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The Process Of Aging Health And Social Care Essay

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)

Demographic aging is a global phenomenon. By 2025, the world’s population is expected to include more than 830 million people at an age of 65 yrs. With a comparatively young population, India is still poised to become home to the second largest number of older persons in the world.

Recent statistics related elderly persons in India; showed that as many as 75% 0f elderly persons were living in rural areas. About 48.2% of elderly persons were women, out of whom 55% were widows. A total 73% of elderly persons were illiterate and dependent on physical labor. One third was reported to be living below the poverty line, 66% of older persons were in vulnerable situation without adequate food, clothing, or shelter. About 90% of the elderly have no regular source of income.

National sample survey (2004) reveals that majority of the elderly in both rural (50. 20%) and urban (57.35%) areas are totally dependent on others for economic support. About 15.20% of the elderly in rural areas and 13.71% of the elderly in the urban areas are partially dependent on others.

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 years accumulate, 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 old age people become less active. Based on wear and tare theory of aging, degenerative changes takes place almost in all the systems such as brain, cardio vascular system, respiratory system bones 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 ability to perform activities of daily living, threaten the bodily safety, and distort communication.

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 %). 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 complains ( 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, old people usually don’t have money, they must spend money for medications. They can’t eat a lot of dishes, because of health reasons; liver, heart and weak teeth. Old age people often have depressions and sometimes don’t want to live any longer due to the loss of spouse. (Miller, 2007)

Elderly people are highly prone to mental morbidities due to ageing of the brain, problems associated with physical health, cerebral pathology, socio - economic factors such as break down of the family support systems, and decrease in economic independence. The mental disorders that are frequently encountered include Dementia and Mood Disorders. Other disorders include neurotic and personality disorders, drug and alcohol abuse, delirium, and mental psychosis.

Emotional disorders are the most common psychological issue faced by the elderly people which result from the social mal adjustments. Failure to adapt results in bitterness, inner withdrawal, depression, weariness of life and even suicide. Sexual adjustments - After the age of 40, there is cessation of reproduction by women and diminution of sexual activity on the part of men. As a result, physical and emotional disturbance may occur. Jealousy, irritability are very common and frequent. Impaired memory, rigid outlook and resistance to change are some of the mental changes in the elderly.

The rapid urbanization and social modernization has brought in a break down in family values and frame work .Currently, in this modern world there is a great decline in the joint family system, less importance to the family values and decreased respect to elderly people which results in economic insecurity, social isolation, and elderly abuse leading to increased number of aged destitute in India.

Old age homes are a necessity in the present day scenario 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 homes was based on supporting the old age people. 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 to the people, some old age homes are providing only shelter and food, and there are no medical facilities available.

According to national sample survey (2002), there were 728 Old age homes in India. Out of these, 325 homes are free of cost while 95 old age homes are on pay & stay facilities. A total of 278 old age homes all over the country are available for the sick and 101 homes are exclusively for women. Kerala has 124 old age homes which is the maximum in any state.

Reports showed that, admission to a nursing home cause situational depression in the elderly. Nearly fifty percent of all nursing home residents are clinically depressed. It is so prevalent, but it is not just simply a normal part of the aging process. It can be treated.

Elderly people staying in old age home will have worries about personal problems or situation that can distress their sleep. Emotional stress causes a person to be tense and often leads to frustration when sleep does not come. Elderly people frequently experiences losses that lead to stress such as retirement, physical impairment, and loss of loved once. Due to physical problems like pain, breathing difficulty, and emotional disturbances old age home residents are experiencing poor quality of sleep and psychological wellbeing. There are several studies which indicating sleep variation during old age.

Dr. Michael Vitiello, (2009) stated that sleep starts to deteriorate in late middle age and steadily erodes from then on. With aging, the proportion of total sleep time spent in deep (stage 3 or 4) non rapid eye movement sleep decreases. The elderly tend to have more difficulty falling and staying asleep than younger adults. The elderly tend to fall asleep earlier in the evening and awaken earlier in the morning. With aging, recovery from disturbances in the sleep-wake cycle and in circadian rhythms tends to become more difficult. Many drugs commonly used by the elderly and many disorders common among the elderly can disturb sleep.

