A STUDY TO ASSESS THE KNOWLEDGE OF

PERCEIVED HEALTH PROBLEMS AMONG ELDERLY PEOPLE &

FACILITIES PROVIDED TO THEM IN SELECTED OLD AGE HOMES
IN BANGALORE CITY.

By

Mona Prabhakar Londhe.

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences,
Karnataka, Bangalore.

In Partial fulfillment of the requirements for the

degree of

MASTER OF SCIENCES

In

MEDICAL SURGICAL NURSING.

Under the guidance of

Prof. SHEELA THANGAM

Msc (N)

DEPARTMENT OF MEDICAL SURGICAL NURSING

NAVANEETHAM COLLEGE OF NURSING HORAMAVU
BANGALORE 43.

APRIL 2010.
 I

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A STUDY TO

ASSESS THE KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS

AMONG ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN

SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide

and genuine research work out by me under the guidance of Prof (Mrs)

Sheela Thangaym, Department of Medical Surgical Nursing, Navaneetham

College of Nursing, Hormavu, Bangalore 560043.

Date: - Signature of the Candidate

Place: - (Mona Prabhakar Londhe)

II
 CERTIFICATION BY THE GUIDE

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE

KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS AMONG

ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN

SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide

research work done by Mona Prabhakar Londhe in partial fulfillment of

the requirement for the degree of Master of Science in Medical Surgical

Nursing.

Prof (Mrs.) Sheela Thangam,

Head of Department of
Medical Surgical Nursing,
Navaneetham College Of Nursing.

Place:-Bangalore

Date:-
 III

ENDORSMENT BY THE HOD,

PRINCIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A STUDY TO ASSESS THE

KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS AMONG

ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN

SELECTED OLD AGE HOMES IN BANGALORE CITY” is a bonafide

research work done by Mona Prabhakar Londhe, under the guidance of Prof

(Mrs.) sheela thangam, Department of Medical Surgical Nursing,

Navaneetham College Of Nursing Hormavu Bangalore 560043.

Seal & Signature of the HOD. Seal & Signature of the

Prof.Sheela Thangam. Principal,
Msc (N) Prof. (Mrs) Indira.V
Department of Medical Surgical Nursing
Professor and Head, of Nursing.
Department of Medical Surgical Nursing,
Navaneetham College Of Nursing, Hormavu,
Bangalore 43.

Date: - Date:-
Place: - Place:-
 IV

COPYRIGHT

Declaration by the Candidate

I here declare that the Rajiv Gandhi University of Health Science, Karnataka

shall have the rights to preserve, use and disseminate this dissertation in

print or electronic format for academic/research purpose.

Place: - Bangalore.

Date: - Signature of the candidate

(Mona Prabhakar Londhe)

@ Rajiv Gandhi University of Health Sciences, Karanataka, Bangalore.

V
 ACKNOWLEDGEMENT

“I have cared for you since you were born. Yes, I carried you before you
were born. I will be your God throughout your lifetime – until your hair
is white with age. I made you, and I will care for you. I will carry you
along and save you.” Isaiah 46:3-4.

First of all I Humbly Praise and Thank the Lord Almighty for his great
support, strength and Knowledge he has provided me to complete my study.

Gratitude can never be adequately expressed in words but this is only the
deep perception which makes the words flow from ones inner heart.

I express my sincere thanks to Mrs.Navaneetham Raju, for her continues

Love and Encouragement for me to complete the study.

I specially thank the chairman, Mr.Sampath Raj, and the Secretary, Mrs
Kavitha Sampth Raj, for their continues support to complete my study.

I would like to express my profound sense of gratitude and heartfelt thanks

to my esteemed teacher and research guide Prof. (Mrs) Sheela Thangam,
Head of Department of Medical Surgical Nursing, for her remarkable
teaching capabilities,expert guidance, valuable suggestions and support
throughout the period of this study. Her motivational effort, generous
assistance, clues to proceed further, have proved a great source of inspiration
to me in completing this study.
 VI

I extend my whole hearted thanks to Prof. (Mrs) Indira.V, Principal, and

Navneetham College of Nursing for her motivation, expert valuable
suggestions, formations of ideas and thoughts and continuous and keen
interest in my dissertation work.

I extend my heartfelt thanks to Prof. (Mrs) Plantina David, Department of

Medical Surgical Nursing for her continues guidance and advice during
study.

I extend my whole hearted thanks Prof, (Mrs) Milka Madhale, Vice

Principal, KLES Institute of Nursing Science Belgaum, for her timely advice
for the successful completion of the study.

I especially thanks for the entire expert Professors for there valuable
suggestions and guidance for completion of study.

My sincere thanks to our Administrative Officer, Mr Bernadsha and other a

faculty members of Navaneetham College of Nursing.

I express my gratitude and heartfelt thanks Mr. Umapathy, Statistician, for

his guidance and co-operation to complete the study.

I especially thank to our librarian (Mrs) Jayanti for permitting and

facilitating me to make use of the reservoir of knowledge.

I extend my heart felt thanks to Mother Anntonet, The Superior of Little

Sister of the poor Home for the age Hosur road Bangalore. And all the
Sisters for there co-operation, love, and encouragement during my study.
 VII
I specially extend my thanks for all the Inmates from Little Sisters of the
Poor Home for the Age who gave me lots of love and co-operation during
my study period.

My special deep heartfelt and humble thanks for my beloved husband Mr.
Noel Rodgers who has supported me and the reason for all this hard work
His constant prayer, love, sacrifice, encouragement and support without
which this study would not have been possible.

My vocabulary fall short of right words to express my immense debts to my

father, mother, father-in-law, mother-in-law and all brother-in-laws,
who are the reason for all this hard work and study.

Last but not the least, my sincere gratitude and thankfulness to all well
wishers, friends and relatives for their prayers and best wishes which
helped me to carry out my study.

I extend my thanks to the faculty of Navaneetham College of Nursing for

there encouragement and support.

Place: - Bangalore. Mona Prabhakar Londhe.

Date:-
 VIII
RESEARCH ABSTRACT

A large percentage of today's aging population continues to live

independently despite a variety of chronic health problems. Both age and

disease related changes that affect the elderly's image of themselves; societal

values and life experiences also play a role. Health maintenance is an

ongoing challenge for these people, their families and health care providers.

Health care for a growing elderly population is also of concern throughout

the world. Individuals may have different views regarding ageing and

elderly, which reflect in the attitudes of people including aging person and of

health care providers.

Careful assessment of the aging person's perception of his or her health,

health practices, and knowledge of safety factors affecting their own health

is an important part of primary care in all settings, for especially family

practitioner (FPs) and nurses. Early detection of problems and early

intervention can prevent more serious complications and enable older adults

to maintain the highest possible level of wellness and function. Nurses and

FPs possess the knowledge, skill and caring to build a powerful

understanding-communication with the seniors and to design, to implement

IX
alternative cost-effective elder care environments or direct in old age home

and facility services.

Aim
The aim of this study was to assess the knowledge of perceived Health

Problems among elderly people and level of satisfaction of facilities

provided to them in old age homes.

Objectives Of the study.

1) To assess knowledge of perceived Health problems among elderly

people.

2) To assess the level of satisfaction with the facilities provided to the

elderly people in the old age homes as expressed by them.

Methods
The study was conducted at Little sisters of the poor Home for the

aged, Hosur Road Bangalore. The sample was selected by using purposive

sampling technique was utilized; Data collection was done for a period of

one month. Formal written permission from Little sisters of the poor home

for the aged authorities was obtained prior to data collection. data was

collected using structure interview schedule with a few open ended items

was designed to assess perceived health problems of elderly, and the

satisfaction with facilities provided to them in old age home. Data was

analyzed using descriptive and inferential statistics.

Results
The results of this study shows in the physiological, psychosocial and

financial situation among people aged 60 and above years or older, Health

conditions, quality-of-life measures (QOLM) and housing problems

affecting it are presented. Nearly one-third of the elderly people could not

read a newspaper with or without glasses, more than one-third had impaired

hearing, 47% had some sort of mobility problem (MP) and 66% reported

some form of sleeping problem (SP). 42% felt lonely sometimes or often and

65% were worried, in most cases about the risk of falling. In spite of this,

87% rated their health as good and 79% were content or rather content with

their situation. Even though eyesight and hearing problems were common in

this study, they did not affect perceived health to any large extent. Mobility

problems (MP) and sleeping problems (SP) had a greater impact. The most

important factors related to perceived health (PH) were activity score,

contentment and mobility problems. Contentment was affected by activity

score and loneliness and the latter was in turn affected by age and type of

dwelling. The practical implication of these findings is that perhaps more

attention should be focused on efforts to improve old people's satisfaction

with their life situation rather than on marginal improvements of their

medical situation.

XI

Interpretation and conclusion

Assessment of the perceived health problems (PHP) of elderly people

means to assess or to study the health problems which are related to age

factor.

For eg. In today’s life there are so many elderly people facing the health
problems such as hearing loss or impaired hearing nearly one third of elderly
people could not read a news paper with or without glasses
Some had some sort of mobility problem & some form of sleeping
problem ,some felt loneliness ,in most cases were worried about the risk of
falling ill in spite of their good health, the remaining were adjusting with
there situation, eventhough eyesight & hearing problem is common old age
is similar to child hood, children are treated by pediatrician &similarly the
aged are treated by geriatrician. Early diagnosis is always a better chance for
cure, prevention of the diseases& complications these assessments can help
to identify early sign & symptoms of diseases. It is good to assess there
physical, economical, emotional background, old age homes are a necessity
in the present day scenario as the younger generation do not have the time or
in many cases the resources to meet their needs (like medical expenses,
special food etc). But old age homes should be considered only as a
secondary option. Elders in the family are definitely an asset. It is they who
can impart the much needed ethical values and code of conduct in the
younger generation. Old age homes as an option should be considered only
for the betterment of the senior citizens (SC) by way of better physical and
mental status, greater possibility for social bonding etc. Under no pretext

XII
Should the aged be made to feel that they are a burden and hence turned
away. Builders can also consider allocating a few houses for the senior
citizens within an integrated township (at subsidized rates), so that the
feeling of isolation goes away while proximity to dear ones is maintained.

Key Words
Perceived health problems, Old age homes, senior citizens, social
bonding, and proximity.
 XII
TABLE OF CONTENTS

Chapter No. Title. Page No.

1 Introduction

2 Objectives

3 Review of literature

4 Methodology

5 Results

6 Discussion

7 Conclusion

8 Summary

9 Bibliography

10 Annexure

XIV
 LIST OF ABBREVATIONS USED

QOLM - Quality-of-life measures.

MP - Mobility Problem.

SP - Sleeping Problem.

PHP - Perceived Health Problem.

SC - Senior citizens.

OAG - Old Age Home.

XV
 LIST OF FIGURES
Figure Title. Page No.
No.
1 Conceptual frame Work.
2 Distribution of samples according to Age.
3 Distribution of samples according to Gender.
4 Distribution of samples according to the Education.
5 Distribution of samples according to the Marital Status.
6 Distribution of samples according to the Previous Occupation.
7 Distribution of samples according to the Duration of Stay.
8 Distribution of samples according to the Financial Dependency.
9 Distribution of samples according to the Self Care Activities.
10 Distribution of samples according to History of health illness.
11 Distribution of samples according to Dietary status.
12 To assess the knowledge of the elderly people on perceived
health.
13 To identify the facilities provided for the elderly people in old
age home.
14 Association between age and knowledge level of elderly
people.
15 Association between gender and knowledge level of elderly
people.
16 Association between Marital status and knowledge level of
elderly people.
17 Association between education and knowledge level of elderly
people.
18 Association between occupation and knowledge level of elderly
people.
19 Association between previous occupation and knowledge level
of elderly people.
20 Association between duration of stay and knowledge level of
elderly people.
21 Association between financial dependency and knowledge level
of elderly people.
22 Association between self care activities and knowledge level of
elderly people.
23 Association between history of health illness and knowledge
level of elderly people.
24 Association between dietary and knowledge level of elderly
people.
25 Age Pyramid
 XVI
LIST OF TABLES

Table No. Title Page No.

