The incredible increase in life expectancy may be termed as one of the biggest triumphs of human civilization, but it has also posed as one of the toughest challenges to be met by modern society. The term “old” is always related to physical incapacity, biological deterioration and psychological disabilities. In the Indian context, there are three different trends that are seriously threatening the chances of meeting the needs of the aged. These are: a rapidly growing elderly population, the gradual erosion of the traditional joint family system and the inability of the government to sustain the incremental burden of pension expenses for its own employees. Hence, the possibility of government support for any other section of the elderly population in the society may be ruled out (Vaidyanathan, 2003). With sustained reduction in mortality and fertility rates combined with increased life longevity, the size of the young cohorts has reduced while the size of old cohorts has increased. As a direct consequence the process of population ageing (Alam, 2008) has started globally and can be visualized in India too. According to Population Census of India, the population of persons with age 60 years and above (elderly hereafter) was only 24 million in 1961 which increased more than thrice in next four decades. Their share in the total population has also risen from 5.6 percent in 1961 to 7.5 percent in 2001 (Irudya Rajan, 2008). This rise in ageing population depicts the success story of development process in India on different fronts like advancement in the medical sciences and technology, continuous improvement in living standards, increase in the accessibility of healthcare services, introduction of maternal welfare and childcare programs, better basic education, and successful vaccination programs. But at the same time the steady and sustained growth in the population of this stratum have also posed myriad of challenges to the policy makers. Despite recent developments (WHO, 1998), the basic biological mechanisms involved in the ageing process remain largely unknown. What we do know is that:
1) Ageing is common to all members of any given species;
2) Ageing is progressive; and
3) Ageing involves deleterious mechanisms that affect our capacity to perform a number of functions.
Ageing is a highly complex and variable phenomenon. Not only do organisms of the same species age at different rates, but the rate of ageing varies within the single organism of any given species. The reasons for this are not fully known. Some theorists argue that individuals are born with a particular amount of vitality - the ability to sustain life - which continually diminishes with advancing age. Environmental factors also mediate the length of life and time of death (Dychtwald, 1986). With the process of ageing, most organs undergo a decline in functional capacity and in their ability to maintain homeostasis. Ageing is a slow but dynamic process which involves many internal and external influences, including genetic programming and physical and social environments (Matteson, 1988). Ageing is a lifelong process. It is multidimensional and multidirectional in the sense that there is variability in the rate and direction of change (gains and losses) in different characteristics for each individual and between individuals. Each period of life is important. Thus it follows that ageing should be viewed from a life course perspective.
In order that successful ageing does not seem an oxymoron, the concept of ageing must be viewed from three dimensions: decline, change, and development. The term “ageing” can connote decline, and decline is not successful. After age 20 our senses slowly fail us. By age 70 we can identify only 50% of the smells that we could recognize at 40 (Dolty et al, 1984). Our vision in dim light declines steadily, until by age 80, few of us can drive at night (Woodruff et al, 1997). Ageing seems to be a whole array of irreversible biological and psychological changes that occur in a genetically mature organism, with the passage of time, affecting adversely its survival and adjustment potency and eventually leading to death. Gerontology, the study of ageing is a tremendously varied and complex field, encompassing all the processes which are a part of ageing experience, as well as those which intrude upon, and affect, that experience. Since investigators frequently consider different dependent variables in their research on ageing. It is useful to differentiate three aspects of ageing. These aspects may be “biological”, “psychological” or/ and “social”.
Aspects of Ageing (Barren and Schaie, 1977)
1. Biological Ageing: The biological age of an individual can be defined as an estimate of the individual’s present position with respect to his potential life span. Presumably, the measurement of biological age would encompass measurement of the functional capacities of the vital life- limiting organ systems.
2. Psychological Ageing: Psychological ageing, by definition, refers to the adaptive capacities of individuals, that is, how well they can adapt to changing environmental demands in comparison with average. Clearly, psychological age is influenced by the state of key organ systems like the brain and the cardiovascular system, but it also goes considerably beyond this and involves the study of memory, learning, intelligence, skills, feeling, motivation and emotions.
3. Sociological Ageing: Social ageing refers to the roles and social habits of an individual with respect to other members of a society. Compared with the expectations of his group and society, does an individual behave younger or older than one would expect from his chronological age? Since the basis of age- graded, expected behavior is a product of one’s culture; both biological and psychological characteristics of individuals enter the societal norms and the values of society.
AGEING POPULATION IN THE INDIAN CONTEXT
The twentieth century and the beginning of this one have seen an unprecedented demographic transition in the form of population ageing. Globally, life expectancy at birth increased from around 47 years in the 1950s to 67 in 2008, an increase of 20 years in the space of half a century. The gain has been impressive among less developed regions, i.e. 24 years compared to 10 in developed regions (UN, 2007). In India, the gain has been 21 years (Irudaya Rajan, 2008). India has the second largest number of older persons1 in the world. On average, an older person is expected to live 18-20 years upon reaching 60. In a recent study by Somanatha Chatterji et al. (2008) it was seen that China and India are home to more than a third of the world’s population. The population of India will continue to grow through 2050, whereas China’s population is expected to plateau by 2035. However, because of increases in life expectancy, the age composition of these two populations is likely to change dramatically. While the proportion of the Chinese sixty-plus age group is likely grow more than threefold (from 10.9 percent to 35.8 percent) over fifty years, its population of those age eighty and older are likely expand nearly fourfold (from 1.8 percent to 6.8 percent). For India, these age groups are likely to grow by nearly the same factors (from 8.4 percent to 22.6 percent and from 0.8 percent to 3 percent, respectively). By 2019 in China and 2042 in India, the proportion of people age sixty and older is likely to exceed that of people ages 0–14. Combined, more than 0.75 billion people age sixty and older are likely to live in China and India in 2050, constituting 38.5 percent of the world’s sixty-plus population. The huge absolute numbers and large proportions of the elderly pose economic, social and health challenges. A majority of the elderly will be economically dependent after their retirement. The informal sector has minimal financial security in old age. The joint family system, which formed the main social support system for old age, is gradually eroding. With urbanization and migration of the young people in the family, the number of lone elderly is increasing (Somanatha Chatterji et al., 2008). The elderly are prone to chronic non communicable diseases, including cardiovascular diseases, stroke, mental disorders, diabetes mellitus, cancer, respiratory diseases, urinary incontinence, arthritis and oral/ dental problems. Healthy services for the elderly, particularly in rural areas, are very limited (Somanatha Chatterji et al,2008).
Historically, the elderly have enjoyed a respected and secure old age within the extended joint family. Laws exist to protect the well- being of the elderly in India. The Government of India has recently launched a national policy for the elderly. Some states provide pension to all elderly regardless of their contribution to the system. But the magnitude of issues related to ageing is too large for the government to address in totality. Non-government organizations are becoming active in programs and projects for the elderly (WHO, 2000). In another report submitted by Bhattacharya (2005), the same trend was echoed. He reported that Indian population has approximately tripled during the last 50 years, but the number of elderly Indians has increased more than fourfold. Considering the continuation of this trend, the United Nations predicts that the Indian population is likely to again grow by 50 percent in the next 50 years, whereas the elderly population is expected to grow another fourfold.
WORLD POPULATION OF THE AGED
According to a recent report published by WHO (2007) the world population is likely to see an increase of 2.5 billion over the next 43 years, passing from the current 6.7 billion to 9.2 billion in 2050. This increase is equivalent to the total size of the world population in 1950. The aged population is likely to increase accordingly. The above figures clearly highlight the need for focusing on the health needs and welfare of the aged- who are going to be a sizable portion of the population. The twenty first century is characterized by the successes of modern science which have brought about apparently unlimited materialistic achievements. While people enjoy better health and remarkable means of healing which allow them to live to a much longer age, longevity and the increasing number of elderly have produced new social problems (Buckwalther et al. 2003). Figure 1 illustrate that the current expected age of survival for men and women all over the world is ever increasing; it has become clear that many of the surviving people with higher ages are in fact not in good shape, either socio-economically or physically (Lipsitz, 2004).
Fig. 1: The Senior Boom
Source: Physiological complexity, ageing and the path to frailty ( Lipsitz, 2004)
The World Health Organization (WHO, 2002) defined health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Among the many concerns of humankind, the ability to lead a life free from illness or disability during old age is a dominant one. Health is thus a key factor to livability. For older persons, health determines their ability to perform their roles adequately, be they of an economic, community or family nature.
