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SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
Ms. JANLY GEORGE
FIRST YEAR M.SC (NURSING)
MENTAL HEALTH NURSING
YEAR 2011-2013
INDIAN ACADEMY COLLEGE OF NURSING
BANGALORE – 560 043
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
1
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRES
Ms. JANLY GEORGE
1ST YEAR M.Sc (NURSING)INDIAN ACADEMY COLLEGE OF NURSING,HENNUR MAIN ROAD, HENNUR CROSS, BANGALORE – 560 043
2. NAME OF THE INSTITUTION INDIAN ACADEMY COLLEGE OF NURSING, BANGALORE-560043
3. COURSE OF THE STUDY AND SUBJECT
1ST YEAR M.Sc (NURSING), MENTAL HEALTH NURSING
4. DATE OF ADMISSION TO THE COURSE 25/09/2011
5. TITLE OF THE STUDY“A COMPARATIVE STUDY
TO ASSESS THE EFFECTIVENESS
OF PRANAYAMA ON REDUCING
DEPRESSION AMONG MARRIED
AND UNMARRIED ELDERLY
PEOPLE IN SELECTED OLD AGE
HOMES AT BANGALORE.”
2
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“You do not heal old age. You protect it; promote it; you extend it”.
-Sir James Sterling Ross
Ageing is a universal phenomenon, which is experienced by every human being
across various cultures. The experience of ageing is unique to every individual because of
the individual differences in personalities, varying social support networks and differing
according to the culture to which one belongs. Also aging involves many major life
changes and is a psychological step, or a transition, that alters one’s relation to the world
and demands new responses.1
The Indian family has traditionally provided natural social security to the old
people. However, in more recent times, the traditional role of the family is being shared
by institutions such as old age homes. Many of the elderly parents are compelled to leave
their children and stay in old age homes. The old age homes, which were a rarity, have
recently spread across the country, a fact that indicates the growing rift between the
generations.2
Elderly depression can be quite common as ageing presents its own set of
challenges - many elderly people have to face some very difficult situations where certain
health conditions could be taking a toll on the person on the one hand and, on the other,
failing health or death of a spouse could contribute heavily to depression in the elderly.3
Sometimes, people who have led a fairly independent life might be required to
depend on another because of disabilities and coming to terms with these changes and
challenges can be heart wrenching for the elderly. In such cases, it is only natural one
3
begins to feel terribly lonely and in the absence of a support system in terms of spouse,
family, and friends, elderly depression sets in during old age.4
Pranayama is a yogic tool that can function beyond treatment of depression to
improve a person's overall wellbeing. People practicing pranayama learn to connect their
mind and body by regulating their breath, which also serves as a foundation for
meditation. Learning to manage the breath through pranayama leads to relaxation and
better quality of life, which can reduce or eventually eliminate the persistent symptoms of
depression.5
So the researcher is interested to compare the effectiveness of pranayama on
reduction of depression among married and unmarried old age people because the
prevalence rate was more among elderly persons. Pranayama will have greater impact on
the improvement of the emotional status of old age persons and it will change the attitude
of elderly persons to accept the old age a global phenomenon.4
6.1 NEED FOR THE STUDY
Demographic ageing is a global phenomenon. By 2025, the world's population is
expected to include more than 830 million people at an age of 65. With a comparatively
young population, India is still poised to become home to the second largest number of
older persons in the world. Recent statistics related to elderly people in India,(according
to census 2001), showed that as many as 75% of elderly persons were living in rural
areas. About 48.2% of elderly persons were women, out of whom 55% were widows. A
total of 73% of elderly persons were illiterate and dependent on physical labor. One-third
was reported to be living below the poverty line, i.e., 66% of older persons were in a
vulnerable situation without adequate food, clothing, or shelter.6
4
About 90% of the elderly were from the unorganized sector, i.e., they have no
regular source of income. The socio-economic problems of the elderly are nowadays
aggravated by factors such as the lack of social security and inadequate facilities for
health care, rehabilitation etc. Living arrangements of older people are influenced by
several factors such as gender, health status, and presence of disability, socio-economic
status and societal traditions. To overcome these problems and to ensure a good, healthy
and quality life, the elderly members of the society can move a long way with the support
of the family members as well as the other society members. 7
Old people in India, like those in other countries, suffer from a range of problems.
