CHAPTER – 1
“It’s not how old you are, it’s how you are old
Live your life and forget your age”
Older adults recognize that they have less time in which to continue achieving their goals, so they face their challenges with resilience and determination. Gerontologists are increasingly recognizing that older adults who are aging successfully possess wisdom, which includes factual knowledge, problem- solving strategies, and the ability to manage uncertainty. Because many of the challenges of older adulthood involve health and functioning, older adults need accurate information, not only about aging, but also about interventions to promote wellness. Nurses are ideally positioned to teach older adults about health and aging and empower them to implement problem-solving strategies directed towards wellness, improved functioning, and quality of life (Blazer, Brugman, 2006).
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With increases in life expectancy, delayed onset of morbidity, and higher expectations for old age, interest in well-being in later life and how to achieve it has intensified. ‘Successful ageing’ has come to the fore as a goal for the ageing population. While an agreed definition of successful ageing remains elusive, there is broad agreement that core constituents include physical health and functioning, psychological wellbeing, and social functioning and participation. As the older population surges both in absolute and relative numbers, well-being in old age has also become a focus for policy-makers as a key indicator of the physical and psychological health, social integration and economic security of the older community (Bowling A, Dieppe P Dec 24).
Despite the adverse changes that occur with increasing age, older people typically report high levels of well-being. Most feel younger than their actual age and maintain a sense of confidence and purpose. In the HeSSOP (Health and Social Services for Older People) surveys of older people in Ireland, conducted in 2000 and 2004, over three-quarters of community-dwelling older people scored high on morale (Garavan R, Winder R, McGee H. ; 2001, O’Hanlon A, McGee M, Barker M 2005). In fact, older people are more likely to report satisfaction with their lives than younger people (Strine TW, Chapman DP 2008). Old age, it appears, brings with it an ability to adapt to age- related changes and stresses. One study found, for example, that physical decline did not have an impact on older people’s satisfaction with life, suggesting that they regard it as a normal and relatively acceptable part of ageing (Steverink N, Westerhof GJ .2001). Moreover, older people recognize benefits in old age, such as increased wisdom and maturity, with opportunities for growth and lessening of demands upon them. Research has come to emphasize that ageing is highly specific to each individual, which implies that the pathway of old age is not predetermined. While growing older unavoidably entails losses, some individuals cope better with these losses than others. With this in mind, it aims to shed some light on the personal, material and social circumstances that influence how well people cope.
“Successful ageing” refers to those cases where ageing people are free of (acute and chronic) diseases, do not suï¬€er from disability, are intellectually capable, possess high physical ï¬tness and actively use these capacities to become engaged with others and with the society they live in. Concepts which have been used in gerntological research and which emphasize diï¬€erent aspects of the ageing process are healthy ageing (Ryï¬€, 2009)
Gerontology has seen many diï¬€erent conceptions of active ageing. A classic deï¬nition of active ageing was presented by Rowe and Kahn (1997) who used the term successful ageing: “We deï¬ne successful ageing as including three main components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life” (Rowe & Kahn, 1997, p. 433; Rowe & Kahn, 1987).
“Successful ageing” refers to those who are free of (acute and chronic) diseases and do not suffer from any disability, aged who are intellectually capable and those who possess high physical fitness and actively use these capacities and engage with others and the society they live in. Concepts which have been used in gerontological research and which emphasize different aspects of the ageing process are healthy ageing (Ryff, 2009), productive ageing (Morrow-Howell, Hinterlong, & Sherraden, 2001), ageing well (Carmel, Morse, & Torres-Gil, 2007).
There is a strong normative element in the definition of successful ageing. Successful, healthy and productive ageing are evaluated as the more desirable as “normal” or even “pathological” ageing processes. Most people want to grow old without being affected by chronic illnesses and functional disabilities. Despite the efforts are to increase the proportion of healthy life expectancy, a substantial part of the old, and the very old population will have to face dependency and frailty. Hence, attention have to be paid to the fact that normative definitions of “active ageing” should not lead to the degradation and a discrimination against individuals and groups who do not reach the positive goal of “active ageing”. (Fernández-Ballesteros, 2008).
The WHO deï¬nition of active ageing was more inclusive in respect to diï¬€erent ageing trajectories and the diverse groups of older people: “Active ageing is the process of optimizing opportunities for health and participation and security in order to enhance quality of life of aged people” (WHO, 2002)
The Regional Implementation Strategy for the Madrid International Plan of Action on Ageing, the UNECE members express their commitment to enhance the social, economic, political and cultural participation of the older people and also to promote the integration of older people by encouraging their active involvement in the community and by fostering intergenerational relations (UNECE, 2002).
Old age often bring decreasing functional capacity and health problems which may affect the individual’s sense of wellbeing.The goal of health for the elderly in the society may not be free from diseases but the possibility of having a good life despite of illness are in decreasing capacities (Lawton, 1991; Nordenfelt, 1991b; Sarvimaki and Stenbock-Hult, 2000).
The Quality of life of the people in a developed country with chronic health condition will have a lower impact rather than the patients with the same disease in a low income country where the resources to ameliorate the disability may be scarce.
The subjective and the contextual nature of Quality of life inform the World Health Organization’s definition as: “an individual’s perception of his/her position in life in the context of the culture and value systems in which he/she lives, and in relation to his/her goals, expectations, standards and concerns” (The WHO QUALITY OF LIFE Group, 1995).
Thus Quality of life reflects a extended view of subjective wellbeing and life’s satisfaction that encompasses physical and mental health, material wellbeing, interpersonal relationship within and without the family, personal development, work and activities within the communities, and fulfillment and active recreation (Niemi et al., 1988).
