Cognitive Impairment among Elderly: A Descriptive Survey

 

Mrs. Sukhbir Kaur

 

ABSTRACT:

Introduction: Aging is an inevitable developmental phenomenon bringing along a number of changes in physical, psychological, hormonal and social conditions. Cognitive impairment is defined as a measureable change in the cognitive function. It is distinct from a learning disability in so far as it may have been acquired later in life as a result of an accident or an illness. So, this study was conducted with aim to assess cognitive impairment among elderly of selected community area, Amritsar, Punjab.

Materials and method: A non- experimental research approach and descriptive research design was adopted for the study. A non- probability convenient sampling technique was used to enrol 60 elderly from community, Sri Guru Ram Das Nagar, Amritsar among those 30 were male and 30 were female. Mini mental status examination (MMSE) tool was used to collect the data and interpret the results. Analysis was done by using descriptive (mean, frequency and percentage) and inferential statistics (ANOVA, t-test) was used.

Results: The result showed that 61.7% elderly have no cognitive impairment, 26.7% have mild cognitive impairment and 11.7% have severe cognitive impairment. Among the demographic variables education, marital status and working status were found to be statistically significant at p < 0.05 level.

Conclusion: Cognitive impairment was found more in unmarried than married, illiterate than literate, lower class than upper class and in non working than working. Hence the health care professionals especially community mental health professionals should pay special attention towards early detection and treatment of cognitive impairment among elderly.

 

 

INTRODUCTION:

Cognitive impairment is increasing globally and is predicted to increase proportionately more in developing reason projection indicate that by 2050 the number of individual older than 60yrs will be approximately 2 billion and will account for 22% of the world’s population. Four fifth of the people older than 60yrs will be living in developing countries in Africa, Asia or Latin America.

 

 

 

 

It is estimated that35.6million people are currently living with dementia worldwide and the number will nearly double every 20yrs reaching 115.4 million in 2050, with the majority living in developing countries of the total number of people with dementia worldwide 57.7% lived in developing countries in 2010 and a proportionate increase to 70.5 % by 2050 is anticipated. Consequently the health and social burden of cognitive impairment and dementia will rise dramatically in these regions only a fraction of those who need mental health care can receive it [ by one estimate only about 10% of elderly who are a need of psychiatric treatment ever receive this health care services. (Sharma D, Mazta S R, Parashar A.,2013. Sherina M S, Rampal L, Mustaquim A.,2004. Vargese SS, Gopalakrishnan P, Patki S, Harsha C H, Antony R.2015.)^1,2,3

 

Since Mini-Mental State Examination (MMSE) was introduced in 1975(Folstein, Folstein and McHugh) has been utilized widely as a screening instrument to assess cognitive disorders and dementia. It is a brief, standardized method to determine a patient’s cognitive function that assess orientation, attention, immediate and short term recall, language and ability to follow simple verbal and written commands, (Crum, Anthony, Bassett and Folstein 1993). It has been used as a brief cognitive test in clinical practice and research. The MMSE has been translated into several languages and has been used successfully in many independent cross-national epidemiological studies of dementia. (D Kumar Naveen, TP Sudhakar.,2015. Poddar K, Kant S, Singh A and Singh T B.,2011)^4,5

 

Kavaksi O, Bilici M, Cam G, Ulgen M.( 2011)⁶. Rashidi V, Rezali M, Gharib M. (2014)⁷ reported many socio-demographic and health variables can influence general cognitive performance, with different impacts depending on age and schooling, as do many other socio-demographics characteristics e.g. occupation and gender. Few studies determine the prevalence of dementia have been conducted in sub Saharan Africa. Early studies showed a lower prevalence than in Europe and the United States of America where approximately 6.2 % and 8% respectively of people aged 65 years or older are reported to have dementia.

 

MATERIALS AND METHODS:

RESEARCH APPROACH

Quantitative research approach was used

 

 

 

RESEARCH DESIGN

Non-experimental descriptive survey  research design was selected to conduct the study.

 

RESEARCH SETTING

The setting of study was in selected urban area, Sri Guru Ram Das Nagar of Amritsar. For the setting convenient method was used to select the setting.

 

VARIABLES

Research variables: - Cognitive impairment among elderly

Demographic variables: - Age, Gender, Religion, Educational status, Marital- status, Socio-economic status, chronic diseases, Working status, Regular physical activity and Living with family.

 

SAMPLE

Sample was elderly residing in selected Sri Guru Ram Das Nagar of Amritsar.

 

SAMPLE SIZE

Total 60 elderly were selected for data collection out of which 30 were male and 30 were female.

