A Cross-Sectional Study to Assess the Prevalence and Determinants of Depression among Elderly in selected Old Age Homes of Pathanamthitta District

Aleena Maria Bino, Alen M Jose, Aliya Alikhan, Ann Susan Abraham, Elka Elizabeth Chacko, Fasna A Latheef, Fida Shermin S, Laya Cherian, Maria Mathew, Reeja Annie Zachariah, Soumyamol Jacob

Believers College of Nursing, Kuttapuzha, Thiruvalla, Pathanamthitta, Kerala, India.

*Corresponding Author E-mail: aleenamariabino1@gmail.com

ABSTRACT:

Depression is a significant psychological health concern among elderly population and can adversely affect their physical, emotional, and social wellbeing. This descriptive cross- sectional investigation was carried out to assess the occurrence and associated factors of depression among elderly residents of selected old-age homes in Pathanamthitta district, Kerala. A total of 198 older adults aged 60 years and above were recruited through a non-probability convenience sampling method. Information was gathered using a structured socio-demographic survey tool and the PHQ-9 Patient Health Questionnaire. The findings revealed that 54% of the respondents exhibited varying levels of depressive symptoms while 46% had no or minimal depressive symptoms. Among the individuals identified with depression, 29.79% had mild depression, 13.63%nhad moderate depression, 9.09% had moderately severe depression and 1.51% had severe depression. Statistically significant relationships were observed between depression and certain variables such as gender, satisfaction with living conditions, duration of leisure time activities, presence of medical problems, family history of mental illness, smoking and alcohol consumption(p<0.05). The findings suggest that depression is widely prevalent among older adults living in institutional care settings and is influenced by multiple socio-demographic, psychosocial and health-related determinants. The study highlights the importance of regular mental health assessment, early detection of depressive symptoms and implementation of supportive interventions to enhance the psychological wellbeing and quality of life of elderly residents.

KEYWORDS: Depression, Elderly, Prevalence, Determinants, Old Age Homes, Geriatric Mental Health, PHQ-9, Institutionalized Elderly, Pathanamthitta district.

INTRODUCTION:

Ageing is a universal and inevitable process characterized by gradual physical, psychosocial and social changes over time.¹ Depression in old age is associated with prolonged feelings of sadness, reduced interest in routine activities, tiredness, disturbances in sleep and impaired cognitive functioning, which negatively affect functional ability and independence.²

The World Health Organization reports that nearly 14% of individuals belonging to the age group of 60 years and older suffer from a psychological disorder, with depressive disorder being one of the major contributors to disability among older adults. Globally, approximately 5% of older adults experience depression, although the actual prevalence may be higher due to under diagnosed and under reporting.³ Based on the comprehensive review and meta- analytic study conducted by Mayank and Khamb (2025) using data from 9,050 elderly participants across India, the combined prevalence of depressive disorder in older adults was determined at 32.9%.⁴ The burden of geriatric depressive disorders in India is increasing due to demographic transition, urbanization and changing family structure.⁵

A cross- sectional community survey carried out by Lissy Remesan Manju and colleagues in Thiruvananthapuram district, Kerala, aimed to assess the occurrence and factors related to depressive symptoms among elderly women. The findings of the study revealed that 35.8% of the participants had moderately severe or severe depression. The study also identified several factors significantly associated with higher depression levels, including urban residence, unmarried status, presence of chronic morbidity, and sleep disturbances.⁶

Institutionalized elderly individuals, particularly those living in old-age homes, are more vulnerable to depression due to factors such as loneliness, loss of spouse, social isolation, lack of family support and chronic health conditions.⁷The state of Kerala has one of the highest proportions of elderly population in India due to low fertility rates, higher life expectancy and migration of younger adults to other regions and countries. Elderly residents in old age homes often experience emotional deprivation, limited family interaction and increased dependency, making them highly susceptible to depression. Therefore, assessing the occurrence and associated factors of depression among elderly residents of old-age homes is essential for effective mental health planning and intervention.¹