1 Analysis of sample characteristics of elderly people
regarding demographic variables
2 To assess the knowledge of the elderly people on
perceived health.
3 To identify the facilities provided for the elderly people
in old age home.
4 To find the association between the knowledge of old
age people on perceived health problems and
demographic variables.

LIST OF ANNEXURES

Annexure Title Page No.

No.
1 Letter seeking permission to conduct the research study.
2 Letter requesting expert opinion to establish content
validity.
3 Letter granting permission to conduct the research
study.
4 Letter requesting opinions and Suggestions of experts
for establishing content validity of the research.
5 Letter requesting participation of the elderly people in
the study.
6 List of content validators of the of the prepared tool.
7 Letter of permission of Joint Director of Lal Bag for
Flower Show for elderly people.
8 Photos of Researcher while assisting to elderly people
in Little Sisters Of The Poor Home For The Aged.
XVII
 1 INTRODUCTION

Need for the study

Assessment of the perceived health problems of elderly people means

to assess or to study the health problems which are related to age factor.

For eg. In today’s life there are so many elderly people facing the health

problems such as hearing loss or impaired hearing nearly one third of elderly

people could not read a news paper with or without glasses

Some had some sort of mobility problem & some form of sleeping

problem ,some felt loneliness ,in most cases were worried about the risk of

falling ill in spite of their good health, the remaining were adjusting with

there situation,eventhough eyesight & hearing problem is common old age

is similar to child hood, children are treated by pediatrician &similarly the

aged are treated by geriatrician.

Early diagnosis is always a better chance for cure, prevention of the

diseases& complications these assessments can help to identify early sign &

symptoms of diseases. It is good to assess there physical, economical,

emotional background

In India about 7.5%of the population is above 60years and the life

expectancy is increasing gradually In India the aged prefer to live with their

children, sons consider it their duty to look after their aged parents they do
not allow them to be sent to old age homes the join family is the

predominant house hold from in rural and urban areas and even in the slums

but when elderly do not have family members to care for them old age

homes are their last resort .India is the second most populous country of the

world after china, at the turn of this century, the number of persons aged

60years and over was 12.1 million of these 5.5 million were male and 6.6

million were female and further to 75.9 million in 20011.

Old age was never a problem in India. Old age homes were alien in

concept and elder abuse was considered a Western problem. Not any more.

As life expectancy has increased from 41 years in 1951 to 64 years today,

hundreds of old age homes have sprung up in India. Neglect of parents has

become a big issue, so much so that the Indian government has passed "The

maintenance and welfare of parents and senior citizens bill 2006", which

makes it imperative for adult children to look after their parents. Healthy

ageing is not only related to the advances in medical technology but also to a

wide range of other factors like enabling the aged to lead a stimulating life,

being fully involved in society and having meaningful social relationships2.

Indian government is waking up to meet this challenge head on. At

present over 500 NGOs are given grant-in-aid to provide services like old

age homes, day care centers, medical facilities etc for the aged. The Delhi-
based International Federation on Aging has been campaigning for free

health care for senior citizens; decrease in the age limit for pension; a bigger,

respectable living allowance; change in the eligibility criteria so that even if

the combined family income is Rs.8,000 the senior citizen is entitled to

pension, creation and implementation of a social security scheme and so on.

Old age homes are a necessity in the present day scenario as the

younger generation do not have the time or in many cases the resources to

meet their needs (like medical expenses, special food etc). But old age

homes should be considered only as a secondary option. Elders in the family

are definitely an asset. It is they who can impart the much needed ethical

values and code of conduct in the younger generation. Old age homes as an

option should be considered only for the betterment of the senior citizens by

way of better physical and mental status, greater possibility for social

bonding etc. Under no pretext should the aged be made to feel that they are a

burden and hence turned away. Builders can also consider allocating a few

houses for the senior citizens within an integrated township (at subsidized

rates), so that the feeling of isolation goes away while proximity to dear ones

is maintained.
 Help Age India is the leading advocate for Older People’s rights. We

speak up for India’s 90 million (current estimate) grey population to help

them live with dignity, independence & self-fulfillment3.

So the main Perceived health problems of the elderly people listed

below.

1. Hearing loss.
2. Impaired vision.
3. Impaired physical mobility, confusion, depression, & cognition.
4. Dementia.
5. Delirium.
6. Alzheimer’s disease.
7. Forgetfulness
8. Abnormal behavior.
9. Mentally ill.
10.Loneliness.
11.Hypertension.
12.Diabetes mellitus.
13.Acute myocardial Infarction.
14.Stroke.
15.Hyper & Hypothyroidism.
16.Chronic pulmonary problems
17. Atherosclerosis related diseases & urinary tract infection.

18.CRF and ARF.

 So every elderly person likes to breath his last in dignity, This study

aims to detect the status of health of elderly people and providing proper

nursing care and health screening services in selected old age homes in

Bangalore city4.

Background of the Study.

Studies have described Home for the aged service as a frequently cited

unmet need, ours is the first to identify factors associated with the likelihood

of having unmet need for hospitalization service based on Our findings

suggested that equal use of hospitalization service for equal needs has not

been achieved, and that respondents with unmet need were mainly ‘lower-

educated’, ‘fewer enabling resources’ and ‘more needs’. Consequently, four

types of intervention aimed at reducing unmet need for Home for the aged

service are recommended.

1. Conduct health education: health education interventions can

increase seniors' knowledge of identifying symptoms of illness, and

provide the information about the availability of hospitalization services.

Accordingly, seniors with increased knowledge and information can

more effectively use hospitalization service.

2. Create social support: because of the importance of the social

support in lowering unmet need for elderly home and hospitalization

service, health educators should work more closely with the local

community to design culturally appropriate methods for health-

promotion activities to reach the elderly population and their families.

3. Promote community participation: the community should be

involved in the policy-making process. As India continues to implement

policies for reducing inequalities in healthcare, its experiences should be

closely monitored and evaluated. Involvement of communities in policy

evaluation is desirable to really meet the need of the people. Especially,

in the design of allocation of health-care resources, the voices from the

rural population, especially the poor, need to be heard.

4. Promote inter-sectional cooperation: inter-sectional collaboration

and cooperation with other departments should be enhanced. In India it is

especially important to have harmonious coordination between sectors

because there are at least four departments (including Departments of

Health, Women's Federation, Committee on Aging Population) at the

community level that are related to health issues of the aging population.

For example, in conducting health education, effective communication is

needed between the Departments of Health and Propaganda5.

This study, we used self-reports of diagnosed chronic disease as the

objective, professional evaluation of need. Respondents were asked

long-term conditions that had lasted or were expected to last 6 months

or longer and that had been diagnosed by a health-care professional.

Interviewers read a list of conditions and the number of positive

responses that respondents answered to the 30 specific conditions plus

an ‘other, specify’ option were summed and categorized as 0, 1, 2 and

3 or more. The 30 chronic conditions considered were: hypertension,

gastric ulcer, diabetes, gallstone disease, arthritis or joint conditions,

stroke, bone hyperplasia, osteoporosis, chronic faucitis,

intervertebraldisc disease, chronic bronchitis, chronic pulmonary heart

disease, pulmonary emphysema, asthma, coronary heart disease,

anemia, chronic hepatitis, hyperthyroidism, Alzheimer's disease,

depression, anxiety, cataract, prostate hyperplasia, womb flesh tumor,

cervical cancer, lung cancer, liver cancer, breast cancer, stomach

cancer and colorectal cancer6

 2 OBJECTIVES

Statement of the problem

A STUDY TO ASSESS THE KNOWLEDGE OF PERCEIVED HEALTH PROBLEMS

AMONG ELDERLY PEOPLE & FACILITIES PROVIDED TO THEM IN SELECTED

OLD AGE HOMES IN BANGALORE CITY.

Objectives of the study.

1) To assess knowledge of perceived Health problems among elderly

people.

2) To assess the level of satisfaction with the facilities provided to the

elderly people in the old age homes as expressed by them.

Operational Definitions

Perceptions

Refers to the Elderly people’s faculty of awareness, understanding and

insight in to their health problems and the facilities provided to them in old

age homes.

Health Problems

Refers to the verbal responses of any difficulty experienced by elderly

people regarding physical, physiological, psychological economical and

spiritual as measured using a structured interview schedule and rating scale

with a few open ended items.

Elderly People.

Refers to male and female individuals over 60years of age residing in

the old age homes under the change of care givers.

Elder Abuse

Many types of abuse construe the definition of elder abuse. In general,

elder abuse may be defined as any physical, psychological, or material abuse

toward an elderly person. Additionally, violation of the elder’s right to

safety, security, and adequate health care constitutes elder abuse (Anderson,

Glanze, & Anderson, 1998, p. 2DE8).

Verbal/Psychological Abuse

Verbal abuse or psychological abuse is characterized by inflicting

mental anguish (Wolf, 1996). Humiliation, intimidation, yelling, and threats

are some of many examples of verbal abuse. Keeping an elderly person

isolated from others can also cause psychological distress and lead to more

serious issues such as depression

Financial Abuse

The illegal or improper exploitation and use of funds of an elderly

person denote financial abuse (Wolf, 1996). Theft, fraud, and taking

advantage of a cognitively impaired older person for profit or personal gain

constitute financial abuse. Financial abuse of the elderly tends to occur

overtime rather than a single, overt act such as robbery, purse snatching, or

car jacking.

Neglect/Self-Neglect.

Neglect by others or by oneself is characteristic of elder abuse.

Refusing or failing to fulfill care-taking obligations, aged adults were more

likely to perceive psychological abuse as being harmful to the victim than

younger adults.

Facilities

Refers to an environment with opportunities or means for necessities,

comfort and rest, that include food, living, care in health and illness and

recreational facilities.

Old age homes

Refers to institutions where the elderly people reside and are care for

Satisfaction

Refers to the extent of fulfillment or contentment with the facilities

provided to the elderly people residing in old age homes as measure using a

structured interview schedule.

Assumptions
 1) The elderly people living in old age homes to have health needs.

2) The elderly people have varying self care abilities and functional

performance.

3) The elderly people participating in the study will be willing to

express their health problems and the level of satisfaction of

facilities provided to them in old age homes.

Hypothesis

H1) The elderly people living in old age homes to have health needs.

H2) The elderly people have varying self care abilities and functional

performance.

H3) The elderly people participating in the study will be willing to express

their health problems and the level of satisfaction of facilities provided to

them in old age homes.

Scope of the study

1) This study will provide a data base for planning and organizing health

services for the elderly.

2) The study will provide a baseline to find out the perceived health

problems of the elderly people and facilities provided to them.

 3) The study will also motivate caregivers and significant others, to be

aware of the perceived health problems of the elderly people and be

able to render adequate care.

4) Identification of the perceived health problems and facilities,and

subsequent planning, implementation and evaluation will improve the

quality of care to the elderly people in old age homes.

Conceptual Frame Work.

For structuring the predictor variables of the study, we rely on the

behavioral model of health service use developed by Andersen as the

conceptual framework. This model suggests that people's use of health

services is a function of their predisposition to use services, factors which

enable or impede use, and their need for care. Predisposing variables were

demographic factors, social characteristics, and health beliefs. They

represent the sociocultural element of the behavioural model. The enabling

variables contain factors which make health services available and include

both personal/familial and community resources. First, people must have the

means and knowledge to get to those services and make use of them.

