Effectiveness of aromatherapy and quality of sleep
among elderly inmates of selected old age home.
Mr. Vineeth
Joseph1, Mrs. Jasmine Joseph2
1Asst. Professor, St. Thomas College of Nursing, Chethipuzha, Changanacherry, Kottayam, Kerala
2Principal, Krupanidhi
College of Nursing, Chikka Bellandur,
Bangalore- Karnataka
*Corresponding Author Email: wittyvineeth@gmail.com
ABSTRACT:
Introduction:
Sleep disturbances are
more prevalent among the elderly and act as a major source of stress
for them. Poor sleep in the elderly is typically undertreated or treated with
pharmacological interventions with adverse consequences. So it is relevant to
investigate alternative strategies for sleep management. Aromatherapy is the
method of using pleasant fragrance in treating the different health problems of
the people. Aims and objective: To
study the effectiveness of aromatherapy on quality of sleep among elderly
inmates. Approach and design: Quantitative study approach was selected and the study design was
quasi-experimental, one group pre-test post-test. Samples and sampling criteria: Sixty inmates from selected old age
home were assessed for general pattern of sleep. Among them who were having
fairly and inadequate sleep were selected for the study. Aromatherapy was
administered for five consecutive days. The lavender essential oil was dropped
on a cotton ball and kept under the pillow throughout the night. The quality of
sleep was assessed before aromatherapy, as well as on the third and sixth day using Modified Pittsburg Sleep Quality Index (PSQI).
The data was analyzed using both descriptive and inferential statistics. Findings:
The mean pre-test PSQI score (11.9) was significantly higher than the post
test score (4.875). The computed ‘t’ value (10.184) is greater than the table value (t39= 3.551,
p<0.001). It indicated that there was a significant increase in the quality
of sleep after aromatherapy. There was no significant association found between
quality of sleep and selected demographic variables. Conclusion: The study findings revealed that quality of sleep was
poor in the elderly before aromatherapy and the quality of sleep increased by
aromatherapy and it was concluded that aromatherapy is useful in increasing the
quality of sleep among elderly inmates of the old age home.
INTRODUCTION:
Age related changes are
normal and occur with advancing age. People will enjoy a better quality of life
only when they maintain the adequate process for normal life activities. Sleep
disturbances are more prevalent among the elderly people 1, 2 and
act as a major source of stress for them. It is relevant to investigate
alternative strategies for sleep management.3-5
Among the physical dimensions
adequate rest and sleep play an important role in maintaining the normal life
activities of an elderly.6 Sleep is a complex rhythmic state of rest
accompanied by altered consciousness, relative inactivity and progression of
repeated cycles each representing different phases of body and brain activity.
Sleep loss results in fatigue and decreased competence and aggravates sleep
related problems. Older people often need more time to fall into sleep and they
awake early too. They are also less able
to cope up with the changes in their usual sleep pattern than younger people.7
Insomnia is a common complaint that can
have profound effect on the quality of life among elderly. Complementary
therapy has been found to be helpful in alleviating some chronic illnesses such
as chronic pain, fatigue, anxiety, arthritis, insomnia, and headache. People
who have sleep problem may try different forms of complementary and alternative
medicine like aromatherapy, music therapy, massage
therapy, dietary supplements,
relaxation therapies, to fall asleep faster, stay asleep longer, and to improve
the overall quality of their sleep.8
Aromatherapy utilizes
essential oils extracted from plants and herbs to be inhaled, or externally or
internally applied The aromatic oils extracted from aromatic
plants are used to help the body overcome many physical and mental disorders.9
Lavender (Lavandula angustifolia)
is a popular, essential oil of aromatherapy.10 It can be used
undiluted to treat burns, sleep disorders, small injuries, headaches, migraines
and insect bites.10-12
In India, the use of
aromatherapy and olfactory research is still in its infancy and it is important
that the use of aromatherapy as an effective treatment measures should be
established by the use of scientific and evidence based research. The use of
essential-oils is incorporated into nursing practice in certain hospitals,
nursing homes, hospices, massage centers and primary care centres.9 Preliminary
research suggests that some sleep-inducing effects are in use, but more studies
are needed to prove its effectiveness.6
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of
aromatherapy on the quality of sleep among the elderly inmates of selected old
age home, Bangalore.
