MEAN LEVEL OF DEPRESSION AMONG THE ELDERLY BASED ON EACH INDICATOR OF GERIATRIC DEPRESSION SCALE ( GDS ) INSTRUMENT IN SELECTED SOCIAL INSTITUTION YOGYAKARTA INDONESIA

Introduction : Population around the world are rapidly aging, the increasing number of elderly in the world is expected to be a new problem for world health. Aging presents both challenges and opportunities. In this aging process, several changes concerning the biological, psychological, social and spiritual aspects, is expected to occur. Indonesia has entered the country as well as the provisions of the old population structure of the world body because of the increased number of erderly people that almost reached more than 7 percent. The purpose of this research was to determine Mean Level of Depression among the Elderly based on each indicator of GDS Instrument. Methods : This study descriptive analyzed, quantitative methode. The number of research samples was 60 elderly. Data unvaried analyzed to each indicator Depression of modifications GDS Instrrument. Results : Level of each indicators of modifications Geriatrics Depression Scale (GDS) that is Physical aspect obtained the general weighted mean of 2.86 with verbal interpretation moderate level, Psychological aspect got the general weighted mean of 2.95 with verbal interpretation of moderate level and Social aspect got the general weighted mean of 2.92 with verbal interpretation of moderate level. Conclusions : Clients who are experiencing depression becomes helpless because of loss of energy, Hopelessness and problem of interaction with environment such as family members and friends.


INTRODUCTION
Population around the world are rapidly aging, the increasing number of elderly in the world is expected to be a new problem for world health.Aging presents both challenges and opportunities.It strains pension and social security systems, increase demand for acute and primary health care, requires larger and better trained health workforce and increase the need for long term care (Irawan, 2013).There is a demand to ensure the quality of elderly social welfare so that they will not experience serious problems and remain productive.Indonesia has entered the country as well as the provisions of the old population structure of the world body because of the increased number of elderly people that almost reached more than 7 percent.Indonesia ranked fourth in the world for having the bigger number of elders next to China, India and Japan (U.S. Census Bureau, International Data Base, 2009).
Changes in the body system in the elderly is due to the aging process resulting to decreased ability of the elders for physical activity and changes in their physical appearance affect the elder's social and economic life (Pangastuti et al, 2019).This situation is a stressor that can lead to negative feelings for the elderly that is having the feeling of helplessness, uselessness, frustration, despair, sadness and feelings of isolation, that often cause and lead to their minimal interactions with others on total withdrawal from others.
In addition to biological changes, aging process has an impact on the psychological changes among elderly.Psychological changes are closely related to biological changes that might occur.A change in the biological or physical has an impact on the ability of sensation, perception and psychomotor performances which are extremely important in performing the activities of daily living among elders (Atchley & Barusch, 2009).This functioning decreases the effect on The existence of a serious physical illness in particular with regard to the brain as well as those living in a special place such as social institutions can lead to the elderly experiencing behavioral changes (Ebersole, et al., 2008).Change in behavior relates to emotional feelings of sadness, fear, anger, frustration, guilt, feeling helpless and useless (Judha, & Syafitri, 2018).This change is an indicator of psychosocial problems in the elders.In addition to the biological and psychological changes, the aging process can also affect the social life of the elderly (Pratiwi, 2018).
Social changes experienced by the elderly affects their status and role performances within the group or community, loss of support system by the family, friends and neighbors (Ebersole, et al., 2008).In additions to physical and psychological problems there are some factors that may affect the mental health of elders.Financial problems can also be stressors for the elders.
In Indonesia lot of the elders, are staying in Social Institutions because they feel that they are being neglected by their immediate family members, friends and relatives.These are the elders who at present are experiencing signs and symptoms of depression may be because of loss of social support system, economic, adequacies in life style and many more.Depression among the elderly may worsen if this situation is not addressed properly.
Based on the results of a preliminary study conducted by researchers at the Social Institution in Yogyakarta, they found out that among the twenty (20) elderly people who were interviewed sixty percent (60%) of the elderly experienced depression with symptoms of feeling helpless, useless, lonely, and lazy to follow the activity and do not socialize with other seniors.Observation revealed of that most of the elderly people are left alone in their homes with no opportunities to do any activity and communicate with others.This phenomenon was supported by the background of the elderly, who live in this social institution which is 90% and with the background of being displaced.This research was to determine Mean Level of Depression among the Elderly based on each indicator of GDS Instrument.

