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Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 189-197

Effect of psychosocial care model applied in an “elderly day care center” on loneliness, depression, quality of life, and elderly attitude

Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Near East University, TRNC, Mersin 10, Turkey

Date of Submission16-Jul-2019
Date of Acceptance01-Oct-2019
Date of Web Publication7-Feb-2020

Correspondence Address:
Mrs. S Esmaeilzadeh
Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Near East University, TRNC, Mersin 10
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_366_19

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Background: The purpose of the study is to evaluate the effect of the model applied in order to meet psychosocial care needs of elderly people in an elderly day care center on loneliness, depression, quality of life, and elderly attitude. Method: An intervention program prepared for the psychosocial needs of elderly people was carried out in the study and it was evaluated as pretest-posttest. The data were collected with UCLA Loneliness Scale (UCLA, LS), Geriatric Depression Scale Short Form (GDS-SF), Turkish version of the WHO Quality of Life Instrument Older Adults Module (WHOQOL-OLD-TR) and Turkish version of the WHO – Atittudes of Aging Questionnaire (AAQ-TR) in the study. The psychosocial intervention program was conducted once in a week, nine sessions were held in total and each of them took 90–120 min. Results: A statistically significant difference was found between the points that the elderly people obtained from the prior to and after UCLA Loneliness Scale and WHOQOL-OLD. TR instrument (P < 0.05). Besides, the difference between points gotten from the subdimensions “general,” “psychosocial loss,” and “psychosocial change” of AYTA-TR Scale was statistically significant. Conclusion: The intervention provided for the psychosocial needs of elderly people led to positive results in loneliness perception, quality of life, and elderly attitudes. Therefore, it is thought that this model is appropriate to be used commonly by nurses in psychosocial care of elderly people.

Keywords: Elderliness, psychosocial care model, psychosocial need, psychosocial nursing

How to cite this article:
Esmaeilzadeh S, Oz F. Effect of psychosocial care model applied in an “elderly day care center” on loneliness, depression, quality of life, and elderly attitude. Niger J Clin Pract 2020;23:189-97

How to cite this URL:
Esmaeilzadeh S, Oz F. Effect of psychosocial care model applied in an “elderly day care center” on loneliness, depression, quality of life, and elderly attitude. Niger J Clin Pract [serial online] 2020 [cited 2020 Oct 1];23:189-97. Available from:

   Introduction Top

The World Health Organization (WHO) defined the elderliness concept in ≥65 years over groups as “a decrease in vital functions of an individual due to continuous decrease in productivity and ability to adapt to environmental factors.”[1],[2] In addition, the elderly population was categorized; those between 65- and 74-year age group was classified as “young old,” 75- to 84-year age group as “elderly,” and ≥85 age group as “quite old.”[3],[4] Aging is generally examined chronologically, biologically, psychologically, and sociologically.[5],[6] In chronological dimension, the elderliness expresses total of years since birth, the biological one expresses the current biological step as a time unit.[7] On the other hand, the elderliness in the psychological dimension is generally about cognitive abilities and emotional behavior changes, in the sociological dimension, it is related to expected behavior of a certain age group of society and values given for this group.[8]

The elderly people are generally fragile and vulnerable since roles and responsibilities change, certain negative cases related to the illness, and losses are experienced. Thus, it is quite important to aid and support them in this phase. Moreover, ensuring elderly people to be self-sufficient and happy constitutes the basis of elderly services. In this sense, psychosocial care is quite significant so that they do not lose control in their life, if so, they can regain it and they can spend their remaining years in a more satisfying and productive way.[9] Benefiting from these services is vital so that elderly people live in peace with increasing physical and emotional wellness, have maximum productivity, and to improve their current conditions and so that young generations can look forward to the future. This is also a right for the elderly and a duty for the employees.[9],[10]

The health services are advancing as scientific and technological developments in the field of health take place, controls contagious diseases improve and preventive and developing health measures increase. As the quality of life increases, human life is prolonged; however, the rate of elderly population increases.[11],[12]