OBJECTIVES:
The objectives of the study were
1.
To
assess the quality of sleep among the elderly inmates in the old age home.
2.
To
determine the effectiveness of aromatherapy on the quality of sleep.
3.
To
determine the association of the quality of sleep on selected demographic
variable.
HYPOTHESIS:
H1-There is a significant relationship between
aromatherapy and the mean pre-test and
post-test scores on the quality of sleep.
H2- There is a significant association
between the quality of sleep and the selected demographic variables.
RESEARCH
APPROACH:
A quantitative research approach.
Research design:
Quasi experimental one group pre-test
post-test design was selected.
VARIABLES:
Independent variable- The inhalation aromatherapy
Dependent variable- The quality of sleep among the inmates of old
age home.
Setting:
The
study was conducted
in selected old age homes in Bangalore.
Population:
Males
and females over the age of sixty years and who were residing at selected old
age home
Sample size:
40
inmates of old age home both males and females.
Sampling technique:
Purposive
sampling technique was used. From the selected old age home 60 inmates were
assessed for sleep pattern using Modified
Scale for the General Pattern of Sleep. From them who had inadequate sleep and
fairly adequate sleep were
selected for the study. Forty samples were selected to the study.
Description of the data
collection instrument:
Section
A: Modified Scale for the General Pattern of Sleep (S G P S).
It consisted of 13 items seeking the
general pattern of sleep in the elderly and measures the character of sleep,
change in sleep, and duration of sleep of the elderly. The reliability of the tool
found to be 0.955 by test retest method and was statistically significant.
Section-B:
The Baseline Performa
Consisted of seven items
seeking the age, gender, marital status, social support, reason for staying in
old age home, duration of stay in the old age home and any associated disease.
Section-C:
Modified Pittsburgh Sleep Quality Index (PSQI)
Modified Pittsburg Sleep
Quality Index (PSQI) is used to collect the data regarding pre intervention and
post intervention quality of sleep. The reliability of the tool was found to be 0.9744 which was
statistically significant and
established using test retest method.
Pilot study:
Pilot study was conducted on six inmates of other selected
old age home located in Bangalore.
Data collection process:
A Formal written administrative permission
and ethical clearance was obtained to conduct the study from the authorities.
The inmates were selected based on inclusion and exclusion criteria and
assessed for the general pattern of sleep using the Modified Scale for General
Pattern of Sleep. The participants who had inadequate sleep and fairly
adequate sleep were selected
for the study and informed consent was taken. The baseline characteristics were
collected from the samples. Pre-test
scores on quality of sleep were measured using the Modified Pittsburgh Sleep
Quality Index (PSQI). The subjects were
administered with aromatherapy using lavandula angustifolia essential oil from day one to- day five during the whole night. A drop of lavandula angustifolia essential oil was applied on a piece
of cotton which was placed under the pillow before the sleep. The post-test
quality of sleep score was measured on the third and sixth day morning.
RESULTS:
Description
of baseline characteristics of subjects
The
findings of the demographic variables showed that 47.5 % of the subjects
belongs to 80-90 years and 68%
were female. In relation to marital status 70 % of them were widows/widowers
and of their social support 47.5 % received support from their relatives while
42.5% of subjects were supported by their family. Hypertension was the most
common ailment 25% as diagnosed disease. About 50% of the subjects were staying
for more than five years while 37.5 % were found to have self-motivation to
stay there.
Description of the
Effectiveness of Aromatherapy on Quality of Sleep.
