Introduction and Study Question
Mental health is a crucial determining factor of an individual’s overall state of well-being. Among the aged, experiences, philosophical differences, independence and dependency are some of the key concepts that influence their mental health and well-being. Integration of mental health care services in primary health provision with a focus put on achieving optimal medication management in health and medicine is vital in ensuring that the aged enjoy all aspects of wellness (Larsen et al., 2011). This will in turn ensure that the aged achieve psychological resilience, spiritual, intellectual, emotional and physical wellness. As this research proposal will bring to light, many factors in a community determine the mental health and wellness of the aged. Circumstances and environmental factors such as where they live, their income, education level, relationships with family and friends, and the state of the environment determine to a large extent their mental health and wellness. It is vital to reiterate that emotional wellness is an important aspect of wellness since it assists an individual to know how to deal with challenging emotional situations, express oneself in a healthy manner, manage individual self-esteem, anger issues and emotional IQ. This may be attained by balancing life’s activities with abilities possessed by an individual. Additionally, the mental well-being of an individual may also be described as a state of enhanced mental health with no diagnosable mental health problem (Zivin, Paczkowski & Galea, 2011). On the same note, mental wellness among the aged is largely influenced and affected by biological factors as well as the nature of immediate social and environmental determinants. This research proposal will examine the aspects of wellness with regards to the dimensions of mental health and among the aged.
Review of Literature
Aspects of wellness and mental health
Mental health, commonly described as the absence of mental-related complications, is a state of well-being whereby an individual can be able to fruitfully and productively perform duties, cope with issues of stress and make a significant contribution to a community. Many aged people display feelings of anxiety and depressive symptoms related to mental illness. As such, this impacts their enjoyment of quality of life with spiritual, social, physical and emotional wellness. In mental health, the focus is normally put on achieving psychological resilience. This may be attained through balancing life’s activities with the abilities that an individual has. Research studies indicate that the aspects of wellness and mental health among the aged can be realized when they are put in emotionally enriched environments, have optimistic attitudes such as faith, creativity and humor, get adequate sleep and rest, good nutrition and proper physical activity. It is imperative to note that the mental wellbeing of an individual is a state of enhanced mental health with no diagnosable mental health problem. This, therefore, relates mental wellbeing to the aspects of wellness that include spiritual, intellectual, emotional and physical wellness.
There are many factors in a community that determines the mental health of the aged. Circumstances and environmental factors such as where they live, their income, education level, relationships with family and friends, and the state of the environment determine to a large extent their mental health. This clearly indicates that, a person’s health is determined by the context of his or her life. Therefore, it would be inappropriate to give credit for good health or to blame an individual for poor health. This means that the determinants of health are unlikely to be in direct control of an individual. Some of the main determinants of mental health discussed here in relation to the aged include social, biological and environmental factors.
Social factors
These may be triggered by both social and economic factors that the aged live in. This can also become determining factor of their health. Social determinants such as low economic status, stress, traumatic events and losses are primary in determining whether communities, individuals or jurisdictions as a whole become ill or remain healthy spiritually, socially, physically and emotionally (Zivin, Paczkowski & Galea, 2011). In addition, social determinants are important in determining personal, physical and social resources possessed by an individual that would be used to achieve personal goals, cope with the environment and meet personal needs. Therefore, health experts have realized that alongside improving prognosis and prolonging survival from some deadly illnesses among the aged, it is more important to first tackle social and economic conditions that make them sick (Larsen et al., 2011).
Secondly, the health status of the aged community is determined by behavioral choices that they make at the individual level. The determinants leading to a particular behavior are considered in two mechanisms namely materialist mechanisms and cultural or behavioral mechanisms (Zivin, Paczkowski & Galea, 2011). The behavioral choices among the aged such as the use of alcohol and tobacco, poor health activities, diet and so on are observed to be causes of illnesses that may lead to death. It is important to note that material conditions of life strongly structure the behavioral choices of an individual. These behavioral risks, consistent with mounting evidence, account for incidences of deterioration of mental health. An individual’s material condition can be seen as good working conditions, availability of housing and food, availability of resources to access the amenities life provides among others. The quality development of family life, community environment and interaction health is influenced by material conditions of life. Also, it may lead to differences in physical, developmental, social and educational problems. As individuals grow old, their mental health deteriorates since most of them tend to lose social support that is necessary for spiritual, social, physical and emotional wellness.
