Effectiveness of Foot Bath in Reducing Selected Joint Pain among Elderly People

 

Mrs. Shruthi Keerthi.G¹, Mrs. Malathi. K², Dr. Sangamesh Nidagundi³

¹Assist Prof. of Medical Surgical Nursing, Faculty of Nursing, Sri Kalabyraveshwara Swamy College of Nursing, Bangalore

²Lecturer of Medical Surgical Nursing, Faculty of Nursing, M.S.Ramaiah Institute of Nursing education and Research

³Principal and Prof of Community Health Nursing, Faculty of Nursing, Sri Kalabyraveshwara Swamy College of Nursing, Bangalore

 

ABSTRACT:

Ageing is a natural, universal and inevitable process. The naturally occurring changes that are bound to occur are many, one such change is pain in the joints and the pain is considered as fifth vital sign. The study was aimed to assess the effectiveness of footbath in reducing selected joint pain among elderly people. An evaluative approach with quasi experimental non equivalent control pre test post test design was selected for the study. A total of 30 elderly people [15 experimental and 15 control group] with selected joint pain residing in urban areas of Mathikere health centre were selected by non-probability purposive sampling technique. The pre test level of joint pain was assessed using Modified Geriatric pain measure for both the groups. Footbath was provided to elderly people in the experimental group every alternative day for 2 weeks. Post test was conducted for both the groups using the same tool two weeks after pre test. Data were analysed by using descriptive and inferential statistics. The result revealed that, in the pre test majority of the subjects 86.66% (13) in the experimental group and 93.33% (14) in the control group had moderate pain, 13.33%(2) of the subjects in the experimental group had severe pain and 6.665%(1) of the subject in the control group had mild pain. In the post test majority of the subjects in the experimental group 66.66% (10) and 66.66% (10) in the control group had moderate pain, 33.33%(5) of the subjects in the experimental group and 6.66%(1) of the subject in the control group had mild pain and 26.66%(4) of the subjects in the control group had severe pain. The mean and standard deviation of the experimental group with respect to level of joint pain in the pre-test was 23.8, with standard deviation of 5.045 and that of the control group mean was 22.67 with the standard deviation of 4.530. The mean and standard deviation of experimental group with respect to level of joint pain in the post-test was 15.2 with the standard deviation of 4.143 and that of the control group mean was 24.53 with the standard deviation of 5.194. In the experimental group the calculated paired ‘t’ value was 11.21 which is statistically significant at P<0.01 level. The significant difference between the post-test scores of experimental group and control group with student ‘t’ value was 5.44 which is significant at p<0.01 level. Thus the footbath is effective in reducing the level of joint pain among elderly people.

 

 

 

INTRODUCTION:

Human life is divided into five main stages namely infancy, childhood, adolescence, adulthood and old age. In each of these stages an individual find himself in different situations and face different health problems¹. Ageing is a natural process, universal and inevitable which takes place even with the best of nutrition and health care. The naturally occurring changes that are bound to old age are many one among these change related to health is joint pain. Pain in the joints is the most common complain of elderly people this is because of decline in the production of the synovial fluid, which acts as a lubricator for the joints, without it the friction between joints increases, leading to the pain².

 

International Association for the Study of Pain (2006) defines pain as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage” ³.

 

The Traditional Indian system of medicine has been using water, in different ways, for centuries to treat many diseases. The use of water at different temperatures, in the treatment of various diseases, is known as Water Therapy or Hydrotherapy. One way of delivering hydrotherapy is by the use of hot foot bath⁴. Footbath refers to immersion bath covering the ankle and knee at temperatures ranging from 100° to 115° F (43°C- 46°C) ⁵.

 

Footbath causes the blood vessels to dilate, as the blood vessel dilates the blood rushes from other parts of the body this results in relaxation of muscle which in turn helps to relieve the pain. Foot bath also aid in removal of endotoxins out of the body. Hot Footbath is one of the oldest, economical and safest methods for treating common ailments such as joint pain, insiomnia, fatigue etc⁶.

