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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 56-60

Effectiveness of progressive muscle relaxation therapy on anxiety and depression: A pre-experimental study on elderly people of old age homes


1 Department of Psychiatric Nursing, Government College of Nursing, Bikaner, Rajasthan, India
2 Department of Associate Professor, University College of Nursing, BFUHS, Faridkot, Punjab, India

Date of Web Publication21-Jan-2020

Correspondence Address:
Dr. Sushil Kumar Maheshwari
University College of Nursing, BFUHS, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_20_19

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  Abstract 


Introduction: Old age is the closing period in the life span, and it is characterized by certain physical and psychological changes in human being, including anxiety and depression. These changes often determine personal and social adjustments of the elderly. Aim: This study aimed to assess the effectiveness of progressive muscle relaxation therapy on anxiety and depression among elderly people residing in selected old age homes of Rajasthan. Materials and Methods: Pre-experimental research approach with one group pretest–posttest design was used to conduct the study. Nonprobability convenience sampling technique was adopted to select 50 elderly of selected old age homes of Rajasthan. Hamilton Anxiety Rating Scale and the Geriatric Depression Scale were used to assess anxiety and depression, respectively. Progressive muscle relaxation technique (PMRT) was implemented and continued once a day for 10 days for 20–30 min. Results: The study found that 28.0% elderly had moderate anxiety and 100% had depressive symptoms at baseline. After PMRT, anxiety and depression reduced significantly at P < 0.05.Conclusions: The study concluded that progressive muscle relaxation is effective in reducing level of anxiety and depression among the elderly but need to conduct same study on large sample. Elderly should be taught about progressive muscle relaxation so that they can use to reduce their anxiety and depression.

Keywords: Anxiety, depression, elderly, old age homes, progressive muscle relaxation


How to cite this article:
Ghodela AK, Singh V, Kaushik N, Maheshwari SK. Effectiveness of progressive muscle relaxation therapy on anxiety and depression: A pre-experimental study on elderly people of old age homes. Indian J Psy Nsg 2019;16:56-60

How to cite this URL:
Ghodela AK, Singh V, Kaushik N, Maheshwari SK. Effectiveness of progressive muscle relaxation therapy on anxiety and depression: A pre-experimental study on elderly people of old age homes. Indian J Psy Nsg [serial online] 2019 [cited 2020 Jun 4];16:56-60. Available from: http://www.ijpn.in/text.asp?2019/16/2/56/276345




  Introduction Top


Population aging is a global phenomenon. The elderly over 60 years of age constituted 7% of India's population in 2018, likely to increase to 20%–30% by 2050 as projected. Due to improved health-care delivery and decreased mortality, population of the elderly is growing. This lead to the increased risk of multiple chronic medical disorders and geriatric syndromes and many socioeconomic challenges.[1] It has been documented that the elderly are more prone to psychological problems and depression is the most common geriatric psychiatric symptom. In India, elderly face multitude of psychological, social, and physical health problems. With the advancement of age, there is increased morbidity and functional loss. Various life events greatly impact one's psychological status. Depression in the elderly is manifested as major or minor.[2]

According to the World Health Organization (2001), factors increasing depression risk in older adults include genetic susceptibility, chronic disease and disability, pain, frustration with limitations in activities of daily living (ADL), personality traits (dependent, anxious, or avoidant), adverse life events (separation, divorce, bereavement, poverty, and social isolation), and lack of adequate social support.[3]

The National Health Interview Survey (2011) shows that 39% of people over 65 years of age suffer from some limitation of activity due to chronic conditions and 11% are unable to carry out major activities because of their anxiety toward illness and also they suffer from some anxiety disorders. An Indian survey had shown that the incidence of anxiety-related disease was alarmingly increasing among the elderly due to separation from children's, death of the spouse, and physical changes. The survey has shown that 49% of the elderly will have some form of anxiety disorders, which may lead to the development of depressive disorders in future.[4]

