Populations are rapidly aging throughout the world (Forget et al., 2008; World Health Organization [WHO], 2011). The rapid growth of the older population is especially noticeable in developing countries (Lee & Salman, 2018). According to the WHO's report, 523 million people aged ≥65 years were living in the world in 2010, and this number is expected to reach 714 million by 2020 (United Nations, 2011). According to data collected by the Turkish Statistical Institute for the year 2012, individuals aged ≥65 years constituted 7.5% of the total population in Turkey. It is estimated that this number will increase to 10.2% in 2023 (Turkey Statistical Institute, 2012).
Improvements in health care to prevent disease and provide early diagnosis and treatment have increased the number of people generally, and the life span of the older population. The improved fertility rate and decrease in infant mortality have contributed to overall increases in population. Developments in preventive health services parallel to scientific and technological advancements in medicine have prolonged life expectancy and increased the percentage of older adults in the general population (Gumus et al., 2009; Yeom et al., 2008).
The increase in the older population and prolongation of life expectancy bring about the issue of staying healthy at advanced ages. In this context, continuity of the physical and mental independence of people at advanced ages should be maintained (Koç, 2015). This maintenance is only possible if individuals understand self-care, fulfill their needs, and sustain their psychological and physical well-being (Karagozoglu et al., 2012).
Self-care involves activities initiated and performed by individuals to maintain their life, health, and well-being. The concept of self-care covers one doing something oneself instead of expecting or asking others to help with activities of daily living or health care needs. Self-care agency, on the other hand, is the combination of actions and power factors that determine the self-care performance of the individual in regard to sustaining and promoting health (Fadiloğlu, 2003; Karakurt et al., 2017; Nahcivan, 2004; Orem, 2001; Velioglu, 1999). Self-care skills depend on an individual's age, gender, sociocultural status, financial status, education level, knowledge level, environment, health status, interpersonal relationships, and communication environment (Karagozoglu et al., 2012).
As individuals age, they experience inadequacies in fulfillment of self-care needs depending on physical, emotional, and economic difficulties that arise due to various diseases that come with aging (Altay & Avci, 2009; Civi & Tanrikulu, 2000; Jiang et al., 2002; Karagozoglu et al., 2012; Koç, 2015; Parissopoulos & Kotzabassaki, 2004; Rantanen et al., 2000). In a study conducted by Yildirim et al. (2013), it was determined that the presence of a chronic disease, being single, living alone, low education level, and low income predicted low self-care agency.
Physical changes that occur in the aging process form a basis for the presence of emotional difficulties, and it becomes difficult for individuals to continue their lives as independent, effective, adequate, and strong people with increasing age. In addition, when aging progresses, individuals lose their effective roles and turn to passive positions, encountering negativities such as lack of trust in people, fear of being exposed to violence, and decreased financial support. These life challenges shut older adults out from society and intensify their feelings of loneliness and alienation. Progressive deterioration of the psychosocial condition of the individual may result in a depressed emotional state (Jylhä, 2004; Rokach, 2000; Ünal & Bilge, 2005).
Depression is a common illness worldwide, with more than 264 million people affected (WHO, 2020). The prevalence of geriatric depression is estimated to be 8% to 15% in the United States, and 12% to 34% in Asia (Chu et al., 2019). The aging of the world population will cause an increase in the prevalence of depression (WHO, 2020).
Depression is the most frequent psychological problem among older adults, and its management in the aging population is important. Studies have shown that there is a correlation between depression and daily activities, physical functioning, and chronic disease (Altiok et al., 2012; Bozo et al., 2009; Carayanni et al., 2012). Sendra-Gutiérrez et al. (2017) found that older adults with poor health perceptions and physical discomfort (e.g., pain) had high levels of depression.
There is an increase in the prevalence of depression with aging (Argyropoulos et al., 2015; WHO, 2012), and as a result, there is a decrease in self-care agency (Altay & Avci, 2009; Civi & Tanrikulu, 2000; Jiang et al., 2002; Karagozoglu et al., 2012; Koç, 2015; Parissopoulos & Kotzabassaki, 2004; Rantanen et al., 2000). Although previous studies have evaluated self-care agency and depression frequency in older adults (Babatsikou et al. 2017; Elkin, 2016; Karagozoglu et al., 2012), no study has determined the correlation between self-care agency and depression. Thus, the current study contributes to the literature with its findings on self-care agency and depression, as well as influencing factors, in a Turkish older adult population.
Design and Sampling
The current correlational descriptive study was conducted in the internal medicine clinics (i.e., General Internal Medicine, Gastroenterology, Endocrine, Thoracic, and Nephrology) of a university hospital. The study population comprised 473 patients aged ≥65 years who were hospitalized in the internal medicine clinics. A G*Power analysis was conducted and determined a sample size of at least 471, with a significance level of 0.05, 95% confidence interval (CI), and 0.95 representation of the population. Inclusion criteria were: (a) age ≥65 years, (b) able to communicate (i.e., can complete questionnaires/scales), and (c) no history of mental illness. Exclusion criterion was age <65 years.
