case study on old age home

Lifestyle Changes and Perception of Elderly: A Study of the Old Age Homes in Pune City, India

Priyanka v janbandhu 1 , santosh b phad 1 , dhananjay w bansod 2.

1 Research Scholar at International Institute for Population Sciences, Mumbai, India

2 Professor, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India

* Corresponding author Priyanka VJ , Research Scholar at International Institute for Population Sciences, Mumbai, India

Received Date: 13 October, 2022

Accepted Date: 10 November, 2022

Published Date: 15 November, 2022

Citation: Janbandhu PV, Phad SB, Bansod DW (2022) Lifestyle changes and perception of elderly: A study of the old age homes in Pune city, India. Int J Geriatr Gerontol 6: 138. DOI: https://doi.org/10.29011/2577-0748.100038

The increase in old age homes and its residents mandates attention to the living condition of elderly at these institutions. The study is based on the information collected from 500 residents of 23 old age homes of Pune city in India. A multistage random sampling used for the selection of samples. A semi-structured interview schedule was adopted to gather the information from the respondents, the interview schedule was approved by the research ethical board of the institute. To strengthen the study qualitative insights are also gathered using case studies and key informant interviews. About half of the respondents were having issues while adjusting at old age home and similar percent has reported that their life has considerably changed after joining the old age home. Over half (52%) of these have experienced negative impact, such as homesickness, feeling of left alone (abandoned) by family members, feeling of staying at a hostel, follow certain schedule, elderly have to adjust in their daily life, and so on. Due to family attachment, many respondents feel lonely. For instance, 56 percent of the respondents perceive that they are being left out by their family members. While, two-thirds of respondents perceive that other elderly who are staying with their family members are having a better life than themselves. Hence, many respondents would like to go back to their families. Despite the fact that more than half (54%) of respondents know that they will spend their remaining days at the old age home. Whereas, 42 percent of the respondents said they are not certain about their future stay and 2 percent believe that soon they will return to their former homes among family members. Although many respondents experienced positive outcome after joining the old age home. Yet, the issues of uncomfortable living, loneliness, or similar unpleasant feeling is present among some of the respondents. These experiences are mostly due to the absence of family members in surrounding.

Keywords: Adjustment; Living condition; Old age home; Family; Elderly

Introduction

Population ageing is considered to be one of the biggest challenges of demographic transition in the twenty-first century [1-3]. Decreasing fertility rates and increasing longevity have resulted in a higher population of elderly people (aged 60 years and above) compared with the younger and adult population than ever before [4-6]. Although developed regions were the first to witness the phenomenon of population ageing, now the developing regions are witnessing a rapid growth of aged population [7, 8]. The share of persons aged 60 years and above in the world is expected to increase by 56 percent between 2015 and 2030. [9]. As per United Nations Population Division estimates increase the share of old age population from 5.7 percent in 2019 to 7.6 percent in 2030 in lower middle income countries [10]. As per 2011 census [11], India’s older population aged 60 years and above is 103 million and it is expected to increase 319 million by 2050 [12].

Increase in the proportion of older population due to shift in the age structure from younger population to older population create various challenges for policy makers and create burden on younger generation and increase demand for social and economic support care for elderly [13]. Before advancement of demographic transition in India, traditional family system was providing care for elderly especially in joint family system. In the past several years, as a result of advanced demographic transition along with socioeconomic development and urbanization, a large chunk of migration has occurred. As skilled professionals have moved to developed countries and from rural to urban areas for better opportunities, leading to reduction in family size and the erosion of traditional families. It led to growth of nuclear families, reduced socioeconomic support and care for elderly, and increased the demand for old-age homes in India [14].

With increased longevity, many of the elderly would require some form of long-term care, the cost of which needs to be borne by their families. This might result in family members withdrawing from school or employment to care for the elderly member. Hence, older people are viewed as a burden [15,16]. Traditionally, within the familial hierarchy elderly people have enjoyed a high status [17-21]. However recently, with the increase in age, several elderly people experience eroding status. In addition to other factors, it contributes to the behaviour of the elderly towards their families and their living arrangement [22,23].

According to BKPAI report [24] marriage of children is and other reasons such as include death of spouse, family conflicts, and migration of children are reasons for elderly to live alone. In addition, the demand for old age homes increased. Some evidences indicate that the increase in old age homes was seen largely in the southern regions of the country, particularly in Kerala and Tamil Nadu, then in the western state of Maharashtra [25-28], due early demographic transition, urbanization and migration led small family norm compared to other states. There has been changes in the social and family structure which affected the culture and norms of the society. The process of modernization and search for better standards of living and job opportunities forced children to move away leaving their parents behind. In This study we assess the lifestyle of elderly and their perception who live in old-age homes in Pune city of India.

Data Source and Methodology

A list of old age homes was obtained from Help Age India, Pune office [29]. This study was conducted in 23 old age homes of Pune city, India. From these old age homes, a total sample of 500 respondents was selected using the lottery method. The researcher used the purposive sampling technique and limited the sample size to 500 elderly respondents from 23 old age homes. The study includes old age homes which have completed at least 2 years of functioning, avoiding all those old age homes which were established or in function not more than 2 years. The study includes only those elderly who were aged 60 years and above, living in old age homes at least for one year. Elderly persons have experience of living in old age home for less than a year are not considered in this study. Those elderly who was unable to respond to the question or who had any psychological issues (diagnosed by a medical practitioner) are not considered for the study.

Participants

The study population was comprised of 500 elderly people, residents of old age homes. Those elderly who are physically mobile and capable of conducting interviews on their own behalf the respondents should have stayed in the old age home for one year so that they can give a better understanding of the facilities provided in the particular old age home where they are staying. A semi-structured interview schedule was developed for the data collection. This interview schedule received approval for data collection from the ethical board of the institute. Data was coded and analysed with STATA (v.14.0) software.

Sample characteristics of elderly population who are living in old-age homes

Table 1 presents the sample characteristics of elderly living in old age-homes in Pune city, Maharashtra. Among respondents, over three-fifths (63%) are women and 37 percent are men. Higher proportion (42%) of respondents are aged 70-79 years, followed by aged 80 years and above (31%) and aged 60-69 years (26%). Percentage of elderly living in the old age homes increases with the up to certain education level. For instance, 13 percent of respondents live in the old age homes have never attended school, whereas 24 percent of respondents have completed 8-10 years of schooling. Share of female respondents is higher with no schooling than the male respondents (16% against 9%). According to marital status, higher proportion (62%) of respondents are widowed/widower compared to 23 percent are never married, 8 percent are currently married and 7 percent are divorced/separated. Share of elderly men who are never married is higher than the never married elderly women (28% against 19%). While, share of elderly women who are widowed is higher than the widowed elderly men (67% against 54%). With regard to social groups, majority (79%) of the respondents does not belong to Scheduled Caste (SC), Scheduled Tribes (ST) or Other Backward Caste (OBC). While, 12 percent of respondents are belonging to SC and 7 percent are OBC. According to the type of family, higher larger share (73%) of respondents were living in nuclear family and 26 percent came from joint family. Since, women tend to have lower social status compared to men, they are more likely to depend on the male person of the family either father, husband or son. Hence, women are inclined to have lesser significance in the family. In line with other several factors, women are more likely to join the old age home compared to men.

Table 1: Percentage distribution of women and men aged 60 years and above by selected background characteristics, Pune, Maharashtra, 2017.

Lifestyle of the elderly living in old-age homes

Elderly respondents were asked about whether they have experienced any changes in their personal lifestyle and either positive or negative changes after joining the old-age home. The changes in personal lifestyle of the elderly covers various dimensions such as adjusting with the environment of old-age home, feeling loneliness or left alone, home sickness, health issues as chronic and psychological health problems. While, some respondents have experienced positive changes such as improvement in health condition, received good care at old-age home, good social networking as mingling with other old age home residents, peaceful environment, engagement in various activities which is also a part of entertainment for them.

Table 2 shows the percentage distribution of elderly with significant changes in their personal life style. Over half (52%) of the respondents have experienced negative changes after joining the old age home, while about two-fifths (39%) have experienced positive changes and around one-tenth (9%) have neither experienced any positive nor negative changes in their lifestyle at old age home. Share of elderly women with negative changes in higher than the share of elderly men (56% against 35%). Similarly, among widowed elderly more 54 percent have experienced negative changes and 38 percent have positive changes. Whereas, respondents who are from rural areas are more likely to experience negative changes (57%) compared to respondents from urban areas (44%). Share of elderly with experienced negative changes decreases with increase in number of sons (71% elderly with no son to 33% elderly with 3 or more sons). While, percentage of respondents with experienced negative changes increases with increase in number of daughters (48% elderly with no daughter to 81% elderly with 3 or more daughters).

Mr. Singh (name changed) shared - “I could not afford the cost associated with the required health treatment. In order to receive health treatment and basic care, I have joined the old age home. As a result, my health improved after joining the old age home. At old age home, I have been receiving health care services, the availability of care-taker is an additional advantage. Eventually, my health started recovering at old age home.”

Table 2: Percent of elderly with significant changes in their personal life and positive change in their life after joining the old age home of Pune city.

Perception of elderly

The results presented in (Table 3) shows the percentage distribution of elderly’s perception who live in old-age homes about the others (elderly who lives at home with their family) are better-off compared to them and they feel lonely or left out at oldage home, which varies with different demographic and social characteristics. Perception among elderly staying at old age home that other elderly (who are not staying at old age home) are betteroff than themselves is higher among widowed/widower elderly (69%) compared to never married elderly (65%) (χ2 p-value <0.05). According to type of family, perception of elderly from joint family who live at old age homes that other elderly (who are not staying at old age home) are feel better-off than themselves is significantly higher (74%) than nuclear family elderly (64%) (χ2 p-value<0.05). Similarly, perception of elderly whose residence is abroad and lives at old age homes that other elderly (who are not staying at old age home) are feel better-off than themselves is significantly higher more (71%) than whose earlier residence is same district at local (64%) (χ2 p-value <0.05).

Mr. Ganpat (named changed) never married respondent said “Many elderlies have children and still they are staying in the old age home with me. After watching them suffering like this, I feel that it’s better I am not married and I don’t have a family (children). What is the use of having such children who cannot take care of their parents in their last stage of life? Because, in the end, we (never married and ever married elderlies) are sailing in the same boat.”

Higher percent of widower / widowed elderly who live at old age homes perceive (60%) that they feel lonely or left out than never-married elderly (55%) (χ2 p-value<0.1). According to type of family, the joint family elderly who live at old age homes perceive (60%) that they feel lonely or left out is significantly higher than nuclear family elderly (55%) (χ2 p-value<0.05). Other demographic and social characteristics of elderly perceiving those other elderly persons are better –off who are not living in the oldage homes and feeling loneliness who are living at old age homes are not shown significantly.

