Impact of Jacobson Progressive Muscle Relaxation (JPMR) and Deep Breathing Exercises on Anxiety, Psychological Distress and Quality of Sleep of Hospitalized Older Adults

Abstract

INTRODUCTIONOld age is a crucial period of life during which mental health related problems may become a cause or an effect of various physical health related problems, amongst which anxiety (Wolitzky-Taylor, et al., 2010), psychological distress (Joshi, Kumar & Avasthi, 2003; Rabinowitz, et al., 2005) and sleep difficulties (Lindstrom, et al., 2012) are commonly reported. The association of anxiety disorders are moderately associated with reduced sleep quality resulting in poor the quality of life (Ramsawh, et al., 2009). Recently, studies revealed significant association between higher anxiety, depression and poor sleep quality in elderly chronically ill (Suh, et al., 2013). However, remaining active was associated with lesser psychological distress (Yorston, et al., 2012). A review of 106 articles on sleep problems among older adults reported the common problems as waking up too early, trouble falling asleep, daytime napping, and multiple nocturnal awakenings (Cochen, et al., 2009).Among the non-pharmacological interventions, deep breathing and other relaxation exercises (such as Jacobson Progressive Muscle Relaxation - JPMR) have been found to be effective in for various categories of hospitalized population such as cancer patients on chemotherapy (Lee, et al., 2012; Hayama & Inoue, 2012), patients with gynecological diseases (Pan, et al., 2012; Zhao, et al., 2012), patients with COPD (Singh, et al., 2009) and coronary artery bypass graft surgery (Dehdari, et.al., 2009). Also these resulted in decreased state anxiety, psychological stress, fatigue, and increased subjective wellbeing (Vancampfort, et al., 2011), and positive mood (Jain, et al., 2007; Tsai, 2004), increased quality of life (Chio, 2010), anxiety (Manzoni, et al., 2008) and positive effects on sleep quality and fatigue (Demiralp, et.al, 2010) of older adults. However, the duration of JPMR in studies varied from 12 weeks (Zhao, et al., 2012), to 6 weeks (Dehdari, 2009), and to 6 weeks twice a day (Yildrim and Fadiloglu, 2006). The oneweek intervention in the present study was decided keeping the average duration of stay (10 days), number of total beds occupied in a given time (With a rapidly ageing population and increasing life expectancy, treatment services aimed at improving the mental health and quality of life of older adults are extremely important and therefore, hospital care of the older adults needs to be expanded to go beyond disease orientation and involve the total multidimensional approach with adjunct therapies such as JPMR and breathing on a regular basis.The key objective was to assess the effect of progressive muscle relaxation and deep breathing exercises in reducing anxiety, psychological distress and improving quality of sleep of older hospitalized adults so as to include this as a regular care service to the admitted patients as a part of multidimensional health care model.METHODOLOGYStudy design and SamplingOlder patients admitted to the geriatric ward of a public sector tertiary care level hospital meeting the inclusion criteria were studied during period of June 2013December 2013. A quasi-experimental study design, total enumeration technique in which all the consecutively admitted patients were assessed for eligibility and the consenting individuals were included in the sample.Inclusion Criteria1. Hospitalised older adults.2. Patients who were able to follow instructions and willing to provide written consents.3. Able to communicate in Hindi /English.Exclusion Criteria1. Unconscious and disoriented patients. …