Statement of the problem
Old age is associated with several mental illnesses, which culminate into other psychosocial issues. For example, dementia and other related conditions such as the Creutzfeudz Jacob’s disease – as caused by advanced senility – have become common in the modern world. Usually, these diseases affect old people, which become more and more problematic as the age advances. The role of caring for the old people has therefore become very vital, usually requiring increased care and special treatment to these people.
Introduction
The elderly people face several challenges due to the mental, social and health problems associated with old age. In the modern world, the role of taking care for the aged has been left in the hands of several entities, either at homes or in nursing facilities. The number of nursing homes in developed nations has been on the increase, especially because there are few family members available to take care of these aged persons. In the United States of American, Europe and Japan, nursing homes have been playing a pivotal role in taking care of these old persons in the society than in any other countries.
Old age is associated with several mental illnesses, which culminate into other psychosocial issues. For example, dementia and other related conditions such as the Creutzfeudz Jacob’s and Alzheimer’s diseases – caused by advanced senility – have become common in the modern world. Usually, these diseases affect old people, which become more and more problematic as the age advances. The role of caring for old people has therefore become very vital, usually requiring increased care and special treatment to these people.
The problems associated with old age have been a major source of controversy over who should take care of old people in societies. In particular, the role of nursing homes on the well-being of old people in the society has raised concerns in several occasions, as people tend to have mixed opinions and feelings towards these homes. While some people tend to support these nursing homes and the roles they have been playing towards the improvement of the wellbeing of the elderly, proponents have had different opinions, often questioning the credibility of these facilities and the effect they have on the society in general.
Of importance in this controversy is the effect of the nursing homes on the psychological and social well being of the elderly. Proponents have argued that nursing homes and other related facilities have played a crucial role of supporting not only these persons, but also reducing the dependency on family members. In addition, they argue that since nursing homes have facilities and highly qualified personnel, the quality of care provided to these persons is quite high, and the number and effect of the problems associated with old age have reduced due to the manageability of the situation in these homes.
Background information
Although there are a number of studies conducted on the past to determine the effect of nursing homes on the health and mental well being of old persons in these facilities, few studies have revealed what is the exact effect of the facilities in the end. In addition, only few studies have focused on the psychosocial effect caused by these facilities on the long-term basis. This study will therefore focuses on the weaknesses displayed by these studies, with an aim of providing public health care system with the first hand information that could be used by psychologists and other medical practitioners in catering for the aged presented in for medical, mental and psychiatric check ups.
Literature Review
Several studies have been done to determine the long-term effect of nursing homes on the health, psychological and the social issues on the old people in different societies. The role of nursing homes within different communities has been shown by some of these studies to be different, and it seems that the effect of the homes is multiple, whether negative or positive.
Levin, Wei, Akincigil, Lucas, Bilder, and Crystal (2007) conducted a study in Ohio in an attempt to determine these effects. Levin led a group of other authors to examine the existence and treatment of depression diagnosed among the elderly in nursing homes. They were also to research on the facility and resident characteristics related to diagnosis and treatment. This study examined a group of elderly persons within the defined nursing homes. The sample consisted of 76,735 residents in 921 nursing homes in Ohio. This was merged with online survey certification and reporting system data. The researchers used Chi-squared statistics for testing group differences in depression diagnosis and treatment. In addition, they used multiple logistic regressions to test for prevalence. The results showed that 48% of residents were found to have active depression. Of these, 23% received no treatment, 74% received antidepressants, 0.5% had psychotherapy and 2% had both. The African Americans were rarely diagnosed, and the same was worse for the 85+ African Americans. Using sociodemographics, pharmacotherapy, psychotherapy, and medical conditions, the researchers found the rate of diagnosis of depression. In addition, the aged and especially the African Americans were rarely diagnosed due to economic hardships. This was one of the main strengths of this study.
However, the study had several weaknesses; for example, the excessive use of mathematical interpretation caused too much estimation and rounding off, some of which may have affected the results of the data. In addition, the data collected was cross-sectional.
