EFFECTIVENESS OF MUSIC THERAPY ON LEVEL OF DEPRESSION AMONG ELDERLY WOMEN IN A SELECTED
OLD AGE HOME AT COIMBATORE.
COIMBATORE
DISSERTATION SUBMITTED TO THE TAMILNADU
DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL
FULFILMENT OF REQUIREMENT FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2011
EFFECTIVENESS OF MUSIC THERAPY ON LEVEL OF DEPRESSION AMONG ELDERLY WOMEN IN A SELECTED
OLD AGE HOME AT COIMBATORE
BY N.GEETHA
A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL
FULFILMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
APRIL 2011
EFFECTIVENESS OF MUSIC THERAPY ON LEVEL OF DEPRESSION AMONG ELDERLY WOMEN IN A SELECTED
OLD AGE HOME AT COIMBATORE
APPROVED BY THE DISSERTATION COMMITTEE ON ...…………
RESEARCH GUIDE
……….………
PROF. DR. MRS. R. ANNAPOORANI, MA, DSP, M.Phil, Ph.D.D.Sc (GER) ANNAI MEENAKSHI COLLEGE OF NURSING,
COIMBATORE.
CLINICAL GUIDE ……….
MRS.M.SUSILA KUMARI, M.SC(N) PROF. & HOD
DEPT. OF PSYCHIATRIC NURSING
ANNAI MEENAKSHI COLLEGE OF NURSING COIMBATORE.
MEDICAL EXPERT ………
PROF.DR. MARIKANNU, M.D., (PSY) ASST. PROF. OF PSYCHIATRY,
COIMBATORE MEDICAL COLLEGE HOSPITAL, COIMBATORE.
A DISSERTATION SUBMITTED TO THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL
FULFILMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
APRIL 2011
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF
N.GEETHA
ANNAI MEENAKSHI COLLEGE OF NURSING, COIMBATORE, TAMILNADU.
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING TO
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY, CHENNAI.
COLLEGE SEAL:
CAPT. PROF. MRS. KALPANA JAYARAMAN.M.SC (N), PRINCIPAL,
ANNAI MEENAKSHI COLLEGE OF NURSING, COIMBATORE, TAMILNADU.
DEDICATION
“Keep Your Dreams Alive. Understand to Achieve Anything Requires Faith and Belief in Yourself, Vision, Hard work, Determination, And Dedication.
Remember All Things Are Possible For Those Who Believe And Work For It.”
I
Dedicate This Book To My Beloved Husband
V. ELANGO
Who Is My Soul And Support To My Life And Career And
My Family
ACKNOWLEDGEMENT
Interdependence is certainly more valuable than independence. Completing any work is never been a one man show. A journey is easier when we travel together. In the course of research, this dissertation is the result of unbound, immeasurable contribution and support from many people. It is a great pleasure that, I have an opportunity to express my gratitude to all of them.
The chain of my gratitude begins with our Prime Mover God Almighty for the showers of his blessings, support and guiding spirit which strengthened and sustained me throughout this endeavor.
It is my bounden duty to express at the outset gratitude to our beloved Correspondent Mr.M.PADMANABAN.M.A, has given me an opportunity for higher studies and provided the required facilities for successful completion of this study in this esteemed Institution.
I express my heartiest gratitude to the dynamic and eminent personality Capt.Prof.Mrs. KALPANA JAYARAMAN. M.Sc (N), our beloved Principal for her inspiring smile, constant guidance, support, encouragement, motivation, and throughout the study without which this study would have never taken this shape.
I honestly express my sincere thanks and gratitude to elderly people in old age home for their cooperation throughout the study.
I honestly and deeply express my sincere gratitude to Prof. Mrs. SAHAYA MARY.M.Sc (N), Class Coordinator for her valuable suggestions, guidance, support and encouragement to achieve this goal.
Excellent teacher is a complex matrix of builder, architect, leader, and harvester.
I would like to proudly express my immense and deep sense of gratitude with pleasure to Mrs. M.SUSILA KUMARI. M.Sc(N), Professor and HOD in Department of Psychiatric Nursing for his insisting support, constructive suggestions, and immense encouragement which enabled me to reach my objective and complete my research work successfully. Being guided by him has been great honor and privilege.
I honestly and deeply express my great appreciation and gratitude to Mr.P.SELVARAJ M.Sc (N), and Mr.SATHISH RAJAMANI. M.Sc (N), Department of Psychiatric Nursing for their illuminating comments, intuitiveness, patience, and untiring interest shown throughout the study. They shown me the different ways of approaching research problem and the need to be relentless in accomplishing goal.
I extend my deepest gratitude to Missionaries of Charity Old age Home in charge Sister.MONITA for granting me permission to conduct the research study in their old age home and also for the facilities provided. I extend my sincere thanks to Sister.NANCY who offered timely support and guidance in conducting this study. I wish to thank the all the residents of old age home for their kind co operation.
I honestly and deeply express my sincere thanks to Medical guide, Prof. Dr K.MARIKANNU.MD (Psy), Asst. Professor of Psychiatry, C.M.C.H. for his
impressive suggestions and timely help extended for this research.
I deeply express my sincere gratitude to my Research Guide, Prof.Mrs.DR.ANNAPOORANI.MA, DSP, M.Phil., P.hD., D.Sc (Ger),Professor in
Research Methodology for her expert suggestions and guidance for the study.
My special thanks to Dr.SALEENDRAN Ph.D (Psy)., MBA and other experts for their valuable suggestions, directions in statistical data analysis.
I deeply express my sincere gratitude to Mrs.PONNAMMAL M.Sc.(N), Mrs.MEERA.M.Sc(N), Mrs.BALAMANI.M.Sc(N), Mrs.RUCKMANI. M.Sc.(N) Mrs.MANAVALAM M.Sc.(N), Ms.SUTHANTHIRA KUMARI M.Sc.(N), Ms.EBINEZER M.Sc.(N), Mrs. VAN VAGULA DEVI M.Sc.(N), Mrs.DHANA LAKSHMI M.Sc.(N), and for their valuable guidance and suggestions. I consider it as a great honor to have completed under their supervision.