Ageing is not a disease and does not necessarily corroborate with drastic changes in mental fitness. Today emphasis is there on active and healthy ageing. However, because the modern world gives emphasis to active ageing, retirement is often seen as a traumatic and degrading experience, especially for those who are weak in terms of finances, health, family support and social involvement. It can also adversely affect those who formerly held very prestigious jobs. The loss of a highly valued occupational identity leads to a sudden identity crisis, feeling of inferiority in social interactions, a vacuum in daily routines, a decreased level of contentment and poor adjustment, which altogether accelerate physical and psychological complications, and often result in early demise. This however can be prevented if regime for healthy ageing is followed (WHO, 2002). Thus it is very important to focus on the needs and health requirements of the aged.
DEFINITIONS OF HEALTHY AGEING
The World Health Organization (WHO, 2003), the White House Conference of Ageing (White House Commission on Ageing, 1996), and the National Institute of Ageing (Action Plan for Ageing Research, 2001) have stressed that healthy ageing goes beyond avoidance of disease and disability. Yet, further agreement on what factors constitute successful ageing is surprisingly limited. The prevailing model, advanced by Rowe and Kahn and used in the MacArthur Research Network on Successful Ageing (Rowe and Kahn, 1987 and 1997), characterizes successful ageing as involving freedom from disability along with high cognitive, physical, and social functioning. Other ways of defining successful ageing involve the degree to which elderly individuals adapt to age associated changes (Baltes, 1997), view themselves as successfully ageing (Faber et al, 2001), or avoid morbidity until the latest time point before death. There is considerable debate as to which components are essential to the definition of successful ageing and which are overly restrictive or even possibly “ageist” (Strawbridge et al., 2002). Furthermore, there is no consensus about whether successful ageing should be defined objective. Ely by others or subjectively by older adults themselves or about which components are necessary and/or sufficient (Lupien and Wan, 2004). There is even no agreement about the term to be used, with descriptors ranging from “healthy ageing” (Peel et al., 2005), “successful ageing” (Rowe and Kahn, 1997; Baltes, 1997), “productive ageing” (Butler, 1988), to “ageing well”. The implications of population shift are manifold and negative predictions are not uncommon, with ageing traditionally described as a “dependent" stage of life, a medical problem and a time of loss, dependency and burden (Katz, 2001). However, these traditional negative conceptualizations, expectations and assumptions of ageing are being challenged in modern society, as ageing is repositioned as a time of opportunity (Biggs, 2001). There has been a significant paradigm shift in how ageing is conceptualized and experienced, from survival in the twentieth century to the twenty-first century focus of ensuring quality of life for those who have survived (Kalache and Keller, 1999). This paradigm shift in the meaning and experience of ageing is captured by contemporary theoretical frameworks, which emphasize the importance of maintaining and fostering the physical and mental well-being of people as they age. Table-A outlines the definitions of five popular contemporary theoretical frameworks, which represent recent efforts to more aptly describe, predict and accommodate the changing needs of a rapidly increasing cohort of older adults. Notably, although each framework was developed to present a more positive reflection of ageing, as opposed to negative attitudes and stereotypes about old age, each has its own weaknesses, strengths and particular focus on specific aspects of ageing (Laurie at all, 2006).
Table A: Definitions of contemporary theoretical frameworks of ageing
| Framework | Definition |
| Active Ageing | “The process of optimizing opportunities for physical, social and mental wellbeing throughout the life course, in order to extend healthy life expectancy, productivity and quality of life in older age” (WHO, 2002). |
| Healthy Ageing | “Ability to continue to function mentally, physically, socially, and economically as the body slows down its processes” (Hansen-Kyle, 2005) |
| Productive Ageing | “Any activity by an older individual that produces goods or services, or develops the capacity to produce them, whether they are to be paid for or not” (Bass et al., 1993) |
| Successful Ageing | “low probability of disease and disease-related disability; high cognitive and physical functioning and active engagement with life” (Minkler and Fadem, 2002). |
In the Second World Assembly on Ageing held in Madrid in 2002, the relevance of active ageing was highlighted as a key strategy for achieving the maximum health, wellbeing, and quality of life (QOL) of older adults, defining this as "the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age" (United Nations, 2002). Active ageing refers to the empowerment of older persons in biological, psychological, and social areas, understanding empowerment as the individual's self-promotion, independence, and self-confidence, as well as his/her right to a dignified way of life according to self-imposed values, the ability to stand up for one's own rights, and to be free (United Nations,2002). Active ageing entertains three levels of approach, including a) paradigm, b) policy strategy, and c) instrumental action at the community level (Figure 2).
Fig. 2: Active ageing as paradigm, policy framework, and strategy for healthy ageing
Source: Report of the Second World Assembly on Ageing (United Nations,2002).
Fig. 3: Types of support that elderly individuals can offer through social networks of social support in Community Gerontology program.
Source: The social capital of older people (Gray, 2009)
Social networks refer to the personal, community, and institutional contacts by means of which the individual maintains his/her social identity and receive material, instrumental, emotional, and informative support (Figure 3). In these terms, social capital depends to a great extent on the social contacts that the individual possesses (Gray, 2009), thus the importance of generating and strengthening older adults' social networks in formal programs with specific objectives and goals provisions, real or perceived, provided by family, friends, the community, and formal institutions (Gray, 2009). The concept of successful ageing, however, lends itself to more than one interpretation. Two main perspectives exist: one that looks at successful ageing as a state of being, a condition that can be objectively measured at a certain moment; and one that views it as a process of continuous adaptation. Rowe and Kahn, (1987) hold the former view and describe successful ageing as the positive extreme of normal ageing, while others like Garfein et al., (1995) use definitions such as the elite of healthy elderly persons or robust ageing. In these definitions, successful ageing is a better than normal state of being old. Several population- based studies (Reed et al., 1998) on successful ageing have adopted this concept. Others, like Baltes and Baltes, (1990), view successful ageing as a successful adaptation of the individual to changes during the ageing process. In a similar view, (Keith et al, 1990) define successful ageing as reaching individual goals or experiencing individual feelings of well- being.
According to Quick et al. (2001) THERE ARE SEVEN KEYS TO WELL- BEING IN LATER LIFE. These are:
- Physical and Mental Fitness:- It has been found that frail men and women in their upper 80’s and 90’s most with arthritis and walkers made significant physical, mental and social gains after enrolling in appropriate exercise helps.
- Good Nutrition: - Eating a healthy meal three times a day, one head nearly 1100 chances a year to help one’s body age in the best possible way. Each serving of fruit or vegetables, whole- grain cereal, or protein- rich sea food and every glass of water or juice has a positive effect on one’s mind and spirit.
- Following one’s heart’s desire helps.
- Material well-being- For a variety of reasons, many older people is “retiring” and chooses to re- enter the world of work. Others retire from a long term career and work part time or try their hands on different types of employment, perhaps working at a more relaxed pace. And of course many seniors volunteer their services and talents thereby making invaluable contributions. No matter what life style choices are made, wise retirement planning remains basic to material well-being in later life.
- Healthy relationships
- Positive attitude
7. Spiritual Vitality- Larry Dressy, a respected researcher, physician and author sums it up nicely- “There are at least 250 studies showing that people who follow some religion or religious practices in their lives and that almost always include prayers are healthier across the board compared to people who don’t.” Thus healthy life styles are associated with prolonged survival and sustained health and well-being in old age (Seaman and Chen, 2002). Critical behaviors of healthy ageing include regular activity, no smoking, moderate alcohol consumption and prudent diet (Steptoe et al, 2006).
Looking at the literature, it seems that successful or positive ageing or development in adulthood has been discussed and explored in at least two general ways. First, successful ageing has been equated with life satisfaction. The higher one's satisfaction with life, the more successfully he or she is ageing. According to Riff (1982), notions of positive ageing included such dimensions as happiness, morale, adjustment, and subjective well-being (Riff, 1986). Another concept of successful ageing defines it in relation to theories of adult psychosocial development or personal growth. The work of Buhler and Masaryk (1968) and Negatron (1977) have served to define what ageing is and should be. The work of all these individuals and Erikson in particular, is the basis of more research on adult life and development Riff (1982, 1985). Most of this work defines adulthood as a sequence of age-related stages in which various psychosocial concerns or preoccupations come to the fore and must be resolved before one can successfully move on (grow/develop) to the next. Development is seen to be a process of interaction between the biological/psychological individual and her/his socio-cultural environment. Hence, successful ageing would be seen as the progressive resolution or meeting of the psychosocial conflict or task of each stage.
Seeing a number of similarities among the various theories of adult development, Riff (1986) has synthesized them in an effort to develop an integrated model of successful ageing. This model is composed of six components or psychosocial issues. According to Riff, successful ageing is defined by self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth.
