EFFECTIVENESS OF AROMA THERAPY MASSAGE ON

ANXIETY AMONG ELDERS AT SELECTED OLD AGE HOME,

MADURAI.

M.Sc (NURSING) DEGREE EXAMINATION

BRANCH - V MENTAL HEALTH NURSING

COLLEGE OF NURSING

MADURAI MEDICAL COLLEGE, MADURAI -20.

A dissertation submitted to

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,

CHENNAI - 600 032.

In partial fulfillment of the requirement for the degree of

MASTER OF SCIENCE IN NURSING

APRIL - 2013
 A STUDY TO EVALUATE THE EFFECTIVENESS OF AROMA THERAPY
MASSAGE ON ANXIETY AMONG ELDERS AT SELECTED OLD AGE
HOME, MADURAI-20.

Approved by Dissertation committee on………………………………

PROFESSOR IN NURSING RESEARCH _

MRS. S. POONGUZHALI M.SC (N), M.A, M.B.A, PhD

Principal in charge
College of nursing
Madurai medical college
Madurai.

CLINICAL SPECIALTY EXPERT_ _

Mrs. S.RAJAMANI M.Sc (N),MBA, PhD

Department of Mental Health Nursing
Madurai medical college
Madurai

MEDICAL EXPERT _

DR.C.P. RABINDRANATH MD, DPM, FIPS.

Professor/head of the department of psychiatry
Madurai medical college
Madurai.

A dissertation Submitted to

THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY,

CHENNAI- 600 032.

In Partial Fulfillment of Requirement for the Degree of

MASTER OF SCIENCE IN NURSING

APRIL -2013
 CERTIFICATE

This is to certify that this dissertation titled, EFFECTIVENESS OF AROMA

THERAPY MASSAGE ON ANXIETY AMONG ELDERS AT SELECTED

OLD AGE HOME, MADURAI-20. is a bonafide work done by

Mrs.G.JAYANTHI, College of Nursing, Madurai Medical College, Madurai - 20

and it is submitted to the Tamilnadu Dr.M.G.R. Medical University, Chennai in

partial fulfillment of requirements for the award of the degree of Master of Science in

Nursing, Branch V, Psychiatric (Mental Health) Nursing Under our guidance and

supervision during the academic period from 2010 - 2013.

Mrs.S.Poonguzhali M.Sc (N), M.A, MBA, Ph.D., Dr.N.Mohan, M.S., F.I.C.S., F.A.I.S.,
PRINCIPAL IN CHARGE DEAN
COLLEG OF NURSING MADURAI MEDICAL COLLEGE
MADURAI MEDICAL COLLEGE MADURAI – 20.
MADURAI-20.
 ACKNOWLEDGEMENT

"My grace is sufficient for you, for my power is made perfect in weakness.”

Therefore I will boast all the more gladly about my weaknesses, So that

Christ’s power may rest on me. That is why, for Christ’s sake, delight in

weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am

weak, then I am strong”.

(II-Corinthians12:9, 10)

The satisfaction and pleasure that accompany the successful completion of any
task would be incomplete without mentioning the people who made it possible, whose
constant guidance and encouragement rewards, any effort with success. I consider it a
privilege to express my gratitude and respect to all those who guided and inspired me
in the completion of this study.

I wish to acknowledge my sincere and heartfelt gratitude to Almighty of God

for continuous support, strength and guidance from the beginning to the end of this
research study.

I extend my sincere thanks to Dr.N.Mohan M.S., F.I.C.S., F.A.I.S., Dean,

Madurai Medical College, for his acceptance and approval for the study.

I express my deep sense of gratitude and heartfelt thanks to

Mrs.S.Poonguzhali M.Sc (N), M.A, M.B.A, Ph.D Principal I/C, College of
Nursing, Madurai Medical College, Madurai for her guidance and suggestions to
carry out the study.

I express my heartfelt and faithful thanks to Mrs.S.Rajamani M.Sc (N),

M.B.A, Ph.D Head of Psychiatric and Mental Health Nursing department, College of
Nursing, Madurai Medical College, Madurai for her hard work, efforts, interest and
sincerity to mould this study in successful way, her easy approachability and
understanding nature inspired me and she laid strong foundation on research. It is very
essential to mention her wisdom and helping nature had made my research a lively
and everlasting one.

I wish to express my sincere heartfelt thanks and gratitude to Dr.Prasanna

Baby, M.Sc (N), PhD. former Principal, College of Nursing, Madurai Medical
College, Madurai for her guidance and suggestions to carry out the study.

I extend a special thanks to Ms.Jenette Fernandez, M.Sc (N), former

Principal, College of Nursing, Madurai Medical College, Madurai for her advice and
encouragement in completing the study.

I convey my special thanks to Mr.M.Nithyananthum, M.Sc (N), Faculty of

psychiatric and mental health nursing for his valuable guidance, constant
encouragement and moral support.

My deep sense of gratitude to Dr. C.P.Rabindranath M.D, DPM, FIPS

Professor and Head of the psychiatric department, Government Rajaji Hospital,
Madurai, for his timely help, encouragement and guidance.

I extend my sincere thanks to all the Faculty Members of College of Nursing,

Madurai Medical College, and Madurai for their support and assistance.

I also thank to Mr.S.Kalaiselvan, M.A., B.LI.S. D.C.A., Librarian, College

of Nursing, Madurai Medical College, Madurai for his advice and suggestions.

I extend my sincere thanks to Mr.Victer Devasakayam, MSc (N) for his

guidance and suggestions to carry out the study.

I also thank to Mr.V.Mani, M.Sc (Bio-Statistics), M.Phil, Bio-statistician,

Aravind Eye Hospital Madurai for suggestions and statistical analysis.

I owe my sincere thanks to Mr. Gnanavaram, president & secretary of Old

Age Homes, Madurai, for their co-operation and permitting me to conduct the study
in old age home.

I give my thanks to Mrs.J.Ramona Emma Rani. Tamil Pandit for doing

Tamil editing, and also thanks to Mrs.S.Beulah,M.A.M.Ed , English teacher for
doing English editing of this study.
 I also thank to Mr.R.Rajkumar, My Computer teacher, and Master.Arockia
Pravin IX std for their timing help and support for this study.

I thank all the elders who participated in the study.

As a final note, my sincere thanks and gratitude to my sisters and their family,
all my friends and relatives who directly or indirectly helped me to complete this
study.

It has given me immense pleasure to express my affectionate thanks to my

beloved parents, Mr.S.Gnanamuthu. (late) and Mrs.G.Marygrace and my brothers
Mr.G.Anbarasan, D.E.E.E, Mr.K.Sam, Service Engineer, and Mr.V.Sankara
subramanian, M.A, (ECO) and My sisters G.Jayamani, Mrs.Victoria
Manokaran Hanna trust and Mrs.S.Munniammal M.Sc (N) for their loving
support, encouragement, earnest prayer which enable me to accomplish this study.

My special and affectionate thanks to my husband Mr.S.Johnson Theader

Jacob, my mother in law Mrs.Saratha Sargunadoss and my ever loving daughter
J.Rubanya Esther M.D(RUS)., for their care, guidance, assistance and support
throughout this study which cannot be expressed in words.

I dedicate this dissertation study to my Beloved father Mr.S.Gnanamuthu.

 ABSTRACT
Effectiveness of aroma therapy massage on anxiety among elders at selected old
age homes, Madurai-20.

Objectives: The main objective was to evaluate the effectiveness of aromatherapy

massage on anxiety among elders at selected old age home. Conceptual framework:

the conceptual frame work based on CIPP Model, this model was created by Daniel L.

Stufflebeam. It is an acronym that stands for context evaluation, input evaluation,

process evaluation and product evaluation. Design: This study employed a one group

pre test and post test design and the samples were selected by using purposive

sampling technique. Setting of the study: The study was conducted in selected old

age homes (inba illam old age home) at Madurai. Subjects: The study was conducted

with the total number of 30 subject aged above 60 years. Intervention: The selected

sample received 10 minutes of aroma therapy massage as an individual session.

Totally 15 sessions of aroma therapy massage was given. Main outcome: Pre and

post test anxiety were measured using Aaron beck anxiety scale before and after

aroma therapy massage. Findings: The aroma therapy massage proved that there is a

difference between the pretest and posttest. It revealed that the calculated “t” value

(17.743**) was much higher than the table value 2.05 at 0.05 level of significance.

Conclusion: These findings support that the aroma therapy massage is an effective

non pharmacological, Complementary and Alternative therapy to manage the anxiety

among elders residing in old age home.

 TABLE OF CONTENTS
CHAPTER PAGE
TITLE
NO NO
1. INTRODUCTION 1
1.1 Need for the study 7
1.2 Statement of the problem 9
1.3 Objectives 9
1.4 Hypothesis 10
1.5 Operational definitions 10
1.6. Assumptions 11
1.7 Delimitations 11
1.8 Projected outcome 11
2. REVIEW OF LITERATURE 12
2.1 Literature related to anxiety among elders. 13
2.2 Literature related to effectiveness of aroma therapy 20
2.3 Literature related to aroma therapy massage on anxiety 25
among elders.
2.4 Conceptual Framework 28
3. RESEARCH METHODOLOGY 31
3.1 Research approach 31
3.2 Research design 31
3.3 Variables 32
3.4 Setting of the study 32
3.5 Population 32
3.6 Sample 32
3.7 Sample size 32
3.8 Sampling technique 32
3.9 Criteria for sample selection 33
3.10 Research tool 33
3.11 Scoring procedure 34
3.12 testing of tool. 35
3.13 Pilot study 35
3.14 Data collection procedure 35
CHAPTER PAGE
TITLE
NO NO
3.15 Plan for Data analysis 36
3.16 Protection of human subjects 36

4. ANALYSIS AND INTERPRETATION OF DATA 38

5. DISCUSSION 58
6. SUMMARY AND CONCLUSION 62
6.1 Summary 62
6.2 Findings of the study 63
6.3 Conclusion 64
6.4 Implication of the study 64
6.5 Recommendations 66
6.6 Limitations of the study 66
7. BIBLIOGRAPHY 67
 LIST OF TABLES

TABLE
TITLE PAGE NO
NO

1. Distribution on demographic characteristics of the elders 40

Distribution of the elders according to the level of anxiety in

2. 51
the pre test and post test.

Comparison of mean and standard deviation between pre-

3. 53
test and post- test measurement of anxiety among elders.

Paired’-test for pre and post test of Aromatherapy

Massage on anxiety among elderly residing at selected old
4. 55
age home at Madurai.

Association between post test aromatherapy massage on

5 anxiety among elders residing at selected old age home with 56
their selected demographic variable.
 LIST OF FIGURES

FIGURE PAGE
TITLE
NO NO

1. Conceptual framework 30

2. Percentage Distribution of elders according to their age. 42

3. Percentage Distribution of older adults according to their sex 43

4. Percentage Distribution of elders according to their religion 44

Percentage Distribution of elders according to their

5. 45
educational status
Percentage Distribution of elders according to their economic
6. 46
status
Percentage Distribution of elders according to their place of
7. 47
domicile
Percentage Distribution of elders according to their duration
8. 48
of residing.
Percentage Distribution of elders according to their support
9. 49
system
Percentage Distribution of elders according to their reason for
10 50
residing.

Percentage Distributions of subjects according to the pre and

11 52
post level of anxiety

Comparisons of mean score between pre- test and post- test

12 54
measurement of anxiety among elders.
 LIST OF APPENDICES

APPENDIX TITLE

A. Questionnaire & Scoring key

B. Tips for Massage technique

C. Content validity Certificates

D. Ethical Committee Approval to Conduct the study

E. Letter seeking permission to conduct the study

F. Certificate of Training in aroma therapy massage

G. Consent Form

H. English and Tamil editing certificate

I. Photographs
 CHAPTER - I

INTRODUCTION

“Age is a slowing down of everything except fear and worries”

worries”

(Mignon Mc Langhlin., 1960)

Aging is the Normal Process of time related changes, begins with birth and
continues throughout life. The aging of population is a global phenomenon, the later
years of life the conventionally seen as one where pathologic of body, minds and
social relationship takes place.

According to Khmer Rouge (1979) Old age consists of ages nearing or

surpassing the average life span of human beings, and thus the end of the human life
cycle. Euphemisms and terms for old people include seniors (American usage), senior
citizens (British and American usage) and the elders. Old people have limited
regenerative abilities and are more prone to disease, syndromes, and sickness than
younger adults.

World Health Assembly on aging (2001) Over the past few years, the world's
population has continued on its remarkable transition path from a state of high birth
and death rates to one characterized by low birth and death rates. At the heart of that
transition has been the growth in the number and proportion of older persons. Such a
rapid, large and omnipresent growth has never been seen in the history of civilization.

The current demographic revolution is predicted to continue well into the

coming centuries. One out of every ten persons is now 60 years or above; by 2050,
one out of five will be 60 years or older; and by 2150, one out of three persons will be
60 years or older. The older population itself is aging. They currently make up 11
percent of the 60+ age group and will grow to 19 percent by 2050.

In some developed countries today, the proportion of older persons is close to

one in five. During the first half of the 21st century that proportion will reach one in
four and in developing countries one in two. As the tempo of aging in developing
countries is more rapid than in developed countries, developing countries will have
less time than the developed countries to adapt to the consequences of population of
aging.

The impact of population of aging is increasingly evident in the old-age

dependency ratio, the number of working age persons (age 15 - 64 years) per older
person (65 years or older) that is used as an indicator of the 'dependency burden' on
potential workers. Between 2000 and 2050, the old-age dependency ratio will double
in more developed regions and triple in less developed regions. The potential
socioeconomic impact on society that may result from an increasing old-age
dependency ratio is an area of growing research and public debate.

