Level of Independence Towards Self-Esteem in The Elderly

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Level of Independence Towards Self-Esteem
in The Elderly
Elida Ulfiana
Faculty of Nursing Universitas Airlangga
Surabaya, Indonesia
elida_u@fkp.unair.ac.id
Mohammad Saelindra
Faculty of Nursing Universitas Airlangga
Surabaya, Indonesia
Setho Hadi Suyatmana
Faculty of Nursing Universitas Airlangga
Surabaya, Indonesia
Abstract— The aging process can cause mental changes, both
psychosocial and physical conditions can decrease the level of
independence in activities daily living. One of the consequences is
a deterioration in self-esteem that has the feeling useless and
worthless. The purpose of this study was to analyze the
correlation between level of independence to self-esteem in the
elderly. This study used descriptive correlational with cross-
sectional approach and using proportional sampling. Total
population were 143 elderly people and obtained 71 samples who
determined by inclusion criteria. The Data collected by
questionnaire and observation then analyzed by Spearman’s Rho
with significant level test (p<0,05). The independent variable was
level of independence and dependent variables was self-esteem.
The result showed that there was correlation between level of
independence with self-esteem on elderly (p=0,568). The elderly
could perform activities daily living independently cause an
impact on self-esteem. The result of independent elderly can have
high self-esteem, high levels of confidence and can socialize with
their environment. The Elderly that do the activities daily living
independently can increase self-esteem. The result showed that
elderly people always think positive, accept the changes that
happened and can socialize with their surroundings. Further
research could develop the results of this study in elderly with
male gender, factors that affects self esteem in their body both in
nursing home and in the community.
Keyword: Level of Independence, Activities Daily Living, Self
Esteem, Elderly
I. INTRODUCTION
A natural process that will be experienced by humans is the
aging process that can cause mental changes, psychosocial and
physical deterioration that will affect the level of independence
[1]. The degradation of independence in the elderly occur due
to mobility limitations, weakness, onset of mental or physical
problems, and decreasing of economic status [2]. The
condition, in addition to physical health problems, it also raises
the issue of mental health (psychological). A consequence is a
decreasing in self-esteem that can feel useless and worthless
[3], [4].
According to the Basic Health Research in Indonesia, the
prevalence of the elderly population with mental disorders
emotional problems (depression, impaired self-concept,
anxiety) is 11.6%. Meanwhile in East Java province there are
elderly population with mental-emotional disorder as much as
6.5% [5]. Data obtained from Health Office of Surabaya,
elderly population who experience mental-emotional disorders
is 18.8% [5]. The elderly who suffer health problems can lead
to low self-esteem as much as 80% of the total elderly
population [6]. The decline in motor and cognitive function in
the elderly themselves would lead to a decrease in physical
condition. It caused elderly can not perform activities of daily
life. Such conditions have an impact on the mental health, so
psychologically elderly susceptible to decrease self-esteem [7].
Self-esteem is meaningful as an overall view of the individual
about him or herself [8]. Main aspects of self-esteem is to be
loved, cherished, and received an award from the others.
Elderly who have low self-esteem can be marked by feelings of
fear, anxiety, lower confident, and depression [9]. Based on the
background above, the researchers intend to explain the
correlation of independence level towards self-esteem of
elderly in nursing home (Panti Werdha) Surabaya.
II. METHODS
This study used descriptive correlation with cross-sectional
design. This research was conducted in Werdha Anugerah
Nursing Home Surabaya, Hargo Dedali Nursing Home
Surabaya and UPTD Griya Werdha Surabaya, in December
2016.
The population in this study were elderly people in Werdha
Nursing Home Surabaya. Researchers selected in Werdha
Anugerah Nursing Home Surabaya, Hargo Dedali nursing
home Surabaya and UPTD Griya Werdha Surabaya with a total
population of elderly were 143. Samples of this study were 71
respondents who met the inclusion and exclusion criteria of the
proportional sampling technique.
The inclusion criteria were elderly who able to read and
write, elderly who have cognitive scores MMSE> 24. While
8th International Nursing Conference (INC 2017)
Copyright © 2017, the Authors. Published by Atlantis Press.
This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).
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118

the exclusion criteria were elderly with communication
impairment, elderly with dementia, deafness, loss of
consciousness and mental disorders or psychotic, and elderly
who rejected became respondents.
The independent variable in this study was the level of
independence, and the dependent variable in this study was
self-esteem. The data in this study were obtained by
questionnaire and observation sheet. The analysis in this study
using univariate and bivariate (Spearman's Rho test).
This research has passed the conduct of review and
certified Ethical Approval with No. 255 - KEPK on December
20, 2016 issued by the Faculty of Nursing, Universitas
Airlangga.