I am thankful to all the experts for having spent their most valuable time in validating tool.
It is a sense of honor and pride for me to place on record my immense appreciation and gratitude to my husband Dr.V.ELANGO who continues to be a bright spot in my life with great encouragement and moral support in successful completion of the study.
I submit this credit to my beloved parents Thiru.C.M.NATARAJAN and Tmt.N.DHANALAKSMI and my in laws Thiru S.VELU, and Tmt.V.GOMATHI who made my life more special and without whom it wouldn’t have been possible to complete my study.
I honestly express my sincere thanks to my brother, my sisters, and my in law Mr.N.Vijiyakumar.M.A.B.L, (Adv) and all family members, who guided and supported me in all my activities.
I express my deep sense of gratitude and it is a pleasure to thank my friend Mrs.SAROJA GANESAN. B.Sc (N), Vice Principal, School of Nursing, C.M.C.H, and their family for their love, support, and motivation with forbearance during the entire period of my study.
I would like to acknowledge the immense help and support extended to me by Ms. REVATHI, B.Sc., M.L.I.S and Mrs. RAJESWARI, B.Sc., M.L.I.S for their help in collection of literature.
I extend my grateful thanks to all the teaching and non-teaching faculty, and members of Annai Meenakshi College of Nursing for their help rendered in various ways to fulfill my research work.
I honorably owe before my husband, parents, family members, and all my dear friends and well-wishers for their prayers, and blessings which helped to reach where I am today.
Little words of appreciation and gratitude cost so little, yet when it is missing life’s best charm is lost. There were so many people involved in completion of this study. I would like to extend a special word of thanks to all.
I express my gratitude to Mr. VENKATESH. B.Sc., GREEN PARK INTERNET CAFÉ, Coimbatore for computing the manuscript clearly, legibly and effectively within short time as requested.
Above all, I would like to owe before “Lord, The Divine Power” for his abundant grace and blessings.
ABSTRACT
The reduction on level of depression among elderly women has an important role to play in enabling effectiveness of music therapy as an independent nursing intervention. The objective of the study was to evaluate the effectiveness of music therapy on level of depression among elderly women in a selected old age home.
The research design adopted was quasi-experimental pre-test and post-test with control group design. The conceptual framework for this study was based on Wiedenbach’s Helping Art Of Clinical Nursing Theory (1964). The study has been conducted in Missionaries of charity old age home at Ramanatha puram, Coimbatore.
Non-probability purposive sampling technique has been adopted to select the desired sample. The sample sizes were 60. Music therapy was administered daily for 30 minutes once in the morning for 15 days to experimental group. Routine nursing care intervention was given to control group. The data collected through structured interview and pre -test and post- test assessment by using GDS-15 (Brink.et.al, 1986).
The collected data were analyzed by using both descriptive and inferential statistical methods. ’t’ test was used to evaluate the effectiveness of music therapy on level of depression among elderly women in a old age home. The obtained ‘t’ value 14.95. The findings of the study revealed that the administration of music therapy helps in reducing on level of depression among elderly women in a selected old age home.
Keywords: Effectiveness, Elderly, Depression and Music Therapy.
TABLE OF CONTENTS
CHAPTER
NO CONTENTS PAGE
NO I
II
III
INTRODUCTION
¾ Background of the study
¾ Need for the Study
¾ Statement of the Problem
¾ Objectives
¾ Hypotheses
¾ Operational Definitions
¾ Assumptions
¾ Delimitations
¾ Projected Outcomes
REVIEW OF LITERATURE
¾ Studies Related to Elderly Depression
¾ Studies Related to Music Therapy
¾ Studies Related to Music Therapy And Elderly Depression
CONCEPTUAL FRAMEWORK
METHODOLOGY
¾ Research Approach
¾ Research Design
¾ Variables
¾ Setting of the Study
¾ Population
¾ Sample
¾ Criteria for Sample Selection
1 7 12 12 12 12 13 14 14
15 20 24
29
34 34 35 37 37 37
IV V VI
• Inclusion Criteria
• Exclusion Criteria
¾ Sampling Technique
¾ Tool Description
¾ Scoring Procedure
¾ Music Therapy Intervention
¾ Validity Of The Tool
¾ Pilot Study
¾ Data Collection Procedure
¾ Data Analysis
¾ Protection of Human Rights
DATA ANALYSIS AND INTERPRETATION
DISCUSSION
SUMMARY, CONCLUSION AND RECOMMENDATIONS
¾ Summary
¾ Major Findings of the Study
¾ Conclusion
¾ Implications of the Study
¾ Limitations
¾ Recommendations
REFERENCES APPENDICES
38 38 38 38 39 39 39 39 40 40 41
42 62
70 71 73 73 76 76
LIST OF TABLES
TABLE
NO. TITLE
PAGE NO 1
2
3
4
5
Frequency and Percentage Distribution of Demographic Variables Among Elderly Women In Old Age Home With Depression In Experimental and Control Groups – Pre-test.
Frequency and Percentage Distribution On Level of Depression Among Elderly Women In Experimental Group.
Frequency and Percentage Distribution On Level of Depression Among Elderly Women In Control Group.
Mean Pre-test and Post-test Value on Level of Depression Among Elderly Women In Experimental and Control Group.
Frequency, Percentage and Chi Square Distribution on Level of Depression Among Elderly Women with their selected Demographic Variables.
43
48
50
52
55
LIST OF FIGURES
FIGURE
NO. FIGURES
PAGE NO
1
2
3
4
5
Conceptual Framework Based On Modified Wiedenbach’s Helping Art Clinical Nursing Theory Model
The Schematic Representation of Research Methodology.
Level of Depression Among Elderly Women In Experimental Group.
Level of Depression Among Elderly Women In Control Group.
Mean Pre-test and Post-test Value on Level of Depression among Elderly Women in Experimental and Control Group.
33
36
49
51
54
LIST OF APPENDICES
APPENDIX TITLE
A B C
D E F G H
I J K L
Letter Requesting Expert Opinion For Content Validity of the Tool
Certificate of Validation.
Name List of Experts Who Validated The Tool.
Letter Seeking Permission to Conduct Study.
Letter Granting Permission to Conduct Study.
