The Health of the Elderly: Depression and Severe Emotional Disturbance

Purpose of the Study

This study is intended for males and females over the age of 50 years who are likely to suffer from depression and severe emotional disturbance. The study will be conducted in Baltimore, Maryland. The purpose of the research is to evaluate the health of the elderly. It is accepted that numerous diseases affect old people. With this in mind, this paper seeks to achieve the following objectives

1. To find out the major diseases that affect the elderly
2. To evaluate the quality of health care available in the country
3. To evaluate the disease that is a result of depression
4. To gauge the extent to which lack of enough sleep can affect the health of the elderly
5. To find out what should be done to improve the health of the current old people and the future generation of the old.

Participants are required to have suffered from depression or a disease that is related to it. Age will be strictly observed as it is of importance in the final analysis. When choosing the patients to interview, it will be done with the help of physicians in the facility. Authority will have been sought to get private information and data on human health. Files will be perused to ensure that there is good background information of the patient relating his past life; whether he is married or not, the number of children, the kind of relationship that he has with a spouse (if he/she has any) among others.

The study will involve both inpatients and outpatients. They both have different experiences which need to be captured for a good comprehensive analysis however the greatest concentration will be given to inpatients such that the researcher will have lengthy talks using unstructured questions to gain more information from the patients.

Hypothesis

For this study, it is presumed that patients with depression suffer lack of adequate sleep; secondly, the diseases that are a result of being depressed can be cured through counseling. It is also assumed that the elderly staying together as wife and husband experience more depression than those living apart.

Background & Significance

Needs Assessment

Getting old is inevitable in the life of human beings, each day that passes means that one has become older. A child has no issues with growing the way a grown-up (those who are above forty-five) will have. There are many issues that come along with growing old; they range from diseases; more responsibilities, and deteriorated health. There are some things that an individual can do when young to reduce the negative impacts of old age and some things are meant to be. There are many reasons that can result in depression; but from a general perspective, it has been noted that it is influenced by a combination of environmental and genetic factors.

Our daily life may result in stress; since the way people interpolate things is different, a situation that may result in stress to one person may not be a stressful situation to another. As one grows, he becomes more vulnerable to stress than when young; he becomes more sensitive to things that affect and sometimes do not affect his or her life (Birrer & Vemuri, 2004: 12). Statistics show that women are the ones that are more stressed but they overcome the condition more easily since they talk out their problems more often than not. Despite the number of depressed being more on women the severe conditions that result from it are seen more in men (Birrer & Vemuri 2004:9).

At a certain time in life a person undergoes depression due to various issues; causes of depression among couples vary. In the case of couples living together there are a number of personal issues which the couples have to live with, eventually it leads to stress. In the case of unmarried individuals, they have the chance to live their own life; they have fewer chances of stress and depression. In old age, unmarried people have a higher chance of being depressed since they do not have time together, there lacks someone to console the other. When they decide to come together and try to solve each other’s problems, they fall into issues not conforming to each other at old age; this results in more depression.

There is no one way that can be termed as the best and less depressing, the way couples interact determines their level of success, and whether they will be depressed or not. In marriages the best way to avoid stress and depression is through communication. Again before engaging in a marriage, people are encouraged to understand their responsibilities and be willing to undertake them accordingly. An old saying goes “marriage is not a bed of roses but if well prepared for it can be a source of happiness.”

In simple terms, depression is a mental disorder whereby one is not in the right mind to make sound decisions; it is actually not a disease by itself but just a condition that would lead to diseases. In old age this is a common phenomenon that may take different forms in terms of the duration that one undergoes through it. It is the major cause of old age diseases. According to the National Institute of Mental Health (NIMH) ten percent of the 35million people over the age of 65 years suffer from a depression-related condition.

One of the major factors that make depression prevail in the society is that it is seen as a normal situation of life and thus those suffering from it are seen as undergoing the normal way of life; this is though not so because the effect of depression especially in old age can be so severe that it leads to death. One of the first areas that depression affects is the sleeping pattern of the elderly; this is interrupted and the urge to sleep may disappear altogether.

