http://doi.org/10.33698/NRF0186 – Navjot Kaur, Jasbir Kaur, Kanika Thapar
Abstract : The aim of the study was to assess the perceived self-care deficit and social support system among elderly residing in Ludhiana city Punjab.A Descriptive study was conducted on 100 elderly residing in Haibowal Kalan of Ludhiana city, Punjab. An interview schedule to assess socio-demographic characteristics, standardized Modified Barthel Index by Shah Surya for self-care assessment (MBI) and Personal Resource Questionnaire (PRQ 2000) by Weinert for measuring social support were used for data collection. The Results of present study revealed that more than half (55) elderly perceived slight self-care deficit, whereas 35 perceived moderate self-care deficit, seven had no self-care deficit, two perceived total self-care deficit and only one perceived severe self-care deficit. Two third (63) elderly had high social support and rest of them (37 had low social support.Perceived self-care deficit and social support had significant positive relationship between them. Perceived self-care deficit was higher and Social support was lower among age group ≥ 80 years, in females (widow/widower/divorced, living with their children and had no income).
Keywords
Perceived self-care deficit, social support, elderly.
Correspondence at
Dr. Navjot Kaur Assistant Lecturer College of Nursing, DMC, Ludhiana
Introduction
Old age is the last stage in the life journey and closing period in the life span of a man with decreased capacity for adaptation.1 The population of world is undergoing a dramatic shift in age structure. The world’s population that aged 60 and older is currently 760 million people, representing 11% of total population.2 The most important self-care activities are feeding, bathing, dressing, grooming and toileting. In assessing activities of daily living, it is to be determined whether the individual is able to perform self-care activities independently or requires the assistance.3 Factors that influence the practice of self-care include maturity, cultural practices and beliefs, skills, values, level of knowledge, membership in social groups, social support system, illness, disabilities, injuries and availability of health resources.4
Longitudinal aging study in India (Arokiasamy, 2011) evaluated that in older adults of age 65 years 16.6% of men and 22.9 % women had difficulty in performing self-care activities like dressing, bathing, eating, walking, toileting.5 Social support is the perception and actuality that one is cared for, has assistance available from other people, and that one is part of a supportive social network.6 It has numerous ties in physical health, including mortality. People with low social support are at a much higher risk of death from variety of diseases. It can be said that social support influences the person’s motivation for self- care related to their aging, diseases and is likely one of the mechanisms that has a direct impact on changing health-promoting behaviours and outcomes.7
With fast changing socio-economic scenario, rapid urbanization and the increasing participation of women in the workforce, roots of joint family system has been eroding very fast. In such changing situations, majority of older persons, who have passed most part of their life with their joint families are on the verge of isolation. Even basic needs and rights of many of them are not addressed. Taking into account that elderly persons perceive greater difficulty in performing activities of self-careand suffer a gradual degradation of their social abilities, this study may contribute to knowledge in this area, as it promotes the adequate structuring of the attention to this population. Therefore, the investigator has undertaken the present study with the objectives to assess the perceived self-care deficit and social support system among elderly residing in Ludhiana city Punjab and also aimed to find out its association with each other and selected socio demographic characteristics.
Materials and methods
A descriptive design was used to carry out the study on perceived self-care deficit and social support system among elderly residing in Ludhiana city Punjab. Inclusion criteria were elderly of age 60 years and above residing in Ludhiana city, Punjab and willing to participate. An exclusion criterion was the elderly people who were not present at the time of data collection. An interview schedule to assess socio-demographic characteristics, standardized Modified Barthel Index by Shah Surya for self-care assessment (MBI) and Personal Resource Questionnaire (PRQ 2000) by Weinert for measuring social support were used for data collection.The Modified Barthel Index includes the 10 subtest items for assessing self care deficit, scored on a 5-point ordinal scale. There are 5 categories for interpretation of this tool: (0-20) total self- care deficit, (21-60) severe self-care deficit, (61-90) moderate self-care deficit, (91-99) slight self-care deficit, (100) no self-care deficit.8 The PRQ 2000 is composed of 15 items on a 7-point Likert scale that measure social support. The item response range from 1 to 7 score. (1) strongly disagree, (2) disagree, (3) somewhat disagree, (4) neutral, (5) somewhat agree, (6) agree, (7) strongly agree. Possible total scores can range from 15 to 105. Scores (15-60) indicates low social support and (61- 105) indicates high social support.9 The reliability of tools were predetermine i.e. 0.90 for Modified Barthel Index and 0.87 for Personal Resource Questionnaire (PRQ 2000) by using Kappa coefficients and Cronbach’s alpha respectively.Data was collected during the month of January, 2014 from 100 subjects were interviewed. It was collected by convenience sampling technique from Haibowal area of Ludhiana city by going house to house and public parks. An average 20 minutes was taken by each subject to answer the interview schedule. To obtain the free responses, the purpose of the study was explained and the subjects were assured about the confidentiality of their responses and also the maintenance of their anonymity. Analysis of data was done using statistical package for the social sciences (SPSS) software.