Jongenellis, Poi, Eisses, Beekman., Kluiter, and Ribbe, (2004), carried out a study to determine the prevalence and risk indicators of depression in elderly nursing home patients. The researchers noted the scarcity of nursing home-based research and decided to study the risks among the frail patients in the nursing homes. The sample consisted of 333 nursing home patients from 14 nursing homes in northwestern side of Netherlands. The researchers used Geriatric Depression Scale to measure depression scales. The DSM-IV criteria were used for minor and major depression diagnosis. The results showed that for the major depression, prevalence was 8.1%, 14.1% for minor depression, and 24% for sub-clinical depression. The risks for major depression lay in pain, functional limitations and stroke among others while all these were present for sub-clinical depression except for social support. The Diagnostic and Statistical Manual of Mental Disorders was used to diagnose for major and minor depressions. Sub-clinical depressions were defined as 10< GDS scores. Other risk factors were identified related to the depression levels. However, the major limitation is the fact that the data consisted of all the people in the people in the nursing homes. In this case, they were cross-sectional. Harris, (2007) set out to determine depression as a Risk Factor for Nursing Home Admission among Older Individuals, and conducted another study on the same. Harris conducted a research to investigate on the rate of depression and mental health of patients and the risks associated when these depressed individuals are in the nursing homes. The sample-included individuals aged 65 years and over, associated with increased mortality and morbidity. The research was conducted using the Cox proportional hazards model. It was found out that Medicare Choice patients over 65 years had depression irrespective of controlling their physical health, and these patients were at an increased risk while in the nursing homes. By controlling the demographic variables, co-morbidity, and functional status, it was easier to establish the risks associated with admitting a patient in the nursing homes. However, the data collected was cross-sectional and this might have affected the relevance of some findings as they might have fallen out of the intended limits. Another study by Djernes, (2006) was conducted to determine the prevalence and predictors of depression in populations of elderly.
Djernes conducted a research aimed at establishing the prevalence and causes of increased depression among the elderly in the community. The samples taken were from literature, MEDLINE, and Psychinfo of 1993 and later years. Literature reviews from databases of MEDLINE and Psychinfo, dated 1993 and later years. Djernes found prevalence of depression among private households to be 0.9% to 9.4%, in homes; there were 14% to 42% and 1% to 16% among the elderly in either private or institutionalized homes. Gender, somatic illness, functional and cognitive impairment, depression history and lack of social contacts were the main predictors of depression. By considering the community’s prevalence rate, the researchers were able to establish some other causative factors to increased depression among the elderly like social stigma. The data used was excessively large for proper analysis as it reflected a wide scope and included many years within which the causing factors might have changed. Kamel, Phlavan, Malekqoudarzi, Gogel, and Morley (2001) conducted a research to determine the utilizing pain assessment scales increases the frequency of diagnosing pain among elderly nursing home residents. The main objective of the assignment was to establish the frequency of diagnosing pain among the elderly in the nursing homes. The samples were collected from two nursing facilities; one in long island, New York with 899 beds and another in Maryland heights, Missouri with 201 beds. In addition, there were 305 randomly selected aged persons, 60>. The method adopted by these researchers involved abstracting of medical records through a cross-sectional study. There were questionnaires and test scales for assessing the pain. From the studies, it was found out that the pain tests using the testing instruments displayed greater frequency, 30% against the questionnaire;15%. Among the old, (>85) three pain assessment scales showed greater diagnosis frequency, 32% against 6% to the questionnaire and for the cognitively impaired, there were 16% to 10% frequency for scales against questionnaire. The three pain assessment techniques displayed greater and better results due to their intensity of study. It was found through past records that pain assessment was a great issue and this made the analysis comprehensive. The major weakness was conducting the cross-sectional study, which generalized many samples without being specific on the aged persons.
McCurren, Dowe, Rattle, and Looney, (1999) determined the depression among nursing home elders through the Tests on an intervention strategy. The researchers were aimed at assessing the depression among elders in nursing homes and evaluating an intervention strategy using a neuropsychiatric nurse. The samples consisted of 139 nursing home residents. The method used was Geriatric Depression Scale (GDS) to test the depression rates among the elderly nursing home residents. From this method, the researchers found out that 68% of the persons had depressive symptomatology. Those receiving intervention had reduced rates while the control group showed no significant decline. The strength of the study was the use of control groups to eradicate any anomaly in analysis. In addition, the medium data set enabled for proper evaluation of results. There were no clear-cut measures to evaluate on the quantitative survey of those receiving the intervention and hence the assumption.