When the elderly have gone to sleep, instead of sleeping they get time to deliberate about issues, this even makes them more depressed. This brings us to the question of what adequate sleep is; most people sleep between three to ten hours a day but medical experts suggest that six to eight hours a day are enough to leave one refreshed and rejuvenated for the next day (Thinès, Costall & Butterworth, 1994:67).

Prior Research

A depressed person has a changed sleeping pattern that may not result inadequate sleep, it looks like the elderly takes too long to get the sleep, there is no deep sleep and the elderly sleep with episode that he is awake although not physically but the body and mind is still functioning; this includes talking at night or waking up to do some duties unknowingly, REM sleep, there is little or no sleep at all

Statistics show that over 80% of those suffering from depression have sleeping problems; this shows the need to understand the connection between depression and sleep. When one is in a depression circumstance, the mind is not at peace and thus it is willing to work extra hard to attain an equilibrium of peace and comfort. It then interpolates the situation as a moment to think and deliberate the issues at hand. This leads to one not having sleep or staying for long before sleeping.

Sleep is important for the health and well-being of an individual, lack of sleep leads to health complications that lead to further costs and problems. What makes the diseases even more complicated is that they are not diagnosed and treated early enough. The symptom of a depressed person vary but in general they are seen in the moods swings, being nervous, having a feeling of emptiness, feeling unloved, restlessness, irritability among others. The above signs are the resultant of the affected psychological situation of the depressed (Frazer, Christensen, & Griffiths, 2005:56). The importance/ effect can be discussed from psychological, medical, social and economic angles;

Depression is a condition of the mind, it is the mental aspect of the human being that is in danger and thus the psychological well-being of the person is not proper. The way he is going to take things and make choices is different. One of the major advantages of having adequate sleep is to relax our mind and body. The psychological well-being of the individual operates in the correct way if it is given adequate resting intervals after work.

The way a person perceives the world that surrounds him is different from the way other people perceive it and thus it results in cognitive dissonance; this is the feeling that a person gets when he or she is confronted by two opposing ideas at the same time. It happens when one is persuaded to do something that is contrary to his or her believes. It can be explained as embarrassment, guilt, or the uncomfortable feeling. The strength of the feeling is increased with the increase in the importance of the conflicting matter and the inability to make a rational decision on the best way of doing something. Since the elderly are depressed and have not had enough sleep, he is more likely to interpolate the world around him differently; this makes him have conflicts with other people as well as the inner being.

Other areas are affected by being depressed they are; When one fails to get adequate sleep, the memory level decreases. What happens is that the elderly mind starts to forget the things that he thinks he should be remembered; this leads to further depression. As life changes there are new things that we have to learn to be in line with the changing life, the elderly are not exempted but also need to learn. With lack of sleep, then his absorption level reduces and cannot learn new techniques of doing things. This makes him operate at a low level than the general society that might be a source of stress and eventually depression. In our case, when the elderly are already depressed and then get some side forces that accelerate the depression the case is even worse (Cartwright, 2001:111).

When someone has not slept well the mood that he has the following day is not good; it goes further to affect the attitude of the person. According to the “law of attraction”, a person attracts those things that rhyme with the pulses that he is attracting; so when moody the elderly do not go along well with those with who he interacts with. This is more likely to accelerate the depression condition of the elderly (Freud and Strachey, 1976:45).

Lack of sleep and depression affects the health of an individual; this is because they both interfere with the normal functioning of the body. When one is depressed, the coordination of the body and mind is affected. Lack of sleep leads to a condition called insomnia (not sleeping enough). It leads to reduced appetite and eventually weight loss. This though is not for all people since some people have a boosted appetite when they are depressed and this leads to overweight.

Lack of sleep as result of one being depressed results in fatigue, memory problems, and confusion. Older people are more likely to display aches and pains in different parts of their bodies (Phillips and Penhale 2007:117-133).