Table-1: Mean percentage of quality of sleep among the
elderly inmates before, during and after aromatherapy. n=40
|
Sl. No |
Components of sleep |
Mean
percentage |
||
|
|
|
Before
aromatherapy |
During
aromatherapy |
After
aromatherapy |
|
1.
|
Subjective sleep
quality |
56.00 |
34.33 |
14.17 |
|
2.
|
Sleep latency |
74.00 |
62.67 |
38.33 |
|
3.
|
Sleep duration |
31.00 |
26.00 |
10.00 |
|
4.
|
Habitual sleep
efficiency |
23.33 |
17.67 |
14.17 |
|
5.
|
Reduction in
sleep disturbances |
62.67 |
41.67 |
34.17 |
|
6.
|
Reduction in use
of sleep medication |
71.00 |
38.33 |
23.21 |
|
7.
|
Reduction in
daytime dysfunction |
78.33 |
35.00 |
30.00 |
Table 1 shows
that the mean percentage pre-test score of the subjective sleep quality was
56.00 and of post-test was 14.17, Sleep latency had a score of 74 and post-test
of 38.33, the mean percentage score of the sleep disturbances was 62.67, 41.67
and 34.17 before, during the third day and after aromatherapy respectively.
With regard to the day time dysfunction in the mean percentage score, there was
a change from 78.33 to 30.00 before and after aromatherapy. These indicated that daytime dysfunction reduced and thereby
the
sleep quality improved.
Figure-1: Diagram showing components of sleep and mean
score before, during and after aromatherapy.
Figure 1shows mean score for various components of sleep
of the subjects. Subjective sleep quality had a pre test mean score of 1.68,
and post test mean score of 0.4250. Sleep duration had a pre test mean score
0.93, and post test mean score of 0.4250 which depicts increase in the duration
of sleep. The mean test scores of habitual sleep efficiency were 0.70,0.30,
during pretest and post test, indicating increase in habitual sleep
efficiency.Sleep disturbances had a pre test mean score of 1.88, third day test
mean score of 1.25 and post test mean score 1.0250. Use of sleep medication had a pre test mean score of
2.13, third day test mean score 1.15 and post test mean score of 0.90 which
showed reduction in use of the sleep medication. Daytime dysfunction had a pre
test mean score of 2.35and post test mean score of 0.65, which showed improvement in day time
function.
Figure-2: Diagram showing mean Global PSQI score before,
during and after aromatherapy.
Figure 2 showed that the Global PSQI score of
pre test was 11.9 while it significantly reduced on the third day
(7.65) as well as at the
time of post test (4.875). This indicated an improvement in the quality of
sleep among the elderly inmates of selected old age home with the intervention.
In order to determine the effectiveness of
aromatherapy on the quality of sleep, paired t – test was computed.
Table
2: Comparison of the pre-test and post
test score. n=40
|
Score |
Pre test |
Post test |
t value |
df |
Inference |
||
|
|
Mean |
S
D |
Mean |
S
D |
|
|
|
|
Global PSQI score |
11.90 |
2.43 |
4.88 |
1.64 |
10.18 |
39 |
p<0.001* |
(t39=
3.551, p<0.001), * = significant
Table 2 shows that there was a significant
difference between the mean PSQI pre-test score (11.9) and the mean post test
score (4.87). The computed‘t’ value was greater than
the table value. So the null hypothesis was rejected and concluded that there
was a significant relationship between aromatherapy and the quality of sleep of
the elderly.
Figure-3: Diagram showing number of subjets and their
sleep pattern on the basis of Global PSQI score before, during and after
aromatherapy.
Figure
3 shows before aromatherapy, 40 subjects were poor sleepers and on the third
day the number of poor sleepers totalled
to 36. By the end of the aromatherapy session, 29 subjects had a low PSQI score
which projected good sleep.
Association of the pre-test quality of
sleep with selected demographic variables.
The obtained X2 value for
gender (0.620) and
social support (0.410) were lesser than the table value at 0.05 level of
significance. Therefore, it was concluded that there was no association between
the pre-test quality of sleep of elderly with gender and reason for stay in old
age home.
The p value obtained for the association
between quality of sleep and age (0.479) and marital status (0.276) , social
support (0.154 ) and duration of stay in old age home (1.000) were greater than
0.05 level of significance using Fishers Exact Probability Test. The null
hypothesis was accepted and concluded that there was no association between the
pre interventional quality of sleep with age and marital status of the elderly.