Radha (named changed) a widow respondent said “An old age home is unable to provide a warm and welcoming environment like home. My family is always on my mind. Being away from them, and the realization that I will never get a chance to return to them, makes me more uncomfortable at old age home. I feel being isolated by my family members, which makes me feel lonely.”

Table 3: Percentage distribution of the elderly perceiving that the other elderly person is better off and the feeling loneliness at old age homes, Pune city.

Future intention of elderly to length of stay in the old-age homes

(Table 4) presents percentage of elderly and their future intention to length of stay in the old-age homes in Pune city, Maharashtra with different demographic and social characteristics. Percentage of elderly and their future intention to length of stay in the old-age homes is significantly associated with educational level. Length of stay in the old-age homes till death is decreases with increasing educational level. More than half of elderly population with no-schooling (55%) have future intention to length of stay in the old-age homes till death compared to graduation and above educational level (46%). The 44% of elderly have no idea about their future intention to length of stay in the old-age homes with no-schooling compared to graduation and above educational level (47%) (χ2 p-value <0.1) The higher percentage of elderly population whose childhood residence is rural and their future intention to length of stay in the old-age homes till death (58%) compared to others (51%) and lower percentage of elderly population whose childhood residence is rural and they did not have idea about their length of stay in the old-age homes (35%) compared to others (45%) (χ2 p-value<0.1). Percentage of elderly people who had no children with them with length of stay in the old-age homes till death is significantly lower (72%) than others who were having children (44.2%) and percentage of elderly who had no idea about their length of stay in the old-age homes is significantly lower (50%) compared to other who were having children (24%) (χ2 p-value<0.001). Other demographic and social characteristics of elderly such as age, sex, martial-status, religion, social groups (SC, ST, and OBC), family type (nuclear and joint family), having sons and daughters have not shown significant association with their length of stay in the old-age homes in Pune city.

Table 4: Percentage of the elderly with future intentions to stay in the old age home, Pune city.

Discussion and Conclusion

The gender difference is quite prevalent in living in oldage homes as elderly women are more likely to live in the oldage homes than elderly men. Majority of widowed/widower elderly and elderly who came from nuclear family live in the oldhomes due to lack of care and support and death of their partners, especially women have prolonged widowhood due to longer life expectancy than men [38]. Previous evidence shows that increasing urbanization and globalization lead toward nuclear family and migration of children for their job leads to unable to care for their aged parents [30]. For elderly persons, without support of their children, caring themselves is very difficult [30,31].

Most of the elderly have experienced negative change in their life after entry in the old age home as they felt home sickness, health issues as chronic and psychological problems, feeling lonely or left alone, need to adjust with environment of old-age homes and responded that neutral as neither satisfied nor felt bad living at old age homes. Many of previous studies have shown similar evidence that elderly who live olde-age homes suffer from Socio-psychological health problem such chronic health issues as stress, loneliness, depression, anxiety and other health and social issues as loneliness and lack of familial relationship. Especially staff of old-age homes lack caring for elderly, empathy, insufficient understanding of aging issue and skill to take care of elderly in old-age home led to worsen the lifestyle of elderly [3236]. Among these elderly persons, widowed/widower and elderly from rural areas have not satisfied much about their life compared to their counterparts. Widowed/widower elderly are forced to join in the old-age homes due to lack care and socioeconomic support, death their partners, and for being from nuclear family. Majority of the women respondents have spent most of their time with family members and taking care of the household chores. While men have played part in both indoor and outdoor activities. As a result, compared to men, women while staying away from home or family members have shown more disappointment [37].

Important emerging finding of this study is that share of elderly who have experienced negative changes decreases with increase in number of their sons, whereas it increases with increase in their number of daughters. Only few of the elderly have experienced positive changes after joining the old age home such as improvement in their health, received good care at old-age homes, good social networks as mingling with other friends and peaceful environment. Old age brings several issues, and health problems and lack of care and support are the key issues for the elderly. At the old age home, elderly receive health services, care and support which are important needs of the elderly. Hence, several respondents stated that their health condition has improved or they received appropriate health services at the old age homes. While many respondents have unpleasant experiences with their family members and old age home avoids such unpleasant events.

Majority of elderly’s perception who live in old-age homes about the others (elderly who lives at home with their family) are better-off compared to them and they feel lonely or left out at old-age home. Of these, perception of widowed/widower elderly and elderly from joint family about other elderly is that they are better-off and they also feel lonely or left out at old age home is significantly higher than their counterparts as never married and nuclear family. A large part of the respondents covers never married elderly or those who never intended to join the old age home. So, this group considers other elderly who are living with their family members having better life than themselves. Majority of elderly’s intend to stay at old-age home till death and some have no idea that how long they will stay at old age home. Of these, the elderly who have no children have more likely to stay at old-age home till death compared to those who have children.

The study mainly suggests that situation of elderly living in old age homes need attention, as several elderly are experiencing homesickness, unable to cope up at old age home, and feel lonely or left out, irrespective of availability of all required facilities at old age home.

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Transition of Elderly from Home to Old-Age Home: A Narrative on Marginalisation and Seclusion in Urban India

• First Online: 21 September 2017

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• Smita Verma 3  

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The escalating elderly population in India is changing the demographic structure of the nation and is transforming the sociocultural dynamics of ageing in modern India. With process of globalisation, liberalisation and urbanisation, the family structure has been altered and has dialectically transformed the social landscape. Shrinking spaces, high cost of living, dual-career families and changed priorities result in negligence of the elderly parents. The disassociation of the youth—‘ Gadget techno generation ’ — from the elderly generation within families somewhere points to the incapacity of the middle generation in building a connection of ‘ Communicative Action ’ . The increasing life expectancy instead a reason for celebration has become an anxiety for the society. The mushrooming of old-age home and growing indifference for the elderly parents signify the thinning of social values and rise of individualism in society. This paper deliberates on the factor which leads to the alienation of the elderly parents and critically examines the increasing complexity of both the ‘push and pull’ factor for their migration to old-age home in city of Lucknow. Bringing the narratives of the elderly in old-age home would help in understanding the extent of quiescence of family relations and their multifarious experiences of subalternity and marginalisation in modern India.

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Verma, S. (2018). Transition of Elderly from Home to Old-Age Home: A Narrative on Marginalisation and Seclusion in Urban India. In: Bhattacharyya, A., Basu, S. (eds) Marginalities in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5215-6_16

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To Design for the Elderly, Don't Look to the Past

• Written by Matthew Usher
• Published on October 30, 2018

When the world undergoes major changes (be it social, economic, technological, or political), the world of architecture needs to adapt alongside. Changes in government policy, for example, can bring about new opportunities for design to thrive, such as the influx of high-quality social housing currently being designed throughout London. Technological advances are easier to notice, but societal changes have just as much impact upon the architecture industry and the buildings we design.

The same is true of changes in demographics, and we are in the midst of a monumental shift. In 2015, 8.5% of the population of the world was aged 65 or over (617 million people). This is predicted to grow to 12% of the population by 2030, and to a staggering 16.7% of the population by 2050 [1]. Historically, this percentage has steadily grown but dramatic advances in medicine are allowing people to live longer, creating aging populations across the globe. This problem is compounded in countries where the birth rate is also incredibly low, as is the case with Japan. We must reevaluate how the elderly are treated within society.

When thinking about the impact of these statistics, the natural assumption within the context of architecture is to think about medical care, hospital design, and accessible cities. However, this overlooks an emerging and serious problem: loneliness and social isolation. Within the UK, 51% of those aged over 75 live alone, and 11% of older people are in contact with friends and family less than once a month [2]. Similar results are present across Europe.

Chronic loneliness within the elderly population is incredibly prevalent and a significant number of studies have been conducted looking at the measurable health impact it has, such as creating a higher risk of disabilities, heart disease, strokes, and dementia. Architects can help tackle loneliness at the source and dramatically help increase the quality of life for a portion of the population who are often isolated. This article explores how good design can help further this cause, how architects have combated this previously, and what the industry leaders are doing now.

In recent years, architects and developers alike have begun to rethink how housing for the elderly should be treated. Multiple panels discussing and studying the needs of the modern older person have been held, including with RIBA and New London Architecture . The new approach features light, modern and very sensitively designed property - the exact opposite of the traditional image. In these schemes, part of the solution is making the housing desirable to residents regardless of perceived or traditional tastes. Living in modern retirement communities provides an opportunity for engagement and interaction while beginning to shed this stigma, and allowing residents to retain their independence.

The Housing our Ageing Population Panel for Innovation (serendipitously acronymed HAPPI) was originally held in 2009, and their reports have since become industry standard. The original 2009 report featured multiple high-quality case studies from throughout Europe, and subsequent issues featured not just the panel's findings but guides for implementation. Advice includes ranges from the architectural  (generous space standards, daylight, and adaptability for ‘care readiness’) to the social (engaging positively with the public.)  It is the latter part of this range that is most crucial and can be combined with architectural standards. 

PRP have become leaders within this field and heavily draw upon this advice from the HAPPI reports. Their Pilgrim Gardens project won multiple awards between 2012-2014 and features several of the design features advised by HAPPI. Double-aspect flats encircle communal garden spaces of hard and soft landscaping, and a shared colonnade acts as a slow circulation space. In-built sliding glass doors to allow the use of the balconies year round.

While focusing more on those requiring care, Dietger Wissounig Architekten’s nursing home in Austria employs a similar effect internally and is incredibly light, liberally using timber and wood within to create a soft and caring environment. Double-stacked corridors are again avoided, allowing the circulation to be inhabited socially as inviting spaces.

The report also highlights the need for multipurpose space where the residents can meet and which could possibly act as a hub for the local community. At The Architect in Utrecht, residences for the elderly requiring care are stitched into the building with the rest of the housing alongside communal spaces and the nursery. Similar projects by Haptic in Norway and Witherford Watson Mann’s almshouse in London also stress the need for social connection. These projects share spaces between neighbors, school children, and the local community through gardens, allotments, shops, and public squares.

Cities have begun to acknowledge the changing needs of an aging population. The ‘Campaign To End Loneliness’ has established a framework of three methods in order to address the multifaceted issue: individual intervention, neighborhood action, and a whole system approach. To help combat the wider scale challenges, the city of Manchester has become the UK’s first ‘age-friendly city’ [4], a World Health Organisation initiative which several forward-thinking cities across the world have subscribed to. The key priorities of the initiative include known benefits such as improvements in transport, housing, and health services, but also highlights the need for civic participation.

Architects can take a leading role in the design of new policy. In Manchester, the ‘Age-Friendly Design Group’ assists with designing local parks to be more age-friendly, listening to the elderly to inform good practice, and publishing of design guidelines. Stephen Hodder, a previous RIBA president, said that such groups open up a “much-needed debate on how we can start shaping the landscape of our built environment for our older age”.