Since emotional disturbances and sleep deprivation are more common among old age home residents every one needs to develop methods for invoking the relaxation response, the natural unwinding of the stress response. Relaxation lowers the blood pressure, respiration, and pulse rates, releases muscle tension, and eases emotional strains.

During stress and anxiety breathing becomes shallow and rapid. Taking a deep breath is an automatic and effective technique for winding down. Deep breathing exercises consciously intensify this natural physiological reaction and can be very useful during a stressful situation, or for maintaining a relaxed state during the day and also it promotes sleep, there by it improves the psychological wellbeing of the elderly people.

American physician Edmund Jacobson (1920) stated that, since muscle tension accompanies anxiety, one can reduce anxiety by learning how to relax the muscular tension. PMR entails a physical and mental component. Progressive relaxation involves alternately tensing and relaxing the muscles. A person using PMR may start by sitting or lying down in a comfortable position. With the eyes closed, the muscles are tensed (10 seconds) and relaxed (20 seconds) sequentially through various parts of the body. The whole PMR session takes approximately 30 minutes.

Numerous controlled studies have evaluated relaxation therapies for the treatment of insomnia. These studies are mainly combined with other methods such as biofeedback, sleep restriction, and paradoxical intent (trying not to sleep). Overall, the evidence indicates that relaxation therapies may be somewhat helpful for insomnia there by it helps to improve the physical and psychological well being.


Old age people are like the tones of knowledge and experience in your basket but their suggestion 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 got much attention from all their children. 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. Their children also provided care to the parents

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 turn to have look towards their parents. Since the children are away and no body to care for them, they feel lonely, become depressed and more concerned about their health problems much more.

As a result there are numerous old age homes has emerged as a new trend to take care the elderly in India, basically it was the culture followed in western countries. But old age homes should consider only as a secondary option. Elders in the family are definitely an asset. It is they who can impart the much needed ethical values and code of conduct in the younger generation

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 take care of them.

Old age homes should have adequate physical facilities, food, safety and security, and medical facilities. Unfortunately not all the old age homes are having all the facilities especially the medical facilities.

Reports shows that nearly fifty percent of all nursing home residents are clinically depressed. And another common issue of elderly people staying in old age home is their sleep is disrupted by brief wakeful moments typically lasting about 3 to 10 seconds. And also they are having problem in falling asleep. The time taken to sleep after going to bed is prolonged.

By improving sleep and emotional stability one can promote the psychosocial wellbeing and quality of life of elderly people.

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 a technique 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.

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, poor concentration. They are very much worried about their problems. There is a need for effective, low-cost interventions that are ecologically acceptable and efficient. 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 staffs need to take steps to improve the quality of life of elderly 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.


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.


The aim of the study is to evaluate whether relaxation technique make a difference in the level of psychosocial wellbeing and sleep among old age people after the relaxation therapy compared to those who do not receive relaxation therapy.


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


H1: There will be a significant difference in the mean score of psychosocial wellbeing in the experimental group before and after the intervention

H2: There will be a significant difference in the mean score of cognitive wellbeing in the experimental group before and after the intervention

H3: There will be a significant difference in the mean score of emotional wellbeing in the experimental group before and after the intervention

H4: There will be a significant difference in the mean score of social wellbeing in the experimental group before and after the intervention

H5: There will be a significant difference in the mean score of spiritual wellbeing in the experimental group before and after the intervention

H6: There will be a significant difference in the quality of sleep in the experimental group before and after the intervention

H7: There is significant relation between level of psychosocial wellbeing and quality of sleep in the experimental and control group


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: a subjective term that means different things to different people. A feeling of wellness by an individual. In this study it include the felling 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,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 regarding 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 is a technique of breathing in which a person inhale through nose slowly and deeply to the count of ten, where the stomach and abdomen expands, but the chest does not rise up. Exhale through the mouth slowly and completely.

Progressive Muscle Relaxation Technique is an exercise, in which a person sits in a chair comfortably.. He then tenses each muscle as tightly as he can, for a count of one to ten and then releases it completely.


Aging is a normal part of human development.

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, available supportive system.

Variability in the sleep behaviors of older people is common.


As sample size is small result 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.


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

The study is delimited to people in the age group 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.


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, and role function 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 he conceptual framework based on modified Roy’s adaptation model.