When someone is getting married, he/she does so in anticipation of joy and good life; however this is not always the case. Marriage comes with a number of expectations, responsibilities, and commitments which sometimes are the cause of depression among couples.

Depression is more in married couples than in unmarried couples; one of the major causes is responsibilities brought about by marriage which neither party is willing to take effect. Secondly, as far as human beings are social animals, they deceive some freedom; they need to be independent and repel any dictatorship. When people are getting into marriage they overlook and sometimes are ignorant of the new lifestyle that marriage demands. They end up having a shock after their day of marriage or honeymoon. It does not take long before a married couple realizes the realistic picture and responsibilities brought about by marriage.

Significance

Lack of adequate sleep affects the normal functioning of the body; this may lead to adding more weight. Increased weight is hazardous to the life of human beings especially when the weight is accumulated at the upper part of the body. It may lead to heart attack and blood pressure and other diseases that are a result of being overweight. If the elderly get affected by the diseases as a result, he is likely to suffer a great deal. These diseases can lead to the death of the patient. When one is depressed the immune system is reduced; the chances that he will be affected by the above diseases are high. Thus with adequate sleep the life of elderly is more protected (Nuttin, 1966:88).

Lack of sleep can lead to diseases; as much as there are no diseases that can be said to be caused by lack of sleep directly, the result of lack of sleep leads to diseases. Some of the diseases that can come as a result are cancer and high blood pressure. When one is depressed, the mind is compelled to work extra hard in the efforts of solving the problem at hand; this results in overworking the brain and headache is one of the many resultants. On the other hand, if one hand no adequate sleep he will have not rested enough to relax the brain; this may lead to prolonged headaches (Steffens and Potter 2008:7).

Human beings are by nature social beings, they interact with each other at every stage of their development. When a person is depressed, he is more likely to withdraw himself from the people and his social life is affected. The attitude of an individual can be influenced by the internal surroundings that are; the family, friends, and parental training. The external factors are social interactions, educational institutions, and church or other social groups. Your personality grows as you learn about “self, ” as you learn to be an individual with your own identity, as you begin to learn to accept responsibilities, as you learn to possess ideas and thoughts.

You therefore learn to express your ideas, beliefs and thoughts. The case is different in a depressed person; this is so because he perceives the world around her as a threat in one way or another. He is thus likely to repel interaction with people and the resultant is getting even more depressed. The mood swing also affects the way the depressed interact with others, since he is unpredictable, one of the ways to have peace with such a person is to keep him off.

This is seen as if society is fighting back a situation that may make the patient’s condition even more badly. To make the situation even more badly those people that the elderly are closer to may keep him off in their efforts to keep pace with her. The elderly may interpolate this as a negative move by those that he believes should be on her side always; these are the extremes that make one commit suicide (Alexopoulos & Kelly, 2009:90).

The Main Effect of the Independent variable overtime

This proposed study predicts that depression is caused by lack of sleep and on the other hand lack of sleep results in depression. There is a close relationship between lack of sleep and depression and they happen to influence each other in one way or another. When one is depressed there is a high likelihood that he is going to lack sleep. On the other hand, when one is not having adequate sleep, he is likely to suffer some depression.

The Interaction Effect of the Independent variable with the Moderator variable over time

During old age, there are high chances that married couples will have depression. They are likely to miss the company of each other; for those couples who have been staying together they are able to assist each other in solving old age stress, this reduces chances of depression in old age. In most cases, in old age, couples who had not been married tend to come together to live as married couples but they face the challenge that they must learn about each other; they have to take time and learn about each other at this stage. This offers another route to depression.

Participants

The participants will be old people over the age of 50 years who are suffering from stress or stress-related diseases. The following are the guiding questions to be used in the interview (the interviews will be unstructured but based around the following questions;

• How often do you go to hospital?

  • This information can be gotten from those people who have a constant clinic attendance and at least they can remember their trend. If one accepts data can be gotten from the hospital records
• Do you have a private doctor?

