a study to assess the effectiveness of music therapy

A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY

ON BIO PHYSICAL & PSYCHOLOGICAL PROBLEMS OF THE ELDERLY RESIDING IN SELECTED GERIATRIC HOMES, KANCHEEPURAM DISTRICT, TAMIL NADU, INDIA

Thesis submitted in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY by PROF. Mrs. L.LAKSHMI, M.Sc.(N), Ph.D. Registration Number: 99080301

CHETTINAD COLLEGE OF NURSING KELAMBAKKAM, KANCHEEPURAM DISTRICT - 603103 TAMIL NADU, INDIA

JANUARY 2016

BONAFIDE CERTIFICATE

This is to certify that the thesis titled “A STUDY TO ASSESS THE EFFECTIVENESS OF

MUSIC

THERAPY

ON

BIO

PHYSICAL

&

PSYCHOLOGICAL PROBLEMS OF THE ELDERLY RESIDING IN SELECTED GERIATRIC HOMES, KANCHEEPURAM DISTRICT, TAMIL NADU, INDIA” submitted to Chettinad Academy of Research & Education, Chettinad University, Kelambakkam in partial fulfillment of the requirements for the award of degree of Doctor of Philosophy in Nursing (Faculty of Nursing), is the bonafide record of work done by Prof. Mrs. L. Lakshmi, M.Sc.(N)., under my guidance.

Guide

Co-Guide

Dr. Shiv Bhushan Sharma, M.B.B.S., Ph.D., Associate Professor Department of Physiology, Chettinad Hospital and Research Institute Kelambakkam, Kancheepuram Dt.

Dr. Prof. Mrs. Rajalakshmi, M.Sc., Ph.D., Research Coordinator, Department of Nursing Research, C.S.I. Jayaraj Annabakyam College of Nursing, Madurai.

Seal

Date:

Head of the Institution Prof. Dr. K. Ravindran, M.D., Vice-Chancellor, Chettinad Academy of Research and Education,

CERTIFICATE BY THE GUIDE This is to certify that the thesis entitled “A STUDY TO ASSESS THE EFFECTIVENESS

OF

MUSIC

THERAPY

ON

BIO

PHYSICAL

&PSYCHOLOGICAL PROBLEMS OF THE ELDERLY RESIDING IN SELECTED GERIATRIC HOMES, KANCHEEPURAM DISTRICT, TAMIL NADU, INDIA” submitted by Prof. Mrs. L. Lakshmi, M.Sc.(N)., is a record of the original research work done by the candidate under my supervision during the period (from 2009 to 2016). Further the research work has not been submitted here or anywhere else for any other award in this country or elsewhere. The whole of this is the sole work / a part of a collective work, but representing the independent work on the part of the candidate. The thesis submitted as set forth by the candidate in the preface as well as in the thesis as applicable, her written statement narrating the portion of such contributions, shall form the basis for the award of the present degree, by Chettinad Academy of Research and Education. I / We certify.

Signature of the Guide

Signature of the Co-Guide

Dr. Shiv Bhushan Sharma, M.B.B.S., Ph.D., Associate Professor Department of Physiology, Chettinad Hospital and Research Institute Kelambakkam, Kancheepuram Dt.

Dr. Prof. Mrs. Rajalakshmi, M.Sc., Ph.D., Research Coordinator, Department of Nursing Research, C.S.I. Jayaraj Annabakyam College of Nursing, Madurai.

Official rubber stamp / date

DECLARATION BY THE CANDIDATE

I, Prof. Mrs. L. Lakshmi, M.Sc.(N)., Reg. No: 99080301, hereby declare that the thesis “A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON BIO PHYSICAL & PSYCHOLOGICAL PROBLEMS OF THE ELDERLY

RESIDING

IN

SELECTED

GERIATRIC

HOMES,

KANCHEEPURAM DISTRICT, TAMIL NADU, INDIA” is the original bonafide research work carried out by me at Chettinad Academy of Research and Education.

I further declare that the thesis is a record of the research work done by me and has not been submitted here or anywhere else previously or formed the basis of another thesis submitted for the award of any other Degree, Diploma or other similar title in this country or elsewhere. I also declare that the whole of this is my work / a part of a collective work but representing the independent work done by me.

Date: Place:

Signature of the Candidate Prof. Mrs. L. Lakshmi, M.Sc.(N).,

ABSTRACT Background of the study: The proportion of the world’s population aged 60 years or over increased from 8 per cent in 1950 to 12 per cent in 2013. It will increase more rapidly in the next four decades to reach 21 per cent in 2050. Taking care of them was mainly the responsibility of their children. But the trend towards nuclear families and materialism among the younger generation in modern industrial life led to their alienation and isolation from family and society. So elders are forced to stay in old age homes. Institutions are mushrooming since 1990s. In 1998, India had 728 old age homes. In 2006 it is increased to 1049. In geriatric homes more than half of the elderly are suffering from hypertension. Mortality rates will be higher among geriatric which is included in the vulnerable group by the year 2020, mainly due to cardiac illness. In recent years, complementary therapies especially music therapy has got more positive effect on biophysical problems and psychological problems of the elderly. Minimal studies were conducted even in developed countries. Hence, a study was conducted to assess the effect of Indian classical music on the bio physical and psychological problems of the old aged.

Methods: Quasi experimental study was conducted in selected geriatric homes in Kancheepuram district. Two geriatric homes run by the same trust were being selected for the research study. In the experimental group total male and female geriatric population was 392(N1) in a geriatric home.. Inclusion criteria were followed, as the samples that were able to hear the music by conducting whisper test. Among them, 101(n1) were selected by using purposive sampling technique within the age group of 60-90 years. In the control group, total number of male and female geriatric population was 276(N2)..Among them 108 (n2) were selected for the study. In both the groups, as a pre test, their bio physical problems mainly hypertension was assessed by checking their bio physical parameters like pulse, respiration, blood pressure and EEG. Also, a structured questionnaire, Subjective Well Being Inventory, a modified WHO scale was used to assess the psychological problems of the elderly. It has got 25 questions which consisted of Quality of life (6), Relationship with family and others (8), Mood changes ( 6), Subjective feelings about health (4) and (1).

