Research Proposal A Community Research of Depression among Older Adults

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ResearchProposal: A Community Research of Depression among Older Adults Aged65 Years and Above

Table of Contents

Introduction 3

Purpose of the study 4

Study rationale 4

Literature review 5

Prevalence of depression among the elderly people 5

The relationship between gender and prevalence of depressive symptoms 5

Relationship between the risk of depression and the level of education 6

Relationship between the risk of depression and the marital status 7

Research objectives 7

Study methods 8

Participants 8

Inclusion exclusion criteria 8

Sampling 9

Recruitment 9

Interventions 9

Data collection 10

Data analysis 10

Ethical considerations 10

Informed consent 10

Informed consent 11

Confidentiality 11

Other considerations 12

Limitations 12

Proposed budget 12

Plan for dissemination of the study findings 13

Time table of activities 14

ResearchProposal: A Community Research of Depression among Older Adults Aged65 Years and Above

Introduction

Depressionis among the most common types of psychological disorders that affectolder adults, who include persons aged 65 years and above. The highprevalence of depression has created a perception that depression isa normal part of human aging. However, studies have proven otherwiseby showing that people can grow old healthy. For example, a reportpublished by the Center for Disease Control (2009, p. 2) indicatedthat a combination of up-to-date clinical interventions, primarycare, caregiver interventions, and measures that address theend-of-life issues, extends the quality of life and protect olderadults from depression. Depression is defined in different ways, butthe proposed study will be based on the definition provided by theAmerican Association of Suicide, which defines depression as a mooddisorder that leads to a persistent feeling loss of interest andsadness (American Association of Suicide, 2014, p. 1). Depression isaccurately diagnosed using the DSM IV criteria, which is a Diagnosticand Statistical Manual for Diagnosis of Mental Disorders.

Depressionaffects older adults from all countries, both developed anddeveloping nations. It is estimated that between 15 % and 20 % of thepeople aged 65 years and above have experienced severe depressionduring their old age while the average prevalence for depressionamong this population is 20 % (Barua, 2011, p. 1). However, the U.S.records the highest number (7 million) of older adults aged at least65 years, while the United Kingdom has the highest prevalence rate(40 %) of the people aged 85 years who suffer from severe depression(American Association of Suicide, 2014, p. 2). This data indicatesthat the quality of life is more extended in the U.K., thus increasethe prevalence of depression among people aged 85 years than thoseaged between 65 years and 84 years.

Purposeof the study

Giventhe projected increase in the population of older adults aged atleast 65 years, coupled with the expectation that the number ofelderly people suffering from depression will continue to increase(Fiske, 2009, p. 3), the proposed study will assess the currentprevalence of depression among the population of elderly people inthe community. In addition, the existing body of literature andempirical studies has given equivocal findings regarding thecorrelation between depression among the elderly people andsocio-demographic factors (Chong, 2001, p. 29). To this end, thepurpose of the proposed study is to assess the relationship thatexists between socio-demographic factors and the occurrence ofdepression among the elderly people.

Studyrationale

Theprevalence of depression among older adults is extremely high in theUnited Kingdom. It was estimated in 2008 that the United Kingdom hada prevalence rate of depression among older adults of about 19 %, butthe rate is higher (40 %) for seniors with the age of 85 years andabove (Fa, 2007, p. 1). The high prevalence of depressive symptoms inthe United Kingdom creates the need for scientific evidence of thecurrent prevalence of depressive symptoms among the elderly peopleliving in the United Kingdom and to establish the association betweenthe occurrence of depression among the population of elderly peopleand socio-demographic factors. The scientific evidence indicating theexact prevalence of depression among the target population willprovide a body of information that can be used by the stakeholders inthe health care sector and those involved in the management of issuesaffecting the elderly citizens.

