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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 113-117

Views of the elderly living in old-age homes on psychosocial care needs


1 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission06-Jan-2021
Date of Decision07-Aug-2021
Date of Acceptance12-Sep-2021
Date of Web Publication31-Jan-2022

Correspondence Address:
Mr. Manjunatha Shivarudraiah
Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Govindswamy Building 1st Floor, Hosur Road, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_1_21

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  Abstract 


Background: Older adults are likely to experience psychological and social problems due to decline in physical strength, increased health issues, inadequate financial resources, and family dynamics. In this context, they need psychosocial care services to handle such challenges. Particularly, inmates of old-age homes are more vulnerable to experience such challenges as they are away from the family care. In this background, knowing their views on psychosocial care needs while living in old-age homes is significant to improve old-age home-based care. The aim of this study is to explore the psychosocial care needs expressed by the inmates of old-age homes. Materials and Methods: Inmates of old-age homes were selected using purposive sampling. A total of twenty residents out of four old-age homes of Bengaluru Metropolitan City were interviewed using a semi-structured interview guide. The qualitative content analysis has been carried out to identify core psychosocial care needs out of the text data. Results: Three themes, namely “health-care needs,” “concerns regarding the behavior of the staff,” and “mental health needs,” are emerged. Conclusion: The current study findings provide insiders' views and highlight the importance of psychosocial care services to address their needs at every old-age home.

Keywords: Health-care needs, mental health needs, old-age homes, psychosocial care needs


How to cite this article:
Shivarudraiah M, Ammapattian T, Antony S, Thangaraju SP. Views of the elderly living in old-age homes on psychosocial care needs. J Geriatr Ment Health 2021;8:113-7

How to cite this URL:
Shivarudraiah M, Ammapattian T, Antony S, Thangaraju SP. Views of the elderly living in old-age homes on psychosocial care needs. J Geriatr Ment Health [serial online] 2021 [cited 2022 May 23];8:113-7. Available from: https://www.jgmh.org/text.asp?2021/8/2/113/336903




  Introduction Top


The structural changes experienced by families in India and associated changes in value systems have affected the aged. Migration of children and urbanization also declined the social capital available for the elderly to cope with increased aging-associated physical, mental, and social issues. In the last two decades, the number of old-age homes has outnumbered, be it government or private. According to the report by the department for the empowerment of differently abled and senior citizens, Government of Karnataka, 2015, there are 274 old-age homes running in the state, among which 94 are situated in Bengaluru city. However, the number of old-age homes in the city is more than what is mentioned in the report as of today. The Maintenance and Welfare of Parents and Senior Citizens Act in 2007 recommends each state government to start at least one old-age home in each district with a capacity of accommodating a minimum of 150 needy senior citizens. The recent policy directives indicate a need to understand the psychosocial care needs of aging population in old-age homes and prepare them to handle such needs with or without further professional support.

In India, 21 million geriatric population is in need of mental health-care services.[1] With the rapid changes in India's family system, the elderly are prone to develop emotional problems. Studies conducted in India highlighted the importance of addressing psychosocial care needs among the elderly living with dementia under institutional care.[2],[3] There are studies from Asia, America, and Europe, which support the value of psychosocial care services for the elderly.[4],[5],[6] Furthermore, few studies from India have estimated the psychiatric morbidity among older adults living in old-age homes and identified the need to provide comprehensive psychosocial care.[7],[8] A recent study in old-age homes from India highlighted that prevalence of psychiatry illness and depression was found to be the most common mental health problem, whereas anxiety disorders and dementias were the least.[9] Unmet psychosocial care needs of the older adults in old-age homes affect their well-being and quality of life.[10],[11],[12] Inadequate staff and limited learning opportunities for available staff are other significant issues in all old-age homes, directly linked with the quality of care.[13]

In this study, psychosocial care needs are operationally defined as individual needs associated with health, psychological, and interpersonal problems of the residents staying in such old-age homes. However, studies that examined the perspectives of old-age inmates could not found in Indian literature. Hence, this study explored the views of inmates on psychosocial care needs in old-age homes.