Factors responsible for high risk of depression in older adults include genetic susceptibility, chronic disease and disability, pain, frustration with limitations in ADL, personality traits (dependent, anxious, or avoidant), adverse life events (separation, divorce, bereavement, poverty, and social isolation), and lack of adequate social support.[5]

Several interventions are available to reduce anxiety and depression among elderly and progressive muscle relaxation is one of them. Relaxation exercises have a significant psychological effect. Through relaxation, one can improve specific aspects of personality, increase the positive qualities, and changing unwanted habits and attitudes. Edmund Jacobson developed the progressive muscle relaxation technique (PMRT) in the 1920s as a way to help people to deal with stress anxiety with the principal that relaxing the muscles could relax the mind as well.[5]

Progressive muscle relaxation is effective in reducing anxiety, depression and soothing stress by reducing levels of cortisol (a hormone released in response to stress). Progressive muscle relaxation helped to relieve anxiety and improve the quality of life among 29 colorectal cancer patients who had recently received surgery.[6] Hui et al. found that progressive muscle relaxation improves quality of life and reduced blood pressure among people with heart disease.[7]

The PMRT is easily learned and widely used as a choice of treatment for managing anxiety, depression, and other psychological symptoms.[7] Hence, the present study aimed to assess the effectiveness of PMRT in reducing anxiety and depression among elderly people residing in selected old age homes.


  Materials and Methods Top


Pre-experimental research approach with one group pretest–posttest design was used to conduct the study in selected old age homes of Rajasthan. The old age homes as study settings were selected on the basis of availability of number of elderly, giving permission to conduct the study and convenience in terms of distance. Nonprobability convenience sampling technique was adopted to select 50 elderly of selected old age homes of Rajasthan. PMRT was independent, and level of anxiety and depression among elderly were the dependent variable. The Hamilton Anxiety Rating scale (HAM-A) and Geriatric Depression Scale was used to assess anxiety and depression, respectively. PMRT was implemented and continued for once a day for 10 days for 20–30 min. Ethical approval for conducting the study was taken from the Government College of Nursing, Bikaner, and RUHS, Jaipur. Administrative approval and permission were taken from concerned authorities of old age homes. The consent form was prepared for the study participant regarding their willingness to participate in the research study. The research tool for data collection consists of two sections:

Part-I – It consists of demographic variables such as age, gender, marital status, occupation before joined to old age home, source of income, reason for staying in the old age home, and length of stay in old age home. Content validity of tool was determined by experts in the field of psychiatry, psychiatric nursing, and psychology, respectively. Content appropriateness, clarity, and relevance were ascertained by the language expert.

Part–II – It composed of two sections of tool for assessing anxiety and depression.

  1. HAM-A was used in this study to assess the level of anxiety among the elderly. It consists of 14 items which is defined by a series of symptoms and measures both psychic anxiety and somatic anxiety. Each item is rated on a 5-point scale ranging from 0 to 4, and its minimum score is 0 and maximum score is 56. Less than 13 was considered as no anxiety, 14–17 is mild anxiety, 18–24 is moderate anxiety, and ≥25 is considered as severe anxiety. The administration time for scale is 10–15 min. This scale is in public domain to use
  2. Geriatric Depression Scale (Short Form) is a 15-item screening tool used to identify depression in older adults. Each item is answered as yes/no and one mark is assigned for yes. Minimum score is 0 and maximum score is 15. The administration time for scale is 5–10 min. This scale is in public domain to use. A score of 0–5 is normal, >5 suggests depression and ≥10 is almost always indicative of depression.


Intervention

The researcher underwent formal training of PMRT from subject expert. Jacobson's Progressive Muscle Relaxation was demonstrated to all elderly for 45 min in a group of 4–5. A return demonstration was taken from each elderly and training continued till each elderly learnt this technique. Then, intervention was continued for 10 days for 20–30 min once in a day under supervision in selected old age home.