However, of all the problems associated with an aging population, health care
demands the top priority. Ageing is a time of multiple illness and general disability.
Along with the changes in the biological compositions, life style factors are also
important for disorders and diseases in old age. Old age diseases are not always curable,
implying a strain on financial as well as physical health infrastructure resources.
However, the feeling of well- being can still override actual physical discomforts if the
surrounding environment is nurturing.7
According to WHO (2008), the prevalence of depressive disorders varies
throughout the world. The lowest rates are reported in Asian and Southeast Asian
countries. Percentages represent the lifetime chance that a person will experience a
depressive episode that lasts a year or more. For example, Taiwan reports less than 2%,
and Korea 3%. Western countries typically report higher rates, such as Canada 7%, New
Zealand 11%, and France 16%. The United States has a rate of 6%. Also, countries
5
plagued by protracted civil war, such as Bosnia and Northern Ireland, report higher rates
of depression.8
The American Psychiatric Association estimates that 0.4% to 1.2% of adults
experience Depression. This Depression affects women and men equally and is more
common in higher socioeconomic groups. It can begin any time after adolescence, but
onset usually occurs between ages 50 and 70; about 35% of patients experience onset
between ages 60 and 70. Before the onset of overt symptoms, many patients with
Depression have an energetic and outgoing personality with a history of wide mood
swings.9
Depression recurs in 80% of patients; as they grow older, the episodes recur more
frequently and last longer. This illness is associated with a significant mortality; 20% of
patients commit suicide, many just as the depression lifts.
Worldwide Information
To say that depression and anxiety in the U.S. are a problem would be the
understatement of the year. Whereas depression touches over 14 million adults every
year, anxiety disorders clock in as the most common mental illness with 40 million (or 18
percent) of adults in the United States suffering the affects of this particular malady.10 In
world health organization reported that the incidence rate of Depression was 27.5%
In Canada the incidence rate of Depression 7.9-8.9 of adults will have
Depression during their life time at least once.
6
Indian Information
The incidence rate of Depression was 31.2%, the annual incidence of Depression
in slightly higher in male than in female. In National institute of Mental Health and
Neurosciences reported that the incidence rate of Depression was 29.8%.
In the changing society, India is slowly grasping the western culture where the
parents limit their company with their children and even children will have full freedom
to live according to their needs. Old age was never a problem in India. As life expectancy
has increased to around 65 today, hundreds of old age homes have sprung up in India.8
Basic reasons for neglecting old people in the families are:
1. As the life is turning busy, there is no enough time to take care of elders in the
family.
2. Old life is burden and they need support of some one to be with for their needs.
3. Children with a view that there won’t be freedom in the family if there is an old
person. (Due to generation gap, variations in the thoughts.. etc.,)
4. There won’t be any means of income for some elders. Here children may think
that their parents or grand parents’ medical and food expenses are burden for
them.
5. Some people who prefer nuclear families rather than joint families are also one of
the main reasons.
Whatever the reason is, the word neglect is definitely larger in this case, where the
needy and the helpless seniors are getting avoided and left on their own without care and
attention.10
7
Although depression in the elderly is a common problem, only a small percentage
gets the help they need. There are many reasons depression in older adults is so often
overlooked: Some assume seniors have good reason to be down or that depression is just
part of aging. Elderly adults are often isolated, with few around to notice their distress.