More recently James sterling Ross (2004) commented “you do not heal old
age” you protect it, and you promote it, life expectancy had increased in recent years.
In 2011, Indian aging population is 96million, the percentage to the total population is
8.2%. In India the life expectancy projected in 2011, 2016 has been 67 years for male
and 69 years for female, 21% of the Indian population will be above 60 years of age
by the year 2050. Industrialization urbanization, education and exposure of western
life style are bringing changes in values of life. The old age population has become
vulnerable due to which they become distressed, anxiety and depression. Growing old
in a society that has been observed with youth may have a clinical impact on the
manual health of many people. The situation has series implication for psychiatric
nursing.

The concept of “old” has changed drastically over the years. The Tamilnadu
census in the year 2011 shows there are more than 580 million people over 60 years
of age and their numbers are growing at over 11 million a year. More people are
living to older ages, with higher proportions of most countries’ populations aged 60
years and above than at any time in history.

Aging can also be defined as a progressive functional decline or a gradual

deterioration of physiological function with age, including a decrease in fecundity, or
the intrinsic, inevitable, and irreversible age-related process of loss of viability and
increase in vulnerability. Clearly, human aging is associated with a wide range of
physiological changes that not only make us more susceptible to death but limit our
normal functions and render us more susceptible to a number of diseases. (Timiras,
2002.)

Functional aging is a more accurate measure of aging, since individual

differences by age are considered. Functional aging reflects the relationship between
biological maturation and deterioration and how well, if at all, an individual can adapt
and perform specific physical, social, or cognitive tasks. (Phoenix 1990).

Chronological aging represents only an approximate measure of the normative

development or changes within an individual or age cohort. There is great variation in
physical, emotional, social, and psychological development within and between
individuals. The chronological aging of an individual interacts with a societal history,
with a personal history, and with a number of socio demographic factors (Arizona
1990).

Psychological aging involves the reaction to biological, cognitive, sensory,

motor, emotional, and behavioral changes within an individual, as well as the reaction
to external environmental factors that influence behavior and lifestyle.

Social aging involves patterns of interaction between the aging individual and
the social structure. Many social positions are related to chronological age, and
individuals are expected to conform to the age-based norms associated with these
positions. Social aging is also influenced by the size and composition of the social
structure as it changes over time, by change within a society and by cultural and
subculture variations in attitudes toward aging and the aged.

The American geriatrics society (2005) reported that 82% of individuals 65

and older have at least one chronic condition and two thirds have more than one
chronic condition and two thirds have more than one observed condition, emotional
and mental illnesses increased over the life cycle.

A generalized expectation of danger occurs during the stressful condition

known as anxiety. The anxious person experiences a state of heightened tension that
Walter Cannon described in 1927 as readiness for "fight or flight". If the threat passes
or is overcome, the person returns to normal functioning. Anxiety has therefore served
its purpose in alerting the person to a possible danger. Unfortunately, sometimes the
alarm keeps ringing; the individual continues to behave as though in constant danger.
Such prolonged stress can disrupt the person's life, distort relationships, and even
produce life-threatening physical changes was the prospect of death the alarms that
never stops ringing. Death anxiety the source of people's most profound uneasiness.
Death anxiety a situational or abnormal reaction that occurs when coping skills are
overwhelmed.

Elders often express concern about living "too long" and therefore becoming a
burden on others and useless to themselves. Knowing a person's general level of
anxiety, then, does not necessarily identify what it is that most disturbs a person about
the prospect of death. The fact that most people report themselves as having a low to
moderate level of death anxiety does not offer support for either Freud's
psychoanalytic or Becker's existential theory. Respondents do not seem to be in the
grips of intense anxiety, but neither do they deny having any death-related fears.
Kirshenbaum’s Edge theory offers a different way of looking at this finding.
According to the theory, most people do not have a need to go through life either
denying the reality of death or in a high state of alarm. Either of these extremes would
actually interfere with one's ability both to enjoy life and cope with the possibility of
danger. The everyday baseline of low to moderate anxiety keeps people alert enough
to scan for potential threats to their own lives or the lives of other people.

At the perceived moment of danger, people feel themselves to be on the edge

between life and death, an instant away from catastrophe. The anxiety surge is part of
a person's emergency response and takes priority over whatever else the person may
have been doing. People are therefore not "in denial" when, in safe circumstances,
they report themselves to have a low level of death anxiety. The anxiety switches on
when their vigilance tells them that a life is on the edge of total distraction. Signs of
anxiety are more likely to be recognized and measures taken to help the patient feel at
ease. These signs include trembling, restlessness, sweating, rapid heartbeat, difficulty
sleeping, and irritability. Health care professionals can reduce the anxiety of
terminally ill people by providing accurate and reassuring information using
relaxation techniques, and making use of anxiolytics or antidepressants.
 Reducing the anxiety, elders requires more than technical expertise on the part
of physicians and nurses. They must also face the challenge of coping with their own
anxieties so that their interactions with patients and family provide comfort rather
than another source of stress. Family and friends can help to relieve anxiety (including
their own) by communicating well with the terminally ill person.

The constant state of worry and anxiousness may seriously affect older
people’s quality of life by causing them to limit their daily activities and have
difficulty sleeping. If untreated, generalized anxiety disorder may also lead to
depression. Other conditions considered anxiety disorders include phobias, panic
disorder, and obsessive compulsive disorder. With the months reported an overall
improvement in symptoms and quality of life. "Anxiety in people over age 60 might
have some similarities to anxiety in those younger, but it also has marked differences.
We can't just assume that we can treat the two age groups the same,” "We are decades
behind where we need to be in terms of research and treatments for anxiety in this
older age group.”

Anxiety is something everyone experiences and it may vary from time to time
and person to person. For most people, their anxiety is related to something concrete
and passes when the event is past. When there is no apparent reason for
"nervousness," and it becomes chronic, it is particularly hard for both the anxious
person and those around her to live with anxiety in the elders were demonstrated by a
variety of symptoms. We all know an older person who has an attack of "nerves" at
the drop of every hat. Some hyper-anxious people experience tremors, blurred vision,
diarrhea, shortness of breath, and even chest pain. "Not feeling well" and staying in
bed to avoid an anxiety provoking event is common.

Eric J. Lenze, MD, (2006) quoted that “Studies have shown that generalized
anxiety disorder is more common in the elders, affecting 7% of seniors. Surprisingly,
there is little research that has been done on this disorder in the elders.

Old age was always a problem, not only in India but also around the world.
Old age homes were alien in concept and elder abuse was considered a global
problem. As life expectancy has increased from 41 years in 1951 to 64 years today,
hundreds of old age homes have sprung up in India. Neglect of parents has become a
big issue, so that the Indian government has passed "The maintenance and welfare of
parents and senior citizens bill 2006", which makes it imperative for adult children to
look after their parents. As of 1998, there were 728 Old Age Homes in India. Detailed
information about 547 of these is available. Out of these, 325 homes are free of cost
while 95 old age homes are on pay & stay basis, 116 homes have both free as well as
pay & stay facilities and 11 homes have no information. A total of 278 old age homes
all over the country are available for the sick and 101 homes are exclusively for
women. Madurai has nearly 31 old age homes among them the inba illam is a oldest
old age home at Madurai. So the researcher interested to do the study at Inba illam.

Brittany Olivarez (2010) Old age is commonly accompanied by a decline in

cognitive functioning. However, studies show that if elders stay active through
exercise and mental stimulation it will help decrease cognitive decline. Cognitive
decline in the elders can lead to anxiety as people try to cope with the changes
associated with old age. A support system of friends, family members and caregivers
can help with self-esteem and optimism. So can geriatric psychologists by providing
therapy and support to elders. The research felt that age concern measures to break
down the barriors of seeking help. Will modified the reluctant behavior of elders with
anxiety. Since the elders stayed in old age home are left alone without their family
members may aggregate the anxiety episodes.

Naomi Coleman (2005), Massage can be particularly useful for people suffering
from anxiety and panic attacks because it helps them relax - often for the first time in
their life, claim practitioners. Massage can be an important tool in helping to raise self
worth in mental health patients.

Aromatherapy makes use of the herbs and the fragrant essential oils in order
to promote the natural health and healing. The father of modern medicine,
Hippocrates also believed in the use of the herbs in order to maintain one’s health.
Several of his prescriptions contain fragrant crushed herbs and essential oils. Till the
tenth century, the books were being written in the Arabia, these books were devoted
to the utilization and benefits of the specific aromas.

The term known as Aromatherapy is assigned to a French cosmetic chemist

named Rene Maurice Gattefosse. In the early section of 1920, Modern day research
has shown that specific herbs and essential oils actually have the healing and
therapeutic properties. Lavender is the oil that is till now being used for the burn
victims and its scent is utilized in order to treat anxiety and depression commonly.
Aromatherapy is now a part of many methods and treatments due to its high ratio of
positive results.

1.1 NEED FOR STUDY

In this materialist world, traditional family systems are kept on changing.

Joint family system is varnished and nuclear family system is aroused. The old age
people are left in the old age homes. We witness old age homes are present in nuke
end corners of the city.

Life seems to be meaningless. An individual slogs all through his life for the
family and with a view that a day would come when he/she can just relax in his
armchair and read his favorite book and tell tales of his youthful days to the younger
generation.

Vicissitudes of life have contributed to the misery of elders with none to

depend on, no means of income, no emotional security making them destitute with a
question, about how to carry on with their lives. The growing intolerance among
youth, coupled with their inability to adjust with the elders, is just one of the prime
reasons for the rise in the number of old age homes in India.

Recognizing an anxiety in an elders were posses several challenges. Aging

brings with it a higher prevalence of certain medical conditions, realistic concern
about physical problems, and a higher use of prescription medications. As a result,
separating a medical condition from physical symptoms of an anxiety is more
complicated in elders.

Brittany Olivarez (2010) Old age is commonly accompanied by a decline in

cognitive functioning. However, studies show that if elders stay active through
exercise and mental stimulation it will help decrease cognitive decline. Cognitive
decline in the elders can lead to anxiety as people try to cope with the changes
associated with old age. A support system of friends, family members and caregivers
can help with self-esteem and optimism. So can geriatric psychologists by providing
therapy and support to elders.

The researcher felt that age concern measures to break down the barriors of
seeking help Will modified the reluctant behavior of elders with anxiety. Since the
elders stayed in old age home are left alone without their family members may
aggregate the anxiety episodes.

A combination of anxiety and aroma therapy massage to enhance the

relaxation of elders and to enable to improve their mental status and quality of life.
The 21st century as aging one of the world’s greatest challenges of the present century
in the enormous increase in the absolute member and proportion of older person in the
world. According to the united nation projection by the year 2015. The number of
older persons is expected to be more than 3/4 from 60million to almost 2 billion. Out
of India’s more than 8% constitute elders population all this data indicates that India’s
aging population is on the rise. In India life expectancy has grown up from 20 years in
the beginning to 62years today.

Irudayaraj.S, (2006) India is a second population largest population in the

world and elders population also the same. The proportion of those who would be
aged 60years and above is estimated to be 7.7% for the year 2020 and this expected to
range 12.6% in 2050. The main problem among this anxiety. Considering prevalence
of anxiety the researcher selected this study.

Many people find lavender aromatherapy to be relaxing and it has been

reported to have anxiolytic effects. Overall, the evidence suggests a small positive
effect, although additional data from well-designed studies are required before the
evidence can be considered strong. Several human trials have assessed the effects of
massage in patients with anxiety, including those with cancer or chronic illnesses.

Both medication and psychosocial therapies are used to treat anxiety in older
persons, although clinical research on their effectiveness is progressing.
Aromatherapy is one of the complementary and alternative medicines used to treat
various symptoms because essential oils have many kinds of pharmacologic actions
including anxiolytic anti-microbial, sedative, analgesic, and spasmolytic and estrogen
or steroid hormone like effects etc.
 Zhou, Zhenyu, (2011) Aromatherapy is one of the fastest growing and widely
used complementary and alternative therapies in the world today. Nurses use
aromatherapy both in their working and private life for many purposes. Many
researches provided much evidence in the area. Zhou, Zhenyu, RN, RMN, BHSC
(Nursing) said in her paper critically evaluates the current knowledge of aromatherapy
and provides supportive evidences for nurses to incorporate aromatherapy into
practice. Aromatherapy enhanced relaxation, reduced anxiety and promoted sleep,
especially for the elders. It helped people to feel invigorated or rejuvenated,
depending on the types of oil used. Some studies stated that aromatherapy only had
transient effect. While other studies revealed massage had better effect than inhalation
in reducing anxiety level and pain, but more research are required to support these
therapeutic claims.

Aromatherapy promotes relaxation and reduces anxiety. More encouragingly,

aromatherapy appears to be without the adverse effects of many conventional drugs.
However, there is a need for more large scaled, well-designed, randomized control
trial research to provide more detailed scientific evidence. Nurses need to be more
initiated to analyze, investigate and evaluate the knowledge about aromatherapy
before transforming it into clinical practice.

From the above evidence, it is learn that the elder’s anxiety and it also
increases the level of anxiety since they reside in the old age home, so the researcher
adopts certain measures and needs of aromatherapy towards reducing the anxiety
level of elders in old age home.

1.2 STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of aromatherapy massages on anxiety
among elders at selected old age home, Madurai.