 

SIGNIFICANCE OF THE STUDY:

AIM OF THE STUDY:

This study aimed to evaluate the effectiveness of hot footbath in reducing selected joint pain among elderly people.

 

HYPOTHESES:

The following Null hypothesis had been formulated in an attempt to fulfill the aim of the study.

H₀₁: there is no statistically significant difference between the pre test and post test scores in experimental group.

H₀₂: there is no statistically significant difference between the post test scores of experimental and control groups.

H₀₃: there is no statistically significant association between pre test level of selected joint pain among elderly people and selected socio demographic variables.

 

METHODOLOGY:

Research approach:

In a view of the nature of problem selected and objectives to be accomplished Evaluative study approach was considered appropriate for the study.

 

Research design:

The research design selected for present study was Non equivalent control group pre test post test design.

 

Experimental Group         : O1       X            O2

Control Group                    : O1                       O2

Where

O1: Observation 1 [Assessment of pre test level of joint pain among elderly people]

X: Intervention [Administration of Footbath to elderly people with selected joint pain]

O2: Observation 2 [Assessment of post level of joint pain among elderly people]

 

Variables:

The Independent variable was Foot bath, while the dependent variable was selected joint pain and the Attribute variables included were age, gender, marital status, educational qualification, occupation status, type of work, type of family, family monthly income, location of pain, duration of joint pain, associated Medical condition, joint pain after menopause, type of diet and BMI.

 

Setting of the study:

The study was conducted at urban community areas that come under Mathikere Health center at Bangalore. Mathikere Health Center covers about 11 areas and a population of 80,000.

 

Population:

Population of the study was elderly people with selected joint joint pain residing at urban community areas of Mathikere Health center, Bangalore.

 

Sampling technique and Sample size:

Total 30 elderly people with selected joint pain who fulfils the selection criteria (15 elderly people in control group and 15 elderly people in experimental group) were selected using Non Probability Purposive sampling technique.

 

Sampling Criteria:

The samples were selected on the following criteria

1) Inclusion criteria:

Elderly people who are:

·         Willing to participate in the study.

·         60 years and above.

·         Having knee and/or ankle joint pain.

·         Can read and respond either kannada or English.

 

2) Exclusion criteria:

Elderly people who are:

·         Not available during the period of data collection.

·         Currently on analgesic medication.

·         Currently on alternative and complementary therapy.

·         Diagnosed to have cardiovascular disease (arteriosclerosis, vascular disease of the feet and legs, or a loss of sensation in the feet or legs), Buerger’s disease, Insulin-dependent diabetes, skin diseases, under gone any knee surgery.

 

Description of the Tool:

After an extensive review of literature, discussion with the experts and with the investigators personal and professional experience, Modified Geriatric pain measure by Bruce Ferell (2000), validated from experts was used to by the researcher as the following:

 

Section A:

Socio demographic variables: : consist of questions related to age, gender, marital status, educational qualification, occupation status, type of work, type of family, family monthly income, location of pain, duration of joint pain, associated Medical condition, joint pain after menopause, type of diet and BMI.

 

Section B:

Modified Geriatric pain measure by Bruce Ferell (2000), dichotomous questionnaire of 24 items to assess the level of selected joint pain among elderly peopleand the response includes yes and no.

 

Scoring key:

was prepared and followed to interpret the results.

Section A by coding the socio-demographic variables.

Section B Geriatric pain measure by Bruce Ferell (2000) included the following responses and scores.

 

Responses                                             scores

Yes                                                         1

No                                                           0

 

Each yes response is given a score of 1 and 0 for every No response.

 

The numerical response of 19 and 20 is added.

The total score is multiplied with 2.38 to get the adjusted score based on which the score interpretation is made.

