice to complete my study.

I gave my heartiest thanks to Prof. Sanjay Kumar Singh, of Lal Bahadur Shastri

Institute of management, Delhi to guide my study in proper way.

I particularly thankful to librarian, old age care division, National Institute of social

Defence, Delhi Min. of Social justice & Empowerment, Govt. of India. For support me

by books. I thankful to State Govt. welfare officer Mrs. Saroj Rawat for her kind

cooperation.

I am really thankful to my wife Mrs. Uma sarkar (chowdhary) Advocate, Alipore

Judge’s Court, Calcutta for her valuable advice and cooperation since one year.

Also, I thankful to my Professors, Teachers, Md. Arif Khan and my classmates and

CMIG, CALCUTTA, for their cooperation in this study.

I thankful to all individuals’ officials of govt. depts.and other functionaries of the homes

for the aged. I thank them all for their cooperation & assistance in arranging interviews

with the elderly and care givers residing in their institution and thanks to all villagers of

Hassanpur,Najafgarh, Delhi for their kind cooperation.

Delhi

18.10.2004 Gautam Chowdhary.

INTRODUCTION:

The world over, there has been a rapid increase in the number of elderly people, on

India, the “aged “ population ( 60 years & elder) is the second largest in the world. It is

estimated that the proportion of elderly people will increase from 7.7% in 2001 to about

11% in 2020.( AIIAMS,WHO AND UN- GUIDE BOOK on Older person,)

With this demographic change, and increase in the population of the elderly, societies in

developed and developing countries have to learn how to deal with a new set of health

challenges.

The elderly are prone to chronic non communicable diseases and disabilities. Many

studies conducted in India and other developing countries reveal that a majority of elderly

people are socially and economically dependent on their family members. They cannot

afford to seek health care themselves.

In India although physical, social and psychological health are separated out for

convenience, each impinges can affect physical health, especially the environment in

which they live. Hearing may cause physical problem, if rooms are not kept warm in

winter. At best, chest conditions can exacerlected and at worse, hypothermia can occur in

an individual.

Education for the elderly on living in a warm environment may be more concerned with

advice on social and voluntary services than with the physiology of degenerating

temperature regulation. Physical help can be given on effective breathing, the availability

of vaccination against influenza and rights to free prescriptions.

There are difficulties in educating the elderly especially when finance is involved. Many

would rather be cold then accept what to us in their right, but to them is charity. Further

more, many will not discuses their finances and may exist on insufficient money when

they are entitled to supplementary pension.

It can also be that an elderly person will continue to live in the family home even through

it is too big for one person and impossible to keep warm on limited funds. It is easy for

the geriatric carer to see such a situation in a purely practical light where, in fact, social

and psychological factors may also be involved.

It is known that the elderly people suffer from various types of problems, these are

broadly speaking. Psychological, physical, economic and social. In coping with the

changes which come with advanced age and the feeling of help less ness for various

reasons, the cultural or the social norms other help them or push them into further

desolation depending on the social norms of the culture these elderly people live in. the

attitude towards life and surrounding is important if not the most important factor which

may affect the intensity of various types of their sufferings. Bogardus (1931) defines

attitude as “a tendency to act toward or against something in the environment, which

becomes there by a positive or negative value”. Allport (1967) gives this definition as

“An attitude is a mental and neural state of readiness organized through experience,

exerting a directive or dynamic influence upon the individual’s response to all subject

and situations with which it is related”. These definition hold good for the individuals.

But when the social attitudes are considered, there are some important charatertics, some

of there according to Joseph (1991) are, goal directed, they are shared by the members of

a group, they may or may not be long lasting.

Indian society so long was basically traditational, where aged people were respected,

looked after and their opinions or advice were given importance. This attitude is changing

with the growth of industries to considerable extent. One would expect the rural society

in India is still adhering to the traditational social norms, while in the towns it may be in

transitational stage and changing rapidly in the metropolis. The problem of ailing aged,

therefore, may vary accordingly.

The W.H.O.describes health as “a state of complete mental, physical, social,

environmental wellbeing, and not merely the absence of disease or infirmity. This

Description is all disease or infirmity”. This description in all embracing but it is difficult

to measure. Kane (1994) suggests two ways to measure the health to examine the health

situation of individual by collecting information on the types of illness & the age at

which they are likely to die. Besides these suggestion, information on the mental peace &

happiness may also throw some light on their state of health.

The present study is directed to find out the physical health and mental health condition

of the aged both males & females, the care they get from their family members and their

attitude towards their families, from three different setting; rural, urban cities i.e.

traditational, modern societies keeping the income level as a constant.

AGEING SCENARIO OF INDIA:

In the beginning of the last century 12 millions Indian where age 60 years or more. The

number of the aged in doubled in the next sixty years to 24 millions. Since then there has

been a large increase in the number of the elderly, to about 56 millions in 1991. The

projected figures for the years 2001 and 2025 are 70 millions and 177 millions

respectively. The expectancy of life has increase significantly in the last few decades.

The expectancy of life at but has shown a rise of more than 10 years from 49.7 years

during 1970 – 1975 to 60.3 years during the period 1991 – 95. Over this period of 25

years the life expectancy of life at 60 and 70 years has also shown a significant increase

from 13.8 and 8.9 years respectively to 16.2 and 10.6 years.This trend is likely to persist

in the coming years, and in next 50 years the expectancy of life at birth may well surpass

80 years in most countries of the world, including India.

Old age all over the world is marked by poverty and social isolation. Most people enter

old age in poor health as a result of life long exposure to health risks, deprivation, lack of

knowledge and resources for health promotion poor access to health services. Forty-five

percent of older Indians have chronic diseases and disabilities. The number increases to

95% among those who seek health screening. Information on acute health problem and

service requirement is not available.

The common diseases among the ambulatory elderly are hypertension, cateract,

osteoarthritis, chronic obstructive pulmonary disease, ischemic heart disease, diabetes,

benign prostates hypertrophy, dyspepsia, irritable bowel syndrome and depression, which

account for 85% of the burden of ill-health. Among the very old patients, stroke,

dementia, osteoporosis, heart failure and frailty and physical dependence are the usual

problems. The commonest causes of death in the Indian elderly are bronchitis and

pneumonia, ischemic heart disease, stroke, cancer and tuberculosis. In the next 20 years

as per a recent WHO projection, over three quarters of the deaths in the developing world

will be due to noncommunicable diseases, surpassing communicable diseases and

injuries. This remarkable transformation in the profile of ill-health requires the provision

of costly services for the disabling non communicable diseases while continuing

investment in the prevention of communicable diseases. The heavy load of non

communicable degenerative diseases that produce considerable disability and require

costly treatment, along with killer communicable diseases, will have to be learn by a

health care system which is not geared to do so.

In most developing countries including India most of the old people live in their

communities and will continue to do so. They depend on community health services for

most of their health problems.

AGEING AS PHENOMENON

It is probable that ageing occurs through the process of natural selection. Survival after

the reproductive era is not beneficial to the propagation of species because it leads to

over-crowding and competition for resources for survival. Ageing is beneficial in the

weeding out of species not engaged in active reproduction, if it survives predatory

elimination, accidents, environment hazards and disease. Thus, ageing is not

physiological but a natural phenomenon mediated by genes. Principals on the science of

health care of the elderly as based include individuals gradually become more

heterogeneous or dissimilar as they age. Ageing does not produce an abrupt decline in

organ function but disease always does. Ageing process is accentuated by disease and

attenuated by modification of risk factors such as smoking, sedentary lifestyle and

obesity. Healthy old age can be attained with different levels of prevention and health

promotion.

● AGEING IN THE MUSCULAR SYSTEM

Decreasing muscle mass, decreasing elasticity of tendons and ligaments, decreasing

amount of stored sugar, decreasing endurance and agility, Decreasing Blood flow,

Increasing variability of muscle tonicity, Increasing variability of nerve conduction and

irritability, Increasing amount of muscle spasms, increasing amount of waste products.

(Lactic acid, Co2 retained).

● AGEING IN THE SKELETAL SYSTEM:

Decreasing hardness of bones, decreasing activity of bone marrow, decreasing elasticity

of joints and ligaments, decreasing mobility of joints increasing shift of mineral salt,

bones to blood, Increasing postural and foot changes. Age changes in the skeletal system

predispose the elderly in developing osteoporosis, damage to the joints, falls, fractures,

and walk.

