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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
Mr. BIBIN DANIEL
1st YEAR M. Sc NURSING
PSYCHIATRIC NURSING
YEAR 2012-2013
B.M.S. HOSPITAL NURSING COLLEGE
NO. 618, SRI MALLIKARJUNA TEMPLE STREET
N. R. COLONY
BANGALORE – 560019
\
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALURU, KARNATAKA,
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. NAME OF CANDIDATE AND ADDRESS(In block letters)
BIBIN DANIELPUNNAVILAVEEDUKURA P O,KOTTARAKARAKOLLAMKERALA
2NAME OF THE INSTITUTION BMS HOSPITAL NURSING COLLEGE
N.R COLONYBENGALURU-560019
3. COURSE OF STUDY,
SUBJECT
MASTER OF SCIENCE INNURSING
PSYCHIATRIC NURSING
4
DATE OF ADMISSION TO
THE COURSE
06-07-2012
5. TITLE OF THE TOPIC
A STUDY TO ASSESS THE EFFECTIVENESS OF ANULOMA VILOMA PRANAYAMA YOGA ON PSYCHOLOGICAL WELL BEING AMONG ELDERLY RESIDING IN SELECTED OLD AGE HOMES OF BANGALORE
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Learning Is An Ornament In Prosperity, A Refuge In Adversity, And A
Provision In Old Age.”
ARISTOTLE
The World Health Organization (WHO) postulates three components in
its definition of health - the mental, the physical, and the social components. A
final introduction man's life is normally divided into five main stages namely
infancy, childhood, adolescence, adulthood and old age. In each of these stages an
individual has to find himself in different situations and face different problems2.
The old age is not without problems. In old age physical strength
deteriorates, mental stability diminishes; money power becomes bleak coupled
with negligence from the younger generation. The combination of physical,
mental, and spiritual activities may have played an important role in enhancing
overall well-being3
There are several psychological and social factors that have been linked to
increased individual life expectancy and quality of life in older adults.
Psychological well-being has been examined as an indicator of successful
adaptation during old and very old age Brad burn considered the subjective
assessment of well-being as the balance between positive and negative effect .
To improve psychological well being of elderly in many ways, they may use
recreational therapy, walking, gardening, leisure actives, yoga ect. And in this
yoga is found to be more effective in improving psychological well being of
elderly
Yoga is a form of exercise that adapts to your needs and abilities that it
can be done even by senior citizens4. The word yoga means "union" in Sanskrit,
"yoga" can be more accurately described by the Sanskrit word asana, which refers
to the practice of physical postures or many people think that yoga is just
stretching. But while stretching is certainly involved, yoga is really about creating
balance in the body through developing both strength and flexibility5.
Yoga makes your body fitter, the mind calmer and more relaxed. Yoga is
also beneficial in the prevention and control of common health and emotional
problems that is linked with Old Age. It helps you in becoming more in touch
with yourself and your body enabling you to accept who you are and the state you
are in which creates a positive approach in life6.
In addition to practicing the poses, yoga classes may also include
instruction on breathing, call and response chanting, meditation, or an
inspirational reading by the teacher. The variety and amount of this will depend
on the individual teacher and the yoga style in which he or she is trained.
Typically, a yoga class at a gym will be more focused on the purely physical
benefits of yoga, while one at a yoga center may delve more into the spiritual
side. Some people find that the physical practice of yoga becomes a gateway into
a spiritual exploration, while others just enjoy a wonderful low-impact workout
that makes them feel great7.
The demographic transition with ageing of the population is a global
phenomenon which demands international, national, regional and local action.
Traditional perceptions of old age have been challenged during the past few years
and it is important that elderly people are not taken as a burden on society, but
rather as an asset8.
In old age homes this leads to ineffective coping with their day to day
activities thus there is a need to help the old age people to improve their
psychological well being and to cope up with life thus my study aims to assess
the effectiveness anuloma viloma pranayama yogaon psychological wellbeing.