Pre test was done before the intervention of administration of music therapy. It was administered to the participants who were included in listening to a predesigned instrumental music based on raga Malkauns, for duration of 22 minutes at a specified time in the evening for a period of 30 days. All the above mentioned tests were repeated on the 31st day for the experimental group. In control group, 8 elderly samples dropped out due to their sickness. So the post test was done only for 100(n2) samples. Data was analyzed using Univariate, Bivariate and Multivariate statistical methods.

Demographic variables in categorical/dichotomous were given in frequencies with their percentages. Clinical parameters and SWBI score were given in mean and standard deviation.

Categorical variables are analyzed using chi Square method. Quantitative variables are analyzed using student independent t-test, student dependent t-test, repeated measures of analysis of variance. Differences between pretest and posttest score was analyzed using proportion with 95% CI and mean difference with 95% CI. Correlation between SWBI score and clinical parameters was analysed using Karl Pearson correlation coefficient method. Influencing factors for gain and reduction score are identified using multivariate logistic regression method. Simple bar diagram, Multiple bar diagram, Box plot, Deviation bar diagram and scatter plot matrix with regression estimate were used to represent the data (pRs.1500 Yes

21

20.8

26

26.0

40

39.6

38

38.0

19

18.8

20

20.0

10

9.9

8

8.0

11 68 7 11 15 10 13 9 12 36 53 42

10.9 67.3 6.9 10.9 14.9 9.9 12.9 8.9 11.9 35.6 52.5 41.6

8 62 10 11 17 8 20 12 8 28 64 49

8.0 62.0 10.0 11.0 17.0 8.0 20.0 12.0 8.0 28.0 64.0 49.0

No

59

58.4

51

51.0

Chi square test

2=0.05 P=0.97 2=0.01 P=0.98 2=1.65 P=0.44

2=1.30 P=0.86

2=0.92 P=0.81

2=2.82 P=0.24 2=1.11 P=0.29

Note: The following terms apply to every Table and will not be repeated. * significant at P≤0.05, ** highly significant at P≤0.01, *** very high significant at P≤0.001 Table 1: Various lifestyle related factors like exercise, the personal interests and substance abuse were compared between the two study groups. The proportion subjects reporting regular walking was slightly higher in experimental group (80.2%), compared to control group (75%). The proportion of experimental group subjects reporting interest in games and tailoring was 7.9% and 11.9% respectively, where as these proportions were 5% and 19% respectively in control group. The most common 52

substance abuse reported in both the study groups was pan chewing (12.9% in experimental group vs 20% in control group), followed by smoking (9.9% in experimental group vs 8% in control group). Even though minor differences exist in lifestyle factors between two study groups, they were not statistically significant, hence it can be concluded that the study groups were comparable with respect to life style factors.

53

Graph 2 : Socio demographic profile of the study population

54

Table 2: Comparison of lifestyle related factors between the two study groups Group Life style factors

Exercise

Interest

Substance abuse

Experiment (101) Control (100) N

%

N

%

Nil

20

19.8

25

25.0

Walking

81

80.2

75

75.0

Nil

81

80.2

76

76.0

Games

8

07.9

5

05.0

Tailoring

12

11.9

19

19.0

Nil

69

68.3

60

60.0

Smoking

10

09.9

8

08.0

Pan chewing

13

12.9

20

20.0

Others

9

08.9

12

12.0

Chi square test

2=0.78 P=0.38

2=2.42 P=0.30

2=2.76 P=0.43

Table 2 shows that the life style related factors such as exercise, interest and substance abuse are not significant between the experimental and control groups.

55

Table 3: Comparison of baseline biophysical parameters between the Experimental and Control groups Group

Student independent t-test

Biophysical Parameters

Experimental

Control

Mean

SD

Mean

SD

SBP- mmHg

161.60

14.19

161.00

13.67 t=0.30, P=0.76, DF=198

DBP –mmHg

100.10

7.98

98.60

9.54 t=1.20, P=0.22, DF=198

PULSE rate

84.34

4.45

84.40

4.08 t=0.09, P=0.92, DF=198

RESPIRATION

21.78

2.05

21.98

2.34 t=0.64, P=0.52, DF=198

Table 3 shows the comparison of mean values of baseline biophysical parameters between the experimental and control groups, using student t-test. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBS) were higher and were falling in the range of Stage II hypertension in both the study groups. No statistically significant difference in the blood pressure, pulse rate and respiratory rate was observed between the study groups.

56

Table 4: Nature of antihypertensive medication between the Experimental and Control groups Groups

Drugs

Baseline

1st month

Experimental

Tab. Atenolol

52

51.5%

52

51.5%

Tab. Alprazolam

49

48.5%

49

48.5%

Tab. Atenolol

44

44.0%

43

43.0%

Tab. Alprazolam

56

56.0%

57

57.0%

Control

Chi square test 2=0.00 P=1.00 2=0.03 P=0.98

Table 4 shows the types of antihypertensive drugs administered to experimental and control group at baseline and after 1 month. Atenolol was the most common drug used in both the study groups. Statistically there was no significant difference between the experimental and control groups, with respect to proportion of subjects using various antihypertensive drugs. The proportion of different drugs used also remained relatively constant from baseline to the first month.

57

Table 5: Comparison of dosage of antihypertensive drugs administered to the Experimental and Control groups Group Period Baseline

Drug dosage (Tab. Atenolol)

50mg b.d. 50mg o.d.

After month

1 50mg b.d. 50mg o.d.