COMPONENTS OF HEALTHY AGEING
According to Rowe and Kahn (1998) who are physicians, it is widely accepted that the foundations for healthy ageing can be divided into four distinct components. Avoiding disease and disease- related disability, maintaining high mental and physical function, and being actively engaged in life are integral to successful ageing (Rowe and Kahn, 1998). The four components outlined reflect a strategic shift towards prevention. WHO (2002) outlines these components as:-
- Promoting health and preventing illness, disease and inquiry: Enabling people to increase control over and improve their health. Health promotion focuses on enhancing the capabilities and capacities of individuals, families, and healthy and supportive environments.
- Optimizing mental and physical function: As people age, most people want to remain independent. To remain independent, people need to maintain physical and mental functions. Research shows that not only can functional loss in seniors be prevented, but that many functional losses can be regained (Rowe and Kahn, 1998). Prevention strategies should focus on promoting lifestyle choices such as healthy eating, tobacco cessation, injury prevention, physical activity, and social and mental stimulation.
- Managing chronic disease conditions: Health promotion and disease prevention have substantial benefits for individuals and society as a whole. Specifically they emphasize lifestyle changes such as physical activity, healthy eating, and tobacco cessation as essential in delaying or preventing many chronic diseases in later life.
- Active engagement in life: To achieve healthy ageing it is essential to have close relationships with others and to participate in regular activities that give meaning and excitement to life. For example, visiting friends, volunteering, maintaining some form of regular physical activity, and enjoying increased leisure time contributes to healthy ageing and a better quality of life as people age.
According to Bowling and Dieppe (2007), the substantial increase in life expectancy at birth achieved over the previous century, combined with medical advances, escalating health and social care costs, and higher expectations for older age, have led to an international interest in how to promote a healthier old age and how to age “successfully”. Changing patterns of illness in old age, with morbidity being compressed into fewer years and effective interventions on reducing disability and healthy risks in later life, make the goal of ageing successfully more realistic.
Lay person views
There are a few investigations into older people’s views of what is successful ageing (Phelan, 2004). Their definitions include mental, psychological, physical, and social health: functioning and resources; Life satisfaction; having a sense of purpose; financial security; learning new things; accomplishments; physical appearance; productivity; contribution to life; sense of humor; and spirituality.
Biomedical theories
Biomedical theories define successful ageing largely in terms of the optimization of life expectancy while minimizing physical and mental deterioration and disability. They focus on the absence of chronic disease and of risk factors foe disease: good health, and high levels of independent physical functioning, performance, mobility, and cognitive functioning. The Mac Authur studies of successful ageing, based on three site longitudinal study of elderly US adults living in the community in 1988 (Rowe and Kahn, 1998 and Seeman et al., 1994) are the most well-known and widely published studies of successful ageing. The division of people into “diseased” and “normal” fails to recognize the large heterogeneity within these groups. To overcome this, Rowe and Kahn distinguished between “usual ageing” (normal decline in physical, social, and cognitive functioning with age, heightened by extrinsic factors) and “successful ageing” in which functional loss is minimized (little or no age related decrement in physiological and cognitive functioning with extrinsic factors playing a neutral or positive role) (Rowe and Kahn, 1998). They confirmed the three components of successful ageing as absence or avoidance of disease and risk factors of disease, maintenance of physical and cognitive functioning, and active engagement with life (including maintenance of autonomy and social support). Some investigators have broadened the model to include more psychosocial elements (Valliant, 2002), although attempts to build interdisciplinary models are still rare.
Psychosocial approaches
While the biomedical model emphasis absence of disease and the maintenance of physical and mental functioning as the keys to ageing successfully, socio-psychological models emphasize life satisfaction, social participation and functioning, and psychological resources, are including personal growth.
Main constituents of successful ageing
Theoretical definitions
· Life expectancy
· Life satisfaction and wellbeing (includes happiness and contentment)
· Mental and psychological health, cognitive function
· Personal growth, learning new things
· Physical health and functioning, independent functioning
· Psychological characteristics and resources, including perceived autonomy, control, independence, adaptability, coping, self-esteem, positive outlook, goals, sense of self
· Social, community, leisure activities, integration and participation
· Social networks, support, participation, activity
Additional lay definitions
· Accomplishments
· Enjoyment of diet
· Financial security
· Neighborhood
· Physical appearance
· Productivity and contribution to life
· Sense of humour
· Sense of purpose
· Spirituality
Satisfaction with one’s past and present life has been the most commonly proposed definition of successful ageing and is also the most commonly investigated (Havighurst, 1963). Its components include zest, resolution and fortitude, happiness, relationships between desired and achieved goals, self-concept, morale, and mood and over all well-being. Continued social functioning is another commonly proposed domain of successful ageing. It encompasses high levels of ability in social role functioning, positive interactions or relationships with others, social integration and reciprocal participation in society (Havighurst, 1968).
Suggested psychological resources for successful ageing include a positive outlook and self-worth, self-efficacy or sense of control over life, autonomy and independence, and effective coping and adaptive strategies in the face of changing circumstances. For example, when some activities are curtailed (say because of ill health) strategies need to be activated to find new activities and to minimize one’s reserves (Baltes, 1990). Successful ageing is seen as a dynamic process, as the outcome of one’s development over the life course (Riff, 1989), and as the ability to grow and learn by using past experiences to cope with present circumstances while maintaining a realistic sense of self.
Rowe and Kahn (1997) indicated that the stage is set for intervention studies to identify effective strategies that enhance wellness among older adults. This model also stated that ageing is multifaceted and consisted of interdependent biological, psychological, social and spiritual processes. In addition the literature has found an association between spiritual and religious activities and the reduction in disability and diseases, thus allowing seniors to remain actively engage.
The intellectual acceptance of spirituality as a major facet of life helps reopen doors of opportunity with groups who have avoided or become reluctant recipients of traditional health promotion interventions (Crothers et al., 2002).
The incorporation of positive spirituality into Rowe and Kahn’s (1998) model of successful ageing help underscore the importance of this area in self healthcare.
OTHER THEORIES OF HEALTHY AGEING as quoted in the International Encyclopedia of Social and Behavioral Sciences. (Smelter and Baltes, 2001)
Anthropological Theories
Interest in old age came relatively late for anthropologists with an examination of ethnographic data in the Human Relations Area Files in 1945 that considered the role of the aged in 71 primitive societies. Early theoretical formulations propose a quasi-evolutionary theory that links the marginalization of older people to modernization. Current anthropological currently addressed the complexity of the older population leading to differential experiences of ageing in different cultural context, the diversity of ageing within cultures, the role of context specificity, and the understanding of change over the life course across different cultural settings (Fry, 1999).
Anthropological theories argue that every human society has generational principles that organize social lives. Anthropologists also distinguish between theories about age from those about ageing or the aged. Theories about age explain cultural and social phenomena. That is, how is age used in the regulation of social life and the negotiation of daily living? Theories about ageing are theories about living, the changes experienced during the life course, and the interdependencies throughout life among the different generations. Finally, theories about the age focus on late life, describing old age not only as a medical and economic problem but also as a social problem in terms of social support and care giving (Fry, 1999).
Biological Theories of Ageing
Theories explaining the biological basis of human ageing are either stochastic theories that postulate senescence to be primarily the result of random damage to the organism, or they are programmed theories that hold that senescence is the result of genetically determined processes. Currently most popular theories include: (a) the free radical theory, which holds that various reactive oxygen metabolites can cause extensive cumulative damage; (b) caloric restriction, which argues that both lifespan and metabolic potential can be modified by caloric restriction (thus far not demonstrated in humans); (c) somatic mutation, arising from genetic damage originally caused by background radiation; (d) hormonal theories, proposing, for example, that elevated levels of steroid hormones produced by the adrenal cortex can cause rapid ageing decline; and (e) immunological theories that attribute ageing to decline in the immune system. Another prominent view is that the protective and repair mechanisms of cells are insufficient to deal with the cumulative damage occurring over time, limiting the replicative ability of cells (Cristofalo et al. 1999).