The following instruments were used for data collection: (a) a demographics questionnaire prepared by the researchers upon literature review, (b) the Exercise of Self-Care Agency Scale, and (c) the Geriatric Depression Scale. Data were collected using face-to-face interviews in patient rooms. Each participant was interviewed only once. Interviews were conducted on different days and times of the week. Data collection took approximately 30 to 40 minutes.
Demographics Questionnaire. The demographics questionnaire comprised 12 questions and included descriptive characteristics of the participant (e.g., age, gender, marital status, educational level, occupation, economic status).
Exercise of Self-Care Agency Scale. This scale was developed by Kearney and Fleischer (1979). Turkish validity and reliability of the scale were conducted by Nahcivan (1993). This 5-point Likert-type scale comprises 35 items. Eight items (3, 6, 9, 13, 19, 22, 26, and 31) are inversely scored. Cronbach's alpha of the scale was 0.89 (Nahcivan, 2004). In the current study, Cronbach's alpha was 0.89.
Geriatric Depression Scale (GDS). This scale was developed by Yesavage et al. (1983) to measure symptoms of depression. Turkish validity and reliability of the scale were conducted by Ertan and Eker (1997). The GDS comprises 30 questions with yes or no responses. Scores ranging from 0 to 10 indicate no depression, 10 to 13 indicate possible depression, and ≥14 indicate severe symptoms of depression. The test–retest reliability of the scale was 0.87, and Cronbach's alpha was 0.72 (Sagduyu, 1997; Sertel et al., 2016). In the current study, Cronbach's alpha was 0.95.
Data obtained from the study were assessed using SPSS version 17.0. Frequencies, percentages, means, standard deviations, analysis of variance (ANOVA), independent samples t tests, and Kruskal Wallis tests were used to analyze data. In case of significance, post hoc Tukey's test was used to test the source of the difference. Linear regression analyses were used to evaluate the relationship of depression and self-care agency. Results were accepted as statistically significant at 95% CI and p < 0.05. Parametric tests were used for demographic data (e.g., gender, marital status, education level, economic status, chronic disease, with whom participants lived).
To conduct the study, required written permissions were obtained from the ethics committee and the hospital. Researchers informed participants about the study and obtained their verbal consent.
Most participants (77.2%) were aged 65 to 74 years. A higher percentage of participants were female (52.2%), 68.3% were married, 31.3% completed 5 years of schooling, and 57.3% had moderate economic status. Among participants aged 65 to 74 years, 71.7% had a chronic disease, and 37.8% were living with their spouses (Table 1).
Comparison of Geriatric Depression Scale and Exercise of Self-Care Agency Scale Mean Scores by Participant Characteristics (N = 473)
Although the differences between depression mean scores in terms of age were not statistically significant, the differences between self-care agency mean scores in terms of age were significant (p < 0.05). Participants aged 65 to 74 years comprised the group with the highest mean score of self-care agency (mean = 92.82 [SD = 22.29]).
Although depression mean score of female participants (mean = 20.77 [SD = 14.13]) was significantly higher than that of male participants (mean = 15.77 [SD = 11.59]) (p < 0.001), no statistically significant difference was found between self-care agency mean score in terms of gender. Depression mean score of single participants (mean = 20.26 [SD = 12.9]) was significantly higher than that of married participants (mean = 17.51 [SD = 13.27]) (p < 0.05). Self-care agency mean score of married participants (mean = 95.1 [SD = 21.03]) was significantly higher than that of single participants (mean = 85.9 [SD = 33.44]) (p < 0.001).
In terms of education level, depression mean score was highest in the literate group (mean = 23.5 [SD = 15.52]), and self-care agency mean score was highest in the group with high school education (mean = 105.65 [SD = 19.06]). The difference among groups was statistically significant in terms of depression and self-care agency mean scores (p < 0.001).
In terms of economic status, the highest depression mean score was found in participants with poor economic status (mean = 20.45 [SD = 13.15]), and self-care agency mean score was the highest among participants with good economic status (mean = 100.62 [SD = 22.26]). The difference between groups was statistically significant for both scales' mean scores (p < 0.001).
Depression mean score of participants who had chronic disease (mean = 19.22 [SD = 13.5]) was significantly higher than participants without chronic disease (mean = 16.26 [SD = 12.21]) (p < 0.05). The relationship between self-care agency mean score and having a chronic disease was not statistically significant.
Depression mean score was highest among participants living alone (mean = 22.31 [SD = 12.47]), and self-care agency mean score was highest among participants living with spouses (mean = 96.44 [SD = 19.76]). The difference between groups was statistically significant for the mean scores of both scales (p < 0.05).