Experimental

Control

N

%

N

%

45

44.6

47

47.0

56

55.4

53

53.0

33

32.7

47

47.0

68

67.3

53

53.0

Chi square test 2=0.12 P=0.72 2=4.30 P=0.04*

Table 5 shows the drug dosage of antihypertensive drugs administered to the experimental and control group from baseline and after 1 month. The proportion of subjects using twice daily dose of drugs was 44.6% in the experimental group and 47% in the control group. This proportion was reduced to 32.7% at 1 month after the music therapy in the experimental group but remained same in the control group. Statistically there was a significant difference between the proportions of subjects using twice daily drug dose in the experimental group at 1 month after the music therapy. It was calculated using chi square test.

58

Table 6: Changes in type of antihypertensive drugs used between the Experimental and Control groups Group

Drugs

Baseline

1st month

Chi square test

Experimental

Tab. Atenolol

45

44.6%

33

32.7%

Tab. Alprazolam

56

55.4%

68

67.3%

2=6.64 P=0.03*

Tab. Atenolol

47

47.0%

47

47.0%

Tab. Alprazolam

53

53.0%

53

53.0%

Control

2=0.03 P=0.98

Table 6 shows the changes in type of antihypertensive drugs intake in the experimental and control groups at baseline and after 1 month. In experimental group, the proportion of subjects taking atenelol reduced from 44.6% at baseline to 32.7% at 1 month after music therapy. This reduction was statistically significant. It was calculated using chi square test.

59

Table 7: Comparison of baseline level of wellbeing score between the Experimental and Control groups Group

Level of Well being

Experimental

Control

Chi square test

N

%

N

%

Poor

5

05.0

5

05.0

Moderate

96

95.0

95

95.0

P=0.99

Good

0

00.0

0

00.0

DF =1

101

100.0

100

100.0

Total

2=0.01

Table 7 shows that the majority (95%) of the participants in both the study groups came under the moderate wellbeing category using SWBI score. Only 5% of the participants in each group were classified to have poor SWBI score. There was no statistically significant difference in baseline level of SWBI score among experimental group and control group.

60

Table 8: Comparison of mean systolic blood pressure between the Experimental and Control groups Student’s independent t-test

Group Experimental

Period

Control

Mean

SD

Mean

SD

Baseline

161.60

14.19

161.00

13.67

t=0.30, P=0.76

1st month

151.85

14.45

160.40

12.88

t=4.41, P=0.001***

Table 8 shows that at baseline, the mean systolic blood pressure in the experimental group was 161.60mmHg and in the control group was 161.0mmHg. The mean difference was minimal (0.60mmHg, t value 0.30, P value 0.76). After 1 month of music therapy, the mean systolic blood pressure in the experimental group reduced to 151.85mmHg where as in the control group it remained high at 160.40mmHg (Mean difference 8.55, t value 4.41, P value < 0.001). This difference was large and it was statistically significant.

61

Table 9: Comparison of mean Systolic blood pressure (SBP) between the Experimental and Control groups Group

Baseline

After 1 month

Mean

Student paired t-test

Mean SD

Mean

SD

Experimental

161.6

14.19

151.85

14.45

9.75

t=89.91, P=0.001***

Control

161.0

13.67

160.40

12.88

0.60

t=1.09, P=0.28

reduction

Table 9 shows the comparison of the mean systolic blood pressure (SBP) of baseline and after 1 month among the experimental and control groups. In the experimental group, the mean systolic blood pressure (SBP) was 161.6mmHg at baseline and after 1 month of music therapy it was reduced to 151.85mmHg. The difference between the baseline and 1st month was 9.75mmHg. This difference is statistically significant. In the control group, the mean systolic blood pressure (SBP) was 161.00mmHg at baseline and after 1 month it was 160.40mmHg. The difference between the baseline and after 1 month was 0.60mmHg and it was not statistically significant. Both these differences were analyzed using Student Paired-t-test.

62

Table 10: Comparison of the mean diastolic blood pressure (DBP) between the Experimental and Control groups Group Period

Baseline After 1 month

Experimental

Control

Student’s independent t-test

Mean

SD

Mean

SD

100.10

7.98

98.60

9.54 t=1.21, P=0.23

95.70

8.06

98.22

9.51 t=2.02, P=0.05*

Table 10 compares the mean diastolic blood pressure (DBP) at baseline and after 1 month between the experimental and control groups. The mean diastolic blood pressure (DBP) at baseline was 100.10mmHg in the experimental group, where as in the control group it was 98.60mmHg. So the difference between the experimental and control groups is 1.50mmHg. It is small difference and not statistically significant. One month after the music therapy, the diastolic blood pressure (DBP) in the experimental group was 95.70mmHg and 98.22mmHg in the control group. There is a mean difference of 2.52mmHg. This is large and statistically significant (P value= 0.05).

63

Table 11: Comparison of reduction in the mean Diastolic Blood Pressure (DBP) between the Experimental and Control groups Group

Baseline

After 1 month

Mean

Student paired t-test

reduction

Experimental Control

Mean

SD

Mean

SD

100.1

7.98

95.70

8.06

5.40

t=11.94, P=0.001***

98.6

9.54

98.22

9.51

0.38

t=1.12, P=0.27

Table 11 compares mean DBP at baseline and after 1 month among experimental and control groups. In the experimental group, the mean diastolic blood pressure (DBP) was 100.1mmHg at baseline and after 1 month it was 95.70mmHg. The difference between the baseline and 1st month was 5.4mmHg. This difference was statistically significant (P value 19.2)

n Age group

Sex

Education status

n

31 53.4

27 46.6

58

71 -80 yrs

15 46.9

17 53.1

32

81 -90 yrs

5

6

54.5

11

Male

32 62.7

19 31.3

51

19 38.0

31 62.0

50

13 37.1

22 62.9

35

Married

45.5

Chi square test

%

61 -70 yrs

Female

Marital status

%

Total

2=0.48 P=0.79 DF=2 2=6.18 P=0.01*

Unmarried

22 78.6

6

21.4

28

Widow/widower

16 42.1

22 57.9

38

Illiterate

10 47.6

11 52.4

21

Elementary school

25 62.5

15 37.5

40

High school

10 52.6

9

47.3

19

HSC

2

20.0

8

80.0

10

Under Graduate

4

36.3

7

63.7

11

Nil

35 51.5

33 48.5

68

< 500/month

4

57.1

3

42.9

7

501-1500/month

8

72.7

3

27.3

11

DF=1

2=12.39 P=0.01** DF=2

2=7.00 P=0.13 DF=4

Income

2=5.73 P=0.12 DF=3

91

Level of SBP reduction score Demographic variables

Below average

Above average

(≤19.2)