● AGEING IN THE URINARY SYSTEM

Decreasing number of cells in kidneys, decreasing blood flow to kidney, decreasing

elasticity of bladder, decreasing muscle tonicity of urethra, increasing variability in

irritability and neural condition to urethra.

There is a decline in the efficiency of homeostatic mechanisms, urinary urgency and

frequency. Prostates enlargement in male elderly which is part of normal ageing, may

lead to urinary retention and infections of water soluble medications occurs due to altered

glomerulus’s filtration rate. There is a decrease in interval between the signal of the need

to void and the actual emptying of the bladder. In women pelvic floor weakness as a part

of ageing may produce urinary incontinence.

● AGEING IN THE NERVOUS SYSTEM:-

Decreasing number of cells and endings, decreasing rate of venous returns, decreasing

irritability and conduction, decreasing rate of arterial flow, increasing variability in

perception, equilibrium, motor coordination, increasing variability in reception,

integration and response to external and internal stimuli. The nervous system shows

gradual ageing changes which may lead to progressive decline in short term memory,

forgetfulness, impaired Judgment, wandering behavior and shower processing of

information.

● AGEING IN THE RESPIRATORY SYSTEM:-

Decreasing elasticity of alveoli, decreasing tonicity of intercostals muscles and

diaphragm, decreasing vital capacity, decreases blood flow, increasing variability in

reception, integration and response to external and internal stimuli increasing

desiccations of respiratory mucous membranes increasing carbon dioxide.

These age related changes of the respiratory tract, decrease the efficiency of gas exchange

and increases susceptibility to lower respiratory infections. There is reduction in the

immunity which may lead to severe problems like pneumonia. Mouth breathing,

diminished coughing, increased use of accessory muscles, more energy expanded for

respiratory functioning, lead to diminished efficiency of gas exchange, decreased vital

capacity, slight decrease in overall efficiency and increased susceptibility to lower

respiratory infection.

● AGEING IN THE DIGESTIVE SYSTEM

Decreasing capacity for biting and chewing, decreasing capacity for smelling and testing,

decreasing production of digestive enzymes, decreasing gastric and intestinal mobility,

decreasing thickness of the gastro – intestinal lining, decreasing number of liver cells and

liver functions, increasing variability in swallowing reflex, increasing variability in

peristalsis, increasing variability of the amount of bile flow, increasing incidence of

indigestion, abnormal distention, flatus, increasing variability in bowel habits, increasing

variability in nutritional status.

The elderly loose the ability to enjoy the food and eat less because of absence of teeth,

less efficient chewing and decreased taste sensation. There is also decreased absorption

of vital elements leading to multiple deficiency states. The show mobility of the Gastro

intestinal tract leads to constipation and problems associated with it. Decreased

absorption of iron, folic acid, vitamin B12 malnutrition and dehydration lead to

subsequent cognitive impairments.

●AGEING IN THE CARDIOVASCULAR SYSTEM

Decreasing muscle tonicity; decreasing cardiac output, decrease elasticity, decreasing

venous return decreasing body fluids, decreasing blood cell production, increasing heart

size, increasing arterial resistance to passage of blood,(B.P – increase) increasing

variability of neural conduction and irritability, increasing time required for the heart to

return to the resting stage.

The heart and blood vessels are under going age changes leading to stiffening of the

vasculature, hypertrophy of left ventricular wall, increased peripheral resistance, postural

hypotension, development of blood pressure, increased susceptibility for heart diseases,

arrhythmias etc.

●AGEING IN THE ENDOCRINE SYSTEM

Decreasing number if cells and size of gland, decreasing amount of secretions,

decreasing basal – metabolic rate, cessation of menses (female), decreasing capacity for

tissue repair, decreasing capacity to maintain Na +, K+ and fluid balance, increasing

variability of adapting to stress, increasing variability of calcium metabolism, increasing

variability glucose metabolism, increasing variability of the inflammatory response,

increasing variability of the tolerance to temperature and atmospheric changes, increasing

regression of secondary sex characteristics.

The consequences of age related changes of the endocrine organs lead to alterations in

thermoregulation in the form of either hypo or hyperthermia. Withdrawal of the estrogen

during menopause may lead to osteoporosis and tehological disturbances. There is a

decreased amount of secretions of the endocrine organs which may produce mild

endocrine regression of secondary sex characteristics.

AGEING IN THE SKIN:

Decreasing number of cells, decreasing amount of subcutaneous fat, decreasing number

of nerve cells and endings, decreasing amount of blood flow, decreasing elasticity,

decreasing amount of blood flow, decreasing elasticity, decreasing amount of secretions

of sweat glands and sebaceous islands, increasing areas of pigmentation, increasing

amount of dryness and thickening of nails and hair, increasing variation in hair growth,

increasing variability of maintenance of body temperature, increasing susceptibility to

infection trauma. Ageing skin and appendages may lead to wrinkles, dry skin, delay in

wound healing, increased susceptibility to burns, injury, infections, increased incidence

of cracks and injury occurring to the nails. Decreased sweating and shivering leads to

increased susceptibility to hypothermia and hyperthermia, skin cancer is also more

common in the elderly.

AGEING IN SEXUAL AND REPRODUCTIVE SYSTEM:

Social norms have traditionally interpreted the normal changes of ageing as indications

that is no longer necessary or even appropriate to engage in sexual intercourse. Even in

elderly males, beyond 65 years of age. Morning erections are not uncommon. it is many

of the other diseases such as diabetes, chromic kidney or liver diseases and some of the

drugs such as those taken for hypertension of other ailment that lessen an elderly’s sexual

urge.

Many women, on the other hand, equate the beginning of post-menopausal period with

‘no-sex’. This is not a fact, because of absence of some of the sex-hormones, heralds’

attendant changes in sex organs that may lead to delayed onset of sexual desire, but none

the less, the desire is there. Older people, unless otherwise contra-indicated, may continue

having sex relations with their partners, so long as the desire is there.

AGEING IN THE SENSORY SYSTEM:

Ear

Decreasing elasticity of eardrum, decreasing number of sensitive cells in the cochlea,

increasing rigidity of the small bones in the middle ear, increasing rate of time for the

passage of impulses in the auditory nerve, increasing rate of time for fluid to drain in the

semicircular canals.

Age related changes leads to impaired hearing and diminished ability to hear high pitched

sounds. Diminished sensory input and impaired social interaction.

Eye

Decreasing eye muscle tonicity, decreasing peripheral vision, decreasing elasticity of

lens, decreasing ability of pupil to change size, is decreasing ability to adjust to night

vision, decreasing depth and colour perception. Decreasing moisture on cornea and

conjunction, increasing changes in blood vessels, increasing time required for fluid to

drain from eye chambers. Increasing eyelid droop, increasing tearing. There is decreased

ability to focus on near objects, increased sensitivity to glare, diminished depth of

perception, altered colour perception, difficulty in night driving and slower processing of

visual information.

CHANGES IN THE BODY DUE TO AGEING:

The changes that occur in the body may be categorized as:

(1) External i.e. those that are visible;

(2) Internal, i.e. those which occur in the internal organs of the body .2

(3) In the sense organ perceptions.

External changes are seen most obviously in the hair, face, skin, stature, posture, bony

joints, and mobility. One of the most obvious features of an older person is the graying of

the hair which also tends to become sparse. Wrinkles and creases in the face result from

the loss of fat and elastic fibers, (loss of teeth progressively, leads to resumption of bone

from the upper jaw & the lower jaw.)

When advanced, this produces marked shrinkage in the lower portion of the face, an

increased in folding of the mouth & shortened distance between the chin & nose. Many

elderly persons, in addition to the bending of the trunk, undergo postural changes, among

which slight flexion at the knees and at the hips, tend to contribute further to diminished

stature. An older person has less energy and is not so agile. A general slowing up of

movement is the rule. The gait becomes stiff and the steps tend to be short. The nervous

system, in the joints and in the muscles. In the nervous system, the loss of cells from the

brain and spinal cord, leads to a slowing and diminution of co-ordination in bodily

movements. There is a greater tendency to fall.