Outside of the city-scale, architectural solutions can also provide for a range of needs. Public ‘day-stay’ centers, such as the Casa del Abuelo in Mexico seem particularly popular (especially in Spain and Portugal.) The design of centers such as these is often strikingly modern and open, blurring the distinction between inside and out. This can partly be attributed to the temperate climates these projects are located in, but the prevalence hints at an emerging approach.

The Guangxi senior center in China , serves an atypically large population and features a range of activities and spaces to accommodate this. The undulating form, clad in wood grain aluminum louvers, includes everything from game courts and gardens to an indoor swimming pool and table tennis rooms. This haven of activity attempts to engage the elderly in physical activity alongside social spaces.

Particular success can be found when positioning these centers as hubs for the local neighborhoods rather than simply as single-purpose structures. This method is similar to The Architect in Utrecht, This can include proximity to other types of housing (such as The Architect) but can also be integrated with libraries or universities. A successful example of this is Sant Antoni - Joan Oliver Library , by Pritzker Prize-winning practice RCR Arquitectes .

The project is nestled within one of Barcelona’s city blocks, wrapping around a central courtyard. The library forms the public face of the building and primary programmatic element, appearing to be suspended between two apartment buildings. The community space then occupies one wall of the courtyard and overlooks the public space. This maintains the perceived ‘safe space’ but places it firmly around a local hub, unifying the project into a coherent block.

A final method is to promote interaction between the young and the elderly. These may seem to be an odd combination of programmes, but significant research is being undertaken into this and the centers which currently subscribe to these ideals and offer them in a safe and secure way.

At the beginning of this article, Japan was noted to be one of the countries most impacted by aging populations going forwards. Increasing life expectancy and societal changes (leading mothers to work outside the home) has meant the numbers both nurseries and senior centers/retirement homes are increasing. There is clearly an opportunity to restructure the way care is delivered for both young and old - something Japan has already been doing for over 40 years. Kotoen, a “yoro shisetsu” (facility for the children and the elderly) in Tokyo, is the oldest age-integrated facility in Japan, having opened in 1976. Here, interaction cuts both ways: seniors can volunteer in the nursery, children visit the communal areas of the care home, and both join together for special events. 

When adjoined to care homes, the benefits of this arrangement make sense. Both share basic needs: the provision of meals, physical activity (in the case of the elderly, to keep them active and fit), and communal spaces for socializing. The benefits for the elderly are fairly obvious. The arrangement provides company and activity, bringing life into a space which can often become mundane. But there are notable social and developmental benefits to the children as well: it helps to promote a healthy and positive view of aging and helps counter any preconceptions about the less able.

Mount St. Vincent, a care home in Seattle, runs an ‘Intergenerational Learning Centre’ and endorses similar benefits, stating that it helps to provide a broader perspective of family life for the children who do not have grandparents active in their life.

Surprisingly, there is a dramatic and measurable impact of this upon the physical and mental health of the elderly. St. Monica’s Trust in Bristol housed a study into these benefits, measuring the impact upon the residents over a six week period. At the end of the study, 80% of the residents had improved their mobility and grip strength, and 70% has reduced their score on the scale of depression.

So how can architects begin to promote and further this idea? The impact upon loneliness of aligning these programmes together is dramatic, but the majority of the examples across the world are activity and event-driven. There is the opportunity to develop a new building type to house this program and best suit the needs of the young and old, rather than attempting to retrofit existing spaces. Neither senior citizens nor children want to live in a dull environment, so adapting the design creatively to suit the characteristics of their users is a wonderful opportunity rarely given.

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• Indian J Community Med
• v.43(1); Jan-Mar 2018

A Comparative Study of Health Status and Quality of Life of Elderly People Living in Old Age Homes and within Family Setup in Raigad District, Maharashtra

Priyanka amonkar.

Department of Paediatrics, MGM Medical College, Mumbai, Maharashtra, India

Madhavi Jogesh Mankar

1 Department of Community Medicine, MGM Medical College, Mumbai, Maharashtra, India

Pandurang Thatkar

Pradeep sawardekar, rajesh goel, seema anjenaya, background:.

The traditional concept of family in India to provide support to the elderly is changing soon with disintegration of joint families. In this scenario the concept of old age homes (OAHs) is gaining momentum and the number of people seeking OAH care is rapidly increasing. However, not much is known about the quality of life (QOL) of Indian elderly staying in the OAH setup.

Objectives:

To assess and compare the Health status, Quality of Life and Depression in elderly people living in OAHs & within family using WHOQOL –OLD questionnaire & Geriatric Depression Scale

A cross sectional study was conducted in elderly aged above 60 years of age. After taking a written consent and matching for age and sex & socioeconomic status, 60 elderly from OAHs & 120 elderly living within family setup were selected randomly. The WHOQOL-OLD standard questionnaire & GDS were used to assess quality of life & depression in elderly.

The QOL of elderly in domains of autonomy, past present & future activities, social participation and intimacy was better in family setup (60.62, 70.62, 66.14 and 58.43) as compared to OAHs (51.35, 62.91, 59.47and 41.16) (p<0.05). There was statistically significant difference in mean geriatric depression scores of both the group (3.96 within family setup and 5.76 in OAH's).

Conclusion:

Quality of life of elderly within family setup was better as compared to elderly in OAHs.

I NTRODUCTION

India is the second largest population of the elderly (60+) in the world.[ 1 ] With the increase in life expectancy, the size of the geriatric population in India has gone from 20 million in 1951–100 million (8.3%) in 2014 and the number will rise to approximately 130 million by 2021.[ 2 ] The conventional concept of family in India, which was to provide support to the elderly, is changing soon with urbanization; modernization, the disintegration of joint family structures into nuclear ones and the changing role of women. Thus, older people have become more vulnerable. Their vulnerability lies mainly in lack of employment, financial insecurity, ill health, and neglect by society.[ 3 ] To add to this, misery 45% of aged Indians have chronic diseases and disabilities.[ 4 ] The lack of family support made elderly resort to old age homes (OAHs) run by private or voluntary organization for their care and support. In this scenario the concept of OAHs is gaining momentum, and the number of people seeking institutionalization is rapidly increasing. However, not much is known about the response of its residents to institutionalization and its impact on their physical and mental health. Hence, the present study was conducted to assess the health status and QOL of elderly in OAHs as compared to elderly within family setup.

O BJECTIVES

• To assess the health status, morbidity pattern, and living conditions of elderly people living in OAHs and within family setup
• To compare quality of life (QOL) of elderly people living in OAHs and those living within family setup, by using the World Health Organization QOL assessment Quality of Life Assessment OLD (WHOQOL–OLD) questionnaire.
• To assess the prevalence of depression in both the groups using the geriatric depression scale (GDS) 15 Short Form.

M ATERIALS AND M ETHODS

After obtaining permission from Institutional Ethics Committee, a cross sectional descriptive study was conducted, during the period from January 2015, to July 2015, on elderly people living in two different settings as follows: (a) Those living in OAHs and (b) Those living with their families. Out of three OAHs situated in Panvel, Raigad District, two were selected randomly by lottery method. Thus, a total of 60 consenting elderly from OAHs were interviewed. About 120 elderly from family setup (sample size of 1:2) were selected randomly by the door to door visits in the area surrounding these OAHs and were approximately matched for age, sex, and socioeconomic condition. Matching was made to ensure both the groups are similar and thus eliminate sociodemographic confounding factors which may also affect the QOL. Elderly in the age group of 60–90 years and willing to participate were included in the study. Elderly, who were bedridden, severely ill, audio-visually handicapped or cognitively impaired were excluded from the study. For study purpose, we decided that a minimum of 6 months experience at OAHs would be required to give an unbiased opinion on living conditions of OAHs. Thus, those living in the OAH for <6 months were excluded from the study. Informed written consent was obtained from the study participants after explaining the aims and objectives of the study.

WHOQOL-OLD Module standard questionnaire was used to assess QOL in elderly. The WHOQOL-OLD was developed from the parent instrument: WHOQOL Group's WHOQOL-100. It is a multidimensional measure of QOL and comprises of six domains (24 items): sensory abilities, autonomy, past present and future activities, social participation, death and dying, and intimacy (4 items per domain). Items are scored with the reverse coding of positive responses so that higher scores equal higher QOL; the authors define the scale ranges as 24 (lowest possible QOL) to 120 (highest possible QOL). Response scales are all 5-points.[ 5 , 6 , 7 ] A predesigned and prestructured questionnaire was used to evaluate sociodemographic characteristics, morbidity pattern and living condition in OAHs and attitude toward life. The results so obtained were compared between both the groups.

GDS Short Form is designed and validated by Yesavage et al ., specifically for rating depression in the elderly was used to assess the presence of depression.[ 8 , 9 , 10 ] A score of 0–5 is normal. A score >5 suggests depression. Elderly were interviewed in regional language Marathi by the research investigator. Data thus collected was analyzed by SPSS 20 (SPSS company Bangalore, India). Appropriate tests were used for comparison between two groups. The value of P = 0.05 was considered as statistically significant.

In OAHs >45% of the elderly were in the age group of above 80 years and 63.30% elderly were widowed. There was no statistically significant difference observed between elderly in both groups in terms of age, sex, and financial dependency. In the OAHs, about 31.67% elderly reported that they had suffered domestic violence/verbal abuse, not satisfied with food (16.67%), and not able to pursue hobbies (21.67%). The overall living condition in the OAHs was different from the living condition of elderly in family setting ( P < 0.05) [ Table 1 ].

Sociodemographic profile and living condition of elderly people

Majority of elderly were suffering from hypertension (46.67%, 58.33%), joint pain (43.33, 33.33%) hearing impairment (40.0%, 23.33%), and diabetes mellitus (6.67%, 33.33%) in OAHs and within family setup, respectively. It was observed that Diabetes Mellitus, hearing impairment, and difficulty in sleeping were more common problems among elderly staying in OAHs as compared to those staying within family setup.

The total WHOQOL-old score was 59.42 in the elderly staying in OAHs and 64.41 in elderly staying within family setup ( P > 0.05). The WHOQOL domain scores in terms of autonomy, past present and future activities, social participation and intimacy were comparatively more (60.62, 70.62, 66.14, and 58.43) in the elderly staying with family than those staying in OAHs (51.35, 62.91, 59.47, and 41.16). The differences between mean scores of two groups were statistically significant [ Table 2 ]. In WHOQOL domain Death and Dying, the mean score was higher (70.41) in elderly people staying in OAHs than in elderly people staying with their family (54.79). The difference between mean score was statistically significant ( P < 0.001). The GDS mean score was significantly more ( P < 0.001) in OAHs (5.76) than within family (3.96).

