INTRODUCTION:

Aging or growing old is natural and unavoidable process that everyone has to go through when people pass from one psychological stage to another¹. Erikson E (1982) described about personality theory and looks at aging as a stage of transition. Personality development goes through series of eight hierarchically ordered stages².

Each stage is associated with psychosocial crisis that individual either successfully resolves or fails to resolve. The eighth stage of psychosocial development is ego integrity versus despair between the age group of 65 years and above. he proposes that this stage begins when individual experiences sense of mortality, this might be in response to retirement, the death of spouse or close friend, or may simply results from change in social roles.

The goal of individual is to review, his past life and derive meaning from both positive and negative events, while achieving a positive sense of self.³Success at this stage results into sense of satisfaction, acceptance of past and no fear of death while failure leads to dissatisfaction, regrets and fear of death. The onset of this stage is usually initiated by life eventssuch as retirement, loss of spouse, friends and acquaintance, facing a terminal illness, and other changes to major roles in life.

Achieving ego integrity is dependent on accepting the life one has lived, perceiving both the positive as well as negative life events links together in a cohesive and meaningful manner. An aged individual may find it necessary to analyze and review what they have accumulated throughout their life and decides what offspring will receive from them upon death⁴. (Torges C. Stewart A.J. 2008). People who attains wisdom will inevitably experience both integrity and despair as altering states that need to be balanced. This balance is necessary during this stage as it leads to wisdom and the acceptance needed for mastery⁵.

If this stage is handled well, the person will have mastery which refers to ego strength or ego quality. Safe and secure sense of the ego and perception of his/her legacy, be it through the family support or the working environment, it may result into ego integrity which is characterized by self-acceptance, no fear of death and tolerance for the life styles of others, and yet they're decisive in defense of their own mode of living and feel happy and satisfied with their lives⁶. The resulting balance involves acknowledging despair and its role within the individual’s experience of self. The individual’s task is ultimately accepting the alternatives made during the past and becoming more satisfied with one’s self. Individual who are satisfied with their life are not afraid to face death⁷.

OBJECTIVES OF THE STUDY:

1. To assess the level of ego integrity among geriatric population.

2. To find out the association between ego integrity with the selected socio-demographic variables of geriatric population.

3. To prepare and disseminate the IEC material (Information Education and Communication material) on maintaining the ego integrity.

MATERIAL AND METHODS:

A Non -experimental research design was used to assess the level of ego integrity among geriatric population. The non-probability convenience sampling technique was used to select 340 geriatric population residing in RHTC, Pohir. Respect of human dignity as well as anonymity and confidentiality of the subjects was maintained throughout. Informed written consent was taken from geriatric population. Ryff and Heincke Ego integrity questionnaire tool was administered to assess the level of Ego integrity. It contains 16 items to assess ego integrity among geriatric population of RHTC, Pohir. Validity of tool was done from the field of Psychiatric Nursing, Medical Surgical Nursing. A total number of 16 questions were included and each question had a maximum score of 5 marks. The participants made their responses by choosing one option according to their level of ego integrity. Maximum score was 80 and minimum score was 16. After the data collection, data was coded, tabulated and analyzed by relevant descriptive and inferential statistics.

Score Criteria:

Mastery of ego integrity is denoted by an individual’s acceptance of his or her life and achievements. While moving through this process of mastering ego integrity versus despair, there must be the acceptance and disdain of life experiences. Therefore,

Table :1 criterion measure to assess the level of ego integrity

Level of Ego Integrity	SCORE
Low	16-37
Moderate	38-59
High	≥60

Table – 2: Frequency and percentage distribution of demographic variables regarding stress among elderly resident of old age home.

Demographic Variables	Number of Participants (n=340)	Percentage (%)
Age (years)
65-74	233	68.5%
75-84	99	29.1%
85-94	08	2.4%
Gender
Male	155	45.5%
Female	185	54.5%
Religion
Muslim	06	1.8%
Sikh	334	98.2%
Marital Status
Married	242	71%
Unmarried	5	1.4%
Widow/Widowers	2	0.5%
Divorced	91	27.1%
Educational status
Illiterate	154	45.2%
Primary school	120	35.2%
High school	50	15%
Senior secondary	14	4.1%
Graduate /postgraduate	02	0.5%
Types of family
Nuclear	48	14%
Joint	292	86%
Source of income
Dependent	152	45%
independent	88	55%
Utilization of leisure time
Engage with friends	107	31%
Engage with grandchildren	104	30.5%
Engage in religious activity	99	29%
No leisure activity	30	9.5%
Present working status
Yes	20	5.9%
No	320	94.1%
Past occupation
Government job	15	4.4%
Private job	20	5.88%
Self-employed /laborer	88	25.8%
Business	20	5.88%
Unemployed	05	1.66%
Homemaker	163	47.9%
Social worker	06	1.76%
Socio-economic status
Upper middle	16	4.7%
Lower middle	192	56%
Upper lower	71	20.8%
Lower class	61	18.5%