Structured Questionnaire (English)
Standardized Geriatric depression Assessment Scale (English)
Structured Questionnaire (Tamil)
Standardized Geriatric depression Assessment Scale (Tamil)
Consent form (English)
Consent form (Tamil)
Music Therapy Intervention Module
CHAPTER I
INTRODUCTION
“ Youth is like a fresh flower in May Age is like a rainbow that follows the storms of life
Each has its own beauty.”
- DAVID POLIS
Back Ground Of The Study
Old age is not a disease. Aging is an integral, natural part of life and it is a normal process of time related change, begins with birth, and continues throughout life. Aging, which is an inescapable reality of the human existence on the planet earth, plays a crucial role in the global demographic transition. The life expectancy of the human being is increased in both developed and developing countries due to advancement and improvement of latest technology in the medical field.
Old age is a phase of life cycle characterized by its own developmental issues, many of which are concerned with loss of physical agility and mental acuity, friends and loved ones and status and power. At the same time old age is associated with accumulation of wisdom and the opportunity to pass that on to future generations.
Successful aging is reflected in the ability of older people to adapt to physical, social, and emotional losses and to achieve contentment, security and life satisfaction.
Because changes in life patterns are inevitable over a life time, older people need resiliency and coping skills when confronting stresses and change.
Failure to adaptations of the aging which can lead to frustration, loneliness, bitterness, hopelessness, helplessness and insecurity which makes older people prone for depression.
India’s older population is projected to quadruple by mid century, while that of the world is expected to triple, the US Census Bureau said. In its latest report, the Census Bureau said the world’s 65-and-older population is projected to increase from 516 million in 2009 to 1.53 billion in 2050. Because women generally live longer than men, they account for slightly more than half of the older population and represent nearly two thirds of the 85 and older population.
At present total number of depressed elderly in India is about 9 Crores.
Older women are of high risk for depression. Ruegg.et.al. (1998) reports 20% of female population over 60 years of age have had an episode of depression. Brennan and Moos (1996) found that women who reported greater over all negative life events and chronic stressors in the domain of home had greater incidence of depression.
Elderly depression is a major public health problem. As the population grows, the number afflicted increases. The problem is further compounded because levels of depression are especially high in elderly individuals who are medically ill. Elderly clients who experience loneliness often feel, they no longer have a purpose in life and are at risk for the development of late life depression.
Depression is pervasive and can diminish the spark of life. (Kristen. L. Mark 2006). Depression has found to occur at high rates in the old age homes and nursing home residents with prolonged illness. (Howard.K.Butcher.et.al, 2005) "Depression can be a deadly illness"," It's associated with suicide" said by Dr.Gary Kennedy, Chief of Geriatric Psychiatry, London. (2005).
Depression unfortunately, usually goes undetected and untreated because many elderly many group up with the notion that depression is a character they worry about being stigmatized blame themselves for their illness and felt too ashamed to get help. Many elderly and their families don’t recognize the symptoms of depression, commonly mistaking them for a physical disorder.
Unfortunately, very little attention has been focused on the pitiable plight of the elderly population. There are several factors for which a number of old age homes have been increasing today. Some reasons as follows;
Migration of young couples from the rural areas to cities in search of better employment opportunities to fend for themselves. Thus the families are becoming more nuclear.
Elders who have been in control of the household for a longtime are unwilling to give up the responsibility to their children.
Youngsters on their part are sometimes resentful of the attitude of their parents.
Many youngsters have moved to places far away from their native homes and in the recent past to many countries abroad. So, even if they want to accommodate their parents in their homes, they are unable to do so.
All these made the old age homes seem more relevant in the Indian context than ever before. As sociologists point out, the biggest enemies of the geriatric population include solitude, loneliness, isolation, neglect and a sense of not being wanted. In order to combat loneliness, the elderly population should interact and ventilate their worries and difficulties with their families, friends, and neighbors.
Relaxation therapies, regular exercise, and intake of a balanced diet will go a long way towards helping the elderly people maintain its physical fitness and mental poise. Hence, the old age home care extends to elderly and neglected people;
“A heart to care, a ear to hear, and a hand to help for the aged and ailing “
An elderly period is the critical period, which requires special attention to adopt the changes of life, it includes the comprehensive care, good nutrition, psychological support and many interventions are available to relax the mind and body and thereby it reduces the depressive episodes. Music can be beneficial for every one. It is an essence of order, and leads to all that good and beautiful. Music therapy is all about music therefore.
Plato said, “Music is a moral law. It is an expression of soul and soul to the universe, wings to the mind, flight to the imagination, a charm to sadness to gaiety and life to everything”.
Music therapy is one of the mind and body relaxation techniques where a client listens to music which affects his mood and feelings. Music is known to affect both the mood of the client as well as his physiological functions. Music has the power to access deep emotions. Music of choice has been a great healer. Healing is concerned with bringing the body into a natural state of balance. A blend of musical tones can lead to such a balance more easily. The aim is to restore, maintain and improve emotional, physical, physiological, and spiritual health well being.
Listening to the music provides wonderful effect to alleviate stress. Music is a significant mood changer. Music can lead a person to a state of harmony. Thus music has frequently used as the therapeutic agent and various ragas are found to be very effective in curing many diseases. Indian classical ragas are proved to be very effective from the ancient times. The key of Indian classical music is melody.
We all experience the enchanting effects of good music in some form or other.
The melodies of vocal and instrumental music sooths our mind and heart. As said by, Swami Ganpati Sachidananda,
“The principle underlying music therapy is that physical health results from a healthy mind. The right type of music helps a person relax by soothing effect”.
Soothing music can be used to achieve an alpha wave brain state which initiates a state of relaxed response and with its soft tone it facilitates the emotional homeostasis and ultimately it alleviates depression and help to boost happy feelings.
A slow and lower tone, classical light melody relieves anxiety and released physical tension and calms the mind. The moderately fast music with high frequencies,
stimulate the mind, enhances mental alertness and boost mentally. A slow rhythmic music is always much effective than a faster one.
Shakespeare once wrote, ‘ if the music be the food of love, play on’……
Music is very much a part of our lives. It is a powerful force that opens our minds and awakens our senses to human experiences. Music therapy is a science; it studies the therapeutic effects of music in human beings and reveals that it has distinct effects on the same.
