Determine the psychosocial well-being of elderly residents living in old-age homes

Abstract

BACKGROUND:

Old-age homes provide crucial care for elderly individuals facing physical, mental, or social challenges. Ensuring their psychosocial well-being is vital for fulfilling life. This study addresses the gap in the literature by comprehensively assessing factors like anxiety, feeling of security, and desire for longevity aiming to inform interventions for better support systems in old-age homes.

MATERIAL AND METHODS:

Methodologically, a cross-sectional design was employed involving 100 elder populations in Pune City, Maharashtra. The time taken to conduct the study was 1 month. Data was collected using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) tools. Interviews were conducted personally, with assistance from caretakers, maintained confidentiality, and addressed social gerontological considerations.

RESULT:

The study findings revealed that the majority of male participants (78%) expressed a desire for a longer and healthier life, while a smaller percentage (22%) showed no interest in longevity. Among females, (85%) expressed a wish for an extended life with improved mental and physical health, while (15%) expressed no such desire. However, the correlation between anxiety and feelings of security did not reach statistical significance.

CONCLUSION:

In conclusion, these findings emphasize the significance of seeing individual preferences in conniving interventions aimed at promoting psychosocial well-being in such settings. Furthermore, the lack of statistically significant correlation between anxiety and feelings of security suggests the complexity of factors influencing the mental and emotional states of elderly individuals in institutional care.

Introduction

There is no denying that India’s demographics are changing to become more elderly. The old population is expected to double by 2050, which will have a significant impact on social networks, familial ties, and psychosocial behavior. Simultaneously, there is a discernible trend of older people living single lives, indicating changes in customary support networks.[1] Nevertheless, worries regarding the psychological health of the elderly continue to exist notwithstanding these developments. This group may have underdiagnosed mental health issues, which are made worse by social stigma, loneliness, and restricted access to mental health specialists.[2] “Psychosocial well-being” refers to the complex interaction between social and psychological elements that support mental and emotional well-being in individuals. Therefore, it is essential to comprehend and deal with these factors in order to create a supportive atmosphere that enhances the general well-being of India’s senior population.[3]

Mental health problems are common in India, particularly among older people who come from low-income backgrounds.[4] Studies reveal that people who are in a state of well-being are capable of realizing their own potential, being able to cope with day-to-day challenges, being productive, and making valuable contributions to their communities. Research has indicated that those who experience greater levels of well-being also typically have lower incidence of depression and suicide. This emphasizes the need of maintaining psychological well-being as a preventive strategy as people age.[5]

In light of these factors, it is imperative that older individuals’ well-being be improved in order to support their general health and reduce their risk of depression and suicide. But there are a few things that need to be considered.[6] The World Health Organization reports that the world’s population is aging at a rapid rate. According to predictions, the numeral of people 80 years of age or older between 2020 and 2050 reached an estimated 426 million.[7]

Social well-being faces a multitude of complex difficulties in modern society. These include problems like social isolation, where a lack of deep connections can prime to spirits of loneliness, and have a negative effect on mental strength. Prejudice and discrimination constitute yet another dimension since they have the potential to significantly impair one’s sense of justice and increase stress levels.[8] Poverty and economic inequality compound the complexity by preventing people from accessing opportunities and necessary resources due to financial limitations. These difficulties are exacerbated by family dysfunction, which hinders social well-being through toxic interactions or a lack of support within families.[9] Furthermore, inadequate assistance from loved ones, friends, or the larger community might hinder the development of healthy coping strategies and exacerbate pre-existing mental health conditions. Concern number two is cultural alienation, since being cut off from one’s cultural or social identity can lead to a sensation of being out of place and negatively impact general well-being.[10]

The psychological environment of assisted living facilities is significantly shaped by the dynamics of social interaction. These settings provide opportunities for social interaction, which may lessen residents’ feelings of loneliness. But the subtleties of these relationships—such as how often and how well they occur—have a big impact on psychological health.[11] Additionally, the development of a welcoming and encouraging community within these homes promotes a feeling of inclusion, which in turn supports psychosocial wellness. The maintenance of older people’ autonomy and dignity, which is essential to their well-being, is at the center of this paradigm.[12]

Giving people the ability to make decisions about their daily life can significantly improve their sense of agency and self-worth. Similarly, encouraging meaningful activities—whether leisure-based or goal-oriented—holds the potential to improve psychosocial well-being by giving life meaning and fulfillment.[13] This framework is further supported by the availability of emotional and medical support, which guarantees residents’ complete physical and mental requirements are met. In the end, senior living facilities play a crucial role in meeting the needs of those who are too old to receive family care by providing a secure haven with the possibility of achieving overall well-being.[14]

The care quality landscape in assisted living facilities is complex and variable, raising questions about possible neglect or inadequate attention. For some people, moving into these facilities could represent giving up their independence, which could have an effect on their sense of self-worth and perceived agency. But against this backdrop, personal preferences become a powerful factor; some people choose to live in assisted living facilities out of personal desire.[15]

Perceptions of these institutions are further influenced by cultural factors, with attitudes towards family care for the elderly versus institutional care being shaped by cultural norms and traditions. By keeping these balances in place, assisted living facilities can create an environment that supports the psychological welfare of their senior residents and helps them have happy and meaningful final years.[16] The present study is conducted to evaluate and investigate the mental illness and psychosocial well-being of elderly residents residing in old-age homes in Pune City.

