Thesis Nurs. 1997 T469e
c. 2
Thompson, Deborah L.

The Effect of Depressio

The effect of depression
on perceived quality of
1997.

on Perceived Quality of Life
in the Elderly

by
Deborah L. Thompson, RN, BSN

Submitted in Partial Fulfillment of the Requirements
for the Masters of Science in Nursing Degree

Approved by:

Chairperson, Thesis Committee'
Edinboro University of Pennsylvania

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Date

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Committee Member

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Committee Member

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Acknowledgements
This author wishes to extend sincere appreciation
to the following people for their contributions in

assisting me to complete this research project.

To

Dr. Charlotte Paul, Mrs. Jan Giltinan, and Dr. Ken
Milles for their support and expertise in research.

To my parents, brothers, and sisters-in-law for their
constant prodding and encouragement as I worked.

And

last but certainly not least, I need to thank Brian

and Jacob for all their patience and love throughout
the entire thesis process.

I could not have done it

without all of your support....THANK YOU!!!

ii

Table of Contents
Page

Acknowledgements.

ii

Table of Contents .

ill

Abstract

iv

Chapter I - Introduction . .
Background of the Problem
Purpose of the Study . .
Statement of the Problem
Definition of Terms . . .
Assumptions
Limitations

.
.
.
.

Chapter II - Review of the Literature . .
Elderly .

Depression ....
Quality of Life . .
Conceptual Framework

1
1
4
4
4
5
5

6
6
9
12
15

19
19
19
24
25

Chapter III - Methodology
Sample Population . .
Instrumentation . . .
Data Collection . . .
Data Analysis . . . .

Chapter IV - Data Analysis
Chapter V - Discussion . .
Recommendations . . • •
Implications for Nursing
Appendix A

Appendix B
Appendix C

Appendix D

References

Bibliography

iii

29
31
32

Abstract
This thesis is a compilation of literature,

research data, and conclusions looking at the
relationship between depression and quality of life
in the community based elderly. The literature

provided a great deal of information discussing the

prevalence of depression in the elderly, and the
corresponding need for quality of life.

The Geriatric Depression Scale was used to
measure elderly depression, and the Life Satisfaction

Index was used to measure quality of life.

The two

tools are less than 25 items in length promoting the

participant's ease in completion.
two tools are inverted.

The scoring of the

A low score on the

Depression Scale would indicate a low level of
depression, where a high score on the Satisfaction

Index would indicate a positive view of quality of
life.

The research

data will establish the existance

of the relationship between depression and quality of
life.

Even though a statistically significant

relationship was established, a low level of
predictability was obtained.

iv

Chapter 1
Introduction
Background of the Problem
Throughout the life span, there are many periods

of potential depression which may influence an

individual's outlook on life.

Approximately two

decades ago, mortality rates began to decline and

assumptions were made regarding the health of the
elderly.

It was assumed their health must be

improving, when in fact their health status appears

to be remaining the same while medical treatments are
improving. The elderly of today face diseases,

conditions, physical/mental impairments, functional

losses, and disabilities (Crimmins, 1996).

The medical model of health is usually defined as
an absence of disease.

The social definition of

illness is seen as a decrease in a person's ability

to function in the roles they expect to fulfill
(Liang, 1986).

In an aging population, many problems

associated with mobility, nutrition, communication,
physical stamina, and health maintenance will become

more promiment through their interaction with the
other physical and emotional problems they have
already experienced (National Center for Health
Statistics, 1987).

Many times the elderly perceive

these health changes as negatively impacting their
1

2

value as a person.

With these varied declines,

average levels of depression increase at an

accelerated rate in older age groups (Mirowsky &
Ross, 1992).
Across the life span, average levels of

depression decline from early adulthood to middle age
and then rise with older age.

The acquisitions and

achievements of young adulthood form the base for the
prosperity of middle age, which eventually erodes

with the declines and loss happening with old age
(Mirowsky & Ross, 1992).

These subtle changes across

the adult life span are what allow depression to be

one of the most serious undiagnosed health
problems in the older adult.

When studying

depression in community based elderly, Blazer and
Williams (1981) found a 14.7% prevalence of

significant depressive symptomology.

Depression in the elderly is often accompanied

by subjective, age~related experiences of memory loss

and cognitive dysfunction (Yesavage, et.al, 1983).
Research suggests there is a strong correlation
between perceived health and quality of life in the
elderly (Moore, Newsome, Payne, & Tianswad, 1993).

The concept of quality of life goes beyond
physical condition. Quality of life encompasses all
aspects of an individual s life including material

3

and physical components, in addition to social,
emotional, and spiritual well-being (Yesavage, 1992).

The Institute of Medicine (1986) defined quality of
life as a sense of well-being. constant satisfaction

with life, feelings of worth, and positive
self-esteem.

Good quality of life is a goal of the elderly.
Quality of life is evaluated according to factors

such as an individual's autonomy and self-respect
within their own environment (Fletcher, Dickinson, &
Philp, 1992).

The individual is the only proper

judge of his or her well-being.

When there is little

variation from middle age abilities, there is a
greater feeling of well-being stability (Neugarten &
Havighurst, 1961).
Individual perceptions appear to be the basis of

whether or not an individual is depressed.

When

negative issues arise, depression begins to develop.
As these feeling of depression continue, the
individual's views related to their quality of life

also begin to take a negative turn.

In the

literature, there is a four sector definition of the

good life.

Psychological well-being, behavioral

competence, perceived quality of life, and an
objective environment are all needed to feel positive

4

in relation to life (Steiner et al, 1996).

This

researcher believes, after reviewing the aforementioned data, there is a correlation between
depression and perceived quality of life.

Purpose of the Study

The purpose of this research study is to assess

the relationship between depression and perceived
quality of life in an elderly, community based
population.

The subsequent correlation of the

individual test scores will determine if there is a

relationship between depression, and perceived
quality of life.
Statement of the Problem
This study is focused on the following question:

Does depression directly relate to perceived quality
of life in an elderly, community based population?

Definition of Terms

The following terms are defined for this research
study:
Depression:

A state of mind, or adaptive mechanism,

in which the client experiences sadness, pathos, and
withdraws physically, emotionally, mentally, and
verbally from society and social activities (Forbes &

Fitzsimmons , 1981).
Elderly:

An individual greater than 65 years of age

5
Quality of Life:

The multidimensional, subjective
evaluation by both interpersonal and social criteria

of the person-environment system of an individual's
life in a time past, current, and anticipated

(Birren, Lubben, Rowe, & Deutchman, 1991).
Assumptions
In this study, it was assumed the elderly

population selected for this study are community

based without major depressive syndrome diagnoses.