Physicians are more likely to ignore depression in older patients, concentrating instead on
physical complaints. Finally, many depressed seniors are reluctant to talk about their
feelings or ask for help.7
The consequences of this oversight are high. Untreated depression poses serious risks
for older adults, including illness, alcohol and prescription drug abuse, a higher mortality
rate, and even suicide. So it’s important to watch for the warning signs and seek
professional help when you recognize it. The good news is that with treatment and
support, depressed seniors can feel better.11
The researcher realized that there is an immense need of alleviating the stress
of the elderly in order to maintain good physical and mental health. During the literature
review the researcher found that pranayama provides good activity to all internal and
external organs to reduce the stress hormones level, increases the circulation and relaxes
the muscles. Hence the investigator felt that, it is necessary to assess the effectiveness
pranayama to reduce the level of depression among married and unmarried elderly.
8
6.2 REVIEW OF LITERATURE
Review of literature is an important step in the development of any research
project. It helps the investigator to analyze what is known about the topic and to describe
method of inquiry used in earlier world including their success and short comings. It
gives a broad understanding of the problem keeping those aspects in mind of the
investigator. Probed in to available resource of the document, informations and studies
related to pet therapy and its relation on depression among old age.
The review of the literature is an extensive systematic scrutinization of potential
sources of previous study and work. This process helps in identification and selection of
problem, back ground of the study, formation of the tool, choosing the methodology,
formulating hypothesis. (Polit and Hungler 1990).
Review of literature of the present study was arranged under the following
headings:
1. Literature related to prevalence and incidence of depression among old age
people.
2. Literature related to management of depression among old age people.
3. Literature related to effectiveness of pranayama on reducing depression
among old age people.
I. Literature related to prevalence and incidence of depression among old
age people.
A T Beekman, (2000) conducted a study to assess the prevalence of depression in
later life. The objective of the study was to assess the prevalence of late-life depression
in the community. Systematic review of community-based studies of the prevalence of
9
depression in later life (55+). This study concluded that there is consistent evidence for
higher prevalence rates for women and among older people living under adverse socio-
economic circumstances.12
Dyer CB, (2000) conducted a study to assess the prevalence and incidence of
depression and dementia in neglected patients. The objective of the study was to describe
the characteristics of abused or neglected patients and to compare the prevalence of
depression and dementia in neglected patients. They selected Baylor College of Medicine
Geriatrics Clinic at the Harris County Hospital District (Houston, Texas). Standard
geriatric assessment tool has used./ this study revealed that there was a statistically
significant higher prevalence of depression (62% vs 12%) and dementia (51% vs 30%) in
victims of self-neglect compared to patients referred for other reasons.13
David C. Steffens,(2000) conducted a study to assess the Prevalence of
Depression and Its Treatment in an Elderly Population. examined the current and lifetime
prevalence of depressive disorders in 4559 nondemented individuals aged 65 to 100
years. This sample represented 90% of the elderly population of Cache County, Utah.
Using a modified version of the Diagnostic Interview Schedule, we ascertained past and
present DSM-IV major depression, dysthymia, and subclinical depressive disorders. This
study concluded that These estimates for prevalence of major depression are higher than
those reported previously in North American studies. Treatment with antidepressants was
more common than reported previously, but was still lacking in most individuals with
major depression. The prevalence of subsyndromal depressive symptoms was low,
possibly because of unusual characteristics of the population.14
10
Patricia A. Parmelee, (2002) conducted a study Depression Among
Institutionalized Aged: Assessment and Prevalence Estimation. Aged nursing home and
congregate apartment residents were screened for symptoms of depression and
cognitive impairment. Of 708 survey respondents, 12.4% met DSM-IIIR criteria
(33) for major depression; about half this group also displayed significant cognitive
deficits. Another 30.5% of the total sample reported less severe but nonetheless
marked depressive symptoms. Such “minor” depressive syndromes were much more
common among congregate housing than nursing home residents. Possible major
depression was more prevalent among newly admitted residents of both housing
components.15
K. Jongenelis, (2004), conducted a study Prevalence and risk indicators of
depression in elderly nursing home patients: the AGED study. Prevalence and risk
indicators of depression were assessed in 333 nursing home patients living on somatic
wards of 14 nursing homes in the North West of the Netherlands. Depressive symptoms
were measured by means of the Geriatric Depression Scale (GDS). This study showed
that The prevalence of depression in the nursing home population is very high.