The study explores psychosocial well-being of senior citizens in an effort to gain a comprehensive understanding. It does this by utilizing a wide range of assessment instruments, such as the Generalized Anxiety Disorder-7 (GAD-7) Scale and the Patient Health Questionnaire-9 (PHQ-9), in addition to qualitative techniques like observations and interviews. The results highlight the intricate interplay among these individuals, indicating a tendency to develop a range of comorbidities even in the face of significant recent progress in lowering the death rate among the aged.[17]

Not only do many elderly people participate actively in their families and communities, but they also volunteer and work in society. Many people may also require long-term care due to additional health concerns, such as dementia, reduced mobility, chronic pain, frailty, or other ailments. People are more prone to have multiple ailments at once as they get older.[18]

The goal of this study is to give vital information about the effectiveness of awareness programs in increasing social wellness among senior citizens in Pune, Maharashtra, boosting awareness, and encouraging preventative measures.

Materials and Method

Study design and setting

In April 2023, study was employed to examine the 100 elderly residents of Pune, Maharashtra using quantitative study approach who met the inclusion criteria for the study and who provided consent. The time taken to conduct the study was 1 month.

Study participant and sampling

The study utilized a non-probability purposive sampling method to choose 100 elderly individuals. Eligible participants of both genders who were present and consented to take part during the data collection phase met the inclusion criteria.

Data collection tool and technique

Non-probability purposive sampling was used to choose participants, who were elderly residents of both genders living in assisted living facilities and who satisfied the inclusion requirements.

Participants gave their informed agreement after being reassured that their wishes and emotions would not be violated and were informed that the evaluation results would only be utilized for research.

The goal of the study and the associated assessments were explained by the researcher. To reduce distractions, the GAD-7 and PHQ-9 tests were given one-to-one in a quiet, comfortable environment.

The nine items on the PHQ-9 scale, which measures depressive symptoms, and the seven questions on the GAD-7 scale, which measures anxiety symptoms, were answered by the contestants.

The gathered information underwent statistical breakdown to reveal information on the frequency and intensity of anxiety and depression symptoms in the senior people.

Ethical consideration

The research was authorized by the institutional review committee (No. 2023-021).

Statistical analysis

The subjects are being analyzed for the period of one month, and the status of mental illness and psychosocial well-being were addressed in conjunction with the demographic variables.

Result

Section I: Assessment of demographic variables

Section II: Assessment of the desires of longevity

Section III: Assessment of the feeling for security with the present living situation

Section IV: Mean, standard deviation, and correlation between total depression/desire for longevity and anxiety/feeling of security of studied subjects

Table 1 exhibits percentage scattering of demographic traits with esteem to different factors. With an emphasis on age and gender, a representative sample of one hundred senior citizens was selected from Pune City’s metropolitan area. One hundred senior citizens from four old-age homes located throughout Pune City, arranged by zonal districts, were included in the study. Of the participants, forty percent were women and sixty percent were men. It’s noteworthy that 53% of participants were between the ages of 60 and 70, 39% were between the ages of 71 and 80, and 8% were older than 80.

Table 1.

Assessment of demographic variables

Old-Age Home elderly
Age in groups (in years)		Male		Female		Total
60-70 years		34 (64.15%)		19 (35.84%)		53 (53%)
71-80 years		23 (58.97%)		16 (41.02%)		39 (39%)
≥81 years		03 (37.5%)		05 (62.5%)		08 (08%)

Figure 1 illustrates the percentage of citizens who suffer from depression, suggesting that a significant number of older people have depressive symptoms. In particular, out of the participants, 40% of the girls and 25% of the males did not exhibit any depressive symptoms. Subsequently, 28% of females and 40% of males showed minor symptoms. Slightly less than 17% of females, or 22% of males, had moderate symptoms of depression. Furthermore, compared to girls (15%), a lower proportion of males (13%) showed severe depressive symptoms.

Figure 1.

Association between gender of participants and PHQ-9 scale (Depression)

Figure 2 shows the levels of anxiety among the participants. Out of the 100 older participants, 28% showed no signs of anxiety and were able to live a very normal life. Approximately one-third of the residents, accounting for 34%, had minor symptoms of anxiousness. In addition, 22% of the aged population displayed moderate symptoms of anxiety, and 16% exhibited severe signs of anxiety.

