A cross sectional study on depression among elderly people living in old age homes in Kurnool city

INTRODUCTION

The number of older population of both developed and developing countries has increased in the 20^th century. In India, population over the age of 60 years has tripled in the last 50 years.¹ Census 2011 says that in India 8.6% (10.4 crores) of the people are aged above 60 compared to 7.4% (7.5 crores) in 2001 census.² In old age, it is not the physical aging that affects them but also the challenges they have to face with their mental and social well-being. Geriatric depression can be attributed to a number of causes such as physical problems of aging leading to limitations in daily activities, financial insecurities after retirement, loss of social recognition, physical diseases, psychological illness and adjustment problems and loss of spouse are quite common during this phase of life. This leads to loneliness and depression.³ According to projections the elderly in the age group 60 and above is expected to increase from 72 million in 2001 to 179 million in 2031 and further to 301 million in 2051. This increasing number and proportion of elderly will have direct impact on the demand for health services.⁴ A study in 2005 done on depression in elderly showed that depression is associated with low socio economic status, psychological adversities, chronic illnesses and disabilities in addition to suffering caused by disrupted family relationships.⁵ In India, aged population are very emotional and sentimental and would like to prefer to stay with family members most of the time and their acceptance for old age homes is very less. Hence this study was conducted to know the prevalence and level of depression among inmates of old age homes. The level of depression was assessed using Geriatric depression scale.⁶

METHODS

The study was a cross-sectional study conducted in the old age homes of Kurnool city during the period of August 2019 to October 2019 with the participants being the inmates of old age homes. Institutional ethical committee clearance was obtained for the study. Permission is taken from the heads of old age homes. Currently, there are four working old age homes in the Kurnool city. Inmates were selected by simple random sampling method. Sample size was calculated using the formula 4pq/d². Prevalence was 66.1% taken from the previous study d=20%, taken 10% as non respondents, the sample size was rounded off to 60.4×66.1×33.9/(13.22×13.22) = 51 rounded off to 60.⁷ Data was collected by interviewing the study subjects after obtaining informed consent after explaining Questionnaire was explained to the participants in their local language.

Study tool: It has two parts 1) Socio demographic profile containing information on age, sex, education, occupation, marital status, sleep duration, socio economic status, economical dependency, depending for daily activities of living and 2) 15-item geriatric depression scale (GDS).⁶

Inclusion criteria

Elderly people aged above 60 years living in old age homes; staying in old age homes since 6 months or more; able to communicate, understand and reply to questions.

Exclusion criteria

Elderly who were not inmates of old age homes and inmates with less than 6 months stay.

Statistical analysis

Data was entered in MS Excel version 2007 and analyzed by using IBM SPSS version 21. Results were expressed as frequencies and percentages. Chi square test was applied to test the significance. P value less than 0.05 was considered statistically significant.

RESULTS

There are four old age homes in Kurnool city. A total of 60 elderly people were selected in the study by simple random sampling method. Participants were divided into young old (60-69 years), old old (70-79) and oldest old (>80) (Figure 1).

Out of them majority were in the age group of 70-79 years (46.7%) with the mean age of 71.23±5.57 years. Majority of them were females (78.3%), illiterates (68.3%) and widows (70%). Prevalence of depression in the present study was 66.7% (Table 1). Prevalence was found to increase with increasing age. It was 38.3% among 60-69 years, 46.7% among 70-79 years and this difference was statistically significant with p value 0.036 (Table 2). Chi square statistic with Yates correction is 16.804, p value 0.00041, significant. GDS scale score 0-5 considered normal. >5 considered as depression present.

Prevalence of depression was more in females (63.3%) when compared to males with significant p value (<0.0004) (Figure 2). Among illiterates, 31.0% had depression and 11% in those who studied up to primary education and this was statistically significant (p value <0.049). Depression was found to be more in widowed inmates (70%) when compared to married inmates living with their spouse (20%) and this was statistically significant with p value <0.0001. It was more in inmates of low socio economic status who belong to class IV (70%) and was significant with p value<0.001.

DISCUSSION

Majority of the old age home residents were aged between 70-79 years which is similar to the study done by Tiwari et al.⁸ Most of them were females, illiterates and widows which is similar to the study done by Ramachandran et al and Tiwari et al.^8,9 In studies by Wijeratne et al, Maulik et al depression was not found to be significantly associated with marital status.^10,11 But in this study depression is associated with marital status and is increased in widows and is similar to the study done by Chong et al.¹² In the present study there is increase in the prevalence of depression as the age increases which is similar to the study done by Radhakrishnan and Nayeem.¹³ The overall prevalence of depression in the present study is 66.7% where as it is 53.7% in a study done by Goud et al.¹⁴ Majority of the females (88.2%) were economically dependent which is similar to Tiwari et al study. In a study by Hoffman et al and Mubeen et al statistically significant association was present between depression and duration of sleep which was not consistent with the present study.^15,16 In the present study depression was more in low socio economic status belonging to class IV which is similar to the study done by Ramachandran et al.⁹ Similarly Lowenthal (1967) in San Fransisco observed that mental illness was negatively related to current income and level of education.¹⁷

The present study was carried out in a limited time period of time on a small sample of old age home inmates thus results may not be generalized on general population.

CONCLUSION

The prevalence of depression was found to be high among inmates. Early intervention is required to prevent the morbidity and disability. Better utilization of social security measures of the government and services of the voluntary agencies would enhance institutional support and care of the elderly.

ACKNOWLEDGEMENTS

The author takes this opportunity to thank Principal Dr. P. Chandra Sekhar, MD; DM (CARDIO), Dr. A. Sreedevi, Professor and HOD, Department of Community Medicine, Kurnool Medical College, Kurnool, The heads of old age homes and the study participants.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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