LiteraturereviewPrevalenceof depression among the elderly people

Theperceived high prevalence of depression among the elderly people hasattracted a number of researchers, who have studied the relationshipbetween the variables, depression and old age. One of thecross-sectional study conducted in Ahmednagar district in Maharashtaestablished a positive association between age and the risk ofsuffering from depression. The study indicated an average prevalencerate of 53.5 % of depression among elderly people old age homes(Ananthram, 2012, p. 4). However, the study separated prevalenceamong the young old (65-70 years), mid old (70-84 years), and Olderold (85 years and above) indicating a prevalence rate of 47.92 %,57.69 %, and 83.33 % for each of the three groups respectively(Ananthram, 2012, p. 4).

Acomparative data analysis conducted to determine the underlying causeof the relationship between age and depressive symptoms indicatedthat the risk of suffering from depressive symptoms was positivelyassociated with the occurrence of other health conditions, livingconditions of the elderly (Ber, 2011, p 103). A cross-sectional studyconducted by Singh (2012, p. 51) revealed that age is positivelyassociated with depressive symptoms, but older adults with limitedsocial interactions are at a higher risk of suffering from depressioncompared to social seniors. However, other studies (Ananthram, 2012,p. 4) could not explain the reasons behind the age difference in theprevalence of the occurrence of depressive symptoms among the elderlypeople.

Therelationship between gender and prevalence of depressive symptoms

Therelationship that exists between gender and the occurrence ofdepressive symptoms among older adults is another area of study thathas attracted the attention of several scholars. A survey conductedwith the objective of establishing the association between depressionand age after adjusting for different sociological factors indicatedthat elderly men are at a higher risk of suffering from depressioncompared to worm, with an odd ratio of 0.60 (Akhtar, 2007, p. 3).However, one randomized trial conducted in Taiwan showed thatdepression is more prevalent among female participants compared totheir male counterparts (Chong, 2001, p. 33). One cross-sectionalstudy indicated that the prevalence rate of depression among men was10.19 % and 11.44 % for women, but the difference was notstatistically significant (Steffens, 2009, p. 6). These findingscontradicted most of the previous studies showing either male orfemale predominance. It is evident that there is a lot ofdisagreement regarding the association between the associationbetween age and the prevalence of depressive symptoms and betweendifferent genders. Moreover, none of the previous studies reviewed inthis section identified the mechanism to explain their genderdifference in the prevalence of depression among the senior citizens.

Relationshipbetween the risk of depression and the level of education

Thelevel of education is considered as among the key factors thatdetermine the risk of suffering from depressive disorders. Arandomized trial conducted in Taiwan a positive relationship betweenthe risks of contacting depressive symptoms and the level ofeducation, whereby the elderly people who managed to acquire a higherlevel of education (Chong, 2001, p. 33). However, the study could notexplain the phenomenon in which the elderly people in the westerncountries where the level of literacy is high are subjected to ahigher risk of depression compared to older adults living in thedeveloping nations (Steffens, 2009, p. 6). However, a longitudinalstudy conducted on 8,295 older adults in the U.S. indicated asignificant difference in the level of education and the risk ofsuffering from depression among the senior Americas. Educated olderadults tend to feel that they have accomplished what they wanted toachieve in life, which enhances their psychological well-being andreduce the risk of getting depressed.

Relationshipbetween the risk of depression and the marital status

Maritalstatus influences the wellbeing of individual persons throughouttheir lives. This implies that there is a possibility of thepsychological well-being of the elderly persons being affected bytheir being in a marriage, deceased, or divorced. A randomized trialof about 1,500 subjects indicated that widows were at a higher riskof suffering from depression compared to elderly women who wereliving with their elderly husbands (Chong, 2001, p. 34). A similarsurvey conducted on subjects aged between 25 and 74 years indicatedthat being single increase the risk of depression among young peopleas well as older adults (Shapiro, 2007, p. 334). The study revealedthat being single reduced the opportunity for leading social life,which is a risk factor for depression.