1.3 OBJECTIVES
 To assess the pre and post test level of anxiety among elders at selected old age
home.
 To evaluate the effectiveness of aromatherapy massage on anxiety among elders
 To associate posttest score of anxiety among elders and selected demographic
variables
1.4 HYPOTHESES

H1 - The mean posttest score of anxiety will be significantly lesser than the
mean pretest score of elders.
H2 - There will be a significant association between the posttest score of
anxiety among elders and selected demographic variables

1.5 OPERATIONAL DEFINITION

EFFECTIVENESS

In this study the effectiveness refers to a successful positive outcome on

anxiety as an aroma therapy massage and is measured in term of significant positive
values in the post test.

AROMATHERAPY MASSAGE

In this study the aroma therapy massage refers to a therapeutic technique of

manipulating the muscles and soft tissues of the back of the body with using
lavender oils mixed with base oil (sunflower) of plants in which the odor or fragrance
plays an important part to reduce the level of anxiety.

ANXIETY

In this study the anxiety refers to an emotional response to anticipation of

impending and dread accompanied by danger tension, uneasiness, persistence
increased helplessness, restlessness, uncertainty, fear and distress perceived by elders,
as measured by using Aaron beck anxiety scale.

ELDERS

In this study the elders refers to an older individual (or) aging individual
between 60-80years of age.

OLDAGE HOME

In this study the old age home refers to the destitute of elders residing with
free of cost in Inba Illam, Pasumalai at Madurai.
1.6 ASSUMPTIONS
 The study is based on the assumption that elders were residing at old age home
having varying degree of anxiety.
 Aroma therapy massage is reducing anxiety among elders were residing at old
age home.

1.7 DELIMITATION
 The study was delimited to elders residing in Inba Illam Old age home.
 The study was delimited for a period of 4 weeks duration.
 The study was delimited to elders between 60 - 80 years

1.8 PROJECTED OUTCOME

Aroma therapy massages work out its efficacy on anxiety and shallowness
issues on elders. Massage can be an important tool in helping to raise self work of
elders because that relieves pain and reduce stress, enhance relaxation, decrease the
feeling of anxiety and increased general well being of elders.
 CHAPTER – II

REVIEW OF LITERATURE

“A good day is one where I cannot just read a book, but write a
review of it. Maybe today I'll be able to do that. I get for some
reason somewhat stronger when the sun starts to go down. Dusk is
a good time for me. I'm crepuscular.”

Christopher
Hitchens

A literature review is a body of text that aims to review the critical points of
current knowledge including substantive findings as well as theoretical and
methodological contributions to a particular topic. Literature reviews are secondary
sources, and as such, do not report any new or original experimental work.

Most often associated with academic-oriented literature, such as a thesis, a

literature review usually precedes a research proposal and results section. Its ultimate
goal is to bring the researcher up to date with current literature on a topic and forms
the basis for another goal, such as future research that may be needed in the area.

A well-structured literature review is characterized by a logical flow of ideas;

current and relevant references with consistent, appropriate referencing style; proper
use of terminology; and an unbiased and comprehensive view of the previous research
on the topic.

The related literature was studied and reviewed to broaden the understanding
and to gain insight into the problems under the study.

The literature review has been organized under following headings.

2.1. Literature related to anxiety among elders.

2.2. Literature related to effectiveness of aromatherapy massage.

2.3. Literature related to aromatherapy massage to reduce the anxiety
among elders.

2.1. Literature related to anxiety among elders.

Amy, L. Byers, Kristine Gaffe, Kenneth ,E. Covinsky, Michael, B.

Friedman, Martha, L. Bruce (2010). Psychiatric Epidemiology Surveys study was
conducted twelve –months period at united states to know about prevalence of
anxiety and mood disorder among older adult dwelling at community. the probability
sampling method used for this study, sample size were 2575 among older below 55
and older in that 43%, 55-64 years;32%,65-75 years; 20%,75-84 years;5% >_85
years. The likelihood of having mood shown a pattern of declining with age (p,.o5).
Disorders showed higher rates in women compared with men, a statistically
significant trend with age. In addition, anxiety disorders were as 12% mood disorders
5% across age groups.

Amy, L. Byers, Kristine Yaffe, Kenneth ,E. Covinsky, Michael, B.

Friedman & Martha L. Bruce (2010). Population-based study to determine
nationally representative estimates of 12-month prevalence rates of mood, anxiety,
and co morbid mood-anxiety disorders across young-old, mid-old, old-old, and oldest-
old community-dwelling adults, Continental United States. they studied the 2575
participants 55 years and older who were part of NCS-R (43%, 55-64 years; 32%, 65-
74 years; 20%, 75-84 years; 5%, ≥85 years). Twelve-month prevalence of mood
disorders, anxiety disorders, and coexisting mood-anxiety disorder were assessed
using DSM-IV criteria. Prevalence rates were weighted to adjust for the complex
design to infer generalizability to the US population. The likelihood of having a
mood, anxiety, or combined mood-anxiety disorder generally showed a pattern of
decline with age (P < .05). Twelve-month disorders showed higher rates in women
compared with men, a statistically significant trend with age. In addition, anxiety
disorders were as high if not higher than mood disorders across age groups (overall 12-
month rates: mood, 5% and anxiety, 12%). No differences were found between
race/ethnicity groups.
 Christina Bryant, Henry Jackson & David Ames (2007). A Cohort study
Conducted from 1980–2007, University of Melbourne, Australia, to find out the
prevalence of anxiety symptoms, anxiety disorder or specified anxiety disorders in
adults aged > 60 in either community or clinical settings. The prevalence of anxiety in
community samples ranges from 1.2% to 15%, and in clinical settings from 1% to
28%. The prevalence of anxiety symptoms is much higher, ranging from 15% to
52.3% in community samples, and 15% to 56% in clinical samples. These
discrepancies are partly attributable to the conceptual and methodological
inconsistencies that characterized this literature. Generalized Anxiety Disorder is the
commonest anxiety disorder in older adults.

David, L. Streiner, John Cairney, Scott Veldhuizen, B.A (2006). The

Canadian Community Health Survey on Mental Health and Well-Being, to determine
the prevalence of mood, anxiety and other disorders in the population of Canadians
aged 55 years and over. There was a linear decrease for all disorders after age 55
years. This was true for men and women; for Anglophones, francophone and
allophones; and for both people born in Canada and people who immigrated to
Canada after age 18 years. Consistent with previous research, the prevalence were
higher for women than men. Immigrants reported fewer problems than
nonimmigrant’s, with the differences decreasing with age. Francophone of both sexes
reported more mood disorder than Anglophones, but francophone men had less
anxiety disorder than Anglophone men.

Gerstorf, D. Smith, J. & Baltes, P. B (2006). The Berlin Aging Study, to examine
the distribution of anxiety symptoms and disorders in a representative community
sample. A sample of 258 old (70 to 84 years) and 258 very old (85 to 103 years)
subjects were examined. The raw score distributions of anxiety subscales obtained by
this procedure are examined by age, gender, education, personal living situation, and
psychiatric co morbidity. The weighted overall prevalence of anxiety in the elderly
community is 4.5% (n = 17), including specified (n = 8) anxiety disorders according
to the DSM-III-R and unspecified (n = 9) disorders. Prevalence rates in the younger
old were 4.3% and in the older old 2.3%. Weighted prevalence rates for males were
2.9% and for females 4.7%.Indepentently of the nosological level, 52.3% reported one
or more symptoms of anxiety. Factor analysis of anxiety-related symptoms yielded 5
independent subscales, reflecting hypochondrias is, panic, phobia, worries, and
vegetative anxiety. There were more phobic symptoms in the younger age group (P <
.001).

Amal Chakraburtty, MD (2006). The epidemiological study conducted on

generalized anxiety disorder among the elderly at Pittsburgh, Toronto. "Studies have
shown that generalized anxiety disorder is more common in the elderly, affecting 7%
of seniors, than depression, which affects about 3% of seniors. Surprisingly, there is
little research that has been done on this disorder in the elderly,"

Heun, R. Papassotiropoulos,A. & Ptok,U (2006). A comparative study

conducted the Department of Psychiatry, University of Bonn, Venus berg, Germany.
The aims of the present study were to compare the current and lifetime prevalence for
major and sub threshold affective disorders in elderly subjects in the general
population, to assess the influence of demographic variables on prevalence rates, and
to examine co-morbidity between these disorders. Major and sub threshold disorders
were diagnosed in 286 subjects (aged ≥ 60 years). Four-point-nine percent of the
subjects had a lifetime diagnosis of major depression, 31.8% either minor or recurrent
brief depression, 6.6% a major anxiety disorder, and 18.5% a sub threshold anxiety
disorder. The risk for current and lifetime sub threshold anxiety was higher in females
than in males, the lifetime prevalence for sub threshold anxiety disorders was
increased in elderly subjects and subjects with low professional levels. Increased co-
morbidity between major and sub threshold depressive and anxiety disorders could
not be observed. In the elderly, sub threshold depressive and anxiety disorders are
frequent, more so than major affective disorders.

Kari Kvaal, Jurate Macijauskiene, Knut Engedal & Knut Laake(2005).

Controlled cross-sectional study to examine the prevalence of anxiety symptoms in
hospitalized geriatric patients. Ninety-eight geriatric in-patients and 68 healthy home-
dwelling controls of similar age recruited from senior citizen centers. Anxiety
measured as a current emotional state by Spielberger's State–Trait Anxiety Inventory
.The geriatric patients scored significantly higher than the controls. Applying
Spielberger's recommended cut-off of 39/40 on the State–Trait Anxiety Inventory sub
score, 41% of the female and 47% of the male geriatric patients might be suspected of
suffering from significant anxiety symptoms.
 Le Roux, Hillary B.A, Gatz, Margaret, Wetherell & Julie Loebach
(2005). The explorative study to find out the distribution and correlation of age-at-
onset of late-life generalized anxiety disorder . Authors examined the distribution of
age at onset in a sample of 67 older adults with GAD recruited for a psychotherapy
study. They compared those with an early onset of symptoms (before age 50) to those
with a late onset (after 50) on demographic variables and measures of
psychopathology and health-related quality of life. There was a bimodal distribution
of age at onset, with 57% reporting early onset and 43% reporting a late onset.
Patients with an early onset of symptoms had a higher rate of psychiatric co morbidity
and psychotropic medication use and more severe worry. Patients with a late onset of
symptoms reported more functional limitations due to physical problems. Although
older GAD patients report an onset in childhood or adolescence, almost half develop
the disorder in late life. Older adults with an early onset of GAD appear to have a
more severe course, characterized by pathological worry, than those with a later onset.
Role disability may be a risk factor for onset of GAD in late life

Tomader Taha Abdel Rahman (2005). Cross sectional study was done
among elders aged 60 -80yrs, to evaluate the prevalence of anxiety and depression
thus who were living in the old age home and geriatric clubs Cairo at Egypt. .They
are living at their own homes and going to geriatric clubs regularly as Elwaily,
Elshams and Eltayaran (group I) or living at geriatric homes as Elsafa, Elmarwa and
Oly Elalbab (group II). Sample size of at least 110 subjects from each group. The
duration of survey was 6 months, Hamilton Anxiety Scale was used in this study. It
consists of 14 items, each defined by a series of symptoms. Each item is rated on a 5-
point scale, ranging from 0 (not present) to 4 (severe). The total score is 0 – 17 for
normal individual, 18 – 24 for mild anxiety, 25 – 29 for moderate anxiety and ≥ 30
for severe anxiety. Data was coded for analysis test was used for categorical data. P-
value < 0.05 was considered statistically significant.

Samuelsson, et al (2005). Described a longitudinal cohort study of 192

healthy subjects aged 67 years at first assessment; these subjects were followed up for
up to 34 years. The cumulative probability for the development of clinical anxiety
during follow up was 6%. No significant risk factor for anxiety was found.
 Flint (2005). Reviewed the epidemiology of GAD in the elderly and
concluded that, when present alone, this disorder has a period prevalence of about 1%
in community-dwelling older people; In the National Co morbidity Survey
Replication, 9282 English-speaking adult American subjects were interviewed.
Among all disorders, anxiety disorders showed the highest lifetime prevalence: 28.8
% overall and 15.3 % in the elderly. Elderly subjects had a lower prevalence for each
of the anxiety disorders relative to the rest of the population. The overall lifetime
prevalence in the whole sample and in the elderly subjects, separately, were 5.7% and
3.6% for GAD, 4.7% and 2.0% for panic disorder, 1.4% and 1.0% for agoraphobia
without panic, 12.5% and 7.5% for specific phobia, 12.1% and 6.6% for social
phobia, 6.8% and 2.5% for posttraumatic stress disorder, and 1.6% and 0.7% for
obsessive-compulsive disorder .

Schoever Robert,A.,Deeg, D. J.H., Tilburg & W., Beekman, A. T.F(2004).

Explorative study conducted by Department of Psychiatry, VU University Medical
Center, Amsterdam, The Netherlands to establish the natural course and risk-profile
of depression, generalized anxiety disorder (GAD), and depression with co-existing
GAD in later life. A total of 2,173 community-living elderly persons were interviewed
at baseline, and at a 3-year follow-up. The course of pure depression, pure GAD, and
depression with coexisting GAD was studied in 258 subjects with baseline
psychopathology. The risk-profile for onset of pure depression, pure GAD, and the
mixed condition at follow-up was studied in 1,915 subjects without baseline
psychopathology. Remission rate at follow-up was 41% for subjects with depression-
only, 48% for pure GAD, and significantly lower (27%) for depression with
coexisting GAD. A pattern of temporal sequencing was established, with anxiety
often progressing to depression or depression with GAD. Onset of pure depression
and depression with co-existing GAD was predicted by loss events, ill health, and
functional disability. Onset of pure GAD, and, more strongly, that of depression with
coexisting GAD, was associated with longstanding, possibly genetic vulnerability.

