INTRODUCTION:

“Old age is not a disease, it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trial and illness.” Maggie Kuhn

Health is wealth. To keep body in good health is a duty otherwise we shall not be able to keep our mind strong and clear. So, health is something that should be taken into serious consideration and also it become one of most concerned issues of any human being¹.According to data from world population prospectus 2017 revision, the number of older persons those aged 60 years or over is expected to be more than double by 2050 and more than triple by 2100, rising from 962 million globally in 2017 to 2.1 billion in 2050 and 3.1 billion in 2100².

People in the old age home experience diverse health problems including physical and emotional problems such as anger, anxiety, helplessness and depression. For these reasons, elderly people in the old age home show physical and emotional symptoms and the symptoms are usually related to severe fatigue and a low quality of sleep³. Fatigue is defined as a subjective state in which one feels tired or exhausted and is related to depressive symptoms, paralyzed status, restlessness and poor sleep quality⁴. Sleeping is a necessary factor for normal activity and is related to well-being and the quality of life, an appropriate level of sleeping improves tissue restoration, functions of immune system, emotional functions and the quality of life. However, sleeping disturbances are general symptoms occurring in elderly people and they produce negative effects including physical and emotional problems. Sleeping disorder is a risk factor for fatigue, anxiety anddepression⁵.

Because fatigue and sleeping disturbances are serious problems for elderly people, many non-pharmacological interventions are used to improve the problems, including music intervention, aromatherapy, horticulture therapy and image therapy. Of these interventions, Aroma therapy is an appropriate non-pharmacological intervention for elderly people because it is safe and easy to provide. Aromatherapy is defined as the “use of essential oils for therapeutic purposes that encompass mind, body, and spirit.” and it is the therapeutic use of essential oils derived from plants and these oils can be absorbed into the body via the skin or the olfactory system. Each essential oil acts as olfactory stimulants via the olfactory bulb to the limbic system of the brain which includes the amygdala and the hippocampus. The amygdala governs emotional responses and the hippocampus involves in the retrieval of explicit memories⁶.

NEED FOR THE STUDY:

The previous studies have reported the positive effects of aromatherapy in alleviating physical problems such as pain, and emotional problems such as depression and anxiety. But these studies were limited to other health problems more than fatigue and sleeping. Because fatigue and sleeping problems are significantly related with well-being and the quality of life in elderly people, it is very important to decrease clients fatigue levels and improve their sleep quality. Therefore, there is a need to test the repeated use of an aromatherapy with inhalation and to test the long- term effects on fatigue and sleeping.

Better quality of life in elderly people can be achieved by increasing quality of sleep and reducing fatigue. In order to improve their quality of life and health status, the assessment of sleep characteristics and fatigue level by health care providers, especially nurses is an important caring activity. Nurses play an important role in recognizing the negative effect of sleep disturbances and fatigue on wellbeing and quality of life of elderly and to conduct research activities to solve such the problems. Since sleep disorders and fatigue are important factors influencing the well- being of elderly, Nurses can use aromatherapy as an independent nursing intervention, as it is safe, easily applicable and cost effective.

A study was conducted on fatigue and physical activity level of 65 and over older peoples living in rest home by Ferhan Soyver and Vesile senol and the result showed that fatigue is a symptom often found among older people, and higher fatigue was associated with lower physical activity level in older people⁷.

Nursing is the central to the delivery of high- quality care for old people. Geriatric nurses should play a major role in improving the quality of life of old age home residents. There are few number of nursing studies in our country regarding sleep quality, prevalence of fatigue among elderly and use of aromatherapy as a complementary therapy to treat sleep problems and fatigue among elderly. So the researcher has chosen this topic to identify the effect of Inhalation Aromatherapy on quality of sleep and fatigue among elderly.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of Inhalation Aromatherapy on quality of sleep and fatigue among elderly residing in selected old age homes of Kannur district.

OBJECTIVES:

1. Assess the level of quality of sleep among elderly residing in selected old age homes of Kannur district.

2. Assess the level of fatigue among elderly residing in selected old age homes of Kannur district.

3. Evaluate the effectiveness of Inhalation Aromatherapy on quality of sleep among elderly residing in selected old age homes of Kannur district.

4. Determine the effectiveness of Inhalation Aromatherapy on fatigue among elderly residing in selected old age homes of Kannur district.

5. Correlate quality of sleep and fatigue among elderly residing in selected old age homes of Kannur district.

6. Find out the association between pre-test level of quality of sleep among elderly residing in old age homes of Kannur district with selected demographic variables such as age, gender, marital status and duration of stay in the old age home.