FINDINGS:

Fig 1: Distribution as per living status

Fig 2: Distribution as per extend of mobility

Fig3: Distribution as per chronic illness

Fig 4: Distribution as per participation in social activity

Table 2: exhibits that majority 233 (68.5%) of the geriatric population were in the age group of 65-74 years, followed by 99(29.1%) 75-84 years and 08(2.3%) 85-94 years of age group with mean age (71±5.4). Majority 185(54.5%) were female whereas 155(45.5%) were male. Majority 334(98.2%) were Sikh and 6(1.8%) Muslims. Maximum 242(71%) were married followed by 91(27.1%) widow/widower, 5(1.4%) were unmarried and 2(0.5%) divorced/separated, Maximum 154(45.2%) were illiterate, 120(35.2%) primary schoolers, 50(15%) high schoolers, 14(4.1%) senior secondary whereas 02 (0.5%) were graduates/post graduates. Majority 292(86%) were from joint family and 48(14%) from nuclear family. Maximum of 188(55%) elderly people were independent whereas, 152(45%) were dependent. majority 107(31%) of geriatric population utilized their leisure time with friends, 104(30.5%) engaged with grandchildren, 99(29%) engaged in religious activity. majority 320(94.1%) of geriatric population were non-working whereas by 20(5.9%) were working. maximum 163(47.9%) of geriatric population were homemaker. Followed by 88(25.8%) self-employed/laborer, 43(12.6%) in private job, 20(5.88%) in business, 15(4.4%) in government job, 6(1.76%) were social workers and 5(1.66%) were unemployed. Most of them 192(56%) were from lower middle class followed by 71(20.8%) upper lower class, 61(18%) lower class and 16(4.7%) belonged to upper middle class.

Figure 1: shows that majority 210(62%) of geriatric population were living with their spouse and children followed by 71(21%) only with children, 31(9%) with spouse only, 23(6.6%) living alone and 5(1.4%) with their relatives

Figure 2: displays that most of 228(67%) geriatric population were able to move freely followed by 68(20%) able to move only in the house, 23(7%) move only in their room, and 21(6%) were bedridden

Above pie depicts that majority 184 (54.1%) of the subjects possessed high ego integrity followed by 154(44.7%) moderate ego integrity and 4(1.19%) low ego integrity.

Table 3(a): Frequency, percentage and mean distribution of geriatric population.

Level of ego integrity	Frequency	Percent	Mean±sd
Low	4	1.19	36±0.36
Moderate	152	44.7	56±3.1
High	184	54.11	64±3.8

Table 3(b): Domain-wise mean and mean percentage of ego integrity score among geriatric population.

Domains of Ego Integrity.	Mean ± SD	Mean %
Satisfaction	22.1±3.23	73.6
Acceptance of past	33.7±6.73	74.8
Fear of death	3.4±0.76	68

Table 3(b) illustrates that mean score for acceptance of past (33.7±6.73) was higher than mean satisfaction score (22.1±3.23) and mean fear of death score (3.4±0.76).

Figure 3: indicates that maximum 186(55%) of geriatric population were chronically ill and 154(45%) were not chronically ill.

Figure 4: exhibits that most of them 190(55.8%) of geriatric population had vision problem followed by 110(32.3%) had hearing problem and 40(11.7%) had no sensory deprivation.

Table 3 (c) Item analysis of ego integrity among geriatric population.

Items	Mean ± SD	Mean %	Rank order
When I consider ups and down of my past life, they somehow fit together in meaningful way	4.09±0.90	81.8	1
*If I could turn back the clock, there are many things I would do differently.	3.9± 0.94	78.3	2
*Reading old diaries and letters usually brings more pain than pleasure.	3.9± 0.98	78.12	3
*In general, I would say I have few regrets about my past life.	3.9±0.9	78	4
My life has been fulfilling, and I am not frightened by thought of death.	3.9± 0.9	78	4
*I wish I had been born during different period of history.	3.9± 0.9	78	4
It does not bother me to think about goals I haven’t reached and probably never will.	3.6 ±0.90	76.34	5
*One of my greatest disappointments is that, I have not been able to do more traveling.	3.8 ±0.88	76.32	6
*There are many people whose life I would prefer to my own.	3.8 ±0.83	76.20	7
*If I had just couple more lucky breaks, my life would have turned out much differently	3.8±0.81	76	8
I feel generally contended with what, I accomplished in my life.	3.7±0.8	74	9
All in all, I am comfortable with the choices I made regarding my life’s work.	3.7±0.77	74	9
If I had to do it all over again, there are very few things about my life I would change.	3.69±0.72	73.8	10
*There are some disappointments in life I will never be able to accept.	3.6±1.24	72.4	11
*I still feel angry about certain of my childhood experiences	3.6±1.06	72	12
I wish my life were just beginning’s so I could avoid many mistakes I made earlier in my life	3.6±0.8	71	13

Above table depicts ‘they consider ups and down in their past life as meaningful’ which is ranked as 1 with mean score (4.09±0.90) and item “I wish my life were just beginnings so I could avoid many mistakes I made earlier in my life” is ranked last.