It is very important to know and recognize the changes occur, normally, with aging,

because this knowledge helps one to distinguish a particular symptom, sign or result of a

test in an older person as normal due to aging, or abnormal due to a disease. Furthermore,

it helps in proper understanding of the behavior and response of an aged person.

● COMMON FEATURES OF ILLNESS IN OLD AGE:

When an older person falls ill, there are some features which are more often met because

of the age and not because o a particular disease. These have to be recognized and sorted

out from the particulars feature of a disease, so as to manage the patient as best as

possible.

●MULTIPLE PATHOLOGY-

In old age, it is a rule rather than the exception for the patient to suffer from several

diseases at a time. In an acute illness, it is actually clear which disease is dominant, but

some account must be take of the others, a patient with a brain stroke, for example, may

well be handicapped also by cataract which limits his vision, heart disease which limits

his capacity for effort, an urinary infection which increases the risk of incontinence and

osteoarthritis of the hips or knees which further limits his mobility. All this as well as the

stroke demand treatment, and influence his rehabilitation.

● TENDENCY OF CONFUSION –

In an older patient, the stability of the brain is precariously balanced probably because of

the brain is readily upset by any kind of bodily disturbance, and a sudden onset of

confusion is one of the commonest indication of physical illness in old age.

● LESSER SENSIBILITY TO PAIN-

An older patient has admonished sense of pain. This makes life less uncomfortable for

him, but it increases the risk that he may injure himself. For example, he may burn his

skin by sitting too close to the fire. Hot water bottles are a special danger. Even serious

injurious like fractures may not be obvious. An old person, who breaks the neck of the

femur, may have only mild discomfort even though he cannot walk. In acute abdominal

conditions such as acute appendicitis, there may be little pain or tenderness until the

disease is far advanced and the patient is gravely ill.

● DIMINISHED TEMPERATURE REGULATION –

The regulation of body temperature is less efficient in the older patient and fever is less

obvious and less severe. Thus an illness which would provoke a sharp rise in temperature

in a young patient may in the elderly cause only a small rise are none at al. If an old

person seems unwell, there can be no assurance in the fact that his temperature is normal.

The pulse and respiration is often a better guide to his condition.

● LOSS OF APPETITE –

If the illness is of a toxic or feverish nature, old patients lose their appetite completely.

Appetite is probably the last thing to recover.

●SPECIAL HAZARDS OF ILLNESS IN OLD AGE –

Young people overcome their illness because of ample bodily reserves them to fight their

illness that are not usually expected in your younger individuals. Thus, a young person

may be immobilized for long periods without coming to any harm, but an older person

deteriorates fast in general mobility and capability, in vigor and even in spirit if he cannot

move about. This happens more so in those who are already arthritic or have disorders of

mobility.

Confinement to bed for older people is a harbinger of more problems to come. Those

commonly seen are constipation, incontinence farces and urine, pressure sores,

contractures of the joints, and thrombo-embolism.

● USE OF DRUGS IN OLD AGE –

Ageing causes an changes in the body with regards to drug absorbed distribution &

action, it is important to understand this an changed behavior of the leody towards drugs

so that a proper response in obtained, and ride –effects eliminative. It may lead to poor

compliance, with the potential of either under-dosin. Many factors influence drug

response. Some of the important ones are:

ABSORPTION: - following their absorption, al drugs pass in the portal (abdominal)

cireulayion to the liver where some undergo substantial metabolism before entering the

general circulation. A reduction in liver metabolic activity is likely to occur in order

people leading to increased systemic bio-availabity following oral administration of the

drug.

EXCRETION: - for some drugs, namely antibiotics like vetreptomycim & elimination.

Changes in renal function association with aging have important implications for such

drugs. The elderly are at risk of reduced elearmes and resulting accumulation of the

parent drug & the active metabolites.

MENTAL HEALTH is the balance development of the individual’s personality and

emotional attitudes which enable him to live harmoniously with the fellow men.

Characteristic of mentally healthy person –

Mentally healthy person has 3 characteristic –

(1). Feel comfortable about himself and feel secure at home. Neither under estimate nor

over estimates his own ability accepts his limitation and has self – respect.

(2). Feel right towards other so that he is able to be interested in others and to love them

he has friendship that are long lasting and satisfied.

(3). the mentally healthy person is able to meet the demands of his life. He is able to take

independent decision in life.

●MENTAL HYGIENE:

Mental Hygiene means the science of the preservation of mental health.

Purpose : The main purpose of mental hygiene of health but also to make the person feel

secure, loved at his home and developing positive habits so that he may have harmonious

development of his/her personality.

●Mental Changes in Old Age:

LEARNING – Older person are more cautious about learning, need more time to

integrate their responses, are less capable of dealing with new earlier experiences, and are

less accurate than younger people.

REMINISCING: The tendency to reminisce about the past becomes increasing more

marked with advancing age. How much the individual reminisce depends mainly on how

pleasant or unpleasant the elderly send their living condition now.

REASONING: There is a general reduction in the speed with which the individual

reaches a conclusion in both inductive and deductive reasoning. This is partly the result

of the tendency to become increasingly cautious with age.

SENSE OF HUMOR: A common stereotype of the elderly is that of humorless

people. While it is true that their comprehension of the comic tends to decrease with

advancing age, their appreciation for the comic that they can comprehend increases.

VOCABULARY – Detoriation in vocabulary is very slight in old age because elderly

people constantly use words most of which were learned in childhood or adolescence.

Learning new words in old age is more infrequent than frequent.

MENTAL RIGIDITY – Mental rigidity is far from universal in old age, in contradiction

to the stereo – type of the elderly as mentally rigid, age it tends to become more

prenounced with advancing age partly because the elderly learn more slowly and with

more difficulty than they did earlier and partly because they believed that old values and

ways of doing things are better than new ones. This is not mental rigidity in the strict use

of the term but a carefully reasoned decision.

CREATIVITY – Older people tend to talk the capacity for, or interest in creative

thinking. Thus, significant creative achievements are less common among older people

than among younger ones.

MEMORY - Old people tend to have poor recent memories but better remote memories.

This may be due partly to the fact that they are not always strongly motivated to

remember things, partly to lack of attentiveness, and partly to not hearing clearly and

distinctly what others say.

RECALL - Recall is affected more by age than recognition, many older people use cues,

especially visual, auditory and kinesthetic one’s to aid their ability to recall.

LITERARY VIEWS IN MENTAL ABILITIES

Shakespeare, made 132 references to the physical and behavioral changes accompanying old age. In describing senility he wrote:-

Last scene of all.That ends this strange eventful history,

Is second childishness and mere oblivious?Sans teeth, sans eyes, sans taste, sans everything.

Like every other period in the life span, old age is characterized by certain physical and psychological changes. One cheerful literary reference to old age is provided by

Browning:

Grow old with me!The best is yet to be,

The last of life for which the first was made.

The common stereotype of the aged is that of men and women who are worn out

physically and mentally. Who are unproductive, accident – prone, crotehety and hard to

live with, and who because their days of usefulness are over, should be pushed aside to

make way for younger people. According to this stereo type “young is beautiful and old

is ugly” as Berry had explained. This unfavorable stereotype, it should be apparent,

makes it difficult to see ageing as anything but a negative phase in the life span.

Motivation likewise plays a very important role in decline. The individual who has little

motivation to learn new things or to keep up to date in appearance, attitudes, or patterns

of behavior will deteriorate much faster than one whose motivation to ward off ageing is

stronger. The new leisure time, which comes with retirement or with the lessening of

household responsibilities, often brings boredom which lowers the individual’s

motivation.

Age sixty is usually considered the dividing line between middle and old age. However,

it is recognized that chronological age is a poor criterian to use in marking off the

beginning of old age because there are much marked differences among individuals in the

age at which ageing actually begins.

Because of better living conditions and better health care, most men and women today do

not show the mental and physical sign of ageing until the mid – sixties or even the early

seventies. For that reasons, there is a gradual trend towards using 65 – the age of

retirement in many businesses to mark the beginning of old age.