Second, health personnel and facilities must be available for individuals. The

need component is specified as the most immediate cause of health service

use, and involves both perceived and evaluated health status. Perceived need

included the amount of illness that an individual perceives and explains

individuals care-seeking and adherence to medical regimens, while

evaluated need is more closely related to the kind and amount of treatment

to be provided.

A conceptual frame work is a theoretical approach to the study of

problems that are scientifically based and emphasizes the selection

arrangement and classification of its concepts

Fig -1: Conceptual framework on the perceived health problems of the

elderly people and the facilities provided in old age homes based on the

health belief model.

Individual Modifying Likelihood of

Perception Factors Action

 Age, Sex, Perceived
Ethnicity, Benefits
Personality, minus
Socioeconomic, Perceived
Knowledge
Barrier

Perceived
Susceptibility / Perceived Likelihood
Perceived Threat of Behavior
Severity

Cues to
Action

According to the Health Belief Model, modifying variables, cues to action,

and self-efficacy affect perception of susceptibility, seriousness, benefits and
barriers and, behavior based on individual’s perceptions, modifying factors,
likelihood of action.23
3 REVIEW OF LIERATURE
 The task of reviewing research literature involves the identification

selection critical analysis and written description of existing information on

the topic of interest. When a general topic has already been selected readings

on that topic help to bring the problem in to sharper focus and aid in the

formulation of appropriate research questions. (Polit 1978)

For the readers understanding the reviewed, literature has been

presented under the following headings.

1) Literature related to Perceived Health Problems in Elderly People.

2) Literature related to Self care abilities of Elderly People.

3) Literature related to level of satisfaction with the facilities provided

to the elderly people in the old age homes.

Literature related to Perceived Health Problems in Elderly People

Growing older can be a frightening and stressful experience, especially for

those who feel lonely. Before continuing, allow me to make a distinction

between “being alone” and loneliness. Some older adults may prefer to

spend time alone, however feeling lonely (or experiencing constant

loneliness) is a different experience altogether On one hand, research has

shown that older adults tend to focus on relationships that make them
happier, while letting other relationships fade Feeling “lonely” is an

emotional reaction a person has when he or she has no one to talk to about

problems, and feels isolated and cut off from others Loneliness is different

for everyone, but life changes, such as retirement, losing a spouse, and

having friends and family move away can lead to isolation Also, as we age,

people have more health problems, which eventually begin to interfere with

mobility, making it harder for older adults to leave their homes24

It isn’t surprising that the combination of life changes and mobility problems

may lead to feelings of loneliness. Although research has shown that

loneliness is relatively stable over a person’s lifetime, in the later ages,

feelings of loneliness become a much greater possibility In fact, a recent

study found that for adults over the age of 65, 35% reported that they were

lonely, with 9% describing it as physically painful and another 6% saying it

was almost impossible for them not to feel lonely In this blog I will discuss

who is most likely to suffer from loneliness, the health effects of loneliness,

and how can we help to prevent loneliness in older adults. I will also provide

links to major press releases which provide more information when

possible.25

Hypertension, especially isolated systolic hypertension, is commonly found

in older (60–79 years of age) and elderly (≥80 years of age) people.
Antihypertensive drug therapy should be considered in all aging

hypertensive patients, as treatment greatly reduces cardiovascular events.

Most classes of antihypertensive medications may be used as first-line

treatment with the possible exception of α- and β-blockers. An initial blood

pressure treatment goal is less than 140/90 mmHg in all older patients and

less than 150/80 mmHg in the nonfrail elderly. The current paradigm of

delaying therapeutic interventions until people are at moderate or high

cardiovascular risk, a universal feature of hypertensive patients over 60

years of age, leads to vascular injury or disease that is only partially

reversible with treatment. Future management will likely focus on

intervening earlier to prevent accelerated vascular aging and irreversible

arterial damage. Hypertension is a highly prevalent disorder in older people.

In a recent population-based survey of adults aged 20–79 years in Canada,

hypertension, defined as a blood pressure of 140/90 mmHg or more or being

on antihypertensive medications, was present in 21.3% of the population

overall and 51.6% among those 60–79 years of age. Similar or even higher

age-dependent prevalence rates have been reported worldwide. Hypertension

is a major risk factor for cardiovascular and renal disease, and numerous

clinical trials including studies in older subjects have documented that

effective treatment improves survival and confers cardiovascular

benefits.current knowledge about hypertension in aging individuals. In this

article, older people aged 60–79 years are considered separately from the

very old or elderly, defined as 80 years of age or more. The presence of

comorbid conditions such as diabetes mellitus, chronic kidney disease or

previous cardiovascular disease, which increases with age, may affect the

epidemiology of hypertension and approach to treatment, especially in the

elderly.26

The Albertina Project is an epidemiological study of the medical, social and

economic situation among people aged 75 years or older in Uppsala,

Sweden. In this report, health conditions, quality-of-life measures and

housing problems affecting it are presented. A postal questionnaire was sent

to an 11% random sample (n = 959) of the eligible population out of which

706 (74%) persons responded. Nearly one-third of the elderly people could

not read a newspaper with or without glasses, more than one-third had

impaired hearing, 47% had some sort of mobility problem and 66% reported

some form of sleeping problem. Forty-two per cent felt lonely sometimes or

often and 65% were worried, in most cases about the risk of falling. In spite

of this, 87% rated their health as good and 79% were content or rather

content with their situation. Even though eyesight and hearing problems

were common in this study, they did not affect perceived health to any large

extent. Mobility problems and sleeping problems had a greater impact. The

most important factors related to perceived health were activity score,

contentment and mobility problems. Contentment was affected by activity

score and loneliness and the latter was in turn affected by age and type of

dwelling. The practical implication of these findings is that perhaps more

attention should be focused on efforts to improve old people's satisfaction

with their life situation rather than on marginal improvements of their

medical situation.27

Prevention of falling risk in elderly people: the relevance of muscular

strength and symmetry of lower limbs in postural stability. J Strength Cond

Res 25(2): 567-574, 2011-Falls are one of the major health problems

affecting the quality of life among older adults. The aging process is

associated with decreasing muscle strength and an increasing risk of falling.

The variables and techniques adopted to quantify muscular strength and

postural stability were different in each protocol; a great number of reports

analyzed the risk factors and predictors of falls, but the results appear still

uncertain. To date, there is no clear, definitive statement or review that has

examined the effect of the quadriceps strength on static balance

performances in different sensory conditions. This contribution aims to

provide an overview of experimental works to increase the comprehension

and prevention of falls and fall-related injuries in the elderly. Based on a

review of the literature, this work was designed to explore the relationship
among risk of falls, postural stability, and muscular strength of lower limbs

in older adults.28

Lack of social support increases the risk of mortality and supportive

relationships are associated with lower illness rates, faster recovery rates and

higher levels of health care behaviour (Dhar, 2001).

Falls and fracture are common in older women and men. Recurrent

falls due to intrinsic causes need complete evaluation of the underlying

medical condition and require preventive measures. Sedative use was most

commonly associated with falls. In order to improve the health status of the

elderly population it is important to carry out more studies in different areas

to identify various factors that are related to disability, which should lead to

efforts to develop effective programmes in fall prevention.29

As people age, the ability to interact with the outdoors may lessen. Frailty

and mobility problems create barriers to engaging in outdoor activities or

even experiencing the outdoors. The barriers are greater for people with

dementia. As the disease worsens to the point of institutionalization, access

to the outdoors may be completely barred and opportunities relinquished to

the determination of facility personnel. This article will review current

literature and some older seminal works on nature and nature-based stimuli

for people with dementia, especially those living in nursing homes.30

Dry mouth (salivary hypofunction, xerostomia) is a common problem

among older people. It causes significant oropharyngeal disorders, pain

and an impaired quality of life. Dry mouth has many causes, from local

salivary disorders to a plethora of medications and medical conditions.

Treatments are designed to correct the underlying cause and/or to

enhance salivation with topical and systemic stimulants. Early

intervention for dry mouth problems helps prevent the deleterious

consequences of this disorder in elderly people.Clinicians must be aware

of dry mouth problems in older patients, and they should be prepared to

provide a diagnosis and administer treatment to protect a patient's

oropharyngeal health and quality of life.31

Literature related to Self care abilities of Elderly People.

To determine the concurrent influence of depressive symptoms, medical

conditions, and disabilities in activities of daily living (ADLs) on rates of

decline in cognitive function of older Americans.

Prevalent and incident depressive symptoms, stroke, and ADL disabilities

contribute independently to poorer cognitive functioning in older Americans

but do not appear to influence rates of future cognitive decline. Prevention,

early identification, and aggressive treatment of these conditions may

ameliorate the burdens of cognitive impairment 32.

Physical activity, a large proportion of older adults still lead a sedentary

lifestyle. Especially, for older residents of LTC institutions, ability and

resources for practising physical activity are more restricted than

community-dwelling older adults. They are very likely to encounter barriers

to physical activity. However, little is known about what factors impede

them from being physically active. To implement successful interventions,

more information is needed to address barriers to regular physical activity.

physical activity can be personal or environmental, including physical health

problems and physical frailty, fear of resultant injury or falling, past

sedentary lifestyle, insufficient understanding about physical activity and

environmental restriction33.

The findings advance knowledge of barriers that impede the institutionalised

older adults to perform physical activity. Participation in physical activity

was negatively influenced by these barriers. However, these barriers are

modifiable. Assessment and problem solving to overcome barriers could

result in positive outcomes.

Health care providers are in a unique position to influence older residents to

adopt regular physical activity. Health care providers should consider these

barriers to the development and maintenance of physical activity and to plan

effective individual interventions to reduce these barriers. In planning

physical activities, it is also important to provide a supportive environment34.

To explore the risk factors and management of falls in people with

intellectual disabilities and develop evidence-based recommendations.

Falling is a common cause of physical injury and impaired quality of life in

people with intellectual disability. Risk factors for falls and falls prevention

have been extensively researched in the general population but there is a

paucity of evidence specific to people with intellectual disabilities. Seven

articles met the inclusion criteria. Up to 57% of people with intellectual

disabilities experienced a fall. Falling was the cause of 50-62% of all

recorded injuries. Risk factors for falls in people with intellectual disabilities

may include older age, impaired mobility, epilepsy and behavioural

problems. There was a paucity of evidence for intervention strategies

identified.There is a lack of evidence for falls management in people with

intellectual disabilities. Findings suggest that falls are a common cause of

injury, institutionalisation and impaired quality of life in people with

intellectual disabilities. Environmental safety, careful medical management

and exercise interventions may play an important role in minimising fall-

related injuries. Further research is needed to explore risk factors for falls

and falls management in this vulnerable group.Early identification of the risk

factors and prevention of falls will inform nurses and other healthcare

professionals those who are at most risk and how to minimise injury in

people with an intellectual disability. A multi-model approach of

comprehensive assessment and tailored intervention are worthy of

endeavour35.

An estimated 19 million people (10.1%) reported some mobility difficulty.

The mean age of those with minor, moderate, or major difficulty ranged

from 59 to 67 years. Of those reporting major difficulties, 32% said their

problems began at aged 50 years or younger. Adjusted problem rates were

higher among women (11.8%) than men (8.8%), and higher among African

American (15.0%) than whites (10.0%). Persons with mobility difficulties

were more likely to be poorly educated, living alone, impoverished, obese,

and having problems conducting daily activities. Among persons with major

mobility difficulties, 30.6% reported being frequently depressed or anxious,

compared to 3.8% for persons without mobility difficulties36.