Social Theories of Ageing
Social theories of ageing have often been devised to establish theoretical conflict and contrast (Marshall,1999). A prominent example of a social theory of ageing is presented by the ageing and society paradigm (Riley et al., 1999). The distinguishing features of this paradigm are the emphasis on people and structures as well as the systemic relationship between them. This paradigm includes life course but it also includes the guiding principles of social structures as having greater meaning than merely providing a context for people's lives. This theory represents a cumulative paradigm. In its first phase, concerned with lives and structures, it began with the notion that in every society age organizes people's lives and social structures into strata from the youngest to the oldest, and raised questions on how age strata of people and age oriented structures arise and become interrelated. A second phase concerned with the dynamisms of age stratification defined changing lives and changing structures as interdependent but distinct sets of processes. The dynamism of changing lives began with the recognition of cohort differences and noted that because society changes, members of different cohorts will age in different ways. A second dynamism involves changing structures that redefine age criteria for successive cohorts. In a third phase the paradigm specified the nature and implication of two connecting concepts, that of the interdependence and asynchrony of these two dynamisms, that attempt to explain imbalances in life courses as well as social homeostasis. A fourth phase deals with future transformation and impending changes of the age concepts. It introduces the notion of age integration as an extreme type of age structure as well as proposing mechanisms for cohort norm formation (Riley et al., 1999).
Theories of Everyday Competence
Theories of everyday competence seek to explain how an individual can function effectively on the tasks and within the situations posed by everyday experience. Such theories must incorporate underlying processes, such as the mechanics (or cognitive primitives) and pragmatics of cognitive functioning, as well as the physical and social contexts that constrain the individual's ability to function effectively. Because basic cognitive processes are typically operationalized to represent unitary trait characteristics, it is unlikely that any single process will suffice to explain individual differences in competence in any particular situation; hence, everyday competence might be described as the phenotypic expression of combinations of basic cognitive processes that permit adaptive behavior in specific everyday situations (Schaie and Willis, 1999).
Three broad theoretical approaches to the study of competence have recently been advocated. The first perspective views everyday competence as a manifestation of latent constructs that can be related to models of basic cognition. The second approach conceptualizes everyday competence as involving domain-specific knowledge bases. In the third approach, the theoretical focus is upon the fit, or congruence, between the individual's cognitive competence and the environmental demands faced by the individual. An important distinction must further be made of the distinction between psychological and legal competence. While the former is an important scientific construct, the latter refers to matters of jurisprudence that are involved in the imposition of guardianship or conservatorship designed to protect frail individuals as well as to limit their independent decision-making ability. Although legal theorizing incorporates aspects of virtually all psychological theories of competence, it does focus in addition the definition of cognitive functioning and competence as congruence of person and environment, upon the assignment of status or disabling condition and a concern with functional or behavioral impairment (Schaie and Willis, 1999).
Life Course Theories
Life course theories represent a genuinely sociological approach to what, at the level of surface description, is a rather individual phenomenon as represented by the ageing and life course patterning of human individuals. Life course theories generally represent a set of three principles. First, the forms of ageing and life course structures depend on the nature of the society in which individuals participate. Second, while social interaction is seen as having the greatest formative influence in the early part of life, such interaction retains crucial importance throughout the life course. Third, those social forces exert regular influences on individuals of all ages at any given point in time. However, such thinking also introduces three significant intellectual problems. These are the tendency to equate the significance of social forces with social change, neglecting intracohort variability, and a problematic affirmation of choice as a determinant of the life course (Dannefer and Uhlenberg ,1999).
Theories of Cognition
A distinction is generally made between cognitive abilities that are fluid or process abilities that are thought to be genetically over determined and which (albeit at different rates) tend to decline across the adult lifespan, and crystallized or acculturated abilities that are thought to be learned and be culture-specific, and which tend to be maintained into advanced old age. This distinction tends to break down in advanced old age as declining sensory capacities and reduction in processing speed also leads to a decline of crystallized abilities. Nevertheless, most theories of adult cognition have focused upon explaining the decline of fluid abilities, neglecting to theorize why is it that crystallized performance often remains at high levels into late life (Salt house, 1999). Most theoretical perspectives on cognitive ageing can be classified into whether the proposed primary causal influences are distal or proximal in nature. Distal theories attribute cognitive ageing to influences that occurred at earlier periods in life but that contribute to concurrent levels of performance. Other distal explanations focus on social, cultural changes that might affect cognitive performance. These explanations assume cumulative cohort effects that lead to the obsolescence of the elderly. Distal theories are useful, particularly in specifying why the observed age differences have emerged, since it is generally agreed that mere passage of time cannot account for these differences. Proximal theories of ageing deal with those concurrent influences that are thought to determine age related differences in cognitive performance. These theories do not specify how the age differences originated. Major variations of these theories include strategy-based age differences, quantitative differences in the efficiency of information processing stages implicating deficits in specific stages, or the altered operation of one or more of the basic cognitive processes (Salt house, 1999).
Social Psychological Theories
Social psychologists coming from a psychological background are concerned primarily with the behavior of individuals as a function of micro social variables. Of particular recent interest has been the model of learned dependency (Baltes, 1996). In this theory, the dependency of old age is not considered to be an automatic corollary of ageing and decline, but rather is attributed in large part to be a consequence of social conditions. This theory contradicts Seligman's (1975) model of learned helplessness, which postulates dependency to be the outcome of non- contingencies and which sees dependency only as a loss. Instead it is argued that dependency in old people occurs as a result of different social contingencies, which include the reinforcement for dependency and neglect or punishment in response to pursuit of independence. Also of currently prominent interest is socio emotional selectivity theory. This theory seeks to provide an explanation of the well-established reduction in social interactions observed in old age. This theory is a psychological alternative to two previously influential but conflicting sociological explanations of this phenomenon. Activity theory considered inactivity to be a societally induced problem stemming from social norms, while the alternative disengagement theory suggested that impending death stimulated a mutual psychological withdrawal between the older person and society. By contrast, socio-emotional selectivity theory holds that the reduction in older persons' social networks and social participation should be seen as a motivated redistribution of resources by the elderly person. Thus older persons do not simply react to social contexts but proactively manage their social worlds (Baltes and Christensen 1999).
Stress Theories of Ageing
These theories argue that excessive physiological activation have pathological consequences. Hence differences in neuron endocrine reactivity might influence patterns of ageing. The focus of such theories is not on specific disease outcomes, but rather on the possibility that neuron endocrine reactivity might be related generally to increased risk of disease and disabilities. Stress mechanisms are thought to interact with age changes in the hypothalamic-pituitary- adrenal (HPA) axis, which is one of the body's two major regulatory systems for responding to stressors and maintaining internal homeostatic integrity. Individual differences in reactivity may cumulatively lead to major individual differences in neuron endocrine ageing as well as age-related risks for disease. Certain psychosocial factors can influence patterns of endocrine reactivity. Perceptions of control and the so called Type A behavior pattern may influence increased reactivity with age. Gender differences in neuron endocrine reactivity are also posited because of the known postmenopausal increase in cortisol secretion in women not treated with estrogen replacement therapy (Finch and Seeman 1999).
Psychological Theories of Ageing
As for other life stages, there do not seem to be many overarching theories of psychological ageing, but emphasis in theoretical development is largely confined to a few substantive domains. A recent exception to this observation is the theory of selection, optimization and compensation (SOC) advocated by (Baltes and Baltes, 1990 and Baltes, 1997). This theory suggests that there are psychological gains and losses at every life stage, but that in old age the losses far exceed the gains. Baltes suggests that evolutionary development remains incomplete for the very last stage of life, during which a societal supports no longer suffice to compensate for the decline in physiological infrastructure and losses in behavioral functionality (Baltes and Smith 1999).
GENDER DIFFERENCES IN AGEING
The conditions that currently account for the bulk of mortality and morbidity among older people stem from experiences and behaviors’ at younger ages. Smoking, alcohol abuse, infectious disease, under nutrition and over nutrition, poverty, lack of access to education, dangerous work conditions, violence, poor health care, injuries – experience of any of these early in life and throughout the life course can lead to poor health in later years (WHO, 2003).
Since the gender pattern in a given society affects the degree to which women and men are exposed to these various risk factors, it has an effect on their health in later years, as well. Women generally have higher life expectancy than men, but the picture is not simple. For reasons that are not entirely agreed upon, women in developed countries have higher life expectancy at birth, and at older ages, than do men. Women usually have an advantage in developing countries as well. However, high maternal mortality, discrimination against women in nutrition, access to healthcare, and other areas, and, in some cases, the killing or neglect of girl babies mean that, in certain poor countries, women’s life expectancy is about the same as, or even lower than, men’s.
Over the next few decades, as the conditions cited above improve, women’s life expectancy in the developing world is expected to increase faster than men’s. The situation in these countries will thus come to resemble that in the developed world today (WHO, 2003). This pattern has significant consequences for the health of older women. To begin with, women’s longer life spans, combined with the fact that men tend to marry women younger than themselves and that widowed men remarry more often than widowed women, mean that there are vastly more widows in the world than there are widowers. Given that women in many countries rely on their husbands for the provision of economic resources and social status, this means that a large percentage of older women are at risk of dependency, isolation, and/or dire poverty and neglect.