Thirdly, the psychosocial comparison is another social determinant that shapes health. The mental health, spiritual, social, physical and emotional wellness of individuals get affected the instance they begin to lose the support that other age groups are getting. This lack of support and neglect produces a variety of negative and positive effects and exposures in the lives of the aged that may have health outcomes. For instance, the older individuals who may find themselves in unequal societies where their material needs and health care cannot match with the others may have psychological health effects as the individuals may feel neglected or worthless and adopt health-threatening copying behaviors or additional actions that threaten health in order to alleviate the feeling.
Furthermore, unequal distribution of health resources in a community or in a nation to cater for the aged socially determines their health status. Areas, where hospital care resources have been equally distributed, have many aged individuals with mental wellness and hence narrower exposure to social determinants of health compared to areas where there are fewer health care facilities. Poor health conditions arise from such unequal jurisdictions (Zivin, Paczkowski & Galea, 2011). Therefore, there is a need for the government to put up in all areas public infrastructure such as health and social services, education, health insurance and support the aged. It is important to note that societal factors like the distribution of resources are determinants of health.
Biological factors
Biological factors influencing well-being and mental health among the aged and other groups include family history, illnesses, medications, and changes in the central nervous system. Biological factors and determinants of health and spiritual, social, physical and emotional wellness can be put into two groups. These are the exogenous and endogenous biological determinants of health (Larsen et al., 2011). These microorganisms form a relationship with humans. This relationship can either be symbiotic or commensal. Endogenous biological determinants of mental health include immunity and genetic heritage. The latter is determined exposure and response to physical and biological challenges of the environment (Larsen et al., 2011). These exposures may cause conditions like allergies, certain kinds of cancer and errors of metabolism. In addition, they may influence red blood cell abnormalities to suck as a sickle-cell trait, influence DNA composition and skin pigmentation. Both endogenous and exogenous factors are vital for the mental wellness of an individual.
In addition, immunity plays an important role biological role in determining the mental health and wellness of an individual (Zivin, Paczkowski & Galea, 2011). It is important to note that nutritional status, as well as immunological defenses, determines to a great degree the state of health of a person. Without proper nutrition, individuals become susceptible to invasion by pathogenic microorganisms. Such individuals are in many cases poorly nourished, deprived of vitamins and starved of proteins. Their bodies lack the ability to develop mechanisms of effective immune defense against pathogens.
Environmental factors
Any external agent such as cultural, social, physical, chemical or biological agents would be considered an environmental health determinant if it causes a change in the health status and spiritual, social, physical or emotional wellness of a person. However, it is important to note that these agents are environmental influences and are involuntary (Larsen et al., 2011). For example, smoking of tobacco by a second party is considered to be equally the same as polluting the environment since the effects are almost the same. The health outcomes due to the determinants of mental health clearly determine the scope of health promotion, methods and forms to be used. This is done primarily to equip the aged with abilities that will assist them to gain control over determinants of health. Therefore, mental health promotion combines environmental and educational support for conditions and actions of living among the aged, which is conducive to health (Larsen et al., 2011). The aspects that health promotion touches include personal control of behavior and change in complex lifestyle issues that affect other people’s spiritual, social, physical and emotional wellness like public smoking (Zivin, Paczkowski & Galea, 2011). The government, corporations, groups and individuals are required to take very coercive and aggressive measures to regulate their behavior and actions that may influence the health of other people.
Testable Hypotheses
Based on the literature review, this study proposal hypothesizes that:
- Social, biological and environmental determinants of health play a significant role in mental wellness among the aged
- The aspects of wellness such as spiritual, occupational, social, environmental, physical, intellectual and emotional wellness are chief components that determine the mental health of older persons.
- Lack of aspects of wellness is a cause of mental health.
- In many hospitals, the aged diagnosed with serious anxiety and depression bear these symptoms due to a lack of aspects of wellness.
Study design and timeline
The study will take a period of 6 months. The table below indicates the processes that the study will follow.