6.1NEED FOR THE STUDY
Living in an old age home evokes a picture of apathy, dependence and,
sadness. The inmates often confront problems due to highly institutionalized,
depersonalized bureaucratic atmosphere in old age home. The face problems of
adjustment with tight and rigid schedule, total or near total separation from family
or social milieu, anxiety over entrusting oneself to a new environment, diminished
physical capacity and very close and frequent encounters with death and ailments
in the institution. These factors altogether contribute to depletion in their
psychological well being9.
The world elderly population in the last 50 years from 1950 to 2000 had
increased from 8 to 9.9 percent of total population10 .For mid-year 2010, official
current world population is estimated at 6.841billion of that, 516 million people
are of about 65 years and over that is about 8 percent11.As the old age accounts for
a good number in our population the promotion of their health and welfare is our
responsibility12.
About 250 million are over the age of 65 years among 4.37 billion of total
world population. The life expectancy of an average Indian has increased from 54
years to 64.6 years in 2002. The population of people aged 60 years or above is
likely to increase to 18.4 percent of the total population. About 13.5 percent of
newly admitted elderly home care patients suffered from stress. About 35.8
percent a life stress was an important etiological factor for the most of the
psychiatric disorders in old age home13.
In a research which was done to find the lower levels of positive and
negative affect among the “oldest-old" age group (participants aged 70-100 years
old),they showed that this decline in advanced old age to health related problems
and illnesses that preclude typical functioning, causing these older people to be
less able to perform everyday tasks and activities. In fact, socio-emotional
selectivity theory contends that while people may become better emotional
regulators as they age, they do not necessarily have higher positive affect14.
The National Health Interview Survey shows that 75 percent of old age
population experiences at least some stress. The American Psychiatric
Association survey shows that two thirds of Americans say they are likely to seek
help for stress. A study of 255,164 deaths of people aged 65 or over in England
found excess death rates people older than 75 within each of eight strata defined
by gender and marital status. The author suggested that the excess deaths in the
older sample might be due to psychological stress. The ability of the body to fight
disease normally improves in childhood and declines in old age. Illness itself can
produce stress.
A study conducted by Basemera OM. On 2009. Coping Strategies and
Psychological Wellbeing among the Elderly 2744 aged (57-85) in united states to
examine the relationships between psychosocial resources and deficits, elder
mistreatment, and psychological well-being.. Lower levels of positive support,
higher levels of criticism from close relationships, and feelings of social isolation
are positively associated with self-reported mistreatment experience. And older
adults with fewer psychosocial resources or more psychosocial deficits seem to be
more vulnerable to mistreatment, and mistreatment seems particularly detrimental
to psychological well-being for these people15.
Numerous epidemiological studies corroborate that residents of nursing
homes constitute a particular risk group for mental disorders. A German-English
cooperative project studied depression and dementia residents over the age of 65
years in 12 residential homes in Mannheim and 12 in the London borough of
Camden using the Brief Assessment Interview. The study showed one-third of
the home residents in Mannheim (34.6%) and in Camden (1982, 38.1%; 1986,
33.5%) suffered from depression, the prevalence of dementia was significantly
higher in Camden (1982, 65.7%; 1986, 77.5%) than in Mannheim (37.8%)16.
A quasi-experimental, study used a convenience sample of 68 residents
aged 60 years and above with mild to moderate dementia, was conducted in 1987
an experimental group of 33 elders participated in a 12-week yoga training
program of three 55-minute sessions a week; a control group of 35 elders
maintained their usual daily activities. Data were collected before and after
completing the 12-week study. The yoga-trained participants had better physical
and mental health than those who did not participate, including lowered blood
pressure, reduced respiration rate, strengthened cardiopulmonary fitness,
enhanced body flexibility, improved muscle strength and endurance, improved
balance, and increased joints motion . In addition, the depression state and
problem behaviors of these demented elders were significantly reduced. Yoga
exercise has positive benefits for both the physical and mental health of elders
with dementia living in long-term care facilities17.