(>19.2)

n

Exercise

Interest

Other habits

1501and above

4

Nil

% 26.7

n

Total

Chi square test

%

11 73.3

15

14 70.0

6

30.0

20

2=5.99 P=0.01**

Walking

36 44.4

45 55.6

81

DF=1

Nil

39 48.1

42 51.9

81

Games

3

37.5

5

62.5

8

Tailoring

9

75.0

3

25.0

12

Nil

39 56.5

30 43.5

69

Smoking

6

4

10

60.0

40.0

2=3.60 P=0.17 DF=2

2=6.26 P=0.10

Family income

Pan chewing

4

30.8

9

69.2

13

Others

2

22.2

7

77.8

9

Less than 500/month

8

66.7

4

33.3

12

501-1500/month

14 38.9

22 61.1

36

DF=3

2=3.57 P=0.16 DF=2

1501and above Relationship Yes No

29 54.7

24 45.3

53

19 45.2

23 54.8

42

32 54.2

27 45.8

59

2=0.79 P=0.37 DF=1

# Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives SBP reduction score. Average of this reduction score = 19.2

92

Table 26 shows the association between demographic variables and the level of reduction score in the systolic blood pressure in experimental group. Female gender, married people and people walking regularly had statistically significant effect on mean systolic BP reduction scores, compared to their other counter parts. Statistical significance was calculated using chi square test. The other variables had no influence on the systolic blood pressure reduction score.

93

Table 27: Association between the level of SBP reduction score and their demographic variables in control group Level of SBP reduction score Demographic variables

n Age group

61 -70 yrs

Below average

Above average

(≤0.9)

(>0.9)

%

27 48.2

n

Total Chi square test

%

29 51.8

56 2=1.64

71 -80 yrs

19 57.6

14 42.4

33

81 -90 yrs

4 36.4

7 63.6

11

Male

21 42.0

29 58.0

50

2=2.56 P=0.11

Female

29 58.0

21 42.0

50

DF=1

Marital status Married

23 53.5

20 46.5

43

Sex

P=0.43 DF=2

2=0.42

Education status

Unmarried

10 45.5

12 54.5

22

Widow/widower

17 48.6

18 51.4

35

Illiterate

13 50.0

13 50.0

26

Elementary school

18 47.4

20 52.6

38

High school

9 45.0

P=0.81 DF=2

2=2.30 11 55.0

20

P=0.68 DF=4

Income

Exercise

HSC

6 75.0

2 25.0

8

Under Graduate

4 50.0

4 50.0

8

Nil 0.9)

n

%

n


%

Walking

Nil

Interest

Games

Other habits

75

36 47.4

40 52.6

76

2 40.0

5

Tailoring

11 57.9

8 42.1

19

Nil

32 53.3

28 46.7

60

4 50.0

4 50.0

8

10 50.0

10 50.0

20

4 33.3

8 66.7

12

4 50.0

4 50.0

8

Pan chewing Others

Relationship

39 52.0

3 60.0

Smoking

Family income

36 48.0

Less than 500/month 501-1500/month

13 46.4

15 53.6

28

1501and above

33 51.6

31 48.4

64

Yes

24 49.0

25 51.0

49

No

26 51.0

25 49.0

51

P=0.48 DF=1

2=0.88 P=0.64 DF=2

2=1.60 P=0.65 DF=3

2=0.20 P=0.90 DF=2

2=0.04 P=0.84 DF=1

#Reduction score value is calculated using difference of each person’s after 1month score – pretest score. It gives SBP reduction score. Average of this reduction score = 0.9 Table 27 shows the association between the demographic variables and their level of reduction score in the control group. None of the demographic variables are associated with their level of reduction. Statistical significance was calculated using chi square test. 95

Table 28: Association between the level of DBP reduction score and their demographic variables in the experimental group Level of DBP reduction score

Demographic variables

Below average

Above average

(≤9.0)

(>9.0)

n Age group

Sex

Marital status

Education status

Income

Exercise

%

n

%

Total

61 -70 yrs

22

37.9

36

62.1

58

71 -80 yrs

20

62.5

12

37.5

32

81 -90 yrs

9

81.8

2

18.2

11

Male

31

60.8

20

39.2

51

Female

20

40.0

30

60.0

50

Married

15

42.9

20

57.1

35

Unmarried

13

46.4

15

53.6

28

Widow/wido 23 wed

60.5

15

39.5

38

Illiterate

11

52.4

10

47.6

21

Elementary school

17

42.5

23

57.5

40

High school

9

47.4

10

52.6

19

HSC

8

80.0

2

20.0

10

U. G.

6

54.5

5

45.5

11

Nil

35

51.5

33

48.5

68

< 500/month 4

57.1

3

42.9

7

5011500/month

4

36.4

7

63.6

11

1501and above

8

53.3

7

46.7

15

Nil

14

70.0

6

30.0

20

Chi square test

2=9.82 P=0.01** DF=2 2=4.36 P=0.05* DF=1

2=2.53 P=0.28 DF=2

2=4.68 P=0.32 DF=4

2=1.08 P=0.78 DF=3

2=3.88 96

Level of DBP reduction score


Below average

Above average

(≤9.0)

(>9.0)

n

Interest

Other habits

Family income

Relationship

%

n

%

Total

Chi square test

P=0.05* DF=1

Walking

37

45.7

44

54.3

81

Nil

38

46.9

43

53.1

81

Games

5

62.5

3

37.5

8

Tailoring

8

66.7

4

33.3

12

Nil

35

50.7

34

49.3

69

Smoking

3

30.0

7

70.0

10

2=3.64 P=0.31

Pan chewing 9

69.2

4

30.8

13

DF=3

Others

4

44.4

5

55.6

9

Less than 500/month

5

41.7

7

58.3

12

2=2.13 P=0.34 DF=2

2=2.57 P=0.28

5011500/month

22

1501and above

24

45.3

29

54.7

53

Yes

22

52.4

20

47.6

42

No

2=0.11 P=0.75

29

49.2

30

50.8

59

DF=1

61.1

14

38.9

36

DF=2

# Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives DBP reduction score. Average of this reduction score = 19.2 Table 28 shows the association between the demographic variables and their level of DBP reduction score in the experimental group. People aged between 61 to 70 years of age, females and the people who were walking had achieved statistically significant reduction in DBP scores, compared to their counterparts. The other socio demographic variables had no statistically significant influence on DBP reduction score. Statistical significance was calculated using chi square test.