  • If a patient accepts, his/her private doctor can be contacted for better analysis. Data gotten will be treated privately.
• Do you know the disease that you are suffering from?

  • There are instances where a patient knows which disease he is suffering from. They are made aware by their doctors to assist them to manage their conditions more effectively.
• How many hours do you sleep on average per day?

  • It is expected that people suffering from depression are likely to be suffering from lack of adequate sleep. A normal human being is expected to have at least 7 hours in a day. When one is suffering from depression, this rate may increase but in many cases sleep reduces.
• Is there some food that you are restricted from taking?

  • Old age comes with various complications which may reduce the appetite of a person. When the person is depressed, the situation is made even worse. When taking this data, care will be taken not to include those foods that a patient does not take because he just doesn’t like them and those that the doctor has recommended not to be taken.
• Since when was your condition diagnosed by a doctor?

  • There is a tendency that the old people suffering from depression don’t go to the hospital until their condition is worsened. This data will be important to know the earliest data that old people go for diagnosis.
• Do you think there is adequate medical attention for your health conditions?

  • This will be a personal opinion but should be supported by facts.

Research Methodology

To collect data, the researcher will use both quantitative and qualitative research methods. This is because the kind of data that will be collected will be both theoretical and numerical data. The qualitative method involves an ally of interpretive techniques for data collection and data analysis. Under this method, I will use focus groups and interviews with old men and women. To select the sample from old people the researcher will use Multi-stage Cluster Sampling.

Deductive reasoning will also be employed. This is a systematic method of obtaining knowledge where one proceeds from a general point of view to a specific statement. The research starts from the known and explains the unknown. It provides a means of testing validity of a conclusion by having major premises and minor premises. A major premise is where there exists a previously established relationship and minor premises are the particular case under research for conclusion (Rozakis, 2009:18).

Interviews

Interviews will be conducted on married and unmarried couples. This will involve a face to face of discussion guided by semi-structured questionnaires. In cases where an elderly cannot be reached, the researcher will call them. Data collected on elderly, both inpatient and outpatients, will be merged for a deeper understanding.

Focus groups

Groups of elders will be developed and facilitated to discuss their own experiences in life, this is their youth life and old age; the leaders will be trained to guide discussions to the benefit of the study. For instance, the group may be allowed to talk in their vernacular; this will relax the mood and encourage more information. As people are discussing it is like they are solving their own problems and thus more information is derived from them.

Secondary data

There are numerous researches done in this area; to get an in-depth understanding, an analysis of situation at hand will be interpolated. A wide review will give a good background of the situation and assist in focusing the research.

Rationale for choosing these methods

The researcher will have a wide knowledge of the research topic and develop a wide scope when he reviews secondary data on related topics. Using interviews is a method that will assist open a door for insight discussion with sampled population and develop rich primary data for a better analysis. Focus groups on the other hand will assist the research get first-hand data from discussion with the groups as they review their past experiences and what they are going through. When a well-relaxed mode and environment is realized, the groups can give very reliable information as they compare “notes”.

One of the methods of data analysis is hypothesis testing. Here the relationship between variable and group was examined. In hypothesis testing I used the various mathematical methods which include but are not limited to the following:-

• Z-test- this is based on normal probability distribution and its use for judging the significance of several statistical measures, particularly the mean of a sample. The same test is used for judging the difference between mean of two different samples.
• T-test- this is based on t distribution and considered appropriate for judging the significance of the difference between mean of two samples. The relevant test statistic ”t” is calculated from sample data then compared with its probable value based on t distribution read from “t” statistical tables. The chi-square- this is based on chi-square distribution and is used for comparing sample variances to a theoretical population variance.
• F-test- this is based on f- distribution and is used to compare the values of two independent samples. This test is also used in context of analyzing the variances called “ANOVAs”. ANOVAs are used for judging the significance of more than two samples means one at a time. After it has been calculated it is compared with probable values in the f-ratio tables.