Reports of mobility difficulties are common, including among middle-

aged adults. Associations with poor performance of daily activities,

depression, anxiety, and poverty highlight the need for comprehensive care

for persons with mobility problems.

Diabetes presents many potential pathways for fatigue, but focused studies

on this symptom are rare. Furthermore, research on diabetes-related fatigue

is limited by fatigue's nonspecific symptoms and because fatigue researchers

have yet to agree on standardized definition, measurement, or diagnostic

criteria. Additionally, few diabetes randomized clinical trials included

measurement of patient-reported outcomes, such as symptoms or health-

related quality of life in their study designs, although one that did provided

some meaningful finding that symptom-focused education improved self-

management practices, Hb(A1c) levels, quality of life, and symptom

distress37.

Chronic pain in elderly patients referred to a Norwegian multidisciplinary

pain clinic. Confirm findings from a number of studies on main

characteristics of chronic pain conditions in the elderly. It is important that

regular general practitioners emphasize psychosocial factors when assessing

and treating chronic pain in the elderly. San Andrés-Torcal in Malaga, Spain

determines the needs of elderly individuals living alone and with some

degree of dependency for activities of daily live. The persons evaluated

showed numerous areas of dependency and there was a high proportion

whose basic needs were not suitably covered. Because of the multiple and

distinct problems identified, we believe that active screening should be

performed in this vulnerable population. In addition, special attention should

be paid to these individuals and the required help should be offered so that

they have information and access to the available health and social resources.
In the UK, population screening for unmet need has failed to improve the

health of older people. Those living alone were more likely to report fair or

poor health, poor vision, difficulties in instrumental and basic activities of

daily living, worse memory and mood, lower physical activity, poorer diet,

worsening function, risk of social isolation, hazardous alcohol use, having

no emergency carer, and multiple falls in the previous 12 months. After

adjustment for age, sex, income, and educational attainment, living alone

remained associated with multiple falls, functional impairment, poor diet,

smoking status, risk of social isolation, and three self-reported chronic

conditions: arthritis and/or rheumatism, glaucoma, and cataracts38.

Literature related to level of satisfaction with the facilities provided to

the elderly people in the old age homes.

In this article we explore the development of group homes for elders with

dementia in Japan since the inception of the long-term care insurance

program in 2000. We suggest that the combination of demographic and

policy trends in recent years have created a context in which entrepreneurial

activities related to elder care have increased significantly. By focusing on

one of the new institutions that has emerged, we show one way in which

social policy has had a significant influence on the lives of elders suffering

from dementia and their families. Finally, we point out some of the problems
that have arisen along with the growth of these new forms of care, such as a

lack of involvement by family members in visiting and caring for elders39.

Dutch GP's (General Practitioners) take care of people living in homes

for the elderly. The population of these homes is selected on the basis of

poor functioning on ADL (activities of daily living). We expected to find a

group of elderly people within these homes that need more complex primary

care. We describe the characteristics of care for an institutionalized elderly

population and compare these to the care provided to their independently

living peers. The design of this study is a matched case-control study in a

Dutch General Practice in the study period 1/1/1998 to 1/7/2004. Our main

results show that the rate of cognitive problems is two times, the prevalence

of depression even three times higher in older people living in a home for

the elderly than in those who live independently. Locomotory problems are a

frequent problem in homes for the elderly. Rates of chronic pulmonary

problems, atherosclerosis-related diseases and urinary tract infection are

higher, whereas no significant differences for CVA, diabetes and cancer

were found. Institutionalized older patients use more different types of

medication. GP's do not have more contacts with people living in a home for

the elderly than with older people living independently. We conclude that

people living in homes for the elderly have complex problems, and need

special attention for their specific vulnerability. Differences in care are not
primarily explained by chronic disease but by problems with mobility,

confusion, depression and cognition40.

Health Survey-Healthy Aging, 76% of Canadians in mid-life (45 to

64) and 56% of seniors reported good health in 2009. This is based on a

definition of health composed of: positive self-perceived general and mental

health, functional ability, and independence in activities of daily living.

Good health existed even in the presence of chronic conditions such as high

blood pressure, arthritis and back problems, all of which were common

among people aged 45 or older. Eight modifiable factors were associated

with good health: smoking status, body mass index, physical activity, diet,

sleep, oral health, stress, and social participation. Eighty-four percent of the

younger age group and 91% of seniors reported positive tendencies on four

or more of these factors. The more factors on which positive tendencies were

reported, the greater the likelihood of having good41.

In nursing homes, assessment and management of pain is often

problematic. Older residents in nursing homes often have several chronic

problems, such as cerebrovascular accidents, arthritis, and/or dementia

(Australian Pain Society, 2005). Physical and cognitive impairments often

make it difficult for such residents to report pain to the staff. Furthermore,

older residents often do not actively report pain, because of the stigma
associated with it or because of their own forbearance/stoicism (Hess, 2004).

The heavy workloads of nursing home staff may compound the problem,

making it difficult to identify pain among residents (Australian Pain Society,

2005). In addition, nurses tended to estimate severe pain and pain tolerance

significantly lower than patients (Bergh & Sjöström, 1999). Therefore,

nursing home staff needs to be aware of these problems and efforts should

be directed toward improving pain assessment and management.It is

important to manage pain for nursing home residents by providing

individually tailored care for each resident (Horgas & Miller, 2008). To

promote individually tailored care, it is essential to obtain all necessary

information about the pain, such as its causes, intensity, and other related

factors. Pain assessment and management should also be based on the best

available evidence from studies and tailored for the residents' circumstances

and needs (Herr, 2010). Although there are limited studies on the prevalence

of pain among nursing home residents in Japan, there is an increase in the

number of such studies worldwide that examine pain prevalence among

nursing home residents and explore the factors related to pain.

Therefore the aim of the present review was to identify studies on pain

prevalence among older residents in nursing homes and explore the factors

associated with pain in these prevalence studies. It was hoped that this paper
would serve as a basis for developing systems to manage pain and improve

the quality of life of nursing home residents42.

Probably the main point of controversy is to clearly define the role of

residential facilities, that is whether they should be conceptualized as

intensive treatment programmes, or merely as ordinary homes or living

settings for people who participate fully in treatment and psychosocial

programmes provided by local mental health services. These contrasting

objectives may actually lead to different characteristics of their functioning

and to diverse typologies of care processes, although the scientific literature

usually refers to residential facilities as a unitary concept43.

Related to this point, there is the need to develop a clear taxonomy of

residential facilities, based on specific operational criteria. This taxonomy

should spell out acceptable ranges of available residential facilities, staffing

levels, optimal size, satisfactory environmental features and activities

needed to fill residents' weekly time, and in particular weekends, evenings,

and so on. Precise patients' inclusion criteria should be developed; all

patients that are candidates for residential facility admission should receive

careful, multidimensional assessments, highlighting not only clinical

characteristics but also impairments in social and vocational roles.

Management plans and related organizational frameworks should match

residents' typologies and their various needs and requests. Patients'

rehabilitation plans should be carefully monitored with appropriate

instruments. Avoiding an indistinct case mix (i.e. aged patients mixed up

with young, treatment-resistant patients) in residential facilities is a

prerequisite for the development of tailored treatment plans and for

transforming residential facilities into effective rehabilitation settings for

those patients with realistic prospects of rehabilitation. This strategy also

implies the selection of staff with specific characteristics, and a reasonable

staff turnover should be foreseen to prevent burnout.Specific facilities,

management plans and trained staff should be available for the residential

treatment of specific patient populations, in particular patients at high risk of

violence, with dual diagnoses and with severe personality disorders (and all

these conditions are often associated).Finally, outcome research should

refrain from generic questions (e.g. 'Does residential care work?') and should

address specific questions, such as 'What kind of residential care appears to

be most effective for what kinds of residents by what type of outcomes and

in what kind of social and service context?' (Shepherd, personal

communication). Addressing these important points in research and clinical

practice will enable the whole field of residential care to progress so that it

can respond to the complexities of modern mental health care44.

 4 RESEARCH METHODOLOGY

This chapter presents the methodology adapted for the study including

research approach, Research design and steps taken in the development of

the tool. Further, this chapter describes the setting, sampling techniques,

pilot study and plan for data analysis.

Research Methodology is a way to systematically solve the research

problem, in it we study the various steps that are generally adopted by a

researcher in studying her research problem along with the logic behind

(Kothari 1990)

This study was conducted with the main purpose of assessing the

health problems of the elderly as perceived by them and the facilities

provided to them in old age homes.

Research Approach

Descriptive research was used to study the research problem. Descriptive or

exploratory research studies collect detailed descriptions of existing

variables and use the data to justify and assess current conditions. (Wood

1990).It deals with the relationship between variables. the testing of

hypothesis and the development of generalizations, principles or thesis that

have universal validity (Best 1992)

Research Design:

Descriptive design to assess the knowledge of perceived health problems

among elderly people.

Setting of Study:

The setting is where the population or the portion of it that is being studied

is located and where the study is carried out.

One private old age home run by religious congregations in

Bangalore, which are well known for their care and accommodation were

selected for the purpose of the study, people above the age of 60 years reside

in this homes. This old age home had approximately 140 elderly inmates are

present. there are 70 women and 70 men’s respectively, there were both

single rooms and dormitories, more space for outdoor games, better medical

and nursing care, facilities Opportunities for Spiritual growth like retreats

and gospel meetings, physiotherapy facilities ,participation in making

handicraft, gardening, The elderly in the bigger old age home were more

social and outgoing in there behavior when compaired to the elderly of the

smaller old age home where facilities were must restricted.

Variables under Study

Variables are a concept that has measurable changing attributes.

Dependent Variables.
 It is the variable which is measured or observed following the action

of the independent variable. In the present study it refers to the perceived

health problems of the elderly people.

Independent Variable.

It is the variable that precedes the dependent variable and is observed

in non experimental research (Roberts1989).In this study; it refers to the

facilities provided to the elderly people in the old age homes.

Extraneous Variables.

It is the variable which can account for change in the dependent

variables here it refers to the selected variables such as Age, sex, marital

status, Educational status, Previous Occupation, Duration of stay in old age

home, Financial dependency History of health& illness, Dietary status and

Self care activities.

Population

The target population consists of the total membership of a defined set

of subjects from whom the study subjects are selected and to whom the data

will be generalized (Adbellah 1986)

 In the present study, the population consisted of the elderly people

above 60 years of age in the old age homes of Bangalore.

Sample and Sampling Technique

The set of sampling units chosen for the study is called the Sample.

Sampling

It is process of selecting a portion of the population to represent the

entire Population (polit 1995)

Here the study Sample comprised of the elderly people above 60 years

in the old age homes, fulfilling the Sampling Criteria, The purposive

Sampling Technique will be used to collect data from the available group

falling under inclusion criteria.

Criteria for selection of the sample

1) The elderly people who are 60 years and above

2) The elderly people who are able to express their problems verbally.

3) Subjects who are available at the time of the study.

4) Subjects who are residents of the old age homes.

5) Subjects who are able to understand and communicate in English.

Exclusion Criteria

1) Subjects who are unconscious or handicapped.

2) Subjects who are not able to understand English.

3) Subjects who are not willing to participate in the study.

Selection and development of study tools.

Data collection tools are the procedure or instruments used by the

researcher to observe or measure the key variables in the research problems

(Robert 1989)

The following steps were adopted in the development of the tool.

1) Review of literature provided adequate content area for the tool

preparation.

2) Personal consultation and discussion with nursing experts and

psychologists.

3) Content validity of the tool helped to frame the appropriate

statements.