  Materials and Methods Top


This study has been conducted in four old-age homes, from which a total sample of 20 inmates were selected to take part in the study. The old-age homes were selected from Bengaluru Metropolitan City of Karnataka, India. These old-age homes are established under charitable trust rules, charging low-to-moderate monthly fees from inmates. Services from trained or certified geriatric care professionals are not available in these old-age homes. The researcher used the purposive sampling technique and limited the sample size to 20 out of 4 old-age homes which were feasible to approach and conduct the study. Inclusion criteria are (a) participants who were aged 60 years and above living in old-age homes and able to participate in the study; (b) staying in old-age home for a minimum of 1 year; (c) participants who were able to communicate in Kannada or English and educated minimum of 10th standard; and (d) participants who able to written informed consent, both male and female. Exclusion criteria were (a) inmates who were not interested to participate in the study and (b) unable to join the study due to health-related problems. The study protocol was reviewed and approved by the Institutional Ethics Committee of the National Institute of Mental Health and Neurosciences, Bengaluru, India (No. NIMH/DO/IEC [BEH. Sc. DIV], 2019). All the participants were explained about the research and recruited after obtaining the written informed consent. The study's objectives were to study the sociodemographic characteristics of old-age home inmates and explore the psychosocial care needs. Qualitative data were collected using a semi-structured interview guide. The researcher modified and validated the interview guide in consultation with five experts that include two psychiatric social workers, one psychiatrist, one psychologist, and one psychiatric nurse. All of them had experience working with geriatric mental health settings. The interview guide mainly focused on understanding their sociodemographic background, exploring specific mental health needs, the situations that make them upset, the factors that make them happy, the thoughts which make them feel uncomfortable, health issues, support system, the services available in the old-age homes, and so on.

The interviews lasted for about 30 min. The interviews were digitally recorded and transcribed and participants were given an identification number from P01 to P020 to maintain anonymity. Qualitative data were analyzed using qualitative content analysis norms manually (without the help of any data analysis software).[14] The researcher read each transcription several times to get familiar with the content, later marked relevant parts from the transcriptions, and coded them with appropriate code names. Further, the code names were exercised to group them under suitable category names which are renamed as themes later.


  Results Top


Sociodemographic background

[Table 1] describes their sociodemographic characteristics; the participants' age ranged from 60 to 90 years, with a mean age of the sample being 70.95. The majority (55%) of the participants were female and 80% followed the Hindu religion. About 45% of them were widows/widowers and half of the respondents (55%) studied up to 10th standard. The majority of the residents were from lower socioeconomic status families (70%) and were worked in school (40%).
Table 1: Sociodemographic background of participants

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Psychosocial care needs of the elderly living in old-age homes

The psychosocial care needs of the elderly living in old-age homes are discussed under three themes: health-care needs, concerns on staff' behavior, and mental health needs.

Health-care needs

  • Chronic health problems
  • Health issues as the reasons to get admit into old-age homes.


Concerns on staff' behavior

  • Lack of empathy
  • Lack of awareness of aging-related issues
  • Lack of skills to manage the inmates.


Mental health needs of the elderly

  • Inadequate support from the family members
  • Experiencing helplessness
  • Feeling of loneliness
  • Mental health problems.


Health-care needs of the elderly

All the study participants reported that health-care needs as their primary needs, and often, staff working in old-age homes are not sensitive to their physical and mental health problems. Old-age home residents have multiple health issues and they feel that those needs are not addressed adequately.

Chronic health problems

Most of the old-age home residents had health problems such as gastritis, arthritis, other orthopedic problems, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, thyroid, heart problems, constipation, skin diseases, glaucoma, auditory issues, and urinary tract infection. These health problems have led them to suffer associated psychosocial issues such as stress, loneliness, depression, anxiety, delirium, dementia, and psychosomatic issues.

“I was staying alone at home, and there was no one to look after my medical problems. I am suffering from Gastritis. Hence, my son placed me in the Old-age Home so that there is someone to attend to my problems” (P02).

“My health problem is a chronic obstructive pulmonary disease (COPD); however, now my lungs are getting clear as I am taking medicine” (P18).