Cheryl ,N. Carmin ,Jan Mohlman, Amy Buckley (2004). Contacted

epidemiological studies have underscored the ubiquitous nature of anxiety disorders,
with approximately 25% of adults being affected over the course of their lifetimes.
Given the prevalence of anxiety disorders, it is not surprising that an increasing
amount of attention has been given to investigating the prevalence and treatment of
these conditions. What is surprising, however, is how little attention has been given to
anxiety disorders in what is the fastest growing segment of the population, namely the
elderly. This article summarizes how the existing research literature informs us with
respect to the epidemiology of anxiety disorders in the elderly and then examines the
treatment outcome literature with regard to the individual anxiety disorders.

Beekman, A.T. et al (2004). The Longitudinal Aging Study Amsterdam at

Netherlands. The random sample size of 3107 older adults, stratified for age and sex,
which was drawn from the community registries of 11 municipalities in three regions
in Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview
Schedule in a two-stage screening design. The overall prevalence of anxiety disorders
was estimated at 10.2%. Generalized anxiety disorder was the most common disorder
(7.3%), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and
obsessive compulsive disorder (0.6%) were rare. And also study about risk factors
comprise vulnerability, stress and network-related variables.ti was evaluated by using
bivariate and multivariate statistical methods. The Vulnerability factors (female sex,
lower levels of education, having suffered extreme experiences) appeared to
dominate, while stresses commonly experienced by older people (recent losses in the
family and chronic physical illness) also played a part. Of the network-related
variables, only a smaller size of the network was associated with anxiety disorders.

Pereira, et al (2002). Studied 698 geriatric patients attending a psychiatric

hospital in Goa. They observed that nearly 9% of the patients had neurotic, stress-
related, and somatoform disorders of these, a little over a third were diagnosed with
mixed anxiety and depressions

Lenze, Eric, J (2001). Recent geriatric literature for studies associating late-
life depression or anxiety with physical disability. Studies showed that Anxiety in late
life was also found to be a risk factor for disability, although not necessarily
independently of depression. Increased disability due to depression is only partly
explained by differences in socioeconomic measures, medical conditions, and
cognition. Physical disability improves with treatment for depression; comparable
studies have not been done for anxiety. The authors discuss how these findings inform
current concepts of physical disability and discuss the implications for future
intervention studies of late-life depression and anxiety disorders.

JORM, A.F.et al., (2000). Psychiatric Epidemiology Research study that

examine the occurrence of anxiety, depression or general distress across the adult life
span. at Australian National University, Canberra, Australia. A study had to involve a
general population sample ranging in age from at least the 30s to 65 and over and use
the same assessment method at each age. There was no consistent pattern across
studies for age differences in the occurrence of anxiety, depression or distress. The
most common trend found was for an initial rise across age groups, followed by a
drop. Two major factors producing this variability in results were age biases in
assessment of anxiety and depression and the masking effect of other risk factors that
vary with age. When other risk factors were statistically controlled, a more consistent
pattern emerged, with most studies finding a decrease in anxiety, depression and
distress across age groups. This decrease cannot be accounted for by exclusion of
elderly people in institutional care from epidemiological surveys or by selective
mortality of people with anxiety or depression.

Forsell, Y(2000). The epidemiological follow-up study examined the

predictors for Depression, Anxiety and psychotic symptoms in a population of very
elderly persons. A total of 894 persons with a mean age of 84.5 years were examined
twice using a 3-year interval. Physicians performed a structured psychiatric interview
and persons with a current disorder or symptom were excluded. Persons who had a
history of psychosis, were affected with Dementia and had an insufficient social
network had an increased frequency of psychotic symptoms. A history of
Depression/Anxiety increased the frequency of having Anxiety and Depression. An
insufficient social network was associated with Anxiety. In this study Anxiety,
Depression and psychotic symptoms in the very elderly seem to be linked to a lifetime
psychological vulnerability, since all were related to a previous psychiatric history.
Additionally, psychotic symptoms seemed to emerge due to structural brain damage,
as seen in Dementia.
2.2. Literature related to effectiveness of aromatherapy massage

Lai, T.K (2011). This study employed a randomized control group pre- and
post test design and included an aroma massage group, plain massage group, and
control group. To evaluate the effect of aromatherapy, the degree of constipation was
measured using a constipation assessment scale, severity level of constipation and the
frequency of bowel movements. The score of the constipation assessment scale of
the aroma massage group was significantly lower than the control group. Apart from
the improvement in bowel movements, the results showed significantly improved
quality of life in physical and support domains of the aroma massage group.

Serfaty,M (2011). A randomized controlled trial of aromatherapy massages

versus Cognitive Behavior Therapy in patients with cancer; test and modify the
intervention; determine whether changes in outcomes were consistent with published
data. Patients at all stages of cancer, recruited from oncology outpatient clinics and
screening eight or more for anxiety and/or depression on the hospital anxiety
depression scale, were randomized to Treatment as Usual plus up to eight sessions
weekly of either aromatherapy massage or cognitive behavior therapy, offered within
3 months Of those suitable, over 60% (39/63) participated (aromatherapy massage, n
= 20; cognitive behavior therapy, n = 19) and over 90% (36/39) were followed up.
Both packages were well received. The preference was for AM, with more sessions
were taken up; (Mean number sessions aroma therapy massage = 7.2 (standard
deviation 2.0) and cognitive behaviour therapy = 5.4 (standard deviation 3.1);
P<0.05). Significant improvements in POMS (Total Mood, depression and anxiety
scores) occurred with both interventions.

Diane, M. Welsh, L. Charles, E. Gessert, Colleen, M. & Renier, B.S

(2009). Prospective study designed to examine the potential of massage to reduce
agitation in cognitively impaired nursing home residents. Subjects were identified as
susceptible to agitation by nursing home staff or by Minimum Data Set report. Data
was collected during baseline (3 days), intervention (6 days), and at follow-up. Five
aspects of agitation were Wandering, Verbally Agitated/Abusive, Physically
Agitated/Abusive, Socially Inappropriate/Disruptive, and Resists Care. At each
observation, agitation was scored 5 times during the 1-hour window of observation.
Subjects’ agitation was lower during the massage intervention than at baseline (2.05
vs. 1.22, P < .001), and remained lower at follow-up. Of the 5 agitated behaviors
examined in this study, massage was associated with significant improvement for 4:
Wandering (0.38 vs. 0.16, P < .001), verbally Agitated/Abusive (0.59 vs. 0.49, P =
.002), Physically Agitated/Abusive (0.82 vs. 0.40, P < .001), and Resists Care (0.10
vs. 0.09, P = .022).

Cathy Wong (2009). A small study suggests that aromatherapy massage may
help ease anxiety among people with breast cancer. The study involved 12 breast
cancer patients, all of whom received 30-minute aromatherapy massages twice
weekly for four weeks. Results revealed that aromatherapy massage could help reduce
anxiety, as well as stimulate the immune system.

Yim, V.W.C. Adelina, K.Y. Hector, W.H. Tsang, & Ada ,Y. Leung (2009). A
study conducted in the Department of Rehabilitation Sciences, Hong Kong
Polytechnic University, Hong Kong. The review was conducted among five electronic
databases to identify all peer-reviewed journal papers that tested the effects of
aromatherapy in the form of therapeutic massage for patients with depressive
symptoms the results were based on six studies examining the effects of aromatherapy
on depressive symptoms in patients with depression and cancer. Some studies showed
positive effects of this intervention among these three groups of patients. We
recommend that aromatherapy could continue to be used as a complementary and
alternative therapy for patients with depression and secondary depressive symptoms
arising from various types of chronic medical conditions.

Muzzarelli, L (2006). A controlled, prospective study was done on anxiety

prior to a scheduled colonoscopy a convenience sample of 118 patients. The "state"
component of the State Trait Anxiety Inventory was used to evaluate
patients' anxiety levels pre- and post aromatherapy. The control group was given inert
oil (placebo) for inhalation, and the experimental group was given the essential oil,
lavender, for inhalation. The STAI state anxiety raw score revealed that patients were
at the 99th (women) and 96th (men) percentiles for anxiety. The intervention group
and the control group had similar levels of state anxiety prior to the beginning of
the study (t [116] = .47, p = .64). There was no difference in state anxiety levels
between pre- and post placebo inhalation in the control group (t [112] = .48, p = .63).
There was no statistical difference in state anxiety levels between pre- and post
lavender inhalation in the experimental group (t [120] = .73, p = .47). Although
this study did not show aromatherapy to be effective based on statistical analysis,
patients did generally report the lavender scent to be pleasant. Lavender is an
inexpensive and popular technique for relaxation that can be offered to patients as an
opportunity to promote pre procedural stress reduction in a hospital setting

Naomi Coleman (2005). Comparative study conducted the Royal Berkshire

Hospital NHS Trust in Reading studied the effects of massage and massage using
aromatherapy oils in the intensive care unit as a means of helping to alleviate anxiety
and stress. Around 122 patients were selected to receive massage, aromatherapy
massage, or bed rest. All of the patients were assessed before and after the therapy
sessions. Results showed that the patients in the aromatherapy group were found to be
less anxious and more positive immediately after the treatment.

Naomi Coleman (2005). A randomized controlled trial was conducted to

assess the effects of aromatherapy and massage on post-cardiac surgery patients at the
Royal Berkshire Hospital NHS Trust. Foot massages were given, with or without
essential oils to the patients. Results showed that a significant psychological benefit
was derived from both groups receiving massage, compared to those patients not
receiving massage or aromatherapy massage.

Maddocks- Jennings,W. & Wilkinson ,J .M (2004). Most of the nursing

literature related to the use of essential oils in low doses for massage or use of the oils
as environmental fragrances. The paper reported a literature relating to the use of
aromatherapy by nurses and critically evaluates the evidence to support this practice.
A total of 165 articles have been included in this review. Nursing papers were
published since 1990 were included, but some references from 1971 onwards relating
to scientific research conducted on essential oils were also included. The review
covers key professional issues and the principal areas of clinical practice where
aromatherapy is used. Despite calls for more research in the 1980s and 1990s, there is
still little empirical evidence to support the use of aromatherapy in nursing practice
beyond enhancing relaxation.

Soden ,K(2004). This study was designed to compare the effects of four-week
courses of aromatherapy massage and massage alone on physical and psychological
symptoms in patients with advanced cancer. There is good evidence that these
therapies may be helpful for anxiety reduction for short periods, Forty-two patients
were randomly allocated to receive weekly massages with lavender essential oil and
inert carrier oil (aromatherapy group), inert carrier oil only or no intervention.
Outcome measures included a Visual Analogue Scale of pain intensity, the Verran
and Snyder-Halpern sleep scale, the Hospital Anxiety and Depression scale and the
Rotterdam Symptom Checklist. Sleep scores improved significantly in both the
massage and the combined massage (aromatherapy and massage) groups. There were
also statistically significant reductions in anxiety and depression.

Jennifer Edge (2003). Conducted a pilot study in which she tested the effects
of aromatherapy massages on mood, anxiety, and relaxation on eight subjects. Each
subject was given a Hospital Anxiety and Depression Scale where these levels were
tested both before and after completing the massage treatments. Every subject
received an aromatherapy massage for one hour, once a week, for six weeks. The
average improvement in relaxation and anxiety was 50% and mood was 30% after
each individual massage. The subjects were each tested again with the HAD six
weeks after the completion of their massages to measure their relaxation, anxiety, and
mood scores. Six weeks post-massage their levels had dropped in all three areas but
were still 30%, 10%, and 10% higher, respectively, than before the experiment
started. Only one of the eight subjects did not show any improvement in any of the
three areas. This study can conclude that aromatherapy massage does have positive
effects in the short term with relaxation, anxiety, and mood but the effects drop off if
the aromatherapy use is not persistent.

Moss, Cook, Wesnes, & Duckett (2003). The main findings were that the
subjects assigned to the lavender group were less alert than those exposed to
rosemary. Also, subjects in the control who received no aromatherapy treatment were
unhappier than those who did. This indicates that aromatherapy can have positive
effects on moods. A final finding of this experiment was that the aromatherapy
produced a slower reaction time to memory and performance, most likely due to a
higher state of relaxation.

Stiles, K.G (2002). Conduct a pilot study addressing the effect of

aromatherapy massage on mood, anxiety, and relaxation in adult mental health was
conducted at the Lavender Day Hospital in West Sussex, UK. The study was carried
out over an 8-month period. The subjects' levels of mood, anxiety and relaxation were
recorded using a visual analogue before and after each massage and then again 6
weeks after the last massage. Comparison was made between the HAD Scale results
for each client and also the visual analogue scale results for before and after massage
and also first massage and 6 weeks post massage for the sample group. Improvements
were shown in six out of eight subjects' HAD Scale results. Improvements were also
shown in all areas when comparing the visual analogue scale results.

Hadfield, N (2001). Researcher wanted to find out whether aromatherapy

massage reduces anxiety in patients with a primary malignant brain tumor attending
their first follow-up appointment after radiotherapy. Eight patients were recruited to
the study, which comprised three methods of data collection the measurement of
physical parameters; the completion of Hospital Anxiety and Depression Scales; and
semi-structured interviews. The results from Anxiety and Depression Scales did not
show any psychological benefit from aromatherapy massage. However, there was a
statistically significant reduction in all four physical parameters, which suggests that
alternative medicine affects the autonomic nervous system, inducing relaxation. This
finding was supported by the patients themselves, all of whom stated during interview
that they felt relaxed after aromatherapy massage. Since these patients are faced with
limited treatment options and a poor prognosis, this intervention appears to be a good
way of offering support and improving quality of life.