4) Discussion with the personal working in the old age homes.

5) Observational visits to old age homes prior to the preparation of the

tool.
All these procedures helped in framing the appropriate tools suitable for the

study.

Description of the tool

A structured interview schedule with a few Open-ended items were

utilized for this study.

The tool consisted of 3 parts.

Part-I Demographic Data.

Part-II Tool to assess the Knowledge of Perceived health problems among

elderly people.

Part-III Level of satisfaction of the facilities provided in the old age homes.

Section A- Demographic Data (Annexure 6)

It consisted of 10 items on personal and demographic data of the

subjects in relation to their Age, Sex Educational Status, Marital status,

Previous Occupation, Duration of stay, Financial dependency Self care

activities, Hostory of health illness, Dietary status by criteria of BMI.

Section B- Assess the knowledge of perceived health problems among

elderly people.
Assessment of the perceived health problems was divided in to 3 categories,

1) Physical -----------------17 items.

2) Physiological-----------27 items.

3) Psychological------------16 items.

Section C- Level of satisfaction of facilities provided in the old age

homes.

These are subdivided in to 4 categories.

1) Food Facilities----------8 items.

2) Living Facilities----------10 items.

3) Care in Health and Illness--------5 items.

4) Recreational Facilities------------5 items.

Content Validity of the Tool.

Content validity of the tool refers to the degree an instrument

measures what it is supposed to be measured (Polit1978)

The tool was validated by Nine experts six Medical Surgical Nursing

experts, One statician, one psychologist, and one Physician, Based on their,

Suggestions and Opinions, the tool was Reformed.

Reliability of the tool

The reliability of a measuring instrument is a major criterion for

assessing its quality and accuracy.

Reliability of an instrument is the degree of consistency with which it

measures, the attributes it is supposed to be measuring. (Polit 1976)

To check the internal consistency of the tool, the investigator

interviewed eight elderly people from one of the old age home and split-half

technique was carried out.

The reliability of the half test was found out using Karl Pearson’
product.

Moment Correlation formula.

r= N ∑ XY – (∑X. ∑Y)

√(N∑X2 – (∑X)2) (N∑Y2 – (∑Y2))

The reliability of fullest was calculated using Spearman’s Brown

prophecy formula as shown below.

r11 = 2r 1/2.1/11
1 + 1 1/2 1/11

Were,

r11 = Reliability quotient of the whole test

r1/2 1/11=Reliability quotient of the half test (Gasset 1981)

The reliability quotients obtained were 0.83 & 0.87 which was considered to

be reliable and adequate.

Pilot Study

Pilot and Hungler (1978) defined pilot study as a small scale version

or trial run of the major study. Its function is to obtain information of

improving the project or for assessing its feasibility.

The Main focus is the assessment of the adequacy of Measurement.

The pilot study was conducted in the Little Sisters of the Poor Home

for the Aged, from Nov 15th to 30th a formal permission was obtained from

the authorities.

Ten elderly people fulfilling the criteria for sample selection were

interviewed. The purposive Sampling Technique was used to select the

Samples.

From the old age home the elderly men and women 5 were selected

from sampling frame.

Certain problems were encountered during the pilot study were found

to be lengthy. Certain items were irrelevant and some items pertained to

problems which were uncommon, subjects had to be interviewed for 1&1/2

Hours, which made them tired, therefore, certain items were deleted as

suggested by the experts.

The Main Findings

Data analysis was done using descriptive and inferential Statistics.

The elderly people staying in old age homes have higher mean (72%) in

physical activities compared to physiological (67%) and (64%)

psychological problems.

The elderly people were somewhat satisfied with the facilities

provided in the old age home. They were very satisfied with the facilities

given during health and illness They were best satisfied with the food

facilities there was no significance association between the health problems

and duration of stay and there was a significance association between

physical and psychological problems.

Method of Data Collection

Written permission were obtained from the Mother Superior, of the

old age home, They were made aware of the nature of the study ad were

assured that the study would not interfere with the daily routine activities of

the elderly people.

The data was collected from Dec 10th to Jan11th 2011 .The

investigator collected the required information in the old age home.

 Prior to the actual interview the investigator familiarized herself with

the subjects and explained the purpose of the study to them, She requested

the participants for their full Co-operation and prompt answers. She also

ensured the confidentiality of the subjects’ responses and the importance

sensed by their answers .An informed consent was taken from the subjects

willing to participate in the study The subjects were made to assume a

comfortable position the investigator was seated facing the subjects. The

questions listed in the schedule were read out clearly at a pace

understandable to them. No unnecessary explanation or suggestion to

answers were given.

Interviewer in the structured interview was 35-40 min. keeping in

mind the rest periods of the elderly people the interview was conducted

between 10am to 12 noon and 2:30pm to 4pm.After completion of the

interview process the investigator thanked the respondents for their

participation in the study.

Plan for data analysis

The analysis of data involves the translation of information collected

during the course of a research project in to an interpretable and manageable

forms, it involves the use of statistical procedures to give organization and

meaning to data. Descriptive and inferential statistics will be used for data

analysis in terms of frequency percentage and mean score, chi-square tests

and students t-test for the testing of hypothesis, The various categories of

analysis the numerical data based on the objectives of the study are given

below.

Projected Outcome.

 Personal data will be analyzed using frequency, percentage mean score.

The perceived health problems will be analyzed in terms of frequency,
percentage and mean score.
 Chi-square test would be adopted to find out the association between
perceived health problems and demographical variables in old age home.
 Student’s t-test would be used to find out the difference between the
mean satisfaction score of the facilities provided to the male and female
elderly people.
 5 RESULTS

This chapter deals with the analysis and the interpretation of the data

collected in order to assess the knowledge of the perceived health problems

among elderly people and facilities provided to them in selected old age

homes in Bangalore city.

The data obtained by organized in master sheet for tabulation. The

analysis of the data is organized and presented under following sections.

Objectives of the study.

1) To assess knowledge of perceived Health problems among elderly

people.
2) To assess the level of satisfaction with the facilities provided to the

elderly people in the old age homes as expressed by them.

Organization of findings

Section 1: Analysis of sample characteristics of elderly people in old age

homes regarding demographic variables

Section II: To assess the knowledge of the elderly people on perceived

health problems.

Section III: To identify the level of satisfaction of the facilities provided for

the elderly people in old age homes.

Section IV: To find the association between the knowledge of old age

people on perceived health problems and demographic variables.

Section 1: Analysis of sample characteristics of elderly people regarding

demographic variables

This section deals with description of demographic variable of sample

characteristics. The 50 elderly people were drawn from the selected old age

home in Bangalore. The data on sample were analyzed using descriptive and

inferential statistics. The data obtained from the samples are presented in

terms of age, gender, education, previous occupation, marital status,

financial dependency, self care activities, duration of stay, history of health

illness and dietary status.

a) Analysis of sample characteristics of elderly people regarding

demographic variables
Table 1

Sl. Demographic
Frequency Percentage
No. Data
1 Age
60-65years 1 2
65-70years 13 26
>70 years 36 72
2 Gender
Male 15 30
Female 35 70
3 Educational qualification
Primary 16 32
Secondary 17 34
Higher Secondary 14 28
Degree 3 6
4 Marital status
Married 15 30
Unmarried 3 6
Widow 31 62
Divorce 1 2
 5 Previous Occupation
Professional 17 34
Any other 33 66
6 Duration of Stay
3-5years 26 52
5& above years 24 48
7 Financial Dependency
Self 10 20
On family members 2 4
Old age homes 38 76
8 Self Care Activities
Independent 22 44
Partially Dependent 24 48
Fully Dependant 4 8
9 History of Health Illness
Diabetes Mellitus 3 6
Hypertension 10 20
Bronchial Asthma 2 4
Any Other 35 70
10 Dietary Status by Criteria of BMI
Well Nourished 9 18
Moderately
Nourished 32 64
Poorly Nourished 8 16

FIG:1 Distribution of samples according to Age

40 72%
35
30
25
20
15 26%

10
5 2%
0
60-65years 65-70years >70 years
Age
Among the elderly people, 2% were from age group of 60- 65 years, 26%

were from age group of 65- 70 years and 72% were from age group of > 72

years.

Fig 2: Distribution of samples according to the Gender

70%
40

30 30%

20

10

0
Male Female
Among the elderly people, 30% were male and 70% were female

Fig: 3 Distribution of samples according to the Education

34%
18 32%
28%
16
14
12
10
8
6
6%
4
2
0
Primary Secondary Higher Secondary Degree
Among the elderly people, 32% had primary education, 34% had secondary

education, 28% had higher secondary education and 6% had graduation.

 Fig 4: Distribution of samples according to the Marital Status
35
62%
30

25

20
30%
15

10

5 6%
2%
0
Married Unmarried Widow Divorce
Among the elderly people, 30% were married, 6% were unmarried, 62%

were widows and 2% were divorced.

Fig 5: Distribution of samples according to the Previous Occupation

66%

35
30
34%
25
20
15
10
5
0
Professional Any other

Among the elderly people, 34% were professionals and 66% were non

professionals.
 Fig: 6 Distribution of samples according to the Duration of stay

52%
26
25.5
25 48%
24.5
24
23.5
23
3-5years 5& above years

Among the elderly people, 52% stayed from 3- 5 years and 48% were

staying more than 5 years.

Fig: 7 Distribution of samples according to the Financial dependency

76%
40

30

20
20%
4%
10

0
Self On family members Old age homes
Among the elderly people, 20% were self depended for finance, 4% were

dependent on family members and 76% were dependent on old age homes.
 Fig 8: Distribution of samples according to the Self care activities

48%
44%
25

20

15

10 8%

0
Independent Partially Dependent Fully Dependant
Among the elderly people, 44% were independent for self care activities,

48% were partially dependent and 8% were fully dependent.

Fig 9: Distribution of samples according to History of Health illness

70%

35
30
25 20%
20
6% 4%
15
10
5
0
Diabetes Mellitus Hypertension Bronchial Any Other
Asthma
Among the elderly people, 6% had diabetes mellitus, 20% had hypertension,

4% had bronchial asthma and 70% suffered from other illness.

 Fig 10: Distribution of samples according to Dietary status

Poorly Nourished Well Nourished

16% 18%

Moderately
Nourished
66%

Among the elderly people, 18% were well nourished, 66% were moderately

nourished and 16% were poorly nourished.

Section II: To assess the knowledge of the elderly people on perceived

health problems.

Table: 2

N= 50
Statement Max.
Maximum Range Mean S.D s score Mean%
Knowledge of Perceived Health problems among elderly people
35.
Physical Questionnaire 50 18 -50 8 9.04 17 50 72%

Physiological 30.
Questionnaire 45 15 -45 1 7.01 27 45 67%

33.
Psychological Question 52 15 -52 1 9.16 16 52 64%
Fig: 11

72%

70%

68%

66%
Mean %
64%

62%

60%

58%
Physical Physiological Psychological
Questionnaire Questionnaire Question

The above table and diagram depicts that, the elderly people staying in old

age homes have higher mean % in physical activities compared to

physiological and psychological problems.

Section III: To identify the facilities provided for the elderly people in

old age homes.

Table: 3

Statement Max.
Maximum Range Mean S.D s score Mean%
Facilities provided to Elderly people
19.
Food Facilities 32 8 -32 1 4.89 8 32 60%

28.
Living Facilities 40 19 -40 5 6.81 10 40 71%

Care in Health and 14.