Data Analysis or Interpretation

To analyze data collected most effectively, the researcher will use a thematic analysis procedure. Using this method the researcher will compare and contrast data from homogenous people and continue with the process until he is confident that no new issues emerge. After developing a general idea from the data the next method to fully analyze the data will be the contents method; following the following steps;

Data Understanding

This will involve going through the data collected again and getting the general flow of the data. Various tools used in early development will be understood and the flow of data grasped.

Taking a focus

At this stage with the data collected in mind, the research will review the aim of the research and choose the data that is consistent with the research aim and objectives. Irrelevant data and extreme ends data will be set aside.

Coding the data

At this stage data with the same theme and which have the same meaning are categorized together. Reading and re-reading data is crucial at this level to get an in-depth understanding of the data. Working with coded data will assist in getting the collect analysis and makes work easy.

Identify connections and patterns in codes

At this point critical thinking will be used to derive the meaning of the data and pattern. A relationship of data will be derived. The secondary collected for an insight understanding of depression patterns will assist in making an informed conclusion. After the data has been coded and relationships developed, a conclusion which involves writing a guide on measures that can be implemented to ensure that depression in the elderly is reduced is done.

Limitations

Time constraint- the semester is so squeezed that making comprehensive research is not possible together with other classwork. The period that I will be with the organization is not good enough to give me a full analysis of the health conditions of the elderly; I will have to use a sample. Some of these aspects cannot be revealed by mere observation. Being an outsider may also limit what is revealed to me. I am also warned that some information that I may get may be directed by my presence and maybe manipulated to fit a situation.

Delimitations

I am aware that taking a close analysis of more than one countries elderly may be of great assistance and give more input to the subject as well as offer a chance for comparison; however I choose to only concentrate on one country – my home country. Secondly, I will not use the structured interview to assist me to stay in the course, as much as it is important, I consider my situation not ideal for one.

Conclusion

Old age is an inevitable part of our life that comes with its own challenges. Depression is one of these challenges, as much as it is seen as a part of life; it is a medical condition that calls for the attention of the doctor. It is one of the factors that lead to lack of adequate sleep and the cycle is endless since lack of sleep on its part fights back and leads to further depression. There are other complications (social physical and mental/ psychological) that result from the conditions. As much as there is not much that can be done to stop stress or lack of sleep at a certain time in life, there is the need to always be alert to extreme cases and seek a physician’s advice. Writing the above research proposal has assisted in appreciating the structure and the steps that are followed when developing a research proposal.

Reference List

Alexopoulos, S.G., & and Kelly E. R (2009). Research advances in geriatric depression [Review], World Psychiatry 140-149.

Birrer, B.R., & Vemuri, P.S. (2004). Depression in Later Life: A Diagnostic and Therapeutic Challenge. American Family Physician 2004, 69(10), 2375-2382.

Cartwright, J. (2001). Evolutionary explanation of human behavior. Canada: Routledge.

Frazer, J.C., Christensen, H. and Griffiths, M.K. (2005). Effectiveness of treatments for depression in older people. Medical Journal of Australia, 627-632.

Freud, S. and Strachey, J. (1976). The complete psychological work of Sigmund freud (standard edition) vol. (1-24).New York: W.W. Norton & Company.

Nuttin, J. (1966). Albert Edouard Michotte van den Berck: 1881-1965. The American Journal of Psychology 79 (2): 331–3.

Phillips, J. and Penhale, B. (eds) (2007). Reviewing Care Management for Older People. London: Jessica Kingsley chapter 10 pp. 117-33.

Rozakis, L. (2009). Schaum’sm Quick Guide to Writing Great Research Papers. New York: McGraw-Hill Press.

Steffens, D. and Potter, G. (2008) “Geriatric depression and cognitive impairment.”, [Review]. Psychological Medicine 163-175.

Thinès, G., Costall, A., Butterworth, G. (1994). Michotte’s Experimental Phenomenology of Perception, Review. The American Journal of Psychology (University of Illinois Press) 107 (2): 275–6..