 

LEVEL OF PAIN                                 RANGE

Mild Pain                                                               <30

Moderate Pain                                                     30 – 69

Severe Pain                                                           ≥70

Content Validity of the tool:

The tool for content validation was send to 13 experts of which 10 were Nurse Experts specialized in Medical Surgical Nursing, 2 were Ayurveda physician and 1 was Physiotherapist.

 

The suggestions and corrections were put in a master coding sheet for modification. Minor suggestions were given by the experts, which were incorporated.

 

Reliability of the tool:-

The Reliability of the tool was checked using Cronbach’s.

·         Reliability of English tool is α = 0.85

·         Reliability of Kannada tool is α = 0.75

 

Pilot study:

The pilot study was conducted on 10% of the study sample to evaluate the developed tool for clarity and applicability then necessary modification was carried out.

 

Data Collection procedure:

·         Formal permission was obtained from Principal, M.S.Ramaiah Institute of NursingEducation and Research followed by Dr. Manjula, Medical Officer, Mathikere HealthCentre.

·         The period of data collection was four weeks from 1^st November 2011 to 30^thNovember 2011. The areas selected for the study were M.R.Jairam Colony and Sanjeevappa Garden, urban areas of Mathikere Health Centre, Bangalore (15 experimental group + 15 control group).

·         The researcher selected the samples by using Non probability purposive sampling technique.

·         The student researcher developed a protocol to carry out the intervention and it follows as mentioned below:

·         Explained the nature and the purpose of the study.

·         Obtained Consent form.

·         Performed sensitivity test using cotton swab and hot and cold test tube.

·         Monitored Blood pressure.

·         Assemble the materials [tub, container or bucket, water thermometer, sheet or blanket to drape, washcloth for cold compress].

·         Fill bucket with hot water of 100⁰F to 115⁰ F (37⁰C – 46⁰C).

·         Elderly person is asked to drink 100ml of warm water.

·         Assist the elderly person to immerse the legs up to the knee in the warm water tub.

·         A blanket is wrapped around in order to prevent the heat loss and the head is protected with the cold compress.

·         Treatment is carried out for about 15 minutes.

·         Blood pressure is monitored during the procedure.

·         The feet are then wiped with a towel.

·         The Blood pressure is monitored after the procedure.

 

Data Analysis:

The data obtained was tabulated and analyzed in terms of the objectives of the study by using descriptive and inferential statistics. The plan of data analysis is as follows:

 

Descriptive statistics:

·         Frequency and percentage for describing the socio-demographic data.

·         Mean and standard deviation was used to describe pre test and post test level of joint pain.

 

 

 

Inferential statistics:

·         Paired t test was used to compare pre test and post test scores of experimental group.

·         Student t-test was used to compare pre test scores and post test scores of experimental group with the control group.

·         Chi-square was used to determine association between pre test level of selected joint pain and selected socio demographic variables.

 

RESULT:

The data were analysed according to the plan for data analysis, which includes both descriptive and inferential statistics. The findings have been organized and presented under the following headings.

·         Section A: Socio-demographic data of elderly people with selected joint pain

·         Section B: Comparison of pre-test and post-test scores of experimental group.

·         Section C: Comparison of post test scores of experimental and control groups.

·         Section D: Association of pre-test level of selected joint pain among elderly people with selected socio-demographic variables.

 

SECTION- A SOCIO DEMOGRAPHIC DATA OF ELDERLY PEOPLE WITH SELECTED JOINT PAIN

Table 1: Frequency and Percentage distribution of subject with regard to age in years, gender, marital status and educational qualification, occupational status, type of work, type of family, monthly family income, location of pain, since how long do you have joint pain?, is joint pain associated with any of the medial condition?, medical condition, Did the joint pain develop after attaining menopause?, type of diet amd BMI.                                                                                                                 n = 30 (15+15)

 

Table 2: Level of Joint pain in experimental and control group in Pre-test and Post-test.                  n = 30 (15+15)

 

Table 2 shows that majority of the subjects 13(86.66%) in the experimental group and 14(93.33%) in the control group had moderate pain, 2(13.33%) of the subjects in the experimental group had severe pain and 1(6.665) of the subject in the control group had mild pain in the pre test. Majority of the subjects in the experimental group 10(66.66%) and 10(66.66%) in the control group had moderate pain, 5(33.33%) of the subjects in the experimental group and 1(6.66%) of the subject in the control group had mild pain and 4(26.66%) of the subjects in the control group had severe pain in the post test.