Figure 2.

Association between total participants and GAD-7 scale (Anxiety)

Table 2 depicts the recent study reveals that 78% of male participants express a strong desire to live longer and retain good health, whereas 22% show little tendency towards a longer lifetime. Likewise, 85% of females express a wish for a longer life with enhanced mental and physical health, while 15% show no inclination towards longevity. The decreased inclination towards a longer lifespan in certain individuals can be ascribed to diverse psychosocial factors, such as strained relationships with offspring and relatives, increased reliance on others both in terms of physical and financial support, and emotional distress caused by loved ones through abandonment.

Table 2.

Assessment of desire for longevity

Gender		Components				Total n (%)
		Yes		No
Male		47 (78%)		13 (22%)		60 (100%)
Female		34 (85%)		6 (15%)		40 (100%)

Table 3 depicts an overwhelming majority of males surveyed, accounting for 88%, express satisfaction with their current living conditions in old-age homes, whereas a small minority of 12% do not find their present situation agreeable. Similarly, 78% of females in old-age homes claim happiness with their current living arrangements, while 22% express discontent. This story implies that older folks existing in old-age homes feel a great feeling of freedom and choose to occupy their later years in their current living environment.

Table 3.

Elderly assessment for feeling of security with the present living situation

Gender		Components				Total n (%)
		Yes		No
Male		53 (88%)		7 (12%)		60 (100%)
Female		31 (78%)		9 (22%)		40 (100%)

Table 4 describes there was a solid negative association (-0.57) among depression and the desire for longevity. A P value below 0.05 signifies a significant negative association between the variables, implying that an increase in anxiety is associated with a drop in the feeling of security. However, the association is considered weak because the significance level is more than 0.05. Therefore, the alternate hypothesis is rejected in favor of accepting the null hypothesis. All P values are lesser than the significance level of 0.05%, signifying that the alternate hypothesis was accepted and the null hypothesis was rejected.

Table 4.

Mean, standard deviation, and correlation between depression/desire for longevity and anxiety/feeling of security

Variables		Depression		Desire for longevity		Anxiety		Feeling of security
Mean		7.92		0.87		5.02		0.83
SD		9.01		0.47		4.31		0.37
Correlation		-0.57				-0.53
P (>0.05)		0.037				0.085

Discussion

The results of the study provide important new information about the mental health of senior citizens residing in senior care facilities in Pune, Maharashtra. It is increasingly important to recognize and address the psychological and social needs of older persons as the population ages. Our study’s goal was to close this information gap in the body of literature by thoroughly assessing traits such as anxiety, security perception, and longevity goals among the elderly.

A study by Kumar P and Patra S was carried out in 2019 in Delhi’s metropolitan areas, with an emphasis on elderly homes as the study environment. Their primary objective was to assess older adults’ psychosocial well-being in-depth and to pinpoint the critical factors influencing their mental health. In this study, a sample of 150 elderly people from various elderly care centers in the city was used and a convenience sampling technique was used. Findings show a relationship between depression, loneliness, and support in older people. Specifically, those who reported higher levels of social support had better health and psychological well-being. These results suggest that social support plays an important role in reducing sadness and loneliness among elderly living in nursing homes in Delhi.[19]

The results of the study provide important new information about the long-term mood of male and female participants. While the majority of male participants showed a genuine preference for longevity and health, a small percentage of men showed no preference for longevity. Similarly, most female participants expressed a desire to live longer and have better physical and mental health. These results highlight the importance of considering each individual’s preferences and needs when developing treatments to improve mental health in senior living facilities.

In a 2022 study, Miao L et al.[20] explore the potential of using demographic and psychosocial characteristics to predict family life and individual well-being. In a cross-sectional study, there were 237 regular elderly family members and 186 long-term family members present. For comparison research, 62 long-term elderly people and 57 regular old people were chosen as a sample. The effects indicated a threefold higher proportion of females than males in the long-lived senior category. A considerable disparity was observed in the education levels among long-lived senior individuals, with up to 71.2% having no educational background, compared to ordinary elderly individuals. Long-lived senior individuals exhibited less neuroticism and social support, but higher levels of extraversion, in comparison with typical elderly individuals, in relation to psychosocial factors. These findings suggest that effective emotional regulation, positive social support, and balanced lifestyle decisions are important factors in shaping a person’s lifespan. Additionally, the impact of personality on longevity appears to extend across generations within families.

The study investigated the relationship among anxiety and emotions of security among senior inhabitants. Although a strong association was observed between depression and the aspiration for longevity, the correlation between anxiety and emotions of security did not achieve statistical significance. This indicates the intricate nature of the several aspects that impact the mental and emotional well-being of older adults living in institutional care.

