Indian Journal of Public Health

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 63  |  Issue : 3  |  Page : 227--232

A study on self-perceived uselessness and its determinants among residents of old age homes in North Bengaluru


Gayatri Rangra1, S Archana2, Mohammed Imran3,  
1 Final MBBS Student, Dr. B.R. Ambedkar Medical College, Bengaluru, Karnataka, India
2 Assistant Professor, Department of Community Medicine, Dr. B.R. Ambedkar Medical College, Bengaluru, Karnataka, India
3 Associate Professor, Department of Community Medicine, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, India

Correspondence Address:
S Archana
Department of Community Medicine, Dr. B.R. Ambedkar Medical College, Kadugondanahalli, Shampura Main Road, Bengaluru - 560 045, Karnataka
India

Abstract

Background: The study on self-perceived uselessness may help health-care workers to provide opportunities for intervention for increased quality of health and greater survival rate in elderly. Objectives: To find the prevalence of self-perceived uselessness and its determinants among the elderly residents of old age homes of North Bengaluru. Methods: A cross-sectional descriptive study was undertaken on 129 elderly aged 60 years and above in the old age homes of North Bengaluru. Self-perceived uselessness, sociodemographic variables, morbidity status, functional status, financial status, and personal habits were assessed using a semi-structured questionnaire. Proportions, percentages, and Chi-square test were used for analysis. Results: Nearly half (45%) of the elderly had agreed that they had perceived themselves as useless as they age. Majority of those who perceived uselessness had one or >1 chronic morbidities and were functionally dependent (81.2%). Significant association was seen between self-perceived uselessness and functional dependency, gender, education, and having some form of activities during their leisure time. Conclusions: It can be concluded that self-perceived uselessness is quite prevalent in nearly one-half of the elderly in the old age homes in North Bengaluru having significant association with variables such as gender, education, leisure activities, and functional status.



How to cite this article:
Rangra G, Archana S, Imran M. A study on self-perceived uselessness and its determinants among residents of old age homes in North Bengaluru.Indian J Public Health 2019;63:227-232


How to cite this URL:
Rangra G, Archana S, Imran M. A study on self-perceived uselessness and its determinants among residents of old age homes in North Bengaluru. Indian J Public Health [serial online] 2019 [cited 2020 Aug 6 ];63:227-232
Available from: http://www.ijph.in/text.asp?2019/63/3/227/267220


Full Text



 Introduction



Perception of uselessness is a major component of self-perceived aging and is commonly experienced by elderly people.[1],[2],[3] This perception is one of five items of the 'Attitude toward own aging' subscale of the 'Philadelphia Geriatric Center Morale Scale'.[4]

A sizable body of research indicates that a reduced sense of self-worth due to self-perceived uselessness is associated with greater chances of increased mortality hazard in older adults.[2],[5] Quantitative field study on this matter is almost nonexistent in India; this is primarily due to lack of data on self-perceived uselessness. It has been argued that different cultures likely have different social views about aging because of difference in sociodemographics; there could be alterations in patterns of self-perceived uselessness.[1]

In view of the above, the present study was conducted with objective of assessing the prevalence of self-perceived uselessness and its determinants among the study population. This may help health-care workers to provide opportunities for intervention for increased quality of health and greater survival rate in elderly.

 Materials and Methods



This community-based, cross-sectional, and descriptive study was conducted for 2 months (June 2017 to July 2017) among the elderly individuals living in old age homes in North Bengaluru. People aged 60 years and above who are residing in the old age homes for a minimum period of 3 months were included for the study, and those who had impaired cognition and were unable to provide information were excluded from the study. There were 32 old age homes in North Bengaluru, and the complete list of old age homes in the study area was prepared. The old age home was selected using simple random sampling technique by lottery method, and all the residents fulfilling the inclusion and exclusion criteria in the selected old age home were interviewed. This process was repeated till the sample size was met. The old age homes in the sampling frame had certain criteria for uniformity like the criteria for admission for people aged >55 years and physically fit, and the elderly were charged for monthly fee for upkeep and maintenance of the place as well as for the food provided. Totally, 129 elderly participants were studied from 10 old age homes of North Bengaluru. The nature, purpose, and objective of the study were explained to the participants. During the survey, written informed consent in the local language was obtained from the participant before the interview.

A pretested semi-structured questionnaire was used to collect information on sociodemographic factors such as age, gender, education, religion, previous and present occupation, marital status, living status, monthly dispensable income of the participant, social needs, financial status, health insurance, and pension. To collect information pertaining to self-perceived uselessness, the following two questions were asked, “with age, do you feel more useless?” and “do you currently feel useless?” which were rated on a Likert scale (strongly agree, agree, disagree, strongly disagree). The cognition assessment of the elderly was done using Hindi Mini Mental State Examination (HMSE). In HMSE, illiterate elderly scoring 19 and above and literate elderly scoring 24 and above were considered to have normal cognition and were included for the study. HMSE consists of 22 items, which test different components of intellectual capability. The information pertaining to morbidity was collected as reported by the elderly individual and from medical records (if available). The functional status of the elderly was assessed using “Katz index of independence in activities of daily living (ADL).”[6] Ethical clearance was obtained before conducting the study from the Institutional Ethical Committee.

