INTRODUCTION

The word “Aging” and “Old Age” are highly subjective. “Aging” is defined as the time from birth to the present for a living individual, as measured in specific units (John Anne). The meaning of old and aging depend to a great extent on how old the speaker is and that person’s experiences.

The process of aging is a complex one that can be described chronologically, physiologically, and functionally. Chronological age refers to the number of years a person has lived. Physiological age refers to the determination of age by body function. Functional age refers to a person’s ability to contribute to society and benefit others and himself (Billig, N)

In an attempt to further define the aging population, old age has been divided into chronological categories:

Young-old (ages 65 to 74)

Middle-old (ages 75 to 84)

Old-old (age 85 and older)

World elderly population has been growing for centuries. The size of the elderly population of age 60 years and above will cross one billion in 2020. In India, since 1961, sharp decline in the overall death rate, mortality levels in the older age group as well as increased life expectancy initiated a process of aging. Census data in 1991 showed 55 million persons above the age of 60 representing 6.5% of total population. It has been estimated that nearly 75% of aged persons are living in villages. 48.2% of old aged people are women, among them 55% are widows. One third of the people are living below the poverty line. Nearly 66% of elderly people are living without adequate food, shelter and clothing.

Aging is a normal part of human development. The patterns of aging – what happens, how and when – vary greatly among older people. Although specific changes are identified as part of the normal aging process, each person ages in his own way. As the age advances, people become more diverse rather than more alike, each influenced by physical, social, and environmental factors. How a person ages depends on a combination of both genetic and environmental factors such as life experiences, available support systems, coping skills. Recognizing that every individual has his or her own unique genetic makeup and environment, which interacts with each other, helps us to understand why the aging process can occur at such different rates in different people. An overall, genetic factor seems to be more powerful than environmental factors in the determining the large differences among people in aging and lifespan.

The aging process will affect the old age people physically, psychologically, socially, spiritually. As ageing progress, physically aged people become less active. Based on wear and tear theory of aging, degenerative changes takes place almost in all the systems such as brain, cardio vascular system, respiratory system musculo skeletal system exposing the elderly people to a greater degree of physical illnesses. As a person ages, sensory capabilities such as hearing, vision, touch, taste, and smell are deteriorating. Hearing and vision losses are more upsetting, because they directly affect the ability to perform day today activities, threaten the bodily safety, and distort communication and they develop dependency.

Prevalence of chronic diseases among the aged in general seem to be very high. It is higher in the urban areas (55%) than in the rural areas (52 %) due to the changes in the life style. However, disabilities are more common among elderly females compared to male up to age 80, beyond which disability becomes less due to increased number of woman elderly. The most common problems faced by the elderly are Visual impairment (88%), Loco motor disorder (44%), Neurological complaints (18.7%), Hearing loss (8.2%), Respiratory disorder (16.1%). (Jhilam Rudra 2007).

Psychosocially, due to the aging process old people are often depressed and feel loneliness. Because old people are often sick and tired and also retired, and usually don’t have money, they must spend money for medications. They can’t eat a lot of dishes due to loss of teeth and taste buds losing their sensibility. Old age people often have depressions and sometimes don’t want to live any longer due to the loss of spouse. Due to lack of adequate financial support they feel they are burden to their family members. The most common psychological problems found in old aged people are Mood disorders, Dementia, Memory loss, Personality changes and Psychosis. Some old aged people experience difficulty in adjusting with the changes occurred as a result of aging. As a result there is more chance for bitterness and depression.

In the last decades joint family system was very common. Today due to the socio cultural changes the joint family pattern has been changed to nuclear ones. Currently, the incidence of elderly abuse and aged destitute have increased in India.

Old age homes are a necessity in the current situation as the younger generation are staying away from the parents due to job, education, settled in abroad and also due to the scarcity of the resources to meet their needs (like medical expanses, foods etc).The development of old age home was based on supporting the elderly. There are old age homes run by the government and non governmental organizations. Even though some old age homes are giving proper care with all facilities, some are providing only shelter and food, no medical facilities.

