Effect of Jacobson’s Progressive Muscle Relaxation (JPMR) Technique on stress of elderly living in selected old age homes, Kolkata

 

Maheswari Thapa¹, Debarchana Mandal², Shipra Modak³

¹Assistant Professor, Department of Nursing, Aliah University, Park Circus Campus, Beniapukur, Kolkata

²Senior Lecturer, West Bengal Govt. College of Nursing, SSKM Hospital Campus, Kolkata

³Senior Lecturer, West Bengal Govt. College of Nursing, SSKM Hospital Campus, Kolkata

 

ABSTRACT:

A quasi experimental time series research design was adopted to find out the effect of Jacobson’s Progressive Muscle Relaxation (JPMR) technique on the stress of elderly living in selected old age homes, Kolkata with the objectives to assess the pre-test level of stress among elderly in both experimental and control group, to find out the effect of JPMR technique on level of stress in experimental group and to compare the effect of JPMR technique between experimental and control group. The conceptual framework was based on J. W. Kenny’s Open System Model. The non-probability purposive sampling technique was used to select 60 elderly (30 in each experimental and control group). A semi structured interview schedule and Perceived Stress Questionnaire were used to collect the data. The study findings showed that most of the elderly in experimental group (46.67%) and control group (50%) experienced moderate level of stress. The findings also showed that the JPMR technique was effective in reducing stress in experimental group as evident from ‘t’ value of 10.77 [‘t’df (29) =3.66] at 0.001 level of significance. The JPMR technique was effective in reducing stress in experimental group than control group as evident from ‘t’ value of 2.21 [‘t’ df (58) =2.01] at 0.05 level of significance. This study has several implications in nursing education, practice, administration and research. The study was concluded with recommendations for conducting on larger samples for better generalization of the findings and a comparative study with different relaxation techniques used in stress management.

 

 

 

 

INTRODUCTION:

Aging is a natural inevitable biological phenomenon of becoming older. In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. Population ageing can be seen as a success story for public health policies and for socioeconomic development, but it also challenges society to adapt in order to maximize the health and functional capacity of older people as well as their social participation and security [1].

 

Urbanization, modernization and globalization have no doubt brought a change in the economic structure but it has also caused the erosion and weakening of societal values and social institutions such as the joint family. The traditional sense of duty and obligation of the younger generation towards their older generation is vanishing due to which the elderly are caught between the decline in traditional values on one hand and the absence of adequate social security system on the other [2]. However, in more recent times, the traditional role of the family is being shared by institutions such as old age homes. It is often assumed and sometimes argued that the absence of familial care and surroundings induce feelings of loneliness among the residents of old age homes [3].

 

According to data published by HelpAge India (2009), there are 1,176 registered Old Age Homes (OAHs) in India. Kerala has the highest number of OAHs (182) whereas West Bengal stands at the second position with 164 OAHs followed by Tamil Nadu (151), Maharashtra (133), Andhra Pradesh (114), Karnataka (91), and Gujarat (77) [4]. According to HelpAge India, the problems faced by the elderly are failing health, economic insecurity, isolation, neglect, abuse, fear, boredom (idleness), lower self-esteem, loss of control (lack of respect), lack of preparedness for old age and last but not the least, stress [5].

 

Rayirala A, Nallapaneni RN, Mandadi GD and Bhogaraju A (2014) conducted a comparative study to assess the psychiatric morbidity in elderly living in old age homes and community. The study findings revealed that mild depression, cognitive impairment and somatic dysfunction were found to be higher in old age homes [6].Similarly, Mani G, Udayakumar S, Annamalai K, Ramaswamy DJ (2014) conducted a study on perceived levels of stress and its correlates among the residents of old age home in Kanchipuram District, Tamil Nadu where the study finding revealed majority of the residents had moderate stress which showed association with gender and co-living status with spouse [7].

 

There are many known negative implications of stressful life circumstances on personal health. Temporary stress can cause elevated blood pressure, headaches, stomachaches, sleeping problems, and chest pains. Stress also has been shown to inhibit the immune system, leading to more colds and sickness in times of stress. Further, chronic stress can severely impact both mental and physical health. It can decrease the likelihood of individuals to practice healthy habits including eating a nutritious diet, obtaining adequate sleep, avoiding smoking and drinking in excess, and fostering positive relationships. Distress is a form of stress that negatively impacts the body which is associated with many serious and deadly health risks including various cancers, cirrhosis of the liver, heart disease, lung problems, and in some instances, suicide [8].

 

Keeping in mind the above points, the researcher felt that it was vitally important for an individual to learn simple and cost effective methods for reducing stress. There are various stress reduction techniques which can be applied to any stressed individual to reduce stress. Despite the above literature on stress and its co-relating health risks, little work has been focused on addressing on this issue. More research is required in order to develop adequate programme to decrease stress levels among the elderly living in old age homes. Hence, the researcher selected Jacobson’s Progressive Muscle Relaxation (JPMR) technique in order to see its effect on the level of stress and also that very less studies have been conducted to assess the effect of JPMR on the stress of elderly.