Fig. 4: Overall life expectancy at birth vs. healthy life expectancy at birth among selected countries
Source: Gender, health and ageing (WHO, 2003).
Moreover, even if women on average live more years than men, many of these years may be spent in the shadow of disability or illness. Indeed, if “healthy life expectancy” – that is, expected years of life “in full health” – is examined in place of overall life expectancy, women’s advantage over men often becomes smaller (Figure 4). A further consequence of differential life expectancy is that there are simply older women in the world than older men – especially among the “oldest old,” those 85 years of age and above (Figure 5). Given that disability rates rise with age, this means that there are substantially older women than older men living with disabilities (WHO, 2003).
Fig. 5: Number of men and women 65 and older, worldwide, by age group, 2000 (in millions)
Source: Gender, health and ageing (WHO, 2003).
Despite these facts, however, common gender norms mean that it is women, not men, who are most likely to take care of needy relatives. Thus, it is not an uncommon occurrence for an older woman who is disabled, has lost her husband, and has no one to take care of her, to nevertheless be caring for others (WHO, 2003).
HEALTH PROMOTION OF THE AGED
There has been a different definition for health: Physical, psychological, social and Spiritual well-being is not only absence of disease or disability (Alma-Ata, 2001). Health can be soundness of body and mind, a state of vigor and vitality that permits one to function effectively physically, psychologically and socially. The dimension of health is: Physical, Psychological, Social, Spiritual and Environmental. Physical health refers to soundness of body. It involves such aspects of physical being as weight, body shape, the sharpness of senses, the ways in which the body functions, and the presence or absence of Disease or infirmity (Envied, 1998).
Equity in access to health promotion, that includes disease prevention throughout life, is the cornerstone of healthy ageing. A life course perspective involves recognizing that health promotion and disease prevention activities need to focus on maintaining independence, prevention and delay of disease and disability, as well as on improving the quality of life of older people who already have disabilities. Despite improvements in legislation and service delivery, equal opportunities for women through the life course are still not realized in many areas (Timor et al, 2002).
In a workshop organized by (WHO, 2000) the following major areas were identified for discussion on healthy ageing:
1. Justification for choosing mega countries as focus of the regional meeting- A mega country, by definition, is a country with a population of 100 million and above. Although the percentage of the population aged 60 years and above in some countries is still only 7 percent, these mega countries will face tremendous problems in terms of absolute numbers of the ageing population. The issues have to be dealt with differently for other countries with smaller populations.
2. Specific problems and advantages of mega countries in South East Asia Region- Mega countries in the South East Asia Region are India, Indonesia and Bangladesh, which are also economically developing countries. These three mega countries share common problems of the developing world, such as population density, urban- rural health problems, illiteracy, disparity of resource needs, double burden of disease, limitations in health care, low ability and knowledge of health providers, limited access and availability of health services, especially for the poor and the underprivileged groups (women, the elderly, the poor, the under-five etc.). In relation to older people, these mega countries, as other member countries in the region, show a unique tradition and culture. Respect for the elderly is expressed as a shared responsibility of family members by having parents stay at their children’s house and being taken care of. The existence of extended kin network in wherein parents, children, uncles and aunts are in regular frequent contact with one another is a fundamental part of the traditional welfare system. Thus, in most developing countries, the family remains the only source of support and long- term care of the elderly.
3. Justification for emphasis for the development and programmer for the elderly- Health in old age is determined by lifestyles and many risk factors that can actually be prevented during the life time. Focusing on promotion and disease prevention is a public health priority. During the life time, a person has many opportunities to maintain good health. Therefore, programs for older persons should be based on the objective of maintaining good quality of life throughout the life span, particularly in old age. Primitives and preventive efforts should therefore be implemented, together with curative and rehabilitative efforts.
In many developing countries, which have high maternal and infant mortality rates, health of the elderly is a low priority. As ageing is a biological process, health promotion to reach active and healthy ageing during the life time are not yet geared towards benefiting the later part of life. This is not always because countries do not have a policy of protecting the elderly. Some countries have established national policies, but the system simply does not work due to many aspects, such as unpreparedness of health providers in providing proper care to the elderly and lack of awareness of the community on the importance of good quality of life in old age.
4. Definition of healthy and active ageing as perceived by member countries- Although there are many documents that have been published on healthy and active ageing, no clear definition on healthy and active ageing has been found so far. In order to clarify what is meant by active and healthy ageing, the workshop came up with the following definitions:
“Active and healthy ageing is a process to achieve physical, mental and social well- being of an individual, particularly in the later years”.
Since this is a life time process, involvement should start early in life. Health in the old age is a result of experiences of earlier years of life; therefore, old age should not be looked upon as a separate compartment of life, but rather as the other end of the continuum of one’s life time. The pattern of living which enhances health is formed early in life and is not easily altered. The emergence of cardiovascular diseases and cancer, for example, is in fact, the result of a long- term process.
5. The goal of healthy and active ageing- The workshop agreed that the regional goal of healthy and active ageing should be:
“to promote health over life time in order to attain quality of life for older persons in the countries of the region”.
This goal is in line with the integrated program me on Ageing and Health (AHE) of WHO which emphasizes the concerns on both age and ageing (WHO, 2000).
The aim of the present investigation was to study the role of Health Habits, Health Protective Behavior, Generalized Self Efficacy, Health Efficacy, Exercise, Spiritual Well Being, Good Quality of Sleep, Measures of Positive Thinking (viz. Optimism, Satisfaction with Life, Forgiveness, Happiness, Mental Health, and Hope), Measures of Negative Affect (viz., State Trait Anxiety, Brief Symptom Inventory measuring Depression, Hostility and Anxiety, Depression measured by Beck Inventory, Anger Experienced and Anger Expressed, Stress Symptoms and Presumptive Stressful Life Events), Body Mass Index, Eysenckian Dimensions of Personality and Ways of Coping in Healthy Ageing. In addition the effects of gender and age on the parameters of Healthy Ageing were also assessed. This was done for both male and females subjects in different age groups viz., 65-74 years and 75- 80 years.
REVIEW OF LITERATURE
kikuchi, sai and ooe( 1975). Study on old age.The respondent chosen by the studies are those aged 50 years and above, 55 years and above, 60 years and above and 70 years and above. Among the subject selected by the studies, about 90 percent are retirees between 55 years and above 70 years, nearly 5 percent are between 50and 55 years who are on the verage of retirement, and the remaining 5 percent are women of whom about 3 percent are retirees aged between 55 years and above 70 years and 2 percent are aged between 50 and 55 years and on the brink of retirement. All studies except four covered samples of retirees or workers in urban centers. Three studies, one from Japan (kikuchi, sai and ooe 1975) covered aged people in a fishing village and few agricultural villages respectively. Another study from Germany, (szwarch 1981) included urban and rural respondents in its sample. The respondents of the studies included several occupational, income level, religious and other categories of people in towns and cities: doctors, lawyers, journalists, executive, teachers, telephone company employees, steel, workers, coal miners, skilled craftsman, retail sales persons, church members, church leaders, hospitalized persons beside non-working aged men and women in towns and cities.
menachery (1987).Most of the respondents are whites in the urban centers of western countries. Some are lacks in the cities of U.S.A. an overwhelming number of the subject are Christians and the remaining subject included people from banglades, (chaudury 1982), India (menachery 1987), Israel (eran 1976), Nepal (Sharma ), Japan, Russia (Shapiro & pyshor 1979) and the Chinese and apanese settles in the united states of America, (Kalish and Moriwak 1973).
The size of the sample respondents chosen for different studies varies according to the objectives stated, variable to be examined individuals in more than 150 researches, between 100 and 500 in 20 researches , an from 501 and 1000 individuals in 25 researches, and between 1001 and 6000 persons in about 5 researches.
Among the three approaches for depression, viz., psychoanalytic, interpersonal and cognitive one of the most influential of these theories was proposed by Beck in 1967 which studied the etiology of depression.
Beck (1967) argued that all individuals possess cognitive structures called schemas that guide the ways information is attended to and interpreted. Such schemas are determined from childhood by our interactions with the external world. For example, a child who is constantly criticized may begin to believe she is worthless. She might then begin to interpret every failure experience as further evidence of her worthlessness. If this negative processing of information is not changed, it will become an enduring part of her cognitive organization, that is, a schema. When this schema is activated (e.g by a poor grade on a test or any other failure experience),it will predispose her to depressive feelings(e.g. I am no good).Beck stated that as a result of this faulty information processing, depressed persons demonstrate a cognitive triad of negative thoughts about themselves, the world and the future(Friedman,1998).