In country of this study, individuals who were ≥65 years constituted 7.54% of the total population in 2006, 8.1% in 2011, and 10.7% in 2015.[13] Thus, considering the ratio of the 65-year old and the older population to the total population, the country has the characteristics of an elderly society. The state offers health and social services for the elderly in this country. In this context, there are state-owned nursing home, rehabilitation center, and also private nursing homes and care centers.[14],[15] Besides, a service project for the elderly provided by many municipalities (local authorities) exists. In the scope of the service project, medical nursing services such as accessing to hospitals, medical dressing and injections, hairdressing/coiffure services, and psychological consultancy services are offered.

Many psychosocial losses are also experienced in addition to physical losses during the elderly period. As a result of loss of social roles and status, they lose their self-confidence, and thus, they start to feel insufficient, useless, desperate, in need of others, alone, and to be afraid of death.[12],[16] Minimizing these problems will only be possible by providing psychosocial support.

Determining psychosocial problems and developing effective management abilities may increase healing level of patients and decrease blocking nurses and enhance their motivation. Those facing illnesses and hardships show different reactions depending on their past experiences, coping strategies, and their characteristics. In this context, nurses giving care to the elderly should offer psychosocial care by considering this holistically. The psychosocial care stresses initiatives in order to help individuals having difficulty in coping with emotional aspects of illness, life crises influencing health care and health, or psychiatric disorders.[17] While offering service to elderly individuals, the nurses have the roles of care giver, trainer, consultant, and care coordinator.[18]

H1: The psychosocial intervention model applied to the elderly receiving service in the elderly day care center has an effect on loneliness.

H2: The psychosocial intervention model applied to the elderly receiving service in the elderly day care center has an effect on depression symptoms.

H3: The psychosocial intervention model applied to the elderly receiving service in the elderly day care center has an effect on the quality of life.

H4: The psychosocial intervention model applied to the elderly receiving service in the elderly day care center has an effect on elderly attitude.

   Materials and Methods Top

The research was conducted in an elderly day care center affiliated to the Village of country as pretest–posttest patterned intervention study. The center was approved by the European Union in 2011 and was opened on April 29, 2014. The center is an environment where the elderly can spend time during the day, share social experiences and engage in activities. The daily service capacity of the center is an average of 40 people and the physical infrastructure is sufficient for the services provided.

Data collection tools

The data were collected with the following scales.

Personal data form (PDF): PDF was prepared using the literature on identifying characteristics of elderly individuals[10],[19],[20] and consisted of 17 questions.

UCLA loneliness scale (UCLA-LS): The scale was developed by Russel, Peplau, and Ferguson in 1978 and rearranged by Russel, Peplau, and Cotrana in 1980, and the Cronbach alpha value was found to be 0.94.[21] The Turkish validity and reliability of the scale was made by Yaperel in 1984[22] and then reviewed by Demir and the Cronbach alpha value was found as 0.96.[23] The scale consists of 20 items, 10 of them are evaluated in the opposite direction, and 10 of them are rated in the right direction, and the score range is between 20 and 80 point. As the scale point increases, loneliness feeling increases also.

Geriatric depression scale short form (GDS-SF): The scale was developed by Shiekh and Yesavage and consists of 15 questions.[24] The Turkish validity and reliability of the scale was made by Ertan and his friends and the Cronbach alpha value was determined as 0.87.[25] Some questions of the scale (1, 5, 7, 11, and 13) are considered positive and others are considered negative. No answers to the positive ones and yes answers to the negative one's match with I point. 0–4 point means no depression, 5–8 means mild depression, 9–11 means moderate, and 12–15 means severe depression.