Old age home residents will have anxiety about their current situation and about future. Frequently they will have worries about their children and grand kids. These emotional disturbances can lead to frustration which in turn can distress their sleep.

Due to physical problems like pain, breathing difficulty, and emotional disturbances old age home residents are experiencing poor quality of sleep and psychological wellbeing.

The sleep starts to erode in late middle age and progressively decline from then on. With aging, the percentage of sleep spent in stage 3 or 4 decreases. Episodes of REM sleep tend to be shortening. Some old age people have almost no stage 4, or, deep sleep. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep. The elderly people will experience difficulty in falling and staying asleep. They tend to fall asleep earlier in the evening and awaken earlier in the morning Dr. Michael Vitiello, (2009).

Emotional disturbance and sleep disorder are closely related. Both these attributes can affect the state and quality of other one. Since old age home residents encounters these issues frequently, every one need to concentrate on relaxation methods which will ease the body and mind, by lowering the catecholamine release. These chemicals circulate throughout the body and affect various systems.

Relaxation is the state of generalized decreased cognitive, physiological, and behavioral arousal. Relaxation is also defined as arousal reduction. The process of relaxation elongates the muscle fibers, reduces the neural impulses sent to the brain, and thus decreases the activity of the brain as well as other body systems. The relaxation response can be obtained through a variety of techniques like deep breathing exercise, progressive muscle relaxation technique. Relaxation helps individuals develop cognitive skills for reducing the negative ways in which they respond to situations within the environment.

Deep breathing exercise involve slow, relaxed , deep, usually abdominal breathing which evokes a restful state, lowers oxygen consumption, reduces respiratory and heart rates , and generates reports of reduced anxiety (Fontaine 2000)

Progressive muscle relaxation technique teaches the individual how to effectively rest and reduces tension in the body. By alternatively tensing and relaxing each muscle group one can reduce the muscular tension which in turn ease the body and mind. (Edmund Jacobson 1920)

NEED FOR THE STUDY

Old age people are like the reservoir of knowledge and experience in your basket but their suggestion is not fit for this generation. (Henry Donald 2008)

In the last decades joint family system was very common, with lot of family members around. In such a situation the old age people were well cared by the family members. Even after their retirement they were engaged with some other work like small shopping, going out with their grand children etc., so they don’t feel lonely thinking about themselves, and their problems and aging process.

Today due to the socio cultural changes the joint family pattern has changed to nuclear ones. And even if there is a joint family the members are restricted to 4 or 5. This has created great impact on the old age people as they are left alone due to the higher education and settled jobs of their children in abroad and now days even with the females working, they receive no attention at all. Some do send financial help for their parents but whereas, some do not even look back their parents. Since the children are away and no body to take care of them, naturally they feel lonely, become depressed and forced to be more concerned about their health problems much more.

As a result numerous old age homes have emerged as a new trend to take care the elderly in India. Previously such a trend was prevalent only in western countries. But, now it is very common in our country also.

As mentioned earlier, family bonding is pivotal in sustaining the wellbeing of elderly. We can only consider old age home as an alternative option and should give more stress towards improving and maintaining a strong and emotionally bound family system which can assure a healthy and joyful twilight in one’s life

It is the responsibility of each and every citizen in India especially health care personnel to safe guard life of elderly people. We need to take immediate measures to improve the quality of life of elderly especially those who do not have anybody to support them.

Old age homes should have adequate facilities, such as food, safety and security, and medical facilities. But most of them do not have all these.

Reports showed that nearly half of the nursing home residents are affected by depression, more than 70% of the residents experience sleep disturbance. Depression and sleep disturbance are related to one another. The elderly people with depression may have sleep disturbance. Sleep disturbance also results in emotional instability. The sleep cycle of the elderly people is interrupted by brief wakeful moments. And also they are having problem in falling asleep. The time taken to sleep after going to bed is prolonged.

