Caregiver Empowerment through Self Care Assistance in Improving

ADL (Activity Daily Living) in Elderly

Alfi Ari Fakhrur Rizal

, Milkhatun, Siti Khoiroh Muflihatin and Ni Wayan Wiwin Asthiningsih

Universitas Muhammadiyah Kalimantan Timur, Jalan. Ir. H. Juanda No. 15, Samarinda, Kalimantan Timur,Indonesia

75243

Keywords: Care Giver, Self Care Assistance, Activity Daily Living, Elderly

Abstract: The ADL (Activity Daily Living) of the elderly is one thing that must be concerned seriously by providing

excellent services optimally through self-care assistance. Because it is continuously decreased due to the

degenerative process as the elderly grow. This study aims to determine the effect of selective-care assistance

on the ability of Activity Daily Living for the elderly. The sample in this study is the elderly living in the

Tresna Werdha Social Home, with approximately 64 people. The research instrument used is the Barthel

index to assess functional abilities for the elderly. The design of this research is a Quasi Experiment without

a control group that was analyzed using the Paired T-Test. Based on the results of the Paired T-Test, it is

found that the t value was 0.001 and the probability value (Sig.) was 0.05, so H0 is invalid. Thus, it can be

concluded that the role of caregiver in self-care assistance can increase ADL (Activity Daily Living) ability

for the elderly. It is evidently seen in the average value of ADL for the elderly after Care Giver is given Self

Care Assistance training is 18.23. It is higher than the average value before Caregiver was given Self Care

Assistance training.

1 INTRODUCTION

Self-care assistance is of paramount importance in the

service to the elderly in nursing homes. At present,

the number of elderly nurses or caregivers in nursing

homes is minimal, which is a problem for the

implementation of self-care assistance. Besides, the

number of elderly is increasing, it makes the elderly

care services in Indonesia, especially in homes,

cannot be optimized. It is also because of the specific

needs of each elderly have not been well documented.

Increasing the number of elderly is an indicator of

the success of national development, marked by

increasing social status and life expectancy for the

elderly (UHH). Especially in Indonesia, The number

of UHH in 2010-2015 was 70.7 years, and it is

predicted that 2015-2025 will increase by one year

every five years (Badan Pusat Statistik, 2011).

However, the increase in UHH is followed by the rise

in the number of elderly in Southeast Asia. Starting

by only 7.2% in 2012 and 7.8% in 2013, and it was

increased by 8% in 2015 and it is estimated to double

its number in 2025 (World Health Organization,

2015).

The similar pattern also happens in Indonesia. The

prevalence of the elderly was increased years by year.

It was only 7.4% in 2013, and then, it was steadily

increased by 7.6% in 2014 and 7.8% in 2015.

Specifically, in East Kalimantan, the elderly in East

Kalimantan ranked in the top 30 by 4.03% (Badan

Pusat Statistik, 2015). One city contributing the

increase in the elderly in East Kalimantan is

Samarinda City, and it is because of lacking services

of health and well-being of the elderly.

The effect of increasing the elderly population

will affect the economic and social, health problems,

namely an increase in the incidence of chronic

diseases, degenerative and various types of cancer are

increasing, as well as the mortality rate due to

diseases. Disability due to degenerative diseases will

not be avoided, thereby reducing the productivity of

the elderly (Saifullah & Hastuti, 2013).

The Decrease in productivity of the elderly group

is due to a decline in function, and it makes them

unable in carrying out daily activities such as eating,

toileting, bathing, dressing and other activities in

daily living. As the elderly grow up, they are

increasingly similar to children. Notably, in the

dependence of meeting their basic needs, this is what

258

Rizal, A., Milkhatun, ., Muﬂihatin, S. and Asthiningsih, N.

Caregiver Empowerment through Self Care Assistance in Improving ADL (Activity Daily Living) in Elderly.

DOI: 10.5220/0009190802580262

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 258-262

ISBN: 978-989-758-462-6

causes the elderly went to nursing homes (Reed,

2012) (Wood & Haber) in Saifullah & Hastuti (2013).