Although the depression mean scores of participants were high (mean = 18.38 [SD = 13.20, range = 2 to 53]), their self-care agency mean scores were moderate (mean = 92.18 [SD = 25.95, range = 18 to 382]).
A negative and significant correlation was found between levels of depression and self-care agency. As participants' depression levels increased, their self-care agency levels decreased (r = −0.175; p < 0.001).
Findings derived from regression analysis indicated a linear relationship between depression and self-care agency. Sociodemographic characteristics of participants had a significant effect of 6.3% on self-care agency and 10.4% on depression (Table 2).
Linear Regression Analyses of Self-Care Agency and Depression in Participants
Self-care agency enhances self-care behaviors. Self-care activities alleviate symptoms and complications of diseases, shorten recovery, and reduce hospital stay durations. Moreover, depression is negatively associated with enhanced self-care agency (Tanimura et al., 2019). Therefore, strengthening the self-care agency of older adults is of great importance in reducing health care costs and creating a healthier society.
In the current study, depression levels of participants aged 85 years were higher in comparison to other age groups, but the difference among groups was not statistically significant. In a study by Ünsar et al. (2015), depression levels were found to increase with increasing age. It is thought that factors such as limitation in activities of daily living, fear of death, and an increase in feelings of loneliness with increasing age increase the risk of depression in older adults.
It was determined that self-care agency levels of participants aged ≥85 years were significantly lower than other age groups. In a study by Karagozoglu et al. (2012), it was found that self-care agency was lower among individuals aged ≥81 years, and self-care agency decreased with increasing age. Erci et al. (2017) determined that there was a statistically significant relationship between age and self-care agency. Advanced age leads to a decline in self-care agency (Sundsli et al., 2012). It is thought that older individuals become more dependent in meeting their individual needs (e.g., dressing, nutrition, bathing), and therefore, their self-care agency decreases along with increasing age.
Female participants in the current study experienced significantly more depression than males. In studies by Altiok et al. (2012) and Elkin (2016), the depression levels of women were determined to be higher than those of men. On the other hand, Argyropoulos et al. (2015) found that men experienced more depression than women. In Turkey, 65% to 70% of depressive patients are female, and 30% to 35% are male. The risk of exposure to depression is twice as high in women as men. Economic, social, and cultural factors, in addition to postpartum and premenstrual periods, contribute to a higher number of women experiencing depression than men (Yasar, 2007). Loneliness may also contribute to depression.
Self-care agency levels of male participants were higher than that of female participants, but the difference between groups was not statistically significant. In studies by Altay and Avci (2009) and Erci et al. (2017), self-care agency levels of men were found to be higher than those of women. Karagozoglu et al. (2012) found that self-care agency levels of women were higher than those of men. It has been stated that factors such as being healthy (i.e., physically, mentally, and socially) and having a higher socioeconomic level are effective in fulfilling self-care agency (Altay & Avci, 2009). Self-care agency of Turkish men is expected to be higher due to cultural, social, and financial status. Lower rates of depression in men may be tied to these variables or reflect other protective factors that lower the incidence of depression in this population.
Depression levels of single older adults were significantly higher than in those who were married. In studies by Carayanni et al. (2012), Aba and Tel (2012), and Bakar and Asilar (2015), depression levels of single older adults (including widowed, divorced, or separated individuals) were higher. Loneliness is a risk factor for depression (Alpass & Neville, 2003). For this reason, coping with problems alone is a factor thought to contribute to single older adults' experience of more depression.
In the current study, self-care agency levels of single older adults were significantly lower in comparison to individuals who were married. Chang and Lee (2015) determined that self-care levels of single older adults were also lower than those who were married. When they were studying individuals with diabetes mellitus, Aba and Tel (2012) found that the self-care agency score of widowed patients was lower. It is thought that self-care agencies of single older individuals decrease because their social support is lower than that of married individuals.
Depression levels of participants who were literate were higher than other groups, and the difference between groups was statistically significant. Patra et al. (2017) found that depression levels were higher in illiterate older adults. Jones et al. (2016) found that increased educational level decreased depressive symptoms. In a study by Keskinoğlu et al. (2006), depression levels were found to be higher for individuals with lower education levels. Level of education is one of the most important factors that affects depression in older adults. It is thought that, because low education levels make living conditions difficult, they also increase depression. A higher education level is thought to decrease depression levels because it improves problem-solving abilities.
In the current study, self-care agency levels of participants who were illiterate were significantly lower than others. Altay and Avci (2009) found that self-care agency levels of literate older adults were lower, and as educational levels increased, self-care agency levels also increased. As educational level contributes to the development of positive strategies such as using coping methods to manage disease symptoms, self-care agency is thought to increase as education level increases.
Depression levels of participants with poor economic status were significantly higher than those with good or moderate status in the current study. Argyropoulos et al. (2015) found that depression levels of those with low income were higher than those with high income. Ganatra et al. (2008) found that depression was reported more often in older individuals with financial problems. It is thought that poor economic status may lead to older individuals having limited resources to spend on health care.