 

Table 3: Mean and Standard Deviation of pre test and post test of experimental and control groups.                               n = 30(15+15)

GROUP	POST TEST
	Mean	SD	Mean	SD
Experimental Group	23.8	5.045	15.2	4.143
Control Group	22.67	4.530	24.53	5.194

 

The table 3 shows that the mean and standard deviation of the experimental group with respect to level of joint pain in the pre-test was 23.8, 56.67% and 5.045 respectively and that of the control group mean was 22.67 with the standard deviation of 4.530. The mean and standard deviation of experimental group with respect to level of joint pain in the post-test was 15.2, 36.19% and 4.143 respectively and that of the control group mean was 24.53 with the standard deviation of 5.194.

 

SECTION B - COMPARISON OF PRE TEST AND POST TEST PAIN SCORES OF EXPERIMENTAL GROUP

Table 4: Comparison of pre test and post test pain scores of experimental group (Paired‘t’ test)                       n = 15

GROUP	Pre test		Post test		‘t’ Value	Remarks
	Mean	SD	Mean	SD
Experimental Group	23.8	2.045	15.2	4.143	11.21	S*

t₁₄ = 2.977, S* Significant at P≤0.01 level, df = degree of freedom.

The table 4 shows that the mean for experimental group in the pre-test was 23.8(SD 2.045), whereas in the post test the mean for experimental group was 15.2(4.143).

In the experimental group the calculated‘t’ value was 11.21 which is statistically significant at P≤0.01 level. Hence H₀₁ stated as there is no statistically significant difference between the pre test and post test pain scores in experimental group was rejected and restated as there is a statistically significant difference between the pre test and post test pain scores in experimental group.

 

SECTION C: COMPARISON OF POST TEST PAIN SCORES OF EXPERIMENTAL AND CONTROL GROUP.

 

 

 

 

Table 5: Comparison of post test pain scores of experimental and control groups (Student‘t’ test)                    n = 30(15+15)

GROUP	MEAN	SD	‘t’ Value	REMARKS
Experimental Group	15.2	4.143	5.44	S*
Control Group	24.53	5.194

t₂₈ = 2.763, S* Significant at P≤0.01level, df = degree of freedom

 

Table 5 shows that there is significant difference between the post-test scores of experimental group and control group with ‘t’ value 5.44 which was significant at p<0.01 level. Hence H₀₂ stated as there is no statistically significant difference between the post test pain scores of experimental and control group was rejected and restated as there is a statistically significant difference between the post test pain scores of experimental and control group.

 

SECTION D: ASSOCIATION OF PRE-TEST LEVEL OF SELECTED JOINT PAIN IN WITH SELECTED SOCIO-DEMOGRAPHIC VARIABLES.

Table 6: Association of pre test level of selected joint pain among elderly people and selected socio-demographic variables.n = 30(15+15)

