RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION.

1.

Name of the candidate and

Address

Ms. Jency M. J,

1 Year M. Sc. Nursing,

Florence College of Nursing,

Bangalore – 43.

2.

Name of the Institution

Florence College of Nursing

3.

Course of study and subject

M.Sc. Nursing

Psychiatric Nursing

4.

Date of Admission to the course

02.07.2012

5.

Title of the Topic

“Evaluate the Effectiveness of Self

Instructional Module Regarding

Knowledge on Causes and

Prevention of Organic Mental

Disorder in Old Age Among

Working Adults (30 to 45 years) at

Selected Urban Areas, Bangalore.”

6. BRIEF RESUME OF THE INTENDED WORK

1

INTRODUCTION

And still they gazed and still the wonder grew,

That one small head could carry all he knew

-Oliver Goldsmith

The nervous system is the body’s most organised and complex structural and

functional system. It profoundly affects both psychological and physiologic functions.

It can be divided into two parts: the central nervous system and the peripheral nervous

system. While the central nervous system constitutes of the brain and the spinal cord,

the peripheral nervous system constitutes of the somatic system and the autonomic

system.1

The brain is the largest and most complex part of the nervous system. it is

composed of more than 100 billion neurons and associated fibers. The semisolid

organ weighs about 1400 grams in the adult human1.

The entire behaviour is effectively managed and controlled by the co-

ordination and functioning of nervous system. The behaviour of a person in a

particular situation depends upon the judgement of our brain. The proper growth and

development of nervous tissues and nervous system as a whole, helps in the task of

proper intellectual development. Any defect in the spinal cord or the brain seriously

affects the intellectual growth, emotional growth and the personality of an individual.2

Damage to any part of the brain can cause a cognitive disorder. Cognitive

disorders used to be called "organic mental syndromes" or "organic mental disorders"

to indicate that these disorders had a brain or biological basis. Most mental health

professionals now believe that the majority of mental disorders are caused or

2

influenced by brain chemistry or another medical issue that affects the brain

functions.3

Organic mental disorders (OMD) are behavioral or psychological disorders

associated with transient or permanent brain dysfunction. Organic disorders, acute or

chronic, involve impairment of brain tissue functions due to factors like head injury,

toxic conditions, encephalitis, systemic infection, brain tumor or cerebral

arteriosclerosis.

Organic brain syndrome can be divided into two major subgroups: acute

(delirium or acute confusional state) and chronic (dementia). A third entity,

encephalopathy (sub acute organic brain syndrome), denotes a gray zone between

delirium and dementia; its early course may fluctuate, but it is often persistent and

progressive. The term Delirium is synonymous with the term acute confusional state.

It is common in hospitalized patients, particularly in elderly and refers to an acute,

global disorder of thinking and perception, characterized by impaired consciousness

and inattention, restlessness and, agitation. Dementia implies chronic, progressive

cognitive loss including chronic loss of memory to a degree sufficient to interfere

with occupational or social, performance. Organic amnesic syndrome results in a loss

of memory due to physical (head trauma) rather than psychological causes like a

traumatic experience.4

Among organic mental disorders Delirium has the highest incidence. Elderly

are more prone to develop Delirium than younger people. About 10- 25% of medical-

surgical patients and about 20-40% of geriatric patients meet the criteria for Delirium

during hospitalisation. This percentage is higher in post operative patients. Dementia

occurs more commonly in the elderly than in the middle aged. It increases with age

from 0.1% in those below 60 years of age to 15-20% in those who are 80 years of age.

3

Aetiology of OMDs ranging from irreversible or untreatable causes like degenerating

disorders of CNS, Parkinson’s disease to reversible or treatable causes like vascular

disorders, metabolic, endocrine disorders, infections, drugs, vitamin deficiencies etc.

Early identification of causes and its immediate correction, consuming low fat diet,

including cold-water fish and dark coloured fruits and vegetables in the diet,

maintaining normal blood pressure are the better ways to prevent Organic Mental

Disorders.5

6.1 NEED FOR THE STUDY

“Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul”.