Methodology of research organizes all the components of the study in a way that is most likely to lead to valid answers to the sub problems that have been posed (Burns and Grove, 2002). It refers to various logical steps that are generally adopted by the investigator in studying the research problem.

This chapter explains the methodology adopted by the researcher to assess the level of psycho social wellbeing, and quality of sleep and deals with the description of research design, research setting, sample and sampling technique, development and description of the tool, pilot study, data collection and statistical analysis.


The research approach is an overall plan chosen to carry out the study. The selection of research approach is the basic procedure for the conduct of research inquiry. An evaluative approach was used in this study as the study aimed at assessing the effectiveness of selected relaxation techniques on psycho social well being and quality of sleep


A quasi experimental pretest and post test two group design was used to test the effectiveness of relaxation therapy over psycho social wellbeing and sleep of old age people in old age home.

Experimental group

1st week 2nd week 3rd week 4th week


Control group

O1 ----------------------------------------------------------------------------- O2

O1 Pre intervention assessment of level of psychosocial wellbeing

and quality of sleep in experimental and control group.

O2 post intervention assessment of level of psychosocial wellbeing

and quality of sleep after 4 weeks in experimental and control group.

X deep breathing exercise and progressive muscle relaxation technique.


Independent variable – selected relaxation techniques (Deep breathing exercise and progressive muscle relaxation technique)

Dependant variables _ Psycho Social Wellbeing (cognitive, Emotional, Social and Spiritual) and Quality of Sleep


“Setting” refers to the area where the study is conducted. The setting for the study was a selected old age home at Coimbatore. Total population of the old age home is 150 members. It is managed by Samaritan sisters exclusively for aged and destitute. The criteria for the admission in old age home are aged and destitute above 60 years. It is a service oriented home and no fees for stay and food. A medical team contains 1 general physician and 2 nurses will visit once in a month to the home and provides medical service to the people. The old age home contains two separate block for male and female. Common dining hall, prayer hall, garden. In each block there are two floors - Ground floor is called sick ward where elderly bed ridden people are residing. In first floor mobile elderly people are residing.


The population under the study was all the males and females were staying in the old age home and fulfilled the criteria for sample selection.


Sample refers to a subset of population that is selected to participate in a particular study (Burns and Grove 2002).

In this study the sample size consisted of 50 inmates of the old age home (25 samples in control group and 25 in experimental group). Both male and female subjects were included in this study.


A list of eligible subjects was prepared. By simple random sampling technique _ lottery method 25 samples were assigned to the experimental group and 25 samples were assigned to the control groups.


Inclusion criteria

Elderly people both male and female in the age group of 65-85yrs

Those who were willing to participate

Those who were physically and mentally able to participate in the study

Exclusion criteria

Those who were bed ridden unable to sit alone and do exercise

Those who were mentally incompetent to follow the commands

Un co-operative people


The tool used for the data collection was an interview schedule organized in 3 parts.

Part 1: Demographic data consisted of personal information like age, sex, marital status, education, duration of stay in old age home, presence of relatives, visitors and presence of physical illness, opinion about immediate environment which include food, safety and security and comfort.

Part 2: Psycho social wellbeing scale. It was prepared by the researcher with expert’s guidance by using geriatric depression scale and WHO Health Related Quality of Life index scale. It was designed to assess the psycho social wellbeing in four dimensions (cognitive, emotional, social and spiritual wellbeing). There are 6 items in each dimension. Some questions are positive and some negative. There are two columns ‘yes’ ‘no’ to record the response.

Positive questions were 2 and 3 in cognitive dimension, 1, 3 and 4 in emotional dimension, 2, 3, 4, 5 and 6 in social dimension, and all 6questions in spiritual dimension.

Negative questions were 1, 4, 5 and 6 in cognitive dimension, 2, 5 and 6 in emotional dimension, 1 and 6 in social dimension.

Part 3: Pittsburg sleep quality index scale. It was standardized tool to assess quality of sleep. It has 9 items (subjective sleep quality, sleep duration, sleep latency, sleep efficiency, sleep disturbance, use of sleep medications and day time dysfunctions, which subjectively describe the person’s sleep quality for the month.