Relaxation therapy is one of the best method to improve concentration, emotional stability and promoting sleep by easing body and mind and reducing stress and anxiety. From the literature review it is quite evident that relaxation therapy is beneficial to improve the psycho social wellbeing and quality of sleep. There are different techniques in carrying out the relaxation therapy and some of the technique has already been tried out in post operative pain reduction, anxiety reduction in India and in other countries.

Among all the relaxation techniques deep breathing and progressive muscle relaxation does not take much time to perform, requires no special equipments, except a calm and comfortable place to do the exercise. Both are very simple to teach and practice by any age group. Besides they are cost effective with least side effects.

The researcher, during her clinical posting in geriatric ward, visited various old age homes and community areas and found out that most of the elderly people are suffering from sleeplessness, and emotional disturbance, memory deficit, and poor concentration. They are very much worried about their problems. Old age home residents are mainly take care by the geriatric nurse who is staying along with them in old age home as well as in clinical setting. Old age home staff need to take steps to improve the sense of wellbeing of old age people by relaxing their mind and body and improving their sleep. So the investigator wanted to do something for the benefit of this population. The investigator felt a need to assess the effect of deep breathing and progressive muscle relaxation technique on improving psycho social wellbeing and quality of sleep in elderly people staying in old age home.

STATEMENT OF PROBLEM:

A study to assess the effectiveness of selected relaxation techniques on the level of Psychosocial wellbeing and Quality of Sleep among old age people in selected Old age home at Coimbatore.

AIM OF THE STUDY

The aim of the study was to evaluate whether Deep breathing and Progressive Muscle Relaxation Technique make a difference in the level of Psychosocial wellbeing and Sleep among old age people compared to a group of old age people without receiving the relaxation therapy.

SPECIFIC OBJECTIVES

The specific objectives of the study were,

To assess and compare the level of psychosocial wellbeing (cognitive, emotional, social, and spiritual wellbeing) in the experimental and control group, before and after the intervention.

To assess and compare the quality of sleep in the experimental and control group before and after the intervention.

To associate the selected demographic variables like age, gender, physical illness, supportive system with level of psychosocial wellbeing and quality of sleep.

HYPOTHESIS

H1: There will be a significant difference in the mean cognitive wellbeing score of experimental and control group after intervention and no significant difference before intervention.

H2: There will be a significant difference in the mean Emotional wellbeing score of experimental and control group after intervention and no significant difference before intervention.

H3: There will be a significant difference in the mean Social wellbeing score of experimental and control group after intervention and no significant difference before intervention.

H4: There will be a significant difference in the mean spiritual wellbeing score of experimental and control group after intervention and no significant difference before intervention.

H5: There will be a significant difference in the mean overall psychosocial wellbeing score of experimental and control group after intervention and no significant difference before intervention.

H6: There will be a significant difference in the mean sleep score of experimental and control group after intervention and no significant difference before intervention.

OPERATIONAL DEFINITIONS

Sleep: Sleep is a state of rest in which the nervous system is inactive, the eyes are closed, the muscles are relaxed and the mind is unconscious. The characteristics of sleep can be verbalized by a person who experiences the sleep. In this study, the self report of sleep is measured by standard Pittsburg sleep quality index scale.

Psycho Social Wellbeing: It is a subjective phenomenon that means different things to different people. A feeling of wellness by an individual. In this study it includes the feeling of wellness in psychological, social, spiritual and behavioral aspect of an individual, which is measured by a modified self reported psycho social wellbeing assessment scale.

Cognitive wellbeing; Cognitive wellbeing is a subjective phenomena which reflects the ability of the individual regarding how to think, perceive, remember and learn facts and ideas, which is measured by a modified self reported psycho social wellbeing assessment scale.

Emotional wellbeing; It is a subjective statement which reflects how positively an individual feels, perceives, and reacts to the internal and external stimuli and it can be assessed by increasing heart rate, respiration and BP. In this study emotional wellbeing is measured by individual score obtained from modified psycho social wellbeing assessment scale.

Social wellbeing; It is a subjective statement, which reflects how well an individual is able to interact with the fellow people, is able to adjust to situations, is able to maintain positive social status, is able to involve in group activities, which is measured by a modified self reported psycho social wellbeing assessment scale.