BECK (1976) emphasized the cognitive, or thought aspects of depression. Depression primarily is a thought disorder and only secondarily as a mood disorder. According to Beck, depressed persons are dominated by negative views of self, the outside world and future. They see themselves as losers, and all their perceptions are colored by this major premise.
Depression is projected to be the second leading cause of disability by the year 2020. In India, clinically recognizable depressive disorders have been found to be as common as in the West (Sharma et al., 2001)
Verbal expression of a dysphonic mood is an essential symptom of depression but Poznanski et al. (1979) allowed for a clinical rating of dysphasia based on the child’s non-verbal expression of affect. They considered that overtly depressed children often have difficulty labeling their own feelings of sadness or prolonged unhappiness.
Depression is one of the most common psychological maladies of modern humans, and it afflicts roughly twice as many women as men (Buss, 2000). The prevalence of depressive disorders with high economic and emotional cost and the possibility of its continuing as a major mental health problem for years to come, demand the attention of researchers as well as professionals particularly in the context psychiatrically normal adults, adolescents and children. It makes sense to consider depression as disrupting a person’s thinking processes, emotional reactions and day to day behaviors.
Depression is projected to be the second leading cause of disability by the year 2020. According to Sharma et al. (2001) in India, clinically recognizable depressive disorders have been found to be as common as in the West. Among the three approaches for depression, viz., psychoanalytic, interpersonal and cognitive one of the most influential of these theories was proposed by Beck in 1967 which studied the etiology of depression.
Beck (1967) argued that all individuals possess cognitive structures called schemas that guide the ways information in the environment is attended to and interpreted. Such schemas are determined from childhood by our interactions with the external world. For example, a child who is constantly criticized may begin to believe she is worthless. She might then begin to interpret every failure experience as further evidence of her worthlessness. If this negative processing of information is not changed, it will become an enduring part of her cognitive organization, that is, a schema. When this schema is activated (e.g. by a poor grade on a test or any other failure experience), it will predispose her to depressive feelings (e.g. I am no good). Beck stated that as a result of this faulty information processing, depressed persons demonstrate a cognitive triad of negative thoughts about themselves, the world and the future (Friedman, 1998).
Hae-Sook Jeon1 and Ruth E. Dunkle 2 (199) Stress and Depression Among The Oldest- Old: A Longitudinal Analysis :Stress and psychosocial resources play a crucial role in late-life depression. While most studies focus on predominantly those who are young-old, this study used a sample aged 85 and older. The authors’ study aims to examine three research questions: (1) what are the trajectories of depression and its associated factors such as types of stress and psychosocial resources among the oldest-old? (2) What are the longitudinal relationships among the changes in stress on depression trajectory mediated by changes in psychosocial resources, and depressive symptoms? (3) Are the effects of the changes in stress on depression trajectory mediated by changes in psychosocial resources? The study used a convenience sample of 193 community-dwelling elders aged 85 and older with four interviews every six months from 1986 to 1988. Using multilevel modeling analyses, longitudinal results showed that changes in positive life events, daily hassles ( worries), and mastery were significantly associated with changes in late-life depression among the oldest-old.
S. Rarhed, Y Reffat(1998)Depression among older people: Forty five elderly patients presenting with depression and demential behavior, and 20 young adults presenting with depression were studied. Depression was identified in 53%, 42% and 73% of the Oldsample using psychiatric interview, back depression inventory and the Multidimensional Observation Scale for Elderly Subject (MOSES), respectively. Depressive Pseudo dementia was found in 8.9% of Oldsample (using interview and MOSES). Depression was found to decrease in frequency as dementia was more severe. There is considerable disagreement about what happens to the risk of anxiety and depression disorders and symptoms as people get older.
A search was made for studies that examine the occurrence of anxiety, depression or general population sample ranging in age from at least the 30s to 65 and over and use the same assessment method at each age.
Tanta koropeckyj-cox (2009) mental Health and Depression among aging:
This article reviews the rationale for concentrating mental health system and therapeutic resources on the treatment of depression in aging populations. Etiological factor/clinical formulation, biopsychosocial treatment strategies, and therapeutic outcome evaluation are examined and presented as rational for a renewed concentration on treatment for both dementia and non-dementia related depression in the elderly. The authors conclude that although the older adult depressive patient has special needs and conditions that require specialized psychosocial care, they are no different than any other special needs populations. A lifetime accumulation of stress, specific catastrophic events, and failing physical conditions that require specialized psychosocial care, they are no different than any other special needs population. A lifetime accumulation of stress, specific catastrophic events, and failing physical conditions contribute to reduce coping, but are all conducive to treatment. Accepting a normative view of older adult depression and considering it a normal function in the life cycle, is categorically flawed and thus, unethical as well. Instead, clinicians should be concentrating their efforts on expanding systems and techniques/models that have proven efficacy for these patients.
Department of sociology and Population studies center :This study examines the relative circumstances of community-dwelling childless and parents in middle and old age(50-84years old), using data from the 1988 National survey of families and households, in order to update and test earlier findings of negative consequences related to childlessness in later life. Results indicate that net of other effects, both loneliness and depression are significantly related to childlessness for women but not men. Childless women are 46%more likely to report high depression compared to mothers. Among both men and women, being formerly married is related to greater loneliness and depression. These results demonstrate the greater salience of childlessness for women compared to men. The findings are discussed in the context of the changing norms regarding marriage, divorce, childlessness , and gender roles experienced by the newly emerging cohorts of the middle-aged and elderly.
A descriptive, correlation study was conducted to examine the physical and mental health status of 80year-olds. Thirty seven community –dwelling adults, aged 80 and over, were interviewed about their Physical health, psychological well-being, and demographic characteristics. Both descriptive and correlation data indicated that overall these older adults were positive about both their physical health and psychological well-being. However, depression emerged as a significant problem for 24% of the sample and was strongly related to physical health problem. Results are discussed in relation to both health needs stereotypic beliefs about the very old.
Journal of community Health nursing c 1993 Taylor &Francis, Ltd. This article discusses findings from a study exploring the inner world of older people s life experiences and how they felt about being old. Freedom, slowing down, loss, changes, companionship, faith, and active engagement were main themes. Social access provided opportunities for older people to fulfill their sense of belonging and productivity they believed “being old is being sick” because they were capable, they did not think they were old. They felt aging not only meant losing independence and dignity, but also having more experiences. These findings are critical for extension educators, who should rethink the meaning of aging and how to respond to the needs of the elderly.
METHODOLOGY
Statement of the problem
“Depression among Aging”
Aim of the research:-
The general aim of the present investigation has been to know about depression of Aging.
Objectives of the study
1. To assess and analyze the depression male and female ageing.
2. To find out the depression in different age group.
3. To know the depression among government and non government retired people.
Hypothesis related to the studies.
1) There is significant difference in depression among male and female aged people.
2) Male and female respondent differ significantly in their depression scores.
3) The responses with a different background differ significantly in their depression score.
4) Respondent were working in government and non-government sector differ significantly in their depression scores.
5) There will be significant interaction between, age ,gender and education, for depression scores.
VARIABLE:
Independent variable: Gender and Age
Independent variable: Gender and Age
Dependent variable: depression.
SAMPLES:- 100 sample from Old age home Mysore, male 50 and female 50.have been selected by using the Random sample methods.
TOOLS: The Geriatric depression scale (GDS) ;Lenore kurolowics(1986).
While there are many instruments available to measure depression .The Old depression scale (GDS) first created by yesavage. etc, has been tested and used extensively with the older population .The GDS long form is a 30 –items questionnaire is which participants are asked to respond by answering yes or no in reference to how they felt over the past week, a short form GDS Consisting of 15questions was developed was developed in 1986 question from the long form GDS which had symptoms invalidation studies were selected for the short version of the 15items ,10indicated the presence of depression when answered positively while.
The rest (question number is 1, 5,7, 11,13) indicated depression when answered negatively. Scores of 0-4 are considered normal depending on age, education, and complaints; 5-8 indicate mild depression: The short form is more easily used physically ill and mildly to moderately demented patients who have short attention spans and 1or feel easily fatigued it takes about 5to 7 minutes to complete.
VALIDITY AND RELIABILITY:
VALIDITY AND RELIABILITY:
The GDS was found to have a 92.1% sensitively and a 89% specifically when calculated against diagnostic criteria .The validity and reliability of tool have been supported through both clinical practice and research in a validation study comparing the long and short forms of the GDS for self rating of symptoms of depression both were successful in differentiating depressed from Non depressed adults with a high.