 

SAMPLING TECHNIQUE

Non – probability convenient sampling technique was used to select sample of 60 elderly

 

DISCRIPTION OF TOOL

Part 1:-A Performa to collect the demographic data (10 items). It includes Age, Gender, Religion, marital status, educational status, socio-economic status, chronic illness, regular physical activity, living with family or not.

 

Part 2:- Standardized MMSE to assess the cognitive impairment among people of selected community area, Amritsar. It includes 5 parts i.e. orientation, Attention, Registration, Recall, Language. It consists of total 30 items. Maximum score is 30 and minimum is 0. Rateable on ­0-17 as severe, 18-23 mild, 24-30 no cognitive impairment.

 

DATA COLLECTION PROCEDURE

v  The data was collected from 60 elderly of selected community area of Amritsar that fulfil the sampling criteria using MMSE which was prepared in English and Punjabi.

v  Complete explanation was given to the subjects about the purpose of the study and verbal consent was taken from them.

v  A standardized MMSE, Rateable on ­0-17 as severe, 18-23 mild, 24-30 no cognitive impairment was administered. It took 10-15 minutes to complete MMSE.

v  The process of data collection was terminated by thanking all samples for their participation. The data collected was compiled for final results.

 

RESULTS:

Distribution of elderly shows that maximum were in the age group of 60-65 years (50%) and  maximum elderly were Sikh (95%) while for the educational status 33.3% were illiterate and 66.7% were literate and 98.3% were married. According to socio economic status maximum 80% belong to middle class. In 61.7% elderly chronic diseases were present and maximum elderly 71.7% were not working. According to regular physical activity 51.7% have moderate physical activity and 100% of the elderly were living with the family.

 

Table 1: Frequency and Percentage Distribution of Elderly according to Demographic Variables.                                N= 60

s.no.	Demographic Variables	Frequency	Percentage
1.	Age
a.	60-65	30	50
b.	66-70	15	25
c.	71- 75	13	21.6
d.	76 – 80	1	1.7
e.	80 and above	1	1.7
2.	Religion
a.	Hindu	3	5
b.	Sikh	57	95
3.	Educational status
a.	Illiterate	20	33.3
b.	Literate	40	66.7
4.	Marital status
a.	Unmarried	1	1.7
b.	Married	59	98.3
5.	Socio- economic status
a.	Upper class	6	10
b.	Middle class	48	80
c.	Lower class	6	10
6.	Chronic disease
a.	Absent	23	38.3
b.	Present	37	61.7
7.	Working status
a.	Working	17	28.3
b.	Not working	43	71.7
8.	Regular physical activity
a.	None	2	3.3
b.	Low	25	41.7
c.	Moderate	31	51.7
d.	High	2	3.3
9.	Living with family
a.	Yes	60	100
b.	No	0

According to objective 1: To assess coginitve impairemnet among elderly.

 

Table 2(a) Frequency and Percentage distribution of levels of Mini Mental Status Examination among elderly to assess coginitve impairement                                                       N=60

Level of MMSE	Frequency (f)	Percentage (%)
No cognitive impairment	37	61.7
Mild cognitive impairment	16	26.6
Severe cognitive impairment	7	11.7
Total	60	100

 

Table -2 (a) depicts that out of 60 elderly 61.7% have no cognitive impairment, 26.7% have mild cognitive impairment and 11.7% elderly have severe cognitive impairment. Thus it is concluded that most of the elderly have no cognitive impairment.

 

Table -2 (b) Mean and standard deviation of areas of MMSE among elderly                                                                              N=60

Areas	Mean	Standard deviation
Orientation	8.68	2.13
Registration	2.97	0.18
Attention and calculation	3.22	2.18
Recall	2.30	0.93
Language	7.12	1.08
Total	24.28	4.54

 

Table -2 (b) reveals that according to components of mini mental status examination , orientation mean score was higher 8.68±2.13 followed by language 7.12±1.08,  attention and calculation mean score was 3.22±2.18 ,registration 2.97±0.18 and least recall with mean score 2.30±0.93.

 

Therefore, it can be concluded that orientation and language component of MMSE were better among elderly than the other components of MMSE.

According to objective 2: to assess relationship between coginitve impairement and selected socio- demographic variables.

 

Table 3 (a) ANOVA of socioeconomic status among elderly according to cognitive impairment.                      N=60

Socioeconomic status	n	Mean	SD
Upper class	6	25.83	3.371
Middle class	48	24.62	4.226
Lower class	6	20	6.197

 

 

 

 

 

Source of variation	Sum of Squares	Df	Mean square	F	P
Between group	130.1	2	65.050	3.408*	.040
Within group	1088.083	57	19.089
Total	1218.183	59

     ^*p<0.05 level

 

Table – 3(a) depicts that mean MMSE score was higher in upper class (25.83±3.37) followed by middle class (24.62±4.22) and least lower class(20±6.19). ANOVA test reveals that there is significant difference between different socioeconomic classess which was found to be significant at p < 0.05 level. Therfore, coginitive impairement do vary with change in socio economic status but variables like age and regular physical activity did not impact coginitive impairement among elderly.

