Mr Ajish .T. Stephen

Ist year M.Sc Nursing

Mental Health Nursing

Year 2011-2013







Ist year MSc Nursing
Padmashree Institute of Nursing
2.  / NAME OF THE INSTITUTION / Padmashree Institute of Nursing,
3.  / COURSE OF THE STUDY / Ist year MSc Nursing,
Mental Health Nursing
5.  / TITLE OF THE STUDY / Assessment of the effectiveness of aroma therapy in improving quality of sleep among geriatrics at selected old age home, Bangalore.



"With mirth and laughter let old wrinkles come"

The elderly are the setting sun who retreats into the night after giving light and life during the day time. However no one knows when old age comes, it is said that nobody grows old merely living a certain number of years. The knowledge about the aging process is incomplete. Not much about the disability incident to the aging process is known. Though the physical psychological needs of elderly do vary from those of the younger ones, dissatisfaction of the basic needs creates tension and frustration. They require sympathy acceptance and a spirit of tolerance from their dear ones. 1

Almost half of all older adults report problems with insomnia, defined as difficulty initiating and maintaining sleep. Insomnia has far-reaching and often subtle effects on health and quality of life, with substantial cost to society. Medically ill older adults are at particular risk for insomnia, since many medical illnesses disrupt sleep and impair alertness. Older adult insomnia is often treated pharmacologically, but older adults are especially vulnerable to adverse effects from hypnotic medication, such as memory impairment and impaired daytime performance.2

Fortunately, psychological interventions for insomnia have been developed and, especially in the last decade, applied to older adults with insomnia. several researches are done which includes research studies on a variety of important topics relevant to insomnia among older adults. These include the incidence and effects of insomnia, its causes, the measurement of insomnia, and outcome intervention studies. The interventions focus on psychological treatments of insomnia, including cognitive-behavioural techniques; sleep restriction and stimulus control approaches, and sleep hygiene. 2

According to Mrs. Seneca, "old age is an incurable disease". The appealing words by Sir. James Sterling Ross about old age is "you do not heal old age, you protect it, you promote it, you extent it". Although it is not possible to eliminate all the problems of the aged, but can alleviate most of them through adequate care and concern. Maintaining autonomy should be the basic objectives of care of elderly (WHO) 3

In the year of 2002, there were an estimated 605 million old persons in the world of which 400 million are living in low income countries. By 2025, the number of elderly people is expected to rise more than 1.2 billion with about 840 million of these in low income countries. In India although the percentage of aged is low in comparison to the developed countries nevertheless, the absolute size of aged population is considerable, that is 11.9%. 4

Discoveries in medical sciences and improved social conditions during past few decades have increased the life span of man. The age structure of the population in the developed countries has so evolved that the number of old people is continually on the increase. These trends are appearing in all the countries, were medical and social services are well developed and the standard of living is high.5

The development of medicine had been through a historical process and it was gradual. This process of development has been intrinsically connected and related to culture, economy, objective disease pattern and local understanding and interpretation of disease aetiology. Allopathic medicine is called conventional medicine and other major systems are called parallel to allopathic medicine.6

Today numerous systems of medicines continue to co-exist with allopathic medicine. Complementary and alternative medicine is very popular in the United States and abroad, at recent survey found that over 40% of US consumers used a complementary therapy over the course of last year. These therapies include, but are not limited to, herbal supplements, essential oils, high dose vitamins, amino acids and fish oils.

The term aromatherapy was coined in 1928 by Rene Maurice Gattefosse to define the use of essential oils to treat different conditions. Aromatherapy is known to some as a non-invasive and natural treatment that can help to balance body, mind, and energy. Some feel that the aromatic qualities of aromatherapy are only utilized effectively when supported by an applied approach such as massage. Most aromatherapy advocates agree that aromatherapy can assist an individual’s natural ability to maintain overall well being.

Many complementary and alternative medicines (CAM) have been used for mental health problems but there is little good evidence to support their use. Some of these treatments may work, but most have not been too small to give a clear answer. We know most about the treatments for depression, anxiety, and insomnia. Despite the lack of formal evidence, people all over the world take CAMs and many reports that they find them helpful. Ultimately, whether taking CAMs is a good idea depends on individual circumstances.

Aroma therapy is the use of pure essential oils from fragrant plants (such as Peppermint, Sweet Marjoram, and Rose) to help relieve health problems and improve the quality of life in general. The healing properties of aroma therapy are claimed to include promotion of relaxation and sleep, relief of pain, and reduction of depressive symptoms. 7

Aroma therapy has been used to reduce disturbed behaviour, to promote sleep and to stimulate motivational behaviour of people with dementia. Of the four randomized controlled trials found only one had useable data. The analysis of this one small trial showed a significant effect in favour of aroma therapy on measures of agitation and neuropsychiatric symptoms. More large-scale randomized controlled trials are needed before firm conclusions can be reached about the effectiveness of aroma therapy. 7


Sleep is essential for a person’s health and wellbeing, according to the National Sleep Foundation (NSF). Yet millions of people do not get enough sleep and many suffer from lack of sleep. For example, surveys conducted by the NSF (1999-2004) reveal that at least 40 million suffer from over 70 different sleep disorders and 60 percent of adults report having sleep problems a few nights a week or more. Most of those with these problems go undiagnosed and untreated.