STATISTICAL ANAYSIS:
According to the plan already prepared unvaried and multi variable table were drawn variable have been so arranged that definite interface regarding to presence or absence of actual relationship hypotheses may be drawn, In order to arrive a different concussion statically methods have been applied but greater reliable has been applied but greater has been placed on statistical methods descriptive (MEAN ,SD
t-test and F-test) .regards as we use the mean.
RESULT AND DICSUSSION
TABLE NO: 1
Showing mean,SD and F-value of different age group in depression old age people (N=100).
Showing mean,SD and F-value of different age group in depression old age people (N=100).
| GROUP | MEAN | SD | F-VALUE |
| 60-69 | 5.73 | 3.79 | * 6.658 |
| 70-89 | 8.27 | 3.42 | |
| 90+ | 9.25 | 1.7 | |
| TOTAL | 7.29 | 3.73 | |
*significant at 0.01 level
The table shows the depression in different Old age group .The Old age group the mean of depression of Old age group is 5.73, 8.27, 9.25 and 7.29 respectively. The calculated f-value is 6.658; it shows that there is a significant difference in depression of different age group Therefore, the hypothesis is accepted.
TABLE NO: 2
Distribution of difference in the male and female depression of old age people(N=100).
Distribution of difference in the male and female depression of old age people(N=100).
| GENDER | MAN | S-D | F-value |
| MALE | 7.76 | 3.993 | 1.261 |
| FEMALE | 6.82 | 3.439 | |
The table shows that the depression of the mean of depression of ageing. The mean of depression of male and female is 7.76 and 6.82 respectively and the SD male and female for the same is 3.99 and 3.43 is respectively. The calculated f-value is 1.261it is not significant .Therefore the hypotheses is rejected.
TABLE NO: 3
Distribution of respondent according their education in depression(N=100).
| Education | MEAN | S.D | F-value |
| SSLC | 7.65 | 3.64 | 1.479 |
| PUC2 | 6.87 | 4.24 | |
| Degree | 6.00 | 3.50 | |
| others | 7.89 | 3.73 | |
The table shows that their depression .The mean score of SSLC, PUC and degree is 7.65, 6.87, 6.00 and other mean is 7.89 are respectively. Where are the SD is 3.64.34.24, 3.50and 3.73 is respectively .The calculated f-value is 1.479 it is not significant. It shows that there is no difference of SSLC, PUC degree and others. Therefore the hypothesis is rejected.
TABLE NO: 4
Showing mean,SD and t-value of depression of Govt. and non-government retired people(.N=100)
| occupation | MEAN | S-D | t-value |
| Govt. | 6.79 | 3.85 | 1.049 |
| Non-Govt. | 7.60 | 3.66 | |
Above table shows that the Govt.and non government old age people depression. The mean score of depression of Government and non Government retired people is 6.79 and 7.60 is respectively. Where as the SD is 3.85 and 3.66 is respectively. The f-value is 1.04 it is not significant. Therefore, the hypothesis is rejected.
Summary and Conclusion
This old of subsistence from old age own source of income of interaction gender and Education, occupation Male and Female different old age group, Government and non-government old age group common problem overcrowding is increasing although not alarming.
The generally prepare the master plan for the planning and zoning of the ‘residents’ but in practice the plans are partially implemented. Because of this some problems are tackled while other problem remains neglected.
The learning experience in social work includes broadly four areas our city Mysore they face the problem of Homes and feel lonely. The reason that care of their basic requirement such as food, accommodation, shelter and medical facilities. Many of the residents came to the Homes because they had nowhere to the were too poor to support themselves financially or too old to work to earn a living.
The findings from this study have ample scope in the field work. Since the destitute elderly find the basic facilities provided in these homes adequate. The staff could turn their attention to enabling the residents to become economically reproductive. The skills at the healthy residents could be further enhanced and could effectively utilize their expertise by imparting their skills to residents old age homes.
The planning of the city does not mean the physical planning alone. The social planning needs to be given equal attention. The initiative of an Shanthidhama in managing the OAPS was found to be practical and cost – efficient as it had brought down operational costs in brief this initiative.
Conclusion
There is significant difference in different age group.
There is no significant difference in depression among male and female aged people.
There is no differ in Male and female respondent in their depression scores.
There is no difference in Government and non-government retired people.
REFERENCES:
1) Banerjee, saradendu. Problems of old: psychoanalytic perspective. Samiksa, 1983, 37, 3-14.
2) Bankar, lewellys F. physical changes in old age and their effects upon mental attitudes. In George Lawton. New goals for old age. New York: Columbia University, 1951.
3) Barron, Milton l., streib, Gordon, and such man, e.a. research on the social disorganization of retirement. American social disorganization of retirement. American sociological review, 1952, 17, 479-482.
4) Barron, Milton l. the aging American: an introduction to social gerontology and geriatrics. New York: Thomas y. Crowell Company, 1961
5) Bartus, Raymond t., dean, Reginald, l., beer, Bernard and leppa, Arnold s. the cholinergic memory dysfunction science, 1982, 217, 408-417.
6) Benumbs teven k, and boxely, Russell L. depression and age identification. Journal of clinical psychology, 1983, 39, 584-590.
7) Berger, dale, young, Jeffry and heebner. Aging in the inland empire: a need assessment survey of older persons in sun Bernardino country, California. Catalog of selected documentation in psychology, 1982, 12, 31-32.
8) Bighorn, forest j. the urban elderly – a study of life satisfaction. New Jersey: Allen held and osmium, 1982.
9) Bernard, harlot w. towards better personal adjustment. New York: mc graw-hill Book Company, 1978.
10) Bhattacharjee, P.J. population growth and socio-economic development of India. The journal of family welfare, 1982, 28, 41-48.
11) Bhatia, h.s. aging and society: a sociological study of retires public servants”, Udaipur, 1983, aria’s book center publisher.
12) bharat pensioners” samaj, problems of pensioners in Jabalpur. Jabalpur branch pensioners” samaj, 1971.
12) bhojaraj, shewak. Mental health through recreation. Indian journal of social work, 1964, 9, 2-3.
13) biren, James e. (ed). Handbook of aging and the individual. Chicago: the university of Chicago ress, 1961.
2) Bankar, lewellys F. physical changes in old age and their effects upon mental attitudes. In George Lawton. New goals for old age. New York: Columbia University, 1951.
3) Barron, Milton l., streib, Gordon, and such man, e.a. research on the social disorganization of retirement. American social disorganization of retirement. American sociological review, 1952, 17, 479-482.
4) Barron, Milton l. the aging American: an introduction to social gerontology and geriatrics. New York: Thomas y. Crowell Company, 1961
5) Bartus, Raymond t., dean, Reginald, l., beer, Bernard and leppa, Arnold s. the cholinergic memory dysfunction science, 1982, 217, 408-417.
6) Benumbs teven k, and boxely, Russell L. depression and age identification. Journal of clinical psychology, 1983, 39, 584-590.
7) Berger, dale, young, Jeffry and heebner. Aging in the inland empire: a need assessment survey of older persons in sun Bernardino country, California. Catalog of selected documentation in psychology, 1982, 12, 31-32.
8) Bighorn, forest j. the urban elderly – a study of life satisfaction. New Jersey: Allen held and osmium, 1982.
9) Bernard, harlot w. towards better personal adjustment. New York: mc graw-hill Book Company, 1978.
10) Bhattacharjee, P.J. population growth and socio-economic development of India. The journal of family welfare, 1982, 28, 41-48.
11) Bhatia, h.s. aging and society: a sociological study of retires public servants”, Udaipur, 1983, aria’s book center publisher.
12) bharat pensioners” samaj, problems of pensioners in Jabalpur. Jabalpur branch pensioners” samaj, 1971.
12) bhojaraj, shewak. Mental health through recreation. Indian journal of social work, 1964, 9, 2-3.
13) biren, James e. (ed). Handbook of aging and the individual. Chicago: the university of Chicago ress, 1961.
14) blamker, Margaret. Cultural values and dependency in later life. In r.a. dalish (ed) the dependency of old people, occasional papers in gerontology no.6 institute of gerontology, university of Michigan-Wayne state university, 1969.
15) blum, stephenr. And minkler, merdith. Toward a continuum of caring alternative: community based care for the elderly. Journal of social issues, 198,15 -133-152.
16) borsay, peggy l. Anderson. Information sources and interpersonal influence during transition to retirement: a study among state university retirees. Ohio: the Ohio state university, 1976.