The obtained X2 value
with Yate’s correction for diagnosed disease (7.244) was lesser than the table value at 0.05
level of significance. The null hypothesis was accepted; therefore, it was
concluded that there was no association with the diagnosed disease and the
quality of sleep among elderly.
DISCUSSION:
Description
of baseline characteristics of subjects
The analysis of the data regarding age of
participants were different from the study findings obtained at Maduri, indicating that 52.8 per cent were between the age
group of 60-69 years.13 Similar findings were also obtained from
different studies conducted earlier.14 -17 The study findings showed
the gender and marital status were similar to another study finding done which
revealed that the females outnumbered the males.15 The number of
people without spouses was more in number in a study conducted among old age
home inmates.17,18 With regard to social support the other studies
done previously also supports the findings.15,18 The researcher
further noticed that the children visited their parents and were concerned
about the wellbeing of their loved ones. This study supports the finding that
health problems like hypertension, diabetes mellitus and arthritis are more common
among the elderly.18- 20 In relation to reason to stay in old age home, findings were similar as they were staying
alone at home so they choose to stay in old age home.15 However an
increased no of subjects (37%) in the present study preferred to stay in old
age home due to self-motivation.15 The reason for the
self-motivation to stay in the old age home may be because of the alteration in
the traditional role of old age home from charity based service to the paid
service to elderly, good medical facilities provided by old age home and good
security they receive while in old age home. In relation to the duration of the
stay in old age home study finding was supported by the findings of other
study.15
Description
of the effectiveness of aromatherapy on the quality of sleep.
In
regard to the effetiveness of aromatherpy on the improvement of the quality of
sleep study finding were supported by other study findings which indicated that
aromatherpy was effective in treating sleep problem.21-23 But there
are a couple of contriductory findings obtained in which it indicated that
aromatherapy had no effect on sleep.24,25 This possible variation in
findings could possibly be due to the fact that the previous studies were done
among children and the hospitalized patients and not in elderly people. Further
the sample size was smaller in comparison.
A significant difference was found between
mean quality of sleep score (Global PSQI score) in the post-test (4.87) was
much lesser than the pre-test score (11.9). This projects that aromatherapy was very
effective in improving the qulaity of sleep among the elderly.
Association
of pre-test quality of sleep with the selected demographic variables.
From this study it was found that there was
no significant association between the quality of sleep and the selected
demographic variables. However a study revealed that the health problems of the
elderly men had a significant association with the sleep disturbances.26
A study done among the 82 elderly inmates showed that hypertension as major
cause of sleep disturbances.27 The findings of
the study revealed that the demographic variables which includes age, gender, marital status, social
support, duration of stay, reason for staying, and diseases do not
have any association with the quality of sleep among the elderly.
RECOMMENDATIONS:
On the basis of the present study, the
following recommendations are formulated for a future study.
1. A similar study can be conducted on a large
sample in different settings whereby the findings can be generalized for a
larger population.
2. A similar study can be replicated with a
control group as quasi-experimental design or experimental design.
3. A comparative study can be undertaken to
compare the findings using different essential oils.
4. The study can be undertaken among elderly
in family setting.
5. A comparative study can be done to find the
effectiveness of aromatherapy and other complementary or alternative therapies.
6. The effect of aromatherapy can be studied
to reduce anxiety and stress among the elderly.
7. A similar study can be conducted focusing
on different age groups.
8. The findings of the study could be used by
all health personnel and administrators to formulate policies and implement the
measures to practice complementary and alternative therapies.
REFERENCES:
1. Foley DJ, Monjan
AA, Brown SL, Simonsick EM. Sleep disturbances among
the elderly. Sleep Journal. 18; 1995:425-32.
2. Kryger M, Monjan A, Bliwise D. Sleep health and aging bridging the gap between
science and clinical practice. Geriatrics Journal.59; 2004:24-6.
3. Raymann Roy JEM, Someren
Van Eus JW. Diminished capability to recognize the
optimal temperature for sleep initiation may contribute to poor sleep in the
elderly people. Sleep Journal. 31(9); 2008: 23-7.