Sl NO	SOCIO DEMOGRAPHIC DATA	SEVERITY OF PAIN							CHI SQUARE VALUE(χ2 Value)
		Mild Pain		Moderate Pain		Severe Pain
1.	Age in years
	a.                    60 -64	-				14			-		χ2 = 40.216 df = 6 S*
	b.                    65 - 69	-				11			-
	c.                    70 - 74	1				3			-
	d.                    75 - 79	-				-			1
2.	Gender
	a.                    Male	1				10			-		χ2 = 2.85 df = 2 NS
	b.                    Female	2				17			2
3.	Marital Status
	a.                    Married	1				23			-		χ2 = 8.703 df = 2 S*
	b.                    Widow/widower	-				4			2
4.	Educational Qualification
	a.                    No formal education	-				5			1		χ2 = 15.833 df = 8 S*
	b.                    Primary	1				1			1
	c.                    Secondary	-				7			-
	d.                    Higher secondary	-				8			-
	e.                    Diploma	-				6			-
5.	Occupational Status
	b.                    Self employed	-				2			-		χ2 = 3.271 df = 4 NS
	b.                    Retired	1				10			-
	c.                    House wife	-				15			2
6.	Type of work
	a.                    Sedentary work	-				6			2		χ2 = 6.189 df = 2 S*
	b.                    Moderate work	1				21			-
7.	Type of family
	a.                    Nuclear family	1				26			2		χ2 = 0.114 df = 2 NS
	b.                    Joint family	-				1			-
8.	Monthly family income in Rs
	a.                    1,000 – 10,000/-	1				7			1		χ2 = 3.164 df = 4 NS
	b.                    10,001 – 20,000/-	-				15			1
	c.                    20,001 – 30,000/-	-				5			-
9.	Location of pain
	a.                    Ankle joint	1					14		-		χ2 = 3.037 df = 2 NS
	b.                    Knee Joint	-					13		2
10.	Since how long do you have joint pain?
	a.                    Below 1 year		1				17		-		χ2 = 15.262 df = 4 S*
	b.                    1 – 5 years		-				10		1
	c.                    6 – 10 years		-				-		1
11.	Is joint pain associated with any of the Medical condition?
	a.                    Yes		-		9			2		χ2 = 4.195 df = 2 NS
	b.                    No		1		18			-
12.	Did the joint pain develop after attaining Menopause?
	a.                    Yes		-		16			1		χ2 = 8.668 df = 4 NS
	b.                    No		-		1			1
	c.                    Not Applicable		1		10			-
13.	Type of Diet
	d.                    Vegetarian		-		7			-		χ2 = 1.212 df = 4 NS
	e.                    Ova-Vegetarian		-		1			-
	f.                     Non-Vegetarian		1		19			-
14.	Body Mass Index
	e.                    Under weight		-		-			-		χ2 = 3.429 df = 4 NS
	f.                     Normal Weight		-		12			-
	g.                    Over Weight		1		9			1
	h.                    Obese		-		6			1

df= degrees of freedom, S* = significant (P≤0.05), NS= not significant (P≤0.05)

 

Table 6 shows that the calculated χ2 value was less than table value for all socio demographic variables except for age, marital status, educational qualification, type of work and duration of joint pain, hence H₀₃ stated as there is no between the level of selected joint pain among elderly people and selected socio demographic variables was accepted except for age, marital status, educational qualification, type of work and duration of joint pain.

 

DISCUSSION:

This chapter deals with the discussions in accordance with the objectives of the study and hypotheses. The statement of the problem was “A quasi experimental study to assess the effectiveness of foot bath in reducing selected joint pain among elderly people, residing in selected urban community areas, Bangalore”.

 

Socio demographic data:

·         Majority of the subjects 60% in the experimental group and 33.33% of control group belong to the age group of 60-64 years.

·         Majority of the samples 73.33% in experimental group and 53.33% of control group were female.

·         Majority of the subjects 73.33% in the experimental group and 86.66% of control group were Married.

·         Majority of the subjects 20% in the experimental group had No formal education and Diploma respectively and 46.66% in the control group had high secondary education.

·         Majority, 60% of the subjects in the experimental group and 53.33% in the control group were House wife.

·         Majority of the subjects 11% each in the experimental group and control group performed Moderate work.

·         Majority of the subjects 100% in the experimental group and 93.33% of control group belongs to Nuclear family.

