IMPACT OF AGEING ON DEPRESSION AND ACTIVITIES OF DAILY

LIVINGS IN NORMAL ELDERLY SUBJECTS LIVING IN OLD AGE

HOMES AND COMMUNITIES OF KANPUR, U.P.

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

ABSTRACT
INTRODUCTION: Ageing is a progressive generalized impairment of functions resulting in loss of adaptive
response to stress and increasing the risk of age related disease. METHODOLOGY: A sample of 200 elderly
subjects i.e. 100 from the community (group A) and 100 from Old age home (group B) of sixty & above years
of age were taken by the convenience sampling method. The subjects were collected through various old age
homes and community which includes Vaikunth Dham Old Age Home, Ishwar Prem Ashram, Swaraj Ashram,
Ramkrishna Mission old age home and nearby community located in the Kanpur and Varanasi. The subjects
were assigned a number to maintain the confidentiality of the subjects and then the scales were used to assess
the scores i.e., Geriatric Depression Scale (GDS) and Barthel index of daily livings were used to check the
level of depression & ADL’s and then the scores were compared. THE RESULTS: The mean GDS scores for
group A were 11.32 and for group B were 16.42 with a value of -6.981 with a p value of 0.00* and mean
ADL’s scores on the Barthel index for group A were16. 54 and 17.98 for group B within value of -2.898 with
a p value of 0.004* which shows there is a significant difference. Conclusion: Elderly subjects living in Old
age home are more affected in terms of depression and ADL’s as compared to community dwelling elder
subjects as old people living in their own homes were most able to cope in their homes. They received more
support from relatives and friends than from health and social services16

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

INTRODUCTION However elderly are not preparing themselves for

long life, nor are we receiving any information
Age classification varied between countries
about the aging process at home, school,
and over time, reflecting in many instances the
community in general. Society tends to exclude the
social class differences or functional ability related
elderly. They are considered incompetent and are
to the workforce, but more often than not was a
denied any responsibilities. This is far removed
reflection of the current political and economic
from previous societies in which, given their
situation. Many times the definition is linked to the
experience, the eldest members enjoyed a much
retirement age, which in some instances, was
higher status. They considered wise, the teachers,
lower for women than men. This transition in
and traditions. A great number of people in this
livelihood became the basis for the definition of
sector are slightly depressed and tend to consider
old age which occurred between the ages of 45 and
themselves less productive than they really are5
55 years for women and between the ages of 55
Between the year 2000 to 2050, the
and 75 years for men1.
worldwide proportion of persons over 65 years of
Elderly people are classified into: - 1) 60 yrs
age is expected to more than double, from the
to 70yrs- Young old 2) 70 yrs to 80yrs- Middle old
current 6.9% to 16.4%. As healthcare facilities
3) 80yrs &above- Old old 2
improve in countries, the proportion of the elderly
The risk factors for reduced physical function
in the population & the life expectancy after birth
in elderly people, as identified in longitudinal
increase accordingly. This is the trend which has
studies, relate to comorbidities, physical and
been in both developed & developing countries. It
psychosocial health, environmental conditions,
is commonly believed that the majority of the
social circumstances, nutrition, and lifestyle3
elderly population resides in developed countries.
As the western population is increasingly
However, this is a myth, as about 60% of the 580
ageing, problems connected with old age will
million older people in the world live in
dominate healthcare. Depression, one of the most
developing countries, and by 2020, this value will
prevalent psychiatric disorders, is expected to take
increase to 70% of the total older population 6
an even more prominent position than presently, as
Depression is common in medically ill elderly
the risk for developing depression increases with
and associated with greater morbidity and
old age. Depressive symptoms are present in
mortality, increased health service use and medical
almost one third of the elderly populations and
costs. Studies have shown that antidepressant and
major depression may be present up to 4%
structured psychotherapy, alone or combined, are
Furthermore, once present, the prognosis for
effective in reducing depressive symptoms among
elderly with depression is poor4
older adults7
There have always been elderly people, but
Depression and anxiety lead to a serious
what is new today that they now form the largest
impairment of daily functioning and quality of life.
sector of the population in industrialized societies.