Today, we can find music therapy research in many areas such as the effects of music in children with autism and learning disabilities, adults with psychiatric illness, elderly with depression and anxiety, Alzheimer’s disease, Dementia, and Parkinsonism etc.
Music is not life. But it makes life beautiful. Dr. Robert Zatorre, Neuro- scientist Professor, Montreal Neurological Institute, McGill University, he stated that,
“If you don’t have music you won’t die, but you won’t be happy.”
The beauty of music has the power to heal mind, body and soul and it is a non threatening medium. Music, with its unique quality it can bring lasting benefits to the state of mind, even after stopped listening. Hence, the music therapy makes a person healthy, physically as well as mentally especially for elderly residing in old age homes and in community settings.
Need For The Study
“Nobody grows old merely by living number of years, We grow old by deserting our Ideals,
Years may wrinkle the skin,
But to give up enthusiasm wrinkles the soul”.
- SAMUEL ULLUMAN Elderly depression is a very common and serious medical condition. Some studies report that perhaps as many as 25% of women and 15% of men have experienced a depressive disorder of some sort at some time in their lives revealed by Michigan Depression Center, The University of Michigan Health System.
Depression is not “one size fits all” particularly when it comes to gender and it is about twice as common in women as it is men. (APA, 2000). The chances of developing a depressive illness are estimated to be 1 in 5 for women and 1 in 10 for men. About 13% of national population is over age 65 although the elderly suffers from medical illness, there is a greater contributions to the mental health problem, especially the prior go to depression. (Kristen. L. Mark. 2006)
Although there is no single definitive answer to why an elderly suffers from depression, many factors - genetic, biological, psychological, environmental and physical factors are involved. (Evans 2004). Epidemiologically women demonstrate twice men's incidence of depression. “Women over- estimate their responsibility and at the same time under-estimate their ability to master the situation”. Hormonal factors related to the reproductive cycle may play a role in women’s increased vulnerability to depression. (Kornstein & Wojick, 2002).
The World Health Organization (WHO) estimates that 121 million people world wide suffering from depression. In an analysis of studies worldwide the average prevalence was 13.3% for all depression symptoms (Major and milder depression) with rate of major depression average 1.8% (Beckman.et.al.2004). About 1 in 8 women can expect to develop clinical depression during their lifetime. (National Mental Health Association 2005)
.
In fact, in-depth study by the New Delhi-based All India Institute of Medial Sciences (AIIMS) says that elderly women are affected more by depression, and psychosomatic disorders than their male counterparts. According to this study, the population structure of the elderly is dominated by poorly educated women, economically dependent on children without any tangible authority or status in the family. Of course, an aging society will give rise to special problems from health, family, and social angels. Healthy aging is not only related to advances in medical technology but also to a wide range of other factors like enabling the aged to lead a stimulating life, being fully involved in society and having meaningful relationships.
In addition to shelter, medicare, and nutritional problems, the elderly population in India is also buffeted by a multi-dimensional socio-psychological pressure.
Sometime back, the UN Secretary General Kofi Annan, while referring to the aging population had observed:
"Trees grow stronger over the years, river wider and like with the age, human beings gain immeasurable depth and breadth of experience and wisdom. That is why older persons should not only be respected and revered but they should be utilized as the rich resource to society that they are".
Elders in the family are definitely an asset. But a fast rise in the aged population adds to the socio economic challenges that face India. Notwithstanding the Indian adage “Old is Gold”, life for many people is less than happy. However, India has not yet come out with an appropriate policy framework to provide social security for the elders. Lack of family support, poor financial status, physical and mental disorders and guilt of being dependent on others, are some of the problems nagging the elderly population in India and around the world.
As things stand, the rapid spread of modernization, growing urbanization and crumbling of joint family system have conspired to increase insecurity and loneliness among the geriatric population. As the role of the families as a social safety net for the elderly is fast eroding, the poor among the elderly have become the most vulnerable sections of the society. Elderly people are no longer productive are seen as a burden in the family as a result, they are abused physically and mentally.
All of us have some responsibility towards one’s parents and this is a noble endeavor. Total community of today is insensitive to this issue. Of course there are homes for the aged people but they are mainly focused only on particular level of the society. There should be a balanced focus on the downtrodden community and on the rich and affluent as well.
Kumar M, Bansal R K, (2008) published in Indian Journal of Community Medicine, they had interviewed four old age homes in Surat City from October 2006 to January 2007 to explore their reasons to stay in old age homes. The reasons were given by these residents, which comprise being neglected by their
own children, physical and verbal abuse by daughter in law and son, and poverty and neglect after decreased income distribution. They had stated that they had done their best for their children and society and now there is no reciprocation. Subsequently all of them had felt better and comfortable in residing old age homes. Thus, he recommended that the need to support old age home residents.
The researcher had an opportunity to visit the old age home. During her visit when interacting with elderly people, they expressed their feelings and worries with broken heartedness and they lack for love and affection from their family numbers, lack of self confidence, self esteem, and self worthiness. The elderly had reported of having felt unwanted, insulted, neglected, and useless while living with their families.
The main reason that emerged was the unwillingness of the family to care for aged, which has been expressed through abuse and refusal to co-habit and care for them who had distributed their wealth to children. Therefore the old age homes are more relevant in Indian context than ever before.
By 2020 WHO estimates that depression will be the second leading cause, thereby it increases the family burden and individual impairment. Recent studies say that music therapy can enliven the lives of elderly people who find it hard to cope up with the stress of modern day of living and end up depressed.
Music's ability to "heal the soul" is the stuff of legend in every culture. Music can be an effective therapeutic tool for the mentally or emotionally ill. Music increases
the metabolic activities within the human body and thereby it affects the total central nervous system and circulatory system in listener of the music. While listening to music, it increases the release of endorphins, the body’s natural “feel – good hormones”.
Music is an excellent outlet to provide relaxation, improve mood and socialization skills, explore worries, and reminisce about music that has had special importance to the individual; thereby it lowers the level of depression.
