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

8. LIST OF REFERENCES

1. Annette G. Luckenotte (1996), “Gerentological Nursing”, Philadelphia, Mosby

year book publications.

2. Barbara Fadem, “High yield psychiatry“, Lippincott willams and willkers, 2nd

edition, Pp : 56-60, 2003.

3. Bellack Alan S, “Hand book of behaviour therapy in psychiatric setting”,

Plenum press, New York, London, Pp : 269 – 280, 1993.

4. Bellack, Alan S and Herson Michel, “Dictionary of behavioural technique and

therapy”, Paragons press, New York, 1985.

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

and Sons Ltd, Pp : 68-90, 1978.

7. Dunton Ruth William, “Occupational therapy principles and practice”, Licht

Sidney, U.S.A, 2nd edition, Pp : 177 – 180, 1957.

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.

12. A T Beekman, (2000), The British Journal of Psychiatry, Volume : 174: Page

No: 307-311, http://bjp.rcpsych.org/content/174/4/307.short

13. Dyer CB, (2000), Journal of the American Geriatrics Society,

Volume :48(2):Page No: 205-208,

http://ukpmc.ac.uk/abstract/MED/10682951/reload=0;jsessionid=D1AA94090D2

CD2716981AD92F6D50BEB

14. David C. Steffens,(2000), Archives of General Psychiatry, Volume: 57, Page

No:601-607, http://archpsyc.ama-assn.org/cgi/content/abstract/57/6/601

15. Patricia A. Parmelee, (2002), Journal of Gerontology, Volume: 44, Issue:1, Page

No: 39-41, http://geronj.oxfordjournals.org/content/44/1/M22.short

16. K. Jongenelis, (2004), Journal of Affective Disorders, Volume : 83, Issues : 2-3,

Page No: 447-449,

http://www.sciencedirect.com/science/article/pii/S016503270400182X

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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