Scoring - psycho social wellbeing assessment

For positive questions a response in the ‘yes’ column was given a score of 1and in the ‘no’ column a score of ‘0’ was given. For negative questions a response in the ‘yes’ column was given a score of 0 and in the ‘no’ column a score of ‘1’ was given. In all the dimensions the maximum score was ‘6’ and the minimum score was ‘0’.

The score was interpreted as

0 – 2 Poor

3 – 4 Moderate

5 – 6 Good

It was same in all four dimensions (cognitive, emotional, social and spiritual wellbeing)

Scoring - Pittsburg sleep quality index scale

In scoring the Pittsburg sleep quality index scale, seven component scores are derived, each scored ‘0’ (no difficulty) to 3 (severe difficulty). The component scores are summed to produce over all score (range 0 to 21).

In seven components each one is interpreted as

0 Very good

1 Fairly good

2 Fairly bad

3 Very bad

Overall PSQI Score

Sum of seven components scores

< 5 - Good sleep quality

> 5 - Poor sleep quality


Deep breathing exercise

Deep breathing is a powerful anti-stress technique. When we bring air down into the lower portion of the lungs, where the oxygen exchange is most efficient, heart rate slows, blood pressure decreases, muscles relax, anxiety eases and the mind calms.

Progressive muscle relaxation technique

Progressive Muscle Relaxation is a relaxation technique used to release stress by tensing and then relaxing each muscle group of the body, one group at a time.

Deep breathing and progressive muscle relaxation are essentially a state of inducing deep muscle relaxation of the whole body and relaxed respiratory rhythm

A teaching plan on Deep breathing and progressive muscle relaxation technique is prepared to help people to learn the exercise.

The following steps were adopted to develop the teaching plan

1. Development of aim and objectives based on the study objectives

2. Selection of teaching learning content

3. Selection of teaching learning activities

4. Selection of Audio Visual Aids

5. Organization of the content

The contents included were

1. Basic concepts of deep breathing exercise and progressive muscle relaxation technique

2. Advantages of deep breathing exercise and progressive muscle relaxation technique

3. Demonstration of the relaxation techniques

4. Practice and re demonstration

5. Instructions to follow

Deep breathing exercise

We need exhale completely through mouth, making a whoosh sound.

Then we have to close the mouth and inhale quietly through our nose to a mental count of four.

Then after that hold our breath for a count of seven

The next step is exhale completely through our mouth, making a whoosh sound to a count of eight.

This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Progressive muscle relaxation technique

After the deep breathing

All we need for this exercise is that we need to clench the fists. Hold for 7-10 seconds and then release for 15-20 seconds.

Let the person tighten his biceps by drawing the forearms up toward the shoulders and "making a muscle" with both arms. Hold... and then relax.

Tighten the triceps--the muscles on the undersides of the upper arms--by extending the arms out straight and locking the elbows. Hold ... and then relax.

Tense the muscles in the forehead by raising the eyebrows as far as the person can. Hold ... and then relax. Let the person imagine his forehead muscles becoming smooth and limp as they relax.

Tense the muscles around the eyes by clenching the eyelids tightly shut. Hold... and then relax.  Let the person imagine sensations of deep relaxation spreading all around him.

Tighten the jaws by opening the mouth so widely that it stretches the muscles around the hinges of the jaw.

Tighten the muscles in the back of the neck by pulling the head way back; as if the person is going to touch the head to the back (be gentle with this muscle group to avoid injury).

Tighten the shoulders by raising them up as if the person is going to touch his ears. Hold ... and then relax.

Tighten the muscles around the shoulder blades by pushing them back as if heis going to touch them together.

Tighten the muscles of the chest by taking in a deep breath. Hold for up to 10 seconds ... and then release slowly.

Tighten the stomach muscles by sucking your stomach in. Hold ... and then release. Let the person imagine a wave of relaxation spreading through his abdomen.

Let him try to touch both elbows together behind his back. press the back into the chair or floor

Tighten the buttocks by pulling them together. Hold ... and then relax. Imagine the muscles in thr hip region going loose and limp.

Extend the leg by keeping the foot relaxed and press the back of the knee towards the floor

Tighten the calf muscles by-pulling the toes toward you (flex carefully to avoid cramps). Hold ... and then relax.

Tighten the feet by curling the toes downward. Hold ... and then relax.