Whichever way defined, the prevalence rates found were three to four times higher than
in the community-dwelling elderly.16
Ryan J. Anderson, (2008), conducted a study The Prevalence of Comorbid
Depression in Adults With Diabetes. The objective of the study was to estimate the odds
and prevalence of clinically relevant depression in adults with type 1 or type 2
diabetes. A total of 42 eligible studies were identified; 20 (48%) included a
nondiabetic comparison group. In the controlled studies, the odds of depression in
11
the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0,
95% CI 1.8–2.2) and did not differ by sex, type of diabetes, subject source, or
assessment method. This study concluded that The prevalence of comorbid
depression was significantly higher in diabetic women (28%) than in diabetic men
(18%), in uncontrolled (30%) than in controlled studies (21%).17
II. Literature related to management of depression.
Simon Gilbody, (2003) conducted a study Educational and Organizational
Interventions to Improve the Management of Depression in Primary Care. The objective
of the study is to systematically evaluate the effectiveness of organizational and
educational interventions to improve the management of depression in primary care
settings. They selected 36 studies, including 29 randomized controlled trials and
nonrandomized controlled clinical trials, 5 controlled before-and-after studies, and 2
interrupted time-series studies. Outcomes relating to management and outcome of
depression were sought. This study concluded that there is substantial potential to
improve the management of depression in primary care. Commonly used guidelines
and educational strategies are likely to be ineffective.18
Debbie A Lawlor, (2000), conducted a study to assess the effectiveness of
exercise as an intervention in the management of depression. The objective of the study
was to determine the effectiveness of exercise as an intervention in the management
of depression. The participants in most studies were community volunteers, and
diagnosis was determined by their score on the Beck depression inventory. When
compared with no treatment, exercise reduced symptoms of depression
(standardised mean difference in effect size −1.1 (95% confidence interval −1.5 to
12
−0.6); weighted mean difference in Beck depression inventory −7.3 (−10.0 to −4.6)).
This study concluded that the bexercise is effective in reducing the depression.19
Martin Orrell, (2003) conducted a study Management of depression in the
elderly by general practitioners Use of antidepressants. This study aims to investigate
how GPs manage depression in the elderly. The questionnaire was completed by
407 out of 667 GPs (61%). Many GPs chose the newer antidepressants but a
substantial proportion preferred the older tricyclics. Many GPs selected
subtherapeutic doses, particularly of the older tricyclics. Results reflect GPs
practice there is a danger that many patients will be inadequately treated and also
at risk of relapse because of their antidepressants being stopped too soon after
recovery.20
Bydawell, (2005), conducted a study to assess the The impact of exercise on
depression and psychological well-being. This study set out to investigate the impact
of exercise as a treatment option for depression and low levels of psychological well-
being over a two-month period. The design of this study used both a quantitative
and qualitative approach. Data was collected through standardized questionnaires
and completed pre and post-test by forty participants randomly assigned to an
experimental and control group. Additional data was attained through two open-
ended questions given to participants in the experimental group. This study showed
that exercise does have a positive impact on depression and psychological well-
being.21
Ellen davis jones, (2002), conducted a study to assess the use of reminiscence
therapy for the treatment of depression in rural-dwelling older adults. Reminiscence
13
therapy is a nurse-initiated intervention that has the advantages of being cost-effective,
therapeutic, social, and recreational for the institutionalized older adult. As a
communicative psychosocial process, reminiscence therapy has proven to be a valuable
intervention for the depressed elderly client. It has been shown that depressed elders
living in rural areas resist treatment from mental health services for a variety of different
reasons (Molinari, Boeve, Kunik, & Snow-Turek, 1999; Neese, Abraham, & Buckwalter,
1999). For those elders, reminiscence therapy may prove an extremely beneficial
alternative to more traditional treatment modalities in reducing the effects of depression
and depressive symptoms.22
III. Literature related to effectiveness of pranayama on reducing depression
among old age people.