The information that will be used for this research will be gathered from primary and secondary sources. Secondary data will be obtained using two broad methods. This will include quantitative and qualitative studies. The former will comprise various databases which will contain information on the aspects of wellbeing in relation to mental health among the aged. Some of the resource materials for quantitative analysis of this research study will include published books, peer-reviewed journals, newspapers, magazines and credible websites.
Primary data will be collected from focus groups which will include clinical staff, mental health coordinators, and the aged patients with mental health problems through the use of questionnaires, individual in-depth interviews, group interviews, laboratory tests, routine physical examinations and gathering information from the medical history of the individual participants. This will be necessary in order to establish the medical background of each of the respondents. The information gathered will form a better part of primary data and will be used for qualitative analysis.
The conditions and demographics of patients and caregivers will be obtained by researchers who will conduct focus group discussions. The questionnaires and interviews will help get responses from questions that will be asked like “What do you think can be done to improve the mental well-being of a person?” Additionally, exploratory questions like “What should be done to ensure that the aged enjoy the aspects of wellness in order to overcome mental health problems?” Follow-up questions will be asked after saturation has been reached such as “How can mental health care and treatment be improved in clinics?” data analysis will be done from the transcriptions from the interviews. Content analysis on emerging issues from a set of data collected from mental health coordinators, doctors, nurses, caregivers and patients will be carried out at an individual level and then in groups. (See appendix one for sample questions)
Sampling plan
In carrying out this research, a cross-sectional qualitative study design and quantitative method will be used. The quantitative study this research study will focus on up to 450 aged people, 16 health centers and 2 clinics. The mental health patients that will be included in this research will be those suffering from acute, common mental problems such as adjustment disorders and acute anxiety and those with chronic major psychiatric conditions like dementia, bipolar disorder and schizophrenia. The age group selected for interviews will be between the ages of 50-80 years. The research study has found the age 50-80 convenient since most individuals at these ages are susceptible to being neglected and as such lack the necessary aspects of wellness. The interview will not be gender biased at all. The 450 aged people, 16 health centers and 2 clinics will be searched for via websites, through friends, neighbors and through other credible primary and secondary sources until a long list of names is obtained.
There are some groups that will be excluded from this research. Those will include the aged with a primary diagnosis of mental retardation, those with common problems like sexual difficulties, HIV and spouse abuse issues. Additionally, those with mental health problems but without a concomitant psychiatric diagnosis will be excluded. Such individuals will include those with epilepsy, as this is not a mental health problem.
Data analysis Strategy
During the study, content analysis will be used to assess gathered information and reports from the data collected. It is imperative to note that for easy evaluation of themes from recorded information collected from primary sources, content analysis will be the preferred method that will be used. The researcher will systematically evaluate collected data, and put into smaller categories a large number of words for quick synthesis. Even though the research study will seek to gain information from other medical practitioners, the focus of the study will be on the aged. The age to be researched on will be identified first, their health problem and aspect of wellness. Then their levels of performance, activities and sustainability will be determined.
In conducting content analysis, CRA methodology will be applied. This is a system that uses Crawdad, a specifically developed analytical software package, to analyze reports gathered from quantitative data, interpret and determine meanings of words and phrases. It achieves this through the representation of concepts, checking the position of words and building upon inference based on network theory and a combination of linguistics. The study will use CRA methodology as it is important for analyzing and giving meaning to data that will be gathered from primary sources that have phrases or words through bringing out their inter-relationships, their influence, and main concepts. Individual depth interviews will be conducted when gathering data using the quantitative method. In-depth interviews will be important for this research study since the respondents will provide detailed information and answers to interview questions.
Opportunities/significance of the research study
This research study is will be important in health and medicine for purposes of understanding that health, both mental and physical, is affected by cultural, social, emotional, and mental factors. Gaining recognition of this knowledge will be imperative for making progress in giving individual health an overall approach. It is a fact that most doctors give little notice to the need to integrate the aspects of wellness when dealing with mental issues among the aged. Some exclusively deal with the body while others with the mind. This study will call for health and medicine practitioners to give mental health issues a holistic look and understand it broadly within the concepts of the aspects of well-being, mental health and illness. This will help correct the problems coming from providers and patients who are dissatisfied and lack compliance, as well as other problems related to misdiagnoses and miscommunication.