Brian Cooke & Edzard Ernst (2000). Completed a systematic review of

aromatherapy by compiling and studying the results of six experiments dealing with
aromatherapy use. The general conclusions were that aromatherapy massage can be
beneficial for short periods in reducing anxiety, stress, and increasing well-being.
Five of the six experiments concluded that aromatherapy causes positive effects.
Since six different experiments were conducted by six different researchers, none
were exactly alike. Every experiment was conducted by health care officials to
patients in a hospital setting. The participants were tested in performance by mostly
completing written questionnaires. five of the six did prove that the well-being and
stress levels of patients improved with aromatherapy use.
 Aorn,J (2000). This article reviewed holistic caring-healing therapies that
may decrease preoperative anxiety for the surgical patient, based on the philosophy
and science of caring developed by Jean Watson, RN, PhD, Faan.Dr Watson reveals a
new paradigm emerging in health care that blends the compassion and caring of
nursing in harmony with the curative therapies of medicine. Hypnosis, aromatherapy,
music, guided imagery, and massage are integrative caring-healing therapies that may
minimize preoperative anxiety. Alternative therapies offer a high-touch balance when
integrated with high-tech conventional surgical treatments.

2.3. A literature related to effectiveness of aromatherapy massage on anxiety

among elders.

Eva, S. van deer Ploeg, Barbara Epping stall &Daniel, W. O’Connor

(2010). Random cross-over study will be conducted in mainstream and psycho
geriatric with moderate to severe dementia and associated behavioral problems living
in aged care facilities in south-east Melbourne. to test the effectiveness of topically
applied pure lavender oil in reducing actual counts of challenging behaviors in
nursing home residents. Willing participants will be assigned in random order to
lavender or placebo blocks for one week then switched to the other condition for the
following week. In each week the oils will be applied on three days with at least a two-
day wash out period between conditions. Trained observers will note presence of target
behaviors and predominant type of affect displayed during the 30 minutes before and
the 60 minutes after application of the oil. Nursing staff will apply 1 ml of 30% high
strength essential lavender oil to reduce the risk of missing a true effect through under-
dosing. The placebo will comprise of jojoba oil only. The oils will be identical in
appearance and texture, but can easily be identified by smell. For blinding purposes, all
staff involved in applying the oil or observing the resident will apply a masking cream
containing a mixture of lavender and other essential oils to their upper lip. In addition,
nursing staff will wear a nose clip during the few minutes it takes to massage the oil to
the resident's forearms.

Brooker, et al (2010). A Single case study to evaluated the effects of

aromatherapy and massage on disturbed behavior in severe dementia. Observed
variable effects after treating four psycho geriatric patients for 10-minute periods on
ten occasions each with lavender oil by vapor, massage with a neutral oil and
vaporized lavender oil combined with massage. When compared with 'no treatment'
control sessions, only one participant benefited to a statistically significant degree and
two became more agitated. Two other case series suggested that lavender promotes
sleep in elderly people with dementia.

Rho,K.H.Han,S.H.Kim,K.S.Lee.M.S(2006).This study investigatedthe effect

of aromatherapy massage onthe anxiety and selfesteem experiencedby Korean elderly
women. A quasi-experimental, control group, pretest-posttest design was used. The
subjects comprised 36 elderly females: 16 in the experimental group and 20 in the
control group. Aromatherapy massage using lavender, chamomile, rosemary, and
lemon was given to the experimental group only. Each massage session lasted 20 min,
and was performed 3 times per week for two 3-week periods with an intervening 1-
week break. The intervention produced significant differences in the anxiety and self-
esteem and no significant differences in blood pressure or pulse rate between the two
groups. These results suggest that aromatherapy massage exert
positive effects on anxiety and self-esteem.

Edge, J (2003). This study was carried out with eight subjects specifically
referred for aroma therapy; each received a standardized aroma
therapy massage weekly for 6 weeks. The subjects' levels of anxiety and depression
were measured using the Hospital Anxiety and Depression Scale prior to the
first massage and after the final massage. The subjects' levels of
mood, anxiety and relaxation were recorded using a visual analogue before and after
each massage and then again 6 weeks after the last massage. Improvements were
shown in six out of eight subjects' Hospital Anxiety and Depression Scale results.
Improvements were also shown in all areas when comparing the visual analogue scale
results. The study was carried out over an 8-month period. To date there have been
few studies addressing the effect of aroma therapy massage on mood,
anxiety relaxation. It is acknowledged that whilst this is a small pilot study a number
of methodological issues are raised concerning research into the use
of aromatherapy in this clinical field.

Smallwood (2001). A random controlled trial of the relaxing effects of

an aromatherapy massage on disordered behavior in dementia was conducted. Twenty-
one patients were randomly allocated into one of three conditions,
aromatherapy and massage, conversation and aromatherapy and massage only.
Aromatherapy massage showed the greatest reduction in the frequency of excessive
motor behavior of all three conditions. This reached statistical significance between
the hours of three and four pm (p < 0.05). Post hoc analysis suggested that at this time
of day the aromatherapy and massage consistently reduced motor behavior when
compared with conservation and aromatherapy (p = 0.05). This provides preliminary
evidence of a measurable sedative effect of aromatherapy massage on dementia
within a robust scientific paradigm.
2.4 CONCEPTUAL FRAME WORK

A conceptual frame work is a theoretical approach to the study of problems

that are scientifically based and emphases the selection, arrangement and
classification of its concept. Concepts are words that depict objects, properties or
events and are basic components of theory. The conceptual frame work is a general
amalgam of all the related concepts in the problem area.

Conceptual frame work deals with abstraction or concepts that are assembled
by virtue of their relevance to a common theme. Conceptualization is a process of
forming ideas which is utilized and forms conceptual frame work for development of
research design. It helps the researchers by giving direction to go about the entire
research process.

A conceptual model or theoretical framework provides a coherent,

amalgamated and orderly way of envisioning related events or processes relevant to a
discipline. In research, a framework illustrates the overall conceptual design of the
study. The terms ‘conceptual model’ and ‘theoretical framework’ are habitually used
interchangeably, but a theoretical framework generally incorporates at least part of a
specific theory as the basis for a study. In addition, a theoretical framework often
includes propositional statements describing the relationships among variables and
has received more testing than the more tentative conceptual model.

The most common use of conceptual models is to provide an organizing

structure for the research design and methods. A second purpose is to guide the
development and testing of interventions and hypotheses based on the canon of the
theory. A third function is to explain the study results and place the findings within
the context of science in a specific field of investigation. The interpretation of
findings flows from the conceptualization represented by the framework,
In this study was aimed at to evaluate the effect of aromatherapy massage to
reduce anxiety among elders.
Conceptual frame work is structures together in a meaningful way. Although
relationships are to assume in conceptual frame work, frequently neither the direction
nor the relationships made explicit for use in practice of for testing in a research
project.
 Here the conceptual frame work based on CIPP Model; this model was created
by Daniel L. Stufflebeam. It is an acronym that stands for context evaluation, input
evaluation, process evaluation and product evaluation. Context evaluations help
prioritize goals, input evaluation assess different approaches, process evaluations
assess the implementation of plans, and product evaluations assess the outcomes. The
model is used to evaluate both formative and summative assignments. The CIPP
Model advocated that the purpose is not to prove but to improve.

Context Evaluation:
Evaluation: It highlighted the environment, surrounding from where the
individuals engages and interact. In this study it included selected factors such as age,
sex, religion, educational status, income, place of domicile, duration of residing,
support system, and reason for residing. The setting of the study was inba illam,
Pasumalai, Madurai.

Input evaluation:
evaluation: It specified the resources used in the process such as men, money,
material. In this study it includes measuring pre test of anxiety level of the anxiety
among elderly. .

Process evaluation:
evaluation: It referred to the evaluation of implementing process including
the interaction between the client and care givers. In process the interaction is aroma
therapy massage. Aroma therapy massage it is a technique by which the back of the
recipient are held at various method, stroked gently and rhythmically to attain a
relaxation response. The aroma therapy massage was done according to the steps
stated in procedure for back massage.

Product evaluation:
evaluation: This information referred to the output as a result of the
intervention. It included measuring post test of anxiety among elderly.

Feed back:
back Referred to the information sent backward from the product evaluation to
the input and the process in order to gained understanding and modified or accepted
the strategies.
CONTEXT
INPUT PROCESS

PRODUCT
SELECTED VARIABLES POST TEST.
ANXIETY AMONG ELDERS PRETEST
Age. Anxiety. AROMA THERAPY Anxiety.
Sex. Assessment by using MASSAGE
Religion Effleurage Assessment by using
Education Aaron beck anxiety scale. Aaron beck anxiety
Income Stripping scale
Place of domicile NURSING AGENCY
Duration of residing Frictions
Support system Investigator. MATERIAL.
Reason for residing. Lavender oil Effleurage
SETTING: Inba illam
old age home, pasumalai, Base oil (safflower oil) For four week on
Madurai. alternative days

Reduction Of Negative No
Anxiety changes

Feed back

FIG- I DANIEL L. STUFFLEBEAM MODIFIED CIPP MODEL

 CHAPTER - III

METHODOLOGY

“...the overall process of conducting evaluation research in health requires careful

and detailed planning ... and a combination of tenacity and creativity to address the
inevitable thorny methodological challenges... “

- Ahern, Patrick, Phalen and Neiley.

The research methodology indicates the general pattern of budding or

sanitization methods of obtaining, organizing or analyzing data for gathering valid
and reliable data for investigation. This chapter includes research design, setting of
the study, population, sample, and inclusion and exclusion criteria for selection of
sample, development, and description of the tool, content validity, pilot study, data
collection procedure and plan for data analysis.

3.1 RESEARCH APPROACH

In this study the researcher used Quantitative approach.

3.2 RESEARCH DESIGN

In this study the research design was a Pre experimental design. The Study
emphasis no randomization, no control Group and Only manipulation.

Pretest Intervention Post test

O1 X O2

O1 - Pretest to assess the level of anxiety among elders before

aromatherapy massage.

X - Aroma therapy massage on back of the body of an elder on

alternative days for 4weeks.

O2 - Posttest to assess the level of anxiety among elders after

Aromatherapy massage.
3.3 RESEARCH VARIABLES

Independent variable : Aromatherapy massage

Dependent variable : Anxiety

3.4 SETTING OF THE STUDY:

The study was conducted at the old age home (Inba Ilam) at Pasumalai,
Madurai. It was established in the year 1967, by Dr. Samuel Amirtham, the bishop of
Kerala started it with mission of providing shelter to homeless, destitute, widows. It
was registered under Indian society act on the same day. There are 8 inmates when it
was started. Now the census is 50 inmates, 30 females and 20 males. It is the oldest
home for elders in Madurai at Tamilnadu. It is 6 kilometer for away from our College
of Nursing, Madurai Medical College, Madurai.

3.5 POPULATION

Target population

The individuals those who had anxiety among elders residing at old age home.

Accessible population

The study population comprised of anxiety among elders residing at Inba

Illam, (old age home) Pasumalai, Madurai.

3.6 SAMPLE

It comprises of anxiety among elders residing at old age home who fulfill the
inclusion criteria.

3.7 SAMPLE SIZE

The Sample size consisted of 30 subjects who had anxiety among elders
residing at old age home.
3.8 SAMPLING TECHNIQUE

In this study the researcher selected the sample through purposive sampling
technique. Purposive sampling is a non - probability sampling method in which the
researcher selects participants based on personal judgment about who might be most
representative or informative. It is also called as Judgmental Sampling.

3.9 CRITERIA FOR SAMPLING

INCLUSION CRITERIA:

 Elders between the ages of 60 -80 years residing at Inba Illam Pasumalai,
Madurai.

 Elders who had mild to moderate anxiety.

 Elders who understand either Tamil or English.

 Elders who were willing to participate in the study.

EXCLUSION CRITERIA:

 Elders who were under prolonged medication.

 Elders who were having chronic illness
 Elders who were unable to walk.
 Elders who were having spinal problems.

3.10 DESCRIPTION OF THE TOOL:

The interview schedule was organized in 2 sections Part A and Part B.

Part A: Consisted of demographic variable of 9 items which included Age in

years, sex, religion, education, income, place of Domicile, Duration
of residing, support system, reason for residing.

Part B: Standardized Aaron beck anxiety scale consisted of 21items

rated in 4 point scale to measure the presence of anxiety
3.11 SCORING KEY AS FOLLOWS

Part A: No scoring will be allotted for the demographic variables.

Part B: This is scoring key having 21 items was scored on a scale

0 (not at all)

1 (mild)
2 (moderate)
3 (severe)
With a total score range of 0-63, where after the patient has completed the
test, add up the score for each of the 21questions and obtain the total score. The
highest score for each of the twenty-one items is three; the whole test of the
highest possible total score was sixty-three, if the elders marked any one of the
number from 0 to 3 on all the questions. The lowest score for each item was
zero, so the lowest possible score for the test was zero if the elder’s person
marked zero on each question. The following chart indicates the relationship
between total score and level of anxiety.

Score level of anxiety and inference

Minimum score -0 maximum score- 63

Level of score total score

Minimal 0-7

Mild 8-15

Moderate 16-25

Severe 26-63
3.12 TESTING OF THE TOOL

CONTENT VALIDITY:

The content validity was obtained from 4 psychiatric (mental health) Nursing
experts and 1 Professor of Psychology at various institutions. Experts” suggestions were
incorporated in the tool.