7. Find out the association between pre-test level of fatigue among elderly residing in old age homes of Kannur district with selected demographic variables such as age, gender, marital status and duration of stay in the old age home.

OPERATIONAL DEFINITIONS:

Inhalation Aromatherapy:

Refers to method of using dry inhalation of one drop of lavender angustifolia essential oil on a piece of cotton and placed under the pillow at the night before sleep for the whole night for a period of five days, and its effect on the sleep pattern and fatigue among the elderly inmates of the selected old age home.

Quality of sleep:

Refers to the subjective feeling of quality of sleep experienced by a person in terms of change in the sleeping pattern and is assessed using change in the seven component of Modified Pittsburgh Sleep Quality Index including Subjective sleep quality, Sleep latency, Sleep duration, Habitual sleep efficiency, Sleep disturbances, Use of sleeping medications, and Day time dysfunction over the last one month.

Fatigue:

Refers to discomfort and tiredness experienced by elderly people which is measured by Fatigue Severity Scale.

THE REVIEW OF LITERATURE:

In the present study has been taken up from different sources like text books, journals, articles and published research studies. The literature reviewed for the present study is organized and present in the following headings.

1. Incidence and prevalence of sleep problems and fatigue amongelderly.

2. Complementary/ Alternative therapies to treat sleep problems andfatigue.

3. Aromatherapy and its effect on quality of sleep andfatigue.

RESEARCH METHODOLOGY:

Researchapproach:

A quantitative evaluative approach was adopted

Researchdesign:

A Pre- experimental one group pre-test post-test design was used in the study.

Variables:

Independent variable:

InhalationAromatherapy.

Dependent variable:

Quality of sleep and level of fatigue among elderly.

Setting of thestudy:

The study was conducted in Kripa Charitable Trust (old age home), Thettuvazhi, Peravoor of Kannur district. The old age home consists of 200 elderly people.

Population:

The population is all elderly inmates, residing at Kripa Charitable Trust, Thettuvazhi, Peravoor, Kannur district.

Sample:

40 elderly inmates of Kripa Charitable Trust, Thettuvazhi, Peravoor, Kannur district who fulfilled the inclusion and exclusion criteria.

Sample size:

40 samples (both male and female)

Samplingtechnique:

Non-probability -purposive sampling technique was used as they have fulfilled the inclusion criteria.

Description of thetool:

Tool 1: A structured Interview Schedule for the collection of demographic variables.

It includes Age, Gender, Marital status, educational status, Religion, Number of children, Hobbies and Interest, Medical illness, Religious practices/Spiritual activities and Old Age Home profile including Current source of income, Duration of stay, Reason for joining in the old age home, Recreational activities and Accommodation facilities.

Technique: Interviewing

Tool 2: Modified Pittsburgh Sleep Quality Index:

This tool measures 7 areas, Subjective sleep quality, Sleep intensity, Sleep duration, Habitual sleep efficiency, Sleep disturbance, Use of sleeping medications, and Day time dysfunction over the last one month. A total score of 5 or greater is indicative of poor sleep quality.

Scoring interpretation:

Global score range-0 to21

0-4 – Good sleep quality 5-10– Mild insomnia

11-15– Moderate insomnia 16-21–Severe insomnia

Technique:Interviewing

Tool 3: Fatigue Severity Scale:

This scale contains 9 statements that rate the severity of fatigue symptoms. A total score of less than 36 suggest that the person may not be suffering from fatigue.

Scoring interpretation:

<36– No fatigue 37-45– Mildfatigue

46-54– Moderate fatigue 55-63– Severefatigue

Technique: Interviewing

Reliability of the tool:

Reliability of the tools was established by using Test-retest method and the reliability of Pittsburg Sleep Quality Index was 0.8 and reliability of Fatigue Severity Scale was 0.96. Hence both tools were reliable.

Data collection process:

The investigator obtained a formal clearance from institution ethical committee and a written permission from the concerned authority of Kripa Charitable Trust, Thettuvazhi, Peravoor to conduct datacollection..Study subjects were selected by purposive sampling technique. Subjects were selected according to the inclusion and exclusion criteria.