97

Table 29: Association between the level of DBP reduction score and their demographic variables in the control group Level of DBP reduction score Demographic variables

Below average

Above average

(≤0.8)

(>0.8)

Chi square test

n

%

61 -70 yrs

31

55.4

25 44.6

56

71 -80 yrs

16

48.5

17 51.5

33

P=0.22

81 -90 yrs

3

27.3

8

72.7

11

DF=2

Male

21

42.0

29 58.0

50

Female

29

58.0

21 42.0

50


18

41.9

25 58.1

43

Unmarried

9

40.9

13 59.1

22

Widow/widow er

23

65.7

12 34.3

35

Illiterate

14

53.8

12 46.2

26

Elementary school

18

47.3

20 52.7

38

High school

12

60.0

8

40.0

20

P=0.16

HSC

5

62.5

3

37.5

8

DF=4

Under Graduate

1

12.5

7

87.5

8

Nil

28

45.2

34 54.8

62

0.8)

Chi square test

%

14

56.0

11 44.0

25

36

48.0

39 52.0

75

Nil

36

47.4

40 52.6

76

Games

1

20.0

4

80.0

5

Tailoring

13

68.4

6

31.6

19

Nil

30

50.0

30 50.0

60

Smoking

5

62.5

3

8

Pan chewing

10

50.0

10 50.0

20

Others

5

41.7

7

58.3

12

Less than 500/month

2

25.0

6

75.0

8

5011500/month

16

1501and above

32

50.0

32 50.0

64

Yes

25

51.0

24 49.0

49

25

49.0

26 51.0

51

Nil

n

Total

n

Walking

Interest

Below average

% 2=0.48 P=0.48

37.5

DF=1 2=4.58 P=0.10 DF=2

2=0.83 P=0.84

Family income

Relationship

No

DF=3

2=2.57 57.1

12 42.9

28

P=0.27 DF=2

2=0.04 P=0.84 DF=1

#Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It will give of DBP reduction score. Average of this reduction score = 0.9. Table 29 shows the association between demographic variables and their level of DBP reduction score in the control group. None of the demographic variables were associated with their level DBP of reduction. Statistical significance was calculated using chi square test.

99

Table 30: Association between level of pulse rate reduction score and their demographic variables in the experiment group Level of Pulse Rate reduction score Demographic variables

Below average

Above average

(≤2.99)

(>2.99)

n Age group

Sex

Marital status

Education status

Income

Exercise

%

N

Total

Chi square test

%

61 -70 yrs

32

55.2

26

44.8

58

71 -80 yrs

14

43.8

18

56.3

32

81 -90 yrs

5

36.4

6

63.6

11

Male

31

60.8

20

39.2

51

Female

20

40.0

30

60.0

50

Married

16

45.7

19

54.3

35

Unmarried

16

57.1

12

42.9

28

Widow/widower

19

51.4

18

48.6

38

Illiterate

10

47.6

11

52.4

21

Elementary school

28

70.0

12

30.0

40

High school

7

36.8

12

63.2

19

HSC

2

20.0

8

80.0

10

Under Graduate

4

36.3

7

63.7

11

Nil

33

47.8

35

52.2

68

< 500/month

2

28.6

5

71.4

7

2=3.67 P=0.29

501-1500/month

8

72.7

3

27.3

11

DF=3

1501and above

8

53.3

7

46.7

15

Nil

14

70.0

6

30.0

20

Walking

37

45.6

44

54.4

81

2=1.20 P=0.54 DF=2 2=4.36 P=0.05* DF=1 2=0.85 P=0.65 DF=2

2=11.48 P=0.02* DF=4

2=3.88 P=0.05* DF=1 100

Level of Pulse Rate reduction score Demographic variables

Below average

Above average

(≤2.99)

(>2.99)

n Interest

Other habits

Family income

N

Chi square test

%

Nil

38

46.3

43

53.8

81

Games

6

75.0

2

25.0

8

Tailoring

7

58.3

5

41.7

12

Nil

34

49.3

35

50.7

69

Smoking

6

60.0

4

40.0

10

2=0.59 P=0.89

Pan chewing

7

53.8

6

46.2

13

DF=3

Others

4

44.4

5

55.6

9

9

75.0

3

25.0

12

Less 500/month

Relationship

%

Total

than

2=2.63 P=0.26 DF=2

2=6.27 P=0.05* DF=2

501-1500/month

21

58.3

15

41.7

36

1501and above

21

39.6

32

60.4

53

Yes

18

42.9

24

57.1

42

No

2=1.67 P=0.19

33

55.9

26

44.1

59

DF=1

# Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives pulse rate reduction score. Average of this reduction score = 2.99 Table 30 shows the association between the demographic variables and their level of reduction in the pulse rate score in the experimental group. Female gender, higher educational status, people who were walking and higher family income group had statistically significant reduction in the Pulse rate, compared to their counter parts. Statistical significance was calculated using chi square test.