RELIABILITY

The reliability of the tool was assessed by test retest method. The reliability of a
measuring instrument is a major criterion for assessing its quality and adequacy.
Reliability was the consistency with which it measured the target attributes. The
reliability was computed by spearman co efficient-correlation method r=0.853.Hence
the tool was found to be reliable.

3.13 PILOT STUDY

Pilot study was conducted in old age home at Inba Ilam at Madurai, among 5
elders. The duration of study was one week period from 15.07.2011 to 21.07.2011to
test the feasibility, relevance and practicability of the intervention after obtaining
permission from ethical committee and content validity from 3 nursing personnel, 1
psychologist and one medical expert. The findings evidenced that there was
significant difference in pretest and post test scores on anxiety among elders. It
revealed that the study was feasible.

3.14 PROCEDURE FOR DATA COLLECTION

Prior to data collection necessary permission was obtained from ethical

committee, Head of the department of Mental Health Nursing, College of Nursing and
the secretary of old age home. Written consent was obtained from all the study
subjects after self introduction and explanation regarding the nature of the study.

Data collection procedure was completed in two stages. First prior to nursing
intervention (aroma therapy massage) and after the nursing intervention. Subjects
were divided into two groups comprising of 15 subjects each group.
 Session started with introduction of self, establishment of rapport, explanation
regarding the purpose and nature of the study and the benefits of participating during
the whole study programme. The pretest was conducted and selected the subjects of
mild and moderate anxiety with inclusion criteria by Aaron Beck Anxiety Scale. The
Aroma therapy massage on back of the elders (4ml of lavender oil mixed with 30ml
of base oil[safflower oil]) was given to the subject regularly 10 minutes duration on
alternative days for 4 weeks to each group after 4weeks the posttest was conducted.

3.15 PLAN FOR DATA ANALYSIS

The analysis of the data was done by following methods.

Descriptive statistics

1. Demographic variables of the clients were analyzed using frequency and

percentage distribution

2. Mean and standard deviation were used to analyze changes in the level of
anxiety among elders

Inferential Statistics

1. Student’s’ test was used to determine the effectiveness of Aroma therapy

massage in changing the level of anxiety among elders.

2. Chi-square test was used to find out the association between the level of
anxiety and selected demographic variables among elders.

3.16PROTECTION OF HUMAN RIGHTS

“Injustice anywhere is a threat to justice everywhere.” - Martin Luther King
The research proposal was approved by the Ethical Committee of Government
Rajaji Hospital, Madurai -20 for conduct in the pilot study and main study. The
permission for the pilot study and Main study were obtained from the secretary, Inba
illam, Pasumalai, Madurai. An informed written consent was obtained from each
study subject before starting the data collection. Confidentiality and anonymity was
maintained throughout the study.
SCHEMATIC REPRESENTATION OF THE STUDY
 CHAPTER – IV
DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis of data is a process, the researcher
inspecting, cleaning, transforming, and modeling data with the goal of highlighting
useful information, suggesting conclusions, and supporting decision making. Data
analysis has multiple facets and approaches, encompassing diverse techniques under a
variety of names, in different business, science, and social science domains.

Data mining is a particular data analysis technique that focuses on modeling

and knowledge discovery for predictive rather than purely descriptive purposes. Data
analysis focuses on discovering new features in the data and analysis on confirming or
falsifying existing hypotheses. Predictive analytics focuses on application of statistical
or structural models for predictive forecasting or classification, while text
analytics applies statistical, linguistic, and structural techniques to extract and classify
information from textual sources, a species of unstructured data.

Data integration is a precursor to data analysis, and data analysis is closely

linked to data visualization and data dissemination. The term data analysis is
sometimes used as a synonym for data modeling

The objectives of the study was

 To assess the pre and post test level of anxiety among elders at selected old age
home, Madurai.

 To evaluate the effectiveness of aromatherapy massage on anxiety among elders

at selected old age home, Madurai.

 To associate post-test score of anxiety among elders and selected demographic

variables.
 In this chapter the data collected were compiled, edited, coded, classified,
tabulated, described and interpreted the findings it was arranged the following
sections:
Section – I Frequency and percentage distribution of demographic variables of
anxiety among elders
Section--II Frequency percentage of anxiety in the pre test and post level of elders.

Section – III Comparison of mean and standard deviation between pre- test and

post- test measurement of anxiety among elders.

Section – IV Comparison of anxiety before and after aroma therapy massage

Section – V Association of posttest level of anxiety among elders with
selected demographic variables.
 SECTION – I

DISCRIPTION OF DEMOGRAPIC VARIABLES

TABLE –I
Frequency and percentage distribution of elders according to their
demographic variables n=30

DEMOGRAPHIC VARIABLE Frequency(f) Percentage (%)

60-65 yrs 4 13
65-70 yrs 12 40
AGE
70-75 yrs 10 34
75-80 yrs 4 13
Male 15 50
SEX
Female 15 50
Hindu 22 73
Christian 8 27
RELIGION
Muslim - -
Others - -
No formal education 1 3
Primary 18 60
Middle - -
EDUCATION High school 11 37
Post high school - -
Graduate - -
Profession - -
No income 30 100
INCOME
Pensions - -
PLACE OF Urban 25 83
DOMICILE Rural 5 17
0-1 yrs - -
DURATION OF 1-3 yrs 1 3
RESIDING 3-6 yrs 9 28
6 and above 20 69
Children 3 10
SUPPORT
Spouse - -
SYSTEM
Siblings 27 90
REASON FOR Disaster - -
RESIDING Family negligence 30 100
 The above table revealed that the frequency and percentage distribution of
demographic variables of the study participants majority 12 (40%) were the age group of
65-70 years and 10 (34%) were belonged to 70-75years, and 4 (13%) of the participants
were belonged to 60-65 years and 75-80years.According to age distribution of the study
subjects Males and females were equally distributed. Based on religion 23 (73%) of the
elders were belonged to Hindu religion, 8 (27%) of the elders were belonged to
Christian none of them were belonged to Muslim and any other religion. According to
education the study subjects 18(60%) of them were belonged to primary education, 11
(37%) of the study subjects were belonged to high school education, 1 (3%) of them
were belonged to no formal education; none of them had graduate and professionals. In
the study all participants 30(100%) were belonged to no income group. Among the
study participants 25 (83%) were came from urban 5 (17%) of them came from rural. In
this Research the subjects 20 (69%) of the elders were in the old age home residing
more than 6 years and 9 (28%) of them were residing within 3-6years and 1 (3%) of
them were residing with in 1- 3 years none of them were residing within one year. In the
study participants 27 (90%) of them were supported by their siblings, 3 (10%) of them
were supported by their children none of them supported by their spouse. According to
the reason for the residing 100% of the elders came for the reason of family negligence.
FIG-2. DISTRIBUTION OF SUBJECTS ACCORDING TO THEIR AGE

The above figure showed that the study participants 40% of them were
the age group of 65-70years, 34% of the participants were belonged to 70-75years,
13% of the participants were belonged to 60-65 years and 75-80years.
FIG - 3 DISTRIBUTIONS OF SUBJECTS ACCORDINGTOTHEIR SEX

The above The above pie chart showed that the age distribution
of the study subjects Males and females were equally distributed.
 RELIGION DISTRIBUTION

73%
80

70
60
50
40
PERSENTAG

27%
30
20
10
0
0% 0%

HinduChristianMuslimOthers
RELIGION

FIG - 4 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR

RELIGION

The above figure showed that the study participants in this research Based on
religion there were 73% of the elders belonged to Hindu religion, 27% of the elders
were belonged to Christian none of the participants were belonged to Muslim and any
other religion.
FIG – 5 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR
EDUCATION

The above figure showed that the study subjects 60% of them were belonged to
primary education, 37% of the study subjects were belonged to high school education, 3%
of them were belonged to no formal education; none of them had graduate and
professionals.
FIG – 6 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR INCOME

The above figure showed that the study participants 100% of the elders were
belonged to no income groups.
FIG – 7 DISTRIBUTION OF SUBJECTS ACCORDING TO THEIR PLACE
OF DOMICILE

The above figure showed that the study participants of this research, 83%of the
elders were came from urban 17% of them were came from rural.
 FIG – 8 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR
DURATION OF RESIDING

The above figure showed that the study subjects of this research, 69% of them

were residing in the old age home for 6 years and above 28% of the subjects were

residing within 3-6years, 3% of the subjects were residing within 1-3 years; none of

them were residing within one year.

FIG -9 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR SUPPORT
SYSTEM

The above figure showed that the research participants 90% of them were
support from their siblings, 10% of the elders were support from their children, none
of them were supported by their spouse.
FIG -10 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THEIR REASON
FOR RESIDING

The above figure showed that the study participants of this research, 100% of
the elders were came for the reason of family negligence.
 SECTION II

ANXIETY AMONG ELDERS IN THE PRE AND POST TEST

LEVEL
TABLE - 2

Frequency and percentage Distribution of the elders according to the level of

anxiety in the pre test and post test
n= 30

PRE TEST POST TEST

LEVEL OF ANXIETY
f % f %

Minimal anxiety 0-7 - - 18 60

Mild anxiety 8-15 7 23 12 40

Moderate anxiety 16-25 23 77 - -

Severe anxiety 26-63 - - -- --

The above table showed that the study participants of this research, most of
the elders 23(77%) were assessed to have moderate level of anxiety (score 16-25) and
7 (23%) were assessed to have mild level of anxiety (score 8-15) in the pretest which
is reduced to 12(40%) were mild anxiety and 18(60%) were minimal anxiety in the
posttest and there is no moderate level of anxiety.
FIG – 11 DISTRIBUTIONS OF SUBJECTS ACCORDING TO THE PRE AND
POST LEVEL OF ANXIETY
The above figure showed that most of the elders were 23 (77%) assessed to
have moderate level of anxiety (score 16- 25) in the pretest which is reduced. Mild
level of anxiety (score 8-15) in the pretest 7 (23%) was found increase to 12 (40%) in
the posttest. This revealed that aromatherapy massage great impact in reducing
anxiety score.
 SECTION-III

MEAN AND STANDARD DEVIATION BETWEEN PRE- TEST

AND POST- TEST MEASUREMENT

TABLE.3

Comparison of mean and standard deviation between pre- test and post- test

measurement of anxiety among elders.

MEAN STANDARD
VARIABLE MEAN
DEFERENCE DEVIATION

Pre test 19.23 4.59

11.80
Post test 7.43 2.11

The above table showed that the mean score of anxiety among study
participants was 19.23 in the pre test, and mean score of anxiety among study
participants was 7.43 in the posttest the mean deference was 11.80 and the standard
deviation of anxiety among study participants in the pre test was 4.59, and 2.11 in the
post test. Hence the report revealed that the aroma therapy massage had significant
effect on reduction of anxiety level of elders at selected old age home, Madurai.
FIG - 12 COMPARISONS OF MEAN SCORE BETWEEN PRE- TEST AND
POST- TEST MEASUREMENT OF ANXIETY AMONG ELDERS.

The above figure showed that the mean score of anxiety among study
participants was 19.23 in the pre test, and mean score of anxiety among study
participants were 7.43 in the posttest.
 SECTION – IV

COMPARISON OF ANXIETY BEFORE AND AFTER AROMATHERAPY

MASSAGE

TABLE -4

Paired‘t’-test for pre and post test of aromatherapy massage on anxiety

among elderly residing at selected old age home, Madurai.

VARIABLE MEAN MEAN Calculated Table

SD ‘t’ value “t”value
DEFERENCE
Pre test 19.23 4.59
11.80 17.743*** 2.05
Post test 7.43
2.11

(df=29, table value =2.05 at p=0. 05) calculated value 17.743***highly

significant)

The above table represented that the study participants of this research had
highly significant reduction of level of anxiety in the post test. The paired “t” test
value conformed that aroma therapy massage significantly reduced the level of
anxiety among elders residing at selected old age home, Madurai.
 SECTION- V

ASSOCIATION OF POST TEST LEVEL OFANXIETY AMONG ELDERS

WITH SELECTED DEMOGRAPHIC VARIABLES

TABLE-5

Association between post test aromatherapy massage on anxiety among elders

residing at selected old age home with their selected demographic variable.

DEMOGRAPHIC MINIMAL MILD

χ2 value p-value
VARIABLE ANXIETY ANXIETY
60-65 yrs 4 0
65-70 yrs 4 8
AGE 8.056** 0.045
70-75 yrs 8 2
75-80 yrs 2 2
Male 5 10
SEX 8.89** 0.003
Female 13 2
Hindu 13 9
Christian 3 2
RELIGION 0.028 0.866
Muslim 5 3
Others - -
No formal
1 0
education
Primary 12 6
Middle - -
EDUCATION High School - - 1.969 0.373
Posthighschool 5 6
Graduate - -
Professional - -
No income 18 12
INCOME 0 1
Pensions - -

PLACE OF Urban 15 10
0 1
DOMICILE Rural 3 2
DURATION 0-1 yrs - - 4.167 0.125
 DEMOGRAPHIC MINIMAL MILD
χ2 value p-value
VARIABLE ANXIETY ANXIETY
OF 1-3 yrs 1 0
RESIDING
3-6 yrs 3 6
6 and above 14 6
Children 1 2
SUPPORT
Spouse - - 0.987 0.32
SYSTEM
Siblings 17 10
REASON Disaster - -
FOR Family 0 1
RESIDING 18 12
negligence

The above table showed that the demographic variables such as age, sex, have
significant association with post test score of anxiety level. The demographic
variables of the study participants recording age, the calculated chi square value was
8.056**, df=3, table value =7.82, p<0.05 level of significant. It revealed that the
calculated value greater than tabulated value at p<0.05 significance. so the report
revealed that the significant association between age of the study participants and
aroma therapy massage, and also the sex variables of the study participants calculated
χ2 value was 8.89**,df=1, table value =3.84,p<0.05 level of significant. It revealed
that the calculated value greater than tabulated value at p<0.05 level of significance.
and other demographic variables such as religion, education, income, place of
domicile, duration of residing, support system and reason for residing, doesn’t have
any significant association with level of anxiety and aromatherapy massage since the
calculated value is lower than table value at 0.05 level of significance.
 CHAPTER - V

DISCUSSION

The chapter discusses about the result of the study interpreted from the
statistical analysis the effort of this study was to evaluate the effectiveness of aroma
therapy massage on anxiety among the elders residing in a selected old age home at

Madurai.

