Effects of a Sleep Improvement Program Combined with Aroma-Necklace on Sleep, Depression, Anxiety and Blood Pressure in Elderly Women

Nami Chun; Myoungsuk Kim; Gie ok Noh

doi:10.4040/jkan.2017.47.5.651

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Chun, Kim, and Noh: Effects of a Sleep Improvement Program Combined with Aroma-Necklace on Sleep, Depression, Anxiety and Blood Pressure in Elderly Women

Original Article

J Korean Acad Nurs 2017;47(5):651-662.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.5.651

Effects of a Sleep Improvement Program Combined with Aroma-Necklace on Sleep, Depression, Anxiety and Blood Pressure in Elderly Women

Nami Chun¹, Myoungsuk Kim^1,, Gie ok Noh²

¹College of Nursing, Sungshin Women's University, Seoul

²College of Nursing, Konyang University, Daejeon, Korea

Address reprint requests to : Kim, Myoungsuk College of Nursing, Sungshin Women's University, Mia Woonjung Green Campus, 55 Dobong-ro 76ga-gil, Gangbuk-gu, Seoul 01133, Korea Tel: +82-2-920-2712 Fax: +82-2-920-2092 E-mail: cellylife@gmail.com

Received 15 May 2017 Revised 25 September 2017 Accepted 25 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to evaluate the effectiveness of a sleep improvement program combined with an aroma-necklace on sleep, depression, anxiety, and blood pressure in elderly women living at home.

Methods

A program consisting of a four-week (one hour per week) sleep improvement intervention plus use of an aroma-necklace, was developed based on Cox's Interaction Model of Client Health Behavior. 70 elderly women were assigned to the experimental (n=35) or control group with no intervention (n=35). Data from 62 participants (32 in the experimental and 30 in the control) were analyzed using the SPSS 21.0 program. Women in the experimental group were instructed to constantly wear the aroma necklace filled with marjoram and orange oil until the program was completed. Sleep quality, sleep duration, sleep satisfaction, depression, anxiety, and blood pressure were measured to identify the effectiveness of the program.

Results

Significant group differences were found in sleep quality (t=-5.10, p<.001), sleep duration (z=-3.10, p=.002), sleep satisfaction (z=-4.13, p=<.001), depression (t=2.53, p=.015), and anxiety (z=-2.47, p=.014). No differences were found in the systolic or diastolic blood pressure.

Conclusion

The results indicate that a sleep improvement program combined with an aroma-necklace was effective in improving sleep disturbances in elderly women living at home. Nurses may contribute to improving sleep among elderly women by applying this program to aged women living in various environments.

Keywords: Aged, Sleep initiation and maintenance disorders, Sleep, Depression, Anxiety

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Figure 1.

Research flow diagram.

Table 1.

Sleep Improvement Program Combined with Aroma-Necklace

Session	Topic	Content outline	IMCHB sub-domain	Duration (min)
	Pretest	General characteristic	Intrinsic motivation	15
		Sleep quality, duration, satisfaction
		Depression, anxiety, blood pressure
1st week	Program overview	Program introduction		10
	Sleep in elderly	Characteristics, importance, barriers of sleep in elderly	Health information	30
	Exercise	Exercise for sound sleep	Professional/technical	10
	Meditation	Meditation for sound sleep	competencies
	Self practice	Wearing aroma-necklace	Decisional control	10
		Program practice
2nd week	Discussion	Sharing sleep improvement practice at home and	Affective support	10
		empowering
		Aroma-necklace practice
	Ways to improve sleep (1)	Lecture: sleep management: daytime rules, rules	Health information	30
		when you cannot sleep, rules when you sleep
	Exercise	Exercise for sound sleep	Professional/technical	10
	Meditation	Meditation for sound sleep	competencies
	Self practice	Wearing aroma-necklace	Decisional control	10
		Program practice
3rd week	Discussion	Sharing sleep improvement practice at home and	Affective support	10
		empowering
		Aroma-necklace practice
	Ways to improve sleep (2)	Lecture: exercise, diet rule, water intake rule, foods to	Health information	30
		avoid
	Exercise	Exercise for sound sleep	Professional/technical	10
	Meditation	Meditation for sound sleep	competencies
	Self practice	Wearing aroma-necklace	Decisional control	10
		Program practice
4th week	Discussion	Sharing sleep improvement practice at home and	Affective support	10
		empowering
		Aroma-necklace practice
	Ways to improve sleep (3)	Lecture: avoid medication, environment,	Health information	30
		stress reduction, let-go of worries and anxiety
	Exercise	Exercise for sound sleep	Professional/technical	10
	Meditation	Meditation for sound sleep	competencies
	Self practice	Wearing aroma-necklace	Decisional control	10
		Program practice
	Posttest	Sleep quality, duration, satisfaction	Elements of health	15
		Depression, anxiety, blood pressure	outcome

Table 2.