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 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013
In frail elderly, the effects of depression and
anxiety are especially deep encroaching .The
number of elderly is rapidly growing. Almost a
third of elderly subjects in the community with sub
threshold depression or anxiety will develop a
major depressive or anxiety disorder in three years
8
The prevalence of major depressive disorder
at any given time in community samples of adults
aged 65-67 older ranges from 1-5% in larger scale
epidemiological investigations in the United States
and internationally, with the majority of studies
reporting prevalence at the lower end of the range.
Clinically significant depressive symptoms are
present in approximately 15% of the community-
dwelling older adults 9
Major depressive disorder is one of the most
common forms of psychopathology, one that will
affect approximately one in six men and one in
four women in their lifetimes. It is also usually
highly recurrent, with at least 50% of those who
recover from a first episode of depression having
one or more additional episodes in their lifetime,
and approximately 80% of those with a history of
two episodes having another recurrence. Once a
first episode has occurred, recurrent episodes will
usually begin within five years of the initial
episode, and, on average, individuals with a
history of depression will have five to nine
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separate depressive episodes in their lifetime
Disability in Activities of Daily Living
(ADL) , which are the essential activities that a
person needs to perform to be able to live
independently , is an adverse outcome of frailty
that places a high burden on frail individuals,
health care professionals and health care systems .
Frail elderly people have a higher risk of ADL
11
disability compared to non-frail elderly people
11
The model of the International Classification
of Functioning, Disability and Health can describe
the consequences of dementia that eventually lead
to deterioration in BADL and loss of autonomy. In
the context of this review, dementia (health
condition) has a negative influence on mobility,
endurance, lower-extremity strength and balance
(body functions and body structures). Those body
functions are important for BADL functioning
(activity). Depending on the quality of the BADL
performance, patients are less or more restricted in
their participation (participation). By training
physical components underlying ADL, or by a
direct influence of exercise on ADL, healthy
elderly subjects can stabilize or improve their
ADL score12
The mechanisms by which depression has an
effect on physical disability are not completely
understood. Both behavioral (depressed patients
may have poor lifestyle, such as nonadherence to
medication and self-care regiments) and biological
mechanisms (depression may worsen medical
diseases through changes in hypothalamic-
pituitary-adrenal axis and the sympathetic nervous
and immunological system) have been proposed.
Each could lead to more disability13
One might expect that elevated body mass
index (throughout life) could also promote
impairments in ADL through other mechanisms
that include associations with diabetes and
possibly knee joint injuries in later life or
difficulties in walking around the house (more
common in Hawaii but unrelated to body mass
index in the current sample). It may be that
impairments in the ADL are more frequent in the
presence of subclinical frailty where weight loss is
a problem. Long-term follow-up of the effects of
body mass in middle adulthood on the risk of late-
 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji

life ADL impairment might reveal a clearer Ashram, Ramkrishna Mission old age home and
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association nearby community located in the Kanpur
In a study of patients with and without &Varanasi.
depression during the immediate period after All subjects signed consent forms & were
stroke but with similar impairments in ADL ready to take part in the study .The subjects were
scores, we found, 2 years later, that the depressed given the instructions regarding the procedure &
patients had significantly less recovery in their the subjects who fulfilled the inclusion criteria &
ADL functions than the no depressed patients. The were ready to actively participate, were selected.
recovery curves for ADL function were not Inclusion criteria
significantly different between patients with major 1. Normal elderly male & female with age of
depression versus those with minor depression, ≥ 60 years.
suggesting that both moderate and severe forms of 2. Able to understand verbal instructions &
depression lead to impaired recovery in ADL completed 8-10 years of formal education.
functions. Morris et al who used an abbreviated 3. Subjects with stable medications
version of the Barthel index, also reported that at Exclusion criteria
15 months after stroke, patients with major 1. Any neurological problems such as
depression and those with minor depression had a Parkinsonism, stroke, cerebellar disorders,
significantly greater physical disability than no balance disorders, myopathy, myelopathy
depressed patients15 which can influence the psychological
As in elderly people living in community & status of the subjects.
old age home depression and impairment in 2. Any cardiovascular or orthopedic problems
performing activities of daily livings are major which affects their day to day routine
problem therefore assessing the prevalence of activity & further may become the cause
depression and impairment in ADL’s forms the of depression.
basis of the study. 3. Significant hearing & vision impairment.
4. Uncontrolled hypertension.
MATERIALS & METHODS: 5. Any speech deficit interfering the survey.
This study is a survey type of study which 6. Unstable seizure / disorder affecting the
intends to find changes in levels of depression and psychological status of subjects.
activities of daily livings scores in elderly subjects 7. Smoking or alcohol intake.
living in the community and in old age home.
A sample of 200 elderly subjects i.e. 100 from Procedure
the community and 100 from Old age home of Standard
Group Mean T P
sixty & above years of age were taken by the Deviation
convenience sampling method.
Community 11.32
The subjects were collected through various 4.29 0.000*
(gp A)
old age homes & which includes Vaikunth Dham -6.981
Old Age Home, Ishwar Prem Ashram, Swaraj Home 16.42
5.90
(gp B)