Stress is the number one cause of short-term sleeping difficulties, according to sleep experts. Common triggers include school- or job-related pressures, a family or marriage problem and a serious illness or death in the family. Usually the sleep problem disappears when the stressful situation passes. However, if short-term sleep problems such as insomnia aren't managed properly from the beginning, they can persist long after the original stress has passed.

According to psychologist and sleep expert David F. Dinges, of the Division of Sleep and Chronobiology and Department of Psychiatry at the University of Pennsylvania School of Medicine, irritability, moodiness and disinhibition are some of the first signs a person experiences from lack of sleep. If a sleep-deprived person doesn’t sleep after the initial signs, the person may then start to experience apathy, slowed speech and flattened emotional responses, impaired memory and an inability to be novel or multitask. As a person gets to the point of falling asleep, he or she will fall into micro sleeps (5-10 seconds) that cause lapses in attention, nod off while doing an activity like driving or reading and then finally experience hypnologic hallucinations, the beginning of REM sleep.

Everyone’s individual sleep needs vary. In general, most healthy adults are built for 16 hours of wakefulness and need an average of eight hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six hours of sleep. Others can't perform at their peak unless they've slept ten hours. And, contrary to common myth, the need for sleep doesn't decline with age but the ability to sleep for six to eight hours at one time may be reduced.

The term alternative medicine is generally used to describe practices used independently or in place of conventional medicine. The term "complementary medicine" is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. The non pharmacological interventions of alternative medicine can employ mind- body interventions designed to reduce the pain and concomitant mood disturbances and increase quality of life. Patients often express interest in mind-body alternative system, because they offer a non-drug approach for treating rather than medical treatment 6

Aromatherapy provides health and body care on a completely natural basis, and the subtle qualities of the oils lend themselves best to a gradual experience. Only the highest quality of essential oils should be used in aromatherapy. The majority of essential oils produced in the world market are used in the food flavour and fragrance industry, so essential oils are often found on the market adulterated with similar essential oils, chemicals and synthetics.

Aromatherapy is the use of essential plant oils to help enhance health both physically and psychologically. By using essential oils to help heal the body we can minimize harmful side effects and heal the body gently and naturally. The aroma of essential oils is thought to provide the brain with the stimulation it needs to begin healing. The various essential oils contain different compounds that are useful in treating a wide range of different conditions. When the scent is inhaled through the nose it triggers a reaction in the body via the lungs.

Aromatherapy is the fastest growing of all complementary therapies among nurses in the United States. Although aromatherapy has been used by the public for recreation for thousands of years and by nurses throughout the world during the last 15 years, it is only in the last few years that aromatherapy has become recognized by US State Boards of Nursing as a legitimate part of holistic nursing. Aromatherapy is now set to become one of the most popular tools that nurses can use to enhance their nursing care and simultaneously empower themselves. 8


The practise of using these oils to balance the mind and body goes back many thousands of years. Ancient Chinese, Egyptian and Indian civilisations are known to have used oils extensively and, as the centuries progressed, the use of oils in the perfume industry grew steadily. The wonderfully effective march of orthodox medicine over the past hundred years meant the effects and benefits of essential oils were generally forgotten in the West, becoming the preserve of the hippy dippy culture. However, over the last few years there has been a remarkable resurgence of interest in these misunderstood yet powerful natural remedies.

In recent years, the American Academy of Sleep Medicine has studied non pharmacologic interventions for insomnia and found evidence to support their use in achieving sustained improvements in sleep parameters over time. Methods such as cognitive-behavioural therapy, stimulus-control therapy, relaxation, paradoxical intention, and sleep restriction are efficacious treatments that mental health practitioners can consider in the treatment of insomnia. Researchers are only beginning to review evidence concerning complementary and alternative medicine therapies (CAM); however, given the preponderance of patients who may be employing these techniques for insomnia, it is important that clinicians be familiar with these approaches, which merit further study. This article reviews non pharmacologic treatments for insomnia that are available to mental health practitioners as well as primary care providers, either via direct application of the techniques or by referral. The evidence for each of these modalities is presented in an effort to expand the treating physician's armamentarium beyond sole use of the medications traditionally used to treat insomnia. 9

Hence there is a need to assess the effect of aroma therapy for treating sleep disturbances among geriatrics, Since it is a major problem among the geriatrics. These instances provoked the investigator to select the pre experimental study to assess the effectiveness of aroma therapy in improving the quality of sleep among geriatrics in old age homes.


A study to assess the effectiveness of aroma therapy in improving quality of sleep among geriatrics at selected old age home, Bangalore.


1.  To assess the existing level of quality of sleep among geriatrics.

2.  To assess the post test level of quality of sleep among geriatrics.

3.  To assess effectiveness of aroma therapy in improving quality of sleep among geriatrics.

4.  To associate pre test score regarding aroma therapy in improving quality of sleep among geriatrics with their selected demographic variables.



It refers to the extent to which the quality of sleep is improved by aromatherapy among geriatrics.


Aromatherapy is a natural therapeutic practice. in this study it refers to the use of lavender oil. This oil is mainly used as home remedies, to promote sleep.

Quality of Sleep

It refers to the ability of a person to continue in a state of rest for the mind and body which is assessed by sleep assessment scale.


Those who have the age group between 60 to 70 residing at old age homes.


1.  Quality of sleep may vary among geriatrics

2.  The quality of sleep may be improved by aroma therapy among geriatrics.


H1: There will be a significant difference between pre and post test score of quality of sleep among geriatrics.

H2: There will be a significant association of pre test score in improving quality of sleep among geriatrics with their selected demographic variables.