Quality of life of elderly assessed by World Health Organization Quality of Life.old module and geriatric depression scale

D ISCUSSION

So far, the health policies in India have focused mainly on maternal and child health, and very few polices exist for the support of elderly. There is a need for greater involvement of the government in geriatric care. More than half of the residents of OAHs in our study were above 75 years and widowed. Similar results were found in the studies conducted in OAHs in Ranchi by Panday et al . and Chandrika et al .[ 11 , 12 ] Thus, the elderly may have resorted to OAHs as they had no one to look after them at home after the death of their spouses.

In India, there is lesser awareness about the special needs of elderly and caretakers are yet to understand the basis of elderly care (physical, mental, psychological, and social support).[ 12 ] The study showed that the overall QOL of elderly staying within the family (64.41) is better than the elderly staying in OAHs (59.42). However, the result is not statistically significant; similar to the result found in the study conducted in Vishakhapatnam city.[ 12 ] The QOL in the family setup is significantly better in four out of six domains of the questionnaire. These domains assessed the ability to live independently and take decisions, satisfaction with life and having things to look forward to, ability to participate socially, and have intimate relationships. This difference may be due to care, love, and companionship offered by friends and relatives in family setup. Despite this, elderly in the family setup were more worried and had fears regarding death as compared to OAH residents.

On the contrary, some studies revealed that elderly living in OAH had higher QOL than family setup.[ 3 , 11 ] In our study, we found that there is no statistically significant difference between males and females in all domains of QOL except in the domain social participation similar to a study in Jammu[ 13 ] stated that females in family setup had a good QOL may be due to a positive attitude and good social relationship. On the contrary, the study conducted in rural Northern India reported that males had better QOL in the same domain.[ 14 ]

We found that 60% of the elderly in OAHs are depressed and have significantly higher GDS scores as compared to those in family setup. In family setup, males are significantly depressed than females, this could be due to females are engaged in household chores, rearing of grandchildren. Similar studies conducted in Hyderabad and Maharashtra[ 15 , 16 ] also revealed that geriatric depression was more in OAHs, ranging from 53.6%–60%. This could be due to loneliness after separation from family, poor health or due to adverse living conditions in the OAHs. The limitation of this study is it covers only one district, further multi-centric studies are required to determine the reason for this difference.

C ONCLUSION

The result of this study showed that the QOL of elderly was better within family setup as compared to elderly in OAHs. Elderly people in OAHs were significantly more depressed than elderly within family setup.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

R EFERENCES

• Open access
• Published: 19 June 2024

Does assistive technology contribute to safety among home-dwelling older adults?

• Mariya Bikova 1 ,
• Eliva Atieno Ambugo 2 ,
• Trond Tjerbo 3 ,
• Djenana Jalovcic 1 &
• Oddvar Førland 4  

BMC Health Services Research volume  24 , Article number:  750 ( 2024 ) Cite this article

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Metrics details

Assistive technology carries the promise of alleviating public expenditure on long-term care, while at the same time enabling older adults to live more safely at home for as long as possible. Home-dwelling older people receiving reablement and dementia care at their homes are two important target groups for assistive technology. However, the need for help, the type of help and the progression of their needs differ. These two groups are seldom compared even though they are two large groups of service users in Norway and their care needs constitute considerable costs to Norwegian municipalities. The study explores how assistive technology impacts the feeling of safety among these two groups and their family caregivers.

Face-to-face, semi-structured interviews lasting between 17 and 61 min were conducted between November 2018 and August 2019 with home-dwelling older adults receiving reablement ( N  = 15) and dementia care ( N  = 10) and the family caregivers ( N  = 9) of these users in seven municipalities in Norway. All interviews were audio-recorded, fully transcribed, thematically coded and inductively analyzed following Clarke and Braun’s principles for thematic analysis.

Service users in both groups felt safe when knowing how to use assistive technology. However, the knowledge of how to use assistive technology was not enough to create a feeling of safety. In fact, for some users, this knowledge was a source of anxiety or frustration, especially when the user had experienced the limitations of the technology. For the service users with dementia, assistive technology was experienced as disturbing when they were unable to understand how to handle it, but at the same time, it also enabled some of them to continue living at home. For reablement users, overreliance on technology could undermine the progress of their functional improvement and thus their independence.

For users in both service groups, assistive technology may promote a sense of safety but has also disadvantages. However, technology alone does not seem to create a sense of safety. Rather, it is the appropriate use of assistive technology within the context of interactions between service users, their family caregivers and the healthcare staff that contributes to the feeling of safety.

Peer Review reports

Introduction

In Norway, as well as in all industrialized countries, the proportion of people over 65 years and older is growing. By 2060, Norway’s population aged 65 years or above is expected to double [ 1 ]. Compared to previous generations, Norway’s population lives longer, is better educated, and has high expectations of a meaningful old age. Norwegian long-term care policy over the last decades has had a strong emphasis on enabling older adults to live at home as long as possible by expanding home-based services [ 2 ]. Adding to this, at least in recent years, there has also been a strong policy focus on active ageing, preventive health care, independent living and co-production of care services as a way of enhancing older persons’ quality of life and saving money on public care [ 2 , 3 , 4 ]. Nevertheless, the growth in expenditure on long-term care and on homecare has been substantial [ 5 ] and perceived as not sustainable by political authorities [ 6 ].

Assistive technology (AT) is presumed to have the potential to alleviate costs, compensate for the shortage of care personnel and at the same time support older adults’ quality of life [ 7 , 8 , 9 ]. According to the Norwegian governmental plan for the long-term care sector, the so-called ‘Care Plan 2020’, AT can improve users’ ability to manage their own everyday lives, increase the feeling of safety for users and relieve worries for their family caregivers [ 10 ].

To date, there is limited consensus on the definition and classification of assistive technologies, and terms like ‘welfare technology’, ‘telehealth’ and ‘telecare’ are often used interchangeably. In this study, we follow the World Health Organization’s definition of assistive technology as “the application of organized knowledge and skills related to assistive products, including systems and services” (11, page 6) and view assistive technology as an umbrella term for assistive products and their related systems and services [ 11 ]. Assistive products may be physical products such as wheelchairs, hearing aids, walking sticks, walking frames, alarm buttons and pull cords; or they may be digital and can come in the form of software, sensors and apps to support activities of daily life and communication with care personnel. Assistive products may also be adaptations to the physical environment, such as portable ramps or grab rails installed in different places in a person’s home [ 11 ].

In this article we compare two different groups of service users: home-dwelling older people with dementia and people who receive reablement at their homes, and ask how AT impacts their feeling of safety. The groups are chosen because of several reasons: these are two relatively large groups of service users in the Norwegian municipalities; the services they receive constitute considerable costs; both groups are in need of assistance to perform activities of daily living, and both are target groups for assistive technology.

Previous research shows that service users and their family caregivers perceive, experience, and define safety and the feeling of being safe differently. In their integrative review on older people’s perception of safety, Kivimäki et al. described safety as a multidimensional basic need of home-dwelling older adults with positive and negative aspects. Safety includes physical, social, emotional and mental, as well as cognitive safety [ 12 ]. AT can be considered as a component of physical safety, whereas home care services and trustful relationships with service providers are within social safety and emotional and mental domains, respectively. Cognitive functioning particularly of older people with dementia is part of cognitive safety that includes acceptance of one’s declining health and awareness of available help.

Both home-dwelling older people with dementia and older people who receive reablement need assistance, but the need for help, the type of help and the progression of their need for help differ; with people with dementia more likely to need more help given that, in addition to facing ageing-related limitations in activities of everyday living, they are also struggling with cognitive problems [ 13 ]. Older people receiving reablement, on the other hand, are likely to need less assistance for a half year period after the reablement training [ 14 ]. Knowledge about how AT impacts the feeling of safety among these two service groups will yield important information about the possibilities and limitations of AT and may better inform the design of policy and the provision of public services for these groups.

Dementia is a chronic progressive syndrome that causes gradual and irreversible loss of cognitive abilities such as thinking, memory, behavior as well as the ability to perform activities of everyday living; therefore, it entails increased need for support [ 15 ]. People who receive reablement, on the other hand, are recovering from health conditions that are not necessarily progressive or irreversible; as such, they are expected to need less assistance to perform activities of everyday living over time. These two groups are seldom directly compared despite the fact that they are two large groups of service users in Norwegian municipalities and constitute considerable costs. This article will contribute with new knowledge regarding similarities and differences in how AT is experienced by such huge, but nevertheless quite different user groups.

Research on service users’ and their family caregivers’ experiences with use and acceptance of AT is growing. However, methodologically, this research often focuses on one service group only and explores either how people with dementia relate to AT [ 7 , 16 , 17 ] or how recipients of reablement do so [ 18 ]. In fact, research on reablement users’ use of AT is scarce. To our knowledge, other studies do not distinguish between these two groups and often describe the service users in general terms or simply as older people with various health conditions and in need of assistance. However, AT serves different purposes for these two groups. While for reablement users, the aim is to regain functioning, for people with dementia, the aim is to maintain functioning.

In her realist evaluation of the implementation of telecare, and more particularly, alarm buttons, pull cords and sensors in a medium-sized Norwegian municipality, Berge [ 7 ] refers to the service users as “vulnerable” to emphasize their need of increased safety. However, she does not distinguish between the type of services her study participants receive (services for home-dwelling people with dementia, reablement or other services). Hence, even though the study asks for whom, where and when telecare works, by not making a clear distinction between the different types of service users and the differences in the progression of the users’ needs for help and AT, the findings do not allow a comparison of the different service groups. Such a comparison is important for better adaptation of the services for these two groups.

Although there is great optimism regarding the potential of AT to support older adults receiving care services at home, service users increasingly report ambivalence regarding its use [ 9 , 19 ]. Moreover, different studies show opposing results regarding whether older adults prioritize safety or independence. Robins et al. (2006), for example, found that older adults prioritize safety over independence and that the risk to their safety is a major reason for them to move out of their homes and into institutional settings. A fear of falling, especially when recently discharged form a hospital, is a major concern for home-dwelling older adults [ 20 , 21 , 22 ].

Other studies show that service users are more concerned with keeping their independence [ 23 , 24 ]. The relatives of home-dwelling older adults, however, are more concerned with the safety of their family members especially if the service users had dementia [ 7 , 25 ]. Berge [ 7 ] reported that for older people, the desire to remain living at their homes and the fear of falling were among the major motivating factors for accepting the implementation of AT. The relatives of the older people in Berge’s study felt safer knowing that their family members had AT and could contact the call center should something happen. However, they also reported that their family members preferred receiving home visits rather than relying on technology.

To summarize, research literature does not distinguish between different groups of service users when exploring service users’ and their family caregivers’ experiences with AT. Neither does research literature thematize how the use of AT impacts the feeling of safety among different service groups and the family caregivers.

Hence, this study seeks to answer the question: How does assistive technology impact the feeling of safety among home-dwelling older adults receiving reablement and dementia care, and their family caregivers?