MENTAL HEALTH PROBLEM WITH OLD AGE:

The longevity of the individuals in India is gradually increasing with improving

standards of public health care. Unfortunately, studies on the health problems of the

geriatric population in India are far less the desired number such studies are needed since

psychiatry of the aged cannot be divorced from cultural, social, family, economic,

philosophical, and spiritual dimensions ( see Venkaha Rao, 1979, 1986a, 1988, 1989).

Moreover, it is worthwhile to find out whether increased geriatric population means more

mental health problems. It is, however, a common observation that the elderly are prone

to psychiatric disorders through economic and emotional deprivation, malnutrition, and

social isolation. Living to a longer age no doubt means greater liability for senile

psychosis and other degeneration disorders (Venkaba Rao, 1979). There are, also certain

psychological problems related to retirement (Channaleasavanna, 1987), psycho

geriatrics is the area of research that deal with functional disorders of old age. It is a sub

speciality in psychiatry and has developed recently. As in any new area of research,

initial attempts in this subspecialty have been directed towards the assessment of the

magnitude of the psychiatric morbidity in the older groups.

REVIEW OF MENTAL ILLNESS:-

Data from general epidemiological studies and community surveys on the elderly

in India indicate a varied prevalence rate of mental illness or psychiatric morbidity

ranging from 2.2 percent to 33.7 percent (Anantharaman,1975, Dube, 1970; Elnagar et.al.

1971; Nandi et.al – 1975,1979, Ramachandram and Sarda Menon , 1980; Ramachandram

and Palaniappan, 1984; Sen. et al. 1984; Sharda Menon and Ahmed, 1971; Thacore,

Gupta and Surya 1975; Thiagarajan, 1984, Venkoba Rao, Vasudevan and Madharani,

1982) Male dominance in the depressive illness of the old age has also been observed

(Venkoba Rao and Madhavan, 1982; Ramachandran et.al. 1979,1981, 1982). Most of

these surveys were conducted in gero – psychiatric clinics, mental health centre located in

South Indian Towers, Calcutta and Agra, and also covered the older people from villages

and slums areas. Moreover, in most cases prevalence rates of mental illness in the aged

included the illness that started at younger age and continued into old age. It may be

noted that these prevalence rates are not comparable and representative due to varied

operational definitions of psychiatric morbidity, sampling technique, socio-demographic

variables, and the age groupings. As reliable generalization in this respect cannot be

made for the aged in India. It has, however, been observed that there is a general

tendency of psychiatric morbidity to rise with advancing years; mental illness in the

elderly is characterized by multiplicity and chronicity (Mohan, Praveen lal, Dube, and

Sunderram, 1986). And that physical illness abounds among the elderly and the combined

physical and psychiatric morbidity is appallingly higher.

Moreover, for most of the elderly population, these problems can be subsumed within a

general problem of poverty. (Sharma and Dak (ed) 1987)

Although less in number and restricted in scope, such surveys of the mental health

problems of the elderly, nevertheless, brought into focus the need for conducting

interdisciplinary studies (both clinical and non – clinical on the geriatric population). A

number of general articles monograph have been published that deal with varied aspects

of ageing in India including the social need for a planed, integrated system of services for

individuals and community level interventions and training medicos in geriatric medicine

(e.g. Bhatia, 1983; Chacko, 1986; Doshi, 1989; Kaslival 1986, Mohan 1988, Moudgil,

1986, Ranade, 1985; Sharma and Dak, 1987; Venkoba Rao, 1988, 1989).One way of

classifying studies on the psychiatric morbidity or mental ill health of the elderly in India

can be the settings in which these were conducted. These settings can be community at

large or clinical/hospital where geriatric groups sought professional assistance. -

Venkoba Rao & Madhavan (1982) studied a large sample of individuals aged sixty years

and above (N=686, Men – 291; Women – 395) who resided in and around

Tiruppuvanam. Depression alone contributed 67 percent if total psychiatric morbidity.

This figure was higher than that reported in earlier clinical studies (e.g. Nandi et. al.

1975; Ramachandran and Sarada Menon, 1980). Moreover, there could be a large

segment of invisible depression which escapes detection in the community and the

evidence of depression in the aged could be higher than what has been observed

(Ramachandran and Sarada Menon, 1980). In this respect Venkoba Rao, (1986b) Argued

that depressive illness in the community is invisible due to factors like community

tolerance, mistaking the withdrawal features of the older person to the process of ageing

itself failure to preserve the depression as an illness by the rural population. Venkoba Rao

and Madhavan (1982) also observed that 57 percent of the psychiatric group suffered

physical morbidity and 83 percent from sensory handicaps. They further found that OBS

organic Brain Syndrome constituted 10 percents of their total sample while

schizophrenia, anxiety state, and alcoholism accounted for 23 percents. The major mental

health problems of older persons reported by providers and researchers Liptzin (1986),

Quslander (1982), Harper (1987), Gurland (1982) and matteson and Meconnell (1988)

include the following:

1. Delirium

2. Dementia

3. Depression

4. Agitation

5. Crying Spell

6. Irritability

7. Facing

8. Wondering

9. Assaultiveness

10. Apathy

11. Emotional problems associated with poor physical health.

12. Expressions of feeling of unworthiness, hopelessness

13. Diminished memory, orientation and judgment.

14. Suicidal impulses and or attempts

15. Loneliness

16. Paranoid delusions

17. Demanding behavior

18. Anxiety disorders

19. Alcohol abuse

20. Short attention span

21. Impaired concentration

22. Tendencies to hoard personal items

23. Stress incontinence

24. Disorientation

Emotional reactions to hospitalization or entry into a long – term care facility are

significant in all age groups but may be more intense in older adults. Anxiety, depression

agitation and disorientation are emotional reactions that can results from fears of

hospitalization, diagnostic testing, the outcome of diagnostic testing and treatment, as

hospital routine.

OBJECTIVES: The present study was carried out with the major objective of assessing

the health status of the elderly in Delhi. The specific objectives of the study were:

1. To develop a profile of elderly on their physical and mental health as

observed by themselves and by caregiver also.

2.To study mean difference, if any between self and others observation on

the physical and mental health elderly..

Method of Study: -

Selection of the Place – Old age Home (state Govt) & Rural area of Najafgarh, Delhi. (MCD area –Municipal Corporation, Delhi).

The survey was conducted in Delhi & it suburbs, including the survey & old age homes run by state government. Delhi is a cosmopolitan city and capital of India. So, various types of cultures are included in its daily life leading citizens of Delhi.Delhi- National Capital Territory-Area= 1,500 sq. km (Approx) capital –Delhi, Language- Hindi, Punjabi, Urdu, population =9,420,614; Males: 5,120,733; Females: 4,249,742; Density = 6,319 (person/Km2); Sex Ratio =830; Literacy= 76. 09% Males: 82.63 Females: 68.01. (Manorama, 2002)The territory forms an enclave inside the eastern frontier of Haryana in North India. Extreme dryness with an intensely hot summer & cold winter is the Characteristics of the climate.

The Delhi city was founded in the 11th century A.D. Rajput – Chieftain of the Tomara clan. The chauhans obtains possession of the city from the Tomaras. Prithviraj, the chauhan rular of Ajmer & Delhi; made the city of Delhi famous by his heroic valour & romantic adventures. Delhi under Pritviraj & Kanauj under Jai chand were the principal Kingdoms of North India at that time.The first invansion of India by Muhammad Ghori was beaten back by prithvi raj in the first battle of Tarain in (1191). Ghori came back to average his defeat and in the battle of tarain (1192) the Rajput army was routed. Prithviraj was captured & put to death. Delhi thus passed into the hands of muslim rulers for the next six centuries. Under the Mughal Empower, Delhi became a world famous city. 1857, British deposed the titular Emperor Bahadur shah, & formally annexed Delhi. In 1912, the capital of British India was transferred from Calcutta to Delhi. A new city- New Delhi of imposing dimensions laid out by the side of the old city-old Delhi by the British Indian Government. Independence India has retained their historic capital.

Delhi became a Union territory on November 1,1956. in December, 1991 Delhi gat a Legislative assembly comprising to seats along with a 7 member council of Ministers headed by a Chief Minister.