Homogeneity of General Characteristics of Participants before Intervention (N=62)

Characteristics		Exp. (n=32)	Con. (n=30)	t or χ²	p
		n (%) or M±SD	n (%) or M±SD
Age (yr)		77.59±5.76	76.00±3.76	1.30	.200
Spouse	Yes	13 (40.6)	14 (46.7)	0.23	.632
	No	19 (59.4)	16 (53.3)
Religion	Yes	25 (78.1)	23 (76.7)	0.19	.891
	No	7 (21.9)	7 (23.3)
Regular exercise	Yes	23 (71.9)	20 (66.7)	0.20	.657
	No	9 (28.1)	10 (33.3)
Frequency of exercise per week		3.63±1.67	3.62±1.69	0.01	.992
Duration of exercise (min)		50.00±19.64	51.67±28.08	−0.25	.801
Taking sleeping pills	Yes	10 (31.2)	6 (20.0)	1.02	.312
	No	22 (68.8)	24 (80.0)
Coffee drinking	Yes	21 (65.6)	17 (56.7)	0.52	.469
	No	11 (34.4)	13 (43.3)
Napping	Yes	7 (21.9)	4 (13.3)	0.77	.379
	No	25 (78.1)	26 (86.7)
Perception of health condition	Good	4 (12.5)	3 (10.0)	0.54	.762
	Average	20 (62.5)	17 (56.7)
	Bad	8 (25.0)	10 (33.3)

Exp.=Experimental group; Cont.=Control group; SD=Standard deviation.

Table 3.

Homogeneity of Study Variables before Intervention (N=62)

Variable	Exp.(n=32)	Con.(n=30)	t or z	p
	M±SD	M±SD
Sleep quality	35.25±9.69	39.83±9.45	−1.88	.064
Sleep duration	6.03±1.41	6.72±1.31	−1.79	.074*
Sleep satisfaction	3.72±2.73	4.43±2.13	−1.62	.106*
Depression	19.44±7.94	21.37±12.47	−0.72	.474
Anxiety	38.69±11.22	42.17±12.37	−1.49	.135*
Systolic BP	130.61±16.69	133.60±15.76	−0.72	.472
Diastolic BP	71.69±11.59	76.87±10.83	−1.79	.073*

Exp.=Experimental group; Cont.=Control group; SD=Standard deviation; BP=Blood preessure.

^*Mann-Whiteney U test.

Table 4.

Comparison of Dependent Variables between Experimental and Control Groups after Intervention (N=62

Variables	Group	Pre-test	Post-test	Difference (Pre-post)	t or z	p
		M±SD	M±SD	M±SD
Sleep quality	Exp. (n=32)	35.25±9.69	42.63±10.23	−7.38±8.14	−5.10	<.001
	Con. (n=30)	39.83±9.45	38.87±9.27	0.97±4.25
Sleep duration	Exp. (n=32)	6.03±1.41	6.97±1.78	−0.94±1.34	−3.10	.002*
	Con. (n=30)	6.72±1.31	6.67±1.38	0.05±0.83
Sleep satisfaction	Exp. (n=32)	3.72±2.73	6.78±2.51	−3.06±3.42	−4.13	<.001*
	Con. (n=30)	4.43±2.13	4.20±1.83	0.23±1.33
Depression	Exp. (n=32)	19.44±7.94	17.31±7.79	2.13±8.27	2.53	.015
	Con. (n=30)	21.37±12.47	23.43±11.96	−2.07±4.28
Anxiety	Exp. (n=32)	38.69±11.22	35.41±10.61	3.28±8.97	−2.47	.014*
	Con. (n=30)	42.17±12.37	44.10±11.88	−1.93±6.82
Systolic BP	Exp. (n=32)	130.61±16.69	131.55±16.36	−0.94±12.71	−0.03	.975
	Con. (n=30)	133.60±15.76	134.45±16.45	−0.85±9.11
Diastolic BP	Exp. (n=32)	71.69±11.59	71.87±9.34	−0.19±8.36	−0.35	.724*
	Con. (n=30)	76.87±10.83	78.07±13.20	−1.20±7.45

Exp.=Experimental group; Cont.=Control group; SD=Standard deviation; BP=Blood pressure.

^*Mann-Whiteney U test.

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