Self-care agency levels of older adults with poor economic status were significantly lower in comparison to other groups. In a study by Koç (2015), self-care agency levels of older individuals with low income were also found to be lower. Economic status is an important factor related to health and quality of living. Therefore, poor economic status is thought to negatively affect self-care agency.
Depression levels of participants with chronic disease were significantly higher than those without chronic disease. In the study by Bozo et al. (2009), depression levels of those with physical disorders were found to be higher than those who had no physical disorders. In studies by Kocataş et al. (2004) and Keskinoğlu et al. (2006), the incidence of depression was found to be higher in individuals with chronic disease. Because the presence of a chronic disease makes the living conditions of older individuals more difficult, depression levels are thought to be higher in older individuals with chronic disease.
Self-care agency levels of participants with chronic disease were lower than in those without chronic disease; however, in the current study, the difference between groups was not statistically significant. Koç (2015) found that self-care agency levels of older individuals with chronic disease were lower. Because chronic disease may lead older individuals to have limitations in their lives and difficulties in fulfilling their own care, their self-care agency is considered to be low.
Depression levels of participants who were living alone were determined to be significantly higher than in other groups. In studies by Carayanni et al. (2012) and Keskinoğlu et al. (2006), depression was observed more frequently in older adults living alone. Loneliness may affect individuals negatively and lead to thoughts that life has no meaning or feelings of abandonment.
Self-care agency levels of participants living with their children were significantly lower than those in other living situations. In a study by Altay and Avci (2009), self-care agency levels of older individuals living with their children were also observed to be lower. Older adults living with their children expect support from them in meeting self-care requirements, and consequently, their self-care agency levels are thought to decrease.
Depression levels of participants in the current study were high, and their self-care agency levels were considered moderate. It is thought that depression levels of older adults are elevated due to limitations brought on by age, as well as chronic disease. Providing evidence-based practices for treatment of depression may help improve physical health and reduce functional disability. Mental health nurses should be able to provide care with evidence-based practices, such as the development of a therapeutic relationship and evaluation of mental and physical health history, as well as family history (Substance Abuse and Mental Health Services Administration, 2011).
There was a negative correlation between depression and self-care agency levels, and as self-care agency increased, depression levels decreased. Good mental health is important for older adults to manage daily living (Sundsli et al., 2012). Kleisiaris et al. (2013) found a negative correlation between self-care agency and depression, and as self-care agency increased, depression levels decreased. Ünsar and Sut (2010) observed more depression in older adults who needed help in fulfilling their self-care needs. Mental health nurses should provide care that will increase self-care agency and mental health of older individuals.
The current study found that marital and economic status were predictors of self-care agency and that gender, level of education, and economic status were predictors of depression. Hosseinzadeh (2019) found that marital status was a predictor of self-care agency. In studies by Chalise (2014) and Babatsikou et al. (2017), gender was found to be a predictor of depression.
The current study collected data from only one hospital in Turkey. It may be generalized to only this group of participants. Older individuals who were studied had different chronic illnesses. The primary chronic illnesses among participants were diabetes mellitus, cardiovascular diseases, cancer, and pulmonary diseases. However, participants' clinical diagnoses and acute illnesses were not considered. Results may not represent all chronically ill older individuals, and addition of data in the future may change the results.
Implications for Nursing
The current study contributes to the global literature with its findings on self-care agency and depression levels of a Turkish older adult population. The study found that most participants experienced depression. It was also found that individual characteristics such as gender, education level, and economic status affected mental health. This study showed that levels of self-care agency decrease with higher depression levels. Previous studies investigated fatigue and self-care agency levels of older adults and self-care agency in the case of mental illnesses (Çiftci et al., 2015; Karagozoglu et al., 2012; Yildirim et al., 2013). This study is the first to investigate the relationship between self-care agency and depression among older adults in Turkey. From this perspective, the study also contributes to the literature on mental health nursing. The results support the need to develop mental health policies unique to the older population in Turkey. National older adult care policies should consider self-care agency and depression as problems among the older adult population. This study recommends policies in this field, as well as future studies that consider the relationship between depression and self-care agency, and the formation of clinical guidelines regarding the issues. While providing health care services, mental health nurses should also perform a detailed examination of the mental health status of older adults based on characteristics such as gender, educational status, and economic status. Moreover, a holistic approach considering cultural history will increase the quality of health care standards. Prevention of depression, which is a significant health problem for older adults in Turkey and the world, will provide a significant contribution to improvement of the quality of life of this population.
The current study is an important demonstration of the ability of older adults to seek counseling and education from mental health nurses to plan care that protects their health and improves health behaviors. Support systems should be increased, and older adults should be evaluated in terms of psychiatric aspects to reduce depression levels. Mental health nurses are in a key position to identify depression and enhance the success of therapy in older adults.