-Samuel Ullman 

Aging has been defined as a progressive decline in the physiological capacity

leading to a decreased ability to adopt to stressors, or loss of adaptability of an

individual organism over time .The term ‘Elderly’ has been defined in many

dimensions . Biologically ,the process of aging begins as early as puberty and is a

continuous process through adult life .Socially, the characteristics of members of the

society perceived as being old vary with the cultural setting ,and from generation to

generation. Economically, especially in rural areas, the elderly are simply seen as

being those who are too old to work and earn.6

According to the world health organization, India’s population of those aged

over 65, was 40 million in 1997, which is expected to increase to 108 million by

2025. This means a several-fold increase in age- related problems such as organic

mental disorders mainly, Dementia and Delirium. The WHO estimated that two out of

every three patients with dementia will soon be developing countries, appear to be a

virtual dementia epidemic in India and the urgent need to prepare to face it.7

4

In India, life expectancy at birth has increased from 42yrs since independence

to 65yrs at present and it is higher for women than men. Increasing life span of

population worldwide has been accompanied by an increasing prevalence of age

related disease such as dementia and the number of people with dementia is predicted

to exceed 80 million by 2040.8

There are 24·3 million people have OMD today, with 4·6 million new cases of

dementia every year (one new case every 7 seconds). The number of people affected

will double every 20 years to 81·1 million by 2040. Most people with dementia live in

developing countries (60% in 2001, rising to 71% by 2040). Rates of increase are not

uniform; numbers in developed countries are forecast to increase by 100% between

2001 and 2040, but by more than 300% in India, China, and their south Asian and

western Pacific neighbours.9

Prevalence of delirium in patients on admission is 10-40%, in intensive care

unit 70-87% and in post operative unit 15-53%. About 13 severe organic mental

disorders afflict one million elderly people in Canada and another two million suffer

from moderate organic disorders. 11

In Indian context prevalence of organic mental disorder, mainly dementia is

one in every five elderly Citizens suffer from organic mental disorder. In Kolkata

there are about 46,000 patients with Alzheimer’s. In Delhi it accounts for about

50,000 Alzheimer’s patient and in Bangalore there are 30,000 elderly patients

suffering from Alzheimer’s disease. Today in India 32, 00,000 people are affected by

dementia. The figure is expected to double every 20 Years.7 although there is no

known way to prevent dementia, researchers believe there are several things that will

help to keep the brain healthy. Such as avoiding excessive drinking, frequent reading,

doing cross word puzzles, keeping mentally and socially active, learning new skills

5

and regular exercise. Prevention of reversible causes of organic mental disorder in

possible in younger adults.10

A study was conducted to know the incidence of delirium on the hospitalized

geriatric general medical patients. The assessment of the patients was carried out

within 24 hours of admission and on every fourth day thereafter using Mini Mental

Status Examination (MMSE), Confusion Assessment Method (CAM), Delirium

Symptom Interview (DSI) and ICD-10-Diagnostic Criteria of Research for delirium.

The results show that overall rate of delirium of 27% and 19% was the rate of

‘prevalent’ delirium and 8% was the rate of ‘incident’ delirium. Thus the study

concluded that geriatric patients are in high risk of developing Delirium.13

A prospective study was conducted to know the prevalence, risk factors, and

outcomes of delirium in 229 elderly patients. Fifty patients (22%) met criteria for

delirium; non-delirious elderly constituted the control group. Abnormal sodium

levels, illness severity, dementia, fever or hypothermia, psychoactive drug use, and

azotemia were associated with risk of delirium. Patients with three or more risk

factors had a 60% rate of delirium. Delirious patients stayed 12.1 days in the hospital

vs 7.2 days for controls and were more likely to die (8% vs 1%) or be institutionalized

(16% vs 3%).Thus the study concluded that increased mortality associated with

delirium appears to be explained by greater severity of illness. 14

A descriptive survey was conducted to investigate knowledge regarding

Organic Mental Disorders among 127 young adult and 118 older adults. The data was

collected by using knowledge questionnaire; Younger adults obtained a score of (54

%) while older adults obtained (58%) on knowledge test. Thus the study concluded

that older adults are having sufficient information about dementia than younger

adults.12

6

In the light of above facts and personal experience of the investigator, it is

observed that there is a need to give information to working people by developing self

instructional module, regarding organic mental disorders. The purpose of this study is

to help the people to aware about OMD.

