According to NHS (2011), elderly people who have attained the age of 65 years and above usually spend an average of 10 hours and above daily sitting or lying down, making them the most sedentary group of people. Due to this apparent inactivity among the elderly, they are more prone to accidental falls, obesity, cardiovascular accidents, heart conditions and sudden death than the general population.
In this interview, data was gathered from an elderly man in his early 80s through use of a semi-structured interview schedule that consisted of open-ended questions touching on the instrumental activities of daily living (IADL) and activities of daily living (ADL). The interview schedule provided an opportunity for the interviewer and interviewee to tackle the questions in detail through appropriate probing.
Before commencement of the interview, an informed consent was obtained from the respondent where his anonymity and the confidentiality of the information sought from him were assured. The interviewee was asked to sign a consent form if he agreed to take part in the interview. The Rationale
To ascertain that a person is able to independently live at home or community, the determination of the daily basic activities performed by the individual is necessary. These activities are referred to as Activities of Daily Living (ADLs). According to PayingForSeniorCare (2007), ADLs only serve as a yardstick of independence of individuals, whether or not they perform these basic activities on their own or get assistance.
On the other hand, Instrumental Activities of Daily Living (IADLs) are the actions which are important but not a daily requirement for one to live independently. They usually used to determine what level of assistance is to be accorded to the elderly or disabled people in society.
In the interview nschedule, three (3) ADLs and Three (3) IADLs were included. The ADLs included: Bed mobility, Toileting, and Eating. The IADLs were: Responsibility for own medication, Housekeeping, and Ability to use telephone. These activities and actions were included in the interview because they will in the very least point to the functional ability of the respondent given his advanced age.
ADLs and IADLs are carried out because ‘ Measuring an individual’s ability to perform the ADLs and IADLs is important not just in determining the level of assistance required but as a metric for a variety of services and programs related to caring for the elderly and for those with disabilities (PayingForSeniorCare (2007, p. 1). Ethical considerations
According to Fouka and Mantzorou (2011, p. 3), research ethics involve requirements on daily work, the protection of dignity of subjects and the publication of the information in the research. Research ethics are a set of principles that guide researchers and research organizations on how to conduct themselves when dealing with research participants, other researchers and colleagues, the users of their research and society in general. Among the ethical issues taken into consideration in research include: 1. Informed consent
Informed consent is a major ethical issue in carrying out research. According to Armiger (1997), the participant must knowingly, voluntarily and intelligently, and in a clear and manifest way, give his/her consent. Informed consent confers autonomy to the respondent hence they are protected through self-determination. Through informed consent, the participant’s integrity, personal liberties and veracity are protected from violation by researchers.
Informed consent enables individuals participate in research voluntarily after they have been provided with information on the potential risks and benefits of the research. Free and informed consent should incorporate an introduction to the study, its purpose, an explanation of the selection of the subjects and the procedures that shall be followed. It is essential to describe any physical harm or discomfort, any invasion of privacy and any threat to dignity as well as how the subjects will be compensated in that case. 2. Beneficence- do not harm
This principle ensures that researchers exercise a professional mandate to carry out significant and effective research so as to serve and promote the welfare of the population. A researcher must consider all possible consequences of the research and balance the risks with proportionate benefit. The type, degree, and number of potential risks must be assessed and the risk benefit ratio can only be achieved by identifying these factors. If the risks outweigh the benefits, the study should be revised.
It is important that debriefing of the participants is done at the end of the study. Debriefing refers to explaining the exact aim of the study and why certain disclosures were not done. According to Burns and Grove (2005) ‘if the subjects experienced a high level of discomfort, they should be debriefed or referred to appropriate professional intervention as necessary’. 3. Respect of anonymity and confidentiality
Confidentiality and anonymity are closely linked with the rights of beneficence. The protection of anonymity is achieved when the researcher does not link a participants personal responses and his/her identity. The management of private information of the respondents must be ensured by the researcher in order to protect the participant’s identity. Confidentiality means that individuals can give and/or withhold as much information as they wish to the person they choose. 4. Respect of privacy
Privacy is the freedom exercised by an individual in determining the time, extent, and general circumstances under which private information will be shared with or withheld from others. Therefore, private information shall not be shared with others without the knowledge of the participant. According to Treece and Treece (1982), a researcher must respect a decision by a respondent who considers reporting personal information a violation of privacy.
Fauka and Mantzorou (2011, p. 7) state that ‘this may even apply to report of age, income, marital status, and other details that the subject may regard intimate. They also imply that privacy can be invaded when researchers study certain groups without their knowledge and without identifying themselves. 5. Concerns of vulnerable group of people
Vulnerable group of people are the individuals who are unable to protect their own rights and welfare. Opinion is still divided as to whether they should be included in research studies or not due to their inability to give informed consent. They include prisoners, mentally ill people, the aged and children among others. They need further protection for they are vulnerable to being deceived, threatened or forced to participate in research studies they have no idea about.