Estimation of sample size

It was observed from earlier study by Zhao et al.[1] that the weighted distribution of self-perceived uselessness for low frequency was 43.8%. In the present study, expecting similar results with 95% confidence level and 20% allowable error (relative precision), the sample size required was 125.

Statistical analysis

Variables such as sociodemographic factors, morbidity status, functional status, and financial status were summarized using frequencies and percentages. Chi-square test was used to test the significance of association between perceived uselessness and variables such as sociodemographic factors, morbidity status, functional status, and financial status. The information thus collected was entered into a spreadsheet using Microsoft Excel® Software and analyzed with the help of Statistical Package for the Social Sciences (SPSS Inc., Released 2009. PASW (Predictive Analysis Software) Statistics for Windows, Version 18.0. Chicago, US: SPSS Inc.). P < 0.05 was considered for statistical significance.

 Results



Section A: Sociodemographic characteristics of the study participants

The study was conducted on 129 elderly residents aged 60 and above in the old age homes in North Bengaluru. There were 24 males and 105 females. The mean standard deviation (SD) age of the study population is 73.38 (±8.91) years. The mean age (SD) of the male and female population were 75.58 (±10.43) years and 72.88 (±8.49) years, respectively. Among the study participants, most of the elderly (37.2%) were old-old (70–79 years).

Only two elderly were currently gainfully employed, and majority (94.5%) of the study population was living in old age homes where they have to pay monthly.

Almost two-third (74.4%) of the elderly individuals had less than Rs. 1000/month to spend. 63.5% people had one or more than one living children. Approximately one-half (49.6%) of the elders were financially dependent on others. Most of the elderly's health (62.8%) and living expenses (62%) were looked after by family/friends/others. Only 7% individuals had health insurance. However, 48.8% people were getting pension. Nearly one-third (36.4%) had no living children. Majority of the elderly (88.3%) had someone to whom they can confide. Majority (83.7%) had some form of leisure activity (going to temple/mosque/church, daily chores, talking with friends, and participation in social groups/activities organized by old age home). Around one-half (51.2%) of the elderly had some form of physical activity (walking, physical exercise, and yoga) [Table 1].{Table 1}

Most participants (90.7%) did not suffer from any acute illness at the time of interview. However, almost 81% were suffering from some type of chronic morbidity and was having one or more chronic morbidities. On assessing their functional status, 87.6% participants were independent and did not need external help to perform their ADL [Table 2].{Table 2}

Table 2 shows majority of the elderly had never used tobacco or alcohol. None of the elderly were currently smoking or using alcohol. Among seven elderly who used tobacco, four were current user and three were ex-users.

Most prevalent chronic morbidities were hypertension among 83 (64.3%), diabetes mellitus among 45 (34.9%), and arthritis among 20 (15.5%) elderly which were there for more than 1 year. All the elderly were taking treatment for hypertension and diabetes. Majority (65%) of the participants were seeking treatment for arthritis. There were 12 (9.3%) elderly who had history of falls, and among them, two-third (71.4%) had not sought for any treatment. Furthermore, among nine elderly who had some eye problem, three did not seek any treatment. The other morbidities (9.3%) seen were epilepsy, hemiplegia, coronary artery disease, bronchial asthma, spondylosis, and benign prostatic hyperplasia.

Section B: Perception of uselessness by the study participants

Nearly half (45%) of the elderly had agreed that they had perceived themselves as useless as they aged. Among them, majority (89.6%) were females who perceived so. Around one-third of the elderly (36.4%) had perceived that they felt useless at the time of the interview [Table 3].{Table 3}

Section C: Association between perceived uselessness and sociodemographic and other variables

When comparisons were made across various age groups for the self-perception of uselessness, old-old (70–79 years) perceived more useless as they age than young-old and oldest-old. However, this difference was not significant. Among those who had perceived that they were useless, majority (89.7%) were females, and this difference was found to be statistically significant. Similarly, among those who had perceived uselessness, majority (60.3%) of them had education till school level when compared to graduate/diploma holders/illiterates, and this difference in education was statistically significant. When comparison was made between those who had not perceived uselessness and number of living children, majority (59.2%) of them had one or more children. Most of the elders (57.9%) who had someone to confide in had not experienced self-perceived uselessness. Similarly, among the elderly who did not perceive uselessness, majority (90.1%) of them had some form of activities during their leisure time which was statistically significant [Table 1].