 

MATERIAL AND METHODS:

A quasi experimental study was used to find out the effect of Jacobson’s Progressive Muscle Relaxation (JPMR) technique on the stress of elderly living in selected old age homes, Kolkata.The objectives of the study were to assess the pre-test level of stress among elderly in both experimental and control group, to find out the effect of JPMR technique on level of stress in experimental group and to compare the effect of JPMR technique between experimental and control group. The time series research design was used for the study. The study was conducted at Tollygunge Old Age Homes, N.S.C.B. Road, Kolkata and Navanir Old Age Home, Chetla, Kolkata where non-probability purposive sampling technique was used to select 60 elderly (30 in each experimental and control group). Elderly having musculo-skeletal problems, fractures, active psychosis and medical contraindications for physical activities were excluded from participating in the study.

 

A semi structured interview schedule was used to measure demographic variables and Perceived Stress Questionnaire was used to measure the stress of elderly using interview technique. Perceived stress questionnaire developed by Susan Levenstein is a standardized 4 point Rating scale (1=Almost never, 2=Sometimes, 3=Often and 4=Usually). Formal permission has been obtained from the author to use the tool. Tools have been validated by 11 experts. Pre-testing and reliability of the tool was done, and the tool were found to be reliable using Cronbach’s alpha formula in which the value of ‘r’ was found to be 0.90. Researcher has learned JPMR technique and the procedure has been validated by the experts of its field.

 

Ethical permission was taken from the ethical committee of IPGME and R and SSKM Hospital, Kolkata and informed consent was taken from the participants. Formal permissions to conduct study were taken from the concerned Head of participating institutions. The purpose and the confidentiality of the study were explained to each participant. Each participant took 15-20 minutes on an average to answer. Separate code numbers was used for each participant to maintain the anonymity and privacy. Pre-test was done on 1^st day for both experimental and control group. Experimental group was exposed to JPMR technique for 15 days. Post-test was done on the 15^th day for both the groups.

 

RESULTS:

The study findings showed that 43.33% elderly belonged to the age group of 60 – 70 years and 71 – 80 years; and 53.33% were males in the experimental group whereas 46.67% elderly belonged to the age group of 60 - 70 years and 76.67% were females in the control group. The study findings also showed that 33.34% were widowed and 63.33% had educational qualification up to secondary level in the experimental group whereas 56.66% were widowed and 66.67% elderly had up to secondary level of educational qualification in the control group.It also revealed that 60% elderly in experimental group and 56.67% elderly in the control group had child/children.The data also showed that 73.33% elderly were financially dependent in experimental group and 56.67% elderly were financially independent in the control group. It also revealed that in the experimental group, 56.67% elderly had been living in the old age homes for less than five years, whereas in the control group, 60% elderly had been living in the old age homes for more than or equal to five years. It also indicated that none of elderly had previous history of mental illness in both groups.

 

The mean pre-test stress score was 72.50 + 10.82 for experimental group and 72.37 + 7.82 for control group. The findings indicating pre-test stress scorein both groups are shown in table 1. The findings indicating post-test stress score in both groups are shown in table 2.

 

Table 1: Frequency and percentage distribution of the elderly by pre-test stress score in both experimental and control group.  

n=60(30+30)

Level of stress	Experimental		Control
	Frequency	Percentage (%)	Frequency	Percentage (%)
Minimal Stress	01	3.33	Nil	-
Mild Stress	07	23.33	06	20
Moderate Stress	14	46.67	15	50
Severe Stress	08	26.67	09	30

 

Table 2: Frequency and percentage distribution of the elderly by post-test stress score in both experimental and control group.

n = 60(30+30)

Level of stress	Experimental		Control
	Frequency	Percentage (%)	Frequency	Percentage (%)
Minimal Stress	02	6.67	Nil	-
Mild Stress	18	60	08	26.67
Moderate Stress	09	30	16	53.33
Severe Stress	01	3.33	06	20

 

 

The findings of the study also showed that the JPMR technique was effective in reducing stress in experimental group as evident from ‘t’ value of 10.77 [‘t’df (29) =3.66] at 0.001 level of significance. The JPMR technique was effective in reducing stress in experimental group than control group as evident from ‘t’ value of 2.21 [‘t’ df (58) =2.01] at 0.05 level of significance. Correlation co-efficient and their significance existing between stress of the elderly and years of living in old age homes was calculated as shown in table 3, which concluded that the level of stress increases with years of living in old age home.