Results
Socio demographic profile of subjects
It shows that out of 100 elderly, 40 were in age group 60- 69 years, 41 subjects in 70-79 years and 19 elderly were in ≥ 80 years age group. More than half of the subjects (56) were males and rest 44 were females. Regarding educational status of elderly one third (33) of followed by 2 who were never married. Two third (68) of them belonged to Hindu religion and rest 32 were Sikhs. About type of family majority (87) of elderly were from joint family. More than half (54) elderly were living with their spouse and children, approximately one third(33) were living with their children, 11 were with spouse and 2 were living with their relatives. Regarding present employment status 95 were unemployed. In former occupation 41 were in home maker occupation, 26 were professionals, 24 had done business, 5 had done labour followed by 4 had done agriculture. About monthly income two third (60) had no income, followed by 18 had <Rs.5000/-, 11 had Rs5000/- to 10,000/- and also 11 subjects had >Rs10,000/-. Regarding source of income two third of them (60) were dependent on caregivers, 20 had their pension, 15 were dependent upon both caregiver and pension and five had their own business.
Figure 1 shows the self-care deficit among elderly as perceived by them. It revealed that more than half (55) elderly perceived slight self-care deficit, whereas 35 perceived moderate self-care deficit, 7 had no self-care deficit, 2 perceived total self-care deficit and only 1 perceived severe self-care deficit. them were illiterate, followed by 30 were studied up to secondary, 25 were graduate and 12 elderly were educated up to elementar y . Regarding marital status 65 elderly were married, 33 were widow/ widower/ divorced
Figure- 1 Distribution of elderly as per the level of perceived self-care deficit
Figure 2 shows the social support of elderly. It revealed that 63 elderly were experiencing high social support and rest of them (37) were experiencing low social support.
Table 1 shows the association of perceived self-care deficit and social support system among elderly. The analysis revealed a statistically significant, positive relationship ( r = 0.274) between the perceived self-care deficit and social support system among elderly (p<0.05)
Figure – 2 : Social support among elderly
Table 1: Association between perceived self-care deficit and social support
(n=100)
Variables | Mean ± SD | Mean % | R | p-value |
Perceived Self-care deficit | 89.2± 13.5 | 89.2 | +0.274 | 0.006* |
Social support | 65.8 ± 16.2 | 62.7 |
*- significant (p≤0.05)
Table 2 indicates that self-care deficit was inversely proportional to age and directly proportional to income. Elderly in age group ≥80 years had statistically higher perceived self-care deficit as compared to younger age groups and elderly with higher income has lesser perceived self-care deficit than their counterparts with low income.(p<0.05 as per ANOVA test).It is further obser ved that females, widow/widower/divorced, elders living with their children had significantly higher self- care deficit as compared to other counterparts. (p<0.05 as per ANOVA / t test). Further elders living in nuclear families, unemployed and totally dependent on their children for source of income had perceived higher self-care deficit as compared to their other counterparts, though this difference was statistically not significant.
Table 3 represents that the social support is directly related to educational status, income and inversely proportional to age i.e. illiterate elders, elders of ≥80 years and having no income had significantly lower social support score as compared to elderly of younger age and literate elders and elders having some personal income(p<0.05 as per ANOVA). Further the widow/widower/divorced elders, elders living with their children and having business as previous employment and current income source had low social support as compared to their counterparts other elders (p<0.05 as per ANOVA). It is further observed that male elders and elders living in joint families had higher social support as compared to female elders and elders living in nuclear families, though this difference was statistically not significant.