There is an important consideration in studying the factors associated with the Quality of life of the elder persons is the multi-dimensional nature of the construct and the possibility that determines from one dimension may be different from those of the other dimension. (Patel et al., 2007).
NEED OF THE STUDY
Little is known about factors that determine the Quality of Life of the elderly persons living in the developing societies and who are undergoing rapid social changes. Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasized, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The studies that are conducted among the groups of elderly persons have shown that Quality of life and the subjective evaluation of the life satisfaction are determined by several factors (Jakobson et al., 2007). Other than the demographic features such as age and financially status, the health, including social support functional disability and networks are often found to be important in the elderly person’s assessment of their Quality of life. (Bowling, 1994;Low and Molzahn, 2007;Richard et al., 2005).
Other than functional impairments and the health problems to which most of the elderly persons are vulnerable (Clark and Siebens, 1993), old age may also predispose to some social and economic problems. The ccess to health care is severely limited both by manpower and paucity of health facilities and by out-of-pocket payment arrangement. Traditional family support is decreasing and social network is dwindling as migration and urbanization take the young members of the family away. Social changes are also affecting the position of the elderly in the society and leading to a reduction in their social status and influence in the community (Gureje and Oyewole, 2006). All of these factors affect the Quality of life of elderly. (Hickey et al., 2005)
Quality of life is the central concepts in the ageing research. Two different traditions can be distinguished in this respect: Concepts which define quality of life in terms of objective living conditions, and concepts which define quality of life in terms of subjective evaluation (Noll, 2010). Similar distinctions have been made in the context of social gerontology.
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Objective quality of life can be measured by the extent to which the elderly has access and command over the relevant resources like income, health, social networks, and competencies that serve the individuals to pursue their goals and direct their living conditions. Hence, objective quality of life is high in those cases where the health is good, income is high, social networks are reliable and large and the competencies as achieved by the educational status are high. Objective quality of life can be measured by the external observers (Erikson, 1974).
Subjective quality of life, in contrast, emphasizes an individual’s perceptions and evaluations. Individuals compare their (objective) living situation according to different internal standards and values. That means the elderly people with different aspiration levels may evaluate the same objective situation differently. Subjective quality of life depends upon the individual person – and lies in the “eye of the beholder” (Campbell, Converse & Rodgers, 1976). Hence, high subjective quality of life can be defined as subjective well-being (high life satisfaction on, strong positive emotions like happiness, and low negative emotions like sadness).
Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasized, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The study was of 141 randomly selected people aged from 67 to 99 years that formed a control sample for a study of suicide among older people. They were interviewed in person about their health, socio-demographic background and, using an open-ended question, what they considered to constitute quality of life. Their answers were grouped into eight categories. In addition, they were asked to choose from a ‘show card’ three items that they regarded as important to quality of life. Functional ability was the most frequently selected domain, followed by physical health, social relations and being able to continue to live in one’s present home. It was found that social relations, functional ability and activities influence the quality of life of elderly people as much as health status. ( Katarina Wilhelmson ,Christina Andersson, et al., 2004)
Since 1970s cardiovascular disease is the leading cause of deaths worldwide, cardiovascular mortality rates have been declined in many high-income countries Age is an important risk factor in developing cardiovascular diseases, though it usually affects the older adults. It is estimated that 87 percent of people who die of coronary heart disease are 60 and older. “It’s important that this vulnerable group of people doesn’t get overlooked so that they are properly assessed and they receive the best treatments to improve their quality of life.” Newcastle University,British Heart Foundation, (Professor Bernard Keavney, July 25, 2012)
A study wasrecently carried out376heart scans calledechocardiogramson 87- 89 year olds in their homes. The results revealed that around a quarter hadundiagnosed heart problemsand are missing out on treatments, which could improve their symptoms and theirquality of life. (Newcastle University,British Heart Foundation, Professor Bernard Keavney, July 25, 2012)
The purpose of the present study is to identify the effectiveness of structured teaching program on awareness of quality of life among elderly patients with cardiac disorders, at GKNM Hospital, Coimbatore. The researcher strongly believes that, the result of the proposed study can be used to enhance nursing initiatives, and to establish a teaching strategy for elderly patients attending cardiac and cardio thoracic opd’s at GKNM Hospital and thereby improve their quality of life.
STATEMENT OF THE PROBLEM
A Study to Assess the Effectiveness of Structured Teaching Program on the Awareness of Quality Of Life among Elderly Cardiac Patients at G.K.N.M Hospital, Coimbatore.
- To assess the quality of life of elderly cardiac patients
- To assess the effectiveness of structured teaching program
- To find the association between the pre- test level of scores and selected demographic variables
Effectiveness: It refers to the outcome of the planned teaching program in terms of awareness gained
Structured Teaching Program: It refers to the systematic information provided to the elderly cardiac patients regarding quality of life.
Awareness: It is the state or ability to perceive, to feel, and sense data confirmed by an observer.
Quality of life: It is the personal satisfaction with the cultural or intellectual conditions under which a person lives.
Elderly cardiac patients: Patients above 60 years of age and having cardiac disorders.
H0: There will be no significant difference between the pre-test and the post-test awareness scores of elderly cardiac patients regarding quality of life.
H1: There will be significant association between the demographic variables and the pre-test awareness scores of elderly cardiac patients regarding quality of life.
- The elderly patients will not have adequate awareness regarding Quality Of Life.
- The structured teaching program will enhance the quality of life of elderly cardiac patients.
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