LEVEL OF INDEPENDENCE OF OLDER ADULTS IN TUGUEGARAO CITY

A Research Proposal Submitted to the Faculty of School of Health Sciences

In partial fulfillment to the Degree Bachelor of Science in Nursing

APPLE JANE ABAD JOAN S. BAAY FRANCES ORTEZA

Chapter 1 THE PROBLEM AND REVIEW OF RELATED LITERATURE Introduction Everyone grows old. As people grow old, not all easily accepts ageing. The WHOs report on improving life expectancy brings about the possibility of increasing number of older person on the next decades/years. Along with the improved life expectancy are also the associated problems with aging which includes coping up to modernization, work and retirement policy and financial security. As the researchers observed, older adults often experience both social devaluation and scarcity upon leaving the labor market leading to social insecurity. Moreover, the most common complaint of aging is seeking independence. Older adults seeking support to maintain independence and quality of life in the society frequently encounter either lack of social services or services that are poor in quality or unresponsive to linguistic and cultural diversity. Older adults are usually perceived as with poor health, incompetent, weak and dependent that results to feeling of social isolation. With the Filipino families who are closely knit, the children of older adults tend to be over protective of the elderly. Along with being protective and caring, as the custom Filipino value of children of older adults, is the seeking control of older adults activities, preferring to do things in behalf and giving reminders of dos and donts which brings about common complaints among the older people. The researchers who grew up with their grandparents want to measure the level of independence of older adults to know the difference in the level of independence of the

participants when grouped according to gender, civil status, educational attainment and living arrangement. Review of the Related Literature and Studies Related Literature Old Age World Health Organization (WHO) explained that aging process is largely beyond human control. They elaborated that in some cases, it is the loss of roles accompanying physical decline which is significant in defining old age. WHO also discussed the measures of independence with its certain concepts related to it. Mobility This facet examines the persons view of his/her ability to get from one place to another and to move around the work place without the help of others. Activities of daily living The facet explores a persons ability to perform usual daily living activities which focus on a persons ability to carry out activities that he/she is likely to need to perform on a day-today basis. Dependence on medication or treatments This facet examines a persons dependence on medication or alternative medicines (such as herbal remedies) for supporting his/her physical well-being. Working capacity This facet examines a persons use of his or her energy for work. Work is defined as any major activity in which the person is engaged.

According to Josie Quiambao-Udan, 2009 she said that elders represent an increasingly diverse population. Major characteristics of the elder population include demographic, socioeconomic, ethnicity, and health characteristics. Demographic All individuals over the age of 65 were considered old. People 85 years and older are the fastest growing of all age groups in the country, numbering 4.6 million in 2002, but projected to reach 9.6 million by the year 2030 (U.S. Department of Health and Human Services [USDHHS}, 2003). Socioeconomic Socioeconomic characteristics such as gender, marital status, education, income, and living arrangements vary among young-old and old-old groups (Miller, 2004). Categorizing the aging population: Young-adult (65-75); Old (75-85); Old-old (85-100); Elite-old (Over 100 years). Health Chronic health problems and disabilities increase as age increases. However disease is not a normal outcome of aging. Nurses need to be aware that promoting health and wellness and assessing and promoting functional abilities for activities of daily living continue to be valid and important for 65-year-old clients who have 16 to 19 more years to enjoy life. Related Studies Independence is subjective and relative, varying according to the person and situation. At the heart of older peoples sense of independence and well-being lies their capacity to make choices and to exercise control over their lives. This is not the same as being able to do everything without help. Indeed, accepting help in some areas of their lives allows many older people to remain independent in others (Bundred).

Studies have shown that use of formalized comprehensive geriatric assessments can result in improved survival, reduced hospital and nursing home stays, decreased medical costs, and improved functional status. (KC), 2008) Loss of muscle mass (sarcopenia) with age in humans is well documented. A primary factor in sarcopenia is disuse of skeletal muscle, resulting in atrophy. A reduction in muscle strength is directly associated with loss of muscle mass. Inactivity may also play a role, contributing to other factors affecting aging muscle mass, including: Neuromuscular realignment (changes in motor units and innervation of fibers), reduction in growth factors, changes in muscle protein turnover. (Wilken, 2006) Maximal heart rate decreases about six to ten beats per minute per decade, and is responsible for much of the age-associated decrease in maximal cardiac output. However, a reduction in stroke volume during maximal exercise in older adults also contributes to the decline in cardiac output. In addition, left ventricular contractility appears to be reduced in older adults during maximal exercise compared to young adults. (Stannard, 2008) Aging is a multi-faceted process in which a variety of factors interact (genetics, lifestyle, disease) and frequently is associated with reduced functional capacity and chronic illness. In addition, physical inactivity and maintenance of a sedentary lifestyle represent a significant health risk to aging individuals. Regular physical activity has been shown to elicit a number of favorable adaptations that contribute to healthy aging. (Robert S. Mazzeo, 2008) Older adults report that living safely and independently in their own home is a principal health goal. Disability, aging, and illness can adversely affect the ability of an older adult to live independently by increasing one's vulnerability to health and safety risks within the home. Vulnerability is the failure to engage in acts of self care that adequately regulate safe and