Illness 28 10 -28 9 4.58 5 28 53%

14.
Recreational Facilities 24 10 -24 4 4.18 5 24 60%
Fig: 12

80%
70%
60%
50%
Mean % 40%
30%
20%
10%
0%
Food Living Care in Recreational
Facilities Facilities Health and Facilities
Illness

The above table and diagram depicts that, of the elderly people staying in

old age homes, more than 60% were dissatisfied with food facilities, > 70%

were dissatisfied with living facilities, 53% were dissatisfied with care in

health and illness and 60% were dissatisfied with recreational facilities.

Section IV: To find the association between the knowledge of old age people on
perceived health problems and demographic variables.
Table 4
Respondents knowledge
χ2 p
Demographic Inadequate Moderate Adequate Total
value value
Variables Category n % n % n %
60-65years 1 100% 0 0% 0 0% 1
65-70years 1 8% 4 31% 8 62% 13
Age >70 years 2 6% 17 47% 17 47% 36 12.80 0.01

Male 3 20% 5 33% 7 47% 15

Gender Female 1 3% 16 46% 18 51% 35 4.29 0.12

Primary 0 0% 6 38% 10 63% 16

Secondary 2 12% 11 65% 4 24% 17
Higher
Educational Secondary 2 14% 3 21% 9 64% 14 15.32 0.03
qualification Degree 0 0% 1 33% 2 67% 3

Married 3 12% 12 46% 11 42% 26

Marital status Unmarried 1 4% 9 38% 14 58% 24 1.71 0.43
 Professional 3 18% 5 29% 9 53% 17
Previous
Occupation Any other 1 3% 16 48% 16 48% 33 10.21 0.04

3-5years 3 12% 12 46% 11 42% 26

Duration of Stay 5& above years 1 4% 9 38% 14 58% 24 1.71 0.43

Self 1 10% 1 10% 8 80% 10

On family
Financial members 0 0% 1 50% 1 50% 2 5.53 0.24
Dependency Old age homes 3 8% 19 50% 16 42% 38

Independent 3 14% 5 23% 14 64% 22

Self Care Partially
Activities Dependent 0 0% 13 54% 11 46% 24 10.97 0.03
Fully
Dependant 1 25% 3 75% 0 0% 4

Diabetes
Mellitus 1 33% 2 67% 0 0% 3
Hypertension 2 20% 5 50% 3 30% 10 15.88 0.01
Bronchial
History of Health Asthma 1 50% 0 0% 1 50% 2
Illness Any Other 0 0% 14 40% 21 60% 35

Well Nourished 1 11% 4 44% 4 44% 9

Moderately
Dietary Status Nourished 3 9% 13 39% 17 52% 33 13.15 0.05
by Criteria of Poorly
BMI Nourished 0 0% 4 50% 4 50% 8
The above table depicts the demographic variables like age, education,

previous occupation, self care activities, history of health illness and dietary

status are significant with knowledge of elderly people and other

demographic variables are not significant.

Fig 13: Association between age and knowledge level of elderly people.
 100% 0%
90%
80% 47%
70% 62%
60%
50% 100%
%

40%
30% 47%
20% 31%
10%
8% 6%
0%
60-65years 65-70years >70 years
Age

Inadequate Moderate Adequate

The association between age and knowledge levels is significant (χ2= 12.80)
at 5% level of significance.

Fig 14: Association between gender and knowledge level of elderly people.
 51%
46%
47%
60%
33%
50%

20%
40%

30%
3%
20%

10%

0%
Male Female
Gender

Inadequate Moderate Adequate

The association between gender and knowledge levels is not significant (χ2=

4.29) at 5% level of significance.

Fig 15: Association between marital status and knowledge level of elderly people.

58%
Unm arried 38%
4%
Marital status

42%
Married 46%
12%

Inadequate Moderate Adequate

The association between marital status and knowledge levels is not

significant (χ2= 1.71) at 5% level of significance.

Fig 16: Association between education and knowledge level of elderly people.
 65% 67%
70% 64%
63%

60%
51%
46%
47%
50%

33% 38%
40% 33%

30% 20% 24%

21%

20% 12% 14%

10% 3%
0% 0%
0%
Male Female Primary Secondary Higher Degree
Secondary
Education

Inadequate Moderate Adequate

The association between education and knowledge levels is significant (χ2=
15.32) at 5% level of significance.

Fig 17: Association between previous occupation and knowledge level of elderly

people.

53% 48%

48%
60%
50% 29%
40%
18%
30%
20% 3%

10%
0%
Professional Any other
Previous Occupation

Inadequate Moderate Adequate

The association between previous occupation and knowledge levels is
significant (χ2= 10.21) at 5% level of significance.

Fig 18: Association between duration of stay and knowledge level of elderly people.

38%

58%
5& above years
4%
Duration of stay

12%

46%

42%
3-5years

0% 20% 40% 60% 80% 100% 120%

Inadequate Moderate Adequate

The association between duration of stay and knowledge levels is not
significant (χ2= 1.71) at 5% level of significance.

Fig 19: Association between financial dependency and knowledge level of elderly

people.
 80%

80%
70% 50%
50% 50%
60% 42%

50%
40%
10% 10%
30%
8%
20% 0%

10%
0%
Self On family members Old age homes
Financial Dependency

Inadequate Moderate Adequate

The association between financial dependency and knowledge levels is not

significant (χ2= 5.53) at 5% level of significance.

Fig 20: Association between self care activities and knowledge level of elderly

people.

64% 75%
80%
46%
70% 54%
60%
50%
40% 23%
25%
30% 14%
20% 0% 0%
10%
0%
Independent Partially Dependent Fully Dependant
Self Care activities

Inadequate Moderate Adequate

The association between self care activities and knowledge levels is
significant (χ2= 10.97) at 5% level of significance.
Fig 21: Association between history of health illness and knowledge level of elderly
people.

40%

60%
Any Other

0%
History of health illness

50%

50%
Bronchial Asthma

0%
20%

50%

30%
Hypertension

33%

67%
Diabetes Mellitus

0%
0% 20% 40% 60% 80% 100% 120%

Inadequate Moderate Adequate

The association between history of health illness and knowledge levels is

significant (χ2= 15.88) at 5% level of significance.

Fig 22: Association between dietary status and knowledge level of elderly people.

60% 52% 50%

50%
50% 44%44% 39%
40%
30%
20% 9%
11%
10%
0%
0%
Well Nourished Moderately Poorly Nourished
Nourished
Dietary status

Inadequate Moderate Adequate

The association between dietary status and knowledge levels is significant
(χ2= 13.15) at 5% level of significance.
 6 DISCUSSION

Various criteria are used to assess a person's level of health. Objective

measures can be noted and counted by a trained observer, while subjective

measures of health depend exclusively on a person's self-evaluation.

Objective measures include the presence of a disease or disorder, measuring

of blood pressure, days spent in bed or in the hospital, or observation of the

ability of the person to perform daily activities. A subjective measure of

assessed health can be collected by simply asking a person if his or her

health is excellent, good, fair, or poor. Both objective indicators and the
subjective measure of self-rated health are designed to capture the health

status of an individual, and there is a moderately strong relationship between

the two measures. Most people report an evaluation of their health that

matches or comes close to the objective indicator of a physician's diagnosis.

In general, those with more functional disabilities are likely to rate their

health less favorably. In addition, those with specific chronic conditions,

such as heart disease, chronic lung problems and diabetes also report worse

health.

Objectives of the study

1) To assess knowledge of perceived Health problems among elderly

people.
2) To assess the level of satisfaction with the facilities provided to the

elderly people in the old age homes as expressed by them.

Hypothesis

H1) The elderly people living in old age homes to have health needs.

H2) The elderly people have varying self care abilities and functional
performance.

H3) The elderly people participating in the study will be willing to express
their health problems and the level of satisfaction of facilities provided to
them in old age homes.
Sample Characteristics.

• Among the elderly people, 2% were from age group of 60- 65 years, 26%
were from age group of 65- 70 years and 72% were from age group of >
72 years.(Table-1)
• Among the elderly people, 30% were male and 70% were female (Table-
2).
• Among the elderly people, 32% had primary education, 34% had
secondary education, 28% had higher secondary education and 6% had
graduation.(Table-3)
• Among the elderly people, 30% were married, 6% were unmarried, 62%
were widows and 2% were divorced.(Table-4)
• Among the elderly people, 34% were professionals and 66% were non
professionals.(Table-5)
• Among the elderly people, 52% stayed from 3- 5 years and 48% were
staying more than 5 years.(Table-6)
• Among the elderly people, 20% were self depended for finance, 4% were
dependent on family members and 76% were dependent on old age
homes(Table7)
• Among the elderly people, 44% were independent for self care activities,
48% were partially dependent and 8% were fully dependent. (Table-8)
• Among the elderly people, 6% had diabetes mellitus, 20% had
hypertension, 4% had bronchial asthma and 70% suffered from other
illness. (Table-9)
• Among the elderly people, 18% were well nourished, 66% were
moderately nourished and 16% were poorly nourished. (Table-10)

Description of the Knowledge of perceived health problems in Elderly.

 • Among elderly people staying in old age homes have higher mean %

in physical activities(72%) compared to physiological(67%) and

psychological(64%) problems.(Table-2)

Description of Level of Satisfaction of the facilities provided to Elderly

people.

• Among the elderly people staying in old age homes, more than 60%

were dissatisfied with food facilities, > 70% were dissatisfied with

living facilities, 53% were dissatisfied with care in health and illness

and 60% were dissatisfied with recreational facilities.(Table-2)

Association between the knowledge of old age people on perceived

health problems and demographic variables.

The demographic variables like age, education, previous occupation, self

care activities, history of health illness and dietary status are significant with

knowledge of elderly people and other demographic variables are not

significant.

• The association between age and knowledge levels is significant (χ2=

12.80) at 5% level of significance.
• The association between gender and knowledge levels is not

significant (χ2= 4.29) at 5% level of significance.

• The association between marital status and knowledge levels is not

significant (χ2= 1.71) at 5% level of significance.

• The association between education and knowledge levels is significant

(χ2= 15.32) at 5% level of significance.

• The association between previous occupation and knowledge levels is

significant (χ2= 10.21) at 5% level of significance.

• The association between history of health illness and knowledge

levels is significant (χ2= 15.88) at 5% level of significance.

• The association between dietary status and knowledge levels is

significant (χ2= 13.15) at 5% level of significance.

 7 CONCLUSIONS

On the basis of findings of the study following conclusions were made:-

• Majority of the elderly people 72% belong to age group of above 70

years.

• More than half of the elderly people 70% were female.

• Approximately half of the elderly people 34% had studied up to

secondary school.

• Most of the elderly 62% were married.

• Majority elderly people 66% were had previous occupation.

 • 52% of elderly people were duration of stay.

• 76% of elderly people were financial depend on old age home.

• Most of the elderly people 48% were taking self care.

• Majority of elderly people 70% were suffering with other perceived

health problems.

• In dietary status 64% of elderly people were moderately nourished.

• 72% of elderly people were suffering with physical health problems.

• 67% of elderly people were suffering with physiological health

problems.

• 64% of elderly people were suffering with psychological health

problems.

The facilities provided for the elderly people in old age Home.

• The elderly people staying in old age homes, more than 60% were

dissatisfied with food facilities, > 70% were dissatisfied with living

facilities, 53% were dissatisfied with care in health and illness and

60% were dissatisfied with recreational facility.

Nursing Implications
 The study findings have several implications in nursing. They can be

categorized under nursing Practice, nursing education and nursing research.