Karen Pilkington, (2005) conducted a study to assess the effectiveness of
Pranayama for depression.Five randomised controlled trials were located, each of
which utilised different forms of pranayama interventions and in which the severity
of the condition ranged from mild to severe. All trials reported positive findings but
methodological details such as method of randomisation, compliance and attrition
rates were missing. This study concluded that pranayama was potentially beneficial
effects of yoga interventions on depressive disorders.23
Ali Tayyebi, (2011), conducted study of the effect of pranayama exercises on
stress, anxiety and depression among hemodialysis patients. The objective of the study is
to determine the effect of pranayama exercises on stress, anxiety and depression among
these patients. The present research is a two-group semi-experimental controlled trial
done in 2010, in which 31 hemodialysis patients were selected from Shahid Labbafinejad
14
hospital as the control, and 31 condition-matched patients from Baqiyatallah hospital as
the case group, and pranayama exercise was performed for the experimental group for an
hour twice a week during two months, after primary training by the yoga instructor. This
study concluded that Performing the low-cost, simple, and enlivening pranayama
exercise is accompanied by improving living conditions of hemodialysis epressive
patients, and a positive step can be taken toward improvement and prevention of the
patients' psychological problems.24
Kimberlee Bethany Bonura, (2009), conducted a study to assess the Effects of
pranayama versus Exercise on Stress, Anxiety, and Depression in Older Adults.
Participants (M age = 83; N = 42) were randomly assigned to one of four activity
groups: chair Yoga, chair aerobics, walking, and social games (non-activity control
group). Classes met for 30 minutes, 3 days per week, for 6 weeks. the pranayama
group showed the most stress reduction over time.25
Purvi Mehta, (2010), conducted a study on pranayama as a Complementary
Therapy for Clinical Depression. The objective of this study was to examine research
regarding the benefits of pranayama for depression. A total of 18 studies met the
criteria. Some of the designs utilized by the interventions were pretest posttest,
quasi-experimental and randomized controlled trials. It was found that majority of
the interventions (17) were able to significantly reduce depressive symptoms in the
patients under study. However, several methodological limitations were identified in
the conduct of the intervention trials, which future interventions must consider.26
Uebelacker, (2005), conducted a study to assess the effectiveness of pranayama
on Depression. The purpose of this article is to review the evidence for the efficacy of
15
pranayama for depression and possible mechanisms by which pranayama may have an
impact on depression. They examined pranayama for depression uncovered eight trials: 5
including individuals with clinical depression, and 3 for individuals with elevated
depression symptoms. This study concluded that pranayama may be an attractive
alternative to or a good way to augment current depression treatment strategies. Second,
aspects of pranayama —including mindfulness promotion and exercise—are thought to
be “active ingredients” of other successful treatments for depression.27
6.3(A) STATEMENT OF THE PROBLEM
“A comparative study to assess the effectiveness of pranayama on reducing
depression among married and unmarried elderly people in selected old age homes at
Bangalore.”
6.3(B) OBJECTIVES OF THE STUDY
To assess the existing level of depression of married and unmarried elderly people
To evaluate the effectiveness of pranayama among married and unmarried elderly
people.
To compare the effectiveness of pranayama among married and unmarried elderly
people.
To associate the pre-test level of depression of married and unmarried elderly people
with their selected demographic variables.