Researchobjectives

Althoughseveral researchers have studied the prevalence of depression amongthe seniors in different parts of the world, very few of the scholarshave addressed the issue in the United Kingdom. To this end, theproposed study will seek to accomplish the following objectives

  • To determine the prevalence of depression among older adults aged 65 years and above in the United Kingdom

  • To assess the study the relationship between socio-demographic factors as well as life events and depression among older adults at the age of 65 years and above

Studymethods

Adescriptive study design will be used to accomplish the purpose ofthe proposed study. A describe design is used when the researcherintends to collect data that describes the study participants. Datafor a descriptive study can be collected in different ways (includingobservation, case study, and survey), but an interview will thesuitable method of data collection for the proposed study. This typeof study design is preferred because it allows the researcher tocollect data that inform about an existing condition and it reducesthe cost of conducting the research (Murphy, 2014, p. 1).

Participants

Theproposed study will be conducted on a total of 200 participants.These participants will include older adults who are aged at least 65years. The total number of female participants is expected to be 50 %(100) and 50 % (100) male participants. This sample size is perceivedto be a sufficient representative of the older adults suffering fromdepressive symptoms in the United Kingdom.

Inclusionexclusion criteria

Foran older adult to be included in the study, one must have beendiagnosed and confirmed to be suffering from depression using theDSM-IV criteria. However, older adults who may not be suffering fromdepression at the time of sampling, but there is documented evidencethat they were diagnosed with the disorder within a period of 12months will also be included in the study. By considering the seniorswho have already been diagnosed, it will be possible to save on timeand resources since there will be no need to screen the studyparticipants for depression once they are recruited.

Sampling

Themethod used to sample the study participants influence thereliability of the findings since it determines if the sample is arepresentative of the population being studied. A random samplingtechnique is the most appropriate method that will be used to samplethe 200 older adults, who will take part in the proposed study.Random sampling is preferred by researchers because it reduces thechances for bias, which in turn enhances the reliability as well aswell as the generalizability of the study findings (Teddlie, 2007, p.79 and Rada, 2014, p. 391). In addition, random sampling isconsidered as the only sure way of obtaining a study sample thatrepresents the target population in a fair manner.

Recruitment

Theolder adults will be approached from the senior living facilities andhealth care facilities that deliver mental health care for theelderly people. They will be recruited from the two places becausethere is a high probability of finding older adults who have beendiagnosed with depressive symptoms recently and are willing to takepart in the study. The selected older adults will be informed aboutthe proposed study before being requested to take part in it. Thenames and contact of those who will agree to be part of the studywill be written down in order to facilitate the compilation of thelist of the all participants before the subsequent procedures can becarried out.

Interventions

Thespecific instrument that will be used to collect data is known asLife Events and Difficulties Schedule (LEDS) that was designed byBrown and Haris (Chong, 2001, p. 29). LEDS is a special form ofsemi-structured interview instrument that is used to collect data ondiscrete events as well as long-term difficulties that have beenexperienced by an individual (McQuaid, 2000, p. 788). The date ofspecific events and their difficulty will be sought out and recordedduring the process of interview. The degree of threat associated witheach event will be rated on the scale of 1-4, where 1=a markedthreat 2=moderate threat 3=little threat 4=no threat.

Datacollection

Datafor the proposed study will be collected during the process of theinterview and the help of LEDS instrument. The interview is preferredbecause it gives researchers the opportunity to collect primary datafrom the subject by interacting with them directly (Woods, 2014, p.3). This form of interaction allows the researcher as well as thestudy participants to seek for clarification and further details. Inaddition, the researcher is able to establish a relationship with thestudy subjects and gain their trust, which in turn facilitates thecollection of reliable data (Kajornbon, 2014, p. 3. The depressivesymptoms will be the dependent variables while socio-demographicconditions (including gender, level of education, and marital status)and life events will be considered as independent variables.

Dataanalysis

Theresearcher will perform the univariate analysis of differentsocio-demographic variables as well as life events in relation todepressive disorders and with the descriptive statistics that willinclude the odd ratio. The identified significant variables will beanalyzed by performing the multivariate analysis that will requirethe use of logistic regression.