“In the last one month of staying here in this old age home, I have knee joint pain, foot, and shoulder pain. This irritates me a lot because of this I am staying here” (P02).

“Walking difficulties made me sit in wheelchair those things get to me nowadays worried here” (P05).

“Diabetes mellitus made me a handicap; my right leg has been removed. It worries more nowadays” (P04).

“My health problem is high blood pressure which worries me nowadays, and it is fluctuating” (P16).

“I have a health problem of thyroid, which makes me feeling cold, gaining weight, feel tired, weakness and aches in muscles and joints, and hair loss. I could not do any of my work here; I always feel it is better to die instead of suffering from this problem” (P11).

“I am staying here for almost two years and suffering from heart problems and have no financial support” (P03).

“I have the health problem of constipation, and I manage it with medicine and tonic every day” (P07).

“Blood has been blocked in the right leg. It worries and one of the most health concerns for me. I am also allergic to this weather, somehow I am managing with medicine, and I try to keep myself away from the dust and use socks” (P09).

“Glaucoma made me visually impaired, and I lost so much money for getting treated for this glaucoma” (P13).

“I am having a urine problem; now it is getting better. I have only urinary tract infections nowadays, feeling burning pain and frequent urination” (P20).

As mentioned in the quotes above, many of them silently suffer from their health problems without getting proper medical care at many old-age homes due to inadequate resources.

Health issues as the reasons to get admit into old-age homes

One participant said, “My mother, who was 82 years old and my two brothers, looked after me. One brother had a job; another brother was not working, since he had paralysis and stayed at home. I was not able to manage myself due to my knee pain and shoulder pain. Because of my ill-health, I joined here” (P02).

Concerns on staff' behavior

Many participants in the study had concerns over the old-age home staff members' behavior. They felt that the members of the staff should show more empathy to residents. Many of them had insufficient understanding of aging-related issues and skills in engaging old-age home residents according to inmates. To provide care to old-age home residents, the staff needs to have good communication skills and staff must know basic supportive counseling techniques.

Lack of empathy

One participant describes her experiences “I am not able to go to the toilet alone. I need support from people. Sometimes staff comment, this highly educated lady cannot go to the toilet without support. It makes me sad” (P02).

Lack of awareness of aging-related issues

One of the participants reported that “Their behaviour is a problem. I think they need to get the proper training to care older people” (P13). Another participant agreed that “Staff should also undergo some training on how to take care of the elderly in old age home” (P14).

Lack of skills to manage the inmates

Inmates also had an impression that “They (staff) are not spending time with me. I am expecting proper communication from the staff here” (P01). Similarly, another participant reported that “They should stop scolding residents, and maintain hygiene. They need to show love and affection towards residents. They should follow their roles and responsibility properly. When residents call staff, they have to respond immediately” (P04). The above quotes from inmates of old-age homes indicate that caregivers in such homes lack skills to address older people's needs.

Mental health needs of the elderly

Most of the residents agreed that geriatric mental health knowledge might help staff provide better care. It is noted that many elderly livings in old-age homes are also suffering from mental health problems.

Inadequate support from the family members

There was also inadequate support from the family. One resident shared that “My parents have passed away, and my husband also passed away three years ago due to heart problem, and I do not have children. We were seven siblings; one of my elder sisters passed away recently. I am staying here for almost two years. The reason for staying in this old age home is health problems and not having financial and other family support.” (P03). Many inmates are experiencing the feeling not connected with their family of origin and procreation.

Experiencing helplessness

Another core need emerged was helplessness. One resident said, “I do not have any happiness here because I am worried about my wife's death. She died 12 years ago; even I worry about my father's death also” (P01). Another resident also expressed that, “I cannot manage myself. It is my major worry” (P02). It is essential to explore the reasons behind feeling helpless.

Feeling of loneliness

Some of the residents were tired with their experience of loneliness, as stated by an inmate “I am feeling lonely here, and I want to see my son. My son does not come to see me here for the last two years. He did not pay any amount to old age home as fees” (P04).