Turkish version of the WHO Quality of Life Instrument Older Adults Module (WHOQOl-OLD.TR): The original of the instrument was developed by Power and his friends,[26] the Turkish validity and reliability of the scale was made by Eser and others, and the Cronbach alpha value was determined as 0.85.[27] The WHOQOL-OLD.TR instrument consists of six subdimensions of “sensory functions,” “autonomy,” “previous-current-future activities,” “social participation,” “death and deceasing,” and “relationship” and 24 questions. Each subdimension is evaluated between 4 and 20 points and as overall score. High scores show that quality of life is high.

Turkish version of the WHO – Atittudes of Aging Questionnaire (AAQ-TR): WHO European aging attitude quiz developed in the framework of a multicenter project supported by the fifth Framework Program of the European Union which is AAQTR was done Eser and others and the Cronbach alpha value was found as 0.75.[28] AAQTR consists of three subdimensions, “psychosocial loss,” “physical change,” and “psychosocial development” and a total of 24 questions 75. The score of each subdimension ranges from 8 to 40 and is evaluated over the total score. High scores indicate that the elderly attitude is positive.

Sample of study

The universe of the study consists of 51 elderly people who are ≥65-year old registered in the elderly day care center. Among these people, those to be intervened according to the inclusion criteria were determined. The criteria for inclusion in the study were being ≥65 years, having no psychiatric diagnosis, attending in the sessions regularly, no communication barriers, and volunteering to participate in the study. Accordingly, intervention programs for a total of 44 people, as six groups, were initiated. Since the number of institutions providing elderly care is not sufficient, it was decided to include all elderly in the intervention program. In the intervention process of the research, two people said that they would participate in the program but did not participate; two people were not able to complete the program because of the health problem and one of them was not able to complete the program due to family reasons. Therefore, the research was carried out with a total of 39 people.

Application process

The research was carried out at the elderly day care center between September 17, 2018 and January 04, 2018. The intervention program was conducted once a week in the meeting hall of the center in a total of nine sessions, each session took for ~2 h. The objective of the intervention was to decrease negative effects of emotional, social, and physical problems that the elderly faced, to increase interpersonal interaction levels, to enhance their adaptation to the social life by developing communication skills, to inform them about their current period, to provide them to be aware of their needs, to create awareness about arising problems, to leave a positive effect to the future, and to help them to gain effective coping up abilities. For this purpose, visual methods, question answer and discussion technique, homework, and warming games were used. In the program, data collection tools were applied before the first session, and all the scales were applied again after the last session was completed.

Topics covered in sessions are as follows:

  1. Introduction of the program, creation of group consciousness, adaptation to elderliness.
  2. Creating self-awareness and consciousness.
  3. Increasing self-esteem.
  4. Problems and solutions in old age: Individual and social empowerment, psychological and physical losses: Physical insufficiency / weakness, loss of independence, lack of social interaction, family problems, deterioration in interaction and family care burden, loneliness.
  5. Problems and solutions in old age: Support and adaptation to role changes to prevent loss of power and depressive symptoms (worthlessness, inadequacy, hopelessness, etc.).
  6. Coping with regret in the past and uncertainty and death.
  7. Givingthemeaningtolife, effectivecopingandadaptationtoelderliness.
  8. Improving the quality of life.
  9. Completion.

Analysis of data

Statistical package for Social Sciences (SPSS) 24.0 program was used in order to analyze data statistically.

The frequency analysis was used to determine the sociodemographic characteristics, disease conditions of individuals, people whom they live with, and some descriptive characteristics of their daily activities.

Average, median, standard deviation, and descriptive statistics such as the highest and lowest values of UCLA-LS, GDS-SF, WHOQOL-OLD.TR, and AYTA-TR points prior to and after the intervention are shown. To determine hypothesis tests to be used in comparing the points of UCLA-LS, GDS-SF, WHOQOL-OLD.TR, and AYTA-TR prior to and after the intervention, the normal distribution of the scores obtained from the scales was examined by Shapiro–Wilk test, kurtosis, and diameters and found to be normal distribution. Accordingly, a paired sample t-test was used to compare the scores obtained prior to and after the intervention. Since data set did not show normal distribution in comparing all scale points prior to and after the intervention depending on the demographic characteristics of individuals' nonparametric hypothesis tests were not used. Accordingly, while Kruskal–Wallis H-test was used to compare scale scores according to age group of individuals and Mann–Whitney U-test was used to compare scale scores according to gender, marital status, and child status. The relationship between pretest and posttest intervention scales was determined by Pearson correlation coefficient.