In the current study, depression levels of participants were high, and self-care agency levels were moderate. Furthermore, depression levels were high in participants who were female and single, and those who had low education levels and poor economic status. Self-care agency levels for these groups were low. A negative and significant correlation was found between depression and self-care agency.
According to the results of the study, support systems should be increased, and nurses should evaluate older adults in terms of psychiatric aspects to reduce depression levels in this population. The characteristics of depression in old age should be known, and the negative effects of depression on existing physical illnesses should be evaluated. It is important to screen and examine every older individual who visits primary health care institutions for depression. Older adults should have accommodations to facilitate self-care whenever possible. Nurses are in a perfect position to assist with facilitating home care needs to ensure as much independence as possible. Assessment of each individual's health care needs and providing resources at home to maximize independence is essential to an active lifestyle and good mental health.
- Aba, N. & Tel, H. (2012). Depression and self-care agency among diabetes mellitus patients [article in Turkish]. Cumhuriyet Nursing Journal, 1(1), 18–23 https://pdfs.semanticscholar.org/f552/868f771caa3b932028ebec272cb5df55ce79.pdf
- Alpass, F. M. & Neville, S. (2003). Loneliness, health and depression in older males. Aging & Mental Health, 7(3), 212–216 doi:10.1080/1360786031000101193 [CrossRef] PMID:12775403
- Altay, B. & Avci, I. A. (2009). The relation between the self care strength and life satisfaction of the elderly living in nursing home. Dicle Medical Journal, 36(4), 275–282 https://www.ingentaconnect.com/content/doaj/13002945/2009/00000036/00000004/art00007;jsessionid=3l194d9o0dp94.x-ic-live-03
- Altiok, M., Yilmaz, M., Onal, P., Akturk, F. & Temel, G. O. (2012). Relationship between activities of daily living, sleep and depression among the aged living at home. Pakistan Journal of Medical Sciences, 28(1), 162–166 https://www.pjms.com.pk/index.php/pjms/article/view/1465
- Argyropoulos, K., Bartsokas, C., Argyropoulou, A., Gourzis, P. & Jelastopulu, E. (2015). Depressive symptoms in late life in urban and semi-urban areas of South-West Greece: An undetected disorder?Indian Journal of Psychiatry, 57(3), 295–300 doi:10.4103/0019-5545.166617 [CrossRef] PMID:26600585
- Babatsikou, F., Konsolaki, E., Kouri, M., Zyga, S. & Koutis, C. (2017). Depression in the elderly: A descriptive study of urban and semi-urban Greek population. International Journal of Caring Sciences, 10(3), 1286–1295 https://www.internationaljournalofcaringsciences.org/docs/19_babatsikou_original_10_3.pdf
- Bakar, N. & Asilar, R. H. (2015). Factors affecting depression and quality of life in the elderly. Journal of Gerontology & Geriatric Research, 4(5), 2–8 doi:10.4172/2167-7182.1000249 [CrossRef]
- Bozo, O., Toksabay, N. E. & Kürüm, O. (2009). Activities of daily living, depression, and social support among elderly Turkish people. The Journal of Psychology, 143(2), 193–205 doi:10.3200/JRLP.143.2.193-206 [CrossRef] PMID:19306681
- Carayanni, V., Stylianopoulou, C., Koulierakis, G., Babatsikou, F. & Koutis, C. (2012). Sex differences in depression among older adults: Are older women more vulnerable than men in social risk factors? The case of open care centers for older people in Greece. European Journal of Ageing, 9(2), 177–186 doi:10.1007/s10433-012-0216-x [CrossRef] PMID:28804418
- Chang, A. K. & Lee, E. J. (2015). Factors affecting self-care in elderly patients with hypertension in Korea. International Journal of Nursing Practice, 21(5), 584–591 doi:10.1111/ijn.12271 [CrossRef] PMID:24954584
- Civi, S. & Tanrikulu, M. (2000). An epidemiological study to evaluate the level of dependence and physical disability with the prevalence of chronic diseases in the elderly [article in Turkish]. Turkish Journal of Geriatrics, 3, 85–90 http://geriatri.dergisi.org/uploads/pdf/pdf_TJG_40.pdf
- Chalise, H. N. (2014). Depression among elderly living in Briddashram (old age home). Advances in Aging Research, 3(1), 6–11 doi:10.4236/aar.2014.31002 [CrossRef]
- Chu, W., Chang, S. F., Ho, H. Y. & Lin, H. C. (2019). The relationship between depression and frailty in community-dwelling older people: A systematic review and meta-analysis of 84,351 older adults. Journal of Nursing Scholarship, 51(5), 547–559. doi:10.1111/jnu.12501 [CrossRef] PMID:31328878
- Çiftçi, B., Yildirim, N., Sahin Altun, Ö. & Avsar, G. (2015). What level of self-care agency in mental illness? The factors affecting self-care agency and self-care agency in patients with mental illness. Archives of Psychiatric Nursing, 29, 372–376 doi:10.1016/j.apnu.2015.06.007 [CrossRef] PMID:26577549
- Elkin, N. (2016). Evaluation of life satisfaction and depression prevalence in elderly patients administered to a family health center [article in Turkish]. Mersin University Health Science Journal, 9(1), 9–21 https://dergipark.org.tr/tr/download/article-file/182816
- Erci, B., Yilmaz, D. & Budak, F. (2017). Effect of self-care ability and life satisfaction on the levels of hope in elderly people. Journal of Psychiatric Nursing, 8(2), 72–76 doi:10.14744/phd.2017.52714 [CrossRef]
- Ertan, T. & Eker, E. (2000). Reliability, validity, and factor structure of the geriatric depression scale in Turkish elderly: Are there different factor structures for different cultures?International Psychogeriatrics, 12(2), 163 doi:10.1017/s1041610200006293 [CrossRef] PMID: 10937537
- Fadiloglu, C. (2003). Chronic diseases. In Fasiloglu, C. (Ed.), Aegean days of internal medicine in chronic disease care. Meta Printing Services.