Design and setting

The data analyzed in this article is collected as a part of a larger research project evaluating the ‘Care plan 2020’ [ 10 ] for the municipal health and social care services. The research evaluation of the ‘Care plan 2020’ examines how Norwegian municipalities are adapting to demographic changes in the society by looking at the following areas: (1) municipal investments in health and social care services, (2) municipal strategies and innovations for different forms of housing and (3) the effects of services for home-dwelling older adults with dementia and older people receiving reablement [ 26 ]. This article is part of component 3, which included 96 in-person interviews in seven Norwegian municipalities. Participants were home-dwelling service users ( N  = 25) and their own family caregivers ( N  = 9), healthcare staff ( N  = 48) and mangers ( N  = 14). For this article, we analyze the interviews with home-dwelling service users ( N  = 25) and their family caregivers ( N  = 9).

The study employed qualitative research design and data was gathered through individual face-to-face interviews with home-dwelling older adults and their own family caregivers. A qualitative design [ 27 ] was found appropriate given the study’s focus on an exploration of how assistive technology impacts the feeling of safety among service users and their family caregivers.

Data collection procedures

Inclusion criteria.

To ensure that the municipalities reflect the country’s diversity in terms of geography, size and population density, both smaller and bigger, rural and urban municipalities situated in different parts of Norway were selected. The most important selection criteria were that municipalities were taking part in one of the plans in the ‘Care plan 2020’, and had reablement services. We managed to get a diverse sample of seven municipalities that reflect the diversity of the country. Both urban and rural areas were included, as well as smaller and bigger municipalities from different geographical regions. The municipalities are kept anonymous to avoid the possibility of identifying respondents. Leaders of the municipal health and social care services in the seven municipalities suggested healthcare staff, who in turn, suggested participants for the individual interviews. The healthcare staff delivering reablement and homecare services to older people with dementia know the service users well and have the professional competence to assess whether the service users are able to provide informed consent or not. The staff’s expertise and knowledge of the users’ health condition was especially important in the recruitment of service users diagnosed with early stages of dementia to ensure that the participation was voluntary, and that informed consent could be provided.

Respondent recruitment

To be included in the study, individual participants had to be home-dwelling older people (age 65+) with early dementia diagnosis and able to provide informed consent. The other group of service users included in the study were home-dwelling older people (age 65+) receiving reablement care. Family caregivers of the respondents were also invited to participate in the interviews. Due to practical reasons such as not living nearby the service user, only few of the family caregivers were able to participate in the interview. Some of the service users in our study did not have family caregivers. Hence the smaller number of family caregivers in our selection.

Data collection

Face-to-face, semi-structured interviews were conducted individually with service users ( N  = 25) and their family caregivers ( N  = 9). The interviews were conducted in Norwegian language by the first and fifth authors, between November 2018 and August 2019 at the private homes of the service users. The duration of the interviews was between 17 min and 61 min. The overall theme of the interviews with service users and their family caregivers was their experiences with the homecare services, whether and to what degree they experienced the services as person-centered, well-coordinated and whether the service users could continue living at home with the services they were receiving. The interviews included also questions about safety and whether the provision, implementation and use of AT increased the feeling of safety. For the analysis in this article, we have selected data that focuses particularly on safety regarding the use of and experiences with AT among home-dwelling service users and their family caregivers (Appendix 1 includes the complete interview guide used in component 3 of the research evaluation of ‘Care Plan 2020’).

Characteristics of study participants are presented in Table  1 .

Data processing and analysis

The individual interviews with service users and their family caregivers were audio-recorded, transcribed verbatim, thematically coded and analyzed with NVivo 12 software by the first and fifth authors.

Thematic analysis

The data were analyzed following Clarke and Braun’s [ 28 ] principles for thematic analysis of qualitative data. The first, second and the fifth authors read the transcripts to familiarize themselves with the data. Next, they inductively generated and collated the first set of codes. These initial codes were organized under potential themes and collated within the identified themes. Then the first author reviewed the themes to identify those that were relevant for this study’s objectives. The first author again reviewed all the codes across the relevant themes with the purpose of identifying anew potential themes and subthemes. The second, third and fifth co-authors reviewed and approved the coding. The feeling of safety related to the use of AT emerged as a major issue in most of the interviews. Henceforth, analytic themes reflecting services users’ and their family members’ experiences with AT were developed. The study’s results are thematically organized and described in the sections that follow. Research ethics approval and consent to participate in this study are described under Declarations .

We first describe the types of technologies that the service users in this study are provided with and then introduce how service users and their family caregivers relate to these technologies.

Types of technologies

The reablement users in our study are provided with AT aimed at enhancing their recovery by making the activities of daily living more accessible. Among the AT provided to them were walking sticks, walking frames, assistive handles installed in the older person’s bathroom or other places in their home, shower chairs, but also personal digital alarms (pendants) to be activated in case of a fall or other emergencies. Many of the same AT were also provided to the service users with dementia, but in addition, the latter are provided with electronic calendars to remind them of the time and date, electronic medicine dispensers, stove guards and GPS. This finding is in line with findings from related studies from Norway [ 29 , 30 ].

The biggest difference between the two groups when it comes to the types of technologies is that the home-dwelling service users with dementia are equipped with more technologies to remind them to perform the activities of daily living (e.g., to wake up, eat and take medication), to prevent them from getting lost and utterly to help them maintain functioning and continue living safely at home; whereas service uses receiving reablement have more assistive devices to assist their mobility and help regain functioning while recovering safely at home. However, while most of the informants had been provided with several different assistive devices, in both service groups, one of these devices was the pendant. Hence, the majority of the service users in our study did have experiences with using a pendant.

In the sections that follow, we explore service users’ experiences related to the use of these technologies We focus particularly on the feeling of safety that AT creates for the service users and their family caregivers.

Experiences with use of assistive technology

The service users’ and their family caregivers’ experiences with AT are explored under the topic ‘Sense of safety related to the use of AT’, which has three major themes. The three main themes and their subsequent subthemes are presented in Table  2 .

In what follows, the main three themes with their subsequent sub-themes are illustrated with quotations from the interviews with service users and their family caregivers.

Theme 1: feel safe with assistive technology

This theme illustrates different scenarios where AT seems to enhance service users’ and their family caregivers’ sense of safety.

When asked whether they feel confident about continuing living at their own homes despite having conditions that require attendance, several of our informants replied positively. This was the case for both service users receiving dementia care and for service users receiving reablement. For both groups the sense of safety was partly connected to the fact that they had been provided with different types of assistive devices, including personal digital alarms (pendants), which they knew how to operate; and that they had experienced getting quick response from the response center when activating the alarm. In addition, having been provided with enough information about the use and functioning of the assistive device seems to give an extra sense of safety to the service users and their family caregivers.

Reablement users

A reablement user living alone, shares that he feels confident that he will get help in case of an emergency, because he has the pendant and knows how to use it:

I: What kind of support do you have if you suddenly get sick? U: I have a pendant. It gives me safety because I can quickly get help when using it. I: You have tested it already? U: Yes, I have. I: You have activated it? U: Yes, I have. And I do feel very safe living here (having the alarm). (reablement user 2, municipality 6)

Another reablement user, who had been hospitalized several times, shares that having the alarm makes him feel safe in his own home despite several occasions of serious falls:

U: Last year I fainted four times and this happened four days in a row. While sitting in my rollator, I collapsed and fell. I: Do you know whom you can contact or what you should do if your condition gets worse? U: I can push the alarm button and help will come. I feel completely safe with the pendant. (reablement user 1, municipality 7)

In addition to the pendant, this service user has been provided with a walking frame and a wheelchair that he uses in his everyday life to get the activities of daily life done. Falling seems to be a common situation for several of the informants in our study. Having been provided with an alarm, however, seems to give a sense of safety as another reablement user also reports:

I: What kind of support do you have in case you feel unwell? Or if the healthcare staff has not arrived yet? U: I have the pendant. I: You mentioned the pendant, but how safe do you feel living at home when having a pendant? And do you experience that the healthcare staff contribute to you feeling safe at home? U: Yes, because they have showed me how to use the assistive devices and this includes the pendant as well. I: So you do feel safe living at home? U: Yes, I feel safe. I: This is good to hear. And how have the last months been for you? Has anything new happened? U: In fact, I did fall at home, but this was before I got the alarm. It was after the fall I got the alarm. I: What other assistive devices have they equipped you with? U: I have special handles several places in the house. I have a special chair to sit on when showering. I do not have a tube anymore. And I have a rollator. Sometimes I use a walking stick. (reablement user 1, municipality 5)

Dementia users

Also the service users receiving dementia care report feeling safe living in their homes when being provided with assistive devices such as pendants, which they know how to operate and experienced getting help when they used it. This is what a service user with dementia shares about living alone at her home:

U: I feel very safe when I have this (shows the alarm). It was me who asked for an alarm and now I feel very safe knowing that I have it. I: And you just need to push the button …? U: In case I fall, which has happened many times, it starts beeping and then they (the healthcare staff) come in a short time. (dementia user 1, municipality 5)

The interviews with service users and their family caregivers show that it is often the family caregivers, and especially the family caregivers of persons with dementia, who request AT. This is because the technology gives a sense of control, and hence safety and a relief, to them as well. The daughter of one of the home-dwelling service users with dementia shares that in addition to the pendant, she has required a GPS for her father (family caregiver of dementia user 2, municipality 7). Another family caregiver, a spouse of a home-dwelling person with dementia, shares the following about his wife having the alarm:

C: We have applied for alarm, and I am sure we will get one. It is safety both for her and for me. Yes, it is a safety. Because when I am not at home, I always wonder where I will find her when I come back home from work. Is she visiting somebody, is she sitting in her chair, or has she had an accident and is lying on the floor? I worry a lot about this. (family caregiver of dementia user 2, municipality 6)

Theme 2. Feel unsafe with assistive technology

Having the knowledge of the functioning and use of assistive technology does not necessarily create a sense of safety for service users. In fact, being aware of the limitations of AT, such as the limited scope of range of the pendant, can bring a sense of anxiety. The discussion between a reablement user and his wife illustrated with a quotation below, shows some of the challenges related to the use of technology. The user reports that he feels safe when he is at home, but seems at the same time dependent on his spouse being around:

U: But what if I don’t reach the device? C: Well, you have put it on your wrist. U: Yes, but what if I am outside the house and I need help? C: Then you have to cry for help. U: But there is nobody nearby! C: Well, the neighbors may hear you, if they are at home. I: If I understand you correctly, you do not feel very safe outside the house, because the alarm only works within the house. But what about when you are inside the house? Do you feel safe? U: Yes, I do feel safe at home. C: Yes, he does. And then you have both me and the alarm. As long as we last (caregiver laughs). U: But what if something happens with me while you are doing the groceries? It may take some time before you are back from the groceries. C: Well, then you must remember to wear the pendant alarm. U: Ok, but what if it is not nearby? C: You have to remember to have it nearby. U: But what if you haven’t planned to go to the shop and I haven’t put on the alarm? (reablement user 1 and family caregiver, municipality 1)

The service user has been receiving reablement care after prolonged hospitalization and has been provided with a pendant that he is instructed to wear on his wrist. However, he forgets to wear the alarm, especially when he is at home, and is thus dependent on his wife reminding him wear the pendant or her being around. Later in this interview when asked whether he will be able to continue living at home with the services he receives, the user states that he would not be able to do so without the help from his wife. It seems that technology limits the user’s possibility to explore and use the physical space around his own home due to the technology’s limited scope of functioning.