The focus of this study is to evaluate the level of
depression in the individual, and determine the

degree of relationship to perceived quality of life.

Limitations
There are two limitations of this study.

First,

there is the attendance at the senior center.
If the number of attendees at the center is down, the

potential number of participants for this study could
also be compromised.

Second, there is individual

willingness to participate in the study.

Even if there is a large number of elderly in

attendance, if the individuals are not willing to
participate, there would be an impact on this study.
If these limitations materialize, there could be

difficulty in obtaining a satisfactory sample

population size.

6
Chapter II
Review of the Literature

The reviewed literature addressed four topics
related to this researcher's theory:

(a) the

elderly, (b) depression, (c) quality of life, and (d)

Betty Neuman’s System Model.

In relation to the

elderly, various issues were identified as relevant,

such as health, historical trends, and changes in
views.
Depression was widely discussed throughout the

literature.

Definitions, parameters, patterns, and

characteristics of elderly depression were examined

for relevancy.

Quality of life is a topic which is

quite varied throughout the reference material. Betty
Neuman's Systems Model states the individual is a
multidimensional being.

When one area of life is

compromised by a stressor, the entire person feels

the effects.
Elderly
Approximately two decades ago, mortality rates

began to decline, and the assumption was made that
the health in the elderly was improving. In reality,
the improvements were being made in health care which
aided in prolonging life.

Many health problems such

as disease, impairments, and functional losses were

7
able to be addressed (Cummins, 1996). Medicine looks
at health as defined by an absence of disease while

society views health as a relationship between the
physical, social, cultural, psychological, and

environmental aspects of life (Birren, Lubben, Rowe &
Deutchman, 1991).

Mirowsky and Ross (1992) developed three views of

the aging process.

historical trend.

First, there is age as a
This view states that depression

and a diminished self-esteem increase as the
individual gets older.

These changes are due to the

loss of control which many elderly face.

Secondly,

age as a stage sees the achievements and acquisitions
of early adulthood build the foundation for

prosperity of middle age.

This prosperity can

eventually disintegrate with the losses of old age.

The life-style hypothesis sees the average level of
depression declining from early adulthood to middle

age, and then rising subsequently as aging occurs.
Thirdly, age as decline explores physical and mental

decline.

This decline accumulates with increasing

rates of disease and dysfunction, less activity,
decreased peak performance, and increased problems

with memory attention.

This hypothesis also states

6
Chapter II

Review of the Literature

The reviewed literature addressed four topics
related to this researcher's theory:

(a) the

elderly, (b) depression, (a) quality of life, and (d)

Betty Neuman's System Model.

In relation to the

elderly, various issues were identified as relevant,

such as health, historical trends, and changes in

views.
Depression was widely discussed throughout the

literature.

Definitions, parameters, patterns, and

characteristics of elderly depression were examined
for relevancy.

Quality of life is a topic which is

quite varied throughout the reference material. Betty

Neuman's Systems Model states the individual is a
multidimensional being.

When one area of life is

compromised by a stressor, the entire person feels

the effects.
Elderly
Approximately two decades ago, mortality rates

began to decline, and the assumption was made that

the health in the elderly was improving. In reality,
the improvements were being made in health care which

aided in prolonging life.

Many health problems such

as disease, impairments, and functional losses were

7
able to be addressed (Cummins, 1996). Medicine looks
at health as defined by an absence of disease while

society views health as a relationship between the
physical, social, cultural, psychological, and

environmental aspects of life (Birren, Lubben, Rowe &

Deutchman, 1991).
Mirowsky and Ross (1992) developed three views of
the aging process.

historical trend.

First, there is age as a
This view states that depression

and a diminished self-esteem increase as the

individual gets older.

These changes are due to the

loss of control which many elderly face.

Secondly,

age as a stage sees the achievements and acquisitions

of early adulthood build the foundation for

prosperity of middle age.

This prosperity can

eventually disintegrate with the losses of old age.

The life-style hypothesis sees the average level of

depression declining from early adulthood to middle
age, and then rising subsequently as aging occurs.
Thirdly, age as decline explores physical and mental

decline.

This decline accumulates with increasing

rates of disease and dysfunction, less activity,
decreased peak performance, and increased problems

with memory attention.

This hypothesis also states

8

average levels of depression increase at an

accelerated rate in older age groups proportional to
the rate of decline (Mirowsky and Ross, 1992).
Tressler and Mechanic (1988) researched health

status in the elderly.

They found a correlation

between psychological stressors and low self-rated
health.

An increase in psychological stress led to a

decrease in satisfaction with the client’s self-rated
health.

Psychological stressors may include

bereavement, and diminished ability to perform

activities of daily living (U. S. Congress, 1985).
The elderly often experience a loss of self-esteem
which is related to a loss of productivity, and a

loss of control over their life. These losses seem to

be central to depressive symptoms in elderly
individuals (Dunn & Sacco, 1989).
The elderly also experience elevated levels of

stress associated with fair to poor levels of health,

all due to life events and chronic strain.

Krause

(1987) identified a list of stressful events

including such items as losing the ability to drive,
being judged legally incompetent, retirement, or the
death of a grandchild.

Areas of chronic strain can

include a change in ability to perform self-care,

9

constant or recurring pain, loneliness,
diminished
eyesight, hearing loss, and declining financial
status (Steiner et al, 1996).

With all the changes the elderly must face, some
elderly develop a shaken sense of well-being.
Steiner, et al (1996) identified dimensions which

affect well-being in the elderly as physical health,

social behavior, emotional/psychological stability,

cognitive status, economic prosperity, role
functioning, and overall quality of life.

Depression
Depression is one of the most serious undiagnosed
health problems in elderly in the United States.
Elderly depression is a major contributor to twenty
percent of the suicides in this country (Yesavage,

1992) .

In 1993, a research study was completed in
Pennsylvania looking at primary care physicians’

perception, diagnosis, and treatment of depression in
older people.

According to the study, all the

participants stated they had experienced varied
degrees of depression throughout their lives ranging

from days to months at a time.

The clients were

asked what specific experiences in their older life
led to depressive episodes. The most frequently

10

mentioned experiences were death of a loved one or
friend, illness, death of a spouse, and not being
able to perform tasks they were once able to do in

their daily routine.

