Psychosocial factors that influence the development of anxiety in
institutionalized older adults in the geriatric home Ismael Perdomo de el
Espinal-Tolima
……………………………………
Factores psicosociales que influyen en el desarrollo de la ansiedad en adultos mayores
institucionalizados en el geriátrico Ismael Perdomo del Espinal-Tolima
Luisa Fernanda Martínez García
1
Adriana Rocío Vargas Luna
2
Fredy Javier Guarnizo Ante
3
ABSTRACT
This research work is aimed at an elderly
population, in order to identify how
psychosocial factors influence the
development of anxiety and depression. It is
quantitative, descriptive and correlational in
nature. The Goldberg anxiety and depression
scale instruments and the psychosocial factors
classification instrument were applied to a
sample of 10 older adults institutionalized in
the geriatric home Ismael Perdomo del
Espinal-Tolima. From the application it is
evident that 50% of the participating
population presents traits related to anxiety;
due to factors such as the absence of company
and the disinterest of their family members.
Added to elements such as the enclosed
condition to which they are permanently
exposed, likewise, the other 50% of older
adults present few anxiety traits related to
psychosocial factors that are present. In terms
of depression it was identified that in the
population, 30% indicated the presence of
depression and 70% of the studied population
Revista investigación, desarrollo educación,
servicio, trabajo (ID EST)
Vol 1 – No 2
July - December 2021
e-ISSN 2745-1194.
Pag 95-105
Received: October 03, 2020
Approved: March 19, 2021
…………………………………….
Psicóloga, FUNDES, Bogota Colombia,
lmartinez@fundes.edu.co, https://orcid.org/0000-
0001-7517-8266
Psicóloga, FUNDES, Bogota Colombia,
avargas@fundes.edu.co
https://orcid.org/0000-0001-9405-8104
Psicólogo, FUNDES, Bogota Colombia,
centro.investiacion@fundes.edu.co,
https://orcid.org/0000-0002-7139-7960
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stated that psychosocial factors have little
influence on the presence of the traits of
depression.
Keywords: Elderly, geriatric home, anxiety,
depression, psychosocial factors.
RESUMEN
Este trabajo de investigación está dirigido a una población de edad avanzada, con el
fin de identificar cómo influyen los factores psicosociales en el desarrollo de la
ansiedad y la depresión. Es de carácter cuantitativo, descriptivo y correlacional. Se
aplicaron los instrumentos de la escala de ansiedad y depresión de Goldberg y el
instrumento de clasificación de factores psicosociales a una muestra de 10 adultos
mayores institucionalizados en el geriátrico Ismael Perdomo del Espinal-Tolima. De
la aplicación se evidencia que el 50% de la población participante presenta rasgos
relacionados con la ansiedad; debido a factores como la ausencia de compañía y el
desinterés de sus familiares.Sumado a elementos como la condición de encierro a la
que están permanentemente expuestos, así mismo, el otro 50% de los adultos mayores
presentan pocos rasgos de ansiedad relacionados con los factores psicosociales que
están presentes. En cuanto a la depresión se identificó que en la población, el 30%
indicó la presencia de depresión y el 70% de la población estudiada manifestó que los
factores psicosociales tienen poca influencia en la presencia de los rasgos de depresión.
Palabras Claves: Ancianos, hogar geriátrico, ansiedad, depresión, factores
psicosociales.
Introduction
Geriatric homes have been defined by the Ministry of Social Protection, (2018), as
institutions for older adults who meet the fundamental requirement of being over 70
years of age. Except for cases in which a person who is over fifty years of age, and who
has some type of physical or mental disability that prevents them from guaranteeing
their own livelihood and survival. For these reasons in such homes there is a high level
of dependence on the caregiver staff. In these local government homes residents' well-
being is guaranteed, if they do not have the support or backing of their family. In the
same way, if older adults present abandonment by their relatives, the government has
an obligation to offer them help and to guarantee a better quality of life, (Ordoñez and
Guillen, 2017). They receive permanent care from nurses, which is why they
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sometimes come to experience feelings and thoughts related to being not very
functional or useful for their families and for society. The residents may feel significant
discomfort as a result of their physical, psychological and social health. Examples are
decreased vision, poor hearing, limitations in mobility, profound loss of taste. This
cross between health difficulties, limitations in the autonomy of their movements and
the marked decrease in sensory functions lead older adults to develop symptoms
related to anxiety and depression. (Guillen and Ordoñez, 2017).
