INTRODUCTION:

Aging and disability are the phenomena of human existence, which have been an object of study of philosophers, theologians, progressive public figures for southern of years. The main approaches to understanding the old age and disability issues were offered by ancient thinkers. However, only in modern times the aging and disability began to be viewed not only as phenomena inherent in the existence of an individual, but also as one of the most important elements of human life. Only in XIX-early XX centuries, aging became to be recognized as an indispensable attribute of human social life, that allowed to high light it’s the most important social aspects. In XX-XXI centuries the increasing of the proportion of old people in the total population in many developed countries in the world leads to the urgent need to address the problems of this socio-demographic groups and to develop technologies for their well-being.

According to United Nations, there were approximately 200 million people aged 60 years in 1950, by 1975 their number had grown to 550 million, by 2025 we will have had more than 1 billion 100 million elderly. In comparison since 1950 their number will have increased to more than five times, while the world population will have tripled [1]. In the modern Russian society the social situation of the elderly and disabled, especially living in institutions, can be characterized as social exclusion. The main indicators of this are the following: the low level of quality of life; social isolation; negative socio-psychological barriers and stereotypes about older adults and people with disabilities as “socially weak” categories, who unable to fully participate at social and economic processes; unsatisfactory conditions for their self-development and self-realization; the lack of well-organized leisure. One of the main problems of aging are psychological problems: depression; loneliness; feelings of uselessness, abandonment; social network losses; loss of social support and personal communication with relatives, children and colleagues; change in social status due to being placed in institutional care system, which increases the severity of depression, dementia, cognitive deficits, declining functional status, and negative life events in the elderly and the disabled. Unfortunately, despite the availability of effective treatments for depressed elders, the majority remain untreated or undertreated. Co-morbidity of depression with physical and mental illnesses is the high risk of suicide in the elderly [2]. According to the most conservative estimates, there are1.3– 1.8 million people suffer from dementia in Russia. It is much more that SPID epidemic victims, while there is no state programs aimed at combating it [3]. The increasing issues of older and disabled people dictate the need to improve and expand the range of social services in residential care system for them as well as the quality of treatment, including psychotherapy. According to scientific data obtained by foreign scientists, symptoms of depression experienced 10– 15% of the older people from the total population, in comparison with 46.5% of the elderly living in residential institutions [4]. According to Orth, Trzesniewski, Robins, the peak of depression falls to age of 60 and decreases over time [5]. Some foreign scientists register positive changes in well-being of institutionalized older and disable people, who takes psychotherapy on a regular basis: the improvement of orientation, the stimulation of cognitive functions, the increase of self-esteem, integration and adaptation features and social behavior stability [6, 7]. In Western culture, job is one of the pillars of well-being and personal identity. The loss of this important connection with the entire world can lead to difficulties that threaten the well-being, to violate the emotional and social balance, to form different types of deviant behavior. In addition to that, reducing work capacity and productivity begins after 45 years, increasing of 12.0 % every year and peaks at approximately 50 year-old, and then declines [8].

METHODS:

In order to assess the well-being of institutionalized elderly and disabled adults, in 2015 the sociological research was conducted in five retirement homes in Belgorod region. The survey included two stages. The first stage suggested partly structured inter views of 95 managers, professionals and social workers. Participants ranged in age from 32 to 63 years-old, with respect to gender 91.6 % of them were women. The second phase involves conducting interviews with elderly patients and people with disabilities living in retirement homes, located in Belgorod region in order to assess their social and psychological well-being and the quality of services provided to them. Participants included 177 elderly and disabled adults aged 60– 79 years, 84.1 % of them were female. In terms of civil status, 3.9% respondents were married, 63.8 % widowed, and2.3 %divorced.

MAINPART:

According to the survey of managers, professionals and employees of retirement homes, “elderly” was considered as people who were 60 years old– 37.8 %; over 70 years old – 34.8 %, 80 years old – 27.4 %. The majority of respondents (71.5 %) considered the issues of older and disabled people as important and worthy of attention. Speaking about the attitude of the society towards the elderly and disabled, 29.5 % of respondents believed that older people were perceived as “outlived elements”; 25.3 % registered some positive changes for the last decade; 14.7 % saw some negative attitudes towards the elderly; 14.7% claimed “no changes”; 8.4% were considered older people as active participants of social relations; 7.4 % were undecided (Table 1).