 

Table – 3(b) T – test of education status, marital status and working status according cognitive impairment.                    N=60

Variables	N	Mean	S.D.	t	P
1. Education
a)illiterate	20	20.9	4.811	-4.772	000**
b)literate	40	25.98	3.340
2. Marital status
a)Unmarried	1	15.00	0	-2.120	0.038*
b)Married	59	24.44	4.415
3. Working status
a) working	17	26.29	3.0317	2.22	0.03*
b) not working	43	23.49	4.817

*p<0.05 level   **p<0.001 level

 

Table -3(b) According to educational status mean mini mental status examination score was highest (25.98±4.8) among literate as compared to illiterate (20.9±3.34) and   difference between two groups was found statistically significant at p<0.05 level. According to marital status mean mini mental status examination score was highest (24.44±4.415) among married as compared to unmarried (15) and  difference between two groups was found statistically significant at p<0.05 level. According to working status mini mental status examination score of working elderly is high ( 26.29±3.03) as compared to non working elderly (23.49±4.81) and difference between two groups is  found statistically significant at p<0.05 level. Therefore, it reveals that educational status, marital status, working status had significant impact on coginitive impairement. The demographic variables like gender, religion, chronic disease were not having any sifnificant impact on coginitive impairement.

 

DISCUSSION:

According to first objective i.e. to assess cognitive impairment among elderly. In the present study it was concluded that maximum elderly (61.7%) had no cognitive impairment and minimum elderly (11.7%) had severe cognitive impairment whereas (26.7%) elderly had mild cognitive impairment. These findings reveal that majority of the elderly had no cognitive impairment.

 

Vargese S S, Gopalakrishnan P, Patki S, Harsha C H, Antony R (2015)³ conducted another cross sectional study for the screening of cognitive deficit among inmates of old age home in Kerala which shows, among 30 inmates studied, 18 (60%) were found to have cognitive impairment out of which 5 (16.7%) had mild, 10 (33.3%) had moderate and 3 (10%) had severe cognitive impairment. Cognitive impairment was significantly higher among those above 60 years, p value=0.026.

 

According to second objective - current study apply ANOVA and t – test to reveal association between socio demographic variables with cognitive impairment. By applying ANOVA socioeconomic status was found statistically significant with cognitive impairment. By applying t-test it was found that education , marital status and working status was found statistically significant with cognitive impairment at p<0.05 level . Hakansson K, Rovio S, Helkala L E, Vilska R A, Winblad B, Soininen H, et al (2009)⁸ did the prospective population based study with an average follow-up of 21 years, with an objective to evaluate whether mid-life marital status is related to cognitive function in later life. Results were people cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79. Those widowed both at mid-life and later life have odd ratio of 7.67 (1.6 to 40.0) for Alzheimer’s disease compared with married or cohabiting people. So, living in a relationship with a partner might imply cognitive and social challenges that have a protective effect against cognitive impairment later in life, consistent with the brain reverse hypothesis.

 

IMPLICATIONS:

Nurses are unique health care provider , working directly with individuals , families and community , who can play a vital role in national health care delivery system. The finding of the study have several implications for Nursing Education, Nursing Practice, Nursing Administration and Nursing Research.

 

Nursing Education:

It is important to mention the implication of the present study for the education system. The findings of investigation may help  the college teachers, personnel , counsellors or guidance workers to understand the need of teaching various measures to detect cognitive impairment which is essential for future staff nurses to  practice in the hospital.

 

Nursing Practice: 

The nursing student should be taught to apply MMSE as a part of physical examination. So, that cognitive assessment becomes an important part of regular health assessment. Also it results in easily detection of cognitive impaired cases in the hospital as well as community. So, knowing the prevalence rate of cognitive impairment in elderly, together with the associated factors may inform the policy makers and aid in designing better geriatric friendly health services. When planning elderly health services priority should be given to the elderly who are old-old, widowed and those who are illiterate

 

Nursing Administration:

Nurse administrator as an educator provide in – service education programme for staff nurses who are working in geriatric wards to enhance their competencies to conduct MMSE for early detection or screening of cognitive impairment among elderly.

 

Nursing Research:

Nursing research should be conducted to assess cognitive impairment among elderly to screen out various problems and find measures to rectify them.

 

RECOMMENDATIONS:

·        The study needs to be replicated in a large sample size to validate and generalize its findings.

·        A comparative study can be conducted to assess cognitive impairment among elderly of rural and urban areas.

 

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