According to Burns and Grove (2005), the vulnerability of these individuals increases the need for justification for the use of such subjects in research studies. 6. Honesty, objectivity, integrity, legality and competence
It is important to maintain honesty in research undertakings. Honestly report data, results, methods and procedures, and publication status. Avoid any fabrication, falsification, or misrepresentation of data. Do not deceive colleagues, granting agencies, or the public. To maintain objectivity, the researcher must avoid bias in study designs, data analysis, data interpretation, peer review, personnel decisions, grant writing, expert testimony, and other aspects of research where objectivity is expected or required. Avoid or minimize bias or self-deception. Disclose personal or financial interests that may affect research. Integrity should be ensured through keeping of promises and agreements.
The researcher must act with sincerity, and maintain consistency of thought and action. Every researcher must ensure and improve his/her own professional competence and expertise through lifelong education and learning and steps must be taken towards the promotion of competence in science as a whole. Research studies are guided by the relevant rules and regulations that must be adhered to at all times, whether institutional or governmental. Research ethics play important roles in research studies as they; 1. Bring about respect for and cause no harm to the participants 2. They are a professional requirement in research studies
3. They are a requirement in obtaining funding for research undertaking 4. They ensure that research studies are conducted within the ethical guidelines provided by the Ethics Committee 5. Ensures that the research findings are acceptable to the research community and the public Interviewee
current IADL/ADL practices
According to Quinn et al. (2011), elderly individuals usually present with acute and chronic problems that adversely affect function, often defined by functional decline and loss of independence. This might eventually lead to institutional care for such individuals. The decreased function may be a pointer to occult pathologies which lead to increased mortalities (Schumacher, 2005).
From the interview, it was found out that the respondent had limited capacity in carrying out daily activities. For instance, in determining the ADLs, in bed mobility, he needed other than two persons physical assist, had a limited physical assistance in toileting and limited assistance when eating. His actions too were limited as he scored lowly in IADLs.
For instance, in responsibility for own medication, he only takes medication when it is prepared in advance and in right dosages, he answers the telephone only and cannot dial by himself, and finally he does not participate in any form of housekeeping. The respondents attributed all this to poor memory, fast failing eyesight, affliction by arthritis and advanced age. Conclusion
Elderly individuals are afflicted by many ailments that lead to poor health, and as a consequence they are usually unable to undertake simple tasks that are geared towards maintaining good health. It is therefore imperative that functional assessment are done on such persons in order to put in place appropriate strategies that can help them lead at least ‘normal’ lives. Therefore, ADLs and IADLs are important towards this end and can help determine the kind of care to be provided to elderly individuals. This can be in the form of institutional care, family and friends care giving.
Armiger, B. (1997). Ethics in Nursing Research: Profile, Principles, Perspective. Nursing Research, vol. 26, no. 5, pp. 330-333. Burns, N & Grove, S. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.), St. Louis, Mo: Elsevier/ Saunders. Fauka, G & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), pp. 3-14. NHS (2011). The importance of exercise as you get older. Retrieved from: http://www.nhs.uk. Quinn, J, McArthur, Ellis, G & Stott, J. (2011). Functional assessment of older people. BMJ. doi: doi: http://dx.doi.org/10.1136/bmj.d4681
Schumacher, J. (2005). Emergency medicine and older adults: continuing challenges and opportunities. Am J Emerg Med, 23: pp. 556-60. Treece, E & Treece, J. (1982). Elements of research in Nursing. St-Louis: Mosby.
Informed consent letter
My name is …………………., an undergraduate student at …………………….. University carrying out a study on ‘the importance of ADLs and IADLs’. All information provided in this study will be treated with confidentiality and your identity shall not be disclosed. All information provided in this study will be treated with confidentiality and your identity shall not be disclosed. The participation in this study is on voluntary basis, and therefore you are free to accept or decline to take part in the study. Your cooperation shall be of great importance in achieving this goal. If you agree to take part in this study, please append only your signature below ____________________________________ ______________________ Respondent Signature Date
Interviewer signature Date
Part 1: ADLs
1. How will you describe your ability to move in bed while you lie on it? Any
difficulties? 2. Please describe your ability to use the washrooms. Any important information worthy noting? 3. Can you please describe to me your eating habits? Are you able to cut chew and swallow food independently or with supervision?
Part 2: IADLs
1. Are you responsible for taking your medications? Yes [ ] No [ ] If NO in the above question, please explain.
2. Do you perform housekeeping chores?
3. How will you describe your use of the telephone? any reasons for that?