Dr.Titiksha.M. (2006) Senior Medical Officer with Northwest Distribution Company published an article in Journal of Delhi News on Music to ears: Therapy to treat relieve stress in aged, she quoted that the human body is made up of 70 per cent water. As sound travels faster in water, there is whole body stimulation at cellular level which increases the metabolism and in turn speeds up healing process.
Music interventions have been used in medicine and nursing throughout history.
Music therapy is an easy-to-administer, relatively inexpensive, non- invasive intervention and non threatening medium with its unique quality that has been used to reduce heart rate, blood pressure, anxiety, depression, pain and it is beneficial for everyone. As internationally known professor and researcher Dr.Thaut said,
“The brain that engages in music is changed by engaging in music”.
Music therapy is a scientific and research based process of healing through music. For older people who have nowhere to go and no one to support them, old age homes provide a safe haven. These facilities strive to enhance opportunities for improving quality of life and for becoming “places to live” rather than “places to die.”
The use of music with geriatric patients could prove to be especially fruitful;
both in its receptive and its active aspect. Hence, the present study was designed by the researcher to evaluate the effectiveness of music therapy on level of depression among elderly women in a selected old age home at Coimbatore.
Statement Of The Problem
Effectiveness Of Music Therapy On Level Of Depression Among Elderly Women In A Selected Old Age Home At Coimbatore.
Objectives
To evaluate the effectiveness of music therapy on level of depression among elderly women in a selected old age home.
To determine the association between the level of depression among elderly women with their selected demographic variables. (Age, religion, education, marital status, prior occupation, number of children, duration of stay in old age home, support from family, duration of sleep at night, mode of entry etc ).
Hypotheses
H1 : Music therapy is effective in reducing the level of depression among elderly women in a selected old age home.
H : There is significant association between the levels of depression among elderly women with their selected demographic variables.
Operational Definitions Effectiveness
It refers to the outcome of music therapy in terms of reduction on level of depression among elderly women in a selected old age home. In this study it is determined by significant difference in mean- pre test and mean - post test level of depression scores among elderly women in a old age home.
Music Therapy
Music Therapy is the use of soft instrumental, classical music administered daily for 30 minutes once in the morning for 15 days and the ragas used were karakara priya, sindu bairavi, anandha bairavi, mathimavathi and kalyani and the instruments used were veena, violin, saxophone, mandolin and flute applied for elderly women to induce relaxation and restoration, exploration of inner feelings and enhance an overall sense of well being.
Elderly
The people who are in the age group of 60 and above living in a selected old age home at Coimbatore.
Depression
It is marked by an alteration in mood, which is expressed by feelings of sadness and dejection, inactivity, loss of interest and helplessness and it is measured by GDS -15 (Brink et.al, 1986 ) Geriatric Depression Rating Scale.
Old Age Home
The place where the elderly people are residing.
Assumptions
Music therapy is one of the mind and body relaxation techniques.
Music therapy is a non pharmacological treatment and it is simple measure to reduce depression.
Music therapy is an easy-to-administer and relatively an inexpensive intervention.
Music therapy has influence in reducing the level of depression among elderly women.
Music therapy is a non invasive therapy to relieve stress and lend strength to the healing process.
Music therapy has no adverse effects to the participants.
Delimitations
The study was limited to elderly women who are residing in a selected old age home.
Elderly women who can understand Tamil and English and respond verbally.
The study was limited to data collection period of 30 days.
Projected Outcomes
The study will help the nurses to assess the level on depression among elderly women in a old age home.
The study will help the nurses to identify the effectiveness of music therapy on level of depression among elderly women in a old age home.
The study findings will help the nurses to practice administration of music therapy as a mind and body intervention in reducing the level of depression.
The study findings will help to improve the quality of life among elderly women in a old age home.
CHAPTER II
REVIEW OF LITERATURE
" One good thing about music – when it hits you ; you feel no pain .”
- BOB MERLEY.
Review of literature is a key step in the development of any research project. It helps the investigator to analyze what is already known about the topic and describe methods of inquiry used in the earlier work including the success and short comings.
This chapter deals with the information collected with relevant to the present study through published and unpublished materials. These publications were the foundation to carry out the research work. Highly extensive review of literature pertaining to research topic was done to collect maximum information for laying foundation of the study.
Reviews of literatures were organized as follows:
Studies Related To Elderly Depression
Studies Related To Music Therapy
Studies Related To Effectiveness Of Music Therapy And Elderly Depression
Studies Related To Elderly Depression
Aihara Y.et.al, (2010) conducted a cross sectional analysis aimed to Analyze the relationship between past lifestyle, social support and depressive symptoms among community dwelling elderly people in Japan by using the standardized Geriatric Depression scale. Logistic regression analysis showed that physical exercise, daily intake of well balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms, while among both men and women.
Barcelo’ Ferreira R.et.al, (2010) has done a systematic review and Meta analysis on Depressive morbidity and gender in community dwelling Brazilian elderly among elderly - average age participants varied between 66.5 and 84.0 years by selected and extracted the articles from Medline, LILACS and SciELO data bases. A total of 17 studies were found. The review indicates that the odds ratio for major depression and clinically significant depressive symptoms (CSDS) were greater among women.
Covinsky.KE.et.al, (2010) conducted a prospective cohort study on Depressive symptoms in middle age and the development of later life functional limitations: the long term effect of depressive symptoms among a sample of people aged 50 to 61 by using 11 item Center for Epidemiologic
studies depression scale (CES-D 11). The results depicts that the depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle aged persons advance into later life.
Kenne.N.et.al, (2010) investigated a randomized controlled trial an experimental study on Home based activity programme for older people with depression symptoms: Depression in Late Life Interventional Trial Exercise (DeLLITE) among 193 elderly people aged 75 years and older depressive symptoms by using Geriatric Depression Scale (GDS-15). It revealed that significant improvements in mood and quality of life in elderly people.
Tor Atle Rosness et.al, (2010) investigated a study published in International Journal of Geriatric Psychiatry on Occurrence of Depression and its correlates in early onset dementia patients (EOD) and which characteristics were associated with depressive symptoms among 221 patients under the age of 65 by using standardized Montgomery Asberg Depression Scale (MADRS).