Additionally, the study will create an understanding that aspects of well-being and mental health are inseparable. In this sense, medical practitioners will be armed with the knowledge that will ensure that diagnosing and describing symptoms of mental health is done properly and in a way compatible with the biomedical model. Moreover, the concepts surrounding aspects of wellness and mental health explored in this research study will aid health caregivers in distinguishing physical states from mental states.
Furthermore, it will aim at ensuring that people, other than making healthy choices, take mental wellness as their own personal concern. This calls for the intervention of all sectors across the health department, economy and the nation such as education, welfare, justice, housing, community and families among others to provide support towards effective and urgent action to realize the goal of having a mentally healthy nation. This will happen when all the mentioned sectors and people will offer support in all ways. For instance, the support can be social whereby the communities and other sectors will network to enhance mental health promotion. In order to achieve this, the support needs to be equitable, reciprocal and comprehensive by showing empathy assurances, advice, material support, respect and a sense of belonging. Upon achieving this, both the poor and rich in their respective circumstances will largely benefit from wellness due to good mental health. In making wellness and mental health everyone’s business, the research will call for personal empowerment of each individual in order to enhance the perception of control and power and be able to fully develop health-wise.
Moreover, it will call for the formation of small groups to provide support for lifestyle choices to help promote personal behavior change and improve social support. The research will also call for political action. This is by practicing democracy in participation in matters of health, supporting broad-based social movements, and creating a vision of a better, manageable, preferred future. Future research studies should advocate for public policies that target healthy living alongside promoting collaborations and proper conflict resolutions in order to achieve consensus. Moreover, the study should seek to develop local actions attached to community levels, lower conflicts to manageable levels and have critical professional and community dialogue.
Besides, in mental wellness, it is pertinent to note that currently, there are quite a number of factors that if not properly handled would continue acting as weak points and a hindrance to achieving the. These issues range from psychological factors to morbidity and mortality. For instance, there are a number of individuals who are living in isolation, they are so poor, and have low self-esteem. Some lack social support, work in a dangerous polluted environments and have low economic power.
Study limitations
The potential limitation to this study may occur in obtaining primary data from patients with mental problems who may not be successfully interviewed. Another limitation is that most of the findings of this study will be based on interviews as the primary source of information. Indeed, there will be the inevitable challenges of inability by patients to fill questionnaires.
Conclusions
To sum up, the mental wellness of the aged population is significant. This research intends to indicate the importance of accomplishing mental wellness by improving social status, social gradient and ways of acquiring income by any given population. In addition, the ability to offer food security, access to health services, education on health issues, better and safe working conditions among other things have been identified as some of the important parameters in ensuring healthy mental well-being. Furthermore, it calls for a strategy to be devised in setting viable healthcare infrastructure, interventions, preventions, detecting, screening, treating and managing mental health issues. Therefore, it is imperative to understand that the aforementioned factors are important for the well-being of an individual. Hence, all societal influences on mental health should be managed well. The deleterious consequence of societal influences on mental health would in fact be mental illness. Therefore, there is a need for individuals to be empowered. This empowerment can be at personal, small group, organizational level or even entire community as part and parcel of building capacity, gaining and utilizing resources in order to enhance control over health determinants.
References
Larsen, T. et al. (2011). Early detection of psychosis: positive effects on the 5-year outcome. Psychological Medicine, 41(7), 1461-1469.
Zivin, K., Paczkowski, M. & Galea, S. (2011). Economic downturns and population mental health: research findings, gaps, challenges and priorities. Psychological Medicine, 41(7), 1343-1348
Appendix
Interview questions
- How can the roles of social, biological and environmental determinants of health in mental well-being be improved to ensure that issues of anxiety and depression among other mental health problems among the aged are reduced?
- What can be done to provide the aspects of wellness such as spiritual, occupational, social, environmental, physical, intellectual and emotional wellness to the aged to enable them to have better mental health?
- What are some of the barriers to mental health and wellness?
- Why would doctors and nurses underreport the seriousness of anxiety and depression symptoms in patients?