The territory is made up of three census towns. Delhi, New Delhi & Delhi cantonment. And 214 village; the territory is covered by 3 local bodies. Delhi Municipal Corporation; New Delhi Municipal Corporation & Cantonment Board. The rural area of the territory falls within the jurisdiction of the Municipal Corporation of Delhi.

The survey was conducted by visiting old age homes and rural areas where the aged persons live in. All interactive sessions, interviews of the aged were done in their respective household, which in our unit of observation. Elderly persons of both sexes had been selected from those areas respectively. The cut-age of the respondent was 60years. A total of 100 (65male, 35 female) elderly persons in the respective areas were surveyed.

The elderly persons also represented both old age home rural dwellers. Thus the population represent more or less a cross-section of the elderly pollution of the Delhi cosmopolitan.

Considering the duration of the proposed survey and the variety of information to be collected, It has done a total enumeration in the respective homes & locality. As a result no such sampling frame was adopted for the present survey. But as the aged are not a homogenous population the care was taken for an appropriate representation of the following two markers namely;a). Different age groups,b). Gender to obtain a presentable number of elderly persons.

There is another survey on caregiver. It was done a total enumeration be collected in the respective homes & locality. As a result care giver also represented both old age home & rural areas. Then care giver represent more or less a cross-section of the elderly care provider of Delhi.

Rapport:-

Establishing rapport with respondent with respondent is integral part in any kind of sociological survey. Full Co-operation was received through out the period of data collection by govt. of Delhi, social welfare Dept. and Najafgarh Municipal Corporation. The purpose of data collection & clarification were received well by them with a spirit of co-operation. For the present survey attitude response scales made all enquiries. A series of statements are rated in the following five point scale-strongly agree, agree, undecided, disagree, strongly disagree. Before going to start he survey work it was conducted a pilot survey get an idea about the response of the aged.

Data collected by face- to- face interview and direct observation methods. In order to understood the general inter-personal behavior with the aged, the care provider, observation method was very much useful. This enabled me to take note of the type of respect pr neglect extended to the aged by their caregivers of family members.

Types of data:-

I Respondent (elderly person)

A) ‘ physical health status covered by the normal health, chronic health problem, allergies immobility, physical problem, surgical intervention faced by the elderly respondents.

B) “Mental health status” covered by the-Consciousness, emotion, perception disturbance, abstract reasoning, personality disorder faced by the elderly respondents.

C). “ Socio-Demographic status ‘ covered by the age, gender, married status, Religion, education level. D). “ Economic status” covered by the earning status, property ownership.

II. Care giver

A). ‘ Social status ‘ covered by age, gender, relation. B). “ Health Status on physical’ on their feeling & observation covered by-chronic Disease, disability with ageing, Healthy life style; Diabetes mellitus, loss & Sensor motor stimulation. C). “Mental Health status” of elderly on care given feeling & observation covered By- wandering, consciousness, perception, construction ability of talking, Mental illness with high income.

Data Processing:-

The respondent were free to answer without reservation all statement, put to them, and also to express their statements put to them, and also to express their opinion or attitude regarding socio-demographic, economic, physical & mental health status, care giver attitude regarding physical & mental health status. The information thus collected have been codified for classification into categories & these coded response data subsequently have been used for analyses. The confidentiality of individual information is maintained.

The sample of the study in 150. 32 Respondent aged 60 yrs and care givers (8) chosen from two old age homes different status groups on the basic of their economic capabilities to stay free of cost or paid. In order to find out the condition of the old people at their own homes. 68 more respondents &42 more caregiver from the nearby village were interviewed. Old age homes are selected because they are only for the aged people. In this study health in not considered purely as a biological disturbance but viewed in terms of physical & mental activities. To be healthy is be active. To be healthy facilities provide by the home as follows:-

1. Even though meal are provide two times a day, no special care is taken for the nutritive value of the diet. Neither do they offer any supplementary food.

2. The home has arrangement for a visit of govt. doctor, once in 7 days for check-up of the inmates. For simple ailment like fever, cold and pain, medicines are readily available at the institution itself and for other health problems they have to approach other hospitals according to their home preferences. As this type of visit by the doctor is not sufficient to meet their health problems, the inmates go to government hospitals whenever it is necessary.

3. Sanitary conditions & other facilities are not so good. Separate rooms are not available for their members. The rooms walls are not white washed and floors not cleaned properly.

4. However the home has a television set and subscribes to a few magazines & newspapers. The inmates seem to be quite. Content with their facilities and pass their time chatting quarreling. A kind of self-imposed isolation and withdrawal from the external world indicates their disengagements.

5. Unfortunately, the Govt. programmes for the aged welfare have not reached there. The inmates complain that the service provide by the management is not sufficient on taken care of by the institution.

An analysis of the life history of each respondent makes it clear that our senior citizens have a spectrum of problems ranging from physical problem to widowhood. Each case furnishes a unique problem. A careful analysis shows that many cultural aspects function at a negative ride for the old. Lack of economic facilities of the older person with dealing health, makes their plight awful. In order to highlight there aspects a few cases are given below.

Case No. 1Mr. A.G. is 75 yrs. Old. He is a widower & has daughter. When he 62, he lost his partial mobility, then he was burden daughter’s family. Frequent conflicts disturbed the peace of the home and the family members decided to send him off. He was admitted to their home for the aged. His daughter visits him once in a month. Main worry being ill health.

Case No. 2Mr. G is 72 yrs old. He is from Bombay and ex-Govt. employee, He is a widower & his son settled abroad. Then he came to this home for the aged. He is very co-operative; enjoy his life with other members of the Home. He sings well. He has depth of knowledge but there is no way to use knowledge, however, a school also attached with that old age Home.

Case No. 3 Mr. K. is 93 old. He bachelor in perfect, He is Helpful to all inmate, He has joined the home on his own as he disliked the idea living alone.

1. the analysis of the cases above discloses two different & extreme kinds of problems for the senior citizens owing to ill-health & economic inability. On the other side old people get themselves admitted to home because they have no family at all to care for them. Therefore, two things are clear, one in that elderly people want some security & prefer to be under the care of an institution and secondly due to unsound economics position the family considers the old as a burden & send them to Homes. Therefore, economic security is a crucial one in the life of aged.

2. Except for one respondent all the other inmates are found to withdraw themselves from their social contacts. It is self imposed lethargy leading to a condition of possibility, true that they require money and good health for social activities, but the respondents are found to be lacking in private activities like reading, hobbies & visiting temples, except one member who shows interest in gardening. But home has not any income generation programmed to spent inmates time in work.

The needs, problems & the healthy behavior differ among the old according to the place in which they stay. Institutionalized older persons are just one group among the old population in India. There is another picture of old living outside the institutions. The second half of the study analyses the health condition of the aged living in rural areas under non- institutional setting. The data has been collected from Najafgarh, Hasanpur, a village in Delhi. The entire respondents belong to the lower income group. In rural areas the problem is different from the urban centers.

In rural areas, against the common belief of strong joint family living, 80% of the elderly respondents are found to be living separately. Joint living may be convenient for the rich agricultural families. Whenever, in the lower income group, the sons, a few years after marriages, construct separate huts and stay to some one come out their own living and themselves have to someone come out their own living and themselves are not in a position to take care of their parents. Hence there is a compulsion for the parents to accept their lot. They regret and accept that their sons had to toil in the field from morning till night and it is their own fate to remain all alone uncared. 62% of the respondents including women do some work & earn their Livelihood & have their own property.

Case No. 4

Mrs. G. 81 yrs. Old widow, has two sons & two daughters. Sons are working as laborers and are just unable to look after her. Sometimes she may not see them for days. All that she wants just enough food and clothing.

Case No. 5

Mr. H. lives with his wife. As he has some disability, his wife goes to work and looks after him. Their three sons & two daughters’ are of no help to them. Their is need is just care and clothing. His wife health is better than her Husband, earns by some works.

Now, we consider elder care, it is the second & third generational. Who may act as care givers? Therefore, the views or a valueless perception of adult children and grand children of the aged name become critical determinants of quality care. Two decade ago, in 1984, a study was carried out with objective of assessing various elder care issues. It brought to light that the joint family system was dwindling, yet a majority of adult and young children viewed elder care as part of their adult life (Rammorit & Jamuana, 1986). In view of their observation the present study was planned to reexamine the views of adult children, younger persons& also elderly to know whether time had brought any significant change in the perceptions & expectation with regard to few important aspects of eldercare issues. Here it found that to know perceptions/ expectations of the caregiver from generations’ regarding-

a). old age as problem in physical health.b). old age as problem in mental health.c). Institutional care is good.d). Non- institutional is best.