6.2 REVIEW OF LITERATURE

The review of literature is defined as a broad, comprehensive in depth,

systematic and critical review of scholarly publications, unpublished scholarly print

materials, audiovisual materials and personal communications related to the topic of

the study.16

A study was conducted to determine the prevalence of Organic Mental

Disorders. Among the samples of 6721, 2145 samples were randomly selected by a

door-to-door survey, who aged over 65 years. The number of people over 65 years

numbered 6721 and 2145 of them were randomly selected for a door-to-door survey.

They were initially administered household questionnaire and then subjected to a

screening tool.  Findings revealed that prevalence of dementia was 4.1%. Socio-

demographic factors which conferred a statistically higher risk for OMDs were

identified to be older age, low socio-economic status, low level of education, presence

of family history, whereas, marriage was found to be protective. Thus the study

concluded that prevalence of Organic Mental Disorder in high in elderly people and

the aging process, withdrawal from the previous societal roles, restriction in all types

of interactions are playing a major role in developing Organic Mental Disorder.17

A study was conducted to estimate the Prevalence of Alzheimer's type

dementia in an elderly Arab population. The data was collected from 821 persons

(362 males) (459 females) aged 60 years or older by using a semi structured

7

questionnaire. The results showed that the prevalence increased steeply with age,

from 8% among those younger than 70 years to 33% among those aged 70–79 years

and 51%among those 80 years or older. Thus the study concluded that Alzheimer’s

dementia was more prevalent among females than males.18

A prospective case control study was conducted to find out the relation

between pre operative executive dysfunction and depression and the incidents of post

operative delirium. Among 998 patients who were under going major non cardiac

surgery were selected as samples. Confusion Assessment Method (CAM) screening

and retrospective chart review was done. The result revealed that after surgery 35

were identified as having delirium. It is observed that there is increased risk with age

and co morbidity. Patients with mean age 63.9+ /– 15.5 were developed Post

Operative Delirium. It was concluded that Patient exhibiting both executive

dysfunction and clinically significant levels of depression were at greater risk for

developing post operative delirium.19

A prospective study was conducted to find out the relation between cognitive

function, cerebral oxygenation and the incidents of delirium. About 23 elderly

patients, over age 65 undergoing major abdominal surgery were selected as samples.

Researchers’ evaluated cognitive function in patients, using Hasegwa dementia score

(a brief, standardized dementia screening scale) and the kana-hiroi test (an auditory

verbal learning test). It is observed that after surgery, five (25%) of the patients

developed delirium, those who developed delirium were significantly older than those

who did not (76+/– 4 years vs. 68 + / – 3 years). Thus the study concluded that old

age and lower scores on the pre operative kana-hiroi test (16 + or - 5 vs. 32 + /– 10)

and lower base line cerebral oxygen saturation levels are closely related to the

incidence of developing Post Operative delirium.20

8

A study was conducted to know the prevalence, etiologies, clinical profile and

outcome of delirium in hospitalized elderly in medicine wards. About 400 elderly

patients of more than 60 years of age admitted with delirium in the emergency and

medicine wards, were evaluated and managed. Mini-Mental Status Examinations, was

used for evaluation of cognitive function status of patients and Confusion Assessment

Method (CAM), a screening instrument based on the third edition of the Diagnostic

and Statistical Manual of Mental Disorders was used for diagnosis of

delirium .Findings revealed that Sepsis and metabolic abnormalities were the most

common etiologies of delirium. Thus the study concluded that CAM is a useful

screening method for diagnosing delirium at bed side.21

A study was conducted to know the influence of sedation technique in the

development of post operative delirium among 120 patients aged 65 years or older.

Out of it 114 patients, with no pre existing cognitive impairment, under went hip

fracture repair, under spinal anesthesia with propofol sedation. It is found that the use

of light propofol sedation halved the frequency of POD when compared with deep

sedation(19 % Vs 40%). The mean number of days of delirium during hospitalization

was significantly fewer in the light sedation group than in the deep sedation group

(0.5 + /– 1.5 days Vs 1.4 + /– 4 days). Thus the study concluded that limiting the

depth of sedation in some spinal anesthesia procedures may be effective strategy for

preventing post operative delirium in elderly patients.22

A factor analytic study was conducted to determine the symptoms of Delirium

among 151 patients in a multi specialty hospital. Assessment was done with the DRS-

R-98 prior to starting treatment. Patients of this study were relatively younger (mean

age 47 years), with mainly hyperactive delirium, and did not have comorbid dementia.