independent living, or to take actions to prevent conditions or situations that adversely affect personal health and safety. Vulnerable older adults may display poor personal care and nutrition, have difficulty managing basic medications and personal finances, or live in unsafe environments regardless of physical appearance or behavior. (Aanand D. Naik, MD Mark E. Kunik, MD, MPH, Kristin R. Cassidy, BS, Jeethy Nair, MD and John Coverdale, MD, MEd, september 2010). The significance of the aging of the U.S. population has been stated repeatedly. It is estimated that by the year 2030, the number of older Americans will nearly double, and older adults will make up about 20% of the entire U.S. population (Abeles, Gift, & Ory, 1994, p. 1). Such a demographic trend brings with it many issues and challenges for health and health care; although people are living longer, they are also living with more chronic health conditions and disabilities (Zimmer & Chappell, 1994). These developments have implications for both the formal health care system, such as increased ambulatory health care and short-term hospitalization (Weiss & Lonnquist, 2000), and informal health care, such as increased provision of elderly care by adult children and greater use of home health care services. Management of disability and maintenance of functional independence among elderly adults remain salient issues because of the growing proportion of older age groups. Increasingly, research has emphasized the importance of health promotion (Nicholas,1993)and maintenance of functional independence(Zimmer & Chappell, 1994) in older adults. Informal health care practices have increasingly been cited as a way of maintaining health and functioning among elders while simultaneously reducing medical expenditures (Edwardson, Dean, & Brauer, 1995; Jirovec Kasno, 1993; Kart & Engler, 1995).

Elderly persons often experience decrease in functional ability and greater difficulty in performing everyday tasks (Verbrugge, Rennert, & Madans, 1997). There is great diversity in the health and wellbeing of older people. Many older people remain healthy well into their seventies and beyond while others experience increasing levels of ill health. Normal ageing involves physical and mental changes which may impact on sight, hearing, memory, motor sensory skills, mobility and balance. Ageing also brings an increased risk of developing chronic diseases and other age related diseases. The rate of ageing varies between individuals and is influenced by genes, behaviours and environments. The ageing process is experienced and understood by older people and the broader community in many different ways. Differing values, cultural beliefs, expectations, experiences and stages in the life span all influence the meaning of health and wellbeing for older people. (Division.) According to the study in Physical activity among physically independent older adults in Hong Kong (Au Yeung Wai Shan, Chan Hoi Kei, Chan Mun Yee, Chan ), it revealed that those personal factors, such as age, marital status, living situation, income, educational level, and health perception have an influence on the physical activity, however the way how these personal factors influencing the PA cannot be concluded. Living arrangements are influenced by a variety of factors, including marital status, financial well-being, health status, and family size and structure, as well as cultural traditions such as kinship patterns, the value placed on living independently or with family members, the availability of social services and social support, and the physical features of housing stock and local communities. In turn, living arrangements affect life satisfaction, health, and most importantly for those living in the community, the chances of institutionalization. Ones living arrangements are dynamic, they change over the life course, adapting to changing life

circumstances. Some significant observations emerge from a cross-national comparison of living arrangements of the older population. First, women in developed countries are much more likely than men to live alone as they age older men are likely to live in family settings, typically with a spouse. Secondly, there has been an increase in the proportion of the older population that is living alone in developed countries. Thirdly, both older men and women in developing countries usually live with adult children. Fourthly, the use of non-family institutions for care of the frail elderly varies widely around the world but is relatively low everywhere (Velkoff, 2008). Conceptual/Theoretical Framework

Profile of the respondents in terms of: Gender educational attainment civil status living arrangements Respondents level of independence in terms of:

Identification, analysis and understanding of the Level of Independence of Older Adults

ability to use the telephone marketing food preparation housekeeping laundry mode of transportation responsibility for own medication ability to handle finances Significant difference in the level of independence of the participants when grouped according to profile variables

Level of Independence of Older Adults analyzed

FEEDBACK

The paradigm of the study consists of three major components namely: Input, Process and Output. The first component is the input. It involves the profile of the older adults. The second component is the process which involves the identification, analysis and understanding of the Level of Independence of Older Adults. The third component is the output which ends up with the Level of Independence of Older Adults analyzed. Statement of the Problem This research aimed to determine the level of independence of older adults of Tuguegarao City. Specifically, this research will seek to answer the following: 1. What is the demographic profile of the respondents in terms of: 1.1 gender 1.2 educational attainment 1.3 civil status 1.4 living arrangements 2. What is the level of independence of the participants? 3. Is there a significant difference in the level of independence of the participants when grouped according to profile variables? Hypothesis There is no significant difference in the level of independence of the participants when grouped according to profile variables. Significance of the Study The finding of the study will benefit the following: Older Adults. The older adults will be able to be aware and improve their level of independence with the use of the Lawtons Instrumental Activities of Daily Living. Researcher. The researchers will be able to gain knowledge about the level of independence of older adults of