The study concludes there were

2 issues blocking resolution of elder depression.

First, the elderly are not being effectively

diagnosed with depression, and secondly, the elderly

are often unwilling to discuss depression with others
(Pennsylvania Department of Aging, 1993).

Blazer and Williams (1981) found 14 percent
prevalence of significant symptomology of the
community based elderly population studied.

Between

5 and 20 percent of the 20 million aged in America

are estimated to be depressed (Gurland, 1976).
Depression is clinically defined in terms of

health status or functional ability (Birren, Lubben,

Rowe, & Deutchman, 1991).

The majority of

researchers agree the definition of depression should
include characteristics such as physical, emotional,
behavioral, intellectual, and cognitive functioning
(Birren, Lubbin, Rowe, & Deutchman, 1991). Some
examples of physical dysfunction related to

depression may include gastrointestional dysfunction,
anorexia, recurrent headaches, and excessive fatigue
(Forbes, & Fitzsimmons, 1981).

11

Depression can also be exhibited
through
emotions. Envy can arise when the individual
compares himself with others he sees as more
active than himself. They can also become more
critical of others than they were in the past due to

their perceived failures (Weiss, Nagel, & Aronson,
1986) . Elder depression is also often accompanied by

subjective experiences of memory loss, and cognitive
impairments (Yesavage et al, 1983).

In research done with community based elderly,
there was frequent documentation of an increase in
various psychiatric symptoms when compared to younger

age groups (Blazer, Hughes, & George, 1987).

Blazer

and Williams (1981) also researched elder depression.
This study showed the majority of elderly subjects

with depression had no previous history of

psychiatric illness (Weiss, Nagel, & Aronson, 1986).

The prevalence of symptoms increased with age but
major depressive disorders do not.

Psychiatric

instability did not appear to be the primary cause of
depression while physical illness was (Kennedy et al,
1989).

Due to the increase in age, and the organic

decline seen in the elderly, depression is more
prevalent today than any other time in the last
twenty years (Mirowsky, & Ross, 1992).

12

Average levels of depression increase after age
sixty. Retirement, widowhood, and economic hardship
account for the rise in depression, along with
physical degeneration, and the loss of personal

control.

Depression often rises with major lifestyle

changes, accumulating erosion of function, and

control.

Depression will also fall and rise

correspondingly with the gains and losses experienced

during the life cycle (Mirowsky, & Ross, 1992).
Quality of Life
Quality of life is an issue of much importance to

older adults and to the individuals who work with

them (Moore, Newsome, Payne & Tiansawad, 1993).

Good

quality of life is a goal of the elderly (Fletcher,

Dickinson & Philp, 1992).

The individual is the only

proper judge of their well-being.

When the elderly

feel there is little variation from their pattern of

activity found in middle age, there is a greater
sense of well-being (Neugarten, Havighurst, & Tobin,
1961).

Subjectively perceived quality of life is a
combination of sense of well-being, level of

satisfaction with life, feelings of value, and
positive self-esteem (Institute of Medicine, 1986).

13

Perception is an active process where
the individual
reacts, links, and responds to
their environment.
The perceived meanings given to an individual’s
physical, mental, and social health provides an
integral part of the individual's perception of their

quality of life (Lee, 1993).
There is a strong correlation between perceived

health and quality of life in elderly populations
(Moore, Newsome, Payne, & Tiansawad, 1993).

Health

is commonly listed as a component of the quality of
life definition, but research displayed a need to

include other elements as well.

Both objective and

subjective elements need to be included.

Objective

elements could be described as items such as
finances, health, mental functioning, and social

contacts.

Some examples of subjective elements are

happiness, well-being, life satisfaction, and

positive self-esteem (Birren, Lubben, Rowe &

Deutchman, 1991).

Quality of life becomes an even more pertinent
issue as the older adult lives to an older age than
many individuals in the past. The elderly often

ask questions of themselves to aid in determining why
they are alive, and what their life quality is

(Bass, 1986).

Assessment tools need to be based on

14
the individual’s own opinion of his
or her physical,
emotional, and social well-being.
Hughes (1990)
believed in the importance of multidimensional
assessments to accurately reflect quality of life in
the elderly.
There have been several research studies looking
at quality of life.

Laborde and Powers (1985)

postulated a positive view of life satisfaction was
directly related to a good perception of health,
strong internal locus of control, and a low level of

pain.

Magilvy (1985) stated the best predictors of

quality of life are functional social support, and
perceived functional health.

Functional health has

been defined as the personal opinion of the
individual regarding their own feelings in relation

to how they perceive their life to be (Magilvy,
1985).

Finally, Ryden (1984) felt functional

dependency, health, and socioeconomic status are
significant variables directly affecting morale, and

perceived quality of life-

When the individuals feel

they are dependent on others for their daily care,

are in poor health, and have decreased socioeconomic
status, often they feel they do not have a high

quality of life.

15

There are two

reasons for evaluating quality of
life which directly relate to this study.
Assessing
the impact of environment on perceived quality of
life is crucial when working with elderly clients,

A

major change in environment, whether objective or
subjective, can produce elderly depression which
possibly directly effects their quality of life.

Also, understanding the causes and consequences of
decreased perceptions of quality of life may be the

most important reason for research (Birren, Lubben,
Rowe, & Deutchman, 1991).
Studies have shown that perceived health is

significant as it relates to quality of life in older

people.

Outcomes of research related to quality of

life and perceived health fall into two categories.

First, there are the predictors for positive quality

of life.

Secondly, there is a need to determine if

relationships between aspects of life and quality of

life exist (Moore, Newsome, Payne, and Tianswad,
1993).

Quality of life is of major importance to the

elderly, and further research should be done.

Conceptual Framework

Betty Neuman’s Systems Model is a comprehensive,
dynamic, and multidimensional view of individuals who

16

are in constant interaction with environmental
stressors. The model focuses on
the ability to
adapt. Neuman states nurses can
use this model to
assist individuals to attain and maintain
maximum
levels of total wellness (Neuman, 1980).
There are basic assumptions providing the

foundation for Neuman's conceptual framework which
relate to this study.

Neuman believed each

individual, over time, develops a normal range of

response to their environment.

This is referred to '

as a normal line of defense otherwise known as the

usual wellness/stability state.

The

interrelationships of variables such as
Physiological, sociocultural, developmental, and

spiritual, determine the nature and degree of the

system’s reaction to stressors.