·         Most of the subjects 53.33% in the experimental group had monthly income 1,000 – 10,000/- and 66.66% of control group had monthly income 10,001-30,000.

·         Most of the subjects 60% in the experimental group reported having Knee joint pain and 60% in control group reported to have Ankle joint pain.

·         Most of the subjects 46.66% in the experimental group had joint pain below 1 year and 1 – 5 years respectively and 73.33% had joint pain below 1 year.

·         Majority of the subjects 66.66% in the experimental group and 60% of control group reported to have no medical condition in association with joint pain.

·         Majority of the subjects 60% in the experimental group and 53.33% of control group developed joint pain after attaining menopause.

·         Majority of the subjects 93.33% in the experimental group and 53.33% of control group were Non-vegetarian.

·         Majority of the subjects 40% in the experimental group had normal weight and 40% of control group had normal and overweight respectively.

 

The First objective of the study was to assess the pre test level of selected joint pain among elderly people residing in selected urban community areas, Bangalore.

The findings showed that:

Majority of the subjects 13(86.66%) in the experimental group and 14(93.33%) in the control group had moderate pain, 2(13.33%) of the subjects in the experimental group had severe pain and 1(6.665) of the subject in the control group had mild pain in the pre test.

 

Majority of the subjects in the experimental group 10(66.66%) and 10(66.66%) in the control group had moderate pain, 5(33.33%) of the subjects in the experimental group and 1(6.66%) of the subject in the control group had mild pain and 4(26.66%) of the subjects in the control group had severe pain in the post test. The finding is supported by a study conducted on Morbidity Pattern among the Elderly Population in the Rural Area of Tamil Nadu, at Pondicherry Institute of Medical Sciences, Kalapet. The sample size was 320 rural elderly people and the study concluded that Pain in the joints and joint stiffness was the most common cause of morbidity (139) accounting for about 43.4%⁷.

 

The second objective was to assess the effectiveness of footbath by comparing pre test and post test score in experimental group. The findings showed that:

The mean for experimental group in the pre-test was 23.8(SD 2.045) and that of the control group was 22.67(SD 4.530): whereas in the post test the mean for experimental group was 15.2(4.143) and that of the control group was 24.53(SD 5.194).

 

In the experimental group the calculated‘t’ value was 11.21 which is statistically significant at P<0.01 level. Hence H₀₁ stated as there is no statistically significant difference between the pre test and post test pain scores in experimental group was rejected and restated as there is a statistically significant difference between the pre test and post test pain scores in experimental group.

 

The Finding is supported by a comparative study conducted by graduate school of medicine, osaka university to examine the effect of nursing care using footbath, foot massage and foot massage combined with footbath for relaxation. The result suggests that all forms of care contributed to psychological and physiological well being⁸.

 

The third objective was to assess the effectiveness of footbath by comparing post test scores of experimental group and control group. The findings showed that:

There is significant difference between the post-test scores of experimental group and control group with ‘t’ value 5.44 which was significant at p<0.01 level. Hence H₀₂ stated as there is no statistically significant difference between the post test pain scores of experimental and control group was rejected and restated as there is a statistically significant difference between the post test pain scores of experimental and control group.

 

The fourth objective is to determine association of pre-test level of selected joint pain in experimental and control group with selected socio-demographic variables. The findings showed that:

The calculated χ2 value was less than table value for all socio demographic variables except for age, marital status, educational qualification, type of work and duration of joint pain hence H₀₃ stated as there is no significant association between the level of selected joint pain among elderly people and selected socio demographic variables was accepted except for age, marital status, educational qualification, type of work and duration of joint pain in experimental and control groups.

 

The finding is supported by a study conducted at Nottingham to examine the relationship between occupation and knee pain. The results showed that overall prevalence of knee pain was 28%. Highest prevalence of pain was seen in carpenters and miners and construction workers⁹.