According to the "Diagnostic and Statistical Manual of Mental Disorders-DSM-5"
(2013), it is determined that anxiety disorders are a group of diseases characterized by
the existence of worry, fear or excessive and irrational fear. Impending destruction and
behavioral obstacles can cause serious distress or clinically apparent damage to
personal activities. The loss of interest in maintaining social contact with others, on
the other hand the development of various recreational activities in homes for the
elderly to perform basic motor and sensory functions.
This article presents the research, in relation to the understanding of the factors
related to the presence of depression and anxiety in the elderly. In the same way it
could be evidenced by the normative framework that regulates the care processes and
assistance regarding the needs of the elderly resident of the Ismael Perdomo geriatric
home in the municipality of El Espinal. The methodological design that tries to fulfill
the achievement of the objectives proposed in the present investigation are presented;
and finally, the results that were obtained. The analysis of the results will be evidenced,
through which the caregiver staff or the organizations in charge of protecting this type
of population can construct strategies that give the possibility of reducing symptoms
related to anxiety and depression.
Materials and methods
Design: It is quantitative, descriptive and correlational in nature, taking into
consideration that quantitative research is used in a structured way to collect and
analyze the data obtained. It implies the use of computer and statistical, and
mathematical tools to obtain results. The descriptive criteria is intended to be fulfilled
by specifying the characteristics that the population presents in terms of the conditions
of the psychosocial factors and the state of their influence on the population of
participating older adults.
Participants: The population of 10 older adults institutionalized in the Ismael
Perdomo geriatric home in El Espinal-Tolima
Instruments: The following instruments were used to carry out the research; the
Goldberg Anxiety and Depression Scale, which, designed to detect “probable cases”,
not to diagnose them. Its discriminative capacity helps to guide the diagnosis, but
cannot replace clinical judgment. This scale was validated in Spanish by Montón,
Pérez, Campos et al. (2015).
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Additionally, an instrument to categorize psychosocial factors was implemented to
make the respective correlation between the variables of anxiety and depression and
the psychosocial factors, said instrument consists of 9 items which are divided into 3
psychosocial areas of the elderly which are: social , affective, motor.
This research work was conducted through three phases:
Phase 1, Design
The design and planning of the research was carried out taking into account the
guidelines and protocols established by the university to give acceptance to the
development of the research processes, taking as a point of reference the parameters
that must be contained within a research exercise.
The researcher carried out the completion of the permits by the geriatric home, for the
application of the instrument to the elderly. Informed consent was given, to proceed
with the application of the instruments, and thus collect the relevant data.
Phase 3, Analysis of results
In this last phase, the data collected by the instruments were tabulated, using the Excel
office suite. What proceeded was the completion of the rest of the research work,
responding to each of the proposals made at the beginning. This allowed the researcher
to design the strategy for the contribution of the reduction of anxiety or depression
found in older adults.
Results and Discussion
The research instruments were applied to the sample of 10 older adults who were all
able respond to the Goldberg anxiety and depression scale. Likewise, for the
application of the tool of the psychosocial factors the help of the caregiver of the Ismael
Perdomo was received. This helper provided information about the target population.
According to the results obtained, the scale was applied to one woman and nine men
who are between the ages of 69-95 years, all of whom are from social class 1.
It is observed that, to the question: “Have you felt very irritable ?”. 70% answered yes,
while 30% said no. This was the highest percentage seen in the entire questionnaire.
Regarding the questions: “Have you felt very excited, nervous or tense?”, “Have you
had difficulty relaxing?”, “Have you had headaches or neck pain?”, “Have you had any
of the following symptoms: tremors, tingling , dizziness, sweats, diarrhea?” and “Have
you had any difficulty falling asleep, falling asleep ?”; 60% said yes, while 40% said no.
On the other hand, to the question: “Have you been very concerned about your health
?”, 50% of the participants say yes, while 50% say no. When asked: “Have you slept
poorly” or “Have you had difficulty sleeping?” 40% answered yes, while 60% said no.