Three factors which together explained 47.32 % of variance of symptoms were

9

identified. A “global cognitive” factor including disturbances of orientation, attention,

short- and long-term memory accounted for 18.33% of the variance. A “sleep and

motor symptoms” factor consisting of sleep–wake cycle disturbances, delusions, and

perceptual disturbances including hallucinations, motor-agitation, inverse of motor-

retardation, and affect-lability accounted for 16% of the variance. A “thought and

language” factor comprising abnormalities in language and thought process, temporal

onset, and fluctuation of symptoms explained 13% of the variance. It was concluded

that cognitive, motor, thought disturbances are common in patients with delirium.23

A study was conducted to know the effect of cognitive stimulation

intervention on severity and duration of delirium in 16 dementia patients. Patients

were selected randomly with delirium superimposed on dementia hospitalized on a

medical- surgical unit. 11 patents (n = 11) were selected as intervention group, mean

age 88 +/– 4.9 years and control group (n=5) mean age 82.4 + /– 2.9 years. It is

observed that patients with delirium superimposed and who were engaged in

cognitively stimulating activities for 30 minutes per day (the intervention group

demonstrated significantly less decline in physical function and mental status over

time compared with those given usual care (the control group). Thus the study

concluded that cognitive stimulation intervention is an effective strategy in reducing

the severity and duration of delirium.24

A prospective study was conducted to know the effect of vitamin E

supplements for clients with Alzheimer’s disease. The study included 341 moderately

impaired clients who were randomly assigned to receive 2000IU of vitamin E, 10mg

of selegiline, vitamin E and selegiline, or placebo for 2 years. It is observed that there

was an increase in medical survival of 230 days for clients taking vitamin E alone,

215 days for clients taking selegiline, and 145 days for taking vitamin E and selegiline

10

compared with clients on placebo. Thus the study concluded that vitamin E and

selegiline are effective in the treatment of dementia.25

A prospective study was conducted to know the relation between dietary

factors and Organic Mental Disorder. About 815 individuals, aged 65-94 years were

selected as samples. These individuals completed a dietary questionnaire on average

2-3 years before clinical evaluation. A total of 131 individuals developed Alzheimer’s

disease. It is observed that Individuals who consumed fish once per weak or more had

60% less risk of developing Alzheimer’s disease compared with those who rarely or

never ate fish. It was concluded that including fish in diet is might be effective in

reducing the risk of developing Alzheimer’s disease.26

A study conducted to evaluate the effectiveness of a SIM in increasing

working women’s knowledge regarding Diabetes Mellitus. 262 women were selected

as samples. Participants completed a questionnaire used to measure baseline

knowledge regarding Diabetes Mellitus. Participants then reviewed a self-

instructional module and completed a posttest questionnaire. There was a significant

increase of 20.8% in participants' mean knowledge score on the posttest (M = 89.0%,

SD = 8%, range = 67%-100%) as compared with the pretest (M = 69.0%, SD = 12%,

range = 42%-92%), based on paired t-test analysis(t = 11.74, SE = 0.426, p < .0001).

The study concluded self-instructional module on DM for working women was

effective in increasing knowledge regarding Diabetes Mellitus.27

6.3 STATEMENT OF THE PROBLEM:

“A study to evaluate the effectiveness of Self Instructional Module regarding

knowledge on ‘causes and prevention of Organic Mental Disorders in old age’ among

working adults (30 to 45 years) at selected urban areas, Bangalore.”

11

6.4 OBJECTIVES OF THE STUDY:

The objectives of the study are to:

1. assess the level of knowledge of working adults (30 to 45 years), regarding

causes and prevention of Organic Mental Disorders in old age.

2. find out the difference between the mean pretest and post test knowledge score

on causes and prevention of Organic Mental Disorders in old age

3. determine the association between the mean pre-test knowledge level of

working adults (30 to 45 years) regarding causes and prevention of Organic

Mental Disorders in old age with selected socio demographic variables.

4. determine the association between the mean post-test knowledge level of

working adults (30 to 45 years) regarding causes and prevention of OMD with

selected socio demographic variables.

6.5 HYPOTHESIS :

H1 : The mean post-test knowledge score of working adults (30 to 45 years),

regarding causes and prevention of Organic Mental Disorder in old age will be

significantly higher than the pretest knowledge score.