Table 1

Attitude to elderly
Outlived elements	Positive attitude	Negative attitude	No changes	Active participants
29.5 %	25.3 %	14.7 %	14.7 %	8.4 %

According to the analysis of the survey results, 69.5% of the interviewed employees of social institutions noted a steady increase in the proportion of people of retirement age in the last decade, which was reflected to the emergence of additional professional functions, requirements, regarding to new standards, rising of paper work, increasing workload, exacerbating issues about modernization of traditional technologies and methods. The social and psychological well-being of institutionalized elderly and disabled often depends on their environment, living conditions and consequences of outcomes in life. So not surprising, that 91.6 % managers and staff believed it was important to maintain contacts with family and children, to involve patients into the feasible work, active leisure time, and creative activities. In this connection, psychological assistance providing for the elderly and disabled (joint training, leisure, involvement in training, general activities) as an effective tool was reported by 87.4 % of respondents. According to 78.9 % of employees of retirement homes for elderly and disabled persons, patients showed extremely low social activity, only 7.4 % were members of non-governmental organizations, associations, clubs, etc., and 8.4 % took part in permanent activities carried out by agency staff. Research showed that 83.2 % of respondents supported providing government social support for the elderly due to low income, the lack of free medicine, the increase of utility services that makes elderly and disabled struggle with poverty. In the second phase we conducted partly structured interviews with elderly and disabled people aged 60 – 79 living in two retirement homes, located in Belgorod (“Shebekinsky home for the elderly” and “Urban rehabilitation center for the elderly and persons with disabilities”, N=177). In the author’s survey the main reasons for institutionalization of elderly and disabled were social causes (the lack of housing, poverty, low income, etc.) – 36.2%; medico-social problems (the necessity of care and supervision, medical treatment, inability to live independently) –18.1 %; psychological issues (family conflicts, depression, loneliness, mental health problems)–45.7 % (Table 2).

Table 2

Main reasons for institutionalization of elderly and disabled
Social causes	Medico-social problems	Psychological issues
36.2%	18.1 %	45.7 %

Moving to the residential home for elderly and disabled patients leads to a significant and sometimes traumatic events that requires tremendous adaptation skills [7], that along with social isolation increases the risk of physical and psychological diseases. This was supported by V.P. Voitenko’s and S.G. Kozlovsky studies, who noted that for the first time 43.5 % institutionalized elderly and people with disabilities experienced severe symptoms of social exclusion, depended on the type of their personality, among them emotionally labile individuals had the most severe symptoms – 67.0 %, in comparison with anxious-hypochondriac–15.5 %,and patients with excitable personality type – 4.0 % [9].However, in 40.4 % of cases elderly concerns were not justified after six months staying in nursing homes. They assessed their situation of being institutionalized as less severe than it was some months ago, 7.7 % residents considered life in retirement homes even highly that their first expectations [10].Adaptation level of elderly and disabled patients who maintained high physical and social activity was 65 %, compared to 36 % of individuals, who followed passive way of life, suffering from depression and psychological distress [9]. Research on well-being of institutionalized elderly and disabled, living in retirement homes in Belgorod region, has shown the most important aspects of ageing with patients’ point of views. Among others were named“poor health” –93.2 %, “social isolation”– 37.8 %, “loss of independence” – 41.2 %, “mandatory sharing space with others” – 46.9 % and “loneliness” – 50.3 % (more than one question can be checked in the questionnaire). 53.1 % of retirement homes’ patients had low level of self-esteem (Table 3).

Table 3

Important aspects of ageing
Poor health	Social isolation	Loss of independence	Mandatory sharing space with others	Loneliness
93.2 %	37.8 %	41.2 %	46.9 %	50.3 %

The majority of patients noted that they had had low level of self-esteem since their youth due to early orphan hood, serious disease or disability, dysfunctional family, etc. and they were not able to reach their full life potential. Termination of employment and retirement is the important milestone in persons’ life. The research found different attitude of older patients to that particular fact. Some of them demonstrated relatively quickly adaptation to emerging circumstances, shifting their attention to household duties, parenting grandchildren, and hobbies. The others, on the contrary, turned in on themselves, felt a sense of loneliness, abandonment, depression, passive attitude to life, which was manifested in the abuse of alcohol, break social connections with other people, negativism, attempts of suicide, etc. Therefore, the elderly are particularly sensitive to other people’ attention, social and psychological support of their close environment and staff. O.B. Yakovleva observed 104 institutionalized elderly patients with depression, aged 60 – 86,and found out the trend to an increase in the number of deaths (46.1 %, 36.7 %, 21.4 %, 11.4 %) and the development of dementia of various origins(7.7 %, 17.2 %, 28.6 %, 40 %), associated with an unfavorable course of the disease and the formation of the “double” depression [11]. A specific role in assessing of the well-being of the elderly and disabled people plays their social activity. Among the most significant indicators of activity / passivity of the respondents were named in order of importance: “good health” – 23.2 %; “family support”–19.8 %; “communication with children, friends, colleagues”– 18.8 %; “income” – 16.9 %; “ability to continue working after retirement”– 7.3 %; “ability to care about anyone” – 5.1 %; “quality of social services” – 5.1 %; “well-organized entertainment for the elderly” – 4.0 %.Over 70.0 % of the elderly and disabled people describe their leisure as passive, which is limited by listening to the radio and watching television, despite the fact that there are several recreational centers for the elderly on the territory of the Belgorod region; 40.1 % patients are not satisfied by their leisure opportunities.