Chung, (2008) conducted a study to determine the residential status and depression among elderly people in South Korea, which was based on a comparison between residents of nursing home and those based in the community. Chung conducted this study to compare the depression levels between elderly people in the nursing homes and those in the community as well as finding the variables contributing to these depression rates. The sample of the study was 307 elderly persons in nursing homes and 166 living in the community. Chung used the Geriatric Depression Scale-Short form (GDS-SF) to measure for depression rate. From the study, 39.3% of the community elderly showed depression signs, higher than the rate of nursing home elderly, 24%. The mean GDS-SF scores for the nursing home elderly was 6.1 and 7.4 for community elderly. Adjusted odds ratio of depression for the nursing home elderly was 3.14, holding all other factors constant, much lower than those of community elderly do. By making a comparison between the community and the nursing homes, significant depression was found to originate from the community, mostly due to lack of social support. The GDS-SF study method used ensured that precision was attained. The sample collected for both nursing homes and community-based elderly were not equal. This could have resulted to errors in assessment as the results could have been biased on the nursing home elderly.
Barca, Engeda, Laks and Selbaek, (2010) conducted a 12 months follow-up study of depression among nursing home patients in Norway. Barca and her colleagues conducted the research to examine the incidence, prevalence and the persistence rates of clinically significant depressive symptoms as well as the risk factors among the patients of nursing homes.
The sample used by these researchers was 902 randomly selected patients in nursing homes for assessment. The methods used included the Cornell Scale, self-maintenance scale, Clinical Dementia rating scale, a physical health measurement. These measurements were to proceed for 12 months. After 12 months, 231 had died whereby, depression, together with other factors like worse physical health, cancer and higher CDR score, among others contributed to the death at 0.03 rates. Depression prevalence was 21.2% at baseline to the end of period, incidence rate of 14.9%, and persistence rate of 44.8%. Cornell score at baseline was p<0.001, shorter stay in homes, 0.011, use of antidepressants 0.050, for incidence depression., for shorter stay, Cornell score was 0.019 at baseline, 0.002, for shorter stay, and higher CDR at 0.003 for the persistent depression. Higher Cornell score at 0.011 baselines, 0.045 for anxiolytics use, and 0.037 for the unmarried. The definition of clinical depression at 8+ on the Cornell scale provided for precision and accuracy in information collection. The 12-month follow-up study provided for ample time to make clear-cut judgments and resolutions on the depression prevalence and impacts on nursing home patients. However, the random selection of patients did not fully eliminate the chances of picking the wrong sample for the tests.
Study question
Do nursing homes have any long-term effect on the elderly psychosocial well being?
Alternative hypothesis
Nursing homes have some significant long-term effect on the elderly psychosocial well-being.
Null hypothesis
Nursing homes do not have any significant long-term effect on the elderly psychosocial well-being.
Methodology
Study area;
The study will utilize the population of persons in several home based, public, and private nursing homes within (the area of study).
Target population;
The study will select its study subjects from the nursing homes within the selected area of study. Both the supportive staff and the management in these facilities will be requested to full the consents and targeted as the source of information of the study. The elderly will also be asked some questions in order to gain information from them. The elderly are the main subjects of study in this particular study.
Inclusion criteria: the study shall include nursing homes which have been operating for a period not less than six years and in which have operated in full time since the inauguration date. Any nursing home for the elderly which meets this criterion is eligible for the study. In addition, the study will include any elderly person with over 70 years of age, and who has been under the care nursing home for a period not less than five years.
Exclusion criteria: any nursing home which has not been in operation for more than six years will be excluded from the study. In addition, any person with less than 70 years of age and/or has not been under the care of nursing homes will also not be recognized as a study subject.
Procedure
The study will target the elderly persons within the specified areas of study. The main method of study employed will be the use of questionnaires. These questionnaires will be developed within the time period before the actual study starts. The first task shall be to request for permission for the study from the relevant authorities as well as the nursing homes themselves.
There are several authorities who are involved in one way or the other in conducting and monitoring the way in which the elderly people are handled in the society. Some of these entities are government agencies, local authorities as well as other departments. They will be notified of the study at the same time and using the same communication channels. In this case, the communication channels shall include hand delivery, emails and surface mail. In addition, family members of the elderly persons selected for the study will be informed on the study. Consent forms will then be distributed to the nursing homes, with clear indications on the purpose, process, significant and the intended use of the study.
After the signing of the consent forms, the study population will be exposed to the study. Questionnaires will be sent to these persons through the same communication channels as those used in sending and receiving consent forms.
Data collection procedures
Sources of data
a) Internal sources; the selected cases (nursing homes for the elderly)
b) External sources: other entities: legal entities, Government agencies, ministries.
