THESES OF DOCTORAL WORK THE ELDERLY TODAY Geriatric socio-psychological study, options of improving the quality of life Eszter Majercsik MD Semmelweis University 4th Interdisciplinary Doctoral School Istitute of Behavioural Sciences Tutor and director of the Program: Prof. Mária Kopp MD DSc Budapest, 2004
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Research competition papers in the topic of the thesis: Majercsik E.: Lisopress terápia során szerzett tapasztalataink. Richter Gedeon Rt. 1998. I. díj. Majercsik E.: Hogyan befolyásolja az életminoséget a transzdermális nitroglycerin alkalmazása idos korban. Shering-Plough, 1999. II. díj. Majercsik E.: Anxiron terápiával szerzett tapasztalataink geriátriai betegeknél. ICN Rt., 1999. II. díj. Majercsik E.: Cavintonnal szerzett tapasztalataim. Richter Gedeon Rt., 2000. III. díj. INTRODUCTION The increase of the average expectation of life at birth, the rise of the number of elderly people is world phenomenon. The biological and psychosocial status of the elderly is changing as they advance into higher age, and the problems of the provision for them are increasing. The maturity of a society is well indicated, how does it provide with care its aging people, how does it compensate their negative feeling that they were important only until they were active contributors of national income. The primary aim of the cure, care and provision for the elderly people is to provide solicitude in accordance with age, corresponding to the expectations, needs and demands of the elderly. The cure and care does not provide necessarily a full recovery, since the natural physiological processes cannot be stopped. Acquiescing the limitations of medical treatment we strive primarily to improve the general condition of elderly and help them over the most difficult phase of their life. What do we have to do that aging people should have good feeling of health and through psychic feedback a good state of health? First, we have to 14 3
get acquainted with the real well-being of elderly people. If we have got a realistic picture, than we can determine more easily the things to do state of the art and science. The problems of senior years are biologically, psychologically and sociologically equally important and relevant within the system oriented gerontology. As regards to the well-being and quality of life of elderly people, the harmonic maintenance of the physical-spiritual equilibrium is, as long as it can be, the aim and it can be achieved by individual, social and public health measures. Present research consists of two investigation series: In the first study (n=303) we have determined and quantified the well-being of the geriatric patients. There were two possible ways to carry out this investigation. One of them was based on the hierarchy of needs by Maslow s motivation approach. The other was the self-rated-health method. Majercsik E.: Közérzet, szükségletek, egészségi állapot az idos korban. Ünnepi Gerontológus Kongresszus az Idosek nemzetközi éve alkalmából, Keszthely, 1999. június 3-4. Majercsik E.: Cavintonnal szerzett tapasztalataink vascularis dementiaban. Eloadás a Pilisi Orvosi Kamara Tudományos Ülésén, 2000. december 10. Majercsik E.: Az idosödés testi-lelki kérdései. Eloadás az Óbudai Társas Kör Tudományos Ülésén, 2001. szeptember 12. Majercsik E.: Az idoskor egészségügyi és szociális problémái. Eloadás az Országos Nyugdíjas Polgári Egyesületben, 2002. december 11. In the second study with geriatric patients (n=384) the investigation targeted to analyze the interaction among psychosocial factors (social support), anxiety and the anxiolitic drug responsiveness. 4 13
Scientific lectures in the topic of the thesis: OBJECTIVES OF THE RESEARCH Majercsik E., Marián É., Rigó E.: Geriátriai Osztályunkon ápolt betegek párhuzamos belgyógyászati és pszichiátriai kezelése. Jubileumi Tudományos Ülés Szent Margit Kórház, 1997. november 8. Majercsik E.: Geriátriai Osztály új finanszírozási modellje a Szent Margit Kórházban. Magyar Gerontológiai Társaság 1998. évi Kongresszusa, Lillafüred 1998. május 21-23. Majercsik E.: A Szent Margit Kórház (Budapest) Geriátriai Osztály, mint új finanszírozási modell, valamint a kórház vonzáskörzetébe tartozó geriátriai-szociopszichológiai vizsgálat bemutatása. V. Soproni Tudományos Szakmai Konferencia, Sopron 1998. szeptember 30-október 2. Majercsik E.: Idoskori közérzet és mentális állapot. II. Lillafüredi Gerontológiai Kongresszus, Lillafüred 1999. május 21-22. The primary objective of this research was to contribute to the improvement of the quality of life of geriatric patients. During the investigation and analysis the following questions and tasks were postulated as objectives of the research: 1. Determination of the geriatric hierarchy of needs on motivation approach. 2. The quantification of the well-being of patients. 3. The self-rated-health of geriatric patients. 4. The investigation of interaction between general health feeling, social support and anxiolitic treatment of geriatric patients. 5. The possibility of improvement of well-being and quality of life of geriatric patients. 12 5
