Impact of Mindfulness Based Stress Reduction (MBSR) Technique on Depression, Anxiety and Stress among Elderly Residing in selected Old Age Homes in Guwahati, Kamrup (M) Assam

Rimpi Talukdar¹, Renu Talukdar²,Kalpana Nath³,Anand Lakshminarasimhan⁴

¹Senior Nursing Officer, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.

²Associate Professor, Regional College of Nursing, Guwahati, India.

³Lecturer, Regional College of Nursing, Guwahati, India.

⁴Reader/Associate Professor, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.

*Corresponding Author E-mail: rimpitalukdar49@gmail.com

ABSTRACT:

Depression, anxiety, and stress are some of the common problems in older adults, affecting every aspect of life, including energy, appetite, sleep, and interest in work, hobbies, and relationships. Mindfulness-Based Stress Reduction (MBSR) is a program that incorporates mindfulness to assist people with pain and a range of conditions and life issues. There is growing evidence of the effectiveness of mindfulness-based meditation in treating everything from depression to breast cancer. Thus, the present study was undertaken to assess the impact of the MBSR technique on depression, anxiety, and stress among elderly people. Forty-two elderly individuals residing in Amar Ghar Old Age Home in Patharquarry, Narengi, Guwahati, were selected as a sample using purposive (total population) sampling technique. Data were collected using the DASS-42 scale to assess the levels of depression, anxiety, and stress among the elderly. The MBSR technique, which includes body scan practice, breathing exercises, and simple yoga asanas, was provided for two hours every day for a period of four weeks under the supervision and guidance of Mr. Anil Sharma, HOD, Yoga Department, GMCH. Ethical consideration was obtained from the IEC, Regional College of Nursing, and informed consent was taken from the subjects. After four weeks of intervention, it was found that the mean score of depression significantly decreased from 10.52 in the pre-test to 8.16 in the post-test (p=0.00001), anxiety significantly reduced from 11.62 in the pre-test to 5.26 in the post-test (p=0.00001), and stress decreased from 15.6 in the pre-test to 7 in the post-test (p=0.00001). Thus, it shows the effectiveness of MBSR in reducing depression, stress, and anxiety among elderly people. There was also a significant association of depression with marital status and nature of the relationship with visitors; anxiety with age, gender, source of financial help, nature of admission to the old age home, activities of daily living, and psychological support; and stress with educational status, source of financial help, and the number of children of the elderly. The positive outcome of the study indicates that MBSR is effective in reducing depression, stress, and anxiety levels among the elderly.

KEYWORDS: Depression, Stress, Anxiety, MBSR (Mindfulness Based Stress Reduction).

INTRODUCTION:

Aging is a universal and inevitable biological process experienced by humanity throughout history. India is an aging society, with the growth rate of its elderly population outpacing that of the general population.¹ Currently, India's elderly population is the second largest in the world, following China. By 2025, the geriatric population in developing countries is expected to reach 840 million. In India, the proportion of individuals aged 60 and older is projected to increase from 7.5% in 2010 to 11.1% in 2025. In 2010, there were more than 91.6 million elderly people in India, with projections suggesting this number will rise to 158.7 million by 2025. According to the Population Census of 2011, there are nearly 104 million elderly persons (aged 60 years or above) in India, comprising 53 million females and 51 million males. The share and size of the elderly population have been increasing over time, from 5.6% in 1961 to 8.6% in 2011.²

The North Eastern region of India, which consists of eight states, accounts for 3.8% of the country’s total population and covers 8.05% of its geographical area. In 2001, almost 70% of the elderly population in this region resided in Assam. According to the 2001 census, about 6% of Assam's total population were senior citizens (aged 60 years or above).³

With age comes wisdom, but also a range of challenges. According to the National Council on Aging, approximately 92% of seniors have at least one chronic disease, and 77% have at least two. Globally, around 47.5 million people have dementia, a number expected to nearly triple by 2050. The World Health Organization reports that over 15% of adults over 60 suffer from a mental disorder.⁴

BACKGROUND OF THE STUDY:

Depression, anxiety, and stress are common issues among older adults. Individuals aged 85 and older are particularly vulnerable to stress and depression, more so than other age groups, due to increasing stressors associated with declining health and diminishing social relationships.⁵

Mindfulness-Based Stress Reduction (MBSR) is a program that integrates mindfulness to help individuals cope with pain and various conditions that were initially challenging to treat in a hospital setting. Developed in the 1970s by Professor Jon Kabat-Zinn at the University of Massachusetts Medical Center, MBSR combines mindfulness meditation, body awareness, and yoga to enhance mindfulness. Recent controlled clinical research indicates that meditation may have beneficial effects, including stress reduction, relaxation, and improvements in quality of life.⁶

Mindfulness-based approaches have been examined for a range of health issues, including anxiety disorders, mood disorders, substance abuse disorders, eating disorders, chronic pain, ADHD, insomnia, and coping with medical conditions. These approaches have been tested with various populations, including children, adolescents, parents, teachers, therapists, and physicians. Interest in mindfulness research has grown significantly, with 52 papers published in 2003 and 477 by 2012. By early 2014, nearly 100 randomized controlled trials had been published. Research suggests that mindfulness training can improve focus, attention, and the ability to work under stress, and MBSR can be beneficial in alleviating depression and psychological distress associated with chronic illness.⁶

OBJECTIVES OF THE STUDY:

The objective of this study is to evaluate the impact of the Mindfulness-Based Stress Reduction (MBSR) technique on depression, anxiety, and stress among elderly residents in selected old age homes in Guwahati, Kamrup (M), Assam.

