Statement of the Problem

A study to assess the Effectiveness of Mental Health Outreach Initiatives upon Cognition and Depression among elderly population at selected old age homes, Chennai.

Objectives

Primary Objectives

1.      To estimate the levels of cognition and depression among elderly population at selected old age homes, Chennai.

2.      To determine the effectiveness of mental health outreach Initiatives upon cognition and depression among elderly population at selected old age homes, Chennai.

Secondary Objectives

3.      To find the correlation between cognition and depression among elderly population at selected old age homes

4.      To associate the selected variables with cognition and depression among elderly population at selected old age homes.

Hypotheses

1. H₁ - There will be a significant difference in cognition and depression between control group and experimental group of the elderly population in pre test and post tests
2. H₂ -There will be a correlation between cognition and depression between control group and experimental group of the elderly population in pre test and post tests
3. H₃ - There will be a significant association of selected background variables with cognition and depression in the experimental and control group.

Operational Definitions

      Effectiveness:  It refers to improvement in cognition and depression after mental health initiatives as evidenced by significant improvement in scores of cognition, and significant reduction in scores of depression, after administering the intervention.

      Mental health outreach initiatives:  It refers to selected models of delivery of mental health care services which includes reminiscence therapy and validation therapy to address the problems related to cognition and depression among elderly population

Validation therapy –It is an intervention that approach towards elderly population with empathy and understanding, reassurance and comfort such as using clear loving tone of voice, respect and empathy etc. It is given for one month in 8 sessions (2 sessions / week). Each session will be conducted for 3 hours (1 hour 30 minutes for individual session and 1 hour 30 minutes for group session with 10 minutes break after every 30 minutes session).

Reminiscence therapy- It is an intervention that uses all the senses and improves self esteem and provides elderly population with a sense of fulfillment and comfort as they look back to their lives such as listening to favorite music, foods, look at photos, painting, pottery and other crafts etc. It is given for one month in 8 sessions (2 sessions / week). Each session will be conducted for 3 hours (1 hour 30 minutes for individual session and 1 hour 30 minutes for group session with 10 minutes break after every 30 minutes session).

    Cognition: It refers to mental process to assess the ability of higher mental functions such as orientation, recall, attention, verbal recall, reading, writing and copying among elderly population which is measured using Mini Mental Status Examination.

           Depression: It refers to a mood disorder as manifested by a state of feeling very unhappy, sadness and hopelessness among elderly population, as measured by Elderly Depression Scale (EDS).

           Elderly Population: It refers to the people aged 60-80 years who are living in old age homes.

Research Methodology

Research approach

                   Evaluative approach

Research Design

                   Quasi Experimental –research design

                                                    O1      -     O2 - O3

                                                    O1     X    O2 - O3

Variables

•       Independent Variable: Mental health outreach initiatives (Validation and Reminiscence therapy)

•       Dependent Variables: Cognition an Depression

Research Setting

This study will be conducted in selected old age homes, Chennai.

•         Thayagam Old age HOme -It is a home for the aged people, which are located at Sembakkam, Chennai.

•         Sivanandha old age Home, Chennai -It is a home for the aged male and female people who are located at Tambaram, Chennai,. Population

•       Target population – All elderly population

•       Accessible population – Elderly population at selected old age homes

Sample

The samples elderly populations who fulfill the inclusion criteria.

Sampling Technique

             Consecutive sampling technique will be used to select the participants who are accessible to the researcher and who meet the inclusion criteria of the study .

Sample size

Sample size is estimated based on the previous study findings using power analysis.

90% Power

95% Confidence Interval

Required sample size (open epi) was 88 ie., 44 for control group and 44 for experimental group.

  However considering the possible attrition and better generalization 220 samples will be included in this study- 110 for control and 110 for experimental group.

The samples size will be 220 elderly populations who fulfill the inclusion criteria, 110 in control group and 110 in experimental group.

Sampling Criteria

           Inclusion Criteria

1. Elderly population who are in the age group of 60-80 years.

2. Elderly population who are available at the time of data collection.

Exclusion Criteria

      1. Elderly population who are not willing to participate in the study.

2. Elderly population who are having problems such as:

a)      Severe visual and hearing problem

b)      Severe Communication problem

c)      Physically challenged and major health problem, who are unable to participate in the study

d)     Elderly who are completely dependent on others

e)      Elderly with Covid-19 at the time of data collection.

Development and Description of Tools

1.      Section A:  Demographic Variables Proforma

2.      Performa Section B : Health Variables Proforma

3.      Section C : Mini Mental Status Examination- Standardized tool for assessing Cognition: Assessment of orientation, memory, judgment, attention, naming, repetition, stage command, adding, writing and copying etc.

4.      Section D : Geriatric depression scale - Standardized tool for assessing depression: 15 items, with Yes/ No type responses

Score between 0-4 : No depression

A score of > 5 suggests depression

 Pilot Study

              Pilot study will be conducted with 10% of the total population Permission will be obtained from the concerned authorities. Pilot study will be conducted using the same tools and procedures planned for the main study.

Data Collection

            Data will be collected using predetermined, validated and pretested tools through face to face interview method. Intervention will be administered to the experimental and control group will receive routine care. First post test will be conducted one month after intervention and post test 2 will be conducted after 2 months of intervention.

Data Analysis

Descriptive statistics

The descriptive statistical analysis includes frequencies, percentages, means, and Standard deviation.

Inferential statistics

Inferential statistics measured like independent’T’ test used test the hypothesis.

The chi-square test will be used to find the association between the demographic variables.