H2: There will be a significant association between mean pre-test knowledge level of

working adults on causes and prevention of Organic Mental Disorder in old age with

selected socio demographic variables.

H3:- There will be a significant association between mean post-test knowledge level of

working adults on causes and prevention of Organic Mental Disorder in old age with

selected socio demographic variables.

6.6 OPERATIONAL DEFINITION OF TERMS:

12

In this study it refers to;

Evaluate:

The method of estimating and interpreting the effectiveness of self

instructional module on knowledge of working people (30-45 years) regarding causes

and prevention of Organic Mental Disorder in old age.

Effectiveness:

Refers to determine the extend to which the Self Instructional Module has

achieved desired effect, as measured in terms of significant gain in the post test

knowledge score of the working people. The knowledge scores interpreted as

adequate, moderately adequate and inadequate knowledge.

Self Instructional Module:

A booklet in English prepared by the investigator for the working people, age

group between 30-45 years, to provide information about causes and prevention of

Organic Mental Disorder in old age.

Prevention:

Refers to measures, which are taken to prevent the occurrence of Organic

Mental Disorders in old age.

Organic Mental Disorders:

A pattern of organic psychological or behavior symptoms associated with

permanent or transient brain dysfunction but without reference to etiology

Working Adults:

13

Working men and women, between the ages 30-45, at selected urban areas,

Bangalore.

Socio demographic variables:

Socio demographic variables are attributes of subjects that are attributes of

subjects that measured through the study. Such as age, gender, monthly family

income, professional qualification, religion, experience, family history of Organic

Mental Disorder and other source of information.

6.7 ASSUMPTIONS

The study is based on the following assumptions;

1 working adults may have inadequate knowledge regarding causes and

prevention of Organic Mental Disorder in old age.

2 education may improve the knowledge of working people regarding Organic

Mental Disorder in old age.

3 knowledge regarding causes and prevention of Organic Mental Disorder in old

age may help the working adults to prevent the causes of Organic Mental

Disorder in old age.

14

6.8 DELIMITATIONS

The study is delimited to:

1. working adults, between the age group 30 to 45 years at the selected urban

community

2. knowledge will be assessed only as correct responses given to the item in the

structured questionnaire.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Working people (30-45 years) at selected urban areas, Bangalore

7.2 METHODS OF DATA COLLECTION

Research Method : Quasi experimental study

Research design : One group pretest – post test design

Sampling technique : Purposive sampling

Sample Size : 60 working men and women

Setting of the study : Selected urban area, Bangalore.

7.2.1 CRITERIA FOR THE SELECTION OF SAMPLES:

A) Inclusion criteria:

The study includes working adults who are:

1. between the age group of 30 to 45 years, from selected urban area, Bangalore.

2. available at the time of data collection.

3. willing to participate in the study.

4. able to speak and communicate in Kannada and English.

15

B) Exclusion Criteria

The working adults who:

1. have attended any awareness program regarding Organic Mental Disorder in

old age with in last 6 months

2. medical and paramedical personals.

7.2.2 DATA COLLECTION PROCEDURE:

A structured questionnaire will be prepared to assess the knowledge of

working people regarding causes and prevention of organic mental disorder. Content

validity of the tool and SIM will be ascertained in consultation with the guide and

experts from nursing and psychiatric medicine and Nursing. Reliability of the tool

will be established by split half methods, priority study. Written permission must be

obtained from the concerned authority. Further consent will be taken from the

samples regarding their willingness to participate in the study. The data will be

collected in August 2013.

7.2.3 DATA ANALYSIS METHOD:

Data analyses will be done by descriptive (mean frequency, percentage, and

standard deviation) and inferential (paired T test and chi square test) statistics.

Frequency and percentage distribution will be done to analyze socio-demographic

variables. Mean and standard deviation will be done to assess the knowledge of

working people between the age of 30-45 years, regarding the causes and prevention

of Organic Mental Disorders. A paired t-test will be done to compare the mean pre

test and post test knowledge score of working people regarding Organic Mental

Disorder in order to evaluate the effectiveness of Self Instructional Module. A chi-

16

square (χ2) test will be used to find out the association between the mean pretest

knowledge score with selected socio-demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS OR

INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR

OTHER HUMAN BEING OR ANIMALS?

No, only a structured questionnaire and Self Instructional Module will be

used. No other interventions which cause any physical harm will be used in the study.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED

Yes.