Method of data collection

On day 1, interview method was used to assess pretest level of anxiety by using HAM-A and pretest level of depression by using the geriatric depression scale in experimental group. It took 10–20 min for each participant. Then, PMRT was given to experimental group by demonstration method within 45 min and continued practicing intervention for 20–30 min for 10 days once in a day. Then on last day, interview method was used to assess posttest level of anxiety and depression by using same scale to assess the effectiveness of PMRT on anxiety and depression. Statistical analysis was performed through differential and inferential statistics using SPSS 18 (Statistical Package for the Social Sciences, India) and the level of significance < 0.05 was considered as the level of significance.


  Results Top


[Table 1] shows that majority of patients were 35 (70%) were in the age group of 60–65 years, and all (100%) patients were male. The majority of the elderly 36 (72%) were single and were farmer/laborer before coming to old age home.
Table 1: Frequency and percentage distribution of demographic variables of subjects (n=50)

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[Table 2] represents the pretest level of anxiety among the elderly. It shows that 46% had mild anxiety followed by 28.0% had moderate anxiety and 13 (26.0%) had no anxiety. Hence, it can concluded that majority of them had mild anxiety.
Table 2: Frequency and percentage distribution of the pretest level of anxiety among elderly (n=50)

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[Table 3] depicts the pretest level of depression among elderly, and findings showed that all (100%) elderly had suggested depression as per the Geriatric Depression Scale. Hence, it can be concluded that all the patients may have suggested depression.
Table 3: Frequency and percentage distribution of the pretest level of depression among elderly (n=50)

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[Table 4] reveals the posttest level of anxiety among the elderly and it showed that majority of them (60.0%) had no anxiety, followed by (36%) had mild anxiety and only 4% had moderate anxiety. Hence, it can be concluded that majority of them had mild anxiety after progressive muscle relaxation.
Table 4: Frequency and percentage distribution of the posttest level of anxiety among elderly (n=50)

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[Table 5] shows the posttest level of depression among the elderly, and it was found that majority of them (80.0%) had no depression, and only 20.0% had suggested depression. Hence, it can be concluded that majority of them had no depression after progressive muscle relaxation.
Table 5: Frequency and percentage distribution of the posttest level of depression among elderly (n=50)

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[Table 6] shows the pretest and posttest comparison of anxiety among the elderly and it was found that progressive muscle relaxation was significantly effective (χ2 = 15.33, P = 0.002) in reducing the level of anxiety among elderly.
Table 6: Comparison of pre-and post-test level of anxiety among elderly (n=50)[Table 6]

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[Table 7] shows the pretest and posttest comparison of depression among the elderly and it was found that progressive muscle relaxation was significantly effective (χ2 = 13.336, P = 0.014) in reducing depression among the elderly.
Table 7: Comparison of pre-and post-test level of depression (n=50)

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Hence, it can be concluded that progressive muscle relaxation therapy was effective in reducing anxiety and depression among the elderly, so hypothesis H1 and H2 is accepted, i.e., posttest level of anxiety and depression is lower than pretest level of anxiety and depression among elderly after administration of progressive muscle relaxation therapy.


  Discussion Top


These results were supported by Diana S L, who conducted a quasi-experimental on effectiveness of progressive muscle relaxation on stress and anxiety among the elderly residing in selected old age home of Kanyakumari district, Tamil Nadu, where PMRT showed significant results in lowering the level of anxiety.[6]

These results were supported by Tak et al. who conducted a quasi-experimental study on the effectiveness of PMRT on anxiety among the elderly residing in selected old age home of Punjab where PMRT showed significant results in lowering the level of anxiety.[5]

These results in line with Nalawade and Nikhade who conducted an experimental study on the effectiveness of Jacobson PMRT on depressive symptoms and quality of life enjoyment and satisfaction in community-dwelling older adults where PMRT showed significant results in lowering the level of depression.[8]

PMRT is the choice of relaxation therapy to reduce anxiety and depression symptoms used in most of the chronic disease.[9] Previous research showed that anxiety-related symptoms improved after the regular use of PMRT.[10],[11] Indian studies also showed that PMRT are effective in decreasing anxiety among people affected with psychological symptoms,[12] reducing the degree of stress among the old age patient with psychotic illness,[13] and reducing the physical symptoms due to chemotherapy induced in patients with cancer.[14],[15]

Implications and recommendations

PMRT needs to be implemented as a part of other therapies and should be practiced by the nurses to teach elderly. Findings of the study will act as a catalyst to carry out more extensive research in a large sample and in other settings, and such research work enforces evidence-based practice. The study recommends that PMRT should be given for more than 7 days, and the study should be conducted on a large sample. Nonpharmacological anxiety management should be emphasized in nursing curriculum. Training programs to nurses can be given on complementary therapies.