It was found that high occurrence of depressive symptoms in EOD patients and a history of depression was most important correlate of depression in these patients.
ArjunW.Braam.et.al, (2009) investigated a study published in International Journal of Geriatric Psychiatry on Depression and Parkinsonism in older Europeans: results from the EURODEP concerted action, he quoted that the data employed from the EURODEP collaboration. Nine study centers from eight western European countries provided data on depression (most GMS - AGECAT), depressive symptoms (EURO - D items and anxiety), Parkinsonism (self report of PD or clinical signs of PD), functional disability and dementia diagnosis. Data were complete for 16313 respondents aged 65 and older. It depicts that as among clinical patients with PD, depression is highly common dwelling older people with Parkinsonism, even among those without functional disability.
Juelin.D.et.al, (2009) published in International Journal of Geriatric Psychiatry conducted a cross sectional study on Subjective well being, social support and age related social functioning among the very old in China with 732 old age people by using standardized interview questionnaire inventories, the 23 item Philadelphia Geriatric Center Morale Scale (PGCMS),functional status was assessed by the physical self maintenance scale (PSMS),the instrumental activities of daily living (IADL) scales, the mini mental status examination(MMSE) was used to measure cognitive function and the social support was assessed by the family adaptation, partnership, growth, affection and resolve(APGAR) and the social support requirement scale (SSRS).It recommends that both social support from family members and cognitive
function appear to be key factors associated with quality of life among the very old in China.
Mike Murphy, Eleanor O’Leary (2009) conducted a cross sectional survey style design on Depression, cognitive reserve and memory performance in older adults among cognitively normal 99 Irish older adults by using Mini Mental Status Examination (MMSE). It indicates that a need for intervention in cases of sub clinical depression with associated memory complaints and may suggest useful non-pharmacological approaches to memory deficits in later life.
Ryan.Y.et.al, (2008) conducted a study on Lifetime hormonal factors may predict late life depression in women among 1013 community dwelling elderly women aged 65 years by using structured questionnaires and depressive symptoms were assessed by Epidemiological Studies Depression Scale. It reveals that life time hormonal factors that are significantly in later life have been identified.
Steffens.D.C.et.al, (2007) in review of Geriatric depression and cognitive impairment he stated that cognitive impairment is common in Geriatric depression, and depressed individuals with co morbid cognitive impairment. It suggests that the clinicians are encouraged to develop pro-active approaches
for treatment, which may include combination of pharmacological and psychotherapeutic interventions.
Hoptman.M.J.et.al, (2006) in article the Structural Neuro imaging research method in Geriatric depression he quoted that there is a evidence that abnormalities in specific brain structures and their inter connections confer vulnerability to the development of late life depression.
Cathy.J.Frazer.et.al, (2005) Published in Medical Journal of Australia (MJA) the article of Effectiveness of treatments for depression in older people he quoted that treatments effective for depression were grouped under three categories: medical treatments, psychological treatments and life style changes / alternative treatments. Estimates of the prevalence of depression among elderly people living in the community vary widely, from less than 1% to 35%
by using the Geriatric Depression Scale. It summarizes the level of evidence and the effectiveness of a range of proposed treatments for depression in older people aged ≥ 60 years including the above said three categories.
Kennady.G.J (2005) in his article the Geriatric syndrome of late life depression he quoted that a comprehensive geriatric assessment and a tripartite treatment approaches incorporating definitive, rehabilitative, restorative and supportive intervention for elderly people.
Studies Related To Music Therapy
JP (2010) Published in Healthy Fellow of Music therapy, a current report from the Department of Psychology at the University of Sussex methodically elucidates How sounds can literally alter the make up of the body and mind.
According to this review the paper describes it thusly: “music engages sensory processes, attention, memory - related processes, perception - action mediation, multi – sensory integration, activity changes in core areas of emotional processing of musical syntax and musical meaning and social cognition”.
JP (2010) article published in Healthy Fellow of Music therapy – Music Therapy as an Anti-Histamine, he investigated that listening to “feel- good music” may be an effective way to moderate histamine release in the body. The findings was established by having a group of volunteers eat foods while listening to 5 minutes of happy music and before and after salivary samples were used to quantify histamine secretion induced by the food challenges.
Based on this preliminary experiment, it seems that the presence of feel- good music may have moderated the participant’s stress response, thereby decreasing histamine release.
Bradt.J.Dileo (2009) has done a randomized controlled trial an experimental study on Music for stress and anxiety reduction in coronary heart diseases among coronary heart disease clients. It evidences that listening to
music have beneficial effect on heart rate, respiratory rate, anxiety, and blood pressure in clients with coronary heart disease.
Emiley.Servila, Ellan Ray field (2009) conducted a randomly assigned an experimental study on Patient and professional perception of music therapy efficacy on an acute patient in psychiatric unit among patients and staff in different areas. It reveals that significant effects in psychiatric unit patients.
Guetin.S.et.al, (2009) conducted a randomized controlled study on Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia among 15 clients with diagnosis of Alzheimer’s type by using the standardized Hamilton Depression Scale and Geriatric Depression Scale. These results confirm the valuable effect of music therapy on anxiety and depression in patients with mild to moderate Alzheimer's disease. This new music therapy technique is simple to implement and can easily be integrated in a multidisciplinary programme for the management of Alzheimer's disease.
Hsu sin Yi Chung (2009) conducted a randomly assigned an experimental study on Elder’s music preference, physiological response and the effect of familiarity on listening to classical music among 30 elderly clients
by using continuous response digital interface (CRDI). It shows that significant response changes in finger temperature.
Jessica.L. Rushing (2009) investigated a randomly assigned an experimental study on the Effects of music therapy on feelings of hopelessness and personal control for women affected by domain violence among women by using Action Step Check List, Beck depression scale, Hopelessness scale and Personal control and structured emotional state questionnaire. It evidenced that significant difference through music therapy.
Michel. J. Silverman (2009) conducted a two group post test only design experimental study on the Effect of live music in a University health clinic among 48 patients in the waiting hall. The findings recommended that there is high degree of significance in providing live music.