6.3(C )OPERATIONAL DEFINITION
Effectiveness: It refers to the outcome of Pranayama in reducing depression among
old age people residing at selected old age homes at Bangalore.
16
Pranayama: Pranayama is the art of harmonizing breathing. It has the capacity of
freeing the mind from stress.
Depression: The level of mood such as feeling of loneliness, decrease passion for
life, feeling of unworthiness which is measured by using geriatric depression scale.
Old age people: Refers to the individual who are above 60 years of age living in
selected old age homes at Bangalore.
Old age homes: It is a place where deserted elder people are looked after with
compassion and their basic needs are fulfilled.
6.3(D) RESEARCH HYPOTHESIS
H1. The mean post test level of depression of married and unmarried elderly people
will be significantly lower than the mean pre test level of depression of married and
unmarried elderly people after administration of Pranayama among old age peoples.
H2. There will be significant difference between the level of depression of married and
unmarried elderly people.
H2. There will be an association between the pre test level of depression among
married and unmarried elderly people and their selected demographic variables (age,
sex, religion, education, previous occupation, marital status, type of family, duration
of visit by the family members, hobbies and reason for staying in the old age home).
6.3(E) ASSUMPTION.
The study is based on the assumption that:
1. Old age peoples residing at old age homes have more chance for experiencing
depression.
17
2. The level of depression of unmarried elderly people will be higher than the level
of depression of married people.
3. Successful administration of Pranayama makes positive changes in the level of
depression among married and unmarried elderly people.
6.3(F) LIMITATION
Old age people those who are residing at selected old age homes at Coimbatore.
Old age persons those who are above 60 years.
The data collection period is limited to 6 weeks.
This study is limited to Old age peoples who are willing to participate in the
study.
18
7. MATERIALS AND METHODS
This chapter gives a description of the research approach, research design,
variables, the setting of the study, population, sampling, research tool, methods of data
collection and plan for data analysis.
7.1 Sources of data
Data will be collected from old age peoples residing in selected old age homes at
Bangalore.
7.2 Methods of data collection
I. Research design
Quasi Experimental Design
II. Research approach
Evaluative Approach
III. Research variables
a. Dependent variables
Level of Depression of elderly peoples residing in selected old age homes at
Bangalore.
b. Independent variables
Pranayama
c. Demographic variables
19
Characteristics of old age people such as Age, Sex, Education, Occupation,
Religion, Marital status, Type of family, Duration of visit by the family members,
Hobbies and Reason for staying in the old age home.
IV. Setting
Study is planned to conduct in selected old age homes at Bangalore.
V. Population
Old age peoples residing in selected old age homes at Bangalore.
VI. Sample
Old age peoples residing in selected old age homes at Bangalore. For pilot study
sample size will be 10. For main study the sample size will be 100.
VII. criteria for sample selection
a) Inclusion criteria
Old age peoples residing in selected old age homes at Bangalore.
Old age peoples who can communicate freely in Kannada or English.
Old age people those who are in the age of 60 and above.
Those who are available at the time of data collection.
Old age persons those who are having depression.
b) Exclusion criteria
Old age peoples who are not willing to participate in the study
Those who are suffering from any chronic physical and mental illness.
Old age people those who are in the age of below 60.
VIII. Sampling Technique
20
Non- probability convenience sampling technique.
IX. Tool for data collection
The data was collected by using Geriatric Depression Scale to assess the level of
depression among old age persons. Tool consists of two parts:
Part I: Demographic variable.
Part II: Geriatric Depression Scale.
Part I: Demographic variable.
The questionnaire consists of 10 items seeking demographic variables such as Age,
Sex, Religion, Educational status, Occupation, Marital status, Type of family, Duration of
visit by family members, Hobbies and Reason for staying in old age home. It is a self
administered questionnaire. Instructions were given to the old age persons for using the
questionnaire.
Part II: Geriatric Depression Scale.
It consists of 30 items to assess the level of depression. Instructions were given to
the old age persons for using the Geriatric Depression Scale.
