The Effect of Cognitive Puzzle Therapy on the Independence Level of Elderly with Dementia in Nursing Home East Jakarta

ISSN 2354-8428 e-ISSN 2598-8727 JURNAL KEPERAWATAN KOMprEhEnsIF COMPREHENSIVE NURSING JOURNAL Vol. 10 No. 2, April 2024 Published by : Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat JURNAL KEPERAWATAN KOMPREHENSIF VOL. 10 NO. 2 Bandung April 2024 ISSN 2354-8428 e-ISSN 2598-8727 315 p-ISSN : 2354 8428 | e-ISSN: 2598 8727 Jurnal Keperawatan Komprehensif Volume 10 Issue 2 April 2024 Research Article The Effect of Cognitive Puzzle Therapy on the Independence Level of Elderly with Dementia in Nursing Home East Jakarta Dheni Wahyudi1* │ Syamsul Anwar2 │ 1,2,3Faculty of Nursing, Universitas Muhammadiyah Jakarta 10510, Indonesia *contact Received : 29/09/2023 Revised : 18/04/2024 Accepted : 28/04/2024 Online : 30/04/2024 Published : 30/04/2024 Lily Herlinah3 Abstract Aims: This study aims to identify the effect of puzzle cognitive therapy on the level of independence of elderly people with dementia in nursing homes. Method : the research used a quasi-experimental pre-post design with control group design. Sampling was taken using a total sampling technique, 24 respondents in the intervention group and 24 in the control group. Puzzle therapy was carried out for 9 sessions. Measurement of independence used the MMSE (Mini mental status examination) questionnaire and the Katz Index. Analysis with dependent t-test at significance 0.05 (CI 95%) and GLM-RM (General Linear Model Repeated Measure). Results: The results of the paired T test in the intervention group produced a p-value of 0.000, while the control group had a p-value of 0.043. dependent T test and Greenhouse-Geisser (sig) with p value 0.00. Elderly people who are given puzzle activities improve the health and well-being of elderly people with cognitive decline Conclusion: puzzle therapy can improve increasing independence in elderly people with dementia. Keywords: Elderly, Independence, Puzzle Cognitive Therapy INTRODUCTION The elderly population is growing as medical facilities and services are improved, birth rates are regulated, life expectancies rise, and mortality rates fall. Extended life expectancy in the elderly does not eliminate the issue of declining body function, which affects the elderly's independence in performing daily activities. The structure and function of our cells, tissues, and organ systems deteriorate with grow older, which has a negative impact on our physical and mental health. This, in turn, affects how our family, socioeconomic status, and social roles change, which makes it more difficult to adapt to new situations and engage in social interactions (1). https://doi.org/10.33755/jkk The elderly's physical changes in the nervous system occur with impaired memory, thinking, comprehension, orientation, arithmetic, language and value functions as a result of impaired brain function, experiencing a decline in the body system which includes physical, mental and psychosocial changes (2) Dementia is a syndrome of decreased cognitve function which results in disruption of daily activities and is accompanied by behavioral disorders without delirium or major psychiatric disorders (3). The elderly often suffer from Alzheimer's dementia, which is a degenerative disease that occurs due to a decrease in brain function which affects emotions, memory, decision making, This is an open access article under the CC BY-SA license 316 p-ISSN : 2354 8428 | e-ISSN: 2598 8727 Jurnal Keperawatan Komprehensif Volume 10 Issue 2 April 2024 behavior and other brain functions, thereby interfering with activities in daily life, (4). images or information absorbed, and retaining the information obtained (7). Health problems in the cognitive function of the elderly are very important for the wellbeing of the elderly. Cognitive activities carried out regularly are thought to be able to maintain excellent cognitive function in the elderly. This needs to be proven by examining differences in cognitive function in groups of elderly who carry out cognitive activities regularly and non-routinely. It is believed that frequent cognitive exercises might help the elderly maintain outstanding cognitive function. This has to be demonstrated by comparing cognitive performance between groups of older people who engage in cognitive activities frequently and irregularly (5). METHODS Puzzle Therapy is a non-pharmacological therapy to prevent decline in cognitive function (6). The elderly can engage in brain-training exercises with puzzle therapy, which reassembles pictures that have been broken into pieces, to improve their capacity to think critically, develop patience, and become accustomed to sharing. Puzzle therapy is a cognitive exercise that stimulates the brain by providing adequate stimulation to maintain and improve the brain's remaining cognitive functions. The brain will work when taking, processing, interpreting The research design used a quasiexperimental design with a two-group pre-test-post-test control group design carried out for 3 weeks at Nursing Home East Jakarta. Sample collection was based on inclusion criteria. The elderly were required to be conscious and peaceful, to have mild to severe dementia, and to not be receiving medical treatment., do not have any hearing, vision, or communication issues. The sample size used in this research using the Lameshow formula obtained 24 respondents in each group. The sampling technique used is a non-probability sample using the sampling technique method in this research using purposive sampling. In this study, MMSE (Mini mental status examination) questionnaire and Katz index are used to assess elderly independence. The intervention group had 9 sessions of puzzle therapy over a three-week period, with each session involving a re-assessment of independence using the Katz index. Frequency distributions and percentages are used in univariate analysis, the tdependent test with a level of significance of 0.05 (CI 95%) is used in bivariate analysis, and the Generalized Linear Model (GLM) is used in multivariate analysis. RESULT Characteristics Of Respondents The results of the research on the characteristics of respondents include age, gender and independence of the elderly Table 1. Distribution of respondent characteristics by age, gender, and level of independence Variable Age Gender elderly old age elderly very old females male https://doi.org/10.33755/jkk Intervention f (%) 18 (75.0%) 6 (25,0%) 11 (45,8%) 13 (54.2%) Control f (%) 14 (58.3%) 8(33.3%) 2 (8.3%) 12 (50%) 12 (50%) This is an open access article under the CC BY-SA license 317 p-ISSN : 2354 8428 | e-ISSN: 2598 8727 Independence Jurnal Keperawatan Komprehensif Volume 10 Issue 2 April 2024 Full function Moderate impairment Severe functional impairment 1 (4.2%) 20 (83.3%) 3 (12.5%) 1 (4.2%) 18 (75.0%) 5 (20.8%) According to the table above, respondents in both the intervention group (75.0%) and the control group (58.3%) had a majority of elderly. Males made up the majority (54.2%) o (...truncated)