III. RESULTS
TABLE 1. DISTRIBUTION OF RESPONDENTS
Characteristics
N
%
Gender
1. Male
2. Female
9
62
12,7
87,3
Total
71
100
Ages
1. 60-69 years
2. 70-79 years
3. 80 years or above
23
36
12
32,4
50,7
16,9
Total
71
100
Religion
1. Moslem
2. Christian
3. Khonghucu
58
12
1
81,7
16,9
1,4
Total
71
100
Ethnics
1. Javanese
2. Sunda
3. Madura
68
2
1
95,8
2,8
1,4
Total
71
100
Educational Background
1. No Education
2. Elementary School
3. Junior High School
4. Senior High School
5. College
2
24
26
14
5
2,8
33,8
36,6
19,7
7
Total
71
100
Length of Stay
1. 0-5 years
2. 6-10 years
3. >10 years
65
6
0
91,5
8,5
0
Total
71
100
Complaints
1. immobilization due to
incidence of falls
2. Joint’s pain
5
2
7,2
2,8
Total
7
10
TABLE 2. THE CORRELATION BETWEEN INDEPENDENCE LEVEL
AND SELF-ESTEEM OF THE ELDERLY
Variable
Self Esteem
Total
Level of
Independence
High
Low
N
%
Independent
38
2
40
56,3
Mild depencence
6
8
14
19,7
Moderate
dependence
3
3
6
8,5
Severe dependence
7
4
11
15,5
Total
54
17
71
100
Significant value (p): 0,000
Spearman’s Rho coeficience correlation (r): 0,568
Table 1 showed that most of the respondents were women
with a total of 62 people (87.3%). The majority of respondents
were in the middle-old (70-79 years) as many as 36 (50.7%).
The majority of respondents’s religion were moslem (81.7%)
and most of them were Javanese (95.8%). The last education
for most of the respondents were low that as many as 24
respondents in elementary school (33.8%) and 26 respondents
in junior high school (36.6%). In terms of the length of stay, 65
respondents stayed in nursing home for 0-5 years (91.5%).
Table 2 showed that the majority of respondents were
independent elderly with high self-esteem as much as 95% (38
respondents), but there was independent elderly with low self-
esteem as much as 5% (2 respondents). The cross-tabulation
data showed that there were 7 respondents with severe
dependence but still have high self-esteem. Based on non-
parametric test, Spearman's rho correlation with a significance
level of α ≤ 0.05, the analysis showed a p-value: 0.000, which
means that there was a correlation between the independence
level to self-esteem on respondents in Werdha Nursing Home
Surabaya. While the value of the correlation coefficient (r) =
0.568, which means the level of correlation was moderate and
positive correlation coefficient that indicated the presence of
the correlation between the two variables in line with the same
high value.
IV. DISCUSSION
The results showed that there was a significant correlation
between the level of independence and self-esteem in the
elderly. The person who had more inability to perform daily
activities could impact on the psychological domain such as a
deterioration in self-esteem.
Results of data distribution showed that respondents who
were independent to perform daily activities would have a high
self-esteem. [10] explained if people think that they can, then
they tend to succeed. It would impact to have high self-esteem.
If people think that they failed, It also would impact to have
low self-esteem. [11] explained that the individual's ability to
meet the daily activities independently will able to maintain
dignity and self-esteem.
The majority of elderly in Nursing Home were independent
level. It is caused by the willingness and ability to perform
activity daily living, and lack of nurses and caregivers (2 nurses
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in each Panti). Elderly regarded their self that they were able to
perform activities without helping of the others.
However, the data distribution indicated that the majority of
respondents who had a dependency in activities of daily living
also had a low self-esteem. It was accordance with [12] that a
person who has a lot of physical changes can have an impact
on a psychological behaviors such as deterioration of self-
esteem indicated by sense of inadequacy, guilt, and irritability.
Physical changes could make elderly feel lack of confidence
when having an interaction with the environment [13].
Deterioration of self-esteem could be caused by feeling not
be able to perform daily activities independently due to
changes of physical and health condition. They needed help of
the others to fulfill their daily activities. This can lead to have
low self-esteem in elderly that can feel useless, worthless and
unable to do what others do.
The results also showed that there were some respondents
who had a dependency in activities of daily living but had no
decreasing of self-esteem. Distribution of tabulation showed
respondents did not feel that they were useless or worthless.
This was consistent with the results of [14] that the physical
and psychological changes should not be regrettable and
avoidable, but it was part of life. Elderly who has positive
thoughts tend to have higher self-esteem.
Elderly in Nursing Home who have high self-esteem
always be grateful and think that every people must pass this
phase of life. They would perform their daily activities as good
as they can in accordance with their capabilities.
However, there were two respondents with good
independent level to perform daily activity but they had a
deterioration in self-esteem. In data distribution, the
respondents felt useless and not needed by the family or
someone closest because respondents feel discarded or
removed. This is supported by [15] said that the elderly who
have low self-esteem would consider themself was not able to
do something useful, feel unneeded and feel there were nothing
to be proud of. The statement also consistent with the theory of
[16] that self-esteem is affected by social and environmental
support, independence in daily living activity, family support
and the experience of success and failure.
Deterioration of self-esteem on elderly in Werdha Nursing
Home Surabaya can occur, affected by the level of
independence in ADL and also the lack of nurses and
caregivers, ineffective individual coping, positive thoughts, and
family support.
V. CONCLUSION AND RECOMMENDATION
Elderly who perform the daily activities independently
could have a high self-esteem. Elderly always think positive,
accept the changes that happened to their life and socialize with
their environment. Family and nurses should be able to
maximize the role of the elderly to perform daily activities. It
could increase self-esteem in the elderly so they could accept
any changes that happened to their life and could socialize with
their environment.
Researchers could conduct the same research to male
elderly, factors affecting the changes in self-esteem both at
Nursing Home and community.
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