Depression is a prevalent mental health disorder characterised by prolonged sadness, reduced interest or enjoyment of activities, decreased energy levels, feelings of guilt or poor self- esteem, alterations in sleep or appetite, and reduced concentration.⁸ The population of individuals aged 60 years and above is increasing rapidly, particularly in India. As the world 2^nd- largest populated country, India has around 76.6 million individuals aged 60 years and above, accounting for more than 7.7% of the total population. Globally, depression affects nearly 120 million people, and close to 1 million individuals die by suicide each year. The condition is report more frequently among females than males, with an estimated female – to – male proportion of 2:1, and its highest prevalence is observed during middle age.⁹ Older adults are especially susceptible to depression and feeling of hopelessness because of factors such as neglect, mistreatment, exploitation, abandonment, separation from loved ones, solitary living, and inadequate support resulting from weakened family and social relationships. Over the next five decades, the global elderly population is expected to increase almost fourfold, rising from nearly 600 million to approximately 2 billion older adults.¹⁰ Changes associated with ageing are a natural part of the life process and occur progressively as individuals grow older. As number of elderly increases, their problems also would increase and contribute to a total health care burden. In spite of various welfare measures, by government, problems of elderly in particular abuse is still at its peak. This necessitates the need to validate most prevalent problems of elderly and adaptive measure adopted by them.¹¹ Depression is a significant contributor to global disease burden and impacts individuals across all societies and populations globally.¹²A good quality of life can be achieved when individuals are able to maintain the functional abilities necessary for carrying out their routine daily activities effectievely.¹³By now, it is evident that the depression has a major impact upon the society, family and individual disability and at the same time it poses significant burden upon the strata of the society.¹⁴ Certain groups of individuals are more susceptible to developing hyponatremia, including patients admitted to intensive care units, post-operative patients, psychiatric patients, older adults and residents of nursing homes.¹⁵The health and socio-economic challenges that are being faced by the elderly population are many. They are vulnerable to physical, mental and social problems.¹⁶ Depression is more commonlyobserved among older adults with physical illnesses, such as heart disease, compared to those who are in good physical health.¹⁷

MATERIALS AND METHODS:

This study employed a descriptive research approach and was undertaken in chosen elderly care homes in Pathanamthitta district involving older adults aged 60 years and above. Overall 198 individuals were selected using a non-random convenience- based sampling technique. Following a pilot study with 15 samples, data were collected through a semi-structured interview using the Patient Health Questionnaire (PHQ). The data were analysed using both summarizing and analytical statistical methods, and the results possess implications for nurse education, health care research, clinical administration, and health care service. Elderly residents were recruited from chosen residential care facilities located in Pathanamthitta district. Respondents were subsequently enrolled using a non-random convenience sampling method. A sample of 198 older adult individuals who were 60 years of age and above were enrolled for the investigation to determine the occurrence and determinants of depression in older adult residents of chosen residential care.

INCLUSION CRITERIA:

· Elderly individuals aged 60 years and above residing in the selected elderly care institutions of Pathanamthitta district.

· Elderly individuals who were available during the period of data collection.

· Elderly individuals who voluntarily agreed to take part in the research.

EXCLUSION CRITERIA:

· Elderly individuals who had been previously diagnosed with depression.

· Elderly participants who were receiving medication for depression

Tool 1: Sociodemographic Data:

Socio demographic data for collecting background information consist of variables such as Age category, Sex, Education, Marital condition, Means of income, Length of residence in the old-age home, Current living arrangement, Regularity of visits from relatives, Frequency of contact with relatives through phone, Emotional support from family, Satisfaction with living conditions, Relationship with other residents, Availability of recreational activities, Duration of leisure-time activities, Presence of medical problems, Presence of diagnosed mental health conditions, Family history of mental illness, Experience of stressful life events during the past six months, History of alcohol consumption and smoking.

Tool 2: Patient Health Questionnaire-9:

The instrument was utilised to determine the occurrence and associated factors of depression among older individuals. It consists of 9 questions, each item has four options. Option a, b, c, d scores ranging from 0 to 3, respectively. The highest possible score for the PHQ- 9 assessment tool is 27 and interpretations are as follows. Scores ranging from 0-4 indicated minimal or no depressive symptoms, while scores between 5 and 9 reflected mild depressive symptoms. A score of 10-14 suggested moderate depressive symptoms, whereas scores from 15-19 represented moderately severe depression. Participants scoring between 20 and 27 were categorised as having severe depressive symptoms.

Reliability of the Tool:

The reliability of PHQ- 9 instrument was determined through split- half technique, and the obtained reliability coefficient was 0.86.

RESULT:

Among the 198 elderly participants, the majority 66 (33.33%) were aged above 75 years. Females constituted the majority of the study population, accounting for 160 (80.8%). Nearly half of the participants, 96(48.48%), had primary education. Most participants were married (35.85%), and 115(58%) had no source of income. The majority, 92(46.46%), had been residing in the old-age home for 1–5 years and 164(82.8%) were living with roommates. A considerable proportion of the elderly was never visited by relatives (34.8%) and had no contact with relatives through phone (53.5%). More than half (56%) did not receive emotional support from their families. However, the majority expressed satisfaction with the residential environment of the old-age homes (90.4%), maintained good relationships with other residents (87.4%), and participated in recreational activities (97.4%). Most participants (74.2%) reported having medical problems.