   Results Top

The findings obtained as a result of scales and intervention determined appropriately for psychosocial needs of the elderly is as follows.

It was observed that 25.64% of elderly individuals were in the 65–69 age group, 51.28% were in the ≥75 age group and 87.18% were women and 12.82% were men. It was found that 25.64% of individuals were not literate, 64.10% were primary school graduates, 43.59% were married, 56.41% were widowed, and the majority (94.87%) of them had children. It was determined that 45.95% of those had two to three children, 54.05% of them had four and more children. It was found that 64.10% of them were housewives, 15.38% of them were tailors, 12.83% of them dealt with husbandry and farming, 17.65% of their economic status were low, 76.92% were middle, 74.36% of their income sources were retired pay, and 79.49% of them had social insurance.

It was seen that 87.18% of them said that they had chronic illness, 55.88% of them had diabetes, 44.12% of them suffered from hypertension, 23.53% of them had heart disease, and 92.31% of them were regularly on medication. About 64.10% of them stated that they were living with somebody, 40.0% of them were spouses, and 36.0% of them were children, 20.0% of them were both spouses and children. It was determined that 61.54% of them needed help while doing housework, 54.17% of them received this help from their children, 25.0% of them received help from caretakers, and 12.50% of them could not receive help from anyone although they needed help [Table 1].
Table 1: Sociodemographic characteristics of Elderly People (n=39)

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In [Table 2], comparison of points that the individuals obtained from prior to and after intervention is shown. In the paired t- test, the elderly individuals obtained x– = 47.38 ± 8.64 point prior to UCLA LS, x– = 39.62 ± 8.67 point after the intervention. The difference between these scores was statistically significant (P < 0.05).
Table 2: Comparison of UCLA Loneliness Scale, Geriatric Depression Scale, WHOQO-OLD.TR and AAQ -TR points (n=39)

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They obtained x– = 6.89 ± 3.19 point prior to the intervention and x– = 5.97 ± 3.30 point after the intervention, this difference was determined as statistically significant (P < 0.05). The overall WHOQOL-OLD scale point prior to the intervention was x– = 74.62 ± 10.99 point, the sensory functions subdimension point was = 9.56 ± 2.68, autonomy subdimension point was x– = 13.28 ± 2.58, the “previous, current, future activities” subdimension point was x– = 11.82 ± 3.09, “social participation” subdimension point was x– = 12.95 ± 2.67, “Death and Deceasing” subdimension point was x– = 12.92 ± 4.39, and relationship subdimension point was x– = 14.08 ± 2.21. They got x– = 85.55 ± 12.88 point as the overall point of the scale after the intervention, x– = 11.13 ± 2.98 point from “sensory functions,” x– = 14.42 ± 2.50 point from the “autonomy” subdimension, x– = 14.38 ± 2.85 point from “previous, current and future activities,” x– = 14.85 ± 2.56 point from “social participation” subdimension, x– = 14.38 ± 4.29 point from the “death and deceasing” subdimension, and x– = 16.36 ± 2.67 point from “relationship” subdimension. This difference was found to be high statistically significant in both WHOQOL-OLD and subdimensions (P < 0.05).

The overall scale prior to intervention was x– = 81.43 ± 8.22 point from AAQ-TR scale, x– = 28.46 ± 4.76 point from the psychosocial loss subdimension, x– = 24.85 ± 3.67 point from the physical change subdimension, and x– = 28.13 ± 3.58 point from psychosocial change subdimension. The overall scale after intervention was x– = 86,.2 ± 7.84 point from AAQ-TR scale, x– = 30.92 ± 3.34 point from the psychosocial loss subdimension, x– = 25.90 ± 3.02 point from the physical change subdimension, and x– = 30.10 ± 3.89 point from psychosocial change subdimension. The points obtained from AAQ-TR and “psychosocial loss” and “psychosocial change” subdimensions after intervention were determined to be higher statistically significant (P < 0.05).