Finally, when faced with the question, “Have you been very concerned about
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something?”, only 30% answered affirmatively, while the remaining 70% said that they
had not.
It is observed that the questions: “Have you felt slowed down?” and “Have you been
waking up too early?” 90% answered yes and the remaining 10% answered no. To the
questions: “Have you lost your interest in things?” and “Have you felt hopeless?” 70%
answered yes, the remaining 30% no. When asked the question: “Have you lost
weight?” 60% of the participants answered yes and 40% said no. To the question:
“Have you lost self-confidence?” 50% answered yes and 50% answered no. To the
question: “Have you felt with little energy?”, 40% answered yes and 60% answered no.
Finally, when faced with the questions: “Have you had difficulty concentrating?” and
“Do you think you have had a tendency to feel worse in the morning?” 30% answered
yes and 70% answered no.
Results of the Goldberg scale with the psychosocial factors sheet
It is identified that 50% of older adults present a high level of anxiety, 30% present low
and 20% medium. It can be seen that these levels correlate with psychosocial factors.
It is identified that 30% of older adults present a high level of depression, 60% medium
and 10% present low and, emphasizing that these levels were made by correlating with
psychosocial factors. It.s 5, 70% of older adults do have a high level in the social
dimension and 30% do not have a high level since they are socially isolated, 60% of
older adults have a high level of affective support and 40% do not have a high level of
affective support, it was evidenced that 100% of the participants have deterioration in
their motor dimension.
According to the results obtained from the Goldberg scale anxiety variable it can be
evidenced from the answers of the participants that there is a clear predominance of
positive responses to those questions oriented to inquire about the existence of
predisposing factors in the development of anxiety on the part of older adults residing
in the Ismael geriatric home. There is a clear predominance of positive answers to
those questions aimed at inquiring about the existence of predisposing factors in the
development of anxiety on the part of older adults residing in the Ismael Perdomo
geriatric home, especially to questions 2 and 3 respectively, where excessive worry and
fear,even when the cause is not clear, are enquired about.
From the results obtained from the anxiety scale depression variable, it can be noted
that there is a marked predominance in terms of positive responses to questions 2, 4,
7 and 8 which were intended to collect information specifically about interest in life
and in the people and things that surround the participants. Montenegro and
Santisteban, (2016)concluded in their research Psychosocial Factors associated with
depression in Older Adults of the Centro Poblado los Coronados , that the social factor
is a great influencing factor in the presence of the depressive state in older adults. In
this way too, the presence of factors related to physical manifestations derive from the
stage of development; that, like the state of mind, where the person usually wakes up
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earlier than they used to and the loss of vigor and they experience a loss of energy for
the actions of daily life.
Likewise, with regard to the instrument to categorize psychosocial factors, regarding
the social support network available to the elderly, it was possible to highlight that 70%
of the participants have a high level of support from their family members, as well as
showing themselves as socially active people. Additionally, participating in activities
programmed by the municipal mayor's office which are aimed at the participation of
elderly citizens. Díaz and Barragán, (2014) found that social factors and lack of
interaction significantly affect the quality of life of older adults, likewise, Cardenas and
Suarez, (2015) pointed out that the prevalence of depressive traits is associated with
social processes such as lack of social interaction, unemployment, and other
psychosocial factors that can contribute to the prevalence of depressive traits.
Continuing with the analysis, the results provided by the instrument for the
categorizing of psychosocial factors in the affective dimension, it was possible to
highlight that for 60% of the residents of the home they have a high level of
affectivity followed by 40% who indicate being at a medium level , taking into
consideration elements such as the manifestation of affection on the part of their loved
ones, the care and assistance of people in their family group in cases in which there is
an alteration of the state of health of the elderly resident, the participation of children
in matters related to their relative is in charge of considerably favoring the possibility
of developing a positive perception of affectivity on the part of the elderly, for this
reason, Chankay and Moreira, (2016) determined that the psychosocial factors that
most affect depression in the elderly are the manifestations of the need to be listened
to, the loss of social roles, the fear of death , the fear of being lonely adults and
widowhood.