This reaction can

affect the degree of protection an individual has

from their flexible line of defense which acts as a
buffer outside the normal line of defense (Neuman,

1980) .

Stressors can be extrapersonal, interpersonal,
and intrapersonal. Extrapersonal stressors occur
outside the system, interpersonal stressors are
between systems, and intrapersonal stressors occur

within the system.

More than one stressor can impact

the individual system at one time (Venable, 1980).

17

In Neuman's model, the goal of primary
prevention
is to prevent the penetration of the
normal line of
defense by stressors. Once a reaction to
a stressor
has occurred, secondary prevention needs to take
place in the form of early treatment of symptoms, and
attempts to strengthen the lines of defense.

Tertiary prevention is the intervention following
active treatment to maintain adaptation by

strengthening resistance to stressors (Neuman, 1982).

Neuman's model emphasizes the whole person.

She

presents the approach to seeing the individual's
perceptions of stressors affecting various parts of

the individual, possibly skewing their perceptions of
themselves.

When one part is involved, the other

parts are also affected to a degree.

When multiple

stressors impale varied areas of the individual, a

systematic breakdown of defenses may occur.

This

breakdown may be manifested in a depression

developing into a negative perception of the
individual’s quality of life*

Neuman's model is directly pertinent to this
study considering her emphasis on the whole person.
Her model also allows for the impact of stressors to
develop into breakdowns in the system. This impact

,
emotional,
intellectual,
could affect the physical,
emotio

18

and spiritual aspects of the individual.

This

complete view of the person gives creedance to the

problem being researched in this study.

Looking at

the relationship between depression and perceived
quality of life is the basis for this study, and

Neuman's model states a breakdown in one area of the
system can cause a breakdown in another.

19

Chapter III
Methodology
The purpose of this study is to determine: What

is the relationship between depression and perceived
quality of life in the elderly? The findings from

this study will contribute to previous research done

related to geriatric depression and perceived quality

of life.
Sample Population
The sample size consisted of 42 elderly

participants who attended 1 of 3 senior centers

in Northwestern Pennsylvania.
Instrumentation

This study utilized the Geriatric Depression

Scale and the Life Satisfaction Index.

These scales

were chosen due to their validity and reliability in
prior research done with elderly, community based

populations .

Both scales are short in length

allowing reliable and valid multidimensional
assessment without participant burden (Steiner et al,
1996) .
health problem
Depression has long been a major
associated with
in the elderly, and is often
Often depression
increased morbidity and mortality.

20

in the elderly can be related to loss of control

which is addressed in this tool (Weiss, Nagel, &
Aronson, 1986). The Geriatric Depression
Scale was
developed especially to assess depression in the
elderly (Dunn, & Sacco, 1989).

The tool consists of 15 yes or no questions.
Each answer which reveals depression is given 1

point.

A score of 5 to 9 indicates the strong

probability of depression with a score of 10 almost
always being indicative of depression (Moore,
Newsome, Payne, & Tiansawad, 1993).

For this study

the score of 10 will represent depression.

A copy

of the Geriatric Depression Scale can be found in
Appendix A.

Yesavage et al (1983) performed two studies to
validate the Geriatric Depression Scale.

The first

study looked at a large pool of items which were

compiled and then tested for the extent to which they
measured depression in the elderly. The scale was
administered to 47 individuals, all over 55 years of

Data analysis was based on the rationale that
the 100 item scale should have prima facia validity
looking at those items which best correlated

age.

providing the best measure

for depression.

This

a median correlation
abbreviated tool demonstrated

21
of 0.675 (range 0.47-0.83).

The 100 item tool showed

a lesser correlation with a median correlation of

0.51 (range 0.07-0.83) (Yesavage, et al, 1983).

In summary, the research done demonstrated
the tool
with lesser items was valid to be used in elderly

populations.
The second study provided a basis for comparing

properties of the scale to other existing measures of

depression.

This study had 2 groups, one diagnosed

with depression, and the second were clients from a

community senior center.

In this study, Cronbach's

Alpha was done to look at internal reliability.

A

score of 0.87 was obtained using the fifteen item
tool to be used in this study (Yesavage et al, 1983).
The findings of both studies provided evidence

for the validity and reliability of the scale as a
measure of geriatric depression.

These studies also

found a high degree of internal consistency in the

scale.

In comparing the mean scores of those

with the diagnosis of depression the research

criteria in the scale was

found to be consistent with

the results of the study (Yesavage et al, 1983).

22

Dunn and Sacco (1989) also did a research study
to evaluate the reliability and validity
of the
Geriatric Depression Scale in an elderly community

based population.

It was found, even though the

scale was done in different geographical locations, a
strong internal correlation remained in the results

of the Geriatric Depression Scale administration.
This study utilized Alpha values for the Geriatric

Depression Scale.

The score for the scale was 0.91

which indicated good internal consistency for this
scale.

To further determine validity, correlation

was done between the Geriatric Depression Scale and

the Depressive system checklist.

This checklist

provides a self-report score relating to the criteria
necessary for a diagnosis of major depression.

The

correlation score was r=0.82, n-227, displaying a

strong validity for the scale (Dunn, & Sacco, 1989).
Quality of life assessments are based on a
emotional,
Person's own opinion of their physical,
of life has become a
and social well-being. Quality
Major criterion for evaluating health and medical

Both quality of life and health
include indicators
status measurement tools need to
of Physical, social, emotional, and mental function

interventions.

along with perceived well-being (Kutner

23

In measuring quality of life there are reasons
for doing research. Assessment needs to be
done to
determine the impact of the environment on quality of
life (Birren, Lubben, Rowe, & Deutchman, 1991).

Individuals with multiple medical problems may also
have functional and support issues which can affect

quality of life (Paist, & Jafri, 1996).

The Life Satisfaction Index consists of 20
statements which the respondent can agree or disagree

with.

The index measured mood, zest for life, and

achievement of personal goals.

This tool also

evaluates factors such as the degree to which

residents maintain autonomy and self-respect
within the individual's environment (Fletcher,

Dickinson, & Philp, 1992).

For each item chosen

which corresponds to the answer key, 1 point is
According to the research, a score of 12
of quality of life.
indicated a positive perception
A copy of the Index can be seen in Appendix B
scored.

(Neugarten, & Havighurst, 1961).