Old age homes are meant for senior citizens unable to stay with their
families. Many old parents don’t have support during their sunset years. Their
experience a sense of security and fail to share their joys and sorrows with each
other. So my study will help them to improve psychological well being and
practice of yoga will help them to reduce stress, strain, and maintain good mental
health. Thus my study aims to assess the effectiveness of yoga on psychological
well being18.
6.2 REVIEW OF LITERATURE
“Review Your Goals Twice Everyday In Order To Be Focused On Achieving
Them”.
- LES BROWN
A cross sectional study conducted by Latiffah A L et al in 2005 at
Malaysia, on psychological well being of 1013 elderly people Overall prevalence
of emotional disorders among the elderly was 18%. 13.7% Malay, 18.1% Chinese
and 47.9%. Indians had poor psychological well being. 14.9% married
respondents had poor psychological well being compared to single respondents
(28.6%)19.
Guzaman et al in 2012 examine the interplay between and among
loneliness, social isolation, social engagement, and life satisfaction among 180
Filipino elderly. Using Loneliness Scale. The study showed on the whole,
loneliness in geriatric nursing homes is evident, and it is shaped by social
isolation, social engagement and life satisfaction. Impliedly, interventions and
measures to minimize loneliness are necessary, and further research is needed to
explore other variables contributing to loneliness in geriatric nursing homes20.
A comprehensive study was conducted Roland KP at Canada in 2011 to
investigate whether psychological well being, physical fitness and function
benefits are engendered through the practice of yoga in older adults. 10 studies
with 544 participants (69.6 ± 6.3 yr, 71% female) . Studies reported moderate
improvements for psychological well being (ES= 63 , 0.91) gait (ES = 0.54, 0.80),
balance (ES = 0.25-1.61), upper/lower body flexibility (ES = 0.25, 0.70), lower
body strength (ES = 0.51), and weight loss (ES = 0.73, 0.99).Yoga may engender
improvements in some components of psychological well being and fitness in
older adult21.
A study was conducted by Kavitha, A.k (2007) to compare quality of life
among senior citizens living in home for aged and family set up in Gokulam
College of Nursing, Erode district, Salem. Convenience sampling technique was
used to select senior citizens in both home for aged and family set up. The sample
was limited to 50 from home for aged and 50 from senior citizens in the family
both male and female were included. Structured interview schedule was used to
collect the data. Findings revealed that quality of life higher among senior citizens
living in family set up than the senior citizens living in home for aged22 .
A descriptive survey study conducted by Sreevani R (2007) to assess the
emotional problems among elderly people in a selected old age home at K.G.F.
Kolar. A purposive sampling technique was used to select 50 elderly people as a
sample. Socio-demographic data and general health questionnaire were used as
tools.. The results revealed that 38% of the subjects were suffering with major
health problems, 16% of them were having minor health problems, 46% were
healthy and nearly half of the sample 46% was suffering from emotional
problems23.
A study was conducted by Shirlee, A. Stokes Susan. E. Gordon (2000) at
rural village Anji (mothi) of Wardha district, Gujarat state, India, to assess the
common stressors experienced by elderly population on psychological and socio-
medical aspects of their family. This study included 600 individuals of age 60
years and above, females were 330 (55%) and males were 270 (45%).. The study
revealed that 91 (15.17%) felt the change in attitude of family members, 139
(31.5%) felt neglected and 146 (24.33%) loneliness respectivel24.
A comparative study was conducted by Smith C, Hancock H, Blake-
Mortimer J, Eckert K. on yoga and relaxation to reduce stress and anxiety. The
study intended to determine if either of the modality reduced the subjects’ stress,
anxiety, blood pressure, and psychological well being and improved quality of
life. The sample comprised of 131 subjects with mild to moderate level of stress
recruited from South Australia. The subjects were given ten weekly 1 hour
sessions of relaxation of Hatha yoga. The findings showed that following 10 week
intervention, stress, anxiety and quality of life score improved over time. Yoga
was more effective than relaxation in improving mental health25.