Myskja.A (2009) article in Norwegian the Therapeutic use of music in nursing homes published by U.S National Library of Medicine and National Institute of Health, he reviewed the articles on The use of music and music therapy in geriatrics and findings from the nursing home project, “Music in the late stages of life”, have been compared with those reported in the literature, particularly from the Meta analyses and systematic reviews. It indicates that
music has a specific potential in nursing homes and it can enhance well-being and alleviate symptoms and sensomotor symptoms.
Olivia Svedberg (2009) conducted a randomly assigned an experimental study on the Effects of medical music therapy on the patient satisfaction scores of hospital inpatients among 250 inpatients by using Press Gary Inpatient Survey (PGIS). It reveals that significant satisfaction scores.
Siedlicki SL, Good. M. (2006), conducted a randomized controlled clinical trial an experimental study on testing The effect of music on power, pain, depression and disability among 60 people with chronic non malignant pain. The finding depicts that music groups had more power, less pain, depression, and disability than the control group.
Kemper K.J, Danhauer SC (2005) article published in south Medical Journal on Music as Therapy, he quoted that Music is widely used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms.
Music appears to exert direct physiologic effects through the autonomic nervous system. It is a low cost intervention and also improves the quality of life for patients receiving palliative care, enhancing a sense of comfort and relaxation.
Wigram.T.et.al, (2005) conducted a randomized controlled trial an experimental study on Music therapy for schizophrenia and schizophrenia like illnesses an experimental study among schizophrenic clients. It shows that music therapy as an addition to standard care helps to improve their global state, and mental state and functioning.
Brotoun M, Koga S.M (2000) conducted a randomly assigned an experimental study on The Impact of music therapy on language functioning in dementia among dementia clients by using Mini mental status examination and language ability via the Western Aphasic Battery (WAB). The findings concluded that music therapy significantly effective and improved performance on both speech content and fluency of the spontaneously speech.
Claudia Pacchaetti.M.D.et.al., (2000) conducted a randomized controlled blinded study on Active music therapy in Parkinsonism disease among 32 clients by using Unified Parkinsonism disease rating scale. The finding suggests that music therapy is effective on motor, affective, and behavioral functions.
Studies Related To Music Therapy and Elderly Depression
Suzanne B.Hanser and Larry W. Thompson (2010) article published in Oxford Journal of Canadian Music Therapy Trust Fund on Positive effects of a Music Therapy Strategy on depressed older adults, he quoted that a music facilitated psycho educational strategy was developed as an accessible intervention for older adults experiencing symptoms of depression, distress, and anxiety. Participants receiving music therapy programme shows significantly better than the controls on interpretation of standardized tests of depression, distress, self esteem, and mood.
Anna Marathos, Milu Crawford (2009) conducted an individual randomized trial an experimental study on Efficacy of music therapy among people with depression to compare the effects of music therapy for people with the depression against other psychological and pharmacological therapies by using the search strategy through CCDANCTR-studies and PsycINFO, EMBASE, PsycLit, PSYindex. The study results concluded that music therapy is accepted by people with depression and is associated with improvements in mood.
Chan M.F.et.al., (2009) conducted a randomized controlled an experimental study on Effectiveness of Music on depression levels and
physiological responses in older adults among 47 elderly people. It reveals that the listening of music can facilitate the non verbal expression of emotion and allow people’s inner feelings to be expressed without being threatened and in the music group; there were statistically significant decreases in depression scores, respiratory rate, heart rate, and blood pressure. It suggests that nurses may utilize music as an effective nursing intervention for older adults with depressive symptoms.
Chen.SL, Lin.HC (2009) conducted a randomly assigned an experimental study on Perceptions of group music therapy among elderly nursing home residents in Taiwan among 17 wheel chair bounded elderly residents by using Focus group methodology to explore the perceptions of elderly participants about their experience of group music therapy. The findings of this study suggest that elderly positively viewed their experiences and healthcare providers should consider integrating group music therapy into their programme for elderly nursing home residents and design the therapy to add variety to their life and improve their cognitive function.
Jeon KY, Kim SY (2009) conducted an experimental study on Effects of music therapy and rhythmic exercise on quality of life, blood pressure and upper extremity muscle strength in institution-dwelling elderly women by using a nonequivalent control group pre test-post test design among 35 elders (18 in the experimental group and 17 in the control group) for twice a week for
8 weeks. The Short Form 36 health survey questionnaire, blood pressure, and grasp power scale were used as instruments. The results revealed that music therapy and rhythmic exercise had positive effects on quality of life, especially on vitality, general health, and mental health. The study suggests that this program can be applied for older women in long-term facilities to improve quality of life.
Lai.M, (2009) conducted a an experimental study on Effects of music listening on depressed women in Taiwan among 30 depressed women by the use of a pre test- post test, control group, experimental design, the heart rate, respiratory rate, blood pressure, and immediate mood states before and after a music/sound intervention were measured in. quantitative data were analyzed descriptively and with t tests. A structured interview questionnaire was administered to participants to elicit information related to the subjective experience of music/sound listening. Significant posttest differences were found in experimental group participants' heart rates, respiratory rates, blood pressure, and tranquil mood states. Significant post-test differences also were found in control group participants' heart rates and tranquil mood states. The results support the use of music listening as a body-mind healing modality for depressed women.
Trappe H.J (2009) published one article in Dtsch Med Wochenschr in German on Music and health -What kind of Music is helpful for whom? What
music not? He stated that it is well known that music not only may improve the quality but also have different effects on heart rate. It has been shown that relaxing music decreases significantly the level of anxiety and it can be utilized as an effective intervention for patients with depressive symptoms, geriatrics and in pain, intensive care, and palliative medicine. It concludes that the most benefit on health is visible in classical music, meditation music whereas heavy metal music or techno sounds are even ineffective or dangerous and will lead to stress.
Murrock .C.J, Higgins PA (2009) published article in Journal of Advanced Nursing on The theory of music, mood and movement to improve health outcomes he quoted that the discussion of the development of a middle range nursing theory of the effects of music on physical activity and improved health outcomes by using the sources from CINAHL, MEDLINE, Proquest Nursing and allied Health source, PsyINFO and Cochrane library. It proposes that music alters mood, is a cue for a movement, and improved quality of life.