\

Here, it was found 50 men & women as sample from old age home & household areas of Delhi. The household & old age home cases where all three generations were living together. i.e. (20-29) young generations;

(30-39) Middle age group; (40-55) old age group;

The rule sects were individuals contacted & the purpose of the study was explained to them. Then the questionnaire which was used in caregiver role in society. The response were analyses & percentages of responses were calculated.

To realize the first objectives, the respondents were asked to indicate their views an-whether old age problem in physical health. There was a disporting in the views among three generations (young, middle & old). It is noteworthy that age or problem in physical age. (Table:

As a second step, the respondents were asked to indicate as to who would take care of the mental health problem? The responses showed that by & large, the view of Caregivers were about same. (Table.

Nextly, eldercare in old age homes as important substitutes to care of the disable elderly. Next, when it comes to non- Institutional care the young, middle & old age care giver viewing some or less equally that care giving by sons & daughters wee due to their emotional attachment to their aged parents. Eldercare by family members ( other than spouse) will become more of a problem in the coming decades in view of selective migration of children from rural to urban areas. Rapid growth of dual career families and a tendency toward more individualistic life style loosen family ties their increasing intergenerational distance.

Therefore, it is time that we should be thinking of alternative strategies of sharing the care giver border. In view of our National priorities some of the possible strategies of elder care managements are:

1. Community car services like (Geri homes) & caring Network services like (Geana-homeNet) rather than the formal family care services must be encourage in the society by family care provider.

2. Greater emphasis an self care, spouse care & the greater provision for home Help services in rural areas for the disabled.

Result and Discussion:-

Table : 1: Mean & S.D. value on 6 Dimensions of physical Health of three group Of elderly in Old Age Homes, Delhi.

Gr. I Gr. II Gr. III X S.D X S.D X S.DNormal Health (10)

3.75 .433 4.00 .707 3.16 .897

Chronic health (11)

2.62 .487 2.80 .979 2.66 .745

Immobility (12)

3.06 .242 2.70 .640 3.50 .500

Allergies (13) 2.56 .540 2.40 .330 2.66 .745

Physical Problem (14)

3.50 .612 2.70 .781 3.50 .935

Surgical Intervention (15)

2.75 .701 2.40 .489 3.16 .687

Table.1 shows on the whole it may be said that all the three groups of elderly of Old age homes, Delhi have favorable perception towards their normal health. At the same time they are also opinioned that they do not have any kind of problems related to chronic disease and allergies. But the elderly belongs to group I. & III do experience that they do have physical problem as well as problem associated with immobility, whereas such kind of perceptions towards the problem just mentioned have not been observed for the elderly belonging to Group II. Finally, the Table.1 also indicates that elderly belonging to Group II and I do not have any kind of surgical Intervention so far but the elderly belonging to Group III have had surgical intervention.

Therefore, on the basis of the findings of the study, different policies and programmed used to be device and implemented by Government working in area of old age, so that the elderly people of the Old age homes, Delhi can be help to live better live.

Table: 2: Mean S.D value on 6 dimensions of mental health of three groups of elderly in Old age homes, Delhi.

Gr. I Gr. II Gr. IIIX S.D X S.D X S.D

Consciousness (22) 3.18 .634 3.20 .871 3.16 .687

Emotional status (23)

3.00 .500 3.40 .800 2.83 .687

Perception Disturbance (25)

2.81 .634 2.80 .871 2.66 .745

Abstract reasoning(26)

2.81 .526 2.80 .806 3.00 .372

Poor Concentration (27)

2.68 .583 2.80 .748 3.00 .577

Personality Disorder (28)

2.68 .463 2.50 .651 2.83 .372

Table.2 presents the mean and standard deviation of all three groups of the elderly of Old age homes, Delhi have favourable perception towards their mental health. At the same time they are also opinioned that they do not have any problem related Consciousness, perception disturbance, abstract reasoning, poor concentration, and personality disorder.

Table :-3, Mean and Standard Deviation on 6 dimensions of physical Health of elderly in rural areas, Delhi.

Statement No.

Group –I (60-70) Years Group-II (71-80) Years Group-III (81+) Years

Mean S.D Mean S.D Mean S.D

Normal Health (10)

4.53 .498 4.22 .974 4.66 .471

Chronic Health (11)

1.93 .725 2.05 .779 1.33 .471

Allergies (12) 1.93 .665 2.22 .916 1.66 .471

Immobility (13)

2.14 .798 2.27 .869 1.33 .471

Physical Problem (14) 2.45 .917 2.44 1.06 3.00 1.41

Surgical Intervention 2.17 .752 2.38 1.01 3.00 1.41

Table.3 present mean and standard deviation of the perception on physical health status of elderly of rural areas of Delhi in their own family setting. As their own perception on their own physical health status shows normal on all dimensions.

Table –4.Mean and S.D values on 6 dimensions of mental health of elderly in Rural area, Delhi.

Statement No.

Group –I (60-70) Years Group-II (71-80) Years Group-III (81+) Years

Mean S.D Mean S.D Mean S.D

Consciousness 3.89 .682 3.38 .755 3.00 .816

Emotional Status

3.76 .749 3.50 .687 2.66 .471

Perception Disturbance

2.19 .733 2.61 .755 2.33 .942

Abstract Reasoning

2.21 .565 2.68 .463 2.66 .471

Poor Concentration

2.21 .741 3.06 .805 3.33 .471

Personality Disorder

2.25 .626 2.50 .600 2.33 .942

Table.4 present mean and standard deviation of the perception on mental health status of elderly live at rural areas, Delhi as perception of their own mental health status. Here on consciousness and emotional status shows high but Group III has low perception on emotional status.

Table –5: - Mean & S.D. Value on 5 Dimensions of physical and mental health status as observe by care giver of old age home, Delhi

Statement Physical Health

Mean S.D

Mental Health

Mean S.D

Statement

Chronic Disease 3.37 .727 3.87 .330 Wandering

Disability 3.87 .599 3.87 .330 Consciousness

Healthy life style 3.75 .433 3.87 .330 Perception Disturbance

Diabetes Mellitus 3.50 .500 3.87 .330 Construction Ability

Loss Sensory Motor Stimulation

3.62 .484 3.75 .433 Mental Illness with High Income Group

The result in Table.5 present on that caregivers staying at Old age homes, Delhi have their own perception on elderly physical and mental health status. It says that both health status on old age home’s elderly likely to be same.

Table –6:- Mean & S.D. Value on 5 Dimensions of physical and mental health status as observe by care giver of Rural area, Delhi.

Statement Physical Health

Mean S.D

Mental Health

Mean S.D

Statement

Chronic Disease 3.83 .651 3.97 .407 Wandering

Disability 4.07 .642 3.61 .485 Consciousness

Healthy life style 3.97 .555 3.64 .526 Perception Disturbance

Diabetes Mellitus 3.83 .613 3.88 .624 Construction Ability

Loss Sensory Motor Stimulation

3.71 .824 3.52 .499 Mental Illness with High Income Gr.

The Table.6 present on that caregivers perception on elderly physical and mental health status. It says that the rural elderly are suffering from chronic disease, Disability with ageing, Diabetes Mellitus, Loss sensory motor stimulation but contradict on healthy life style lead by elderly of rural area.

Table 7: Mean Difference between self and caregivers perception and observation on physical health of elderly person in old age Home, Delhi.

Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Normal Health (10)

3.63 3.75Healthy Lifestyle (10)

Chronic Health (11)2.69 3.37

Chronic Disease (8)

Immobility (12)3.08 3.87

Disabilities with Ageing (9)

Physical Problem (14) 3.23 3.62

Loss sensory motor stimulation (16)

The result in Table.7 present difference in perception towards physical health problem of elderly by themselves and other caregivers. It says that both elderly and caregiver are the opinion that the elderly have normal health but some kind of physical problem such as loss sensory motor stimulation. But for the chronic health and Allergies, elderly people say that they do not have any kind of such problem whereas the caregivers contradict them while saying that the older person does suffer from problem associated with chronic health.