Nursing Practice:

Nursing service includes preventive, promotive, Curetive and

rehabilitative Services, Nurses have important role in the prevention of

perceived health problems increase in chronic and degenerative problems

will cause a high degree of disability, which will require aid and support

from qualified professionals. As a specialty, Geriatric Nursing has

developed recently and is based on knowledge of the aging process for

thebio-psycho-social-cultural and spiritual valuation of elderly people.s

needs. Service organization and theoretical concepts guide practice, data

collection, nursing diagnosis,planning and maintenance of care,

intervention,assessments, multi-professional collaboration, research, ethics

and professional development as its standards of quality. Therefore, the

usage of Nursing Care Systematization (NCS) is a worldwide need for the

quality of its practices. The interest in discovering the main nursing

diagnosesfor elderly inpatients originated from clinical practice during the

first year of the residence specialization coursein Geriatric Nursing, and

from the need to standardize the NCS in order to facilitate, promote and

elaborate proper health care for elderly users.

Nursing Diagnosis in elderly people.

1. Risk of infection
2. Impaired Physical Mobility
3. Altered nutrition: less than corporeal needs
4. Self-care deficit
5. Impaired skin integrity
6. Intolerance to activity
7. Pain
8. Sensorial/Perception changes
9. Risk of injury
10. Constipation
11. Diarrhea
12. Impaired verbal communication
13. Confusion
14. Urinary Incontinence
15. Risk of impaired skin integrity
16. Impaired gaseous exchange
17. Risk of ineffective respiratory patterns
18. Anxiety
19. Risk of caregiver weariness
20. Decreased peripheral tissular perfusion
21. Risk of Imbalanced liquid volume
22. Sleeping patterns disturbs

Nursing Intervention for elderly people

Applicable to elderly people.
* Promoting daily bathing.
* Monitoring fluids and electrolytes.
* Promoting vaccination.
* Controlling exposition to communicable diseases.
* Offering nutritional intake.
* Observing the aspect of the skin.
* Monitoring vital signs.
* Moving immobilized elderly carefully.
* Promoting passive exercise.
* Adequate positioning in bed or chair.
* Promoting body mechanics.
* Promoting fluid balance.
* Fractioning the diet.
* Controlling swallowing disorders.
* Observe weight gain.
* Care for users who receive diet through forced or parenteral nutrition.
* Controlling hypoglycemia or hyperglycemia.
* Performing or helping with bathing.
* Performing oral, eye, ear, hair and intimate hygiene.
* Controlling pain.
* Helping with dressing.
* Assisting and helping with fluid and food ingestion.
* Encouraging the user to perform self-care.
* Reducing bleeding.
* Easing pressure.
* Moisturizing the skin.
* Promoting suitable nutritional intake.
* Preventing pressure ulcers.
* Treating pressure ulcers and existing wounds.
* Stimulating circulation.
 Nursing diagnoses have been examined and represent one of the main
steps in the NCS (Nursing care system) because they contribute to the
identification of the user’s problems and subsequent elaboration of the
nursing interventions. The interventions, when linked, permit a better
solution of the identified problem, making nursing tasks easier and
maintaining individual care. The classification of nursing diagnoses and
interventions in line with taxonomy is used to standardize and guide nursing
activities. We believe that considering the interventions developed in this
classification for the most frequent nursing diagnoses in elderly inpatients
hospitalized in geriatric wings and comparing them to our reality will
contribute to the strengthening of professional practice.

Nursing Education: - Assessing elderly people (continuing nursing

education).

Nurses are increasingly likely to be involved in assessing the health

status of elderly people in a number of care settings. It is important that the

assessment is relevant and useful, not only for the primary health care team,

but also for the elderly person and any involved carers created and is

maintained by RNs dedicated to optimizing a family’s access to valid

information and credible services about senior care and housing options. The

goal of nursing education is to educate families about the types of care

options available in order to help them to better understand what might be

the best choice for their aging loved ones. Access to their on-line databases
facilitates the difficult search for home care, assisted living, retirement

homes, nursing homes and other long-term care facilities.

Nursing Research: - Nursing Research has a major contribution in meeting

the Health and welfare needs of the people One of the aim of nursing

research is to expand and broaden the scope of nursing.\

Assessment and Care Strategies Three strategies to assess for a typical

presentation of illness include: (1) Vague Presentation of Illness; (2) Altered

Presentation of Illness; and (3) Non-presentation (under-reporting) of Illness.

(1) Vague Presentation of Illness;

Non-specific Symptoms
Confusion
Self-neglect
Falling
Incontinence
Apathy
Anorexia
Dyspnea
Fatigue
(2) Altered Presentation of Illness
Altered Presentation of Illness in Elderly Persons Illness Atypical
Presentation Infectious diseases

• Absence of fever
• Sepsis without usual leukocytosis and fever
 • Falls, decreased appetite or fluid intake, confusion, change in
functional status

"Silent" acute abdomen

• Absence of symptoms (silent presentation)

• Mild discomfort and constipation
• Some tachypnea and possibly vague respiratory symptoms

"Silent" malignancy

• Back pain secondary to metastases from slow growing breast masses

• Silent masses of the bowel

"Silent" myocardial infarction

• Absence of chest pain

• Vague symptoms of fatigue, nausea and a decrease in functional
status.
• Classic presentation: shortness of breath more common complaint
than chest pain

Non-dyspneic pulmonary edema

• May not subjectively experience the classic symptoms such as

paroxysmal nocturnal dyspnea or coughing
• Typical onset is insidious with change in function, food or fluid
intake, or confusion

Thyroid disease

• Hyperthyroidism presenting as "apathetic thyrotoxicosis," i.e. fatigue

and a slowing down
• Hypothyroidism, presenting with confusion and agitation
Depression

• Lack of sadness
• Somatic complaints, such as appetite changes, vague GI symptoms,
constipation, and sleep disturbances
• Hyper activity
• Sadness misinterpreted by provider as normal consequence of aging
• Medical problems that mask depression
• Medical illness that presents as depression
• Hypo- and hyper- thyroid disease that presents as diminished energy
and apathy

(3) Non-presentation (under-reporting) of Illness.

Hidden" Illness in Elderly People

Depression
Incontinence
Musculoskeletal stiffness
Falling
Alcoholism
Osteoporosis
Hearing loss
Dementia
Dental Problems
Poor nutrition
Sexual dysfunction
Osteoarthritis.

The expanded role of a professional nurse emphasizes those activities which

promote health maintenance behavior among the Elderly people.The present
 study is only conducted to assess the perceived health problems and level of
satisfaction of facilities in old age home. Further research can be conducted
including other aspects among elderly.

Limitations.

The study will be limited to,

• The elderly people who are 60years and above.

• The elderly people who are willing to participate in the study.
• Those elderly people who are able to express their problems verbally.
• The elderly people who are available at the time of the study residing
in old age home.
• The elderly people who can understand English.
• Reduce adverse drug events in older adults.

Suggestion

Respect (deference) to older patients in culturally appropriate ways helps to

establish a trusting relationship. Many older adults from different ethnic
backgrounds are more responsive to calmness and humility. Speed and self-
assertion or directness can create barriers to the interaction. Specific
strategies to foster the development of trust may include:

Consult informed persons as to what is culturally appropriate.

• Generally, acknowledge and greet older persons first. Generally, use
formal title such as "Mr." or "Mrs." to address the patient, at least
initially. Find an appropriate time to ask the patient's how she/he prefers
to be addressed by the provider.
 • Consider use of informal conversation prior to formal assessment. It
may not be respectful to ask business oriented questions without first
acknowledging the patient in a more personal way.
• For example, to begin a conversation with questions such as "How is
your family?" or "Did you have to travel long to come here?" before
they wish to respond to more formal questions such as "What brings
you here today?" or "How can I help you today?" When an older person
inquires about you, be ready to share something personal about
yourself.
• Despite the increasing pressure of limited time for patient care in
clinical settings, an attitude of sincere concern usually helps to put the
ethnic older person at ease.
• Avoiding the "invisible patient syndrome". Older patients need to be
talked to and with, rather than talked about. Talking to someone else in
the room as if the patient weren't there (or is incapable of
understanding) demonstrates disrespect.
• Acknowledge the importance of ethnicity and ask for the patient's help
as a cultural expert in understanding the current situation and
incorporating salient cultural components in the plan of care.
• Facilities of old age homes should improve more so Elderly can enjoy
their life.

Recommendations
Based on the findings of the present study, the following recommendations
were offered for the future study.

• Similar study can be conducted on a larger sample.

• Comparative study can be conducted with control group.
• A descriptive study can be conducted to assess the knowledge of
perceived health problems among elderly people.
• If interested in Geriatric care can open home for the Aged so elderly
can enjoy there life.
 8 SUMMARY
Research Methodology gives a bird eye view of the entire process of a

talking a research problem in a scientific ,systematic manner, In this study

the dependant variable refers to the perceived health problems of the elderly

people, the Independent variable refers to the facilities provided in the old

age home.
 This chapter has been of permanent use in the development of the

analysis and interpretation,

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

technological 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, chronic 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.

 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

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. There are, also certain

psychological problems related to retirement psycho geriatrics is the area

of research that deals with functional disorders of old age.

MAJOR FINDINGS OF THE STUDY

• Majority of the elderly people 72% belong to age group of above 70

years.

• More than half of the elderly people 70% were female.

• Approximately half of the elderly people 34% had studied up to

secondary School.
• Most of the elderly 62% were married.

• Majority elderly people 66% were had previous occupation.

• 52% of elderly people were duration of stay.

• 76% of elderly people were financial depend on old age home.

• Most of the elderly people 48% were taking self care.

• Majority of elderly people 70% were suffering with other perceived

health problems.

• In dietary status 64% of elderly people were moderately nourished.

• 72% of elderly people were suffering with physical health problems.

• 67% of elderly people were suffering with physiological health

problems.

• 64% of elderly people were suffering with psychological health

problems.

The facilities provided for the elderly people in old age Home.

• The elderly people staying in old age homes, more than 60% were

dissatisfied with food facilities, > 70% were dissatisfied with living

facilities, 53% were dissatisfied with care in health and illness and

60% were dissatisfied with recreational facility.

Association between the knowledge of old age people on perceived

health problems and demographic variables.

The demographic variables like age, education, previous occupation, self

care activities, history of health illness and dietary status are significant with

knowledge of elderly people and other demographic variables are not

significant.

• The association between age and knowledge levels is significant (χ2=

12.80) at 5% level of significance.

• The association between gender and knowledge levels is not

significant (χ2= 4.29) at 5% level of significance.

• The association between marital status and knowledge levels is not

significant (χ2= 1.71) at 5% level of significance.

• The association between education and knowledge levels is significant

(χ2= 15.32) at 5% level of significance.

• The association between previous occupation and knowledge levels is

significant (χ2= 10.21) at 5% level of significance.

• The association between history of health illness and knowledge

levels is significant (χ2= 15.88) at 5% level of significance.

• The association between dietary status and knowledge levels is

significant (χ2= 13.15) at 5% level of significance.

 The elderly people staying in old age homes have higher mean (72%)

in physical activities compared to physiological (67%) and (64%)

psychological problems.

The elderly people were somewhat satisfied with the facilities

provided in the old age home. They were very satisfied with the facilities

given during health and illness They were best satisfied with the food

facilities there was no significance association between the health problems

and duration of stay and there was a significance association between

physical and psychological problems.

 9 BIBLIOGRAPHY

Textbooks:-

1. Abdellah, F.G.& Eugene.L.Better patient care through nursing

Research.London. The MacMillan Company, 1971.

 2. Bahaduri A and Mary F.Fealth Research A community based

approach. New Delhi.WHO.Regional publication south East

Asia.1981.

3. Burnside IM.Nursing and the aged New York MC Graw-Hill

Company 1976.

4. Christ M.A.Faith J.H.Gerontological Nursing –A study and learning

tool. Pennsylvania, Springhouse Publishing Company 1988.

