Prevalence of Depression and Dementia Among Institutionalized Elderly in Kenya - Case Study of Nairobi County

Abstract

Background: The population aged 65 and above is growing faster than any other age group, especially in developing countries. With the significant life transitions that accompany ageing, going with what can be termed as a breakdown to the traditional social protection systems like the extended family in present times; institutionalization of the elderly is becoming quite common of late. The elderly’s adjustment to institutionalization is not always easy and can be accompanied by a number of psychological issues. Objectives: This study aimed at determining the prevalence of depression and dementia among institutionalized elderly. Other objectives include: identify reasons/risk factors associated with institutionalization of the elderly; to determine the association between depression and dementia; and to examine the relationship between risk factors, depression and dementia among institutionalized elderly. The study focused on four main institutions within Nairobi County namely: Nyumba ya Wazee - Ruaraka, Mji wa Huruma - Runda, Kariobangi Cheshire Home, and Mother Teresa - Huruma. Theory: This study was guided by the psychosocial theory of development by Erik Erikson (1963), ‘ego integrity versus despair’ stage (65+ years). Significance: The study was able to generate a list of possible predictors for institutionalization that may facilitate the pre-admission assessment process of the elderly for better care within the institutions. The findings made informed on areas of improvement relating to institutional care for the elderly and have policy implications as well. Methodology: This research utilized the crosssectional design best suited for prevalence studies. The sample of 194 participants was selected through simple random sampling which is relatively easy and allows for the generalization of findings. This study used assessment scales to measure the point prevalence of depression and dementia, and a socio-demographic questionnaire to explore the other objectives. The assessment tools used include: 6-Item Cognitive Impairment test (6-CIT), Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD). Analysis and Presentation: The data collected was keyed into the SPSS software for descriptive and inferential analyses including: Ttests, correlation analysis and Chi-square test and later presented using tables, pie charts and bar graphs. Results: 11% and 37% met the criteria for depression and dementia respectively. More women than men were shown to have depression and more females than males aged 80 years and above had dementia. The main reasons/risk factors for institutionalization identified by this study were: being single, having an impairment, chronic illness, poor self-rated health, being dependent for basic daily functioning and having little social support. This study observed a positive relationship between depression and dementia (r=.253, df=186, p=.000). The study also found statistically significant relationships between having children and dementia (r = -.179, N=191, p = .013); supportive family and friends and dementia (r =-.181, N=191, p = .012); and being dependent for daily basic functioning to both depression (r =.191, N=191, p = .008) and dementia (r =.221, N=191, p = .002). Conclusions and Recommendations: Institutionalized elderly had a higher prevalence for depression and dementia. Factors like being single, widowed or divorced increase the risk for depression and dementia among older adults. The observed relationship between level of education and dementia, suggests that education provides important cognitive reserves that could delay the onset of dementia. This study recommends further research within different contexts in Africa to: generate more reliable estimates for the prevalence of depression and dementia among the elderly, examine the blend of factors that account for the observed gender disparities and improve understanding of the different physical, social and environmental risk factors related to depression and dementia