Awareness of how one’s own physical or cognitive limitations may hinder an optimal use of the technology adds to the service users’ worries about own safety related to the limitations of the technology. Another of the reablement user in our study (reablement user 1, municipality 3) shares that she experienced falling outside her house and been unable to use the alarm since it only works inside the house. Luckily for her, she was discovered by construction workers who helped her up. Shortly after, the homecare service arrived as well. To our question whether she felt confident to use the alarm in case of an emergency, the user answered that she will be able to use the alarm if she is not dizzy or confused because of the fall.

The dementia users in our study report that they often forget to use assistive technology, or they forget that they have it at all. This is the case especially when technological devices such as pendants do not make any sounds unless activated. Other users report putting the assistive devices in drawers to avoid the sound the devices make and then forgetting about having the device. The following quotation from an interview with a service user and their family caregiver shows some of the challenges service users with dementia experience in handling the technology:

I: Whom do you contact in case you feel unwell or need some help? C: She has the alarm. U: Yes, I have the alarm. C: Even though she once fell and hurt herself, she did not release the alarm. But I do not think that the alarm would have helped her anyway. I: Why wouldn’t it? C: She did not manage to release the alarm. I: Is it because you did not reach the alarm? U: I forgot having the alarm. But I did call my daughter and she came quickly. They were just around the corner, doing groceries, and by the time she came, I have managed to get myself up. Had I only managed to push the button…. C: It would have been better if they did not have to remember releasing the alarm, if falls were registered by some kind of sensors. (dementia user 1 and family caregiver, municipality 1).

Theme 3: feel safer with AT when someone attends to the user

The fear of falling and not being discovered is a common source of anxiety among the service users in our study as demonstrated in previous sections. This is especially the case for service users with frail health who have already experienced fractures due to falling and/or other conditions that have required hospitalization. The interview below illustrates such a situation. The reablement user lives with his spouse and despite being provided with a walking stick, walking frame and a pendant alarm, the user is very much dependent on help from his wife:

I: Do you feel you can live an independent life with the help you receive from the municipality? U: Yes, if I do not fall again. I: If you do not fall again? U: If I fall, I would not be able to get up without holding to something. I am that weak. I: Now that your wife is here and can help you…. U: Yes, she has lifted me several times already. I: But what if she is not around? U: I do not know what I would have done without her, she is amazing. [….] C: You have the alarm, but…. U: Yes, but how much time does it take before they arrive, I do not know. (reablement user 2, municipality 2)

Some of the service users in our study report that having someone to contact in case of emergency is more important to them than having AT. This is often related to their deteriorating health and weakened ability to use the technology. Service users and caregivers who know whom to contact in case of need, report feeling much safer should an emergency occur, regardless of whether they have the pendant or not.

When asked how safe he feels in his own home, one of the reablement users in our study stated that he needs someone to call to and that the alarm is not really a device that he relies much on:

I: How safe do you feel in your own home? U: Safe? Well, the thing is that we do not have a person to call to in case of emergency. We do not. We do have the alarm, but I have no idea of how to use it. I know the emergency number. And we have called this number several times with help of the homecare services. (reablement user 3, municipality 5)

For other informants in our study, having someone who attends to them is what gives them a sense of safety. This is especially the case for older people living alone, as seen in the interview with this reablement user:

U: Well, I told the homecare staff, that I would rather have someone who can assist me with things and teach me things. Or just go out for a walk. And now I need somebody I can support myself to when going to the shop. But I do not have anybody, and I still do the groceries alone and use a walking stick even inside the house. When I go outside, I use two walking sticks. This is what I have been offered. (reablement user 2, municipality 7)

This service user shares that she has been living alone for a very long time. Her husband passed away many years ago and she has no children who can visit her and assist her with practical matters. Loneliness seems to be an issue for this particular user and for other participants in our study, and it is an issue that is not easily dealt with despite the availability of AT.

Knowing that someone is attending to the service user, even when the service user is equipped with a number of assistive devices, seems to be of particular importance especially for the family caregivers of home-dwelling older people with dementia. The service user mentioned in the quotation below, is equipped with an electronic medicine dispenser, stove guard, electronic calendar, pendant and a GPS. The family caregiver of this service user has experienced that her mother forgets taking her medication despite being provided with AT to remind her doing so. The family caregiver shares the following:

C: What makes me safe, and I have tried to explain this to my mother, is that when I go to work every day, it is good to know that someone is attending to you [speaks directly to the service user]; that someone checks on you and makes sure that you have taken your medication. It is a bit safer for me to know that someone has visited you. (dementia user 1 and family caregiver, municipality 2)

In the larger context of promoting independent living in one’s home for as long as possible, the different situations, in which home-dwelling service users with dementia, reablement users and family caregivers of these two service groups feel safe, unsafe or safer when provided with AT may have important implications for the service delivery to these two service groups.

Our findings indicate that even though most of the service users in our study had been provided with a number of different assistive devices, such as walking frames, rollators, medicine dispensers, GPS and others, when asked whether they felt safe continuing living at their homes, the majority of them would refer to the pendant as a source of safety or unsafety. Both the reablement users and home-dwelling older people with dementia felt safe when they knew how to use the alarm. The knowledge of the application of technology was related to the fact that the service users had either tested the alarm or released the alarm and experienced getting help. It seems that the experience of getting in contact with somebody who can provide help gives a feeling of safety for both groups of service users. The family caregivers felt also more at ease knowing that their family members can operate the technology. This finding is in line with existing related research on use of AT. Berge [ 7 ] for example, shows that some users experience the intended effects from telecare, such as increased safety; and that it is contextual factors such as the sense of control when living at home or the threat to their safety when living alone, that influenced how people reasoned about the implementation of telecare. However, while Berge [ 7 ] does not distinguish between different types of service users, our study shows that both home-dwelling service users with dementia and reablement users may benefit from AT as long as they know how to properly use the technology. A possible policy and service delivery implication of this finding is that providing service users and their family caregivers with timely information about the functioning of AT and ensuring that service users have tested the technology may increase their confidence in using AT, which in turn, may have a positive impact on their sense of safety continuing living at their homes.

Having the knowledge of the use and application of AT is not enough to create a feeling of safety. In fact, for some users, the awareness of the limitations of the technology, sometimes combined with an awareness of own physical and/or cognitive limitations is a source of anxiety, especially when the service user has experienced these limitations. These are situations when the service user has fallen and not been able to contact the call center due to the technology’s limited scope of functioning or due to own physical limitations. For some users even the awareness that this may happen seems to be a source of anxiety and a reason to feel more dependent on their family caregivers.

Furthermore, several of the service users in our study expressed that they would feel much safer if somebody attended to them, and that they needed more human interaction. This finding corroborates findings of other research that describes safety as multidimensional, and in which social as well as emotional and mental safety are linked positively to the availability of home care and developing trusting relationships with healthcare staff [ 12 ].

Characteristics associated with ageing such as retirement and loss of the workplace as an arena for physical and social participation, as well as chronic illness and functional limitations, can impose constraints on physical and social engagement [ 31 ]. Hence, older people and other impacted groups can be exposed to loneliness and other unfavorable consequences. For some of the informants in our study, especially those with reduced opportunities for social interactions with family and friends, AT, while potentially helpful in maintaining or regaining their functioning, might threaten the few opportunities one has for needed human interaction.

The need for more human interaction despite the availability of AT and despite the users’ having knowledge of the use and functioning of AT shows the limitations of AT and may be seen as an unintended consequence of the living-at-home for as long as possible political ambitions. The need for more human interaction was expressed by both the service users and their family caregivers. Knowing that somebody is attending to the service users seems to be of particular importance especially for the family caregivers of service users diagnosed with dementia. This is also in line with prior research showing that family caregivers worry about the safety of their family members especially diagnosed with dementia [ 32 , 33 ]. Our findings indicate that it is often the family caregivers who request AT for their family members who suffer from dementia. Even so, they recognize that technology is not enough to keep the user safe in their own home.

To summarize, home-dwelling older adults receiving reablement and dementia care at their homes are two major target groups for assistive technology in Norway. This is related to AT’s promise of enabling older adults to live at home for as long as possible and thus alleviating public expenditure on long-term care. However, the two groups reflect two crucial differences in adaption and use of assistive technology. First, while we can expect that the use of AT will increase over time for the dementia group, the purpose for the users receiving reablement is that the need for and the use of AT will decrease over time. Assistive technology and services serve different purposes for the two groups. For the former group, the aim is to regain functioning, while maintaining functioning is key for the latter. However, what both groups have in common, is the need to feel safe at home.

To even better understand these findings, we draw on perspectives from Actor-Network Theory (ANT) – a theoretical framework within Science and Technology Studies (STS) developed by Latour [ 34 ]. Deploying the concept of ‘actant’, we understand assistive technology not as a neutral tool, but rather as an agent that influences the relations between service users and their environments. In ANT, an “actant” is an entity, whether human or not, that plays a role in a network. Actants can be individuals, groups, objects, ideas, technologies, institutions, or any other element that contributes to the formation and functioning of the network. Actants are considered to have agency and be able to influence the network. As seen in the interviews, the assistive technology does play an important role in the everyday lives of the service users and their family caregivers. The aim of the assistive technology is to increase older people’s sense of safety at home. Rather, as we demonstrate in our analysis, technology may have a limiting effect on the everyday life of the service users and their family caregivers. For example, because of the alarm’s limited geographical reach, some of the service users in our study felt anxious and were staying at home, rather than interacting more actively with their environment. Also, the family caregivers of the service users were indirectly restricted by the limitations of the technology as they must plan their own daily routines, such as doing the groceries, in order not to be away from the user for too long. In such cases, technology seems to have power over the service users and their family caregivers, rather than vice-versa. Hence, an unintended consequence of technology if not adapted properly to the specific needs of the user group, may be an increased dependency on the family caregiver and/or sense of unsafey and even anxiety around the use of AT.