Increasing the number of The elderly also tends to

be followed by health problems due to the

degenerative process of the elderly such as

hypertension 57.6%, joint disorders/arthritis 51.9%,

and stroke 46.1%. The occurrence of the elderly

morbidity will affect efforts to meet basic needs

(Zhang et al., 2014).

Meeting basic needs is the most important thing

to be done. The basic needs of the elderly that are not

appropriately met cause a decrease in the quality of

life of the elderly (Alligood, 2011). In line with the

study by Darmojo R.B (2006) that explains the

elderly who experience impaired ADL fulfilment will

experience changes in their quality of life.

The ability of ADL elderly who experience a

decrease due to degenerative processes (ageing

process) must be taken seriously, including by

providing optimal primary services. Therefore self-

care assistance is needed, especially is a mentoring

for the elderly.

UPTD PSTW Nirwana Puri Samarinda has an

area of 20,850 M2, equipped with facilities and

infrastructure which has a total of 37 buildings

including 15 existing guesthouses containing elderly

in every guesthouse. As follows: Frangipani

guesthouses with 7 elderly, Seroja guesthouse with 7

elderly, Tulip guesthouse with 7 elderly, flamboyant

guesthouse with 6 elderly, Seruni guesthouse with 8

elderly, orchid guesthouse with 6 elderly, Lotus

guesthouse with 7 elderly, Bougenvil guesthouse

with 6 elderly, Sakura guesthouse with 10 elderly,

Wijaya Kusuma guesthouse with 6 elderly, Jasmine

guesthouse with 7 elderly, Brigenvil guesthouse with

6 elderly, Sri guesthouse fortune with 7 elderly,

dahlia guesthouse with 5 elderly, Kenanga

guesthouse with 5 elderly, and rose house with 8

elderly. This place has a capacity of 110 elderly. In its

implementation, the UPTD PSTW Nirwana Puri runs

under the regulation of the Indonesian government,

including Law No. 13 of 1998 concerning the welfare

of the elderly and Law No. 11 of 2009 concerning

social and other rules.

Drawing result from the preliminary study that in

Tresna Werdha Nirwana Puri Samarinda Social

Home, there were 110 elderly with varying degrees of

dependency, from independent elderly to total

dependency. The 110 of elderly are in 15

guesthouses, where there is only one caregiver for

each guest 15, and there is an exclusive guesthouse

for total care.

2 METHODS

This study uses a quasi-experimental design with a

pre-post test approach without control. Researchers

will intervene in one group without comparison.

Treatment interventions were assessed by comparing

pre-test and post-test scores (Dharma, 2011).

The sample in this study is a group of elderly

living in the community at the Tresna Werdha

Nirwana Puri Samarinda Social Home. Amounted as

many as 64 elderly taken as the sample and the sample

criteria are as follows; willing to be respondents, able

to speak Indonesian, do not experience mental

disorders, do not experience hearing loss and

dementia.

The instrument in the ADL assessment is to

determine the level of dependency or the amount of

assistance needed in daily life. By using the Barthel

Index which functions to measure functional

independence in terms of self-care and mobility and

can also be used as a criterion in assessing functional

ability for elderly people who experience impaired

balance using 10 indicators namely Feeding, Bathing,

Self-Care (Grooming), Dressing (Dressing),

Urinating (Bowel), Defecating (Bladder), Toilet use,

Transfer, Mobility and Up and downstairs. The

interpretation of the results of the Barthel index is 20

(Mandiri), 12-19 (Light Dependency), 9-11 (Medium

Dependence), 5-8 (Heavy Dependence) and 0-4

(Total Dependence). Barthel ADL questionnaire is a

reliable and valid measuring instrument and can be

used to measure the basic functional status of

Indonesia's elderly because it has a Cronbach value of

0.938 and the validity of Barthel ADL construction is

tested with the Spearman correlation coefficient and

looks at the rho (r) value of each item. The results

obtained by all items were significantly related to the

total value (p <0.001). All items have a value of r>

0.3 (Agung, 2006). Bivariate analysis using paired t-

test with alternative tests using Wilcoxon.