16) Bose, ashish, aspects of against senility. Mental health, 1982, 32,10-11.
17) Brink, t.l. the battle against senility. Mental health, 1977, 32, 1-29.
18) bromley, d.b. the psychology of human aging. Middlesex: penguim bools, 1966.
19) Brom, Robert g. family structure and social isolation of older persons. In erdan pal more. (ed) normal aging. Durham n.c., duke university press, 1970.
20) buhler, charlotte, keith-spieal, and Thomas, karla. Developmental psychology. In Benjamin b. Wolman. Handbook of general psychology. New Jersey: prentice-hall, 1973.
21) busse, e.w. Psychoneurotic reaction and defense mechanisms in the aged. In p.h. hoch and j. jubin (eds). Psychopathology of aging. New York: grune and Stratton, 1961.
22) Butler, Robert n. agenism: a foreword. Journal of social issues, 1980, 36, 8-11.
23) bynum, jack e., cooper, b.l and acuff,f. gene. Retirement reorientation: senior adult education. Journal of gerontology, 1987, 33, 253-261.
24) Carp c.m., person situation congruence in engagement. Gerontologist, 1968,8, 184-188.
25) caron, Ruth shonle et al. personal adjustment in old age. Chicago: science researches associates, 1949.
26) Chapel, neena l. and havens, betty old female: testing the double jeopardy hypothesis. The sociological quarterly, 1980, 21,157-171.
27) chaudruy, rafigul huda. The aged in Bangladesh. Social action, 1982, 32,20-38.
28) chavan, albert and fischer, lucy rose. Retirement and interstate migration. Social forces, 1957, 57, 1365-1380.
29) chown, Shelia m. human ageing. Middlesex: penguins, 1977.
30) Clark, Margaret and Barbara Anderson, g. culture and aging: an anthropological study of older Americans, Springfield ills: Charles c. Thomas, 1967.
31) Covalt, n.k the meaning of religion to old people. In c.b. veddar and a.s. lefkowitz (eds). Problem of the aged. Springfield, III, Charles c. Thomas. 1965, 215-224.
32) Cumming, e., dean, l.r., neweli, d.s and mccaffrey, I. disengagement: a tentative theory of aging. Stoichiometry, 1960, 23, 23-25.
33) dayal, n.v. madgaonkar, j.s. and dhasandriah, a.s. study of adjustment of aged men and women to their day to day activities. Paper presented in the national seminar on psuchological aspects of the elderly. Tirupati, June, 1983.
34) deo, pratibha and bhullar, jatinder. Relationship of physical efficiency to self-concept, intelligence and achievement. Psychological studies. 1974, 19, 56-59.
35) deoras, usha and janabandhu, d.s. Adjustment in old age: an introductory survey, 1979.
36) desai, k.g. and naik, r.d. problems of retired people in greater Bombay. Bombay: tata institute of social sciences, 1970.
37) eden, dov and jacoboson, dan. Propensity to retirement among elder executive. Journal of vocational behavior, 1979, 8, 145-154.
38) eisderfer, carl and Lawton, m. Powell. The psychology of adult development and aging. Washington: American psychological association, 1973.
39) ekerdt, david, j, rose, Charles l., bosse, Raymond and costa, Paul. Longitudinal psychology, 1976, 49, 161-169.
40) Entine, Alan d. counseling for mid-life and beyond. Vocational guidance quarterly, 1977, 25,332-336.
41) Havighurst, r.j and r. albert, older people new York: Longmans, 1953.
42) Havighurst, r.j. successful aging. In r.j. Williams, c. tidbits and w. Donahue (eds) process of aging new York: Atherton press, 1963.
15) blum, stephenr. And minkler, merdith. Toward a continuum of caring alternative: community based care for the elderly. Journal of social issues, 198,15 -133-152.
16) borsay, peggy l. Anderson. Information sources and interpersonal influence during transition to retirement: a study among state university retirees. Ohio: the Ohio state university, 1976.
16) Bose, ashish, aspects of against senility. Mental health, 1982, 32,10-11.
17) Brink, t.l. the battle against senility. Mental health, 1977, 32, 1-29.
18) bromley, d.b. the psychology of human aging. Middlesex: penguim bools, 1966.
19) Brom, Robert g. family structure and social isolation of older persons. In erdan pal more. (ed) normal aging. Durham n.c., duke university press, 1970.
20) buhler, charlotte, keith-spieal, and Thomas, karla. Developmental psychology. In Benjamin b. Wolman. Handbook of general psychology. New Jersey: prentice-hall, 1973.
21) busse, e.w. Psychoneurotic reaction and defense mechanisms in the aged. In p.h. hoch and j. jubin (eds). Psychopathology of aging. New York: grune and Stratton, 1961.
22) Butler, Robert n. agenism: a foreword. Journal of social issues, 1980, 36, 8-11.
23) bynum, jack e., cooper, b.l and acuff,f. gene. Retirement reorientation: senior adult education. Journal of gerontology, 1987, 33, 253-261.
24) Carp c.m., person situation congruence in engagement. Gerontologist, 1968,8, 184-188.
25) caron, Ruth shonle et al. personal adjustment in old age. Chicago: science researches associates, 1949.
26) Chapel, neena l. and havens, betty old female: testing the double jeopardy hypothesis. The sociological quarterly, 1980, 21,157-171.
27) chaudruy, rafigul huda. The aged in Bangladesh. Social action, 1982, 32,20-38.
28) chavan, albert and fischer, lucy rose. Retirement and interstate migration. Social forces, 1957, 57, 1365-1380.
29) chown, Shelia m. human ageing. Middlesex: penguins, 1977.
30) Clark, Margaret and Barbara Anderson, g. culture and aging: an anthropological study of older Americans, Springfield ills: Charles c. Thomas, 1967.
31) Covalt, n.k the meaning of religion to old people. In c.b. veddar and a.s. lefkowitz (eds). Problem of the aged. Springfield, III, Charles c. Thomas. 1965, 215-224.
32) Cumming, e., dean, l.r., neweli, d.s and mccaffrey, I. disengagement: a tentative theory of aging. Stoichiometry, 1960, 23, 23-25.
33) dayal, n.v. madgaonkar, j.s. and dhasandriah, a.s. study of adjustment of aged men and women to their day to day activities. Paper presented in the national seminar on psuchological aspects of the elderly. Tirupati, June, 1983.
34) deo, pratibha and bhullar, jatinder. Relationship of physical efficiency to self-concept, intelligence and achievement. Psychological studies. 1974, 19, 56-59.
35) deoras, usha and janabandhu, d.s. Adjustment in old age: an introductory survey, 1979.
36) desai, k.g. and naik, r.d. problems of retired people in greater Bombay. Bombay: tata institute of social sciences, 1970.
37) eden, dov and jacoboson, dan. Propensity to retirement among elder executive. Journal of vocational behavior, 1979, 8, 145-154.
38) eisderfer, carl and Lawton, m. Powell. The psychology of adult development and aging. Washington: American psychological association, 1973.
39) ekerdt, david, j, rose, Charles l., bosse, Raymond and costa, Paul. Longitudinal psychology, 1976, 49, 161-169.
40) Entine, Alan d. counseling for mid-life and beyond. Vocational guidance quarterly, 1977, 25,332-336.
41) Havighurst, r.j and r. albert, older people new York: Longmans, 1953.
42) Havighurst, r.j. successful aging. In r.j. Williams, c. tidbits and w. Donahue (eds) process of aging new York: Atherton press, 1963.
43) Havighrust, r.j. 1973. Social roles, work, leisure, and education. In Carl eisodorfer and m.powell Lawton (eds), the psychology of adult development and aging. Washington: d.c. American psychological association, 1973.
44) Haynes, Suzanne, g., McMichael, Anthony j., and tyroler, h.a the relationship of moral. Involuntary retirement to early mortality among u.s.rubber workers. Social science and medicine, 1977, 11, 105-114.
45) hay slip, Bert and panek, Paul e. physical self-maintenance, mental status, and personality, in institutionalized elderly asults. Journal of clinical psychology, 1983, 39, 479-485.
44) Haynes, Suzanne, g., McMichael, Anthony j., and tyroler, h.a the relationship of moral. Involuntary retirement to early mortality among u.s.rubber workers. Social science and medicine, 1977, 11, 105-114.
45) hay slip, Bert and panek, Paul e. physical self-maintenance, mental status, and personality, in institutionalized elderly asults. Journal of clinical psychology, 1983, 39, 479-485.
APPENDIX
The Geriatric Depression Scale
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
15. Do you think that most people are better off than you are? YES / NO
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