The study concluded that the middle range theory is prescriptive, and to determine its usefulness for nurses to develop to improve health outcomes across various cultures.
Eraklia.J.et.al, (2008) conducted a randomized controlled an experimental study on the Effect of improvisational music treatment of depression among 85
adults with depression by using structured interview questionnaire and depression scale. The study aims to fill a gap in knowledge as to whether active music therapy applied to people with depression improves their condition. It reveals that significant improvements in their condition of the people with depression.
Saito (2007) the article published in Asian Medical Journal – Science Links Japan on Music therapy for elderly patients he quoted that music which expresses human emotions and ideas, can be used as a medium for communication. Recently, the importance of music has been recognized in the medical field and music therapy is being established as a part of non pharmacologic treatment in medicine. Among variety of music therapy techniques, teaching patients merely how to ‘listen to music’ or ‘how to sing songs’ will help the elderly to reminding past experiences and memories.
Music therapy can be widely popular in interdisciplinary approach.
Hsu.WC, Lai HL (2004) conducted a randomized controlled an experimental study on the pre test and post test with a two group repeated measures design on Effectiveness of soft music of major depression in psychiatric inpatients. Subjects listened to their choice of music for two weeks and depression was measured by using Zung’s Depression scale before the study and at two weekly post tests. It concludes that music resulted in
significantly better depressive scores, as well as significantly better sub scores of depression compared with controls. The findings provide evidence for psychiatric nurses to use soft music as an empirically based intervention for depressed in-patients.
Rorke M.A. (2001) the article published in Journal of Music Therapy on Music therapy in the age of enlightment he stated that in the history of music therapy are the findings of the renowned London physician Richard Brocklesby, the only doctor to write a treatise on music therapy and the subjects treated by his Reflections on the Power of Music include his musical remedies for the excess of various emotions – particularly fear, excessive joy, and excessive sadness. He considers music as well an aid to the elderly and to the pregnant women and music viewed in the mid eighteenth century by an excellent medical mind.
CONCEPTUAL FRAMEWORK
Tabot (1995) stated that a conceptual framework is a network of interrelated changes that provide a structure for organizing and describing the phenomenon of interest. Research studies are based on the theoretical frame work that facilitates visualizing the problem and places the variables in a logical context.
A conceptual framework or a model is made up of concepts, which are the mental images of the phenomenon. These concepts are linked together to express the relationship between them. A model is used to denote symbolic representation of concepts. One of the important purposes of the conceptual framework is to communicate clearly the interrelationship of various concepts. It guides an investigator to know what data needs to be collected and give direction to the entire research process (Kerligner.K.N.1993).
The study is based on the concepts of administration of music therapy for elderly women in a old age home will enable the effective reduction on level of depression. The investigator adapted the Wiedenbach’s Helping Art Clinical Nursing Theory (1964) as a base for developing the conceptual framework.
Central Purpose
It refers to the investigator wants to accomplish the goal. This is a prescriptive theory which directs action towards an explicit goal. The
investigator develops a prescription based on a central purpose and implements it according to the realities of the situation. In this present study, the central purpose was effective reduction on level of depression among elderly women in a selected old age home.
The conceptualization of nursing practice according to this theory consists of three steps as follows;
Step 1: Identifying The Need For Help.
Step 2: Ministering The Needed Help.
Step 3: Validating Whether The Need Was Met.
The factors included are central purpose, prescription, and realities.
Step 1: Identifying The Need For Help
The determination of the need for help is by the process of sample selection on the basis of inclusion and exclusion criteria followed by the pre test assessment on level of depression among elderly women in experimental group and control group by using GDS -15 (Brink.et.al, Geriatric Depression Rating Scale 1986).
Step 2: Ministering The Needed Help.
This refers to the provision of required help to fulfill the identified need.
It has two components.
1. Prescription 2. Realities
1. Prescription :
It refers the care to achieve the purpose. This includes maintaining routine nursing care intervention along with administration of music therapy.
Explaining procedure to the elderly women and administration of music therapy to an experimental group and only routine nursing care intervention to control group.
2. Realities :
It refers to the factors that influence the nursing action in the particular situation. It includes;
Agent : Is the investigator.
Recipient : Elderly women in a selected old age home.
Goal : Refers to effective reduction on level of depression by administration of music therapy daily for 30 minutes once in the morning for 15 days.
Means and Activities:
Administration of music therapy to experimental group daily for 30 minutes once in the morning for 15 days with the help of audio tape recorder and recorded cassettes. Soft instrumental, classical music by using flute, veena, violin, mandolin, and saxophone, and ragas used were karakara priya, kalyani, anandha bairavi, mathima vathi, sindu bairavi, and Panthuvarali.
Framework:
It refers to the infrastructure of the old age home. Separate room with calm and quiet environment provided to the experimental group. 30 samples were grouped into two groups. Comfortable chairs provided for them. After that audio tape recorder was played for 30 minutes with recorded music cassettes. Two sessions were conducted daily for 15 days.
Step 3: Validating Whether The Need Was Met.
This is accomplished by means of post test assessment for both groups on level of depression by using GDS -15 (Brink.et.al, 1986). There was an effective reduction on level of depression among elderly women in a old age home after administration of music therapy daily for 30 minutes once in the morning for 15 days. Based on the findings further management modalities were planned.
CHAPTER III
METHODOLOGY
Music Is the Medicine of the Breaking Heart…
- LEIGN HUNT
Research methodology is one of the vital sections of the research since the success of any research is mostly depends upon the methodological issues that are followed in the execution of the research work. The role of methodology consists of procedures and techniques for concluding the study.
This chapter deals with the methodological approach adopted for the study. It includes description of research approach, research design, settings of the study, population, sample, criteria for sample selection, sample size, sampling technique, scoring procedure, data collection, and data analysis.
Research Approach
According to Treece and Treece (1986) the approach to research is the umbrella that covers the basic procedure for conducting research.
A quantitative and evaluative approach was chosen for analyzing the effectiveness of music therapy on level of depression among elderly women in a selected old age home.
Research Design
According to Nancy Burns and Susan.K.Groove (2005) research design as a blue print, for conducting the study that maximizes control over factors that could