Spiritual wellbeing: It is a subjective statement which reflects how an individual perceives God, how important does one consider prayer to be in their life, which is measured by a modified self reported psycho social wellbeing assessment scale.

Relaxation Techniques : It is individualized or combined, systematically executed exercises, used to ease the body and mind by unwinding natural stress response thus lowering the blood pressure, respiration and pulse rate, relaxing the muscle and easing emotional strains. In this study, relaxation techniques used are deep breathing exercise and progressive muscle relaxation techniques.

Deep Breathing Exercise: It is a type of relaxation technique in which a person deeply inhale through nose by closing the mouth, hold for some time and then exhale completely through the mouth.

Progressive Muscle Relaxation Technique: It is a type of relaxation technique in which a person need to tense and relax each muscle group one by one in sequence

ASSUMPTION:

Aging is a natural phenomenon.

The patterns of aging vary greatly among older people.

Aging is an involuntary process which alters normal biological, psychological and social functions.

Psycho social wellbeing of the older people will vary based on certain demographic factors such as Age, Sex, Education and available supportive system.

Variability in the sleep behaviors of older people is common.

LIMITATIONS:

As sample size is small results cannot be generalized

Data on psycho social wellbeing and quality of sleep based on verbal report may not be a true reflection of what they experience.

DELIMITATIONS:

The study is delimited to one old age home in Coimbatore.

The study is delimited to people in the age group of 65-85 yrs

SCOPE OF THE STUDY

This study will help to assess the level of psycho social wellbeing and quality of sleep of the old age people staying in old age home before and after the intervention. If there is significant improvement in the level of psycho social wellbeing and quality of sleep, it is a clear indication of effectiveness of relaxation techniques. These relaxation techniques will be beneficial for the elderly people staying in old age home. It can be easily implemented and taught by nurses who are employed in old age homes as well as in geriatric ward in hospitals. The regular practice of these techniques will improve the quality of life of the old age people with psychological problems and sleep disturbances.

CONCEPTUAL FRAME WORK

Conceptual frame work refers to interrelated concepts or abstractions that are assembled together in some rational scheme by virtue of their relevance to a common theme (Polit Hunger – 1997)

Theoretical model for this study was derived from Callista Roy’s Adaptation Theory (1996). Roy employs a feedback cycle of input, throughput, and output. Input is identified as stimuli, which can come from the environment or from within a person. Stimuli are classified as focal (immediately confronting the person), contextual (all other stimuli, that are present) or residual (non specific such as cultural beliefs or attitude about illness). Input also includes a person’s adaptation level (the range of stimuli to which a person can adapt easily. Through input we can make use of a person’s processes and effectors. “Process” refers to the control mechanisms that a person uses as an adaptive system. “Effectors” refers to the physiological function, self concept, role function and interdependence involved in adaptation.

In the adaptive system, the term “system” is defined as self parts connected to function as a whole for some purpose and it so by virtue of the interdependence of its parts. This has two major internal control process called “regulator” and “cognator”.

Regulator sub system consists of internal process including chemical, neutral, and endocrine – transmit the stimuli, causing output – physiological response, cognator and sub system regulates self concepts, role function and inter dependence.

Output is the outcome of the system; when the system is a person, output is categorized as adaptive responses (Those that promote a person’s integrity) or ineffective responses (those that do not promote goal achievement) these responses provide feedback for the system.

The modified model in this study explains the input as the focal stimuli namely poor psycho social wellbeing and poor quality of sleep. The contextual stimuli are age, sex, education, duration of staying in old age home, no of children, presence of visitors. The coping mechanism of the cognator subsystem occurs as a result of relaxation therapy. The experimental group is subjected to relaxation therapy. The adaptive responses among the experimental group of old age people show improvement in the psycho social wellbeing and quality of sleep. The control group that has not undergone the relaxation therapy might not show an effective adaptation.

Figure – 1 highlights the conceptual framework based on modified Roy’s adaptation model.