  Conclusions Top


The study concludes that most of the elderly experienced mild-to-moderate level of anxiety and suggested depression before intervention. Progressive muscle relaxation therapy was effective in reducing level of anxiety and depression among elderly.

The study is limited to elderly people of selected old age homes of Rajasthan, India. This study involved the small sample of elderly, and there was no control group to compare the outcome. It is very difficult to ascertain whether the observed anxiety and depression are due to their old age or some other reason.

Financial support and sponsorship

Self.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pandya R, Shukla B. Elderly and their recreational needs. J Soc Welf 2011;58:24.  Back to cited text no. 1
    
2.
Satcher D. Mental health – A report of the surgeon general. Professional Psychology 2000;31:5-13.  Back to cited text no. 2
    
3.
World Health Organization. The World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001. p. 169.  Back to cited text no. 3
    
4.
National Health Census 2001. Elderly Census. Available from: http://www.healthorg.com. [Last accessed on 2014 Apr 15].  Back to cited text no. 4
    
5.
Tak GS, Maheshweri SK, Kaur M. Effectiveness of progressive muscle relaxation technique on anxiety among the elderly residing in selected old age home of Punjab. Int J Ther Appl 2016;32:48-54.  Back to cited text no. 5
    
6.
Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psychooncology 2003;12:254-66.  Back to cited text no. 6
    
7.
Hui PN, Wan M, Chan WK, Yung PM. An evaluation of two behavioral rehabilitation programs, qigong versus progressive relaxation, in improving the quality of life in cardiac patients. J Altern Complement Med 2006;12:373-8.  Back to cited text no. 7
    
8.
Nalawade TC, Nikhade NS. Effectiveness of Jacobson progressive muscle relaxation technique on depressive symptoms and quality of life enjoyment and satisfaction in community dwelling older adults. Indian J Basic Appl Med Res 2016:5:448-52.  Back to cited text no. 8
    
9.
Kaur M, Kumar A, Maheshwari SK. Effectiveness of deep breathing exercise and progressive muscle relaxation technique on stress among amputated patient. BFUNJ 2016;11:23-7.  Back to cited text no. 9
    
10.
Redd WH, Montgomery GH, DuHamel KN. Behavioral intervention for cancer treatment side effects. J Natl Cancer Inst 2001;93:810-23.  Back to cited text no. 10
    
11.
Burish TG, Tope DM. Psychological techniques for controlling the adverse side effects of cancer chemotherapy: Findings from a decade of research. J Pain Symptom Manage 1992;7:287-301.  Back to cited text no. 11
    
12.
Ranjita L, Sarada N. Progressive muscle relaxation therapy in anxiety: A neurophysiological study. J Dent Med Sci 2014;13:25-28.  Back to cited text no. 12
    
13.
Ramakrishnan M, Kalai Chandran K. The effects of progressive muscular relaxation exercise among geriatric patients with psychiatric illness. Int J Sci Res 2015;4:963-6.  Back to cited text no. 13
    
14.
Gupta B, Kumari M, Kaur T. Effectiveness of progressive muscle relaxation technique on physical symptoms among patients receiving chemotherapy. Nurs Midwifery Res J 2016;12:33-40.  Back to cited text no. 14
    
15.
Sharma P, Mahal RK, Maheshwari SK. Level and pattern of psychological distress among family caregivers of cancer patients over the course of chemotherapy and radiation-therapy. Int J Nurs Sci Prac Res 2018;4:89-98.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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