Table 4: Association of level of ego integrity with socio demographic variables of geriatric population

Socio-demographic Variables	Ego integrity
Socio-demographic Variables	n	Mean± SD	F/t value	p value	df
Age (in years)
65-74 75-84 85-94	233 99 08	55.1±9.20 60.93±8.18 64.25±5.23	F=0.013	0.02^*	339
Gender Male Female	155 185	59.9±8.45 58.9±9.26	t=1.705	0.19^NS	338
Religion Muslim Sikh	6 334	54.8±4.49 59.4±8.96	t=1.571	0.21 ^NS	339
Educational status Illiterate Primary school High school Senior secondary Graduate /postgraduate	154 120 50 14 02	57.6±9.8 58.9±7.7 63.4±8.74 66.7±7.41 61.5±10.6	F=0.709	0.001**	339
Marital status Married Unmarried Separated /Divorced Widow/widower	231 06 17 86	59.4±8.7 52.3±9.6 60.7±10 59.38±8.9	F=1.37	0.249^NS	339
Type of family Nuclear Joint	48 292	59.4±9.31 59.2±8.84	t=.006	0.93^NS	339
Are you working presently? Yes No	20 320	60.6±4.0 59.2±9.1	t=0.44	0.5^NS	339
Past occupation Government job Private job Self-employed/labor Business unemployed homemaker Social worker	15 43 88 20 05 163 06	62.86±9.18 62.6±8.39 59.2±7.92 56.2±8.30 64±6.20 58.5±9.4 52.5±7.2	F=2.36	0.04*	339
Source of income Dependent Independent	152 188	59.1±9.3 59.4±8.6	t=0.092	0.761^NS	338
Living status Living alone With spouse only With children only With spouse and children With other relatives	23 32 74 210 01	58.3±9 61.8±9.54 59.4±8.79 59±8.8 51±0.01	F=0.973	0.423^NS	339
Presence of chronic illness Yes No	154 186	57.4±8.74 60.84±8.78	t=1.23	0.001*	338
Extent of physical mobility Bedridden Can move around the room Can moves in the house Can move freely	21 23 68 228	58.14±7.12 58.60±10.18 59.05±8.7 59.63±8.93	F=0.279	0.84^NS	339
Presence of any sensory deprivation Nil Problem in vision Problem in hearing	40 190 110	57.8±8.74 58.9±8.52 60.69±9.55	F=2.061	0.129^NS	339
Utilization of leisure time No leisure activity Engage with friends Engage with grandchildren Engage in religious activity	30 107 104 99	59.35±10.87 59.54±8.87 59.24±8.44 59.7±8.91	F=0.340	0.79^NS	339
Participation in social activity Yes No	206 134	60.24±8.4 57.9±9.54	t=5.22	0.023*	338
Socio- economic status Upper middle Lowe middle Upper lower Lower class	16 192 71 61	67.5±7.59 58.6±8.1 60.98±8.71 57.4±10.4	F=6.835	0.001**	339

OBJECTIVES OF THE STUDY:

MATERIAL AND METHODS:

Score Criteria:

DISCUSSION:

The above study is supported by the following study:

Jolene V. K, Morbee S, Vansteenkiste (2020) carried out the study to assess the role of ego integrity and despair in older adults during Covid-19 crisis. The results revealed that majority were (62.1%) females between age group of 65-89 years⁸.

Vinsi M.S. (2015) similar study was reported which revealed that mean ego integrity score among female geriatric population was 117.35±32.81 and were moderately satisfied on the level of ego integrity⁹.

CONFLICT OF INTEREST:

None.

OBJECTIVES OF THE STUDY:

MATERIAL AND METHODS:

Score Criteria:

DISCUSSION:

The above study is supported by the following study:

Jolene V. K, Morbee S, Vansteenkiste (2020) carried out the study to assess the role of ego integrity and despair in older adults during Covid-19 crisis. The results revealed that majority were (62.1%) females between age group of 65-89 years8.

Vinsi M.S. (2015) similar study was reported which revealed that mean ego integrity score among female geriatric population was 117.35±32.81 and were moderately satisfied on the level of ego integrity9.

CONFLICT OF INTEREST:

None.

Jolene V. K, Morbee S, Vansteenkiste (2020) carried out the study to assess the role of ego integrity and despair in older adults during Covid-19 crisis. The results revealed that majority were (62.1%) females between age group of 65-89 years⁸.

Vinsi M.S. (2015) similar study was reported which revealed that mean ego integrity score among female geriatric population was 117.35±32.81 and were moderately satisfied on the level of ego integrity⁹.