101

Table 31: Association between level of pulse rate reduction score and their demographic variables in the control group Level of pulse rate reduction score Demographic variables

Below average

Above average

(≤0.6)

(>0.6)

n


%

n

%

61 -70 yrs

28 50.0

28

50.0

56

71 -80 yrs

17 51.5

16

48.5

33

81 -90 yrs

5 45.5

6

54.5

11

Male

24 48.0

26

52.0

50

Female

2=0.16 P=0.68

26 52.0

24

48.0

50

DF=1


23 53.5

20

46.5

43

Unmarried

10 45.5

12

54.5

22

Widow/widower

17 48.6

18

51.4

35

Illiterate

16 61.5

10

38.5

26

Elementary school 16 42.1

22

57.9

38

High school

9 45.0

11

55.0

20

HSC

5 62.5

3

37.5

8

Under Graduate

4 50.0

4

50.0

8

32 51.6

30

48.4

62

0.6)

n Interest

n

%

35 46.1

41

53.9

76

3 60.0

2

40.0

5

Tailoring

12 63.2

7

36.8

19

Nil

28 46.7

32

53.3

60

4 50.0

4

50.0

8

13 65.0

7

35.0

20

Others

5 41.7

7

58.3

12

Less than 500/month

1 12.5

7

87.5

8

Games

Smoking Pan chewing

Family income

Chi square test

%

Nil

Other habits

Total

501-1500/month

16 57.1

12

42.9

28

2=1.98 P=0.37 DF=2

2=2.40 P=0.49 DF=3

2=5.13 P=0.07 DF=2

Relationship

1501and above

33 51.6

31

48.4

64

Yes

27 55.1

22

44.9

49

No

2=1.00 P=0.37

23 45.1

28

54.9

51

DF=1

# Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives pulse rate reduction score. Average of this reduction score = 0.6 Table 31 shows the association between the demographic variables and their level of pulse rate reduction score in control group. None of the demographic variables show any significant association with their corresponding level of reduction in the pulse rate. Statistical significance was calculated using chi square test. 103

Table 32: Association between level of respiration reduction score and their demographic variables in the experimental group Level of RESPIRATION reduction score Demographic variables

Below average

Above average

(≤1.65)

(>1.65)

Total

n

%

N

61 -70 yrs

30

51.7

28

48.3

58

71 -80 yrs

16

50.0

16

50.0

32

81 -90 yrs

5

40.0

6

60.0

11

Male

33

64.7

18

35.3

51

Female

18

36.0

32

64.0

50


12

34.2

23

65.8

35

18

64.3

10

35.7

28

Widow/widower 21

54.0

17

46.0

38

Illiterate

9

42.9

12

57.1

21

Elementary school

20

51.3

19

48.7

40

High school

7

36.8

12

63.2

19

HSC

5

50.0

5

50.0

10

Under Graduate

9

81.8

2

18.2

11

Nil

34

50.0

34

50.0

68

< 500/month

2

28.6

5

71.4

7

501-1500/month

4

36.4

7

63.6

11

1501and above

11

73.3

4

26.7

15

Nil

15

75.0

5

25.0

20

Walking

36

44.4

45

55.6

81

Age group

Sex

Unmarried

Education status

Income

Exercise

Chi square test

% 2=0.15 P=0.92 DF=2 2=8.32 P=0.01** DF=1 2=6.15 P=0.05* DF=2

2=6.22 P=0.18 DF=4

2=5.36 P=0.14 DF=3

2=5.99 P=0.01** DF=1 104

Level of RESPIRATION reduction score Demographic variables

Interest

Nil

Other habits

Family income

Relationship

Below average

Above average

(≤1.65)

(>1.65)

n

%

N

46

56.7

35

Total

Chi square test

% 43.3

81

Games

1

12.5

7

87.5

8

Tailoring

4

33.3

8

66.7

12

Nil

31

44.9

38

55.1

69

Smoking

7

70.0

3

30.0

10

Pan chewing

7

53.8

6

46.2

13

Others

6

66.7

3

33.3

9

Less than 500/month

3

25.0

9

75.0

12

501-1500/month

19

52.7

17

43.3

36

1501and above

29

54.7

24

45.3

53

Yes

22

52.4

20

47.6

42

No

29

49.2

30

50.8

59

2=7.31 P=0.02* DF=2

2=3.64 P=0.30 DF=3

2=3.57 P=0.16 DF=2

2=0.10 P=0.74 DF=1

Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives Respiration rate reduction score. Average of this reduction score = 1.65 Table 32 shows the association between the demographic variables and their level of respiratory rate reduction score in the experimental group. Female gender, married people, people interested in games, and the people walking had statistically significant reduction in the respiratory rate compared to their counterparts. Statistical significance was calculated using chi square test.

105

Table 33: Association between level of respiration reduction score and their demographic variables in the control group Level of Respiration reduction score Demographic variables

Age group

Sex

Below average

Above average

(≤0.46)

(>0.46) n

Total

N

%

%

61 -70 yrs

28

50.0

28 50.0

56

71 -80 yrs

17

51.5

16 48.5

33

P=0.94

81 -90 yrs

5

45.5

6

54.5

11

DF=2

Male

23

46.0

27 54.0

50

2=0.12

2=0.64 P=0.42

Female 27

54.0

23 46.0

50

19

44.2

24 55.8

43

8

36.4

14 63.6

22

P=0.07

Widow/widower 23

65.7

12 34.3

35

DF=2

Illiterate

11

42.3

15 57.7

26

Elementary school

16

42.1

22 57.9

38

High school

13

65.0

7

35.0

20

HSC

4

50.0

4

50.0

8

Under Graduate

6

75.0

2

25.0

8

Nil

34

54.8

28 45.2% 62

Marital status Married Unmarried

Education status

Chi square test

DF=1 2=5.67

2=5.36 P=0.25 DF=4

Income

2=3.31 0.46)

N

%

10

40.0

n

Total

%

15 60.0

25

Other habits

2=1.33 P=0.24

Walking

Interest

Chi square test

40

53.3

35 46.7

75

Nil

35

46.1

41 53.9

76

Games

3

60.0

2

40.0

5

P=0.37

Tailoring

12

63.2

7

36.8

19

DF=2

Nil

35

58.3

25 41.7

60

Smoking

4

50.0

4

8

Pan chewing

5

25.0

15 75.0

20

Others

6

50.0

6

50.0

12

Less than 1 500/month

12.5

7

87.5

8

501-1500/month

17

60.7

11 39.3

28

1501and above

32

50.0

32 50.0

64

Yes

29

59.2

20 40.8

49

DF=1 2=1.98

2=6.67

Family income

50.0

P=0.09 DF=3

2=5.79 P=0.06 DF=2

Relationship

2=3.24 P=0.07

No 21

41.2

30 58.8

51

DF=1

# Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives Respiration rate reduction score. Average of this reduction score = 0.46 Table 33 shows the association between the demographic variables and their level of respiratory rate reduction score in the control group. None of the demographic 107

variables are associated with their level of reduction. Statistical significance was calculated using chi square test.