In a 2021 study, Kumar S et al.[21] directed a cross-sectional study with 142 elderly individuals overhead the age of 60 living in old-age facilities in the Mangalore City area. The findings indicate that the general frequency of depression was 47.8% as determined by the Geriatric Depression Scale. Depression has been observed to be associated with a decrease in peer social interaction. Social interaction with other residents was found to have a protective impact, lowering the risk of depression in people who were able to function normally.

Assessing the mental health and well-being of the elderly in nursing homes in India faces many challenges, including barriers to access, participation and engagement language, response bias, participant attrition, usage limitations, access to large populations, and Need for access, engagement, and engagement. for collaborative collaboration. Solving these complex problems requires careful planning, discipline and a strict adherence to ethics. By placing mental health care first in nursing education, research, management, and practice, we can improve the overall health of seniors in assisted living facilities.[22]

Overall, this research helps us understand the health of seniors in assisted living facilities and highlights the need to meet their specific needs. By prioritizing mental health services in nursing education, research, administration, and practice, we can work to create a supportive environment that will improve the overall health of seniors in shelters.

Implications

Numerous implications arise for nursing education, research, administration, and practice from the findings. Understanding the mental health of senior citizens is crucial for nursing curricula. Future nurses can improve their capacity to provide older persons with holistic care by incorporating specialized courses on geriatric care. This will enable them to effectively handle the psychological needs of older adults in addition to their physical health concerns.[23]

Some inferences on the geriatric population can be drawn from this study, and these will be discussed under the following areas,

Nursing Education: Nursing education must take into account the psychological health of elderly residents in senior living homes in India. Modules that expressly address geriatric care should be incorporated into nursing curricula, with a focus on the assessment and management of psychosocial factors that affect older persons. Future nurses will be better equipped to provide complete care to older adults by addressing their psychological and social needs in addition to their physical health difficulties if nursing schools adopt this understanding into their curricula.[24]

Nursing Research: Examining the health of the elderly in nursing homes in India has the potential for advanced nursing education. Psychological factors specific to certain populations, such as the impact of social support, feelings of loneliness, and cultural biases, can be clearly explored in further research. Studies can also investigate treatments designed to improve mental health in residential settings, providing evidence-based ways to improve standards of care for older people.[25]

Nursing Administration: Nurse management is essential to provide quality care in nursing homes. Leaders should recognize the importance of developing policies and guidelines that address the needs of older people. This will mean implementing educational programs to ensure staff understand mental health care and creating a harmonious and welcoming environment in the facility. Additionally, care managers must use the right resources to support activities that improve the mental health of older people.[26]

Nursing Practice: Nursing practice is informed in providing patient-centered care by the assessment of psychosocial well-being among senior citizens living in assisted living facilities. Nurses should use a comprehensive strategy that takes into account each resident’s particular psychosocial needs and cultivates therapeutic connections based on empathy and trust. Interventions to address mental health problems may include collaborating with other health professionals, organizing community events, and emotional support. By integrating mental health services into their work, caregivers can improve the overall health and quality of life of seniors in nursing homes in India.[27]

Conclusions

Findings show that adults can assess their own mental health. Most participants demonstrated a basic understanding of the disease, including its causes and potential impact on overall health and quality of life. This shows the positive impact of geriatric education programs and their contribution to raising public awareness about this important health problem. The findings also highlight the need for greater dissemination and education to better understand geriatric diseases and their complications, as well as ways to prevent the onset of geriatric diseases. By providing education and support to adults and their guardians, healthcare professionals can help children under five take important steps to prevent or manage health problems.

An assessment of the mental health of the elderly in nursing homes in India reveals complex problems and vulnerabilities unique to this population. Research conducted in many cities shows that social, psychological, and environmental factors affect the mental and emotional health of the elderly. Some research has shown that elements like social support, engagement in religious activities, physical activity, and dietary habits are positively correlated with psychosocial well-being; other research has highlighted the prevalence of depression and loneliness and the necessity of interventions like reminiscence therapy.[28]

Going forward, it will be critical to acknowledge the significance of holistic care techniques in assisted living facilities, which give residents’ physical and psychological needs top priority. In this sense, improved nursing practice, research, teaching, and administration are essential because they make it easier to create evidence-based interventions and policies that are specifically designed to support psychosocial well-being. The improvement of social support networks, the promotion of meaningful activities, the creation of inclusive environments, and the provision of mental health services are important suggestions for improving the standard of living of senior citizens residing in retirement homes throughout India.[29]

However, more investigation is necessary to identify other variables influencing psychological well-being and to create tailored interventions meeting the various requirements of senior citizens. In India’s old-age homes, cooperation between families, community organizations, lawmakers, and healthcare experts is crucial to establishing supportive environments that allow senior citizens to age with resilience, dignity, and purpose.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.