Mental health problems

Participants had reported that few already know that they were suffering from mental health problems such as depression, anxiety, schizophrenia, and mild cognitive impairment. One participant narrated his treatment history “I had been on treatment under for my depression; I took treatment from NIMHANS hospital for many years. Even now, I am on treatment” (P09). Another resident described his anxiety disorder “I used to have fear and worries. One of my co-residents died, who stayed near to my bed. Then onwards, I worry about my death” (P04). One of the participants disclosed that “I am disturbed by hearing voices such as someone talking with me; I feel disturbed while I get those voices. I do not have happiness; I am always feeling sad due to the voices. It makes me sad all day, and I am always thinking of running away from this place” (P06). An inmate who had a memory problem shared his struggles “I forget things, and I miss doing day-to-day activities. I want to show myself to a doctor for improving my memory” (P13).


  Discussion Top


Old-age home-based studies, which explore the views of the elderly from the age group 60 years and above,[15] are essential to have insiders' views on the psychosocial needs of inmates. Majority of the study participants were also female, similar to other studies in the past.[16] One-fourth of them were divorced, that was another major vulnerability to be institutionalized.[17] Similarly, almost half of the participants had a minimum education.[18] When stay in old-age homes is not the individual's choice, it causes severe psychosocial issues in old-age homes. Listing various psychosocial needs, mainly health and social care needs, is an essential step before professional intervention, which has been reported as a solution to promote residents' well-being.[19]

Most of the old-age home residents had health problems such as gastritis, arthritis, other orthopedic problems, COPD, diabetes, hypertension, thyroid, heart problems, constipation, skin diseases, glaucoma, auditory issues, and urinary tract infection.

Similarly, two studies from Uttar Pradesh and one study from Karnataka reported joint and muscle disorders, hypertension, diabetes mellitus, respiratory disorders and hearing problems as common health problems observed in old age homes.[10],[20],[21] Many staff had insufficient understanding of aging-related issues and skills in engaging old-age home residents according to inmates. Appointed caregivers of the old-age homes lack skills, and that causes the burden.[18],[22] Consistently, studies have reported that depression, anxiety, and dementia have been common mental health problems among older people.[19] In a similar study, elderly caregivers felt that improved communication with the elderly helped them to understand the older population's emotional needs. Lack of human resources and their workload have compromised the quality of services in these institutions.[22] In this study, participants directly demanded better skills among staff working in old-age homes, which hints the need to develop adequate human resources and strengthen intersectoral collaborations.[23]

Health-care needs of older people are causing trouble for them and their family members. Some of the families who belong to low socioeconomic strata do not have enough resources to address older people's chronic health issues. Few participants mentioned, not having financial and other family support forced them to stay in old age homes. Improvisation of services in old-age homes through providing professional assistance and training the staff by the mental health-care professionals would curb the gap in mental health-care services for the inmates, who are looking forward to such services to address their pain, helplessness, loneliness, and worries associated with aging and chronic health conditions. Insights from this study would help the policymakers and old-age home managements to plan training programs for the staff working in the old-age homes, who are the primary caregivers of the elderly living in such homes. Awareness of mental health problem and promotion strategies in the elderly population would help them to receive regular medical checkups and early detection of chronic diseases. There is a need to have geriatric wards with doctors, nurses, and psychiatric and medical social workers in prominent old-age homes.[24]

Few limitations of this study are small sample size and purposeful selection of participants, which limit the generalizability of the study findings. Since the study has been conducted in urban old-age homes, the sample is not sufficiently represented by the rural population.


  Conclusion Top


The current study explored very important psychosocial cared needs of the residents of old-age homes. It signifies the need for the staff to be aware of these needs and the need for undergoing essential training to cater to these needs to enhance the quality of life of the inmates during their stay in the old-age homes. The staff of the old-age homes can act as change agents, who identify various needs of the elderly and attend those needs with professional skills and expertise. Further, the study findings underline the need to provide individualized psychosocial care and support services for residents in old-age homes as a need of the hour.

Acknowledgment

We express our gratitude to all the four old-age home residents, old-age home founders, and staff working in those old-age homes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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