A Study to Assess the Effectiveness of Family Focused Nursing Interventions on Knowledge and Functional Health Problems among Older Adults and their Caregivers at Selected Rural Community Setting

INTRODUCTION: India is an aging society with the rate of ageing population exceeding the growth of the general population. Prevalent problems experienced by the older adults include sleep disorder, problems with eating or feeding, incontinence, confusion, depression, evidence of fall and skin break down. Falls are a leading cause of death in older adults. Falls lead to 20% to 30% of mild to severe injuries and major cause of 10% to 15% of all emergency department visits. Fall related injuries typically occur in the home. Sleep problems can also have serious medical consequences. Insomnia is a strong predictor of mortality and morbidity. Sleep loss may exacerbate medical and psychiatric illnesses. Inadequate sleep (poor quality of sleep) (or) insufficient duration (or) both may result in difficulty with concentration, memory, confusion, increased risk of fall, and decrease the overall quality of life. Falls in community dwelling older adults are often preventable and sleep disturbances are manageable. There is a need for developing a comprehensive care of providing preventive, curative and rehabilitative services to the older adults and supportive education to their caregivers. So, the nurse investigator devised the various nursing intervention strategies to reduce the burden of fall and sleep disturbance and problem of caregiver burden existing among older adults and their caregivers. OBJECTIVES: 1. To assess and compare the pre and post test level of functional health problems and knowledge on functional health problems among older adults in experimental and control group. 2. To assess and compare the pre and post test level of knowledge on functional health problems among caregivers in experimental and control group. 3. To determine the effectiveness of family focused nursing interventions on level of functional health problems and knowledge on functional health problems among older adults. 4. To determine the effectiveness of family focused nursing interventions on level of knowledge on functional health problems among caregivers. 5. To correlate the post test level of knowledge with the level of functional health problems among older adults in experimental and control group. 6. To correlate the post test level of knowledge on functional health problems of caregivers with the level of knowledge and functional health problems among older adults in experimental and control group. 7. To associate the selected background variables with mean differed functional health problems score and knowledge score among older adults in experimental and control group. 8. To associate the selected demographic variables with mean differed knowledge score among caregivers in experimental and control group. NULL HYPOTHESES: NH1: There is no significant difference in the pre and post test level of functional health problems and knowledge on functional health problems among older adults between experimental and control group at p<0.05 level. NH2: There is no significant difference in the pre and post test level of knowledge on functional health problems among caregivers between experimental and control group at p<0.05 level. NH3: There is no significant correlation between the post test level of knowledge with level of functional health problems among older adults in experimental and control group at p<0.05 level. NH4: There is no significant correlation between the post test level of knowledge of caregivers with post test level of functional health problems and knowledge among older adults in experimental and control group at p<0.05 level. NH5: There is no significant association of selected background variable with mean differed functional health problems score and knowledge score among older adults in experimental and control group at p<0.05 level. NH6: There is no significant association of selected demographic variable with mean differed knowledge score among caregivers in experimental and control group at p<0.05 level. The conceptual frame work for the present study was based on the Integrated theory of Robert R. Carkhuff helping and human relations theory and Stuffle Beam CIPP evaluation model which guided the investigator through a systematic approach to approach the older adults functional health problems and improve the knowledge of older adults and their caregivers. METHODOLOGY: A true experimental two group pretest and post test design was undertaken for the study. The independent variable for the study was family focused nursing interventions and the dependent variable was the knowledge on functional health problems and functional health problems among older adults, knowledge on functional health problems among caregivers. The study was conducted at adopted villages (community) of Omayal Achi Community Health Centre. The samples for the study were older adults who had functional health problems such as risk of fall and sleep disturbances and their caregivers. The total sample size was 220 older adults (108 in experimental group and 112 in control group) and 220 caregivers of older adults (108 in experimental group and 112 in control group). Simple random sampling technique (random number table method) was used to collect the samples. The data collection instrument for screening of older adults with functional health problem was modified Fulmer SPICES tool and level of function health problem such as risk for fall using modified SAFE tool, and sleep disturbances (Sleep quality -Insomnia) using Pittsburg sleep quality index tool and structured knowledge questionnaire to assess the level of knowledge of older adults and their caregivers. The investigator conducted the study in three phases. In the first phase, screening was done for all the older adults with functional health problems and in second phase, pre test assessment of level of functional health problems in older adults and level of knowledge among older adults and their caregivers was done. In the third phase, the investigator administered family focused nursing interventions which included family focused education on functional health problems using flash cards, possible modification at home environment with balance and strengthening exercise for fall prevention and sleep hygiene with breathing exercise for reduction of sleep disturbances. Reinforcement of information and adherence of exercise was administered by direct visit using flashcards and video show and post test was done at 1st, 3rd and 6th months. RESULTS AND DISCUSSION: The data analysis findings at the end of the 6th month (Post test 3) on risk for fall, sleep disturbances and knowledge among older adults and knowledge among care givers after administering Family Focused Nursing Interventions (FFNI) revealed the following results. With regard to the risk for fall among older adults in experimental group, the overall mean score was 3.37 with the SD 1.21, whereas in control group, it was 7.35 with the SD 1.93. The unpaired ’t’ test value of t=18.26 proved that there was a high statistical significant difference between the experimental and control group at p < 0.001 level. FFNI such as education on fall, balance and strengthening exercise, modification of possible home environment had significantly reduced the risk for fall among older adults in the experimental group (29.7%) than in the control group (1.6%). With regard to the level of sleep disturbances among older adults in experimental group, the overall mean score was 4.71 with the SD 3.79, whereas in control group, it was 8.92 with the SD 0.48. The unpaired ’t’ test value of t=11.66 proved that, there was a high statistical significant difference between the experimental and control group at p < 0.001 level. FFNI such as education on sleep, breathing exercises and sleep hygiene had significantly reduced the sleep disturbances among older adults in the experimental group (23.7%) than in the control group (0.6%). With regard to the level of knowledge among older adults in the experimental group, the overall mean score was 17.38 with the SD 1.34, whereas in control group, it was 9.20 with the SD 2.87. The unpaired ‘t’ test value of t= 27.14 proved that, there was a high statistical significant difference in the level of knowledge among older adults between the experimental and control group at p < 0.001 level. FFNI such as family focused education had significantly improved the level of knowledge of older adults in the experimental group (44.8%) than in the control group (0%). With regard to the level of knowledge among caregivers in the experimental group, the overall mean score was 17.82 with the SD 1.59, whereas in control group, it was 9.10 with the SD 2.87. The unpaired ‘t’ test value of t=7.14 proved that, there was a high statistical significant difference between the experimental and control group at p < 0.001 level. FFNI such as family focused education had significantly improved the level of knowledge of caregivers in the experimental group (42.7%) than in the control group (1.1%). Thus the family focused nursing intervention had significantly reduced the functional health problem and improved the knowledge among older adults and their caregivers in the experimental group. CONCLUSION: The research phenomena focused on family focused nursing intervention for older adults and care giver, in which the knowledge and functional health problems among older adults and knowledge of care givers were assessed. The research investigator utilized the FFNI which included family focused education, balance and strengthening exercise, possible modification at home environment, sleep hygiene and breathing exercise. The study concluded that there was a significant reduction of risk for fall rate by 29.7%, reduction of sleep disturbances rate by 23.7% and improvement of knowledge among older adults and their caregiver’s rate by 44.8%, and 42.7% respectively. The study result proposes and the research investigator also recommends that the utilization of FFNI in any setting will help to promote active aging

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