Examining the points, the elderly people obtained prior to and after the intervention depending on their certain demographic characteristics, the points that women obtained from the “social participation” and “relationship” subdimensions were found to be higher statistically significant more than men (P < 0,05). In addition, the points obtained from the “death and deceasing” subdimensions of the elderly individuals aged ≥75 year were higher in terms of statistical significance than the other age groups (P < 0.05).

While there was a positive correlation between the scores obtained from the UCLA LS and GDS scale, there was a negative correlation between the WHOQOL-OLD overall points and AAQ-TR overall points (P < 0.05). A negative correlation was also found between the scores obtained from the GDS scale prior to intervention and the scores obtained from the WHOQOL-OLD scale and AAQ-TR overall points (P < 0.05). There was a positive correlation between the scores from the WHOQOL-OLD scale overall points and the “psychosocial loss” subdimension in AYTA (P < 0.05) [Table 3].
Table 3: Correlations between pre-intervention UCLA Loneliness Scale, GDS Scale, WHOQO-OLD.TR and AAQ -TR scores

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While there was a positive correlation between the scores obtained from the UCLA LS and GDS scale, there was a negative correlation between the WHOQOL-OLD.TR overall points and AYTA overall points after the intervention (P < 0.05). A negative correlation was seen between the scores taken from GDS-SG and the WHOQOL-OLD.TR scale and the scores taken from AAQ-TR and its “psychosocial loss” and “psychosocial change” subdimensions (P < 0.05). There was a positive correlation between the scores from the WHOQOL-OLD.TR scale overall points and the all subdimensions in AAQ-TR (P < 0.05) [Table 4].
Table 4: Correlations between UCLA Loneliness scale, GDS Scale, WHOQOL-OLD.TR and AAQ -TR scores after intervention

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   Discussion Top

It was found that there was a decrease in the scores of loneliness after the intervention compared to the prior to intervention, in other words, the feeling of loneliness after the intervention was less experienced. Elderliness is the period in which loneliness is most felt and experienced.[29] Therefore, it is one of the most important problems experienced in social relations adversely affecting individuals. The feeling of loneliness arises from the quantitative and qualitative lack of social relations network[23],[30] inability to enter social relations, shyness, loss of social status, and results in health problems.[31],[32],[33] The feeling of loneliness can also negatively affect the satisfaction of life.[34] Therefore, prevention of loneliness is quite essential in terms of psychosocial health and it is important to have interventions to reduce loneliness in services rendered to the elderly. Cattan et al.[35] stated that the interventions to be done for the loneliness as group therapies, face-to-face interview, support, house visits, solving problems by telephone and direct meeting. Between 2004-2013, in order to examine the impact of policy changes on the loneliness of elderly individuals in Germany, Austria, Belgium, Denmark, Italy, France, Sweden, Spain, Switzerland, and the Netherlands, the study compared the loneliness levels of the elderly.[36] While the level of loneliness in the study was 9.0% in 2004, it was 21.7% in 2013. In this context, loneliness was also seen as an increasing problem in elderly individuals in developed countries. In a study that examined the effects of psychoeducation program on reducing the isolation of the elderly, it was determined that the program was effective in reducing the isolation levels of the elderly.[37] As in the findings of our study, loneliness can be prevented when it comes to mental health.