A study was conducted by Kjellgren A, Bood SA, Axelsson K, Norlander
T, Saatcioglu F. (2007) on wellness through a comprehensive yogic breathing
programme on 103 older adults from a small university, city of Sweden. The
subjects were instructed in a 6-day intensive programme of Sudarshan kriya and
related practices (SK & P) which they practiced daily for six weeks. The study
found that the participants in SK & P group lowered their degree of anxiety,
depression and stress, and also increased their degree of optimism (ANOVA; P <
0.001). The participants in yoga experienced the practice as a positive event that
induced beneficial effect. The study suggests that older adult participants may
improve their wellness by learning and applying a programme based on yoga and
yogic breathing exercises26.
A study was conducted by Kimberly Bethany at Bonura in 2011 on the
impact of a six-week yoga intervention on the psychological health of senior
citizens. Older adults (N = 98; Mean age = 77.04, SD = 7.28) were randomly
assigned to 3 groups: At one-month follow-up for anger, anxiety, depression,
well-being, general self-efficacy, and self-efficacy for daily living. Yoga
participants improved more than both exercise and control participants, in anger
anxiety, depression, well-being, general self-efficacy, and self-efficacy for daily
living27.
Alpass FM, Neville S. in 2003 conducted a study on social withdrawal,
particularly in the older adult, has been shown to influence psychosocial well-
being among 217 older men (> 65 years). Participants completed self-report
measurement and the research suggested that depression is often a response to
declining health and functional impairment in the older adult. Age-related losses
such as loss of professional identity, physical mobility and the inevitable loss of
family and friends can affect a person's ability to maintain relationships and
independence, which in turn may lead to a higher incidence of lack of
psychological well being28.
A comparative study was conducted at Japan in 2011 by Gururaj d et al, to
find out the effectiveness of yoga on mental health of younger and older adults.
Twenty-five normal healthy volunteers of both sexes were divided into two
groups according to age. Selected individuals were subjected to 90 min of yoga
classes once or twice a week for a month. Salivary amylase activity was assessed
before and after yoga practice. Decrease in Salivary amylase activity may be due
to reduction in sympathetic response. Reduction in State and Trait anxiety score
signifies that yoga has both immediate as well as long-term effect on anxiety
reduction. Thus yoga helps to improve the mental health in both the groups29.
6.3 STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF ANULOMA
VILOMA PRANAYAMA YOGA ON PSYCHOLOGICAL WELL BEING
AMONG ELDERLY RESIDING IN OLD AGE HOMES OF BANGALORE.
6.4 OBJECTIVES OF THE PROBLEM
1. Assess the existing psychological well being of elderly using Philadelphia
geriatric center morale scale in experimental and control group
2. Evaluate the effectiveness of anuloma viloma pranayama yoga on
psychological well being of elderly in experimental group.
3. To determine the association between psychological well being and
anuloma viloma pranayama yoga
6.5 HYPOTHESIS
The entire hypotheses will be tested at 0.05 level of significance
H1- There will be a significant difference between mean pre-test and post test
scores on psychological well being among elderly in experimental group.
H2- There will be significant mean difference between the post test scores of
experimental and control group.
H3- There will be significant association between psychological well being and
selected demographic variables.
6.6 RESEARCH VARIABLES
1. Independent variable: anuloma viloma pranayama yoga
2. Dependent variable: psychological well being
3. Extraneous variable: In these study demographic variables refers to
characteristics of the samples which include age, sex, marital status, education,
and family support.
6.7 OPARATIONAL DEFINITIONS USED IN THIS STUDY
ELDERLY: In this study it refers to the people with chronological age group
above 60 years.
Effectiveness: In this study it refers to determining the extent to which the
anuloma viloma pranayama yoga on elderly has made desired effect as evidence
from improving the psychological well being.
