Comparative study on psychosocial stresses among urban and rural geriatric population in selected areas of district Ludhiana (Punjab),2006.

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1 Comparative study on psychosocial stresses among urban and rural geriatric population in selected areas of district Ludhiana (Punjab),2006. Manpreet Kaur, Amandeep Kaur, Amandeep Saggu, Amanpreet Kaur, Amarpreet Kaur, Arundeep, Davinder Kaur, Bindia Sood, Sukhdeep Kaur Abstract : Life stress is a product of change that occurs in one's life that requires adaptation, coping and social readjustment. As, aging is considered a series of physiological, psychological and psychosocial changes, which further predisposes elderly to increased risk to develop stress, hence, present study was conducted to identify those common stressors among urban and rural elderly population. A comparative study was conducted in the month of February 2006 in Pohir and Kishore Nagar, (Ludhiana) with the objectives, to identify and compare psychosocial stresses of geriatric population among urban and rural population. In present study, 60 geriatric subjects were selected by systematic random sampling. A standardized tool, i.e., Stoke Gordon stress scale (SGGS), was used to determine psychosocial stress among elderly. Findings reveal that about 93% and 70% of subjects were in the mild psychosocial stress in urban and rural areas respectively while 30% of the rural subjects were in moderate psychosocial stress. Rural geriatric population was found more stressed than urban geriatric population. Key words : Psychosocial stress, geriatric population, rural, urban. Correspondence at : Lecturer, College of Nursing, DMC & Hospital, Ludhiana. Introduction Aging is a natural process. In the words of Saneca: "Old age is an incurable disease", but more recently on an optimistic mode, Sir James Sterling Ross commented: "You don't heal old age. You protect it; you promote it and you extend it". Old age should be regarded as a normal inevitable biological phenomenon. 1 One may visualize aging as simple as appearance of wrinkled skin, decreased 79

2 eyesight, but others may relate it with one's own inner strength and attitude towards life. Therefore, definition of aging has varied among different schools of thoughts. There is also contrast variation in concept of aging in different regions of the world, as they have progressed towards socio-economo-techno development. Old age is considered to be near about 70 years in developed countries where life expectancy is more due to advancement in health care techniques, as compared to developing countries where the old age is considered near about 60 years because of low life expectancy. 2 Globally, 1% of population over age of 60 years is increasing and it is likely to reach 30% of world population by According to Census of India (2001), about 7.7% population is over 60 years of age. This is expected to increase to 17% in In other words longevity has increased, at which a man can be considered "old". Aging is normal, universal and an inevitable change. 3 It results in decreased capability of geriatric population to compensate and recover from stress. Hence stress is any situation where a non-specific demand requires an individual to respond or take actions. Psychosocial stress arises due to problems in area of daily living and sub areas (mobilizing, sleeping, work, play and communication). The effects of chronic stresses increase with age. 4 Therefore, vulnerability of aged is more toward stress. Psychosocial stress may widely differ among urban and rural geriatric population in view of their socio economic and cultural inheritance. Here the community health nurse being unique member of health care team can identify psychosocial stress among geriatric population and can further give them guidelines to cope with stress. Methods and Materials This comparative study was conducted in rural area (Pohir) and urban area (Kishore Nagar) during month of February Ludhiana not only excels in the field of industries, agriculture but also provides health care facility to Northern India by two distinguished tertiary care hospitals Dayanad Medical College and Hospital (DMCH) and Christian Medical College and Hospital (CMCH). Village Pohir and urban area Kishore Nagar are practicing areas of Nursing and Medical students of DMCH. The present study focused on all geriatric population of 60 year and above as target population. Using convenient sampling one village from rural area that is village Pohir and one colony from urban area that is Kishore Nagar was selected. List of geriatric population was taken from Master register maintained in rural health centre and urban health centre. Using systematic random sampling method every 3rd geriatric male and female was interviewed. Study was conducted on 30 geriatric subjects from urban and rural areas. Data was collected by Stoke Gordon stress scale (SGSS) 5 that is standardized tool. Questions to collect data regarding their socio demographic variables and physical ailments were added and validated by experts from College of Nursing and Social and Preventive medicine department. Data was analyzed and 80