METHODS:

A quantitative evaluative research approach was adopted for this study. The research was conducted at Amar Ghar Old Age Home in Narengi, Guwahati, Kamrup (M), Assam. The Institutional Ethical Committee (IEC) of the Regional College of Nursing, Guwahati, approved the project. The target population consisted of elderly individuals aged 60 years and above. The total sample size included 42 elderly residents of Amar Ghar Old Age Home. A purposive (total population sampling) technique was employed to select participants. Individuals who were disoriented were excluded from the study.

Table 1: Schematic Representation of the Research Design

Group

Pre – test

Interventions

Post – test

One group of elderly people (42)

K₁

(Dependent Variable)

Day 1 – Day 3

(Independent Variable)

Day 4 – Day 31

K₁

(Dependent Variable)

Day 32– Day 33

INTERVENTION:

The structured program outlined by Kabat-Zinn et al was adopted. Mindfulness-Based Stress Reduction (MBSR) spans over a 30-day period, divided into four sessions. In Session 1 (Day 1 to Day 7), participants are introduced to group rules emphasizing confidentiality, and engage in breathing exercises such as Complete Breathing, Humming Breathing, and Diaphragmatic Breathing. The session also includes Pranayama (omkar) and Body scan practice to cultivate mindfulness. Session 2 (Day 8 to Day 15) focuses on deepening mindfulness with continued Body scan practice, maintaining a Pleasant event calendar to document positive emotions, and integrating mindfulness into daily actions. Sitting meditations with an emphasis on breathing awareness are also central. Moving into Session 3 (Day 16 to Day 23), the program expands with Sitting meditation sessions, the Three-minute breathing space exercise for grounding awareness, and practices of Mindful walking and eating. Participants maintain an Unpleasant event calendar alongside engaging in simple yoga asanas like Tadasana, Vrikshasana, Marjariasana, and Padhastasana. Finally, in Session 4 (Day 24 to Day 30), participants revisit Sitting meditation and Body scan practice, further integrate yoga asanas, and deepen mindfulness through mindful eating and walking practices. Each session builds upon the last, progressively guiding participants towards enhanced mindfulness and stress reduction through structured and varied practices.

DATA COLLECTION PROCEDURE:

The data collection procedure for the study involved several systematic steps to ensure accuracy and ethical adherence. Prior to data collection, the researcher underwent a comprehensive 3-month training period in the MBSR technique and Yoga Asanas under the guidance of Mr. Anil Sharma, HOD of the Yoga Department at GMCH. Formal written administrative permission was obtained from the authorities at Amar Ghar Old Age Home to conduct the study on their premises. Subjects were selected using a Purposive (total population) sampling technique.

Written Informed Consent was obtained from all subjects after explaining the MBSR procedure and their roles in the study. Confidentiality of participants' information was assured throughout the study duration. A pre-test was conducted from the 1st to the 3rd day of March 2019 using a modified interview schedule incorporating the DASS-42 questionnaire to assess depression, anxiety, and stress levels among the subjects before the commencement of the MBSR intervention.

The MBSR intervention was then applied daily in 2-hour sessions, supervised by expert, over the study period. Subjects were divided into two groups, each consisting of 21 elderly individuals, to facilitate the intervention procedure. Upon completion of the intervention, a post-test using the DASS-42 questionnaire was administered on the 8th and 9th of April 2019 to assess changes in depression, anxiety, and stress levels. The pre-test and post-test data collected were compiled for subsequent data analysis, aiming to evaluate the effectiveness of the MBSR intervention in reducing psychological distress among elderly participants.

RESULTS:

In the current study, the pre-interventional assessment of depression levels indicated that a majority of subjects did not exhibit depression, with 33.3% experiencing mild depression, 19% moderate depression, and 7.14% severe depression; none showed extremely severe depression. The overall mean score was 10.523, indicating mild depression on average among the elderly.

Regarding pre-interventional anxiety, the study found that 40.4% of subjects had no anxiety, 9.52% mild anxiety, 33.3% moderate anxiety, 14.2% severe anxiety, and 2.3% extremely severe anxiety. The overall mean score was 9.404, indicating a moderate level of anxiety on average among the elderly.