5. Care of the Ageing New York Churchill Livingston 1981.

6. Ebersole and Hers Towards Healthy Aging Human Needs and

Nursing Response (IInd) 103-636.

7. Ebersole and Hers Supporting Physiologic needs of the patient

towards of healthy Aging.103-193.

8. Need for protection safety and security.197-314.

9. Self esteem status and self respect towards healthy aging (IInd

edition) 401-521.

10. Park .J.E.AND Park .k.text book of preventive and social Medicine

VII, Edition Jabalpur, M/S Banasari Das 1979.

11. Polit Denise and Hungler, Nursing Research, Principles and Methods

Philadelphia, J.B.Lippincott Co-1978.

12. Shrivastava R.S.Aged and the socity,New Delhi,Citizen Develpoment

Socity 1983.
13. Mosby, Driksen Medical – surgical Nursing- Older Adult. Page no.

58-80.

Journals:-

14 Barbara, B.February 1991.The Aging Process, Health Action.Vol.3

(2), 7-8p.

15 Celia.L.H.The effect of early nursing home placement on student

attitudes towards the elderly, Journal of nursing education Vol.34 (3),

128p.

16 Graene J. February 1991”The blind Man’s association –Steps in

development for elderly people health action Vol.3 (2)17-18p.

17 Muriel.S.February 1991Infections in old age, Health Action Vol.3 (2),

9-10p.

Dissertations:-

Tai Chi and Perceived Health Status in Older Adults Who Are Transitionally

Frail.

“Comparative study on physical & mental health status of elderly in

institutional & non- institutional setting - A case study of Delhi” BY:

GAUTAM CHOWDHARY. DPT. ND (CAL) GERIATRIC ANIMATOR

Harmony- AGEING IN INDIA IN THE 21ST CENTURY: A RESEARCH AGENDA.

 Elderly Community Residents' Reactions tothe Nursing Home: An Analysis

of Nursing Home-Related Beliefs, Paula J. Biedenharn, MA2 and

Janice Bastlin Normoyle, PhD.

Being old does not always mean being sick perspectives on conditions of

health as perceived by British and American elderly Hanneke M.Th.

van Maanen RN DrNSc MPH M, Associate Professor of Nursing,

Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

Health Belief Model Chapter 4 by Jones and Bartlett publishers on line.

Loneliness and Older Adults Physical Health,Michael Steinhour.

22 Mobility in aging,

Hypertension in Aging Patients, Alexander G Logan.

Factors related to perceived health among elderly people: the Albertina

project

Prevention of falling risk in elderly people: the relevance of muscular

strength and symmetry of lower limbs in postural stability,Pizzigalli

L, Filippini A, Ahmaidi S, Jullien H, Rainoldi A.

Attitudes of primary care team to diagnosing dementia.Thomas H, Older

Persons Services, Glanrhyd Hospital, Bridgend.

The importance of getting back to nature for people with dementia.Bossen A

Dry mouth and its effects on the oral health of elderly people.Turner MD,

Ship JA.Department of Oral and Maxillofacial Surgery, New York

University College of Dentistry, New York City, USA.

Depressive Symptoms, Chronic Diseases, and Physical Disabilities as

Predictors of Cognitive Functioning Trajectories in Older

AmericansJoshua Chodosh, MD, MSHS; Dana Miller-Martinez, PhD;

Carol S. Aneshensel, PhD; Richard G. Wight, PhD; Arun S.

Karlamangla, PhD, MD

Perceived barriers to physical activity among older adults residing in long-

term care institutions.Chen YM.China Medical University, School of

Nursing, Taichung, Taiwan, ROC. ymchen@mail.cmu.edu.tw

Review of risk factors and preventative strategies for fall-related injuries in

people with intellectual disabilities.Willgoss TG, Yohannes AM,

Mitchell D.Department of Health Professions, Elizabeth Gaskell

Campus, Manchester Metropolitan University, Manchester M13 0JA,

UK. t.willgoss@mmu.ac.uk

33 Mobility Difficulties Are Not Only a Problem of Old Age,Lisa I

Iezzoni, MD, MSc,1,3 Ellen P McCarthy, PhD,1,3 Roger B Davis,

ScD,1,3 and Hilary Siebens, MD2

Fatigue in patients with diabetes: a review.Fritschi C, Quinn L,Department

of Biobehavioral Health Science, College of Nursing, University of

Illinois at Chicago, IL 60612, USA.

Article in Norwegian Chronic pain is a serious and frequent health

problem in elderly people.

In the UK, population screening for unmet need has failed to improve the

health of older people.

34 Explore the development of group homes for elders with dementia in

Japan since the inception of the long-term care insurance program in

2000.

35 Dutch GP's (General Practitioners) take care of people living in homes

for the elderly.

36 Health-promoting factors and good health among Canadians in mid- to

late life,Ramage-Morin PL, Shields M, Martel L,Health Analysis

Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.

Pamela.Ramage-Morin@statcan.gc.ca

Literature Review of Pain Prevalence Among Older Residents of Nursing

Home,Yukari Takai, DNSc, RN; Noriko Yamamoto-Mitani, PhD, RN;

Yuko Okamoto, PhD, RN; Keiko Koyama, PhD, MD; Akiko Honda,

PhD, RN
Residential Facilities and Long-Term Psychiatric Care: A review of the most

recent literature has helped identify at least some of the most relevant

problems in the field of residential care, which we will briefly

summarize.

Web Sites

www.geriatricnursing.com

www.greonotology.com

www.helpage.com

www.ageandaging.com etc.
 ANNEXURE-1

Letter requesting permission to conduct, Pilot Study on senior citizens.

To,
Sr Antoinette,
Mother Superior,

The little sisters of the poor,

Home for the Aged,
No 26, Hosur Road, Bangalore.560025
 Subject: - Letter requesting permission to conduct, Pilot Study on senior citizens

Dear Mother Antoinette,

Mona Prabhakar Londhe is a final year student , for Master of Nursing course in
our College of Nursing Hormavu Bangalore5600 43 She has selected the following topic
for her research Project to be submitted to the Rajive Gandhi University of Health
Science Bangalore in partial fulfillment of the University requirement for the Master of
Nursing Degree.
Topic: - A study to assess knowledge of perceived health problems among elderly
people and facilities provided to them in selected old age homes in Bangalore city.
She needs your esteemed help and co-operation, as she is interested in conducting her
project study at your home for the aged, while she is doing her voluntary services for the
aged.
I am requesting you to kindly grant her permission & provide necessary facilities for her
work on the proposed project. On completion of her project work,. I once again request
you to please give her a letter (To Whom So Ever It may Concern) that Mona Prabhakar
Londhe final year student of Navaneetham College of Nursing Bangalore 560043 was
permitted to be a volunteer in our Home for the Aged. & for her requirement of study on
Elderly Senior Citizens.

Thanking you,

Yours Sincerely,

Principal,

Navaneetham College of Nursing.

Bangalore 43.

ANNEXURE-2

Letter of permission granted for pilot study in Little sister of the poor Home for the

aged by Mother Superior

 ANNEXURE-3

Letter seeking expert’s opinion in validating tool and information regarding topic.

From

Mona Prabhakar Londhe.

IInd year Msc Nursing Student,

Navaneetham College of Nursing,
 Horamav Bangalore 43.

TO,

Forwarded through the Principal,

Subject: - Request for validation of Research tool.

Respected Madam / Sir,

I, Ms. Mona Prabhakar Londhe, am a 2nd. year Msc. nursing student - Medical
Surgical Nursing - at Navaneetham College of Nursing, and as a part of my academic
requirement of Rajiv Gandhi University of Health Science, have undertaken to do a
research project on,

“Assessment of the knowledge related to perceived health problems among elderly

people and the facilities provided to them in selected senior citizen’s (old age) homes
in Bangalore city. With a view to develop information.

I humbly request you to kindly give your expert opinion and suggestions on the above
subject, its scope, and the need for modification or deletion, by using the evaluation criteria
checklist enclosed.

Thanking you in anticipation,

Yours Sincerely,

{Mona Prabhakar Londhe.}

Please find attached herein below the following documents for your kind reference

1) Blue print of the tool.

2) Tool.

a) Demographic Data-Part-I

b) Structured Interview schedule with Questionnaire Part-II

c) Structured Interview schedule with Questionnaire Part-III

3) Scoring Key.

4) Criteria check list for tool validation.

5) Information of the Topic.

6) Criteria rating scale for validation of the knowledge of perceived health problems
amoung elderly people and facilities provided to them in old age home.

7) Content Validity certificate.

Forwarded By,

Principal,

ANNEXURE-4

CONTENT VALIDITY CERTIFICATE

This is to certify that tool for “A study to assess knowledge of perceived health
problems among the elderly people and facilities provided to them in selected old
age homes in Bangalore city.a view to develop information and above topic prepared by
Mona Prabhakar Londhe, IInd year Msc Nursing Student of Navneetham College of
nursing Hormav, all content of tool is found to be valid.
 Signature of expert.

Name:-

Designation:-

Address:-

Date:-

ANNEXURE-5

CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL.

Instruction:

Kindly review the items in the tool. If you are agree with the criteria, place a tick
mark in Relevant column otherwise place a tick mark in need modification column or not
relevant and give your comments in the ‘Remarks ‘Column.
PART-I Demographical Data:

SL.NO. Relevant Needs Not Relevant Remarks.

Modification
1
2
3
4
5
6
7
8
9
10

PART- II Knowledge Questionnaire:

SL.NO. Relevant Needs Not Relevant Remarks.

Modification
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

PART-III

Facilities provided in old age home questionnaire:

SL.NO. Relevant Needs Not Relevant Remarks.

Modification
1
2
3
4
5
6
 7
8
9
10
11
12
13
14
15
16
17
18
19
20

Signature of Expert.

ANNEXURE-6

PART-I DEMOGRAPHIC DATA RESPONSE

1 Age
a) 60-65years
b) 65-70years
c) 70years & above.
2 Sex
a) Male
 b) Female
3 Educational Status
a)Primary
b)Secondary
c)Higher Secondary
d)Degree

4 Marital Status
a) Married
b) Unmarried
c) Widow
d) Divorce
5 Previous Occupation
a)Professional
b)Any other
6 Duration of Stay
a) <3 years
b) 3-5years
c) 5& above years
7 Financial Dependency
a)Self
b)On family member
c) Old age homes
d) Any other
8 Self Care Activities
a) Independent
b) Partially Dependent
c) Fully Dependant
9 History of Health Illness
a)Diabetes Mellitus
b)Hypertension
c)Bronchial Asthma
d) Any Other

10 Dietary Status by Criteria of BMI

a) Well Nourished
b) Moderately Nourished
c) Poorly Nourished.

ANNEXURE-7

List of Validators.

1. Mrs.Thangam Sheila Rosalen.

 HOD.of Medical Surgical Nursing

Navaneetham College of nursing.

Bangalore.

2. Mrs. Prabha Thomas.

HOD.of Medical Surgical Nursing

Krupanidhi College of Nursing

Bangalore.

3. Mrs. Milka Madhale

HOD.of Medical Surgical Nursing

k.L.E College of Nursing.

Belgaum.

4. Mrs.M.Sumitra.

HOD.of Medical Surgical Nursing

Chinmaya Institute of Nursing

Bangalore.

5. Mr.Umapathy.

HOD of Statistics.

R.V.College of Commerce Bangalore.

ANNEXURE-8

Letter of Joint Director of Horticulture Lal Bag Bangalore for Free Entry Pass

for Flower Show.

 ANNEXURE-9

Pix of candidate who is assessing the elderly people in Home for the Aged in

Bangalore.