Data collection process for the study group:

The researcher spent three weeks for collecting data from the entire study group. First and second week the researcher collected information from 15 subjects respectively, and third week 10 subjects. Investigator explained the purpose of the study and confidentiality was assured. After taking consent from each subject pre-test demographic data were collected using Structured Interview Schedule, Pre-test qualityof sleep was assessed by Modified Pittsburgh Sleep Quality Index and Pre-test level of fatigue was measured by Fatigue Severity Scale. The average time taken for pre- test was 15-20 minutes. From the same day, the investigator administered Inhalation Aromatherapy by applying one drop of lavender angustifolia essential oil on a piece of cotton and placed under the pillow at the night before sleep for the whole night for a period of five days. (duration of intervention for each subject per day is around 6-7 hours). Post-test was conducted on 6^th day. Post-test quality of sleep was assessed by Modified Pittsburgh Sleep Quality Index and post-test fatigue was measured by Fatigue Severity Scale. The average time taken for the post-test was 15-20 min for eachsubjects.

RESULTS AND DISCUSSION:

Following were the findings of the study

§ Majority of the subjects (37.5%) were in the age group of 66-70 years. Whereas 30% in the age group of 60-65, 15% in the age group of 71-75, 10% in the group of 76-80, and only 7.5% in the group of 81-85.

§ Higher percentage of the subjects in the study (65%) were males and 35% were females.

§ Among the subjects 40% were married and 35% were widow/widower.Another 17.5 % were unmarried and remaining 7.5 % were divorced.

§ It reveals regarding the educational status that majority of them (47.5%) had completed primary education only. 32% had completed high school education, another 7.5% had completed higher secondary. 2.5% completed graduation and above. And 10 % has no primary education.

§ Majority of the subjects belonged to Hindu religion (57.5%). And the remaining 40%belonged to Christian religion and 2.5 percentage belonged to Muslimreligion.

§ Among the subject’s majority of them are having (37.5%) three and more children. 22.5% are having two children. Another 12.5% are having one child and 27.5% are having nochildren.

§ Majority of them (95%) are having medical illness like hypertension, diabetes mellitus, bronchial asthmas, arthritis and kidney diseases. And 5% are having no medicalillness.

Level of quality of sleep among the studysubjects:

Frequency and percentage distribution of subjects based on the level of quality of sleep:

It reveals that among 40 elderly people who participated in the study, 20 (50%) of them had mild insomnia, 19 (47.5%) of them had moderate insomnia and 1 (2.5%) had severe insomnia in the pre-test assessment. Where as in the post-test 28 (70%) of them had mild level of insomnia, 9 (22.5%) of them had moderate insomnia, none of them had severe insomnia and 3 (7.5%) had no insomnia

Level of fatigue among study subjects:

Frequency and percentage distribution of subjects based on the level of fatigue:

It reveals that among 40 elderly people who participated in the study 32(80%) of them had mild level of fatigue, 4(10%) of them had moderate level of fatigue, and 4 (10%) of them had severe level of fatigue in the pre-test assessment. Where as in the post- test 24 (60%) of them had mild level of fatigue, 5 (12.5%) of them had moderate level of fatigue. 1 (2.5%) of them had severe level of fatigue and 10 (25%) of them had no fatigue.

The findings are supported by the report of another study conducted to determine the effectiveness of Inhalation Aromatherapy on symptoms of sleep disturbance in the elderly. In 19 subjects, normal sleep was observed for a 20-day control period, Inhalation Aromatherapy was then applied for a 20-day intervention period, and the control and intervention periods were compared. The results indicated positive effects of Inhalation Aromatherapy on symptoms of sleep disturbance in elderly⁸

The current study finding is parallel with the study by Vineeth Joseph, and Jasmine Joseph. Their study from 40 inmates of old age home both males and females report that there was a significant increase in the quality of sleep after aromatherapy⁹

A scientific poster presentation by Cherif, W. Hamdi, I. Zouch on correlation between sleep disturbance, fatigue and psychological features in patients with Rheumatoid Arthritis give support to the present study finding that poor sleep quality is especially associated with fatigue, anxiety and depression¹¹. This study finding is parallel with another study done by G.A Hawker, et al. to find out multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Study result showed that poor sleep quality is highly prevalent and significantly linked with fatigue¹²

Association of quality of sleep with demographic variables:

In the study there was no significant association found between the pre-test quality of sleep score with selected demographic variables such as age, gender, marital status, and duration of stay in the old age home.

Association of level of fatigue with demographic variables:

In the study there was no significant association found between the pre-test level of fatigue score with selected demographic variables such as age, gender, marital status, and duration of stay in the old age home.

CONCLUSION:

The study deals with effect of Inhalation Aromatherapy on quality of sleep and fatigue among elderly. Considering the fact, it can be suggested that regular practice of Inhalation Aromatherapy is effective in improving quality of sleep and reducing fatigue among elderly. So, this intervention can be prescribed to patients with poor sleep quality and fatigue with proper monitoring along with medical therapy because it is cost effective and can be practiced at home setting.