Table 34: Association between the level of SWBI gain score and their demographic variables in the experimental group 108

Level of SWBI gain score


Age group

Sex

Below

Above

average

average

(≤16.94)

(>16.94)

n

n

%

%


61 -70 yrs

23

39.6 35

59.4

58

71 -80 yrs

20

62.5 12

37.5

32

81 -90 yrs

8

72.7 3

27.3

11

Male

24

47.0 27

53.0

51

2=6.74 P=0.03* DF=2

2=0.48 P=0.48

Female 27

54.0 23

46.0

50 DF=1


Education

12

34.2 23

65.8

35

2=8.59

Unmarried

20

71.4 8

28.6

28

P=0.01**

Widow/widower

19

50.0 19

50.0

38

DF=2

Illiterate

12

57.1 9

42.9

21

21

52.5 19

47.5

40

6

31.6 13

68.4

19

status Elementary school

2=3.91 P=0.41

High school

DF=4

Income

HSC

5

50.0 5

50.0

10

Under Graduate

7

63.6 4

36.4

11

Nil

41

60.2 27

39.8

68

2=8.24

109



Below

Above

average

average

(≤16.94)

(>16.94)

n

n

%


%

< 500/month

2

28.6 5

71.4

7

501-1500/month

4

36.3 7

63.7

11

1501and above

4

26.7 11

73.3

15

Nil

15

75.0 5

25.0

20

P=0.05* DF=3

Exercise

Walking

Interest

Other habits

2=5.99 P=0.01**

36

44.4 45

56.2

81

Nil

42

51.8 39

48.2

81

Games

5

62.5 3

37.5

8

Tailoring

4

33.3 8

66.7

12

Nil

34

49.2 35

50.8

69

Smoking

6

60.0 4

40.0

10

DF=1

2=1.93 P=0.38 DF=2

2=2.15 P=0.54

Pan chewing

5

38.5 8

61.5

13

Others

6

66.7 3

33.3

9

5

41.7 7

58.3

12

21

58.3 15

41.7

36

Family

Less than

income

500/month

DF=3

2=1.21 P=0.54

501-1500/month

DF=2 1501and above

25

47.2 28

52.8

53 110



Relationship

Yes

Below

Above

average

average

(≤16.94)

(>16.94)

n

n

%

45.2 23

54.8

19

%


42

2=0.65 P=0.41

No

32

54.2 27

45.8

59

DF=1

Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives SWBI gain score. Average of this reduction score = 16.94 Table 34 shows the association between the demographic variables and their level of change in SWBI score in the experimental group. Younger age, married people, higher income level, and the people who are walking had statistically significant gain in SWBI score, compared to their counter parts. Statistical significance was calculated using chi square test.

Table 35: Association between the level of SWBI gain score and their demographic variables in the control group Demographic variables


Total

Chi 111

Below

Above

average

average

(≤0.90)

(>0.90)

n Age group

Sex

n

%

61 -70 yrs

28

50.0

28

50.0

56

71 -80 yrs

18

54.5

15

45.5

33

81 -90 yrs

4

36.3

7

63.7

11

Male

24

48.0

26

52.0

50

Female

52.0

24

48.0

50

20

46.5

23

53.5

43

12

54.5

10

45.5

22

Widow/widower 18

51.4

17

48.6

35

Illiterate

14

53.8

12

46.2

26

19

50.0

19

50.0

38

9

45.0

11

55.0

20

Unmarried

2=1.09 P=0.57 DF=2

2=0.16 P=0.68

26


Education

%

square test

DF=1

2=0.42 P=0.81 DF=2

status Elementary school

2=1.35 P=0.85

High school

DF=4

Income

HSC

3

37.5

5

62.5

8

Under Graduate

5

62.5

3

37.5

8

Nil

30

48.4

32

51.6

62

0.90)

%

n

%

1501and above

9

52.9

8

47.1

17

Nil

14

56.0

11

44.0

25

2=0.48 P=0.48

Walking

Interest

Chi square test

(≤0.90)

Exercise

Total

36

48.0

39

52.0

75

Nil

38

50.0

38

50.0

76

Games

2

40.0

3

60.0

5

Tailoring

10

52.6

9

47.4

19

Nil

27

45.0

33

55.0

60

Smoking

6

75.0

2

25.0

8

DF=1

2=0.25 P=0.88 DF=2

2=2.93 P=0.40

Pan chewing

10

50.0

10

50.0

20

Others

7

58.3

5

41.7

12

2

25.0

6

75.0

8

14

50.0

14

50.0

28

Family

Less

income

500/month

than

DF=3

2=2.25 P=0.36

501-1500/month

DF=2

Relationship

1501and above

34

53.1

30

46.9

64

Yes

24

49.0

25

51.0

49

No

26

51.0

25

49.0

51

2=0.04 P=0.84

113



Below

Above

average

average

Total

Chi square test

(≤0.90) n

%

(>0.90) n

% DF=1

Reduction score value is calculated using difference of each person’s after 1 month score – pretest score. It gives SWBI gain score. Average of this reduction score = 0.90 Table 35 shows the association between the demographic variables and their level of reduction score in the control group. None of the demographic variables are associated with their level of reduction. Statistical significance was calculated using chi square test.