Therefore, it only on the chronic health problem/ chronic disease that difference in perception on the part of gray person and caregiver have been noticed. So that some kind of efforts in terms of research is required to see why is this difference in perception towards chronic health problem between gray person and caregiver are there.

Table 8: Mean Difference between self and caregivers perception and observation on physical health of elderly person in Rural Area, Delhi.

Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement Normal Health (10)

4.47 3.97Healthy Lifestyle (10)

Chronic Health (11)1.77 3.83

Chronic Disease (8)

Immobility (12)1.91 4.07

Disabilities with Ageing (9)

Physical Problem (14) 2.63 3.71

Loss sensory motor stimulation (16)

Table.8 presents the result on difference in perception towards physical health status of elderly at rural area, Delhi by themselves and caregivers. It says that both elderly and caregiver are the opinion that the elderly have normal health but some kind physical problems as such as chronic health problem, Immobility, Physical problem of elderly perception are less suffer. But for the caregiver perception contradict the elderly perception on those above dimension.

Therefore, some kind of efforts in terms of further study is required to see why this difference in perception toward physical health status between elderly and caregiver are there.

Table 9: Mean Difference between self and caregivers perception and observation on physical health of elderly person in old age Home, Delhi.

Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement

Consciousness 3.18 3.87 Consciousness

Personality Disorder 2.67 3.87 Wandering

Perception Disturbance

2.75 3.87 Perception Disturbance

Poor Concentration 2.82 3.87 Construction Ability

In Table.9 on the whole it may be said that all difference of elderly and caregiver perception towards consciousness of mental health status of Old age homes on favourable. At the same time they are suffering from Wandering, perception disturbance, and construction ability as caregiver’s perception but elderly perception do normal.

Table 10: Mean Difference between self and caregivers perception and observation on physical health of elderly person in Rural Area, Delhi.

Elderly Person’s Response Caregiver Response Statement Average Mean Average Mean Statement

Consciousness 3.42 3.61 Consciousness

Personality Disorder 2.36 3.97 Wandering

Perception Disturbance

2.37 3.64 Perception Disturbance

Poor Concentration 2.86 3.88 Construction Ability

In Table.10 shows result in differences in perception towards mental health status between elderly and caregiver from rural area. It says that both elderly and caregiver are the opinion that the elderly have normal consciousness.

CONCLUSION

In the brief study on the compared of elderly which will arising between physical

and mental health status of elderly as to develop a profile on their observation by

themselves and by caregiver also. This study shows some new findings that denote that

there some problem in the care for the elderly in society as well as in Old age homes. In

geriatric caregiver is new angle, no caregiver available till the project “NICE” was

started. now caregiver is professional like other field i.e. Medical Practitioner,

Physiotherapist, Occupational therapist, speech therapist, psychotherapist, nursing and

other professionals. The data highlight that this geriatric care giver (geriatric

animator) should have right for recognition as service provider, registration for

licensing and scale for payment and security on housing, education to their children,

medical reimbursement, EPF and CPF facilities.

Bibliography

1.Das, N.G, 2000, Statistical Methods, Das Publication, Calcutta.

2.Kothari.C.S.,1997, Research Methodology,Wiswa Prakasan, Delhi.

3.Phipps, Simmons, 1997-98, Primary data-methods of collection, sampling methods,

survey methods and questionnaire design. The Chartered Institute of Marketing.

Butterwerth – Heinemann, Oxford

4.Jamuna.D, 1997, Public perception in care giving, an evaluation, CMIG, Calcutta.

5.Chakraborty, Indrani, 1997,Life in Twilight years,Kwality Book, Calcutta

6. Ramamurty.P.V. and Jamuna.D and Reddy.L.K. 1992, Psychological aspects of care giving and disability among elderly in India.

7. Hogstel.Mildred.O, (1995), Geropsychiatric Nursing, 2nd edition

8. Harlok, Elizabeth, (1982), Developmental Psychology a life span approach,

9. Siva Raju, S, (2002), Health Status of the Urban Elderly, B.R.Publication, Delhi

10. Kausalya. S., Geriatric Nursing, Help Age India, 2002

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12. Dey.A.B. Health guide for the older persons, AIIMS, WHO, United Nations,2002

Appendix

UNITED NATIONS WORLD ASSEMBLY ON AGEING

United Nations is preparing for the Second World Assembly on Ageing scheduled for the

2002. In this process technical committee was formed and this committee has already

formulated certain strategies with priority issues and objectives for the welfare of the

elderly. It is right time for the social gerontologists in India to examine the issues and

strategies formulated by the UN and in appropriate way the same may have to be

included in our own agenda. The UN priority issues are as follows:

Priority Issue 1: Poverty Alleviation

Objective :

● In accordance with the already agreed International Development

Goals, reduce poverty among older persons by 50 percent by 2015

and further targets for the reduction of poverty thereafter.

● Prevent poverty in old age through the appropriate areas of income

security, employment, family and community support.

Priority Issue 2: Income Security and Social Protection

Objectives:

● Established social protection programmes all workers, including

those engaged in informal sector, to acquire the right to basic social

protection, including an old – age pension.

● Institute and expand pension systems and social assistance schemes.

● Guarantee sufficient minimum income for older persons.

Priority Issue 3: Access to Knowledge, Education and Training

Objective:-

● Ensure that older persons, without discrimination by reason of age,

enjoy equality of opportunity and treatment with

regards to continuing education, training, retraining as well as

vocational guidance and placement services.

● Utilize the potential and expertise of older persons in the different

Areas of the economy and society.

● Ensure that methods appropriate to older persons are used in skills

Training.

Priority Issue 4: Work and Social Productivity (observers from ILO and ISSA

would prefer to revert to “labour market” rather than “work”)

Objective

● established the conditions, which enable active participation in the

labour market, (ISSA suggests adding, “this would

include not only increasing the participation of older

workers, but just as importantly,

also that of the unemployed women, persons with disabilities

and other marginalized groups in the labor marker).

● Promote a realistic understanding of the older worker’s productivity

based on their expertise and potential.

● Assist older persons already engaged informal sector activities to

improve their income, productivity and working conditions.

● Assist older persons by engaging them in self – employment.

Priority Issue 5: Active Participation in Development and Society

Objectives:

● Recognize the social, political and economic potential and contribution of

older persons.

● Include older persons in decision – making processes.

● Clarify, quantity, support and recognize contribution of older persons to

development through, inter alia, their role of carers of HIV/AIDS

infected children and grandchildren, as well as their role as surrogate

parents to orphaned grand children. Acknowledgement that these roles of

older persons reflect their essential contribution to the development of

future labour force.

Priority Issue 6: Intergenerational Solidarity

Objective:

● Achieve and sustain intergenerational solidarity.

● Contribute to positive images of ageing by focusing on societal resources

of older persons by using the expertise of elder workers in the labor

market and by fostering the mutual exchange between the

generations.

Priority Issue 7: Rural Development

Objective:

● Alleviate isolation and marginalization of older persons in rural areas.

● Improve life conditions and develop/extend infrastructure in rural

unities in order to diminish out migration of younger persons to

urban

Areas.

Priority Issue 8: Migration and Urbanization

Objective:

● Support late life migrants to avoid their alienation and marginalization and

cognize the hardships created by displacement and late life migration.

(Note: issues of refugees, emergency situations and forced migration need

be addressed here).

● Assist and support older persons affected by urbanization.

Priority Issue 9: Health Promotion and Development Across the Life Course

Objective:

● Increase the prevalence of factors that protect health and well- being

throughout the life course, including the later stages of life.

● Foster health development and health promotion across the life course to

maximize healthy ageing.

● Develop disease prevention policies.

● Reduce prevalence of risk factors associate with major diseases in the

ageing process.

Priority Issue 10: Universal and Equitable Health Care Services Vital to

Development.

Objective:

● established a range of services to meet the diverse health needs of older

People to maximize their health and functional abilities.

● Ensure fair access to health care.

Priority Issue 11: Primary Health Care

Objective:

● Develop and strengthen primary health care to meet the needs of older

people.