- Forget, E. L., Roos, L. L., Deber, R. B. & Walld, R. (2008). Variations in lifetime healthcare costs across a population. Healthcare Policy, 4(1), e148–e167 PMID:19377335
- Ganatra, H. A., Zafar, S. N., Qidwai, W. & Rozi, S. (2008). Prevalence and predictors of depression among an elderly population of Pakistan. Aging & Mental Health, 12(3), 349–356 doi:10.1080/13607860802121068 [CrossRef] PMID:18728948
- Gumus, A. B., Engin, E. & Ozgur, G. (2009). Evaluation of sleep pattern characteristics of the elderly without a cognitive disorder living in a nursing home. Turkish Journal of Geriatrics, 12(3), 138–146 http://geriatri.dergisi.org/uploads/pdf/pdf_TJG_432.pdf
- Hosseinzadeh, M., Mahdavi, N., Valizadeh, S., Fooladi, M. M., Rahmani, F., Ghanouni, F. & Aghajari, P. (2019). Self-care behavior and self-care agency in lowering salt consumption in hypertensive older patients based on Orem's self-care theory. Social Health and Behavior, 2(3), 89–95 doi:10.4103/SHB.SHB_7_19 [CrossRef]
- Jiang, J., Tang, Z., Meng, X. J. & Futatsuka, M. (2002). Demographic determinants for change in activities of daily living: A cohort study of the elderly people in Beijing. Journal of Epidemiology, 12, 280–286 doi:10.2188/jea.12.280 [CrossRef] PMID:12164333
- Jones, L. C., Clay, O. J., Ovalle, F., Cherrington, A. & Crowe, M. (2016). Correlates of depressive symptoms in older adults with diabetes. Journal of Diabetes Research, 2016, 1–8 doi:10.1155/2016/8702730 [CrossRef] PMID:26682235
- Jylhä, M. (2004). Old age and loneliness: Cross-sectional and longitudinal analyses in the Tampere Longitudinal Study on Aging. Canadian Journal on Aging, 23(2), 157–168 doi:10.1353/cja.2004.0023 [CrossRef] PMID:15334815
- Karagozoglu, S., Arikan, A. & Eraydin, S. (2012). The fatigue and self-care agency levels of the elderly people staying in rest homes and the relation between these two conditions. Archives of Gerontology and Geriatrics, 54(3), e322–e328 doi:10.1016/j.archger.2012.02.009 [CrossRef] PMID:22417402
- Karakurt, P., Kasimoglu, N., Bahçeli, A., Atalikoglu Baskan, S. & Agdemir, B. (2017). The effect of activities of daily living on the self-care agency of patients in a cardiovascular surgery clinic. Journal of Vascular Nursing, 35(2), 78–85 doi:10.1016/j.jvn.2016.10.004 [CrossRef] PMID:28527731
- Kearney, B. Y. & Fleischer, B. J. (1979). Development of an instrument to measure exercise of self-care agency. Research in Nursing & Health, 2(1), 25–34 doi:10.1002/nur.4770020105 [CrossRef] PMID:254279
- Keskinoglu, P., Piçakçiefe, M., Giray, H., Bilgiç, N., Uçku, R. & Tunca, Z. (2006). Depressive signs and risk factors in the elderly [article in Turkish]. Genel Tip Dergisi, 16(1), 21–26 http://www.geneltip.org/upload/sayi/47/GTD-00348.pdf
- Kleisiaris, C., Maniou, M., Papathanasiou, L., Sfiniadaki, A., Collaku, E., Koutsoumpa, C. & Sarafis, P. (2013). The prevalence of depressive symptoms in an elderly population and their relation to life situations in home care. Health Science Journal, 7(4), 417–423.