 

 

Table 3: Correlation co-efficient and their significance existing between stress of the elderly and years of living in old age homes. n=60(30+30)

Variable	‘r’ value	‘t’ value
Stress vs. years of living in old age homes	0.45	3.427*

‘t’ df (58) = 2.01, at p<0.05

 

DISCUSSION:

The stress scores of the study was compared and was found to be consistent with the studies conducted by Maddepalli UR, B Vanaja K, Arumugam I and Katari K (2016) where majority of elderly living in old age homes had moderate stress[9]; Panigrahi S and Dash B (2015) where 60.6% had moderate stress [10] and Mani G, Udayakumar S, Annamalai K and Ramaswamy DJ (2014) where 60% had moderate stress[6].

 

As JPMR technique was found to be effective in reducing stress among the elderly in the study, the findings of the study was supported by a study conducted by Kanchi M and Aruna JM (2015) which revealed that calculated ‘t’ value was 29.381 that was statistically significant at 0.05 level of significance. Hence, the findings showed that JPMR technique was effective in reducing stress [11]. Similarly, the findings of the study are also consistent with the study conducted by Mohan V and Gowda BAYS (2014) where the effectiveness of JPMR technique on stress among elderly hypertensive inmates in selected old age homes was evident from ‘t’ value of 42.39 [‘t’ df(38) = 2.09] at 0.05 level of significance, indicating that JPMR technique was effective in reducing the stress [12].

 

CONCLUSION:

This study has several implications in nursing education, practice, administration and research. The study was concluded with recommendations for conducting on larger samples for better generalization of the findings and a comparative study with different relaxation techniques used in stress management. on the basis of the data analyzed, the following conclusions were drawn. The elderly living in old age homes experienced minimal to severe level of stress. JPMR technique was found to be effective in reducing stress of elderly living in old age homes. The results also showed that stress of elderly increased with years of living in old age homes.

 

ACKNOWLEDGEMENTS:

The authors are highly grateful to Mrs. Bishnupriya Biswas, Principal, West Bengal Govt. College of Nursing, SSKM Hospital Campus, Kolkata; Administrative Authority of the old age homes and the participants for their kind support and co-operation.

 

REFERENCES:

1.      World Health Organization. Ageing and lifecourse. Geneva; September 2015 [updated 2017]; cited [2017 Feb 9]. Available from URL: www.who.int

2.      Dubey A, Bhasin S, Gupta N, Sharma N. A study of elderly living in old age home and within family set-up in Jammu. Stud Home Com Sci. 2011; 5(2): 93-98

3.      Mishra AJ. A study on loneliness in old age home in India. Indian Journal of Gerontology. 2003; 17(1&2).

4.      Chakraborty A, Singh V. Old Age Homes – A Reality of Modern India. Business Economics [newspaper online]. 2016 June 1 [cited 2017 Jan 20]. Available from URL: http://businesseconomics.in

5.      HelpAge India. Elderly Issues - Problems of the elderly. India; 2010-2011 [cited 2017 Feb 2]. Available from URL: www.helpageindiaprogramme.org

6.      Rayirala A, Nallapaneni RN, Mandadi GD, Bhogaraju A. A cross sectional comparative study assessing the psychiatric morbidity in elderly living in old age homes and community. AP J Psychol Med. 2014; 15(1): 86-92

7.      Mani G, Udayakumar S, Annamalai K, Ramaswamy DJ. Percieved level of stress and its correlated among residents of old age home in Kanchipuram District, Tamil Nadu. Medical Journal of Dr D Y Patil University. 2014; 7(6): 728-731

8.      Britz Jacqueline, Pappas Eric. Sources and outlets of stress among university students: correlations between stress and unhealthy habits. Undergraduate Research Journal for the Human Sciences 2010; 9(48823-5031). Available from: URL: http://www.kon.org/urc/v9/britz.html

9.      Maddepalli UR, B Vanaja K, Arumugam I, Katari K. Level of stress among elderly at selected old age homes in Nellore. International Journal of Applied Research. 2016; 2(6): 820-822

10.   Panigrahi S, Dash B. Stress and coping strategies among senior citizen in selected old age home, Berhampur. JNEP. March 2015; 1(1):21 -25

11.   Kanchi M, Aruna JM. Evaluate the effectiveness of jacobson's progressive muscle relaxation technique on stress among elderly people, India. International Journal of Physical and Social Sciences. 2015; 5(7): 283-295

12.   Mohan V, Gowda BAYS. Effectiveness of Jacobson’s Progressive Muscle Relaxation technique on stress among elderly hypertensive inmates in selected old age homes of Dakshina Kannada District. Nepal Journal of Epidemiology. 2014; 4(2): 11

 

 

 

 

 

Received on 16.05.2019         Modified on 18.06.2019

Accepted on 14.07.2019      ©A&V Publications All right reserved