3 RESULTS AND DISCUSSION

Table 1 shows that the most elderly age is the elderly

age (60-74 years) with the number of respondents as

many as 34 elderly (53.13%).

Table 2 shows that the age of the elderly with

male sex is 38 elderly (59.38%) and female gender is

35 children (40.63%).

Table 3 above shows the majority of respondents

has elementary school as their final education level

Caregiver Empowerment through Self Care Assistance in Improving ADL (Activity Daily Living) in Elderly

259

with 28 people (43.08%) and at least one of them is

Bachelor degree (1.54%).

The results of the study of respondents by 64

elderly obtained the frequency distribution of the

ability of Activity Daily Living (ADL) pre-test can be

seen in the following table.

Test the normality of the data using the

Kolmogorov-Smirnov One-Sample Analysis test,

which compares the probability (p) obtained with a

significance level (α) of 0.05. If p> α, then the data is

normally distributed or vice versa. The result of

normality data depicts that the data are normally

distributed by a significant value (p-value) on the

Activity Daily Living (ADL) of the elderly before and

after the Self Care Assistance, namely 0.556 and 0.12,

respectively (p>0.05 ). In detail, the normality test can

be seen in the table below.

After the data normality test is done, then the

statistical testing is done by Paired Sample T-Test,

which is a parametric test to determine the effect of

the independent variables on the dependent variable.

In this study, the independent variables are Self care

Assistance, and the dependent variable is the ability

of Activity Daily Living (ADL). The following are

the results of the Paired Sample T-Test.

The results of the data analysis in table 7 above

shows the effects that an increase in the average

ability of ADL for the elderly after self-care

assistance was 18.23 compared to before self-care

assistance was 11.55. The p-value is 0,000, which

states that there is an effect of self-care assistance on

the ability of ADL in the elderly.

Table 1: Frequency distribution of the elderly.

Age Frequency Percentage

(%)

iddle Age (49-59 Y.O) 3 4.62

Elderly (60-74 Y.O) 34 52.31

ld (75-90 Y.O) 26 40.00

Very Old (> 90 Y.O) 1 1.54

Total 64 100

Table 2: Frequency distribution of the sex of the elderly.

Sex Frequency Percentage

(%)

Male 38 58.46

Female 26 40.00

Total 64 100

Table 3: Frequency distribution of elderly’s level of

education.

Level of Education Frequency Percentage

(%)

ot going to

School

15 23.08

Elementary

Secondary

High School

University

43.08

20.00

10.77

1.54

Total 64 100

Elderly is a natural process that is inevitable.

Physical conditions that are experiencing many

setbacks cause the elderly tend to need help in terms

of meeting their daily needs (Rohaedi, Putri, &

Kharimah, 2016).

Respondents who experienced a decrease in ADL

are mostly male, as many as 38 people (58.46%), the

age range of the majority was 60-74 years old, 34

people (52.31%), and the education level of the

elderly are mostly elementary school with 28 people

(43.08%). Many factors affect the ability of Activity

Daily Living (ADL) in the elderly, namely age, sex,

level of education, health conditions, and sports

(Darsini & Arifin, 2017). In this study, the age of the

respondents into the category of elderly are around

60-74 years. According to WHO, age is very

influential on a person's ability to perform daily

activities. So the older the age, the more person's

ability will decrease. This study is in line with

research conducted by Storeng, Sund, & Krokstad

(2018) where most of the elderly who experience a

setback in the ability of Activity Daily Living (ADL)

are in the age range of 60-69 years. Other research in

line was conducted by Wulandari (2014) said that

most of the elderly were aged 60-74 years (54.45%).

The higher age a person is, the more at risk of

experiencing health problems. Because the elderly

will undergo changes due to the ageing process both

in terms of physical, mental, economic, psychosocial,

cognitive, and spiritual.

The social home or nursing home is a joint

institution of the elderly who is physically and

healthy independent, where the daily needs of the

residents are usually provided by the caretaker

(Wulandari, 2014). Decreased productivity of this

elderly group occurs due to a decrease in function. So,

it will cause the elderly group to experience a

degradation in carrying out daily activities such as

eating, going to the bathroom, clothing, and others in

Activity Daily Living (ADL).