In the initial validation study, this index

in the evaluation of
appeared to be satisfactory
The index
quality of life in elderly populations.
interview
Was correlated with clinical psychologist
Coefficient score was 0.73
The
Correlation
scores.

24

indicating a moderately strong validity of this
tool
(Neugarten, & Havighurst, 1961).

In later studies, the Life Satisfaction Index

displayed high levels of agreement with independent
rating of life satisfaction.

This tool correlated

with other life satisfaction scales with scores
ranging from 0.5 0.8 displaying a moderate to strong

internal validity.

Also, there was strong

correlation with other life satisfaction scales and
the index agreed consistently with associations

between measures of well-being.

The internal

measures of reliability scores in this study ranged

from 0.5-0.8 displaying a moderate to strong level of

reliability. (Fletcher, Dickinson, & Philp, 1992).
Data Collection

The researcher contacted three senior centers and
scheduled educational sessions, unrelated to the

research topics studied.

Verbal and written consent

was obtained from each center.

A sample of the

letters obtained is located in Appendix

C.

After the completion of the session, the

participants were asked to volunteer to
participate in a research study evaluating the

and quality of life
relationship between depression
the participants were made
in the elderly. All of
research being done, and
aware of the nature of the

25

the purpose of the research.

Participation was

strictly voluntary, and anonymity was preserved.
Implied consent was obtained when the
participants
volunteered for the study after they had been made

aware of the nature of research being done, and how
their anonmyity would be preserved.

Between the

3 centers, 42 participants completed the
questionaires.

Each client was also asked to write

their age and gender on their questionaires.

All of

the questionaires were coded so correlation betweeen
the 2 forms could be accomplished, and anonymity

could be further preserved.
Data Collection

After the data was collected, it was analyzed to
determine if there was a significant relationship

between depression and perceived quality of life.

The scores were added, and correlation
between the scores of the 2 tools were done using
the Pearson-R Product-Moment Correlation Coefficient.

This test is to be used in research where there are
two variables, where score data is being used, and

there is one score for each

variable for each subject

(Linton, & Gallo, 1975).
charted, the Pearson R,
After the data was
coefficient of
degrees of freedom, and the

26

determination were calculated.

The significance

test for R was also done to determine the
significance of the research findings. The Pearson R

has limits of +1 to -1, and for a positive and
perfect relationship, a value of +1 would be

obtained.

A -1 would indicate a negative

relationship with a 0 score meaning there is no
relationship between the variables. (Linton, & Gallo,
1975) .

27
Chapter IV
Data Analysis

This study was designed to determine if there
is
a relationship between depression and quality of life

in a community based elderly population.

The sample group consisted of 42 elderly
clients in attendance at 3 senior centers located
in Northwestern Pennsylvania.

The Geriatric

Depression Scale and the Life Satisfaction Index were

distributed personally, and subsequently collected.
All 42 sets of questionairres were used for

the data collected in this study.
The Geriatric Depression Scale was used to
determine the level of depression for each

participant .

A scoring range of 0-15 is possible.

The Life Satisfaction Index was used to

determine the level of perceived quality of life with
each participant.

A scoring range of 0-20 is

Possible.

The sociodemographic characteristics of the
The participants were
sample group were reviewed.
57% (n=28) and 33% (n=13)
Primarily female with
were from 68 years to
being male. The range of ages
All of
82 years with the mean age being 75 years,
involved in community
the participants were obviously

28

social functions, and therefore there were no
homebound individuals involved in this study.

Using the Pearson product-moment
correlation
coefficient, the relationship between depression

and

quality of life in an elderly population was
analyzed. The statistical analysis produced a
Pearson R of -0.44 with 40 degrees of freedom, a
coefficient of determination of -0.20, and a

probability of <0.01 which is less then 0.05 thus

determining a statistically significant result.
The coefficient of determination obtained does

indicate a low level of predictability (20%) when
using the Geriatric Depression Scale and the Life
Satisfaction Index.

With the Geriatric Depression

Scale yielding a low score to indicate lack of
depression, and the Life Satisfaction Index yields a

high score indicating high quality of life, a

negative Pearson R would be expected since there is
an inverse relationship between the scoring of the
relationship
two tools. This information indiates a
between depression and quality of life in this sample

of elderly population (Appendix D).
statistically
In conclusion, the data revealed a
between depression
significant inverse relationship
sample population
and quality of life exists in this

of community based, elderly

individuals.

29

Chapter 5
Discussion

With the vast growth in the elderly populaiton,
this research study was done to assist in

understanding the specific needs of this age group.

The nurse s role in the care of the elderly depends

on research being done providing further information.
Depression and quality of life are issues of

concern for the elderly according to Gurland (1976).
Depression becomes more prevalent in old age as many

life changes occur.

Loss of friends, loss of spouse,

retirement, and decreased independance all contribute
to elderly depression.

Between 5 and 20% of the 20

million aged in America are estimated to be depressed
In research conducted with community based elderly,

documentation reveals an increase in psychiatric
symptoms as compared to younger age groups (Blazer,
Hughes, & George, 1987).

Blazer and Williams (1981)

researched elderly depression and learned the

majority of elderly subjects with depression had no

previous history of psychiatric illness.

Mirowsky

and Ross (1992) found depression more prevalent today
in the elderly than any other time in the last 20

aforementioned researchers
In summary, the
indicate widespread depression in the elderly.

years.

However, the

current research did not find a high

number of clinically depressed individuals.

30

Quality of life in the elderly also has great
importance. Good quality of life has become an
important goal of the elderly (Fletcher, Dickinson, &
Philp, 1992). Magilvy (1985) stated the best

predictors of quality of life are functional
social support, and perceived functional health.

Ryden (1984) felt functional dependancy, health, and

socioeconomic status are significant variables
affecting morale and perceived quality of life in
the elderly.

The elderly need to feel pleased with

the life they now have to promote both physical and
emotional well-being.

In summary, the aforementioned

researchers indicated an importance of quality of
life in the elderly participants in Northwestern

Pennsylvania.

Overall, this study found a

correlation between depression and quality of life
which supports the results of Moore, Newsome, Payne,

and Tianaswad (1993) which found a correlation
between health and quality of life for an elderly
population.

Neuman

(1992) reinforces the connection between

theory emphasizes
mental and physical health. Her
breakdown in one system
the whole person, where a
Stressors
will cause a breakdown in another.
in the mental/
causing depression, a breakdown

31

emotional system, could promote
other breakdowns
affecting quality of life in the elderly individual.