METHODS Hungarian publications : 1. Determination by quantification the well-being of geriatric patients. a./ Weigh has been quantified to each level of the hierarchy of needs. By the help of these weighs the assesments of each level of needs could have been summarized to a final general health feeling index. b./ In case of the self-rated-health evaluation the patients assessed their health status on a 5 grade scale. 2. The hierarchy of needs has been determined by the help of the method of paired comparisons. The weighs to each level have been allocated by the Guilford method. 3. The assessment of social support was carried out by the help of Caldwell questionnaire. 4. The anxiety was registered on the Hamilton scale. 5.Cognitive functions have been inventoried by the Modified Mini Mental State Test. Majercsik E., Nagy E.: Az öregedés biológiai alapjai. SOTE Rektori pályázat, 1976. Kézirat Majercsik E.: Gondolatok az ápolás minoségbiztosításáról. A Fovárosi Szent Margit Kórház Jubileumi Tudományos Évkönyve, 1997. Majercsik E.: Hogyan befolyásolja az életminoséget a transzdermális nitroglycerin (Nitrodur) alkalmazása idos korban? Medicus Universalis 1999; 157-159. Majercsik E.: Anxiron terápiával szerzett tapasztalataink geriátriai betegeknél. Medicus Universalis 2000; 147-150. Majercsik E.: A Curiosin (cink hyaluronát) szerepe a sebgyógyulásban. Sebkezelés Sebgyógyulás, 2000. III. évfolyam 1. szám 10-14. Majercsik E.: Vinpocetin (Cavinton) kezelés hatása a vascularis dementia szimptómáira és a betegség progressziójára. Medicus Universalis 2001; 251-256. 6 11
LIST OF PUBLICATIONS RESULTS International papers: Majercsik E., Haller J., Leveleki Cs., Baranyi J., Halász J., Rodgers J. F.: The effect of social isolation on the anxiolytic efficacy of buspirone in male rats, mice, and men. Progress in Neuropsychopharmacology & Biological Psychiatry 27 (2003) 1187-1189. Majercsik E., Haller J., Interactions between anxiety, social support, health status and buspirone efficacy in elderly patients. Neuro- Psychopharmacology & Biological Psychiatry 2004. (In press) Majercsik E., Hierarchy of needs of geriatric patients. Gerontology 2004. (In press) 1. The geriatric hierarchy of needs in comparison with Maslow s original hypotheses has been substantially restructured. The self-actualisation need has takes over the first place with geriatric patients. 2. We have received the average value of 3,11±0,05 (n=303) as self-rated-health on a five grade scale. 3. The questionnaire has comprised 5 levels of needs and altogether 26 questions. The replies to these questions have been summarized by the previously established weighs and we have received the value of 3,18±0,04 (n=303) for the index of the general health feeling. The two figures the self-rated-health and the general health feeling index show very close result. The general health feeling index continuously decreases as the age of people is advancing. At the same time the self-rated-health value increases. Even if the patient has serious illnesses, still he judges his state of health better than as it is. 10 7
4. There is significant interaction between anxiety, social support and health status. The low number of social contacts paired with large number of diseases proved to be a strong risk factor for anxiety with geriatric patients, whereas the reverse condition (many contacts/few diseases) was associated with considerably lower anxiety scores. These data suggest that major psychosocial problems the elderly patients facing with (the complexity of relation of social support and health status) may induce a necessary shift in the approach to the care of the elderly. SUMMARY, NEW CONCLUSIONS The social support and the health status (disease score) is especially relevant psychosocial problem in old age. Our data suggest that both anxiety and anxiolytic drug responses are modulated by nonpharmacological factors, among which social support and health status appear to play a significant role with elderly patients. New finding is in our study that social support is a positive predictor of buspiron efficacy. We can influence the quality of life of elderly patients by strengthening the protective factors (maintaining individual creativity, striving against isolation, supporting family and friendly relations) and suppresssing endangering factors (improving nutritional practices, working against cognitive function decline). In our research we investigated the well-being of geriatric patients and we discussed on motivation approach the grade of satisfaction of different needs. The main result and new finding is that the hierarchy of needs of geriatric patients shows a different structure than it is hypothesized with Maslow. The self actualization is the strongest need with the geriatric patients and the originally greatest priority slides back to the lowest level. 8 9