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Future Researchers. They will acquire ideas to guide them in the conduct of their future studies related to Level of Independence of Older Adults. Scope and Limitation This study aims to assess the Level of Independence of 56 male and 56 female Older Adults with ages 65 to 75 years old of Brgy. Ugac Sur, Tuguegarao City. The number of participants is limited for each demographic profile, the division of participants are as follows: educational attainment college graduate -7 male 7 female undergraduate-7 male 7 female

civil status married-7 male 7 female widowed-7 male 7 female single-7 male 7 female separated-7 male 7 female

living arrangements living with a family member-7 male 7 female living alone-7 male 7 female

Definition of Terms Activities of daily living. Activities of daily living, also known as ADL, are those activities that people must be able to do routinely to be considered fully independent. The things we normally do in daily living including any daily activity we perform for self-care such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure. Aging. There is often a general physical decline, and people become less active.

Level of Independence. The capacity to make choices and to exercise control over ones life. Mobility. Mobility is the ability and willingness to move or change; this can depend on motor skills, special tools such as a walking stick, walker, mobile standing frame or wheelchair, vehicles, uncongested roads, public transport; mobility with regard to one's home depends on availability of houses and being bound to an area because of a job or school, etc. Mobility with regard to one's job depends on availability of jobs (depending on the general job market and on one's versatility, quality, etc.), mobility with regard to one's home, etc. In solid state physics, mobility generally refers to electron mobility or hole mobility. Older Adults. Older adults are defined as persons 65 years of age and older. The reality is that most older people live independently and maintain close relationships with family and friends.

Chapter 2 METHODS AND PROCEDURES This chapter presents the methods of research used, the respondents of the study, the research instruments used, the data gathering procedures, and the interpretation and analysis of data gathered from the respondents.

Research Design This study will attempt to assess the older adults level of independence primarily in Brgy. Ugac Sur, Tuguegarao City through the use of a descriptive method of research. This method will be used in gathering information and facts from the respondents through survey to assess the older adults level of independence.
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Respondents/Subjects of the Study The study will constitute respondents which will be chosen directly from the records of Office for Senior Citizens Affairs. The researchers chose Brgy. Ugac Sur because according to the records of OSCA, Brgy. Ugac Sur has the highest number of older adults in Tuguegarao City with 561 older adults. The simple random sampling method will be utilized in such a way that the participants will have an equal opportunity to become part of the sample.

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Instrumentation Lawton Instrumental Activities of Daily Living Scale (IADL) is an appropriate instrument to assess independent living skills (Lawton & Brody, 1969). The instrument is most useful for identifying how a person is functioning at the present time, and to identify improvement or deterioration over time. There are eight domains of function measured with the Lawton IADL scale. Women are scored on all 8 areas of function; historically, for men, the areas of food preparation, housekeeping, laundering are excluded. Clients are scored according to their highest level of functioning in that category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) for women, and 0 through 5 for men.

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Few studies have been performed to test the Lawton IADL scale psychometric properties. The Lawton IADL Scale was originally tested concurrently with the Physical Self-Maintenance Scale (PSMS). Reliability was established with twelve subjects interviewed by one interviewer with the second rater present but not participating in the interview process. Inter-rater reliability was established at .85. The validity of the Lawton IADL was tested by determining the correlation of the Lawton IADL with four scales that measured domains of functional status, the Physical Classification (6-point rating of physical health), Mental Status Questionnaire (10-point test of orientation and memory), Behavior and Adjustment rating scales (4-6-point measure of intellectual, person, behavioral and social adjustment), and the PSMS (6-item ADLs). A total of 180 research subjects participated in the study; however, few received all five evaluations. All correlations were significant at the .01 or .05 level. To avoid potential gender bias at the time the instrument was developed, specific items were omitted for men. This assessment instrument is widely used both in research and in clinical practice.
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Data Gathering The researchers will first ask the approval and permission of the Barangay Captain with regards to the floating of the questionnaires in Brgy. Ugac Sur, Tuguegarao City. The tool consists of 2 parts, the first part of the questionnaire is compose of the demographic profile, which includes the personal data of the participants and the second part is compose of 8 categories with corresponding choices, the categories include ability to telephone, marketing, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medication and ability to handle finances. This will be distributed to the older adults through random sampling method. Data Analysis

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Each choice in each category has a corresponding score: Ability to telephone (1-4), marketing (1-4), food preparation(1-4), housekeeping(1-5), laundry (1-3), mode of transportation(1-5), responsibility for own medication (1-3) and ability to handle finances(1-3). The lower the total score, the more independent the older adult is The following scales were used to interpret the data: VERBAL SCALE RANGES INTERPRETATION 1 2 3 8-15 16-23 24-31 Independent Partially-Independent Dependent