Nurses will be able to utilize the knowledge

gained of the relationship between
quality of life in three ways.

depression and

First, it will alert

them to the seriousness of elderly depression.
Secondly, heightened awareness of quality of life

issues enables for more efficient nursing education,
and comprehension of the perceived quality of life in

the elderly today.

Thirdly, recognition of elderly

depression should trigger an evaluation of
quality of life issues promoting quick and accurate
initiation of a nursing plan of care related to these

issues.
Recommendations

Based on the results of this study, the resarcher
recommends further research be done to evaluate the

relationship between depression and quality of life
in different geographic areas,

This should be done

to determine if this relationship is indicative of
Northwestern Pennsylvania or is true accross the

elderly population. It is also suggested this
research be repeated in elderly not living in the

community.

Elderly

based apartment complexes, or

nursing homes would be possible

locations to gather

32

participants for a repeat study.

Also, this study

could be done looking at specific components within
the elderly population. For example, a comparision
between men and women could be done.

This study was

not well balanced between male and female

participants, and a relationship between depression

and quality of life was established.

Looking at a

specific population within the broad population group

would prove beneficial in the treatment of

individuals within the test groups.

Implications for Nursing
This study provides more information for nurses
providing care for the community based elderly.

Being able to identify the relationship between
depression and quality of life in the elderly will
allow for more comprehensive care for the elderly.

The trend in nursing care is moving towards community
based care, and with more and more elderly living in

the community today, it will continue to become more
important for nurses to be able to identify issues

causing concern for the elderly.

33

Appendix A
Geriatric Depression Scale
Choose the best ---to describe how you have felt
over the past week:

1.

Are you basically satisfied
with your life?

Yes

No

Have you dropped many of your
activities and interests?

Yes

No

Do your feel that your life
is empty?

Yes

No

4.

Do you often get bored?

Yes

No

5.

Are you in good spirits most
of the time?

Yes

No

6.

Are you afraid that something bad
is going to happen to you?

Yes

No

7.

Do you feel happy most of the time?

Yes

No

8.

Do you often feel helpless?

Yes

No

9.

Do you prefer to stay at home,
rather than going out and
doing new things?

Yes

No

10. Do you feel you have more problems
with memory than most?

Yes

No

11. Do you think it is wonderful
to be alive now?

Yes

No

12. Do you feel pretty worthless the
way you are now?

Yes

No

13. Do you feel full of energy?

Yes

No

14. Do you feel that your situation
is hopeless?

Yes

No

I; that most people
15. So you think
are better loff than you?

Yes

No

2.

3.

(Yesavage, 1992, p.256)

34

Appendix B
Life Satisfaction Index
Here are some statements about life in general that
people feel differently about, Please
read each
statement and mark the answer you agree with.

1.

2.

3.
4.
5.
6.
7.
8.

9.

10.
11.
12.

13.
14.

15.
16.

17.
18.

19.
20.

As I grow older, things seem better
than I thought they would be.
I have gotten more of the breaks in
life than most of the people I know.
This is the dreariest time of my life.
I am just as happy as when I was younger.
My life could be happier than it is now.
These are the best years of my life.
Most of the things I do are boring
or monotonous.
I expect some interesting and pleasant
things to happen to me in the future.
The things I do are as interesting to
me as they ever were.
I feel old and somewhat tired.
I feel my age, but it does not bother me.
As I look back on my life, I am fairly
well satisfied.
I would not change my past life even
if I could.
Compared to other people my age, I've
made a lot of foolish decisions in my
life.
Compared to other people my age, I
make a good appearance.
I have made plans for things I 11
be doing a month or a year from now.
When I think back over my life, I
didn't get most of the important
things I wanted.
Compared to other people, I get down
in the dumps too often.
I've gotten pretty much what I ve
expected out of life.
- , the
in spite of what people say^
is
getting
lot of the average man
Z~
worse, not better.

(Neugarten & Havighurst, 1961, P- 141)

Yes

No

Y

N

Y
Y
Y
Y
Y

N
N
N
N
N

Y

N

Y

N

Y
Y
Y

N
N
N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

Y

N

35
Appendix C
Sample Consent Letter

September 1, 1997

Senior Center Address

To

The purpose of this letter is to ask for your
permission to come to your center and provide an
educational program on choking for the elderly
individuals attending your center.
After the educational program, I would like the
opportunity to present my research for my Masters
Degree which I am completing at Edinboro University
of Pennsylvania. Once the research has been
explained, I would like to ask for volunteers to
participate in the study. All participants responses
will be treated confidentially.
I appreciate you willingness to allow me to come to
your center, and allowing me the opportunity to
complete my research.

Thank You,

Deborah L. Thompson, RN, BSN

Date scheduled:
Time scheduled:
Permission:

36

Appendix D
Pearson - R Product Moment Correlation Results

PEARSON PRODUCT MOMENT CORRELATION
PEARSON R= -.444

DEGREES OF FREEDOM= 40

COEFFICIENT OF DETERMINATION:: .197

T RAT10= -3.136

VAR. #1

SUBJ
SUBJ
SU3J
SUE J
SU5J
SU5J
SUB J
SUSJ

#1
#2
#3
#4
#5
#6
#7
#3

c; ic j

SUSJ
SUS-J
SUSJ
SUEJ
SUEJ
SL'EJ
SUEJ
S U E >J
SUEJ
SUEJ
SUS-J
SUSJ
SUBJ
SUSJ
SUEJ
SUE.J
E-UB-J
SUE J

subj
:••• :c- ’

w •-- -

3U5J

2
5
3
0
4
1
0
3
■5

^10
#11
#12
#13
#14
#15
#16
#17
#13

0
2
1
1
1
10
0
4
1

#r?

-?

#20
#21
#22
#23
#24
#25
#26
#27
#23
#29
#30

6
3
1
3
2
3
0
0
0
0
.•S

PROBABILITY <.01
VAR. #2
14
17
9
16
12
17
14
10
11
15
13
13
17
15
8
15
11
14
6
11
17
29
16
18
8
16
17
13
15
11

S:J8.J
SUS J
SUEJ
SUB J
SUE J
SUEJ
SUE J
SUS J
S'JBJ
3.JSJ
SUS J
SUE J

#31
#32
#33
#34
#35
#36
#37
#33
#39
#40
#41
#42

0
2
1
1
5
5
4

c
13
16
13
13
15
11
11
‘ 7

6
3
3

LEGEND:
: Depresssion Scale Scores
VARIABLE #1- Geriatric
Satisfaction Index Scores
VARIABLE #2- Life !—

14
15
13 ■

37

References
Bass, D. (1986). Planning to
meet lifecare needs.
Silver Spring, Maryland: National Association of

Social Workers.
Birren, J. E., Lubben, J. E., Rowe, J. C. , &
Deutchman, D. E. (1991). The concept and

measurement of quality of life in the frail
elderly. San Francisco, CA: Academic Press, Inc.