NURSING IMPLICATIONS:

· Geriatric nurses have to realize their responsibility in creating the awareness regarding various complementary therapies to improve sleep quality and reduce fatigue including Inhalation Aromatherapy.

· The nurse educators and student nurses must gain thorough knowledge about various complimentary therapies for poor sleep quality and fatigue through research findings.

· This study finding will help the staff, nursing students and other health personnel to understand the factors that determines the quality of life of elderly.

· The nurse administrator should take active part in arranging Inhalation Aromatherapy classes for staff nurses as well as patients, thereby improving the standard of nursing and research-based nursing practice.

· This study can prove to be a baseline for future studies to build upon and motivate other researchers to conduct further studies.

RECOMMENDATIONS:

· Similar study can be replicated to a larger group of samples.

· Similar study can be conducted in community setup.

· Similar study can be conducted with increasing the duration of the intervention more than five days.

· A similar study can be replicated with a control group as a quasi-experimental design or experimental design.

· A comparitative study can be done to find out the effectiveness of Inhalation Aromatherapy and other complimentary or alternative therapy.

· A similar study can be conducted focusing on different age group.

REFERENCES:

1. Braverman J. The human lifecycle stages. 2017 June 14 available from: https://www.livestrong.Com

2. World population aging 2017(UN) highlights. Department of economics and social welfare available from http://www.un.org>desa publications

3. Andrew Steploe, Angus deaton, Arthur A stone. Psychological Wellbeing, Health and Ageing. Lancet; 2017 Feb 17:640-648

4. Fatigue. Gale Encyclopaedia of Mental Disorders. Available from http://www. Encyclopedia.com

5. Sleep deprivation and deficiency. National Heart Lung and Blood Institute available at http://www.nhibi. Nih.gov/health topics/sleep deprivation and deficiency

6. Christian Nordqvist. Aromatherapy. Medical News Today; 2017 March 20 available from http://www.medical today .com

7. Victor Marchione. Fatigue in elderly; cause and how to treat it. Bel Marra Health. 2017 March 16, available from http://www. Belmarra health.com/fatigue-tiredness-elderly

8. Takenda A, Watanaki E, Koyama S. Effect of Inhalation Aromatherapy on symptoms of sleep disturbance in elderly with dementia, Journal of Evidence Based Complementary and Alternative Medicine 2017 march 19; doi-10.115/2017/1902807

9. Vineeth Joseph, Jasmine Joseph. Effectiveness of aromatherapy on quality of sleep among elderly inmates of selected old age home. Asian Journal of Nursing Education and Research 2016; 6(4): 511

10. Kabiri F, Hasanpour-Debkordi A. Effect of massage therapy and aromatherapy on fatigue in patients with knee osteoarthritis. Journal of Herbel Pharmacology 2018;7(3):141-147

11. Cherif I, Hamdi W, Zouch I. Correlation between sleep disturbance, fatigue, and psychological features in patients with rheumatoid arthritis. Annals of the Rheumatic Disease. 2014 june;73(2):646

12. G A Hawker, French M R et al. The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Osteoarthritis Cartilage. 2010 Nov;18(11):1365-71

Received on 04.11.2022 Modified on 08.01.2023

A and V Pub Int. J. of Nursing and Medical Res. 2023; 2(2):35-40.

DOI: 10.52711/ijnmr.2023.10

Sl. No	Variable	Maximum score	Pre-test		Post-test		Mean difference	‘t’ value	df
			Mean	Sd	Mean	Sd
1	Quality of sleep	21	10.38	2.65	7.95	3.04	2.42	4.382*	39

STATEMENT OF THE PROBLEM:

OBJECTIVES:

OPERATIONAL DEFINITIONS:

Inhalation Aromatherapy:

Quality of sleep:

Fatigue:

Researchapproach:

Researchdesign:

Variables:

Population:

Samplingtechnique:

Tool 2: Modified Pittsburgh Sleep Quality Index:

Scoring interpretation:

Tool 3: Fatigue Severity Scale:

Scoring interpretation:

Reliability of the tool:

Data collection process:

Data collection process for the study group:

Level of quality of sleep among the studysubjects:

Figure 1: Bar diagram showing comparison of pre-test and post-test fatigue severity score of the subjects in the study group

Pre-test mean, standard deviation and type of correlation between quality of sleep and fatigue in the study group N=40