3 presented by using descriptive and inferential statistics. Results Analysis revealed that approximately 46.6% and 57% subjects were in the age group of years in urban and rural areas respectively. Majority of subjects, 86.6% were staying in the joint families in urban and 90% in rural area. About half of the subjects were illiterate and unskilled in both areas. Regarding their marital status it was found that 24% and 37% subjects were widow/widowers from urban and rural areas respectively. It was found that 27% and 30% of the subjects were having impaired eyesight in urban and rural areas respectively. Analysis of the date revealed that no subject was in severe psychosocial stress in rural and urban area. About 93.3% of subjects were in mild psychosocial stress in urban area while three fourth of subjects were suffering from mild psychosocial stress among rural geriatric population. Mean psychosocial stress score of rural subjects was 25.16, where as it was 19.0 among urban subjects. The t value was found statistically significant between psychosocial stress score of urban and rural geriatric subjects. (Table-1 ) Table - 1 : Psychosocial stress score among subjects N=60 Psychosocial Rural Urban stress level n=30 n=30 f % f % Mild stress 22(73.3) 28(93.3) Moderate stress 08(26.6) 02(06.6) Mean score Standard deviation t = 2.3* df = 58 0= No stress, 1-30 = Mild stress = Moderate stress, Maximum score = and above = severe stress * Significant P<0.05 Range = 0-41 The stressful events were ranked in order based on percentage of each event as experienced by geriatric population. The most stressful event among urban subjects from Stoke Gordon Stress Scale was "change in diet or eating habits". It was further followed by "constant or recurring pain or discomfort" and "own personal injury or illness" and "decreasing eyesight". Other stressful events were "concern for grand children", "change in working hours and conditions", "Loss of ability to get around due to illness or aging", "change in sleeping habits" and "decrease in mental abilities" (Table-2). 81

4 Table - 2 : Stressful events among urban subjects N=30 Rank Items f(%) Order 1. Change in diet or eating habit. 22 (73.3) 2. Constant or recurring pain or discomfort. 21 (70.0) 3. Own personal injury or illness. 21 (70.0) 4. Decreasing eyesight. 21 (70.0) 5. Concern for grandchildren. 19 (63.3) 6. Change in working hours or conditions. 18 (60.0) 7. Loss of ability to get around due to illness or aging. 18 (60.0) 8. Change in sleeping habits (such as ability to fall or 17 (56.6) stay asleep, change in place of sleep, etc.). 9. Decreasing mental abilities(such as forgetting, 17 (56.6) difficulty in decision making, planning, etc.). Further ranking of five most common stressful events among rural subjects from Stoke Gorden Stress Scale depicts that change in sleeping habits was the most common stressful event among rural subjects followed by decreasing eyesight and change in responsibilities at work. Other stressful events among rural geriatric population were "reaching a milestone year", and "concern for chitdren"( Table 3) Table - 3 : Stressful events among rural subjects N=30 Rank Items f(%) Order 1 Change in sleeping habits. 21(70.0) 2 Decreasing eyesight. 20(66.6) 3 Change in responsibilities at work. 19(63.3) 4 Reaching a milestone year. 18(60.0) 5 Concern for children (such as out of work, 17(56.6) Divorce, arguments etc.) 82

5 Discussion The findings of present study have been discussed in accordance with the objectives of study. Being a comparative study, psychosocial stressful events were identified and compared both in urban and rural geriatric subjects. During analysis, it was found that majority of subjects were suffering from mild psychosocial stress in both areas (93.3% in urban area and 73.3% in rural area). Moderate stress was found among 26.6% rural subjects and only in 6.6% urban subjects. Regarding scoring, rural subjects had more psychosocial stress score (25.16±8.15) than urban subjects (19.0±6.51) and after applying t-test this was found to be statistically significant (p value< 0.05). SGGS, when applied on 1000 geriatric population in New York surveys, the most common stressful event was 'death of son or daughter' "followed by 'decreasing eyesight' and 'death of close friend. 5, whereas findings of the presents study revealed that, the most common stressful event in rural geriatric subjects was 'change in sleeping habits (70%)' followed by 'Decreasing eyesight (66.6%)', 'change in responsibilities at work (63.3%), 'reaching a milestone year (60%)'. In urban setting most common stressful events noticed were 'change in diet or eating habit (in three fourth subjects) followed by 'constant and recurring pain or discomfort (70%)', 'own personal injury',' decreasing eyesight (70%)'. The difference in rank order could be because of smaller sample size. There were very few subjects in present study, who had actually undergone these events. The findings are further not comparable due to lack of other relevant studies. Conclusion The prevalence of mild psychosocial stress was found to be 93.3% and 73.3% both in urban and rural areas respectively. Psychosocial stress score was more in rural geriatrics population (25.16) as compared to urban geriatric population (19.0), hence the study findings calls for developing guidelines and compatible social support system in this regard. The community health nurse can play an important role in developing such guidelines and implementing them. Further studies are also recommended to have a region specific psychosocial stress assessment tool for geriatric population. References 1. Park K Text book of Preventive and Social Medicine. Jabalpur :M/s Banarsidas Bhanot, 2002: Waxman HM, Carner EA. Depressive symptoms and health service utilization among the community elderly. Journal of the American geriatric society 1982 Oct; 17 (4) : Patricia A Potter. Fundamentals of nursing. Missoure : Mosby's publication, 2001 : Burse W. Ewald Handbook of Geriatric Psychiatry. New York :Van Nastran Reinhold co publishers, 1980: Stoke AS, Gordon ES. Stoke/Gordon stress Scale. Pace University. Unehard School of Nursing. Bedford Pleasntville. New York