CONCLUSION:

The research of the managers and employees of social institutions, as well as patients themselves found out a number of negative factors that affected social and psychological well-being of elderly and disabled, impeding their successful adaptation and self-realization: sharing space; the lack of emotional contact with relatives, children, co-workers; the negative past experience, the psychological trauma. To improve the efficiency of social services for elderly and disabled living in residential care, it is necessary to introduce innovative technologies and methods, in particular, to enhance the range of forms of psychotherapeutic work with residents. Among the most effective forms should be called the individual and family counseling, questioning and hearing techniques; working with family; group therapy; a socio-psychological training; psychotherapy. The main areas of psychotherapy with this category of the population are the following: training employees of social institutions about new techniques in gerontology, psychology of aging and disability; forming the perception of customers as active subjects; developing tolerant attitude to older and disabled people in the public opinion, using mass media; activating and intensifying the cooperation between state and non-governmental organizations to provide social assistance to elderly and disabled; providing qualified psychological assistance to patients living in residential care.

REFERENCES:

1. The report of United Nations. DateViewshttp://www.un.org/esa/population/publications/WPP2004/2004RussianES.pdf. (In Russian).

2. Juurlink, D.N., Herrmann, N., Szalai, J.P., Kopp, A. and D.A. Redelmeier, 2004. Medical illness and the risk of suicide in the elderly. Archives of Internal Medicine, 164: 1179-1184.

3. Dementia: a public health priority. World Health Organization. Date Views 19.03.2016 http://apps.who.int/iris/bitstream/10665/75263/14/9789244564455_rus.pdf. (In Russian).

4. Steffens, D.C., Fisher, G.G., Langa, K.M., Potter, G.G. and B.L. Plassman, 2009. Prevalence of depression among older Americans: The aging, demographics and memory study. International Psycho geriatrics, 21: 879-888.

5. Orth, U., Robins, R.W. and K.F. Widaman, 2012. Life-span development of self-esteem and its effects on important life outcomes. Journal of Personality and Social Psychology, 102: 1271-1288.

6. Korte, J., Bohlmeijer, E.T., Westerh of, G.J. and A.M. Pot, 2011. Reminiscence and adaptation to critical life events in older adults with mild to moderate depressive symptoms. Ageing & Mental Health, 15: 638-646.

7. Meléndez-Moral, J. S., Charco-Ruiz, L., Mayordomo-Rodríguez, T. and A. Sales-Galán, 2013. Psicothema, 25 (3): 319-323.

8. De Morais Ribeiro, J. H., dos Santos, R.P., de Souza Junior, D.I., Pereira, D. S., da Silva, J.V. and M.A. Mendes, 2015. Work Capacity of the Elderly: Assuming Another Social Identity in the Contemporary. World Open Journal of Social Sciences, 3: 24-32.

9. Voitenko, V.P. and S.G. Kozlovsky, 1988. Current problems of gerontology and geriatrics. Moscow, pp: 135. (In Russian).

10. Kavalevich, I.V., 2011. Levels of phenomenological analysis of elderly living in the world maturity. Psychology and Aging, 4: 112-115. (In Russian).

11. Yakovleva, O.B., 2011. The outcomes of depression in later life and the effects of aging factors. Improving the efficiency of treatment and rehabilitative care for mentally ill / Edited by Z.I. Kekelidze and V.N. Krasnov. St. Petersburg, pp: 163. (in Russian).

Received on 26.11.2016 Modified on 05.12.2016

Research J. Pharm. and Tech. 2017; 10(3): 769-772.

DOI: 10.5958/0974-360X.2017.00144.5