● Provide primary care workers with knowledge, training and the necessary

resources to meet the needs of older persons.

Priority Issue 12: Impact of HIV/AIDS on older Persons and Society

Objective:

● Clarify, through research and accurate data collection, the impact of

HIV/AIDS on the health of older persons, both for those who are

infected suffers training, medical care and social support.

● Ensure that older persons who are affected by HIV/AIDS, both sufferers

and carers, receive adequate support in areas such as information,

care s skills training, medical care and social support.

Priority 13: Training of Health Care Providers

Objective:

● Introduce specific and appropriate knowledge of ageing to all health and

social service providers.

● Prepare specialists in gerontology and geriatrics who are also skilled in

interdisciplinary areas.

● Create awareness in the population at large regarding the special needs

and caring for the elderly.

Priority Issue 14: Mental Health, Cognitive and Affective Needs of Older

People

Objective:

● Ensure that appropriate care is provided to older persons with mental

cognitive disorders, including their emotional needs.

● Promote early detection, diagnostic and measurement.

● Create a network of informal and formal care providers.

Priority Issue 15: Older Persons and Disabilities

Objective:

● Prevent disabilities and reduce its prevalence in old age while reducing

disabling consequences through life course.

● Provide appropriate care, rehabilitation and community – based support

services for older disabled persons, as well as for persons with

disabilities reaching old age, so as to ensure fulfillment of their rights to

appropriate services and to integration into society without any discrimination

based on age and disability.

● Obtain knowledge and information and conduct evaluation projects on

older persons with disability and on effective policies, practices and

technologies, enabling their habilitation and integration into society.

Priority Issue 16: Well – being and Self-fulfillment in Old Age

Objective:

● The attainment of full participation of older persons in economic, social

and political affairs in the community and society.

● Provide opportunities and services for self – actualization.

● Promote holistic care for older persons, taking into account the

interdependence of physical, mental, social, spiritual and

environment

factors.

Priority Issue 17: Housing and Living Environment

Objective:

● Strengthen support for interdependent living (and ageing in place) in the

community, with regards given to individual preferences.

● Ensure that housing and environment design cater for the needs of ageing

persons. [OR: that environmental conditions and human settlements

be ● adapted to an ageing society] Ensure the availability of accessible

and affordable transportation for older persons.

● Ensure equitable allocation of public housing for older persons.

Priority Issue 18: Care

Objective:

● Ensure the provision / availability of community – based – care – not to

substitute, but to support family care.

Ensure minimum care standards and regulation of residential care and all

other forms of care.

● Recognize the burden of care falling on older women [in situations of

AIDS, etc].

● Promote holistic care for older persons, taking into account the

interdependence of physical, psychological, social spiritual and

environment factors.

Priority Issue 19: Abuse and Violence

Objective:

● Eliminate all forms of abuse against older persons

Priority Issue 20: Intergenerational Relations

Objective:

● Strengthen intergenerational ties in family and community

● Ensure that policy and services support (harmonious) intergenerational

family relations.

Priority Issue 21: Positive Images of Ageing

Objective:

● Promote public awareness of the positive contribution and resources of

older persons, including older women and older persons with

disabilities.

● Eliminate negative stereotypes of older persons in the mass, media,

particularly older women.

Priority issue 22: Emergency Situations

Objective:

● Ensure that appropriate attention is paid to older persons in emergency

situations.

Priority Issue 23: Well _ being and self – fulfillment in Old Age

Objective:

● The attainment of full participation of older persons in economic, social

and political affairs in the community and society

● Provide opportunities and services for self- actualization.

QUESTIONNARIE No. ………………

Following are the statements that reflect upon how you feel/experience about yourself and the world around. Read each statement carefully and do register your reply the response alternative immediately. There is no right/wrong answer to any of the question in this questionnaire.

1. Name ……………………………

2. Age……………………………… 3. Sex………………

4. Martial status……………… Married/unmarried/Discovered/widow

5. Religion Hindu/ Muslim/Christian/Buddha/Jain

6. Qualification….. Illiterate/ Primary/ Secondary/University

7. Property…… Yes /No;

8. Occupation……. Employment/Rtd/professional.

9. Income = >50,000 p.a

>72,000 p.a

>1, 00,000 p.a

10. I think that my health is normal:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

11. I have chronic health problem:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree;

12. I have immobility:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

13. I have allergies (food/Medicine, if any)

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

14. I have physical problem:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

15. I have surgical intervention:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

16. I take care of myself:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

17. I have loss of appetite:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree; 18. I am abused by family members:-

a). Strongly Agree; b). Agree; c) Undecided; d) Disagree; e) Strongly disagree;

19. I am well in my family:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree;

20. I feel dissatisfaction with life:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e) Strongly disagree;

21. I have alertness and good orientation:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

22. My level of consciousness is good:-

a). Strongly Agree; b). Agree; c).Undecided; d) Disagree; e). Strongly disagree;

23. My emotional status is fine –

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

24. I have no problem with construction ability of talking:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). strongly disagree;

25. I have perception disturbances:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree: e). strongly disagree;

26. I have abstract reasoning, insight, jugdement:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

27. I have poor concentration:-

a). Strongly Agree; b). Agree; c). Undecided; d) Disagree; e). Strongly disagree;

28. I have suffered from personality disorders:- a). Strongly Agree; b). Agree; c) Undecided; d) Disagree; e). Strongly disagree

INTERVIEW SCHEDULE N0……………….

Your answers to the questions will help me in our research. I am interested in how you are feeling generally in your role here.

Caregiver Name__________________________ Age____________ Sex______________Elderly Name____________________________ Age____________ Sex______________Address___________________________________________________________________________________________________________________________________________Relation with the elderly___________________________________________________ Type of problem: Physical/Mental Health.

1. I think that older person’s age will be 60yrs. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

2. I give total response to older person.

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

2. I feel uncomfortable with elderly. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

3. I spent my time with daily activities of elderly person. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

4. Older persons make trouble. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

5. I have seen wandering behaviors in older adults a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

6. I suggest supportive counseling to wanderers. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

7. I think that older person suffer chronic disease. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

8. Older persons are facing disabilities with ageing. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

9. Older persons lead healthy lifestyle. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

10. Maximum older persons facing Diabetes Mellitus. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

12. I believe older adults have lived long life and promote less care or no care. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

13. I think that legal provision for geriatric care giver right is very important.

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

14. ‘Relocation’ one of the major factors that leads to stress in older adults. a). Strongly Agree; b). Agree; c). Undecided;

d). Disagree; e). Strongly disagree; 15. ‘Group-meeting’ in activity room promoting “self-esteem”.

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

16. Older adult loss sensor motor stimulation.

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

17. I feel strain with elderly care for inadequate support service. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

18. Older adult loss their consciousness level.

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

19. Older adults have perception disturbances. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

20. Older adults have problem with construction ability of talking. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

21. Older adults take help with instrumental daily activities like-computer operating, telephone

a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

22. Older persons favour Govt. hospital & modern medicine, more. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

23. Mentally illness more affect high income group elderly. a). Strongly Agree; b). Agree; c). Undecided; d). Disagree; e). Strongly disagree;

APPENDIX ‘B’

SHORT PORTABLE MENTAL STATUS QUESTIONNAIRE (SPMSQ)

Instruction: Ask question 1-10 in this list and record all answer. Ask question 4A only

if patient does not have a telephone. Record total number of errors based on ten

questions.

1. What is the date today?

2. What day of the week is it?

3. What is the name of this place?

4. What is your telephone number?

4a What is your street address?

(Ask only if patient does not have a telephone)

5. How old are you?

6. When were you born?

7. Who is the pradhan / councelor now?

8. Who is the pradhan / councelor before him?

9. What was your mother’s maiden name?

+ _

10. Subtract 3 from 20 and keep subtracting each

new number all the way down.

Total Number of Errors

To be completed by Interviewer.

Patient’s name Date

Sex: Male Female

Years of education: 1. Primary school.

2. High school.

3. beyond High School.

Interviewer’s Name:

0-2 errors intact intellectual functioning.

3-4 errors Mild intellectual impairment.

5-7 errors Moderate intellectual impairment.

8-10 errors High intellectual impairment.