Quality of life in elderly people- A comparative study in different elderly homes of Kathmandu

Abstract

Executive Summary: Many concepts of caring for the elderly have emerged through time. Basically they fall into 2 categories: "Homes for the aged" and "Housing for the Elderly". The former includes nursing homes and long term care( LTC) facilities where clinical care is provided to ill and aged people, usually for the rest of their life. Hospice or the end-of-life care is a similar concept. The latter includes community residential care ( CRC), assisted living facilities( ALF), adult family home, family care home, planned care development, community aging-in-place, etc. In Nepal elderly population has always been considered passive recipients of support. Their choices, their satisfaction and their subjective perception towards their quality of life, their psychosocial problems, etc have always been undermined. There are over 30 NGOs in the name of elderly welfare in Kathmandu itself. Innumerable housings for the elderly are already sprouting in different parts of the country including Deughat, Matatirtha, Koteshwor, Godavari, Panauti, Shantinagar, Golfutar, Soaltee Mod, Balambu, Banepa, etc Researches show that most adults prefer care in home/community settings by kin or non-kin, with few deeming nursing homes or other housing facilities acceptable and that the elderly residing in the retirement center had significantly lower Personal Self and Family Self scores. Results indicated that the women living independently had significantly (P <.05) higher physical activity levels compared to the women living in assisted-care facilities. Six themes contribute to quality end-of-life carein LTC facilities: responding to resident's needs, creating a homelike environment, supports for families, providing quality care processes, recognizing death as a significant event, and having sufficient institutional resources. There's a need to encourage the provision of informal assistance as well as the need to ensure the availability of sufficient staff and other formal helpers are available to provide formal care in these settingsand also substantial need for specialist services to address the unmet needs in these types of continuing-care settings, such asinterventions for social disturbances in NC and suitable daytime activities in RC. In one research in such residential care facility, twenty-four percent had a diagnosis of depression and 8% dementia, but few had clear instructions ‘not to say anything to any enquirers!’ Facilities including fooding, clothing, festivals as well as general living conditions including housing, mess, water, toilet, waste disposal, drainage, etc were good as they had a modern house but again interpersonal relations, creative work and source of entertainment were all virtually non-existent. Perception and Attitude Survey showed that all the respondents felt very good or at least better than at home in all the 3 housing facilities. This discrepancy is understandable, as the socioeconomic background of the inmates is usually so bleak and they have suffered so much that places that provide whatsoever standard of housing and facilities without them having to do anything is a sweet haven for them. They seemed to like the freedom, facilities, respect and care that they got in the housings, and many at Pashupati found it nice to live in such a religious place. One inmate in Koteshwor was particularly vocal about the utter lack of care from the managerial staffs in the home, even bordering on maltreatment. Almost all seemed to like the food though some complained that they are having problems observing dietary restrictions as they have to share the common mess and forced to have fatty and spicy food despite suffering from APD. 7 out of24 responding males and 8 of 37 females at Pashupati and 2 of 8 inmates at Matatirtha found their room to be very congested and very cold in winter, and rightly so. Only 3 males and 6 females at Pashupati found the environment to be unhygienic, else most found it satisfactory though none found it excellent. When asked about outing, most inmates at Pashupati and Matatirtha used to go out once in more than 3 months while 4 of 24 males, 8 of 37 females and 3 of 5 inmates at Koteshwor said that they never do go out for outing. Almost none used to go out more than once in a month. At least in Pashupati most of them can be explained by their debility while it shows lack of fund in Matatirtha and lack of care in Koteshwor. Only 6 male (of 24 who responded) inmates at Pashupati replied that they are engaged in household activities. The females, including 8(of 37) at Pashupati and 6(of 8) at Matatirtha were involved in making wicks for traditional lights. Many inmates in Pashupati used to have regular contact with the nurse for minor ailments. But there was no provision of regular periodic health checkup as such in place Only 2 males and 2 females in Pashupati and 2at Matatirtha expressed dissatisfaction with the services. In Koteshwor, aninmate was complaining that they rarely get any checkup and only when the inmates got moribund were the managerial members called. Most frequent illnesses were fever, diarrhea, fainting, headache, asthma, disability and problems with vision. Other included deafness, diabetes, hypertension, paraplegia, vague pain syndromes, hip dislocation, cough, itchy eyes, myalgia, kyphosis, cataract, jointpains, mental illness, acid peptic disease and even toothache among the males at Pashupati. The females responseswere fever, asthma, facial swelling, limb joint back and other vague pain syndromes, APD, decreased vision and blindness, deafness, dizziness, bodyache, abdominalswelling, shortness of breath, nausea, seizures, hemiparesis, gangrene and amputation of one hand, disability, paraplegia, heart problems and burns. At Matatirtha, the responses were refraction error,APD, joint pains, cataract, fracture femur, myalgia, cough, hypertension, etc. At Koteshwor, the responses were cataract, asthma, kyphosis, cough, etc. On being asked," Has anyone left the place recentlyand why?" an alarming 22 males out of 24 and 29 of 37 responding at Pashupati saidthey didn’t know. At Koteshwor, many inmates had left as they either didn’t like the facilities or were maltreated, and the number of inmates was decreasing each day. On being asked," Why did you come here?", 17 males and 25 females at Pashupati, 6 at Matatirtha and 3 at Koteshwor replied that they have no home left while the second most common answer was that they were mistreated athome. Almost none were left by the family there.