Among those who perceived that they were useless, nearly two-third (72.4%) were financially dependent on others and 94.8% did not have health insurance. However, these differences were not significant [Table 4].{Table 4}

Among the elderly who did not suffer from any chronic morbidity, majority (57.9%) had not perceived uselessness. When comparison was made among those who had perceived uselessness across the number of chronic morbidities that they are suffering, the proportion of elderly perceiving uselessness increased as the number of morbidities increases. However, this difference was not statistically significant. There was a statistically significant difference in perception of uselessness by the elderly who were able to perform their ADL (functional status) independently [Table 2].

 Discussion



Table 3 shows more number of women (81.4%) and widowed people (55%) resided in these old age homes. Literacy rate in our study population was quite high (88.4%) when compared to India literacy rate of 66% in adults above 60 years in urban locality.[7]

Only 9.3% was suffering from acute illness at the time of interview. Therefore the study finding regarding perception of uselessness would not have been biased because of temporary acute illness, since majority were free of any acute illness. 81.4% of the elderly were suffering from one or the other chronic morbidities. In which, hypertension (64.3%) was the most prevalent morbidity followed by diabetes (34.9%) and arthritis (15.5%). Our findings are in agreement with various studies in India where health problems, especially cardiovascular illnesses and diabetes are widely prevalent medical conditions in the elderly.[8],[9],[10]

Nearly half (45%) of our study population perceived themselves useless as they age. Among them, majority (86.3%) were females who perceived so. Similar findings of prevalence of uselessness was found by Zhao et al. in a study in China where they found distribution of self-perceived uselessness was 19.2% for high frequency (always), 34% for moderate frequency (sometimes), and 43.8% for low frequency (seldom/never). The weighted percentage for high frequency was 22% for women and 16% for men.[1] Since the prevalence of self-perceived uselessness among elderly is more, there is a need to provide the opportunities for intervention to increase their quality of health and life.

Comparing different sociodemographic factors such as age, gender, and education had significant association with self-perceived uselessness [Table 1]. It was seen that compared to younger ages (60–69 years), older age groups (70–79 years and >80 years) experienced more self-perceived uselessness. This is in agreement with Zhao et al.'s study in which compared to younger ages 65–79, octogenarians (ages 80–89), nonagenarians (ages 90–99), and centenarians (ages 100+) experienced increased risk of high frequency of self-perceived uselessness relative to low frequency by 69%, 76%, and 76%, respectively.[1] This finding is justifiable because as they age, health tends to decline and activities tend to decrease, leading to diminished opportunities to get involved in other activities. Furthermore, it can be due to deteriorating bodily functions or increase in dependency as they age.[11],[12] In our study, greater prevalence of self-perceived uselessness was in elderly who had education till school level only. This finding was in contrast to the findings of Zhao et al. where they found that compared to those with no schooling, higher levels of education were associated with lower risk ratio for high and moderate frequency of self-perceived uselessness relative to low frequency.[1]

Married people felt less useless when compared to unmarried or widowed people in our study. Similar findings were seen by Zhao et al.[1] Married people have greater emotional support from their spouse. Similarly, greater number of people who had no one to confide in felt useless. Confiding in family, friends, and relatives or among themselves is an important factor associated with perception of uselessness. Zhao et al.[1] concluded the same.

People who had more than one chronic disease and dependent for their ADL felt more useless than those who had no chronic morbidity and were functionally independent. This finding was in accordance with various other study findings.[1],[13] Another approach to the association has been considered by various studies where self-perceived uselessness leads to high risk of functional dependency, disability, morbidity occurrence, and early death.[2],[5],[8] It has been argued that one's perception of self-usefulness to friends, family, or community can lead to better aging (positive ageism) which further boosts quality of life.[1],[2],[5]

Limitation

Being a cross-sectional study, changes with time could not be noted which could provide greater light on association and relative risks for developing self-perceived uselessness. Self-reporting of morbidities such as falls and surgeries by the participants, where records of such events were not available may differ in recall of events.

 Conclusions



From this study, we get to know that self-perception of uselessness is more prevalent among the elderly residents of the old age homes in North Bengaluru. There was a significant association between self-perceived uselessness and variables such as gender, education, leisure activities, and functional status (ADL). There are limited studies on social health of geriatric age group in India. Self-perception of uselessness which has been already studied in a few other countries found that it had implications on affecting the health status of the elderly. More research needs to be done on self-perception of uselessness in geriatric age group in India.

Recommendations

Encouraging elderly to get involved in leisure time activities and being functionally independent might have some effect on perception of uselessness. Functional status can be screened and regular physiotherapy can be provided for those who require assistance with daily activities to improve better quality of life in elderly residing at old age homes.

Acknowledgments

The authors sincerely acknowledge the Short Term Studentship Program of Indian Council of Medical Research under which the research was carried out and sincerely thank the study participants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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