J Univer Surg. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem with depression among them.
Methods: A face to face in-depth interview was conducted with a year-old female living in the nursing room. Her perceptions for life were explored through a questionnaire. Findings of case study: It was observed that old lady was unable to express herself and was reluctant in sharing her views with interviewer.
According to her, she was introverted and was unable to interact socially with other people because of physical disability. She used to feel unworthy and always used to think that she cannot do anything and was not encouraged by her colleagues and always been criticized by others. She was found to be depressed and had no meaning to life. Conclusion: It can be concluded that depression is one of the common problems among geriatric population, attributed to low self-esteem. Based on the personal observation during the interview, it is recommended that such clients should be encouraged, educated and counseled appropriately to enhance their trust and confidence.
There should be some mechanism by which a space can be provided to them to interact with people outside their limited circle and to share their problems with their colleagues and relatives if possible. This may enhance their self-esteem and may decrease the chances of depression among elderly. Self-esteem can be defined as how we value our selves and it affects our trust and relationship in every part of our daily life [ 1 ]. In contrast, low self-esteem refers to a reflection of central negative views about self and it is important not only for adults but also for children and elderly people [ 2 ].
Looking at the population pyramids of various countries, it can be observed that elderly population is growing persistently either due to increased life expectancy or due to advancements in science and technology [ 3 , 4 ]. These demographic and scientific changes have increased the needs of old population which may lead to undesirable consequences if not fulfilled appropriately.
Such consequences might include poor quality of life and lower selfesteem, which in result may lead to anxiety and depression [ 5 ]. Low self-esteem may predict the depression later in the life of an individual particular in the older age [ 2 ]. Individuals with low self-esteem are more sensitive to denial and have a tendency to withdraw and reduce interpersonal closeness after conflicts, thereby declining attachment, support, and satisfaction in close relationships [ 14 ].
Moreover, low self-esteem is considered as a risk factor for depression, which is most common disorder among elderly population both in developed and developing countries [ 14 ], causing multiple behavioral changes [ 15 , 16 ], which may increase the chances of suicide and mortality among the elderly people [ 17 ]. It is estimated that about million people worldwide are affected with depression at any moment in time, and one in every five women and one in every eight men experience an episode of major depression over the course of their life [ 18 , 19 ].
Models and theories, relating self-esteem and depression Different models have been stated in the literature, which relate the self-esteem with depression. These include vulnerability model, which states that low self-esteem is a causal risk factor for depression. On the other hand, reciprocal relational model states that self-esteem and depression are reciprocally related to each other, while diathesis-stress model states that low self-esteem is a predisposing factor that exerts causal influence only if the person simultaneously experiences life stress [ 20 ].
In the face of challenging life circumstances, people with low self-esteem may have fewer coping resources and may prone to spiraling downward depression [ 20 ]. Apart from this, low selfesteem may contribute to depressive symptoms through several interpersonal and intra personal pathways. One interpersonal pathway is that few individuals with low self-esteem individuals excessively seek reassurance about their personal worth from friends and relationship partners, increasing the risk of being rejected by their support partners and thus increasing the risk of depression.
A second interpersonal pathway is that low selfesteem motivates social avoidance, thereby delaying social reinforcement and social support, which has been linked to depression [ 14 ]. Improving self-esteem and letting old aged people to perform optimally may lead to early recovery and sense of wellbeing [ 21 ]. It is essential that along with providing treatment, support and help in the physical aspect of health and attention should also be paid to the psychological needs of the elderly people [ 22 ].
It is highly important to build up the confidence and trust of the elderly people, as we experienced with our client too. During initial conversation, we found our client bit hesitant in talking and sharing her views openly. When we personally provided a space and opportunity to our client, she was able to talk and shared her views and problems with us comfortably.
Case Study A face to face in-depth interview was conducted with a yearold lady living in one of the nursing homes of Karachi, Pakistan. Through that interview, her perceptions for life were explored through a questionnaire. After retirement, she raised a therapy dog and visited nursing homes and hospitals. The biggest blow to her self-esteem was that she now was the patient who relied on others for care, which was an extremely difficult reality for her to face.
Maria reported experiencing worsening urinary frequency and occasional urinary incontinence starting approximately 10 years ago, altering her quality of life. Over the years she increasingly focused on this physical symptom, while her social and professional life suffered, and she withdrew from many activities.
While in rehabilitation, Maria interacted with staff and residents, used humor in most social environments, asserted ideas of hope and recovery, and stayed in contact with friends and family members in the community. However, as time progressed she appeared to be more withdrawn, similar to her life pattern prior to her CVA. She isolated in her room between rehabilitation sessions, rarely spoke with other residents, and presented with increased anxiety and depression.
She used her call light at least every hour to request to go to the restroom. She often focused her attention on physical symptoms that could be related to a UTI. Even after results from multiple urinalyses were negative for an infection, she continued to question the accuracy of the results. Once we began talking about her urinary incontinence, common underlying themes were observed in session. She experienced sadness regarding the loss of independence and control in her life.
Maria felt as if she were not heard by staff. She acknowledged a decreased desire to interact with other residents and family. She expressed feelings of hopelessness and helplessness, and she displayed a poor self-image. Because she had developed good insight and empathy for others through her professional training and life experiences, she was able to pick up on negative non-verbal cues from the staff members, such as poor eye contact, quick and abrupt body movements, sighs and groans, and rapid speech.
She interpreted these cues as an act of not caring. Maria often felt abandoned. As a result of the culminating stress, her concerns about her urinary incontinence and requests for help continued to increase.As far as possible, elderly who are capable, should be encouraged, and if necessary, supported to be engaged in some economically productive manner. Ultimately, she was able to connect with her inner strengths and emotional capabilities because of psychological intervention and training of staff. Based on the personal observation during the interview, it is recommended that such clients should be encouraged, educated and counseled appropriately to enhance their trust and confidence. The interviewer performed exercise by gathering the residents in the group, which was found to be very helpful for both the client and peers. She has specialized training in pain management, geriatric psychology, and health psychology. Maria often felt abandoned.
She used to feel unworthy and always used to think that she cannot do anything and was not encouraged by her colleagues and always been criticized by others. Thus, it is highly important to identify these causes at early stage to avoid the long term consequences among elderly.
Activities centered on older persons that involve their time and skills help to inculcate a feeling of inclusion. Government and non-government agencies need to take this issue up seriously at all these levels. It is important that the elderly feel included in the goings-on around them, both in the family as well as in society. She was found to be depressed and had no meaning to life. During interview, it was found that she was unmarried and she belonged to a middle class and had been living in a nursing home for couple of years.
Conclusion: It can be concluded that depression is one of the common problems among geriatric population, attributed to low self-esteem.
Cognitive emotion regulation strategies of refocus on planning, positive reassessment, and less rumination contribute to resilience in patients with depression and anxiety disorders. Such an approach might extend the focus of prevention and stimulate collaborations among different subfields of prevention of depression [ 26 ].
Listen to each concern empathetically and find a solution to her concern if at all possible. Different positive ways can be taught not only to clients but also to care givers to ensure that self-esteem of the elderly people can be increased [ 25 ].
Health services should address preventive measures keeping in mind the diseases that affect — or are likely to affect — the communities in a particular geographical region. Different positive ways can be taught not only to clients but also to care givers to ensure that self-esteem of the elderly people can be increased [ 25 ]. Within a couple of weeks, Maria noticed a change in her care and her overall self-image.