DEMOGRAPHIC VARIABLES OF ELDERS

The findings revealed that the frequency and percentage distribution of

demographic variables of the study participants majority 12 (40%) were the age
group of 65-70years and 10 (34%) were belonged to 70-75years, and 4 (13%) of the
participants were belonged to 60-65 years and 75-80years.

According to age distribution of the study subjects Males and females were
equally distributed. Based on religion 23 (73%) of the elders were belonged to Hindu
religion, 8 (27%) of the elders were belonged to Christian none of them were
belonged to Muslim and any other religion.

According to education the study subjects 18(60%) of them were belonged to

primary education, 11 (37%) of the study subjects were belonged to high school
education, 1 (3%) of them were belonged to no formal education; none of them had
graduate and professionals.

In the study all participants 30(100%) were belonged to no income group.

Among the study participants 25 (83%) were came from urban 5 (17%) of them came
from rural. In this Research the subjects 20 (69%) of the elders were in the old age
home residing more than 6 years and 9 (28%) of them were residing within 3-6years
and 1 (3%) of them were residing within 1-3 years none of them were residing within
one year.
 In the study participants 27 (90%) of them were supported by their siblings, 3
(10%) of them were supported by their children none of them supported by their
spouse. According to the reason for the residing 100% of the elders came for the
reason of family negligence.

DISCUSSION OF THE STUDY IS BASED ON OBJECTIVES

The first objective of this study was to assess the pre and post test level of
anxiety among elders at selected old age home.

The findings revealed that the total number of 30 participants level of anxiety
were assessed by using beck anxiety scale, most of the elders 23(77%) were
assessed to have moderate level of anxiety (score 16-25) and 7 (23%) were assessed
to have mild level of anxiety (score 8-15) in the pretest which is reduced to 12(40%)
were mild anxiety and 18(60%) were minimal anxiety in the posttest and there is no
moderate level of anxiety after aroma therapy massage..

This finding was consistent with the study done by Amy, L. Byers., Kristine
Gaffe., Kenneth. E., Covinsky., Michael, B. Friedman., Martha ,L. Bruce., (2010)
Psychiatric Epidemiology Surveys study was conducted 12 months period at united
states known about prevalence of anxiety and mood disorder among older adult
dwelling at community. the probability sampling method used for this study, sample
size were 2575 among older below 55 and older in that 43%, 55-64 years;32%,65-75
years; 20%,75-84 years;5% >_85 years. The likelihood of having mood shown a

pattern of declining with age (p,>.o5). Disorders showed higher rates in women
compared with men, a statistically significant trend with age. In addition, anxiety
disorders were as 12% mood disorders 5% across age groups.

The findings were similar to the study conducted by Christina Bryant., Henry
Jackson., David Ames .(2007) to find out the prevalence of anxiety symptoms,
anxiety disorder or specified anxiety disorders in adults aged > 60 in either
community or clinical settings. The prevalence of anxiety in community samples
ranges from 1.2% to 15%, and in clinical settings from 1% to 28%. The prevalence of
anxiety symptoms is much higher, ranging from 15% to 52.3% in community
samples, and 15% to 56% in clinical samples. Generalized Anxiety Disorder is the
commonest anxiety disorder in older adults.

An study conducted by Amal Chakraburtty, MD. (2006) on generalized

anxiety disorder among the elderly at Pittsburgh, Toronto. "Studies have shown that
generalized anxiety disorder is more common in the elderly, affecting 7% of seniors,
than depression, which affects about 3% of seniors.
A one more study conducted by Tomader Taha Abdel Rahman MD. Geriatric
Medicine (2005) among elders aged 60 -80yrs, to evaluate the prevalence of anxiety
and depression thous who were living in the old age home and geriatric clubs Cairo at
Egypt. Hamilton Anxiety Scale was used in this study. The total score is 0 – 17 for
normal individual, 18 – 24 for mild anxiety, 25 – 29 for moderate anxiety and ≥ 30
for severe anxiety. Data was coded for analysis test was used for categorical data. P-
value < 0.05 was considered statistically significant.

.The second objective to this study was to evaluate the effectiveness of

aroma therapy massage on anxiety among elders.

The findings revealed that the aromatherapy massage had greatly decreased
the anxiety level of the subjects. In the inferential statistical method proved that the
difference in the post means score show a significant change the level of anxiety with
in “t” value 17.743. The investigator believed that the difference was due to aroma
therapy massage.

This finding was consistent with the study done by Serfaty, M., (2011)
aromatherapy massages versus Cognitive Behavior Therapy in patients with cancer
outpatient clinics and screening eight or more for anxiety and/or depression on the
hospital anxiety depression scale, were randomized to Treatment as Usual plus up to
eight sessions weekly of either aromatherapy massage or cognitive behavior therapy,
offered within 3 months Of those suitable, over 60% (39/63) participated
(aromatherapy massage, n = 20; cognitive behavior therapy, n = 19) and over 90%
(36/39) were followed up. Both packages were well received. The preference was for
AM, with more sessions were taken up; (Mean number sessions aroma therapy
massage = 7.2 (standard deviation 2.0) and cognitive behaviour therapy = 5.4
(standard deviation 3.1); P<0.05). Significant improvements in POMS (Total Mood,
depression and anxiety scores) occurred with both interventions.

The findings were similar to the study conducted by Diane, M. Holliday-

Welsh, (2009) to examine the potential of massage to reduce agitation in cognitively
impaired nursing home residents. Data was collected during baseline (3 days),
intervention (6 days), and at follow-up. At each observation, agitation was scored 5
times during the 1-hour window of observation. Agitation was lower during the
massage intervention than at baseline (2.05 vs. 1.22, P < .001), and remained lower at
follow-up. Of the 5 agitated behaviors examined in this study, massage was associated
with significant improvement for 4: Wandering (0.38 vs. 0.16, P < .001), verbally
Agitated/Abusive (0.59 vs. 0.49, P = .002), Physically Agitated/Abusive (0.82 vs.
0.40, P < .001), and Resists Care (0.10 vs. 0.09, P = .022). Hence the hypothesis-I
stated that The mean post test score of anxiety will be significantly lesser than the
mean pretest score of elders.

The third objectives to associate post test score of anxiety among elders
and selected demographic variables.

The finding of the study revealed that the level of anxiety was significantly
associated with demographic variables such as age and sex .Regarding age χ2 value
= 8.056**(table value=7.82) and sex the χ2 value = 8.89**(table value=3.84).at
p<o.o5 level of significance.

The other demographic variables such as religion, education, income, place of

domicile, duration of residing, support system and reason for residing, were not
significantly associated with a post test score of anxiety. Hence the hypothesis -2
stated that there is a significant association between the pos-test score of anxiety
among elders and selected demographic variables.
 CHAPTER -VI

SUMMARY, IMPLICATION AND RECOMMENDATION

This chapter deals with the summary of the study recommendation

implementation and conclusions drawn from the data analysis the study focuses on the
implication and recommendations. The recommendation presented for different areas
like nursing practice nursing education, nursing administration and nursing research.

6.1 SUMMARY OF THE STUDY

The Present study was to aimed at evaluating the effectiveness of aroma

therapy massage on anxiety among elders at selected old age home, Madurai.

The objective of the study was

 To assess the pre and post level of anxiety among elders at selected old age
home.

 To evaluated the effectiveness of aroma therapy massage on anxiety among

elders.

 To associate post test score of anxiety among elders and selected demographic
variables.

The following hypothesis were tested

H1 - The mean post test score of anxiety will be significantly lesser than
the mean pretest score of elders.

H2 - There is a significant association between the post test score of anxiety

among elders and selected demographic variables.

The conceptual frame work for this study was based on CIPP Model; this
model was created by Daniel L. Stufflebeam.it is an acronym that stands for context
evaluation, input evaluation, process evaluation and product evaluation.

A pre experimental design was used in this study. The independent variables
were aroma therapy massage and depended variables were anxiety. This study was
conducted at the old age home at Pasumalai, Madurai. The assessable population of
the study was elders who were residing at old age home at Pasumalai, Madurai.

The study subjects were selected using purposive sampling technique is a non –
probability sampling method in the researcher select the participant based o n the
personal judgment about which one will be most representative or informative. The
sample size was 30, the data collection tools used were

1. Demographic data.
2. Aaron beck anxiety scale-21 items scale

The reliability of the anxiety scale found to be reliable, content validity was
obtained from four experts specialized in psychiatric mental health nursing and one
expert in psychology. Pilot study was conducted on 5subjects to find out the
feasibility of the study and it did not show any major flaw in the design of the study.

Data collection was carried out for four weeks from 01.10.3011 to 31.10.2011.
Based on the objectives and hypotheses, the data collected were analyzed by using
descriptive and inferential statistics.

MAJOR FINDINGS OF THE STUDY

• Majority the study participants 12 (40%) were in the age group of 65-
70years

• The equal distribution of the male and female were had anxiety.

• Among the elders majority73% of them were belongs to Hindu religion.

• None of them had graduate and professional education. 60% of them were
primary education and 37% of them were secondary education.

• All of the study participants’ 30(100%) were belonged to no income group.

• Most of the elders came from urban 83%. Only 17% of them were come from
rural.

• Most of the elders were 69% were residing in the old age home above 6 years.

• 90% of the elders were supported by their siblings

 • The reason for admission in old age home was due to the family negligence
for the all elders.

• 77% of the elders had moderate level of anxiety.

• The mean anxiety score in the pre test was reduced from 19.23 to 7.43 in post
test. This reduction was statistically highly significant with paired t test
(t=17.743 and p,<001).

• A significant association was noted between the age and the level of anxiety
among elders in the post test level x2=8.056,p=0.045 with 3 degree of
freedom.

• A significant association was noted between the gender and the level of
anxiety among elders in the post test x2=8.89,p=0.003 with 1degree of
freedom.

6.2 CONCLUSION

According to the result of this study the elders who were in 10minits aroma
therapy massage with lavender oil mixed with base oil (safflower) had a statistically
significant reduction in level of anxiety because aroma therapy massage was effective
for the reduction of anxiety among elders. The aroma therapy massage was less cost
effective non invasive, free from major side effects and highly feasible the researcher
concluded that it can be used as an effective intervention to reduced the anxiety
among elders were residing in the old age home.

6.3 IMPLICATIONS

The Psychiatric mental health nurse plays a vital role in the provision of
massage therapy. The nurse in the psychiatric area knows that anxiety is a baseline
cause for mental disorder. Massage can be an important tool in helping to raise self
worth in mental health patients. In cancer and chronic illnesses patients the
aromatherapy massage is a single complementary therapy and easy way of handling
the anxiety. It can be including our nursing practice therefore this study has important
implication in the following aspects of nursing
i. Nursing Practice

ii. Nursing Education

iii. Nursing Administration

iv. Nursing research

NURSING PRACTICE

The nurses must be trained to assess the anxiety level of the elders who were residing
in the old age home and in the hospital setting and community area.

 The nurses must have an understanding regarding the need to provide

Complimentary and Alternative therapy to improve the quality of life and
psychological effects.

 In the clinical area nurses should practice massage with using aroma oil as the
findings of the study clearly state that the effectiveness in reduction of level of
anxiety.

NURSING EDUCATION

A well organized therapy training on aroma that focuses on Complementary

and Alternative therapies which include aroma therapy massage can be conducted as
an in service programme for all nursing personnel.

NURSING ADMINISTRATION
 Anxiety provoking team can be formed to assist the anxious patient and elders
by implementing intervention that maintain restore a sense of well being.
 The administrator can motivate, supervise and guide the nurses in the
assessment of anxiety for the elders were are admitted in the ward.
 Administrator can encouraged the nurses to practice the massage technique
with using aroma oil in their routine care in the morning.
NURSING RESEARCH

 Nurse’s researcher should motivate the clinical nurse to apply research

findings and can bring out new innovation procedure to reduced anxiety of the
elders those who were alone.

 Researcher should encourage clinical nurse to conduct further research studies

on the aroma therapy massage on other aspect like, postoperative pain, cancer
pain, and constipation.

 This study can be used as a base line for the further studies to build upon.

6.4 RECOMMENDATIONS

1. A similar study can be replicated with a large sample size for better generalization.

2. A comparative study can be done between aroma therapy massage and other
complimentary alternative therapies to evaluate the effectiveness in reducing
anxiety level.

3. A study can be conducted to assess the current knowledge, attitude and practice of
Nursing staff on Complimentary and Alternative therapy for the management of
anxiety before surgical procedure, chemotherapy, and heamodialysis.

4. The effort of aroma therapy massage with using lavender oil can be assessed in
combination of other rosemary oil, It’s also having similar effect..

6.5 LIMITATIONS

The Limitations for the study was

 As the sample size of the study participants was 30 in number caution

must be taken in generalization of its findings.