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 Scientific Research Journal of India ● Volume: 2, Issue: 2, Year: 2013

Subjects were introduced to the study The mean value of the Barthel index for the old
followed by the signing of consent forms ,general age home was 16.54 with standard deviation
assessment regarding of socio-demographic data ( 4.001and mean value for subjects living in the
name, gender, age), education level, past medical community was 17.98 with SD 2.947 and p value
history, personal history, family history were was 0.004 which shows there is a significant
gathered from the participants assessment forms. difference in the scores hence Activities of daily
The subjects were collected from community & livings are more affected in elderly people living
various old age homes & were divided into two in an old age home town community.
groups a (community) and b (old age home) for
comparison. Total 200 numbers of subject’s data Table 2: Analysis of Activity Of Daily Living
was collected, 100 for Group A(community) and by Barthel index between group ‘A’ & group
group B (old age home).The subjects were ‘B’
assigned a number to maintain the confidentiality
Standard
of the subjects and then the scale was used to Group Mean T P
Deviation
assess the scores i.e., Geriatric Depression Scale
(GDS) and Barthel Index (BI) was used to check Community
16.54 4.001
the level of depression and impairment in ADL’s (gp A)
-2.898 0.004*
and then the scores were entered in the data
Home
collection form. 17.98 2.947
(gp B)
*Significant difference
RESULTS
Reading on GDS and BI were taken during
DISCUSSION
first interview contact with the subject and were
As results of the study shows that depression
tabulated as data.
level is more in elderly living in an old age home
The mean value of GDS for the old age
than in community. It is supported by a study
home (group B) was 16.42 with standard deviation
which suggests that urbanization promotes
5.90 and mean value for subjects living in
nucleation of the family system and a decrease in
community (group A) was 11.3 with SD 4.29 and
care and support for the elderly. Depression and
p value was 0.000 which shows there is a
physical illness often coexist in the elderly as they
significant difference in the score hence level of
both occur commonly in old age. There is a close
depression is more in elderly people living in an
relation between depression and physical illness.
old age home town community.
Depression may be caused by a specific physical
disorder possibly as a direct consequence of the
Table 1: Analysis of GDS score in group A and cerebral organic effect of these conditions.
group B Therefore strategies to decrease depression should
be utilized for persons living in an old age home.
*Significant difference The literature shows the institutionalized
participants were more likely to report depressed

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mood, crime, wishing to be dead, future looking 4. Group involvement and interaction with
bleak and staying away from others. Therefore the society may be suggested for subjects
persons living in an old age home should be living in an old age home as loneliness
encouraged to intact with the society and family may be the factor affecting ADLs and
members to cope up depression. depression.
Literature shows that older people living in
their own homes were most able to cope in their
homes. They received more support from relatives
and friends than from health and social
3
services .Result of the present study also shows
that elderly people living in an Old age home were
more affected in terms of ADLs than elderly
people living in the community.

Relevance to clinical practice:

This research study may serve as a basis for
development and implementation of a new
rehabilitation program to cope up depression and
to improve daily living skills for subjects living in
an old age home and in community by which
further their level of dependency and depression
can be reduced.

Future research:
1. This study is a survey type study in which
no training was given to the improvement
of ADLs and to decrease the depression
hence in a future training program can be
administered and its after effects may be
noted down.
2. As sample size was small hence large
sample size may be taken to generalize
the results.
3. Task oriented
goals/activities/training/may be used to
improve the efficiency of subjects living
in an old age home and community.

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CORRESPONDENCE

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

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