In the same order of ideas, the results obtained in the evaluation of psychosocial
factors in the physical-motor dimension indicate that 100% of the participants have a
high level of physical activity which allows them to carry out daily activities such as
moving from from their bedrooms to shared spaces(the dining room or the meeting
room where games are played and activities done, through which the physical and
mental activation occurs, promoting movement, cognitive, motor sensory and manual
eye coordination). Díaz and Barragán, (2016) established in their research that the
activation and development of physical activity is essential because a lack of such
activity can become a reason for the development of depression. Likewise, Díaz and
Barragán, (2016) differ that old age is not an exclusive characteristic. However, they
established that the elderly have greater risks when they are abandoned by their family
in an institution, as well as when their health has deteriorated due to diseases caused
by the deterioration, and due to the deficiencies in their quality of life. In this way,
Valdez, (2018) establishes that older adults do not have a good quality of life due to
the motor conditions that older adulthood entails. There is also the relationship with
the opportunities and deprivations that older adults have had during childhood,
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adolescence and adulthood, lifestyles, exposure to risk factors and possibilities of
access to education and health promotion.
Finally, the correlation between the psychosocial factors and the anxiety and
depression variables is made and it is established that, half of the participants present
a high level of anxiety with factors such as the absence of accompaniment and the
interest of the family members, added to elements such as the cloistered condition to
which they are permanently exposed given the need to care for and ensuring of the
welfare. It is also established the presence of depression,, 30% indicated situations
related to a high level of depression, followed by 60% of the participants who indicated
a medium level, while only 10% of the participants indicated that they were in a low
level This could be associated with the level of dependence that some adults present in
relation to daily actions such as taking the shower, dressing or eating, in the same way
the presence of pathologies and degenerative diseases typical of this stage of life
become factors highly predisposing to development of problems that cause alterations
to the emotional state of the elderly.
When carrying out the correlational analysis of the influence that
psychosocial factors and the variables have on depression and anxiety, it is
concluded that psychosocial factors do influence the development of anxiety and
depression. The results show that the affective, social and physical dimension
significantly affect anxiety and depression variables. In the affectivity dimension with
the anxiety variable, there is a directly proportional relationship with a score of 1. It
could then be said that this is fundamental for the development of anxiety in the
elderly. On the other hand, when analyzing the relationship that occurs between
anxiety and the social dimension of the elderly, it is seen that there is a proportionally
inverse relationship (- .338) with a significance level of .001 and for its part between
society and the physical dimension of the elderly there is a proportionally inverse
correlation of - .138 with a bilateral significance level of .179. This is then interpreted
as meaning that the physical deterioration of the elderly and the limitation for the
development of some specific activities become a highly significant factor,
predisposing them to develop anxiety.
On the other hand, regarding the dimension of depression, it can be observed that the
relationship that occurs between affectivity and the depression, there is a directly
proportional correlation with a level of .175 to the level of significance of, 05, which
can be translated in such a way that the absence of affective manifestations by
members of the family nucleus is a highly predisposing factor for the development of
feelings and thoughts related to depression in the elderly and therefore generate
significant alterations in the health and emotional state of the person. In the same way
it can be seen that between the social dimension and depression there is a level of
correlation directly proportional to (.215) and a level of significance of .008. This can
be interpreted as saying that none participation in social settings or the lack of spaces
where interaction with other people can occur is a precipitating factor to the
development of depression by this population, due to their social abandonment.
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In terms of the physical dimension and depression, a proportionally inverse
correlation level can be seen located at -, 235 and a level of significance of 175, despite
significant physical deterioration in the elderly. The correlation of the two variables
was carried out taking into account the following values: -1, 0 and 1; where -1 is low, 0
is intermediate, and 1 is high.
Finally, H0 is annulled, because psychosocial factors do affect the development of
anxiety and depression, on the other hand, hypothesis H1 is valid since through the
results of the instrument it was evidenced and identified that the psychosocial factors
are a great influence on the development of anxiety and depression in older adults.
Conclusions
The situation of the elderly is is identified as complex due to the loneliness to which
they have been subjected by their relatives, in addition, it is evidenced that the
influence of economic factors, communication, interaction and lack of motivation are
factors that influence the quality of life of the elderly. These lead them to develop
anxiety and depression traits. The need for strategic measures to be implemented
through which older adults can be involved in the development of physical, cognitive
and social activities and through which they can restore their health becomes
recurrent, restoring their desire for life and considerably reducing anxiety levels and
therefore levels of depression.