Blazer, D. & Williams, C. D. (1981). Epidemiology

of dysphoria and depression in an elderly
population. American Journal of Psychiatry, 137,

439.
Blazer, D., Hugher, D. C., & George, L. K.

(1987). The epidemology of depression in elderly
community population. The Gerontologist, 27(3),

281-287.
Crimmins, E. M. (1996). Mixed trends on

Population health among older adults. Journal of
Gerontology, 518(5), 5223-5225.

Dunn, V. K., & Sacco, W. P. (1989). Psychometric

evaluation of the geriatric depression scale and
the Zung self-rating depression scale using an
elderly community samp1e. Psychology and Aging.
ill, 125-126.

38

Fletcher, A. E., Dickinson, E. J., & Philp, I.
(1992). Review: Audit measures: Quality of life
instruments for everyday use with elderly

patients. Age and Aging, 21, 142-150.
Forbes, E. J., & Fitzsimmons, V. M. (1981).
The older adult: A process for wellness. St. Louis:
The C. V. Mosby Company.

Gurland,B. J., Wilder, D. E., & Berkman, C.
(1988). Depression and disability in the elderly:

Reciprocal relations and changes with age.

International Journal of Geriatric Psychiatry,
3, 163-179.
Hughes, B. (1990). Quality of life. In S. M.
Peace (Ed.), Researching Social Gerontology. London:
Sage.

Institute of Medicine. (1986). Improving
guality of life in nursing homes. Washington D. C.:

National Academy Press.

Kennedy, G. J., Kelman, H. R., Thomas, C.,
Wisniewski, W., Metz, H., & Bijur, P. E.

(1989).

Hierarchy of characteristics associated with
depressive symptoms in an urban elderly sample.

American Journal of Psychiatry, 146(2), 220-225.

Krause, N.

(1987), Stress in racial differences

in self-reported health among the elderly.

Gerontologist, 27, 72-76.

39

Laborde, J. M., & Powers,
M. J. (1985). Life

satisfaction, Health control orientation,
and
Illness-related factors in persons with
osteoarthritis, Research Nursing Health, 8(2),

183-190.
Kutner, N. G., Ory, M. G., Baker, D. I. ,

Schechtman, K. B., Hornbrook, M. C. , & Mulrow, C. D.

(1992). Measuring the quality of life of the elderly
in health promotion intervention clinical trials.

Public Health Reports, 107(5), 530-539.

Lee, A. J. (1993). Health perceptions of middle,
new middle and older rural adults. Family Community
Health, 16(1), 19-27.
Liang, J. (1986). Self-reported physical health

among aged adults. Journal of Gerontology, 41(2),
248-260.

Linton, M., & Gallo, P. S. (1975). The practical
statistician: Simplified handbook of statistics.

Monterey, CA: Brooks/Cole Publishing Company.

Magilvy, J. K. (1985). Quality of life of hearing
impaired older women. Nursing Research, 34(3 1,

140-144.
Mirowsky, J.z & Ross, C. E. (1992). Age and

depression. Journal of Health and Social

Behavior, 33, 187-205.

40
Moore, B. S., Newsome,
J- A., Payne, P. L. , &

Tiansawad, S. (1993). Nursing research: Quality o
of life and perceived health in the elderly.
Journal of Gerontological Nursing, 19(11), 7-14.

National Center for Health Statistics. (1987).

Health statistics on older persons (DHHS, PHS
publication No. 87-1409). Washington D.C.: U. S.

Government Printing Office.
Neugarten, B. L. , Havighurst, R. J., & Tobin,
S.

S.

(1961). The measurement of life satisfaction.

Journal of Gerontology, 16, 134-143.
Neuman, B.

(1980). The Betty Neuman health-care

systems model: A total person approach to patient
problems. In Riehl, J. P., & Roy. Sr., C. (Eds.),

Conceptual Models for Nursing Practice, New York:
Appleton-Century-Crofts.
Neuman, B.

(1982). The Neuman systems model_:_

Application to nursing education and, practice.
Norwalk, CT : Appleton-Century-Crofts.

Neuman, B.

(1989). The Neuman systems mode_l.

Norwalk, CT : Appleton-Century-Crofts.

(1996). Functional
Paist, S. S., & Jafri, A.
assesment in older patients: Key to improving

quality of life. Postgraduate
101-108.

Medicine, 99(51,

41

Pennsylvania Department of Aging. (1993).
Depression in older persons: A study of primary care
physicians * perception, diagnosis, and treatment
(Department of Aging Contract No. 9121).

Pennsylvania: Thomas, E.A.

Ryden, M B. (1984). Mora+le and perceived control

in institutionalized elderly. Nursing Research,
33(3) , 130-136.

Steiner, A., Raube, K., Stuck, A. E., Aronow, H.

U., Draper, D. Rubenstein, L. Z., & Beck, J. C.

(1996). Measuring psychosocial aspects of

well-being in older community residents:
Performance of four short scales. The

Gerontologist, 36(1), 54-62.
U. S. Congress. (1985). Technology and Aging in
America (Office of Technology Assessment

Publication OTA-BA-264).

Washington D. C.: U. S.

Government Printing Office.

Venable, J. F. (1980). The Neuman health-care
systems model: An analysis. In Riehl, J. P., & Roy,

C . , (Eds . ) . Conceptual models for nursing practice
(2nd ed.).New York: Appleton-Century-Crofts.
K.
Weiss, I. K., Nagel, C. L., & Aronson, M.
(1986). Applicability of depression scales to the old

42

old person. Journal of American Geriatric Society,
34, 215-218.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum,
0., Huang, V., Adey, M. , & Leirer, V. 0. (1983).

Development and validation of a geriatric

screening scale: A preliminary report. Journal of
Psychiatric Research, 17(1), 37-49.
Yesavage, J. A. (1992). Depression in the

elderly: How to recognize masked symptoms and choose

appropriate therapy. Postgraduate Medicine, 91:1,
255-261.