Methodological considerations

It is a strength that the selection of municipalities differ in terms of size, geography, urbanicity etc. This study was part of a larger research project evaluating the Norwegian Government’s Plan for the health care sector, (‘Care Plan 2020’). The use and acceptance of AT among home-dwelling older adults was one of many different topics we inquired into during the interviews with older adults and their family caregivers. Our findings therefore lack the depth and specificity that in-depth interviews on the topic of use and acceptance of assistive technology could have provided.

The municipalities included in this study were sampled from a list of municipalities that took part in projects for developing services for people with dementia living at home and municipalities that have developed the service reablement care. It is therefore possible that the municipalities in our sample have had particularly strong focus on developing primary care services, of which reablement care and dementia care are part of. Further, due to local variations in the provision and implementation of AT in Norwegian municipalities, we caution against drawing strong conclusions from our findings.

Our data was collected between November 2018 and August 2019 and analyzed at a later point in time. We therefore recognize the fact that new types of AT for home-dwelling older adults might have been developed and offered to the study group of individuals that our study focus on.

For both groups successful use of AT has the potential to significantly reduce overall costs, improve the quality of life for the user and provide a sense of relief for the family caregivers of the users. However, AT alone does not seem to create a sense of safety. Rather, it is the appropriate use of AT within the context of the interactions between service users, their relatives and the healthcare staff that makes people feel safe. Moreover, there are some important differences between the two service groups regarding the progression of their need for AT, the purpose of providing AT (maintaining vs. regaining functioning) and hence need for re-adapting AT to these two service groups. For service users with dementia, AT may help the older person live longer at home thereby postponing institutionalization, given that the user feels confident handling the technology and that technology is timely re-adapted to the user’s changing needs. For reablement users, on the other hand, given that the purpose of providing the user with AT is regaining functioning, providing the right type of technology and then adapting it to the user’s changing needs may be a way of enhancing their safety and recovery. Municipal assistive technology services for older people should therefore be adaptive to differences in needs among different user groups.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We would like to thank the following individuals for their support: the service users and their family caregivers whom we interviewed, without whom this study would not have been possible; and our colleagues Imran Dar and Rina Moe Fosse for their support during the earlier stages of this work.

This study was supported by funding from the Norwegian Research Council (grant #2726709) as part of the research project evaluating the Norwegian Government’s plan for the health care sector, ‘Care Plan 2020’ (Resultatevaluering av Omsorg 2020) The views expressed in this article are solely the authors’ and do not represent the views of the funding agency.

Open access funding provided by Western Norway University Of Applied Sciences

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Mariya Bikova & Djenana Jalovcic

Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Vestfold, Norway

Eliva Atieno Ambugo

Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway

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MB, EAA, and OF conceptualized and designed the study. MB, EAA and TT gathered and managed the data with support OF. MB and EAA analyzed the data. MB drafted the manuscript with contributions from EAA, OF, TT and DJ. All authors critically reviewed and approved the final manuscript.

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The project was reviewed by the Regional Committees for Medical and Health Research ethics (REK) of South-East Norway (2018/1108/REK sør-øst C, 27.06.2018). The committees then concluded that the project did not fall under the Health research law, and that it could be carried out without approval from the REK Committee. Thereafter, on 17.08.2018, the project was approved by the Norwegian Center for Research Data (ref.nb. 304080) – which has the ethics/IRB capacity to approve studies, such as this one, on humans. All methods used in the study were carried out in accordance with relevant guidelines and regulations. All participants agreed to participate in the study and signed an informed consent form before data collection. The consent form included a description of the study and its aims, and of the participants’ involvement and their rights. All participants approved of their interviews to be audio recorded.

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Bikova, M., Ambugo, E.A., Tjerbo, T. et al. Does assistive technology contribute to safety among home-dwelling older adults?. BMC Health Serv Res 24 , 750 (2024). https://doi.org/10.1186/s12913-024-11185-8

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A study of dementia in old age homes

Affiliations.

• 1 Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.
• 2 Department of Psychiatry, Base Hospital, Delhi, India.
• PMID: 34908681
• PMCID: PMC8611600
• DOI: 10.4103/0972-6748.328806

Background: By 2040, dementia is projected to rise exponentially by 300% in India. Studies addressing the need for psychiatric care in the community being few and those focusing in old age homes even fewer, a study was undertaken to study the prevalence of dementia and the association with sociodemographic factors and psychiatric morbidity.

Materials and methods: A total of 558 elderly aged 60 years and above, residing in old age homes in Pune were studied. 179 inmates were included based on the inclusion and exclusion criteria. Those who scored a predetermined cut-off score on the screening tool were included to undergo a detailed physical and neurological examination, cognitive profile using subtests from the cognitive test (community screening instrument for Dementia of 10/66 group).

Results: Mean age of the sample was 75.02 years majority (39.7%) was in the 60-70 years group. Males 25.7% versus females 74.3%. The sample consisted of the following socioeconomic groups: 40.2% middle, 26.3% low middle, 24% high middle, 8.4% high income, and 1.1% in low income. 60.3% widow/widower category, 36.3% never married, 4.5% had family history of dementia. Mean scores of mini mental state examination in the overall sample was 26.02 compared to 18.02 in those cut-off point of 23. The prevalence of dementia in the sample was 22.9%. There was the high prevalence of psychiatric symptoms and psychiatric morbidity in the dementia group than the rest. Frontal lobe dysfunction and impairment of orientation with increasing severity of dementia were observed.

Conclusions: Sociodemographic factors, which were considered protective against the prevalence of dementia, identified were less restriction in physical activity and having fish in the diet regularly.

Keywords: Co-morbidity; dementia; old age homes.

Copyright: © 2021 Industrial Psychiatry Journal.

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Conflict of interest statement

There are no conflicts of interest.

Family history of dementia and…

Family history of dementia and presence of dementia

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Elderly Living in Old Age Homes-a study in some Old Age Homes of Manipur, India

Background: Old age was never seen as a problem in India. But recently ageing issues have begun to emerge as a case of social concern. Demographic, socioeconomic and structural challenges are also taking place within the family institutes. India is now facing a unique situation in providing care for the elderly section and old age homes is one of alternate care facilities. Thus studying elderly in old age homes has become a significant area of social research. Objectives: The study aims to examine the socioeconomic profile of elderly who are living in four old age homes in Manipur, India. It also probes into the factors that have compelled the elderly to stay in these institutions as well as examine the facilities available in the old age homes. Material and methods: The paper is based on the study conducted in different old age homes of Manipur by taking a sample of 69 institutionalized elderly. The data was collected using a specially designed interview schedule and observation technique. Results: The study reveals that majority of the respondents are females (75.36%) and are hailed from rural areas (66.66%). Regarding age distribution, more than half of the respondents (52.17%) are aged between 70-79 years and majority (69.56%) of them belongs to OBC category. Majority of them (76.81%) are widowed, follows Hindu Religion (66.66%), 55.07% of them are illiterate. 68.11% of them came from nuclear family and earlier doing business, followed by agriculture. The most common reasons for shifting to old age homes were verbal abuse of daughter in law, financial constraints , verbal abuse of son, nobody to look after, physical abuse, tarnishing self-respect, health issues and many more. Majority of the respondents are satisfied with the facilities provided by the institute but there are rooms for improvements in many ways.

Related Papers

shamsi akbar , Rakesh Tripathi , ambrish kumar

Background: Now-a-days, almost all the old age homes (OAHs) in India are fully occupied with residents. Why Indian elderly have to reside in old age homes? It was explored during the Ph.D. study titled „A Study of Psychiatric Morbidity, Quality of Life and Expectations of Inmates of Old Age Homes in Northern India‟. The object of this study was to explore the factors compelling elderly to reside in old age homes. Methods: This study was carried out on 174 elderly residing in 14 different OAHs of Uttar Pradesh, India. Factors responsible for their settlement in OAHs were explored using interview method. Results: Misbehaviour of son and daughters-in-law (29.8%) was found to be most common reasons for residing in old age home. Conclusions: Many elderly in India are opting OAHs as their place of stay in their later life. Foreseeing the future the government and voluntary agencies in India must make arrangements for institutional support and care for the elderly.

Manjunath S Mokashi

A study of factors compelling elderly to stay in old age home with special reference to Kundapur city old age homes Abstract Government endeavors are expanding quickly in the field of contemporary, social, financial, open interest and different components to lessen abuse against the old age people. However, in the present time, the circumstance against the old people is evolving,individuals have begun despised them, they strongly made them to move from their own particular homes. Because of this they get to be destitute and may move to old age homes. This article depends on the different requests of old age people.The object of this study was to explore the factors compelling elderly to reside in old age homes. This article has been taken from a old age homes of Kundapur city Udupi district.

International Journal of Indian Psychology

shamsi akbar

Background: Now-a-days, almost all the old age homes (OAHs) in India are fully occupied with residents. Why Indian elderly have to reside in old age homes? It was explored during the Ph.D. study titled ‘A Study of Psychiatric Morbidity, Quality of Life and Expectations of Inmates of Old Age Homes in Northern India’. The object of this study was to explore the factors compelling elderly to reside in old age homes. Methods: This study was carried out on 174 elderly residing in 14 different OAHs of Uttar Pradesh, India. Factors responsible for their settlement in OAHs were explored using interview method. Results: Misbehaviour of son and daughters-in-law (29.8%) was found to be most common reasons for residing in old age home. Conclusions: Many elderly in India are opting OAHs as their place of stay in their later life. Foreseeing the future the government and voluntary agencies in India must make arrangements for institutional support and care for the elderly.

QUEST JOURNALS

There has been a rapid ageing of the earth's population and in a few decades, Asia could become the oldest region in the world. In India, due to the reorganization of the family system, the traditional joint family system is on the decline. Due to the emergence of the nuclear family and the high cost of living, family members who previously cared for the elderly need to find employment outside the home. A rapid increase in nuclear families and an exceptional increase in the number of 'older adults' in the country have compelled them to live in old age homes. Literature has accentuated the difficulties and apprehensions experienced by older adults during the ageing process and the need for old age homes in order to create an environment that fosters a meaningful existence for them in their twilight years. India's old age homes are trying to uphold the needs, desires and values of older adults. There is a lack of studies that attempt to give older adults a chance to communicate their experiences in a care home. Older adults are an invaluable resource for younger generations and change is needed in society's attitude towards ageing. This review can help psychologists, social workers and caregivers gain insight into the needs of older adults in terms of mental wellbeing, economic and social security and elder abuse and create awareness among the people.

isara solutions

International Res Jour Managt Socio Human

There has been a progressive increase in both the number and proportion of the aged in the World and also in India over time, particularly after 1951. India has acquired the label of “An ageing nation” with 7.7% of its population being more than 60 years old. The longer life expectancy and their higher number per 1000 males is showing increase in population of elderly females. With an increase in the geriatric population and an expected decline in the Population of the middle aged, the burden of care giving is bound to increase and lead to some unforeseen problems, one of them being institutionalization of elderly thus giving the concept of old age homes. It should be noted that the proportion of 60+ female populations is invariably higher than that of the male population. By the year 2025, the male and female population will be 11.9% and 13.4% respectively, and by the year 2050, the comparable figures will be 20.2% for males and 22.4% for females. This is because of in the higher life expectancy of females compared to that of males.