 

CONCLUSION:

The overall findings in the present study revealed that footbath was effective in reducing joint pain among elderly people

The following conclusions were drawn on the basis of findings of the study:

·         In the pre test majority of the subjects 13(86.66%) in the experimental group and 14(93.33%) in the control group had moderate pain, 2(13.33%) of the subjects in the experimental group had severe pain and 1(6.665) of the subject in the control group had mild pain.

·         In the post test majority of the subjects in the experimental group 10(66.66%) and 10(66.66%) in the control group had moderate pain, 5(33.33%) of the subjects in the experimental group and 1(6.66%) of the subject in the control group had mild pain and 4(26.66%) of the subjects in the control group had severe pain.

·         The mean and standard deviation of the experimental group with respect to level of joint pain in the pre-test was 23.8 and 5.045 and that of the control group mean was 22.67 with the standard deviation of 4.530.

·         The mean and standard deviation of experimental group with respect to level of joint pain in the post-test was 15.2 and 4.143 and that of the control group mean was 24.53 with the standard deviation of 5.194.

·         In the experimental group the calculated‘t’ value was 11.21 which is statistically significant at P<0.01 level.

·         The significant difference between the post-test scores of experimental group and control group with ‘t’ value was 5.44 which was significant at p<0.01 level

·         There is no statistically significant association found between pre test level of selected joint pain among elderly people and selected socio demographic variables except for age, marital status, educational qualification, type of work and duration of joint pain, hence the H03 stated as there is no significant association between the pre test level of selected joint pain among elderly people and selected socio demographic variables was accepted except forage, marital status, educational qualification, type of work and duration of joint pain.

 

RECOMMENDATIONS:

·         Study can be replicated with larger samples for better generalization.

·         Different treatment modalities can be compared in managing joint pain among elderly people.

·         Similar study can be conducted by comparing level of joint pain between rural and urban settings.

·         Similar study can be conducted by comparing level of joint pain between hospital and community settings.

·         Similar study can be conducted using cross over design with other measures.

 

ETHICAL CLEARANCE:

·         Formal permission was obtained from Principal, M.S.Ramaiah Institute of Nursing Education and Research followed by Dr. Manjula, Medical Officer, Mathikere Health Centre.

·         Informed consent was obtained from the participants

·         Anonymity was maintained

 

REFERENCES:

1.     Yuman Hussain.The problem of old age in India: Available from: URL:http://azadindia.org/social-issues/problem-of-old-age-in-india.html/2010/.

2.     Priyanka Parab. Changes in old age: available from: URL:http://www.medimanage.com/my-parents-health/articles/Changes-in-old age.aspx/2010/

3.     LindaWilliams S and PaulaHopper D. Understanding Medical Surgical Nursing. F. A. Davis Company, United States of America.

4.     Hydro therapy – Water Therapy. Indian Ayurveda Yoga [serial online] [cited 2010 Oct 25]; Available from: URL:http://indianayurvedayoga.com/methods-procedures-used-in-ayurveda-treatments/hydro-therapy-water-therapy.html

5.     A Khokhar and M Mehra. Life style and morbidity profile of geriatric population in an urbans community of Delhi. Indian Journal of Medical Sciences. 2001; 55(11): 609-615.

6.     Patricia Dillon M. Nursing Health Assessment: A critical thinking Case studies approach. . Lisa B. Deitch publishers, United States of America. 2007.

7.     Anil Jacob et al. Morbidity pattern among the elderly population in the rural area of Tamil Nadu. Indian Journal of Community Medicine. 2006; 36(1): 45-50.

8.     Nitta N et al. A comparison of the effect of nursing care using footbath, foot massage and foot massage combined with footbath for relaxation. Science Links Japan. 2002; 22(4): 55-63.

9.     S.C. O'Reilly et al. Occupation and knee pain: a community study. 2000; 8(2): 78-81.

 

 

 

 

 

 

 

Received on 22.11.2017          Modified on 18.12.2017

Accepted on 11.01.2018      ©A&V Publications All right reserved