Assessment of depression revealed that 91(46%) had none-minimal depression, while 107(54%) experienced some level of depression. Among those with depression, 59(29.79%) had mild depression, 27(13.63%) had moderate depression, 18(9.09%) had moderately severe depressive symptoms, and 3(1.51%) had severe depressive symptoms. Significant associations were found between depression and gender, satisfaction with living conditions, duration of leisure-time activities, mental health disorders among family members, past alcohol intake, and smoking behavior (p<0.05).

Objective 1: To determine the occurrence of depression among older adults.

Figure 1: Showing percentage distribution among elderly according to prevalence of depression. (n= 198)

Figure reveals that out of 198 elderly 91 (46%) had no depression whereas 107 (54%) had depression.

Objective 2: To determine the severity of depression among older adults.

Figure 2: Showing percentage distribution of level of depression among elderly.

Figure reveals that out of 198 elderly 91(46%) has none-minimal depression, 59(29.79%) has mild depression, 27(13.63%) has moderate depression, 18(9.09%) has moderately severe depression, 3(1.51%) has severe depression.

Objective 3: To determine the relationship between depression and selected socio- demographic factors.

Table 1: Association of depression with selected socio- demographic factors.

Table

Chi- square

p value

Remark

Variables

None- minimal

Mild

Moderate

Moderately severe

Severe

Gender

Male

Female

19.583

6.034

Significant

Satisfaction with living condition of old age home

Yes

10.495

0.0329

Significant

Duration

of leisure time activity

15-30 min

31-60 min

>60 min

20.976

0.0072

Significant

Family history of mental illness

Yes

44.351

5.4242

Significant

History of alcoholism

Yes

16.677

0.0022

Significant

History of smoking

Yes

15.457

0.0038

Significant

DISCUSSION:

Objective 1: To determine the occurrence of depression among older adults.

The study revealed that 54% among older adults experienced depressive symptoms, while 46% had no or minimal depression, indicating a high burden of depressive symptoms in institutionalized elderly. Mild depression was the most common, followed by moderate and severe forms. Compared to a study by Lunan Gao et al. (2021), which reported a lower prevalence (27%), the present study shows a higher burden, possibly due to psychosocial factors such as limited family interaction and lack of emotional support.¹⁸

Objective 2: To determine the severity of depression among older adults.

Among those affected, 29.79% had mild depression, 13.63% moderate, 9.09% moderately severe, and 1.51% severe depression. These findings show that most elderly experience mild to moderate depression, with fewer progressing to severe levels. Similar patterns were observed in comparative studies, though the present study reports relatively higher moderate-to-severe cases. Factors such as loneliness, lack of social support along with emotional neglect can contribute to greater severity.¹⁸

Objective 3: To determine the relationship between depression and selected socio- demographic factors:

A significant association was found between depression and gender, living conditions, leisure activities, medical problems, family history of mental illness, smoking, and alcohol use. Comparative studies also showed associations with age, gender, diabetes, and sleep patterns. These findings confirm that both socio-demographic and health-related factors significantly contribute to depression among the older adults.¹⁹

CONCLUSION:

This descriptive cross- sectional investigation assessed the frequency and determinants of depression among elderly residents of selected old-age homes in Pathanamthitta district. The findings showed that over half of the respondents exhibited some degree of depression, ranging from mild to severe symptoms. Statistically significant relationships were identified between depression and variables including gender, satisfaction with living conditions, leisure activities, medical problems, family history of mental illness, alcohol consumption, and smoking. No significant association was observed with age, education, marital status, income source, duration of stay, living arrangement, relatives' visits, or family emotional support. The study highlights the importance of routine mental health assessment, early detection, along with supportive interventions for improving overall psychological mental wellness and quality of life among older adults residing in old-age homes.

CONFLICT OF INTEREST:

The authors state that they have no conflicts of interest concerning this study.

ACKNOWLEDGMENTS:

The researchers express their gratitude to the management, staff, and older adult residents from the selected old-age homes in Pathanamthitta district for their valuable support and involvement in this study. The authors also express their sincere gratitude to Believers College of Nursing for its guidance, support, and resources that contributed to the successful completion of this research.

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Received on 10.06.2026 Revised on 27.06.2026

Accepted on 13.07.2026 Published on 10.08.2026

Available online from August 14, 2026

Int. J. of Advances in Nursing Management. 2026;14(3):145-149.

DOI: 10.52711/2454-2652.2026.00030

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