Journal of Politics and Governance

Hakim Singh

Atlanta Talukdar

IJIRT Journal

With the disintegration of the Joint family system in India to nuclear family system, at both rural and urban levels, the care and the responsibility of the aged in the families has reduced. This lack of personal care and loneliness in the family has led the elderly of the family to constant search for new forms of care. Factors like Urbanisation, Modernisation, Good employment opportunities have altered the traditional roles of elderly in the society and in the family as well. As a result of the same, the provision for the care of the elderly is increasingly being passed on to the institutionalised caring. Thus the concept of Old Age Homes came into existence. Majority of the elderly people who do not have any security or are widowed or are abused or disrespected by their own family members take shelter in old age homes in the hope of getting social and familial environment. There is a large no. of financially and physically fit elderly that find an old age home as their last home for their emotional, physical and psychological well being.

MANTHAN: Journal of Commerce and Management

Rohini Sudhakar

Globalisation has resulted in increased mobility of people for pursing their profession, which in turn, has caused the society getting used to living in small unit nuclear families. Focus group discussion with the residents of Old Age Home. An increasing number of senior citizens are now staying in residential old age homes that are designed to cater to the needs of the aged. Most of these old age homes provide help with personal care and hygiene, meals, social interaction and bedside care. This paper is based on a series of Focus group discussions (FGDs) that were held with the senior citizens of Mumbai to know their views on various aspects of elderly life especially regarding the alternative arrangement for aged, that is, old age homes. On the basis of the study, it was generally seen that elderly people who are very sick or dying prefer to stay in their own homes. Moreover, if the aged person stays in the home, it is cost-effective for the family members too. In this situation, ...

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June 24, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

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Older Americans in senior housing have better health than those living at home, study finds

by Dennis Thompson

Independent living is important for seniors, but a new study shows it might not be the best thing for their health.

Older adults living in senior housing tended to have better health than those who remain in their own homes, researchers found.

People in senior housing are less vulnerable to illness and accidents, receive more health care at home and live slightly longer than older adults who remain out in the community.

Overall, aging folks who move into seniors housing are less likely to need hospitalization, particularly for injuries, hip fractures, wounds, COPD, dehydration or urinary tract infections.

"Senior housing residences can be a center for wellness and healthy aging for older adults, with positive outcomes for those who call it home," said Ray Braun, CEO and president of the National Investment Center (NIC) for Seniors Housing & Care.

For the study , researchers with NORC at the University of Chicago tracked common high-cost health problems among seniors.

They compared older adults who moved into senior housing communities starting in 2017 to a similar group of seniors who kept living out in the community.

"Senior housing operators effectively manage residents' health and lower adverse patient safety events, particularly when older adults move in and are more vulnerable, but more can be done to keep residents healthy while reducing health care spending," Lisa McCracken, NIC's head of research & analytics, said in a news release.

The researchers did find that senior housing residents were more likely to visit an ER, "which may be driven by regulatory requirements or being overly cautious in response to an incident such as a fall," McCracken noted.

Further, both groups had similar rates of hospitalization due to falls , high blood pressure , pneumonia and uncontrolled diabetes.

Other research from NIC and the University of Chicago have found that older adults who live in senior housing communities are less frail after moving into a supported setting. They also receive more care from specialty providers like podiatrists, cardiologists and psychiatrists.

Further research aims to estimate the cost savings to Medicare of senior housing, as well as identify the best practices from some of the top senior housing communities.

"With thousands of aging older adults expected to move into senior housing in the near future, there is a substantial opportunity for senior housing to partner with health care payers and providers to improve the lives of older adults," Braun said.

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Watching my mom disappear from view was one of the hardest things both my sister and I could ever imagine. And though there were moments of light (she sang along with Sinatra tunes even when she could no longer speak), those final years do often haunt me. Both as to the past and the possibility of my own future.

Robert S. Nussbaum Fort Lee, N.J.

The beautifully written and supportive essay by Stephen Gettinger about his mother’s journey with Alzheimer’s and his own diagnosis should be read by all families and patients facing this debilitating disease.

We are all facing the “end of life” from the moment of our birth, but with each new arthritic joint, loss of hearing a high note or forgetting a name, the reality of our situation comes increasingly into focus. Adapting and planning are crucial for ending life with equanimity.

I strongly recommend the tools so well assembled by the organization Compassion and Choices . In particular, working through the details necessary to make your wishes known while you still can (if you are facing dementia) could be one of the greatest gifts you could give your family.

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Watch CBS News

Arrests made after 12-year-old Houston girl found dead in creek; one suspect allegedly tried to escape off balcony

Updated on: June 21, 2024 / 7:52 AM EDT / CBS/AP

Two men who were seen on surveillance footage with a 12-year-old girl before her body was found in a Houston creek earlier this week were arrested Thursday in her death, police said. One of the suspects tried to jump off a balcony and escape before officers caught him, a neighbor told CBS affiliate KHOU-TV .

Johan Jose Rangel Martinez, 21, and Franklin Jose Pena Ramos, 26, each face a charge of capital murder in the killing of Jocelyn Nungaray, police said. The medical examiner has determined that her cause of death was strangulation.

It was unclear if the two suspects had attorneys yet to speak on their behalf. Their names were not listed in jail or court records as of Thursday afternoon.

Jocelyn's body was found in the shallow water of a creek early Monday morning. Police have said that she sneaked out of her nearby home the night before.

Police said that surveillance footage showed the men meeting up with Jocelyn before walking to a convenience store with her.

We've learned more about the guys charged with capital murder in a Houston girl's death. Neighbors told us the men liked to sit on their balcony and yell things at women passing by. @AnayeliNews   https://t.co/XloHx3kJ0N — KHOU 11 News Houston (@KHOU) June 21, 2024

The three then walked to the bridge together where Jocelyn was killed, police said. It was not known yet if Jocelyn knew the men, who were roommates, police said.

Police said the results of a sexual assault exam on the victim are pending.

Police on Tuesday had released photos from the surveillance footage of the two men, who were called persons of interest at that time.

Neighbors at the complex where the arrests were made arrived at about 4 a.m. and used a loudspeaker to order the men to come out, KHOU-TV reported. When they didn't, officers approached the second-floor apartment with their weapons drawn. 

A neighbor told KHOU-TV one of the suspects tried to jump off the balcony to get away but officers had the place surrounded and they quickly grabbed him.

Residents told the station that Ramos and Martinez often sat on their balcony and yelled at women who passed by. 

Forensic investigators were seen removing boxes of evidence from the apartment on Thursday, KHOU-TV reported.

Acting Houston Police Chief Larry Satterwhite said the department worked around the clock to identify the killers and begin the process of finding justice for Jocelyn and her family.

"Their hard work paid off. We were able to find video and trace the movements of the suspects and Jocelyn, all the way to the bayou where she was murdered," Satterwhite said.

Jocelyn's mother,  Alexis Nungaray , described her daughter as spunky, goofy, and loving, KHOU-TV reported.

"I'm, like, angry that they took advantage of her. She was so young. She was 12, you took my baby away, you took her away," she said.  "Now, I get to let her little brother know his older sister is never coming home."

More from CBS News

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4th teen girl pleads guilty in "swarming" killing of homeless man

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Friday, 28 June

'He was not a violent person': Second elderly accused in old age home murder case dies in custody

A man in his nineties, who was accused of fatally assaulting a fellow old age home resident who was 80, has died in custody.

He is the second accused to die within a week, after his 75-year-old co-accused also died before they could have their day in court.

The two men were alleged to have beaten up fellow old age home resident Godfrey Temu, 80, who had apparently bumped into one of the accused.

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Gardening Keeps the Brain Healthy in Old Age, New Study Shows

Gardening isn’t just about nurturing old plants. It’s a hobby that can also keep your brain sharp as you age, according to a recent study.

Researchers from Edinburgh University followed hundreds of Scots over nearly a century, tracking their lifestyles. They discovered that gardening could potentially guard against dementia even past the age of 80, irrespective of a person’s wealth or education.

Published in the Journal of Environmental Psychology , the study suggests that the mentally stimulating aspects of gardening, which haven’t yet been fully explored, might help maintain brain function into old age.

Digging, planting, and weeding enhance brain health

Alzheimer Scotland responded positively to the study’s results, describing them as encouraging.

Gillian Councill, the charity’s executive lead on brain health and innovation, highlighted the diverse benefits of gardening. She pointed out that activities like digging, planting, and weeding can improve hand strength, which research indicates can also enhance brain health. Additionally, growing one’s own food supports a healthier diet , another crucial factor for overall well-being.

Councill also emphasized the social aspects of gardening, noting that community allotments provide opportunities for socializing and reducing feelings of loneliness and isolation. This is beneficial for brain health.

#Gardening keeps the brain healthy in old age.. Digging, planting & pulling weeds will increase hand strength, can boost brain health. Growing your own food can help you eat a healthier diet.. Research by Edinburgh versity– published in the Journal of Environmental Psychology pic.twitter.com/rGVhdO7Gqm — Ch.M.NAIDU (@chmnaidu) June 24, 2024

The research team collected data through a long-term study on brain function known as the Lothian Birth Cohorts.

In 1921, children in and around Edinburgh took an intelligence test at age eleven to assess their reasoning and math skills. Many years later, around the turn of the century, hundreds of these individuals were tracked down and re-tested with the same quiz at age 79. They also provided information about their lifestyles and underwent regular assessments of their brain health until they reached 90 years old.

Out of the 467 people studied, nearly 30 percent had never gardened, but 44 percent continued to garden regularly, even in old age.

The findings revealed a clear pattern. On average, the 280 individuals who gardened frequently or occasionally showed better cognitive abilities in old age compared to when they were eleven years old.

In contrast, the 187 individuals who had never gardened or did so infrequently tended to score lower on the test than they did as children.

Dementia affects nearly 100,000 Scots

Dementia is a condition in which the brain irreversibly deteriorates, leading to difficulties in memory, concentration, and problem-solving.

Currently, nearly 100,000 people in Scotland are affected by dementia , and it accounts for 13 percent of all deaths, according to Daily Mail .

Unhealthy lifestyles can increase the risk of developing dementia, but keeping the brain active and ensuring adequate sleep are believed to help delay its onset.

Dr. Janie Corley, the study’s lead author, noted that the relationship between gardening and healthy cognitive aging has largely been overlooked.

She added, “Engaging in gardening projects, learning about plants, and general garden upkeep, involve complex cognitive processes such as memory and executive function.”

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