EthicalconsiderationsInformedconsent

Ethicalconsideration is a significant component of any scientificresearchers. Although ethical consideration is made to achieve variedobjectives, the primary goal of observing ethics in research is toprotect the interests as well as the wellbeing of the people whoagree to take part in a given research (King, 2007, p. 430). Ethicalconsideration will be accomplished in the proposed study by obtainingan informed consent and maintaining confidentiality as consideredbelow.

Informedconsent

Informedconsent is a concept used to describe a process that a researchergoes through to obtain permission from participants before thespecific interventions can be conducted. This is an ethical procedurethat ensures that the rights of the study participants areacknowledged and respected throughout the study (King, 2007, p. 430).The aim of obtained an informed concept for the proposed study is toensure that participants will be able to make informed decisions tojoin the study. To this end, the informed consent form informs willinform the target study participants about the nature of theprocedures that will be used in data collection, possiblealternatives to the interventions that will have been proposed,possible risks, uncertainties, as well as benefits of taking part inthe study, right to withdraw from the study without penalties, andtheir free-will to accept interventions (King, 2007, p. 430).

Confidentiality

Theconcept of confidentiality requires that the data collected from thestudy participants be kept a secret unless participants givepermission to researchers to disclose that information (Palys, 2000,p. 163). Confidentiality will be maintained in the proposed study byconcealing the names of those who will agree to take part in thestudy. It will be made optional for the participants to provide theirreal names during the process of data collection. However, even thepersonal details of the participants who will agree to provide willbe protected by keeping the data collection instruments in a lock andkey drawer to prevent the accessibility of that data to unauthorizedpersons.

OtherconsiderationsLimitations

Theproposed study will only cover the population of seniors or olderadults living in the United Kingdom, which might limit thegeneralizability of the anticipated findings to differentgeographical locations. In addition, the findings of the proposedstudy will be limited to data that will be collected from 200 studyparticipants. This will deny the researcher the opportunity to takeaccount of the findings reported by other researchers in making thefinal conclusion. Moreover, using the total of 200 older adults torepresent millions of elderly people suffering from depressivesymptoms in the United Kingdom might limit the reliability of thefindings and the possibility of acquiring a good representation ofthe target population. Moreover, the study will be cross-sectional,which implies that the data will be collected at a given point intime. This will limit the researchers’ capacity to determine theimpact of changes in socioeconomic conditions with time, which couldbe accomplished with the help of a longitudinal research methodology(Rajulton, 2001, p. 170 and Rindfleisch, 2007, p. 10).

Proposed budget

Item

Quantity

Amount (Pounds)

Wages

Interviewers

10

5,000

Data analysts

2

1,000

Editorial assistant

1

500

Equipment:

Laptop

3

900

Printer

1

50

Pens

12

12

Notebooks

12

24

Other items:

Transport

12

5,000

Communication

12

100

Meals

12

4,000

Total

16,586

Planfor dissemination of the study findings

Disseminationof the findings refers to the process or strategies that are used toshare the findings with the relevant stakeholders who may use theresults of a study to make decisions or enhance their daily practices(Lomas, 2012, p. 1). The findings of the proposed study will bedisseminated in three ways. The first and the most fundamental way ofdisseminating the findings are to make a formal presentation of thefindings to my faculty. The presentation will provide the researcherwith the opportunity to share the new body of knowledge obtained fromthe study with the faculty and students who will be present. Thesecond dissemination strategy will involve the publication of thefinal report in one of the journal with both online and offlinepublications. The journal will ensure that the findings of theproposed study can be accessed by the key stakeholders, including thehealth care providers who specialize in delivery of mental care tothe elderly people, government agencies, and counselor. Lastly, asummary of the findings will be shared with social media followers inorder to inform those may be interested in issues that increase therisk of their elders to suffer from depressive symptoms.

Time table of activities

Activity

Time

Writing proposal

March 11, 2016 – March 19, 2016

Recruitment of study participants

April 1, 2016 – April 10, 2016

Obtaining informed consent

April 10, 2016

Interviews and data collection

April 11, 2016 – May 10, 2016

Data analysis

June 1, 2016 – June 25, 2016

Presentation

June 27, 2016

Dissemination of the study findings

June 30, 2016

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