 Responses were based on their self report and hence the degree of truth
was not assured.
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 http://www.aromatherapy.ir.article.aroma.
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 APPENDIX - A

SECTION—A

DEMOGRAPHIC DATA

1. Age in years 

a) 60-65 years

b) 65-70 years

c) 70-75 years

d) 75-80years

2. Sex 

a) Male

b) Female

3. Religion 

a) Hindu

b) Christian

c) Muslim

d) Others

4. Education 
a) No formal education
b) Primary
c) Middle
d) High school
e) Post high school
f) Graduate
g) Profession
5. Income 

a) No income

b) Pensioner

6. Place of domicile 

a) Urban

b) Rural

7. Duration of residing 
a) 0-1yrs
b) 1-3yrs

c) 3-6yrs

d) 6 and above

8. Support system 

a) Children

b) Spouse

c) Siblings

9. Reason for residing 

a) Disaster

b) Family negligence
 SECTION-B
BECK ANXIETY INVENTORY
Please choose the answer which one is applicable for you which is 0, 1, 2, or3 it
indicates how much the statement applied to you over the past week. There is no right
or wrong answer .Do not spends too much time on any statement.
The rating scale is as follows:

0 - Not at all

1 - Mild

2 - Moderate

3 - Severe

1. Feeling hot 0 1 2 3
2. Muscle numbness or tingling 0 1 2 3
3. Feeling unable to relax 0 1 2 3
4. Dizzy or light headed 0 1 2 3
5. Feeling wobbly in the legs 0 1 2 3
6. Feeling unsteady 0 1 2 3
7. Heart racing or pounding 0 1 2 3
8. Nervousness 0 1 2 3
9. Chocking feeling 0 1 2 3
10. Trembling hands 0 1 2 3
11. Unsteadiness 0 1 2 3
12. Terror or fear 0 1 2 3
13. Afraid of losing control 0 1 2 3
14. Indigestion 0 1 2 3
15. Flushed face 0 1 2 3
16. Hot or cold sweats 0 1 2 3
17. Feeling scared 0 1 2 3
18. Having laborious breathing 0 1 2 3
19. Feeling the fear of dying 0 1 2 3
20. Feeling like the worst is happening 0 1 2 3
21. Feeling faint 0 1 2 3
THE SCORING KEY ARE AS FOLLOWS
Lowest score -0 highest score- 63
LEVEL OF SCORE TOTAL SCORE
Minimal 0-7
Mild 8-15
Moderate 16-25
Severe 26-63
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 BECK ANXIETY INVENTORY
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 APPENDIX - B

TIPS FOR THERAPEUTIC BACK MASSAGE

Required equipment for therapeutic back massage:

1. Warm, quiet, relaxed environment.

2. Firm comfortable surface such as a (firm) bed, massage table or floor mat.
3. Massage Oil. Lavender oil 4drops and mixed with base oil 30ml, it was fine
for anxiety reduction.
4. Towels: to lie on and also to cover the body.
5. Cushions or pillows.

Massage tips:

1. Massage oil decreases the friction created on the skin and prevents the pulling
of hairs. Don't use too much: The less oil, the greater the friction and the
deeper the pressure.
2. Use slower movements for a soothing or calming response.
3. When applying pressure with finger or thumb, provide support with the other
fingers and thumbs.

Massage patient comfort:

1. If the patient is uncomfortable in the lower back, ankles, neck or shoulders,

place cushions as required under the whole length of the torso, and/or under the
ankles, the shoulders, or the side of the head. In pregnancy, the patient can lie on
her side.

2. Cover any parts of the body not being worked on with a warm towel.
3. Pour the massage oil onto your hands first, and then apply once the massage is
started, keep a hand on the person at all times, so that there are no surprises.
4. Avoid direct pressure on bony processes.
5. (Important!) - Ask the patient for feedback: Are you warm enough? Are you
comfortable? How's that feel?
Massage warnings:

1. Minimal direct pressure on bony processes.

2. Avoid broken skin, blisters or areas of possible infection.

Massage benefits:

1. Relaxation, releasing of tight muscles.

2. Emotional comfort and stress management.
3. Increased body awareness.
4. Improved circulation, and improved lymphatic drainage for release of toxins.

Therapeutic back massage technique tips:

Lie the partner on their belly on a firm, comfortable surface (see diagrams below).
Make sure you can reach their whole back without straining your own.

BACK MASSAGE TECHNIQUE

Whole hand effleurage
Warm the massage oil in your hands, and apply a modest amount with whole hand
"effleurage" (definition - smooth rhythmic stroking): Use the whole surface of both
hands .Stroke reasonably firmly upwards from the lower back all the way up to the
neck, then (gentler pressure), circle around and back to the lower back region (2
minutes).
Effleurage using heel of the hand

There is a smaller area of contact, so the pressure is deeper. Both hands work in
circles - start at the lower back. Move in a circle, first outward, then upward and
return to the center. Gradually progress to the upper back (1 minutes).

Effleurage using reinforced fingers

Stand on the opposite side to the one that you are working on. I suggest you stand on
the right side first. Push with the flats of your fingers (one hand on top of the other)
away from the center line, and then glide back toward the spine. Start at the lower
back, and work up to the upper back (1 minutes).

Stripping, using the reinforced thumb

Glide with deep sustained pressure up the full length of the "sausage shaped" muscles
either side of the spine. Back off the pressure a little as you cover the neck. Move
slowly and deliberately, feeling for knots or sensitive spots as you glide from lower to
upper back. Three times each side; alternate with a couple of minutes of effleurage ,
and repeat the string.(2minutes)
Frictions, using the reinforced middle finger:
Firm deep movements either side of each spinous process. Start to the side of the lower
spine and move upward. Apply 5 frictions at each spot (2 minutes)
"Effleurage" using forearms

Apply firm downwards pressure, and move the arm closest to the head up to just below
the shoulder blades. 6 strokes. (1minute)
Finishing with effleurage
Apply effleurage (stroking moves) with supported fingers, then effleurage with the
heel of the hand, then full handed effleurage. (1 minute) Then leave the patient quiet
for a few minutes.
 APPENDIX - C
LETTER SEEKING PERMISSION FOR CONTENT VALIDITY
FOR TOOL
From
G.JAYANTHI.
I Year M.Sc. (Nursing)
Department of mental health nursing,
College of Nursing, Madurai Medical College, Madurai.
To
MRS. JANCY RACHEL DAISY. M.SC (N)
Reader in nursing,
C.S.I. College of Nursing, Madurai.
Through: The proper channel.
Respected madam
SUB: Requesting opinion and suggestion of expert for content validity
of “a study to evaluate the effectiveness of aroma therapy massage on
anxiety among elders at selected old age home, Madurai”.
I am I year master degree student of College of Nursing, Madurai Medical
College, Madurai. In partial fulfillment of master degree in Nursing. I have selected
the topic for the research project to submit to the Dr.M.G.R. Medical University,
Chennai. I have requested you to kindly validate the tool and give your opinion and
suggestion for necessary modification and also I would be very grateful if you would
refine the problem of statement and the objectives.
 CONTENT VALIDITY CERTIFICATE

This is to certify that the tool developed by Mrs. G.Jayanthi. M.Sc II

Year nursing student of college of Nursing, Madurai Medical College,
Madurai doing her dissertation study under the Dr.M.G.R. Medical
University, Chennai. The statement of the problem in this study is “a
study to evaluate the effectiveness of aroma therapy massage on anxiety
among elders at selected old age home, Madurai” I have gone through the
tool for construct, content and criterion validity. I certificate that this tool
could be used for the above mentioned study.
 CONTENT VALIDITY CERTIFICATE

This is to certify that the tool developed by Mrs. G.Jayanthi. M.Sc II

Year nursing student of college of Nursing, Madurai Medical College,
Madurai doing her dissertation study under the Dr.M.G.R. Medical
University, Chennai. The statement of the problem in this study is “a
study to evaluate the effectiveness of aroma therapy massage on anxiety
among elders at selected old age home, Madurai” I have gone through the
tool for construct, content and criterion validity. I certificate that this tool
could be used for the above mentioned study.
 CONTENT VALIDITY CERTIFICATE

This is to certify that the tool developed by Mrs. G.Jayanthi. M.Sc II

Year nursing student of college of Nursing, Madurai Medical College,
Madurai doing her dissertation study under the Dr.M.G.R. Medical
University, Chennai. The statement of the problem in this study is “a
study to evaluate the effectiveness of aroma therapy massage on anxiety
among elders at selected old age home, Madurai” I have gone through the
tool for construct, content and criterion validity. I certificate that this tool
could be used for the above mentioned study.
 CONTENT VALIDITY CERTIFICATE

This is to certify that the tool developed by Mrs. G.Jayanthi. M.Sc II

Year nursing student of college of Nursing, Madurai Medical College,
Madurai doing her dissertation study under the Dr.M.G.R. Medical
University, Chennai. The statement of the problem in this study is “a
study to evaluate the effectiveness of aroma therapy massage on anxiety
among elders at selected old age home, Madurai” I have gone through the
tool for construct, content and criterion validity. I certificate that this tool
could be used for the above mentioned study.
 CONTENT VALIDITY CERTIFICATE

This is to certify that the tool developed by Mrs. G.Jayanthi. M.Sc

II Year nursing student of college of Nursing, Madurai Medical College,
Madurai doing her dissertation study under the Dr.M.G.R. MEDICAL
University, Chennai. The statement of the problem in this study is “a
study to evaluate the effectiveness of aroma therapy massage on anxiety
among elders at selected old age home, Madurai” I have gone through the
tool for construct, content and criterion validity. I certificate that this tool
could be used for the above mentioned study.
 APPENDIX -D
ETHICAL COMMITTEE APPROVAL TO CONDUCT THE STUDY

Ref.no.23339/E4/3/09 dt 09.05.11. Govt. Rajaji Hospital, Madurai – 20.

Institutional review board / independent ethics committee
Govt Rajaji hospital and Madurai Medical Collage, Madurai 625020.
Proceedings and recommendations of the IRB/ IEC meeting held on31.03.2011

The Institutional Review Board/ Independent Ethics Committee of the Govt.

Rajaji Hospital and Madurai Medical College, Madurai 625020 met on the 31.03.2011
at 12 noon, when the following members were present.

1. Dr.S.M.Sivakumar, M.S (Gen. Surgery) M.S, Convener

Govt. Rajaji Hospital, Madurai.
2. Dr.N.Vijayasankaran, M.Ch(Uro.) Sr.ConsultantUrologist
Madurai Kidney Centre,
Sivagangai Road, Madura. Chairman
3. Dr.T.Meena, MD or Dean I/c (MMC) Professor of Physiology,
Madurai Medical College Member
4. Dr.Moses K.Daniel MD (Gen.Medicine) Professor of Medicine Member
Madurai Medical College
5. Dr.M.Gobinath, MS (Gen. Surgery) Professor of Surgery Member
Madurai Medical College
6. Dr.B.K.C.MohanPrasad, M.ch, Professor of Surg.Oncology secretary
(Surg. Oncology) Madurai Medical College -
7. Shri.M.Sridher, B.Sc.B.L. Advocate, Member
623-B.ll.Floor, East II Cross,
K.K.Nagar, Madurai.20.
8. Shri.O.B.D.Bharat, B.sc., Businessman Member
Plot No.588,
K.K.Nagar.Madurai.20.
9. Shri.S.Sivakumar, M. A (Social) Sociologist, Plot No.51 F.F,
M.Phil K.K Nagar, Madurai. Member
The Committee considers the 45 dissertations / research / study Proposal
submitted by PG students / Non Medical students from outside the institution as per
agenda. After discussion, the following dissertations I records / study proposals are
approved.
Second Batch M.Sc A study to evaluate the
G.JAYANTHI Nursing M.M.C effectiveness of aroma therapy
Madurai. massage on anxiety among elders at
selected old age home, Madura-20.

Medical Superintendent
 APPENDIX -E

LETTER SEEKING PERMISSION TO CONDUCT STUDY

From
G.Jayanthi
I Year M.Sc. (Nursing)
Department of mental health nursing,
College of Nursing, Madurai Medical College,
Madurai.
To
The secretary/president
Inbaillam,
Pasumalai,
Madurai.
Through: The principal i/c College of Nursing, Madurai Medical College, Madurai.
Respected sir
Sub: requesting permission to conduct the study.
I would like to bring to your kind notice that I Mrs G.Jayanthi I M.Sc, nursing
student of college of nursing, Madurai medical college, Madurai has to submit my
dissertation in my specialty mental health nursing to the Tamil Nadu Dr.M.G.R.
Medical University, Chennai, as a part of my requirement.
My subject of dissertation is “a study to evaluate the effectiveness of aroma
therapy massage on anxiety among elders at selected old age home, Madurai”.
APPENDIX - F
 APPENDIX - G

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nfhs;tjpy;

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 APPENDIX- H

CERTIFICATE OF ENGLISH EDITING

TO WHOM SO EVER IT MAY CONCERN

This is to certify that the dissertation “a study to evaluate the

effectiveness of aroma therapy massage on anxiety among elders at

selected old age home, Madurai” done by Mrs.G.Jayanthi M.Sc., Nursing

II Year student, college of nursing, Madurai medical college, Madurai-20

has been edited for English language appropriateness.

 CERTIFICATE OF TAMIL EDITING

TO WHOM SO EVER IT MAY CONCERN

This is to certify that the dissertation “a study to evaluate the

effectiveness of aroma therapy massage on anxiety among elders

at selected old age home, Madurai” done by Mrs.G.Jayanthi M.Sc.,

Nursing II Year student, college of nursing, Madurai medical

college, Madurai-20 has been edited for Tamil language

appropriateness.
APPENDIX - I

PHOTOGRAPHS