EFFECT OF ACTIVE AGEING PROGRAM IN IMPROVING GERIATRIC DEPRESSION

SCORE IN COMMUNITY DWELLING ELDERLY

Dr Alakananda Banerjee

President

Dharma Foundation of India

INTRODUCTION The Indian aged population is currently the second largest in the world. The

absolute number of the over 60yrs age group in India will increase from 76 million in 2001 to 137 million by 2021..

Depression is a common mental disorder that presents with depressed mood, loss of interest, pleasure, feeling of guilt or low self worth, disturbed sleep/appetite, low energy and poor concentration.

According to WHO, these problems can become chronic or recurrent and lead to substantial impairment in an individual’s ability to take care of his/her everyday responsibilities.

Community based mental health studies have revealed that the point prevalence of depressive disorders amongst the geriatric population in India varies between 13-25%.

According to WHO remaining active means maintaining one’s physical , social and mental potential throughout the entire lifecycle, allowing the involvement of elderly in social, economic, cultural, spiritual and civic activities.

GERIATRIC DEPRESSION SCORE

The GDS is a 30-item self report assessment tool used to identify depression in elderly and is thereby used as a standard outcome measure in the current study.

GDS is not a substitute for a diagnostic interview by mental health professionals.

It is a useful screening tool in the clinical setting to facilitate assessment of depression in older adults especially when based measurements are compared to subsequent scores.

It does not assess for suicidal tendencies.

Active ageing is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.

•Aim of the Study: To find out the effect of Active Ageing Program in Improving Geriatric Depression Score in Community Dwelling Elderly

•Significance of the Study:If this study is found to be effective then Active ageing model can be promoted in the community which in turn will reduce depression in old age, making the elderly active, and allowing the involvement of the elderly in social, economic, cultural, spiritual and civic activities.

METHODOLOGY Study design: A longitudinal study design Sampling method: Convenience sampling Sample size: 119 community dwelling elderly Place of study: Delhi and NCRInclusion criteria: Elderly (age 60 years or above) of any socio economic strata willing

to participate in the study Ability to read and write either English or Hindi

Exclusion Criteria Subject opting out of the study Subject totally dependent for his activities of daily living, requiring

institutional support and care MMSE score <23

Outcome measures: Geriatric Depression Scale (30 item)

14 awareness programs/ workshops on chronic health and

social issues

14 awareness programs/ workshops on chronic health and

social issues

Elderly attending the lectures/ workshops on regular basis were

enrolled with a written and signed consent form

Elderly attending the lectures/ workshops on regular basis were

enrolled with a written and signed consent form

LS 1

10

….LS 12

1192020

1 110

LS 2

1111

Local supervisors (LS) selected from the targeted

group of elderly

GDS was administered to all the subjects at the time of enrollment and subsequently after 6 months

Textbooks were compiled based on the workshops held in the community were printed in English and Hindi

language

Textbooks were distributed to disseminate the information

Group activity sessions were also held in the community to promote interaction between the local

supervisors and their respective groups.

Follow up of the health and social issues were also done in these group activity sessions

RESULTS

n=119

Demographic distribution

n=119

Demographic distribution

Pre Mean: 4.87±6.086Post Mean: 2.57±4.619

Pre Median : 3 (0-7)MQRPost Median :0 (0-3)MQR

Mean comparison of GDS score in different types of families

Median comparison of GDS score in different types of families

Severity of Depression

Paired t- test showed that the change in GDS score was statistically highly significant (p=0.000); t value=5.12

DISCUSSION WHO has promoted a process of optimizing opportunities for

health , participation and security amongst the elderly with an aim of improving their quality of life.

According to a study conducted at the department of Medicine and Prevention, University of Brazil, having higher schooling of subjects (24.2%) and having an average monthly income greater than 5 minutes was associated to better performance in the environment domain of the QOL.

According to the Xavier et al having good health, good family relationships, financial security, friends and work ability are determinants of good and healthy living amongst elderly.

With the aim of imparting active ageing model within the community, we ensured that the targeted elderly population practices self care by taking valuable information though the workshops and later with the respective textbooks distributed.

Mutual help therefore promises providing necessary information regarding health, social and economic issues to other elderly within the community, also having a follow up of the neighbor elderly in terms of their health and further reporting to the local supervisor/ leader who is in turn connected to the nodal person in the healthcare.

Self promotion finally takes it’s shape where the self care and mutual help completely established.

By promoting one’s own health as well as the health and social status of the co-neighbour/ elderly raises his/ her standards of better living in the community reducing the urgent/ immediate panic at the time of emergency and also increases the bonding which ensures individual’s self promotion.

In our study we observed a great improvement in the GDS score within the elderly population. Parents/ elderly staying alone at home showed a higher score on the GDS as compared to the elderly living in a joint family.

There is significant improvement in the GDS values Pre and Post Intervention at the difference of six months.

Normal (0-9)

Mild (10-19)

Severe (19 above)

Pre 76.5% 18.5% 4.50%

Post 85.7% 9.20% 2.50%

CONCLUSION

Active Ageing Model is a success to reduce depression in community dwelling elderly population

The present study revealed that the elderly living in a nuclear family system are more likely to be depressed as compared to those in a joint family system.