The research presents as a general objective developing knowledge on the influence of
psychosocial factors in the development of anxiety and depression, in the elderly
participants of the Ismael Perdomo geriatric home of the Espinal municipality. When
studying the data obtained, the objective set was met by means of a descriptive
analysis, in which the two dimensions of; anxiety, depression by means of the Goldberg
scale.The correlation between the psychosocial factors was made by the classification
instrument and it was found in the psychosocial factors with the results of the
Goldberg anxiety and depression scale in order to comply with the proposed
objectives.
One of the specific objectives was to determine the psychosocial factors that influence
the appearance of anxiety or depression in older adults. In the present study, this
objective was fulfilled by implementing an instrument to classify psychosocial factors,
which were divided into three dimensions, social, affective and physical-motor. The
results of the social dimension showed that 70% of the participants have a high level
of support and the other 30% have a low level of support. In addition, it is possible to
identify that they are socially active people in terms of seeking interaction with other
residents of the geriatric home. Likewise, it is evidenced that the symptoms or traits
that were identified in older adults are related to the stages of development proposed
by Erik Erikson. This is reflected in the integrity vs. despair stage. Given the
importance it has in the development of the quality of life of the elderly, it is the stage
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where feelings of uselessness, hopelessness are reflected and there is the
predisposition to develop physical and cognitive illnesses. Additionally, the results of
this research conform to the theory of the "Bowen family" given that the psychosocial
factor in the emotional dimension influences the development of anxiety and
depression in patients.
In the affective dimension, it was possible to highlight that 60% of the participants
have a high level of affectivity due to frequent interaction with their relatives and other
residents of the geriatric home. 40% indicate being at a medium level of affectivity,
taking in consideration the lack of visits by family members, in addition to little
interaction with other residents, and despite the deterioration in the health of the
elderly.
Physical-motor dimension shows that 100% of older adults show deterioration in some
areas of health, such as vision, hearing, taste, touch and smell, which is consistent with
the ages of the participants and the consequences of the time passed at this stage of
development.
Now, to fulfill the objective: to identify the presence of anxiety and depression in older
adults. The Goldberg anxiety and depression scale was carried out, identifying that
50% of the participants are presenting a high level of anxiety. These results can be
influenced by the lifestyle that the participants have at home, their basic needs such as
food, lodging, affiliation to the health system, and physical and occupational therapy
are supplied. This gives rise to the loss of autonomy. This could, however, be
influenced by the lack of family support and in the aging process. According to Yuste
and Rubio cited by Buitrago and Cordon, (2017) these results may occur due to the
changes that are experienced at this stage of life, such as health failures, concern about
the economic situation, the family environment and physical exhaustion causing
excessive reoccupation.
Regarding the depression dimension, it is identified that 30% of the residents have
high levels of depression, these results may be associated with the level of dependence
that some older adults present in terms of daily life activities such as showering,
dressing and eating.
Now, in the case of the objective to establish the relationship between the psychosocial
factors and anxiety and depression present in older adults, it was possible to establish
the correlation between the record of psychosocial factors and the scale of anxiety and
depression in the Goldberg by means of the Pearson table. Where it was evidenced that
the dimension of anxiety and affectivity is a directly proportional with a score of 1,
what could be said is that effictivity is fundamental for the development of the anxiety
in the elderly.
On the other hand, when analyzing the relationship that occurs between anxiety and
the social dimension of older adults, it is seen that there is a proportionally inverse
relationship of - .338 with a significance level of .001 and for its part between society
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and the physical dimension of the elderly, it can be shown that there is a proportionally
inverse correlation of -. 138 with a bilateral significance level of point 179, which is
then interpreted as the resulting statement that the physical deterioration of the
elderly and the limitation for the development activities became a highly predisposing
factor for this population to develop anxiety. It was evidenced that most of the
dimensions influence the development of anxiety in older adults due to various factors.
Regarding the specific objectives and giving an answer through the results obtained to
the general objective, which is to know the influence of psychosocial factors in the
development of anxiety and depression in older adults the problem question is
resolved. According to the results, it was shown that psychosocial factors have a great
influence on the development of anxiety and depression traits.
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