HSIC 2019 - The Health Science International Conference

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Table 4: Pre-Test Activity Daily Living (ADL) Frequency Distribution for the elderly.

Activity Daily Living (ADL) Frequency Frequency

Light Dependency 34 52.21

Medium Dependency 17 26.15

High Dependency 12 18.46

Total Dependency 1 1.54

Total 64 100

Table 6: Normality Test Results.

ctivity Daily Living (ADL)

Dependency

Sig. P Information

Pre Test 0.566 > 0.05 Data is normally distributed

Post Test 0.12 > 0.05 Data is normally distributed

Table 7: Results of the Analysis of the Effect of Self Care Assistance on the Activity of Daily Living Elderly.

Activity Daily Living

(ADL )on Elderly

Mean SD SE P-value

Pre Test 11.55 3.58 0.45

0.000

Post Test 18.23 2.76 0.34

According to the results of the study, it was found

that before self-care assistance was conducted,

elderly people who had mild dependence were 34

people (52.21%), moderate dependence there were 17

people (26.15%), severe dependence there were 12

people (18.46%), and a total dependency of 1 person

(1.54%) where all the needs of the elderly need daily

assistance. After self-care assistance, there were 29

people (44.62%) who had an independent ADL, 33

people (50.77%) mild dependence, and two people

(3.08%) moderate dependence.

The role of nurses in independent elderly can

motivate the elderly to continue to maintain

independence. In case of elderly with mild and

moderate dependence, the role of the nurse can help

meet the daily needs of the elderly but only in

activities that still need help and in activities that can

still be carried out independently by the elderly. For

the elderly with total dependence, the role of the nurse

can help the elderly to meet all their daily needs in

accordance with the criteria contained in Barthel

ADL.

In general, the elderly will experience a decline in

biological, physiological, and psychosocial functions.

Such conditions will affect the dependence of the

elderly on physical activity in daily life (Herman &

Akhriani, 2018). The degree of independence of the

elderly can be the basis for the nurse's role in

determining the care or intervention that will be

carried out on the elderly (Rohaedi et al., 2016).

The mean (average) ability of Activity Daily

Living (ADL) for respondents in UPTD PSTW

Nirwana Puri Samarinda before self-care assistance

was 11.55. After self-care assistance for the elderly,

there was an increase in Activity Daily Living (ADL)

by 18.23. From the results of this study, it can be said

that there was an increase of 6.68 before and after

self-care assistance was conducted on the Activity

Daily Living (ADL) of the elderly.

The increased ability of Activity Daily Living

(ADL) to respondents after being given self-care

assistance can be caused by the motivation given by

caregivers/assistants so that the elderly are more

enthusiastic and have enthusiasm in the

implementation of self-care. Self-care assistance is a

nursing intervention carried out by helping to fulfil

daily activities, accompanying their daily activities,

and motivating their activities independently

(Saifullah & Hastuti, 2013). Implementation of

assistance for self-care is in the form of helping ADL,

preparing personal hygiene facilities and

infrastructure, and coordinating with other officers

for environmental hygiene. Besides, the elderly are

also advised to carry out tasks that focus on each

individual, such as personal hygiene and are carried

out routinely.

Caregiver Empowerment through Self Care Assistance in Improving ADL (Activity Daily Living) in Elderly

261

4 CONCLUSIONS

The role of caregivers/assistants in UPTD PSTW

Nirwana Puri Samarinda in conducting self-care

assistance can improve the ability of Activity Daily

Living (ADL) for the elderly. The mean value

(average) of the ability of Activity Daily Living

(ADL) before self-care assistance is 11.55 and after

self-care assistance for the elderly, there is an increase

in Activity Daily Living (ADL) by 18.23. From the

results of this study, it can be concluded that there was

an increase of 6.68 before and after the self-care

assistance of the Activity Daily Living (ADL) of the

elderly.

ACKNOWLEDGEMENTS

Thanks to LPPM Muhammadiyah University of East

Kalimantan for funding this research.

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