Table 2: Association of perceived self-care deficit with
socio-demographic characteristics (n=100)
Socio demographic characteristics | N | Perceived self-care deficit Mean±SD | F/t value | p value |
Age ( in yrs) | ||||
60-69 | 40 | 95.9±4.2 | 26.83 | 0.001* |
70-79 | 41 | 89.8±9.1 | ||
S 80 | 19 | 73.6±20.5 | ||
Gender | ||||
Male | 56 | 92.3±7.9 | 2.71 | 0.004* |
Female | 44 | 85.2±17.7 | ||
Marital status | ||||
Never married | 02 | 95.5±3.5 | 4.37 | 0.015* |
Married | 65 | 91.8±11.4 | ||
Widower/widow/divorced | 33 | 83.7±15.9 | ||
Type of family | ||||
Joint family | 87 | 89.3±12.1 | 0.027 | 0.87NS |
Nuclear family | 13 | 88.6±21.5 | ||
Living Status | ||||
With spouse | 11 | 86.9±23.1 | 3.55 | 0.02* |
With children | 33 | 83.7±15.9 | ||
With spouse and children | 54 | 92.7±7.2 | ||
With relatives | 02 | 95.5±3.5 | ||
Present employment status | ||||
Unemployed | 95 | 88.7±13.7 | 2.22 | 0.14NS |
Employed | 05 | 97.6±2.6 | ||
Monthly income (in rupees) | ||||
Nil | 60 | 87.2±15.2 | 2.656 | 0.05* |
<5000/- | 18 | 87.4±12.7 | ||
5001- 10,000/- | 11 | 95.1±5.4 | ||
>10,000/- | 11 | 97.2±2.0 | ||
Source of income | ||||
Pension | 20 | 93.7±7.3 | 1.88 | 0.14NS |
Business/ self employed | 05 | 97.6±2.6 | ||
Caregiver | 60 | 87.2±15.2 | ||
Both pension and care giver | 15 | 88.5±13.1 |
*- Significant(p<0.05) NS-Non significant(p>0.05) Minimum score: 0 Maximum score: 100 Higher the mean score, lower is the perceived self-care deficit and vice versa.
Table 3: Association of social support with
socio-demographic characteristics (n=100)
Socio demographic characteristics | N | Perceived self-care deficit Mean±SD | F/t value | p value |
Age ( in yrs)
60-69 70-79 S 80 |
40 41 19 |
73.9±12.5 61.8±16.1 57.4±16.4 |
10.6 |
<0.001 |
Gender
Male Female |
56 44 |
66.5±17.2 65.0±14.9 |
0.44 |
0.14NS |
Educational status Illiterate Elementary Secondary
Graduation or above |
33 12 30 25 |
59.4±14.5 61.8±15.9 67.8±18.6 73.9±11.4 |
4.68 |
0.004* |
Marital status Never married Married
Widower/widow/divorced |
02 65 33 |
62.5±3.5 69.2±16.2 59.4±14.8 |
4.28 |
0.017* |
Type of family
Joint family Nuclear family |
87 13 |
65.5±16.1 67.6±16.5 |
0.45 |
0.8NS |
Living Status With spouse With children
With spouse and children With relatives |
11 33 54 02 |
65.4±15.5 59.4±14.8 69.9±16.4 62.5±3.5 |
3.11 |
0.03* |
Former Occupation Business Professional Agriculture
Labour Home maker |
24 26 04 5 41 |
58.8±18.9 73.9±12.3 72.3±7.2 59.2±15.6 64.9±15.3 |
3.51 |
0.010* |
Monthly income (in rupees)
Nil <5000/- 5001- 10,000/- >10,000/- |
60 18 11 11 |
62.4±16.9 69.4±13.5 69.6±12.5 74.9±15.1 |
2.71 |
0.049* |
Source of income
Pension Business/ self employed Caregiver Both pension and care giver |
20 05 60 15 |
72.0±11.9 60.0±14.9 62.4±16.9 73.1±14.5 |
3.29 |
.024* |
*- Significant(p≤0.05) NS- Non significant(p>0.05) Total minimum score: 15 Total maximum score: 105
Higher the mean score, higher is the social support and vice versa.