1. prior permission should be obtained.

2. a written consent will be obtained from the samples regarding willingness to

participate in this study.

3. confidentiality and anonymity of the subject will be maintained.

4. subjects should be informed that their participation is purely on voluntarily

basis and they can withdraw from the study at any time.

17

8. LIST OF REFRENCES

1. Joyce M Black, Jane Hokanson Hawaks, Medical and Surgical

Nursing,vol.2,ELSEVIER publications, 7th edition, page no.1998.

2. R. Sreevani, A Text Book on Mental Health Nursing, Jaypee publications, Page

No.40.

3. http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=3247&cn=231

4. http://en.wikipedia.org/wiki/Organic_mental_disorders .

5. Saldanha D, Maj Raghunandan mani, Srivasthav kalpana, Goyal sunil,

Bhattacharya D. An epidemiological study of dementia under the aegis of mental

health program. Maharashtra. Pune chapter. Indian journal of psychiatry 2010 P

131-132.

6. Aravind kasthuri, Travails of a graying nation. June 2007.

7. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglon IL, Ganguli M, et al. Global

prevalence of dementia; A Delhi consensus study. Lancet.

8. The Lancet, Volume 366, Issue 9503, Pages 2112 - 2117, 17 December 2005

9. Luetz A et al.Crit Care Med 2010;38(2):409-18.

10. Arnals Ganaguly: Struck by Alzheimer’s elders left to struggle. The Times of

India. 2006. Sep.22; Sect.A:3 (vol 1).

11. http://www.mentalhealthcanada.com/article_detail.asp?lang=e&id=3 .

12. Laforce R Jr., McLean S. Knowledge and fear of developing Alzheimer’s Disease

in a sample of healthy adults. Psychol P.2005, Feb; 96(1): P. 204-6.

13. Indian J Psychiatry. 2002 Jan-Mar; 44(1): 41–46.

18

14. The journal of American medical association February 23, 1990, Vol 263, No. 8

15. Chaudhury S, Mahar R, Augustine M. Post - Cataractomy Delirium: A Two Year

Prospective Study.Indian J Psychiatry. 1992;34:154–8.

16. Basavanthappa BT. Nursing research, 2nd edition,JaypeePublication 2007.

17. Indian journal of Psychiatry : 2010  |  Volu : 52  |  Issue : 2  |   Page : 131-139.

18. Bowirrat A, Treven, Friedland Prevalence of Alzheimer’s type dementia in an

elderly arab population. European journal of neurology 2001 8(2):119-123.

19. American Journal of Nursing, volume 112,page no.38.

20. American Journal of Nursing, volume 112,page no.39.

21. Geriatr Gerontol Int 2011; 11: 467–473.

22. Sieber F E et al.Mayo Clin Proc 2010;85(1):18-26.

23. Journal of Psychosomatic Research, Volume 70, Issue 5 , Pages 473-478, May

2011.

24. Kolanowski A M et al.Res Gerontal Nurs 2011;4(3):161-7.

25. Sano M et al. A controlled trial of selegiline and alpha-tocopherol as treatment

for AD,New England Journal of Medicine,336,1216-1222.

26. Morris M, Consumption of fish and omega-3 fatty acids and risk of incident of

AD.Archives of Neurology,60,940-946.

27. Swank C, Christianson CA, Prows CA, West EB, Warren NS.Institute of Genetic

Medicine, The John Hopkins University, Baltimore, MD 21287, USA.

cswank@jhmi.edu.

19

9

SIGNATURE OF THE CANDIDATE

10

REMARKS OF THE GUIDE This study would help to know the causes and prevention of Organic Mental Disorders.

11

NAME AND DESIGNATION

11.1 GUIDE

11.2 SIGNATURE:

Mrs. Kamakshi G.

Associate Professor

Dept of Psychiatric Nursing

Florence College of Nursing

Bangalore.

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE

DEPARTMENT

11.6 SIGNATURE:

Mrs. Kamakshi G.

Associate Professor

Dept. of Psychiatric Nursing

Florence College of Nursing

Bangalore.

12 12.1 REMARKS OF THE

CHAIRMAN OR THE

PRINCIPAL

12.2 SIGNATURE:

Lifestyle in the earlier age affects the future

of an individual. So, educating adults help

to reduce the incidence of mental disorders

in old age.

20