43
Bibliography

Publication Manual of the American Psychological
Association (Fourth ed.). (1994). Washington D.C.;
American Psychological Association.

Bass, D• (1986) ■ Planning to meet lifecare needs.

Silver Spring, Maryland: National Association of
Social Workers.
Birren, J. E., Lubben, J. E., Rowe, J. C., &

Deutchman, D. E. (1991).

The concept and measurement

of quality of life in the frail elderly.

San

Francisco, CA: Academic Press, Inc.
Blazer, D. & Williams, C. D. (1981). Epidemiology

of dysphoria and depression in an elderly population.

American Journal of Psychiatry, 137
Blazer, D., Hugher, D. C., & George, L. K.

(1987). The epidemology of depression in elderly
community population.

The Gerontologist, 27(3),

281-287.
Crimmins, E. M. (1996).

Mixed trends on

Population health among older adults. Journal of
Gerontology, 518(5), 5223-5225.

Dunn, V. K., & Sacco, W. P. (1989).

Psychometric

scale and
evaluation of the geriatric depression
the Zung self-rating depression scale using an
elderly community sample*

125-126.

Psychology. and Aging,

44

Fletcher, A. E., Dickinson, E. J. , & Philp,
I
(1992). Review: Audit measures: Quality of life

instruments for everyday use with elderly
patients.

Age and Aging, 21, 142-150.

Forbes, E. J., & Fitzsimmons, V. M. (1981).

older adult:

A process for wellness.

The

St. Louis:

The C. V. Mosby Company.
Gurland, B. J., Wilder, D. E., & Berkman, C.
(1988).

Depression and disability in the elderly:

Reciprocal relations and changes with age.
International Journal of Geriatric Psychiatry,

3, 163-179.

Hughes, B.

(1990). Quality of life.

In S. M.

Peace (Ed.), Researching Social Gerontology, London;

Sage.

Institute of Medicine. (1986).

of life in nursing homes.

Improving guality

Washington D. C.: National

Academy Press.
Kennedy, G. j., Kelman, H. R., Thomas, C.,
Wisinewski, W., Metz, H., & Bijur, P. E. (1989).

Hierarchy of characteristics associated with
depressive symtoms in an urban elderly sample

American Journal of Psychiatry/ 146121, 220-225.
Krause, N.

(1987). Stress in racial differences

self-reported health among the elderly.
Gerontologist, 27, 72-76.

45
Laborde, J. M., & Powers, M. J.

(1985). Life

satisfaction, Health control orientation, and
Illness-related factors in persons with
osteoarthritis, Research Nursing Health, 8(2),

183-190.
Kutner, N. G., Ory, M. G., Baker, D. I. ,

Schechtman, K. B., Hornbrook, M. C., & Mulrow, C. D.
(1992). Measuring the quality of life of the elderly
in health promotion intervention clinical trials.
Public Health Reports, 107(5), 530-539.

Lee, A. J.

(1993). Health perceptions of middle,

new middle and older rural adults. Family Community

Health, 16(1), 19-27.
Liang, J. (1986). Self-reported physical health

among aged adults. Journal of Gerontology, 41(2),

248-260.

Linton, M., & Gallo, P. S. (1975). The practical
statistician: Simplified handbook of statistics.

Monterey, CA: Brooks/Cole Publishing Company.

Magilvy, J. K. (1985). Quality of life of hearing
impaired older women. Nursing Research, 34(3),

140-144.
Mirowsky, J., & Ross, C. E. (1992). Age and

depress ion. Journal of Health and Social
Behavior, 33, 187-205.

46

Moore, B. S., Newsome, J. A., Payne, P. L. , &

Tiansawad, S. (1993). Nursing research: Quality o
of life and perceived health in the elderly.

Journal of Gerontological Nursing, 19(11), 7-14.
National Center for Health Statistics. (1987).

Health statistics on older persons (DHHS, PHS
publication No. 87-1409). Washington D.C.: U. S.

Government Printing Office.
Neugarten, B. L., Havighurst, R. J., & Tobin, S.

S. (1961). The measurement of life satisfaction.

Journal of Gerontology, 16, 134-143.

Neuman, B. (1980). The Betty Neuman health-care
systems model: A total person approach to patient

problems. In Riehl, J. P., & Roy. Sr., C. (Eds.),

Conceptual Models for Nursing Practice, New York:
Appleton-Century-Crofts .

Neuman, B. (1982). The Neuman systems model:

Application to nursing education and practice.
Norwalk, CT: Appleton-Century-Crofts.

Neuman, B. (1989). The Neuman systems model.
Norwalk, CT: Appleton-Century-Crofts.
Paist, S. S., & Jafri, A. (1996). Functional

assesment in older patients: Key to improving

quality of life. Postgraduate Medicine, 99(5) ,
101-108.

47

Pennsylvania Department of Aging. (1993).

Depression in older persons: A study of primary care
physicians 1 perception, diagnosis/ and treatment
(Department of Aging Contract No. 9121).

Pennsylvania: Thomas, E.A.
Ryden, M B. (1984). Mora+le and perceived control
in institutionalized elderly. Nursing Research,

33(3) , 130-136.
Steiner, A., Raube, K., Stuck, A. E.z Aronow, H.

U., Draper, D. Rubenstein, L. Z., & Beck, J. C.
(1996). Measuring psychosocial aspects of

well-being in older community residents:
Performance of four short scales. The

Gerontologist, 36(1), 54-62.
U. S. Congress. (1985). Technology and Aging in

America (Office of Technology Assessment
Publication OTA-BA-264).

Washington D. C.: U. S.

Government Printing Office.
Venable, J. F. (1980). The Neuman health-care
systems model: An analysis. In Riehl, J. P-/ & Roy'

G. , (Eds . ) . Conceptual models for.

nursing practice

(2nd ed.).New York: Appleton-Century-Crofts.
, & Aronson, M. K.
Weiss, I. K. , Nagel, C. L.
scales to the old
(1986). Applicability of depression

48

old person. Journal of American Geriatric Society,
34, 215-218.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum,
0., Huang, V., Adey, M. , & Leirer, V. 0. (1983).
Development and validation of a geriatric
screening scale: A preliminary report. Journal of

Psychiatric Research, 17(1), 37-49.

Yesavage, J. A. (1992). Depression in the
elderly: How to recognize masked symptoms and choose
appropriate therapy. Postgraduate Medicine, 91:1,
255-261.