The grading was done as follows:
Category. Score. Category. Score.
Mild Depression.
Moderate Depression.
Severe depression.
1 – 9.
10 – 19.
20 – 30.
X. Methods of data collection
After obtaining permission from concerned authority an informed consent from
samples, the researcher will collect data from samples.
21
Phase 1
Pretest will be conducted to assess level of Depression of old age peoples by
using geriatric depression scale.
Phase 2
Pranayama will be administered to the old age peoples.
Phase 3
After 4 week post test will be administered to assess the level of Depression
among old age peoples with the help of same geriatric depression scale.
Phase 3
After obtaining the pre-test and post-test the investigator will be compared the
effectiveness of pranayama for reducing the level of depression among married and
unmarried elderly people. Duration of the study 4 weeks.
XI. Plan for data analysis
The investigator edited the tool, coded the data and entered the data into excel sheet.
Statistical analysis was done on the basis of objectives and hypothesis by using
descriptive and inferential statistics.
Descriptive statistics.
Frequency and percentage distribution was used to analyze demographic variable.
Mean and standard deviation was used to analyze the level of depression.
Inferential statistics.
Paired‘t’ test was used to find out the difference between pre test and post test
scores of experimental group.
22
Chi-square was used to find out the association between pre test score of control
group and their selected demographic variables.
XII. Projected outcomes
After the study, the investigator will able to know the Level of Depression among
old age people and effectiveness of pranayama among married and unmarried elderly
people based on the findings. Pranayama will be administered to old age peoples. It will
help them to reduce the level of Depression.
7.3 Does the study require any investigation or intervention to the patient or other
human being or animal?
Yes
7.4 Has ethical clearance been obtained from the concerned authority to conduct the
study?
Yes
a) Permission will be obtained from the Director of selected Old Age Homes at
Bangalore.
b) Informed consent will be obtained from the old age peoples residing in selected
old age homes at Bangalore to participate in the study with their own knowledge.
23
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year book publications.
2. Barbara Fadem, “High yield psychiatry“, Lippincott willams and willkers, 2nd
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3. Bellack Alan S, “Hand book of behaviour therapy in psychiatric setting”,
Plenum press, New York, London, Pp : 269 – 280, 1993.
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5. Bhatia M.S, “A Concise text book of psychiatric nursing”, C.B.S publishers
and distributors, Delhi reprint, Pp : 180, 1977.
6. Butler J and Richard, “ Behaviour and Rehabilitation ”, Bristol, John Wright
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7. Dunton Ruth William, “Occupational therapy principles and practice”, Licht
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8. Fontaine and Fletcher, “Mental Health Nursing“, Addison – Werley, Longman,
4th edition, Pp : 283-296, 1999.
9. Helen C. Anderson et al. (1971), “Geriatric Nursing”, The C.V Mosby
compony, 5th Edition.
24
10. Irvin R.E. (1998), “The Older Patients”, New York, Hodder and Stoughtan
publishers, 3rd Edition.
11. Jennie Kay et al. (1989), “Nursing Care for the Aged”, Appleton Lang
publications, USA.
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No: 307-311, http://bjp.rcpsych.org/content/174/4/307.short
13. Dyer CB, (2000), Journal of the American Geriatrics Society,
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No: 39-41, http://geronj.oxfordjournals.org/content/44/1/M22.short
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Page No: 447-449,
http://www.sciencedirect.com/science/article/pii/S016503270400182X
17. Ryan J. Anderson, (2008), Journal Of Diabetes Care, volume: 24, Page No:
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9. Signature of the candidate :
10. Remarks of the guide :
11. Name and designation of
11.1 Guide :
11.2 Signature :
11.3 Co-guide :
11.4 Signature :
11.5 Head of the department :
11.6 Signature :
27
12. Remarks of the Principal :
12.1 Signature :
28