Questionnaires: Questionnaires will be developed. Questionnaires will contain both open ended and closed questions. They will be simple, understandable but accurate and contented questions. The questioned will be on paper format or in electronic form. The paper form questionnaires will be communicated through surface mail and hand delivery, while the electronic one will be communicate through email.
Surveys: surveys will be conducted within the localities of the selected cases. Each nursing home will be visited at least twice to get the information from the management and the social workers. The type of data sought for shall include the present and past performance of the individuals selected for the study, as well as the moral, economic and ethical issues the well being of the persons.
Document analysis: documents obtained from all the entities involved in this study will be reviewed in details to get the past information on the health and behavioral performance of the persons. These documents will be exposed to the same treatment for all the companies. Information regarding health and behavioral performance will be reviewed.
Data analysis procedure
The collected data will undergo an analysis procedure to derive qualitative information. The study is scheduled to infer information from the data through an analysis procedure.
Data cleaning
The data shall be inspected to remove errors and redundancy. An attempt to correct some errors will be made, where possible, and where the correction will not affect the entire data in the sheet. Microsoft spreadsheets (excel) tool will be used for this process.
Data analysis
The study will utilize multiple methods of data analysis to ensure that quality information is derived and valid conclusion drawn from it. Statistical analysis methods, correlations and graphical techniques will be utilized. The study will employ the use of statistical analysis system on computers to ensure efficiency and accuracy as well as validity in the derived information. Graphical analysis will involve intensive use of scatter plots, chi squares, t-squares and distribution tables. The study will utilize the SPSS software in data analysis procedure.
Reporting
The results of data analyses will be communicated through study reports. The report shall include data presentation and a conclusion. Data will be represented in form of charts and graphs, leading to a valid conclusion.
Anticipated findings
It is expected that this study will reflect the current conditions present in the nursing homes. There are reports of abuse of the elderly by some workers in several nursing homes, which may affect the way the elderly people behave and carry themselves in the presence of other people and when alone. It is expected that these treatments will be reflected in the study. It is expected that the predictors of depression will be reflected alongside any cases of abuse, ill health and other aspects. For instance, Gender, somatic illness, functional and cognitive impairment, depression history and lack of social contacts are the main predictors of depression. By considering the community’s prevalence rate, the study should able to establish some other causative factors to increased depression among the elderly like social stigma. Since the data used is large enough, proper analysis is expected to be reflected at a wide scope and include many years within which the causing factors will have changed.
It is possible to find that considering the sociodemographics, pharmacotherapy, psychotherapy, and medical conditions, the study may lead to a conclusion that the rate of diagnosis of depression among the aged and are rarely diagnosed due to economic hardships. This is one of the main strengths of this study. However, could have some fewl weaknesses; for example, the excessive use of mathematical interpretation may cause too much estimation and rounding off, some of which may affect the results of the data. In addition, the data to be collected will be cross-sectional.
References
Barca, M. L., Engeda, K., Laks, J., & Selbaek, G. (2010). A 12 months follow-up study of depression among nursing-home patients in Norway. Journal of Affective Disorders, 120 (1), 141-148.
Chung, S. (2008). Residential status and depression among Korean elderly people: a comparison between residents of nursing home and those based in the community. Health and Social Care in the Community, 16 (4), 370-377.
Djernes, J.K. (2006). Prevalence and predictors of depression in populations of elderly. Acta Psychiatrica Scandinavica, 113 (5), 372-387.
Harris, Y. (2007). Depression as a Risk Factor for Nursing Home Admission Among Older Individuals. Journal of the American Medical Directors Association. 8 (1), 14-20.
Jongenellis, K., Poi, A.M., Eisses, A.M., Beekman., A.T., Kluiter, H., & Ribbe, M. (2004). Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. Journal of Affective Disorders, 83 (2), 135-142.
Kamel, H.K., Phlavan, M., Malekqoudarzi, B., Gogel, P., & Morley, J.E. (2001). Utilizing Pain Assessment Scales Increases the Frequency of Diagnosing Pain Among Elderly Nursing Home Residents. Journal of Pain and Symptom Management, 21 (6), 450-455.
Levin, C. A., Wei,W., Akincigil, A., Lucas, J. A, Bilder, S., & Crystal, S. (2007). Prevalence and Treatment of Diagnosed Depression among Elderly Nursing Home Residents in Ohio. Journal of the American Medical Directors Association, 8 (9), 585-594.
McCurren, C., Dowe, D., Rattle, D., & Looney, S. (1999). Depression among nursing home elders: Testing an intervention strategy. Applied Nursing Research, 12 (4), 185-195.