- Koç, Z. (2015). The investigation of factors that influence self-care agency and daily life activities among the elderly in the northern region of Turkey. Collegian (Royal College of Nursing, Australia), 22(3), 251–258 doi:10.1016/j.colegn.2014.01.002 [CrossRef] PMID:26552195
- Kocatas, S., Güler, G. & Güler, N. (2004). Depression widespread in 60 years old and elder adults [article in Turkish]. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, 7(1), 11–18 https://dergipark.org.tr/tr/download/article-file/29213
- Lee, Y. H. & Salman, A. (2018). The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Archives of Psychiatric Nursing, 32(3), 418–424 doi:10.1016/j.apnu.2017.12.008 [CrossRef] PMID:29784224
- Nahcivan, N. O. (2004). A Turkish language equivalence of the exercise of self-care agency scale. Western Journal of Nursing Research, 26(7), 813–824 doi:10.1177/0193945904267599 [CrossRef] PMID:15466617
- Orem, D. E. (2001). Self-care deficit theory of nursing: Concepts and applications. Mosby-Year Book, Inc.
- Parissopoulos, S. & Kotzabassaki, S. (2004). Orem's self-care theory, transactional analysis and the management of elderly rehabilitation. ICUs & Nursing Web Journal, (17), 1–11.
- Patra, P., Alikari, V., Fradelos, E. C., Sachlas, A., Kourakos, M., Gil, A. P. R., Babatsikou, F. & Zyga, S. (2017). Assessment of depression in elderly. Is perceived social support related? A nursing home study: Depression and social support in elderly. Advances in Experimental Medicine and Biology, 987, 139–150 doi:10.1007/978-3-319-57379-3_13 [CrossRef]
- Rantanen, T., Penninx, B. W. J. H., Masaki, K., Lintunen, T., Foley, D. & Guralnik, J. M. (2000). Depressed mood and body mass index as predictors of muscle strength decline in old men. Journal of the American Geriatrics Society, 48(6), 613–617 doi:10.1111/j.1532-5415.2000.tb04717.x [CrossRef] PMID:10855595
- Rokach, A. (2000). Loneliness and the life cycle. Psychological Reports, 86(2), 629–642 doi:10.2466/pr0.2000.86.2.629 [CrossRef] PMID:10840922
- Sagduyu, A. (1997). The Geriatric Depression Scale: A reliability and validity study in comparison with Hamilton Rating Scale for Depression [article in Turkish]. Journal of Turkish Psychiatry, 8(1), 3–8.
- Sendra-Gutiérrez, J. M., Asensio-Moreno, I. & Vargas-Aragón, M. L. (2017). Characteristics and factors associated with depression in the elderly in Spain from a gender perspective. Actas Españolas de Psiquiatría, 45(5), 185–200 PMID:29044444
- Sertel, M., Simsek, T. T. & Yümin, E. T. (2016). Investigation of the relationship between cognitive status, depression level, and balance in elderly [article in Turkish]. Journal of Exercise Therapy and Rehabilitation, 3, 90–95 https://dergipark.org.tr/tr/download/article-file/609831
- Substance Abuse and Mental Health Services Administration. (2011). Treatment of depression in older adults evidence-based practices (EBP) kit. https://store.samhsa.gov/product/Treatment-Depression-Older-Adults-Evidence-Based-Practices-EBP-Kit/SMA11-4631
- Sundsli, K., Söderhamn, U., Espnes, G. A. & Söderhamn, O. (2012). Ability for self-care in urban living older people in southern Norway. Journal of Multidisciplinary Healthcare, 5, 85–95 doi:10.2147/JMDH.S29388 [CrossRef] PMID:22536079
- Tanimura, C., Matsumoto, H., Yoshimura, J., Tokushima, Y., Yamamoto, Y., Fujihara, Y., Miyoshi, M. & Hagino, H. (2019). A path model analysis of the causal relationship between self-care agency and healthy behavior in community-dwelling older people from the GAINA study. Yonago Acta Medica, 62, 137–145 doi:10.33160/yam.2019.03.019 [CrossRef] PMID:30962756
- Turkey Statistical Institute. (2012). Turkey statistical institute. http://istmat.info/files/uploads/47795/turkey_in_statistics_2014.pdf
- Ünal, G. & Bilge, A. (2005). The evaluation of the loneliness, depression and cognitive function in older age group. Turkish Journal of Geriatrics, 8(2), 89–93 http://geriatri.dergisi.org/uploads/pdf/pdf_TJG_260.pdf
- United Nations. (2011). World population prospects: The 2010 revision. http://www.un.org/en/development/desa/population/publications/pdf/trends/WPP2010/WPP2010_Volume-I_Comprehensive-Tables.pdf
- Unsar, S., Dindar, I. & Kurt, S. (2015). Activities of daily living, quality of life, social support and depression levels of elderly individuals in Turkish society. The Journal of the Pakistan Medical Association, 65(6), 642–646 PMID:26060163
- Unsar, S. & Sut, N. (2010). Depression and health status in elderly hospitalized patients with chronic illness. Archives of Gerontology and Geriatrics, 50(1), 6–10 doi:10.1016/j.archger.2008.12.011 [CrossRef] PMID:19203803
- Velioglu, P. (1999).Concepts and theories in nursing. Alaş Ofset.