Table 36: Identification of influence factors for reduction of SBP using multivariate logistic regression in the experimental group


Sig.

Odds ratio

95%CI Lower Upper

114

Age (< 70 yrs Vs > 70 yrs)

0.685

1.133

0.621

2.066

Sex (Female Vs Male)

0.903

1.041

0.544

1.991

Marital status (Married Vs others)

0.041

1.864

1.071

3.870

Education status (Literate Vs Illiterate)

0.080

0.495

0.225

1.087

Income (Income Vs No income)

0.493

0.761

0.349

1.659

Exercise (Yes Vs No)

0.037

2.138

1.044

4.366

Interest (Yes Vs No)

0.309

0.619

0.246

1.560

Other habits (No Vs Yes)

0.391

1.363

0.671

2.770

Family income (> Rs.1500 Vs 70 yrs)

0.184

0.662

0.360

1.217


0.583

0.834

0.436

1.594


0.453

0.760

0.372

1.555


0.002

3.445

1.547

7.672


0.802

0.904

0.411

1.987


0.008

3.440

1.371

7.625


0.245

0.612

0.267

1.401


0.500

1.278

0.627

2.602


0.457

1.247

0.696

2.234


0.015

1.904

1.182

4.693


0.940

0.974

0.486

1.950


0.746

1.132

0.534

2.399


0.504

1.300

0.603

2.804


0.043

2.058

1.033

4.100


0.979

0.989

0.443

2.208


0.909

1.040

0.531

2.038


0.818

1.075

0.580

1.993


0.338

1.387

0.711

2.706


0.074

0.512

0.246

1.066


0.419

0.723

0.330

1.586


0.327

1.515

0.660

3.477


0.004

3.589

1.497

8.668


0.031

2.896

1.091

7.190


0.394

1.365

0.667

2.791


0.014

1.952

1.066

6.342


0.929

1.029

0.554

1.910


0.564

0.818

0.412

1.621


0.730

1.140

0.541

2.404


0.023

2.554

1.148

6.113


0.932

1.035

0.472

2.268


0.931

1.039

0.435

2.484


0.378

0.742

0.381

1.442

Family income (> Rs.1500 Vs
242

SHYAMALA,LAKSHMIL.L.

MANMADE“STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON PSYCHOLOGICAL PROBLEMS OF THE A

MODIFIEDURBANDISASTERAIRPOLLUTIONCAUSEDATOLERANCECHILDDEATH:INDEXEXPERIENCEOFSELECTEDANDLESSONSPLANTS INLEARNT FROM

ELDERLY RESIDING IN SELECTED GERIATRIC HOMES, KANCHEEPURAM DISTRICT, TAMIL NADU, INDIA”

NACHARAMTRAGIC INDUSTRIALCASESTUDY AREAINBANGLADESH–TELANGANA

Volume 7, Issue 08,10, Page no..2125019379--21252,19382,October,August, 2015

20.10. 2015

243

This is to Certify that the paper ID: NOV152169 entitled A Study to Assess the Effectiveness of Music Therapy on Elderly Residing in Selected Geriatric Homes, Kancheepuram District, Tamil Nadu, India

Authored By L. Lakshmi has been published in Volume 4 Issue 12, December 2015 in International Journal of Science and Research (IJSR) The mentioned paper is measured upto the required standard.

244

"...4') 22-24

"Hidden Potential" International Conference on Clinical Specialities and Music Therapy

~February

Effectiveness of music therapy on bio physical & psychological problems of the elderly residing in geriatric homes, Kanchipuram District, Tamil Nadu, India. Prof. Dr. Lakshmi's Background:

India is home to one out of 10 senior citizens in the world. There is a steady increase in the number of elders forced to stay in old age homes which is evident with increase in the number of old age homes too. Studies on the efficacy of music therapy in improving psychosocial issues among the geriatric population has been well reported from countries across the globe, however there is dearth of such studies from India. Objective:

To assess the effectiveness of music therapy on bio physical and psychological problems of the elderly population residing in a geriatric home. Methodology:

This quasi experimental study was conducted in a selected geriatric home in and around Kancheepuram. Equal number of male and female participants within the age group of 60-75 were included in the study (n=10). Based on a structured questionnaire physical well being of the participants were assessed along with biophysical parameters like pulse, respiration, blood pressure and EEG. Music therapy was administered to the participants which included listening to a predesigned instrumental music based on raga Malkauns, for a duration of 21 minutes at a specified time in the evening for a period of 30 days. All the above mentioned tests were repeated on the 31st day. Result:

Music therapy showed a significant improvement in the level of well being (based on 25 questions interviewed) and biophysical parameters assessed in the elderly population studied. Conclusion:

This preliminary study showed that Music therapy has a beneficial effect on the elderly population. Future studies on this line in larger population would throw more light in this area. Keywords: Music therapy, bio physical & psychological problems, elderly geriatric homes

245

Available

Online at http.,' (www.recentscientific.com

luternational Journal of Recent Scientific Research Vol. 6, Issue, 10, pp. Xx.xx, October, 2015

International Journal of Recent Scientific Research rvo-=Z-=

ISS;\: 0976-3031

RESEARCH ARTICLE

A STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON ELDERLY RESIDING IN SELECTED GERIATRIC HOMES, KANCHEEPURAM DISTRICT, TAMIL· NADU, INDIA Lakshmi L and Shiv Bhushan Sharma -Chettinad College of Nursing, Rajiv Gandhi Salai, Kelambakkam, Kancheepurarn District, Tamilnadu, India. -Department of Physiology, Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kancheepurarn District, Tamilnadu, India ARTICLE

ABSTRACT

IKFO

In India, elderly population stands in second place III tilt' worl!. Since 1990s. geriatric homes

!wel'

increasing due W urbanizruion nnd industrinhzetion. The elderly nre ;')I'
Thi, populatioil, which was -,~;rniilion according iO the 20(1 1 is projected to increa5e to 13'" million by 2021. Three-fOlll'll! or Ih