It was found that individuals received a lower score in the intervention of GDS compared with prior to the intervention, but there was no statistically significant difference. In both cases, depressed individuals have mild depression. In a study conducted to maintain daily life activities of ≥65 adults living in country center to determine depression, the prevalence of depression symptoms was determined to be 30.9%.[38] It was determined that reaction to pharmacological treatment to depression which is a mental illness commonly faced during the elderliness was slow and successful at the rates of 60–80%[39],[40] in addition, besides pharmacological treatments, psychosocial interventions were effective.[41] Thus, holding longer intervention programs and maintaining continuity in approaching depression lead to thinking more effective results. Moreover, if some house visits were done by informing family and evaluating the case in a more detailed way and support was provided, the results would be more positive.

Overall scores obtained from WHOQOL-OLD.TR and subdimensions after the intervention were found to be significantly higher than before the intervention. This is important in terms of showing that psychosocial intervention improves the quality of life. For this reason, it is important for elderly individuals to receive psychosocial support in order to cope with many challenges of life. Research findings from Nasiri et al. have determined that daily care services are significantly improving the quality of life of the elderly. These services include social relationship development, healthy lifestyle, remembering therapies, free painting, sports, and exercise programs.[42] In this study, it was determined that the quality of life of 165 elderly living in the nursing home in Turkey and the factors affecting the quality of life were low, and in the provision of services to the elderly, all disciplines and especially nurses were advised to plan services to improve the quality of life.[43]

After the intervention, scores from AAQ-TR overall and psychosocial loss and psychosocial change subdimensions were found significantly higher. This suggests that the perception of interaction with the appropriate intervention to elderly individuals may change in a responsible way. The perception of aging is one of the indicators that determine the attitude toward aging and has been the subject of research as of 1934.[44] Predicting the future health of the individual can be assessed by determining the degree of satisfaction from the individual's current age and adapting to changes in life phases.[19] A positive attitude toward old age is an important determinant of healthy aging. As a matter of fact, Levy et al. have shown that the positive perceptions of the elderly about old age extend their lives.[28]

A negative correlation was found between UCLA LS and WHOQOL-OLD.TR and AAQ-TR overall scores after intervention. This shows that when the elderly experience less loneliness, their quality of life increases and their attitudes toward aging are more positive. They emphasized that lowering the level of loneliness would increase the general well-being of the person and thus the positive effect on the quality of life.[45]

WHOQOl-OLD.TR and AAQ-TR overall scores after the intervention. This shows that elderly people experience less of a sense of loneliness, more of the quality of life, and more attitudes of old age. It was determined that there was a positive correlation between GDS-SF and UCLA LS. This shows that depression levels are also decreased when the age of the elderly is reduced. In addition, it was found that there was a positive correlation between the WHOQOL-OLD.TR and the AAQ-TR overall scores after the intervention. This means the quality of life in the old age is increasing. In Sözen's study[46] similar to our study, there was a positive correlation between quality of life and the perception of old age. The psychosocial intervention program used in our study has been determined to be effective in the elderly on loneliness, quality of life, and elderly attitudes. Similarly, the meta analysis conducted by Ergin in 2017 determined that attempts by nurses based on house visits were effective in reducing the frequency of hospitalization in the elderly and in protecting and improving physical and psychosocial health.[47] In the literature, it is stated that nursing has always played a pioneering role in improving the health of the aging population.[48] In this context, it is thought that this psychosocial intervention program will be widely used in country, thus contributing to the development of services provided to the elderly.

   Conclusion Top

The psychosocial needs and problems affecting the mental health of the elderly with the age of the population are of a different importance. It has been determined that the program of applied medicine has a positive effect on the loneliness, quality of life, and elderly attitude. In this respect, it is recommended to include the applied psychosocial care model in the service system offered to the elderly and to ensure its maintenance. Therefore, quality of service will increase if employees offering service to the elderly evaluate factors influencing mental health of the elderly; improve this intervention program in line with the experienced problems, needs, and expectations; and make common this program.

Ethical dimension of research

To carry out the research, a written permission (2018/5111/88) was obtained from the Municipality Directorate and approved by Scientific Research Evaluation Ethics Committee of University on 28.06.2018 (2018/59-692).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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