Discussion
Old age is the last stage in the life journey and closing period in the life span of a man with decreased capacity for adaptation.1 A descriptive study was undertaken to assess perceived self care deficit and social support system among elderly residing in Ludhiana city, Punjab.
The present study findings revealed that more than half elder ls perceived slight self-care deficit, and one third perceived moderate self-care deficit. Similar study had conducted by Benner AD (2009) on elderly shows that 50% had mild self-care deficit, 40% had moderate self-care deficit and 10% had severe self care deficits.10 The present study indicates that two third elder had high social support. Similar findings had been reported by Piya thida et al. (2007)i.e. 68% elderly perceive high level of social more than 80 years old, illiterate, widow/widower/divorced, living with children, having no monthly income and had business as previous employment and business as current income source. Similarly one another study conducted by Piya thida et al. (2007) to assess the Social support among elderly in Khon Kean Province, Thailand. Results indicate that education level, working status, monthly income were statistically significantly related to perceived social support.11
Overall study brought out that majority of elderly subjects residing in Ludhiana city had perceived slight self-care deficit and more social support. Perceived self-care deficit and social support had significant positive relationship between them. Perceived self-care deficit was higher and social support was low among elders ≥ 80 support.11
The present study depict a statistically significant, positive relationship(r= 0.274) between the perceived self-care deficit and social support system among elderly (p<0.05).This finding was similar to the study of P. Hubbard. et al. (2008) who found a positive association between the social support and self-care activities.12
In present study revealed that elders having self-care deficit were more than 8 years of age, association of perceived higher self-care deficit was related with age(≥ 80 years), females, widow/widower/divorced, living with their children and had no monthly income. Study findings are almost similar to the study carried out by Isabel et al. which showed that older people who had lack of self-care mostly were from 80 years, widower and of female gender.13
The present study indicates that elders having low social support were females, years, females, widow/widower/divorced, living with their children and had no monthly income. Further studies on perceived self- care deficit and social support system among large sample size and different community settings are recommended. Nurses must be motivated to assess the self-care deficit and social support system among elderly in domestic and institutional settings to find out the actual and potential cases and help them in living comfortable life.
References
- Neeraja Textbook Of Growth and Development For Nursing Students. 1st Edition. New Delhi: Jaypee Brothers Medical Publishers, 2006.
- United nation World population Projection to 2150 population and development review, 2001;24:184-189.
- Lynda Self care and the nursing process. Nursing clinics of north America 1995;15(1):131-32.
- Lynd J. Self care. Nursing clinics of north America 1995;12(1):145-46.
- Arokiasamy P, Bloom D, Lee J, Feeney K, Ozolins program on the global demography of aging, http://www.hsph.harvard.edu/ pgda/working papers/2011 /pgda_wp_82.pdf reviewed on 4/7/2013.
- Sood S, Perceived Social Support and Psychological Well-Being of Aged Kashmiri Migrants. Research on Humanities and Social Sciences 2012;2(2):310
- Johnson EJ. Social support and physical health in the rural Applied Nursing Rerearch May 1996;9(2):61-66
- Shah S, Vanclay, Cooper B. Improving the sensitivity of the Barthel Journal of Clinical Epidemiology. 1987;42(2):703 – 709. Available from: http://www. health. wa .gov.au/CircularsNew/attachments/143.pdf reviewed on 19/4/2014.
- Weinert C. Personal resource questionnaire (PRQ2000). Available from: http://www .montana.edu/cweinert/prq2k.html. reviewed on 19/5/2014.
- Benner Self-care in elderly. J care in elderly 2009;40(5);555-58
- Kuhirunyaratn P, Sathira K, Ratan A, Edgar JL, Robert SC. Social support among elderly inkhonkean province, Thailand. Southeast asian j trop med public health Sep 2007;38(5):936-946.
- Hubbard P, Muhlenkamp AF, Brown Relationship between social support and self care practices. J Nurs Res Sept 1984;33(5):266-70. available from: h t t p : / / w w w . n c b i . nlm.nih.gov/pubmed/6566128 reviewed on 19/4/2012.
- Isabel A, Paul Living older in the family context: dependency in self-care, http://www.scielo.br/pdf/reeusp/v45n4/en_v4 5n4a11.pdf reviewed on 28/3/2013