- World Health Organization. (2011) Global health and aging. http://www.who.int/ageing/publications/global_health.pdf
- World Health Organization. (2020). Depression. https://www.who.int/news-room/fact-sheets/detail/depression
- Yasar, M. (2007). Feminine gender depression [article in Turkish]. Firat University Journal of Social Science, 17(2), 251254279282 http://web.firat.edu.tr/sosyalbil/dergi/arsiv/cilt17/sayi2/251-282.pdf
- Yeom, H. A., Fleury, J. & Keller, C. (2008). Risk factors for mobility limitation in community-dwelling older adults: A social ecological perspective. Geriatric Nursing, 29(2), 133–140 doi:10.1016/j.gerinurse.2007.07.002 [CrossRef] PMID:18394514
- Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49 doi:10.1016/0022-3956(82)90033-4 [CrossRef] PMID:7183759
- Yildirim, A., Asilar, R. H., Bakar, N. & Demir, N. (2013). Effect of anxiety and depression on self-care agency and quality of life in hospitalized patients with chronic obstructive pulmonary disease: A questionnaire survey. International Journal of Nursing Practice, 19, 14–22 doi:10.1111/ijn.12031 [CrossRef] PMID:23432884
Comparison of Geriatric Depression Scale and Exercise of Self-Care Agency Scale Mean Scores by Participant Characteristics (N = 473)
|Characteristic||n (%)||Mean (SD) (Range)|
|Geriatric Depression Scale||Self-Care Agency Scale|
|Age (years) (mean = 68.92; SD = 7.81)|
| 65 to 74||365 (77.2)||18.47 (13.5) (2 to 53)||92.82 (22.29) (18 to 141)|
| 75 to 84||95 (20.1)||17.56 (11.6) (2 to 49)||91.73 (36.87) (41 to 382)|
| ≥85||13 (2.7)||21.76 (16.11) (5 to 44)||77.61 (22.65) (27 to 119)|
| Kruskal Wallis||0.26||7.357|
| Female||247 (52.2)||20.77 (14.13) (2 to 53)||90.98 (29.37) (27 to 382)|
| Male||226 (47.8)||15.77 (11.59) (2 to 50)||93.49 (21.58) (18 to 134)|
| Married||323 (68.3)||17.51 (13.27) (2 to 53)||95.1 (21.03) (18 to 141)|
| Single||150 (31.7)||20.26 (12.9) (2 to 50)||85.9 (33.44) (40 to 382)|
| Literate||140 (29.6)||23.5 (15.52) (2 to 53)||87.44 (32.58) (40 to 382)|
| Illiterate||70 (14.8)||16.24 (6.09) (2 to 32)||82.18 (23.68) (18 to 125)|
| Primary school||148 (31.3)||18.84 (13.37) (2 to 50)||94.79 (19.85) (41 to 141)|
| Secondary school||83 (17.5)||12.65 (9.26) (2 to 50)||98.77 (22.57) (44 to 133)|
| High school||32 (6.8)||13.43 (13.2) (2 to 51)||105.65 (19.06) (67 to 134)|
| Good||127 (26.8)||13.89 (11.69) (2 to 51)||100.62 (22.26) (46 to 141)|
| Moderate||271 (57.3)||19.91 (13.44) (2 to 52)||90.59 (27.45) (18 to 382)|
| Poor||75 (15.9)||20.45 (13.15) (3 to 53)||83.64 (22.25) (40 to 130)|
| Yes||339 (71.7)||19.22 (13.5) (2 to 52)||90.73 (27.36) (18 to 382)|
| No||134 (28.3)||16.26 (12.21) (2 to 53)||95.85 (21.64) (41 to 141)|
|With whom they live|
| Spouse||179 (37.8)||16.39 (12.95) (2 to 52)||96.44 (19.76) (44 to 141)|
| Spouse and children||137 (29)||17.97 (13.55) (2 to 53)||94.04 (21.94) (18 to 138)|
| Children||110 (23.3)||20.45 (12.98) (2 to 50)||84.9 (35.75) (27 to 382)|
| Alone||47 (9.9)||22.31 (12.47) (7 to 49)||87.61 (26.74) (40 to 130)|
Linear Regression Analyses of Self-Care Agency and Depression in Participants
|Unstandardized Coefficients||Standardized Coefficients||Unstandardized Coefficients||Standardized Coefficients|