Anuloma viloma pranayama yoga: In this study it refers to the breathing
techniques given to the elderly for about 45 minutes on a daily basis.
Old age home: In this study it refers to the building where a group of elderly
people residing together.
Psychological well being: In this study it refers to a subjective perception of
vitality and feeling well mentally can be described objectively in dimensions of
agitation, attitudes towards on ageing and lonely dissatisfaction.
6.8. ASSUMPTION
1. The elderly inmates in the old age home may have decreased
psychological well being
2. The elderly inmates in old age home have no organized social activity for
their psychological well being.
3. The elderly inmates in the old age home may have poorly organized
facilities for recreation and meditation.
6.9LIMITATIONS
A study is limited to the elderly residing with old age home only
Small sample size is also a limitation
7. METERIALS AND METHODS
7.1.1 SOURCE OF DATA: Data will be collected from elderly people from
selected old age homes in Bangalore
7.1.2 Methods of data collection: for the present study the data will be
collected by questionnaire. The tool for the present study will be developed by the
investigator based on the objectives, review of literature and the suggestion of the
expert regarding psychological well being
7.1.3 Research design
Quasi experimental design Pretest –post test control group design.
E O1 X O2
-----------------------------------
C O1 O2
E- Experimental group
X- Anuloma viloma pranayama Yoga
C- control group
O1-pretest using Philadelphia geriatric morale scale
O2-post test using the same scale.
7.1.4. Research Setting
The study will be conducted in two old age homes of Bangalore. The
experimental group and control will be taken from 2 different old age homes.
7.1.5 Population:
Elderly who are above 60 years
7.1.5. Sample
Elderly who are above 60 years residing in selected old age homes of
Bangalore.
7.1.6 Sampling Size
30 old age people from selected old age homes in bangalore
7.1.7 Sampling technique
Purposive sampling.
7.1.8 SAMPLING CRITERIA
a. Inclusion criteria
Those who are above 60 years
Those who are willing to participate in pretest, post test and anuloma viloma
pranayama yoga
The elderly people who are available during the study period
b. Exclusion criteria
Those who can`t understand Kannada and English
Those who have chronic mental illness
Those who are bed ridden clients, blinds and deaf.
7.2 METHODS OF DATA COLLECTION
7.2.1 Instruments used for the study: based on the objectives of the study a
questionnaire will be prepared which will have two parts
Part 1: Demographic Performa
Part 2: A standardized tool Philadelphia geriatric morale scale
7.2.2 METHODS OF DATA COLLECTION
a. Technique
The activities include the breathing techniques given to the elderly for
about 45 minutes on a daily basis for 18 days.
b. Pilot study
Ten samples will be collected from selected old age homes through
purposive sampling and will be divided into control and experimental group.
Activities will be given and post test will be conducted on the 19 th day and results
will be compared.
c. Plan for data collection
The study will be conducted in selected old age homes of Bangalore. After
conducting a pre-test for both experimental and control group, activities will be
given and experimental group receives 18 of activities and control group receives
no yoga activities and post test will be conducted on the 19th day and the results
will be compared.
7.2.3Data analysis and Method
Study will be done with the help of descriptive and inferential statistics
and data will be analyzed.
Descriptive statistics: Descriptive statistics such as mean, median,
percentage distribution, frequency and standard deviation will be used to describe
demographic variables and interpret the level of psychological well being
Inferential statistic: Mean difference is used to compare the psychological
well being before and after therapy
Chi-square test will be used for determine the association between the
psychological well being and selected demographical variables
7.3 Does the study require any investigations or interventions to
be conducted on patients or other humans or animals?
Yes, the study will be conducted by using demonstration in anuloma viloma
pranayama yoga
7.4 Has the study ethical clearance been obtained from your
institution?
Formal administrative permission was taken from principal and ethical
committee of college of nursing. Administrative permission will be taken from the
directors of old age homes and written consent will be taken from the samples.
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