METHODS
This study was participated by 60 depressed elderly in Social Institution in Yogyakarta.A Self-made survey questionnaire was formulated and utilized by the researcher.This instrument is a scale measuring depression in the elderly (Geriatric Depression Scale / GDS).Scale GDS constitutes a measuring tool for depression among elderlies that is both universal and is more accurate than the measuring tools (Ebersole, et al., 2008).The instrument used was a 20 item questionnaire.The 15 items were derived from the GDS and 5 were formulated by the researcher.Validation of the research instrument was done in consultation with three expert psychiatric nurses.Pilot testing was conducted to assess the validity and reliability of the survey tool utilizing the Cronbach Alpha method.The value of the reliability-Cronbach's alpha-coefficient is 0.877, indicating that the instrument is highly reliable.The data collected were computed utilizing the following statistical tools Weighted mean was used to measure the depression level of the respondents.

RESULTS
The tables 1 show the mean level of the elderly respondents.The assessment taken from the total number of questions answered by the respondents included on about Physical, Psychological, and Social aspects.

DISCUSSIONS
The results of this study, Physical aspect obtained the general weighted mean of 2.86 with verbal interpretation moderate level.Statement number 3 and 5 in the experimental group got the highest mean of 3.13 with verbal interpretation of moderate level of depression and statement no. 4 got the lowest mean of 2.26 with verbal interpretation of low level of depression which further explains that clients who are experiencing depression becomes helpless because of loss of energy.Depression is a feeling of sadness, helplessness, and pessimism associated with an affliction, it is also a psychiatric disorder in form of natural feeling such as affective, and mood disorder characterized by moodiness, lethargy of passion, feeling useless, and hopelessness, Pieter and Lopez (2010).Physical symptoms that can be found in individuals with depression include: Impaired sleep patterns (difficulty sleeping, too much or too little).The reduced level of activity, in general, people with depression showed a passive behavior, like activities that do not involve others such as watching television, eating and sleeping.Depressed individuals easily gets tired and exhausted but able to participate / perform on entire function of the person in all his/her endeavor.
Psychological aspect got the general weighted mean of 2.95 with verbal interpretation of moderate level.Statement no.11 in the experimental group got the highest mean of 3.26 and statement no.14 got the lowest mean of 2.73 with both verbal interpretation of moderate level of depression.Result further explain that clients who are experiencing love to compare themselves with others, the others are more successful, smart, lucky, wealthy, more educated, more experienced, more attention and other negative thoughts.Psychologically according to Miller (2009) depression in the elderly can lead to feelings of anxiety, irritable, decreased self-esteem, no sense or feeling empty and negative feelings about themselves.The psychological symptoms that can be found in individuals who experience depression are: loss of self-esteem, depressed individuals tend to see things in a negative light, including hopelessness.Depressed people feel useless and this feeling arises because the individual also feels he/she is a failure, especially in one's field of especialization.Individuals perceive an event that happened to him as a punishment or a consequence of his failure.The feeling of guilt and being overwhelmed are usual occurrence for depressed people.
Social aspect in the experimental group got the general weighted mean of 2.92 with verbal interpretation of moderate level.Statement no. 15 in the experimental group got the highest mean of 3.26 and statement nos.19 and 20 got the lowest mean of 2.73 with both verbal interpretation of moderate level of depression which further explains that clients who are experiencing social problems that occur normally revolve around the problem of interaction with environment such as family members and friends.This problem is not only in conflict, but there are also other problems like feeling of inferiority, shame, anxiety if it is among the group and feel comfortable to be open and actively establish relationship with the environment even if there is a chance (Lubis, 2010).Social problems that occur in an individual normally revolve around the problem of interaction with environment such as family members, friends, co-workers, superiors or subordinates.This problem is not only in conflict, but also other problems as well as feelings of inferiority, shame, anxiety of being in and among the group and feeling uncomfortable to be open and less intention to establish relationship with the environment even if there is a chance.This phenomenon is in accordance with the material questions in the GDS like feeling dissatisfied, unhappy, feeling empty and hopeless, feeling excited, decreased activity, feeling helpless, feeling the energy and presence of mind of other people are better.

CONCLUSIONS
Clients who are experiencing depression becomes helpless because of loss of energy, Hopelessness and problem of interaction with environment such as family members and friends.

Table 3 ,
Social aspect got the general weighted mean of 2.92 with verbal interpretation of moderate level.Statement no. 15 in the experimental group got the highest mean of 3.26 and statement nos.19 and 20 got the lowest mean of 2.73 with both verbal interpretation of moderate level of which further explains that clients who are experiencing social problems that occur normally revolve around the problem of interaction with environment such as family members and friends.