Mentally scan the body for any residual tension. If a particular area remains tense, repeat one or two tense-relax cycles for that group of muscle.

The first draft of teaching plan is derived by keeping in mind the objectives, literacy level of the sample, and simplicity of the language. The teaching plan is developed in English and it is translated into Tamil (appendix page no)


The tool was developed based on the objectives of the study, Review of literature and discussion with experts


The research tool including the objective of the study along with the criteria check list were submitted to five experts – three Nursing, one Geriatric physician and one Clinical Psychologist. The three nursing experts were Professors with Masters Degree in Nursing and working in different colleges of nursing in Coimbatore with more than 5 years of experience.

The geriatric physician was working in a private hospital in Coimbatore for more than 20 years. The Clinical Psychologist was working in a private hospital in Coimbatore and had an experience spanning 15 years which included private practice.

According to the expert’s opinion changes had been done and final validation done.


The reliability of the psycho social wellbeing assessment scale, and Pittsburg sleep quality index scale was established by test retest method. the rest was given after 14 days. Correlation co-efficient was calculated by Spearman Brown correlation method. The obtained ‘r’ value was 0.82 for psycho social wellbeing assessment tool and 0.86 for Pittsburg sleep quality index scale which confirmed that there was high positive correlation and internal consistency of the tool.


A pilot study was conducted in the same old age home, where main study was intended to be carried out, to test the feasibility of study. Permission was obtained from the concerned authorities of the Old age home.

The study was carried out from 1 – 8 – 10 to 14 – 8 – 10, over a period of 14 days. 10 samples were selected, 5 in experimental and 5 in control group. Both male and female were included in this study. The experimental and control group were selected by using Simple Random Sampling technique – lottery method. After self introduction, the investigator explained the nature of study to the samples. After developing good rapport, the investigator collected the baseline data on psychosocial wellbeing and quality of sleep of the samples for the past one month by interviewing the samples individually.

Deep Breathing and Progressive Muscle Relaxation techniques were taught and demonstrated to the 5 samples of the experimental group as a group teaching and they were asked to re-demonstrate. The relaxation therapy was carried out for 30 minutes every day and it was continued for 14 days in the presence of investigator. On the 14th day the investigator conducted the Post test was conducted by the investigator by using same tool. The tools used were Psychosocial Wellbeing Assessment tool and The Pittsburgh Sleep Quality Index. The Psychosocial Wellbeing assessment tool is having 4 dimensions – Cognitive, Emotional, Social and Spiritual. The reliability of each dimensions were checked and the overall reliability of the tool was checked. The overall reliability of the tool was 0.82. Pilot study proved the adequacy of the tools and techniques. Hence no modifications were required.


The main study was conducted in the same old age home where the pilot study was conducted. Before commencement of data collection once again the old age home authority was informed and permission obtained. A hall was arranged for demonstrating the exercise. Based on the sampling criteria and technique 25 samples were selected for experimental group and the same number of samples was selected for control group. After establishing good rapport and obtaining their willingness the investigator explained the purpose of the study; obtain the willingness and participation in the study. By using psycho social well being assessment scale, and Pittsburg sleep Quality Index baseline data was collected from both group.

The next day onwards the investigator stayed in the old age home from 5 – 6 pm. The experimental group was divided into two subgroups, male and female separately. according to teaching plan relaxation therapy taugt and demonstrated seperately for male and female in 2 session. The old age people were asked to re-demonstrate and carryout the exercises 30 minutes a day for 30 days in the presence of investigator. For control group no intervention was given. In both groups, On 30th day the investigator conducted the post test by using the same tool collected on level of psycho social wellbeing and quality of sleep. The study was done from 15 – 8 – 2009 to 15 – 9 – 2009.


The data obtained would be analyzed in terms of the objectives of the study using descriptive and inferential statistics.

Descriptive statistics:

Frequency and percentage distribution were used to analyze demographic variables, to assess the level of psycho social wellbeing, and quality of sleep of experimental and control group before the intervention.

Mean and standard deviation were used to determine the difference in level of psycho social wellbeing, and quality of sleep.

Inferential statistics:

‘t’ test was used to determine the significant of the difference in level of psycho social wellbeing and quality of sleep .

‘Chi square’ test was used to associate the demographic variables with level of psycho social wellbeing and quality of sleep.

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