4. Sivertsen B, Omvik S, Pallensen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of
primary insomnia in older adults- a randomized control trial. JAMA. 295; 2006:
2851-8.
5. Van Someren EJW, Riemersma RF, Swaab DF.
Functional plasticity of the circadian timing system in old age- light
exposure. Prog Brain Res, 138: 2002; 205-31.
6. Lewis, Heitkemper,
Dirksen, O, Brien, Bucher et al. Medical
and surgical nursing. Mosby publication, St.Louis,
Missouri. 2007; 7th ed: pp 65-8
7. Taylor Carol, Lillis Carol, Lemone Priscilla, Lynn Pamela. Fundamentals of nursing- the
art and science of nursing care. Lippincott Williams Wilkins, New Delhi. 2006;
6th ed: (vol. 2) pp 665-1005
9. Marline C Smith, Larine Kyle, Holistic foundation of aromatherapy for
nursing. Journal of holistic nursing practice. Jan/Feb; 22(1); 2008: 3-9.
10. Aromatherapy action and use.[6] Available
from: URL
http://library.thinkquest.org/24206/aromatherapy.html Accessed on June 4, 2010
11. Mc Gilvery, Mehta
Mira, Reed Jimi, Mehta Silva. The encyclopedia of
aromatherapy massage and yoga. Annes’s publishing
limited, London. 2001.
12. Fontaine K.L. Healing practices. 2nd ed.
Upper Saddle River, Person education, New Joursey.
2005. p. 148.
13. Tom Andrew Fleming MJ. Aromatherapy. Nurses
of India. Feb 15,11(2);2010: 7-8
14. Sr. Showrilu.
Quality of sleep and quality of life among senior citizens. The nurse Jun-July;
1(1); 2009: 22-4.
15. Baby Leeba. A
study to assess the effectiveness of selected strategies to improve the
wellbeing status of elderly inmates of the selected old age home, Bangalore:
2010.
16. Report on survey of Aged in Kerala.
Trivandrum: Department of Economics and statistics. 2002-3.
17. Michael R, Irwin, Olmstead Richard, Motivala J Sarosh. Improving
sleep quality in older adults with Moderate sleep complaints: a randomized
controlled trial of tai chi chih. Sleep.31 (7); 2008:
1001-7.
18. Bharati Kanchan. Old age
homes- new faces of old age care in India. Help Age India Research and
developmental journal. 15(2); May 2009: 13-8.
19. John Mao. Health problems of the aged. Man
in India. The week. Aug 83(1); 2003: 227-32.
20. Unal Avranchi, Nurten Ozdag. Old age and its
related problems in a group of Turkish Elderly. Internet Journal of Geriatrics
and Gerontology. Feb; 2(1); 2005: 697-701.
21. Sy Chang, Sy Seo. Effect of aroma hand massage on sleep deprivation and
quality of life in the institutionalized women. Korean Journal women Health
Nursing. Dec 15(4); 2009: 372-80.
23. Lewith T George, Godfrey Dean Anthiny,
Prescott Philip. A single blinded randomised pilot
study evaluating Aroma of Lavender Angustifolia as a
treatment for mild insomnia. The journal of alternative and complementary
medicine. 11(8); 2005: 631-7.
24. Borromeno AR, The effect of aromatherapy on the
patient outcomes of anxiety and sleep quality in coronary care unit patients.
Texas Women University. Phd thesis. 1998.
26. Ensrud KE, Blackwell TL, Redine
S, Ancoli Isrel S, Paudel ML et. Sleep disturbance and Fatility
status in elderly Community Dwelling men. JAM Geriatric Society Nov
2009:57(11); 2085-93.
27. Kevin Morgan, Diane W. Healey, Patric J Helley. Factors
influencing persistent subjective insomnia in old age. A follow up study of
good and poor sleepers aged 65 to 74. Oxford university press: 1989.
Received on 09.12.2015 Modified on 05.03.2016
Accepted on 18.07.2016 ©
A&V Publications all right reserved
Asian J. Nur. Edu. and Research.2016;
6(4): 511-516.
DOI: 10.5958/2349-2996.2016.00096.3