For pre-interventional stress levels, 52.3% of the population reported no stress, 28.5% mild stress, 14.2% moderate stress, and 4.76% severe stress; none reported extremely severe stress. The overall mean score was 15.309, suggesting mild stress on average among the elderly.

The impact of the Mindfulness-Based Stress Reduction (MBSR) technique on depression, anxiety, and stress levels among the elderly was assessed post-interventionally. The results showed a decrease in depression, anxiety, and stress scores. Specifically, post-interventional depression scores indicated that 59.5% had no depression, 26.19% mild depression, and 14.28% moderate depression. Post-interventional anxiety scores showed 50% had no anxiety, 26.1% mild anxiety, and 23.8% moderate anxiety. Post-interventional stress scores showed 73.8% had no stress, 21.4% mild stress, and 4.76% moderate stress, with none reporting severe or extremely severe stress.

Regular practice of MBSR was associated with increased bodily awareness, enhancing feelings of calm and control among the elderly. Statistical analysis revealed significant differences in depression (t = 8.277, p = 0.000003), anxiety (t = 5.92, p = 0.0000006), and stress (t = 7.62, p = 0.0000002) levels before and after MBSR implementation, indicating the effectiveness of the intervention.

DISCUSSION:

The impact of Mindfulness-Based Stress Reduction (MBSR) on depression, anxiety, and stress among elderly individuals was evident in the post-interventional scores. Following the intervention, the results showed significant improvements: 59.5% of participants had no depression, 26.19% had mild depression, and 14.28% had moderate depression. In terms of anxiety, 50% reported no anxiety, 26.1% had mild anxiety, and 23.8% had moderate anxiety. Stress levels also improved, with 73.8% experiencing no stress, 21.4% mild stress, and 4.76% moderate stress, while none reported severe or extremely severe stress.

These positive outcomes are attributed to regular practice of MBSR, which enhances bodily awareness, fostering feelings of calm and control among the elderly. Statistical analysis confirmed significant differences in depression (t = 8.277, p = 0.000003), anxiety (t = 5.92, p = 0.0000006), and stress (t = 7.62, p = 0.0000002) levels before and after MBSR implementation, underscoring the effectiveness of the intervention.

Therefore, the Mindfulness-Based Stress Reduction Technique demonstrated a clear positive impact in reducing depression, anxiety, and stress among elderly individuals residing in the selected old age home.

These findings align with previous research. For instance, Elizabeth McCallion's study (2014)⁷ in Albuquerque, New Mexico, also noted significant decreases in anxiety and depression among participants in the MBSR group. Similarly, Laura A. Young and Michael J. Baime's research (2010)⁸ on older adults found that MBSR training resulted in more than a 50% reduction in depression and anxiety levels.

The Mindfulness-Based Stress Reduction Technique had a positive impact on reducing depression, anxiety, and stress levels among elderly individuals residing in the selected old age home. However, the study has limitations that must be acknowledged. These include a small sample size of 42 elderly participants recruited through purposive sampling, limiting the generalizability of the results. Furthermore, the study focused solely on the intervention of MBSR.

Future research endeavours should consider replicating the present study on a larger scale and across diverse settings. Employing experimental and control groups would strengthen the evidence base regarding the efficacy of Mindfulness-Based Stress Reduction (MBSR) in elderly populations.

Additionally, comparative studies are warranted to investigate potential differences or similarities in depression, anxiety, and stress levels between elderly individuals residing in old age homes and those living with their families. Such comparative analyses could provide valuable insights into the effectiveness of MBSR across different living environments and social contexts.

By expanding the scope of research in these ways, researchers can further validate and refine the application of MBSR as a therapeutic intervention for improving mental health outcomes among elderly populations. These efforts will contribute to the development of more tailored and effective interventions to support the psychological well-being of elderly individuals.

CONCLUSION:

Depression, anxiety, and stress are significant psychological conditions with widespread negative impacts on individuals, families, and workplaces. This study demonstrates that MBSR positively impacts depression, anxiety, and stress among elderly individuals residing in old age homes. Access to MBSR facilitated by qualified therapists can potentially and safely alleviate distressing symptoms in this demographic.

Table.2: Mean, Standard Deviation and Test of Difference of Depression, Anxiety and Stress Scoresn=42

DASS	PRE-TEST			POST-TEST			MD	t value	P Value	Remarks
DASS	Mean	SD	SE	Mean	SD	SE	MD	t value	P Value	Remarks
Depression Scores	10.52	6.0009	0.92	8.166	4.94	0.76	2.35	8.27	0.00**	S
Anxiety Scores	11.62	5.02	0.77	5.26	3.51	0.54	6.36	5.92	0.00**	S
Stress Scores	15.6	5.23	0.81	7	3.22	0.49	8.6	7.62	0.00**	S

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Received on 15.06.2024 Revised on 16.07.2024

Accepted on 29.07.2024 Published on 16.12.2024

Available online on December 31, 2024

Int. J. Nursing Education and Research. 2024;12(4):261-264.

DOI: 10.52711/2454-2660.2024.00055