RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1

NAME OF THE CANDIDATE

Ms. CHITHRA P.K

AND ADDRESS

Smt. NAGARATHNAMMA COLLEGE OF

NURSING,
SOLDEVANAHALLI,
HESARAGHATTA MAIN ROAD,

NAME OF THE

BANGALORE 560090
Smt. NAGARATHNAMMA COLLEGE OF

INSTITUTION

NURSING,
SOLDEVANAHALLI,
HESARAGHATTA MAIN ROAD,

3
4

COURSE OF THE STUDY

BANGALORE 560090
I YEAR M.SC NURSING

DATE OF ADMISSION TO

PSYCHIATRIC NURSING.
2-11-2009

THE COURSE
5
TITLE OF THE TOPIC

A STUDY TO ASESS THE

EFFECTIVENESS OF LAUGHTER
THERAPY IN REDUCTION OF STRESS
AMONG ELDERLY PEOPLE AT
SELECTED OLD AGE HOMES ,
BANGALORE.

BRIEF RESUME OF THE INTENDED WORK

6.1
NEED FOR THE STUDY:
We need to laugh more and seek stress reducing humor in our everyday lives.
Laughter is the human gift for coping and for survival. Laughter ringing, laughter pealing,
laughter roaring, laughter bubbling. Chuckling. Giggling. Snickering. Snorting. These are the
sounds of soul saving laughter which springs from our emotional core and helps us feel
better, see things more clearly, and creatively weigh and use our options. Laughter helps us
roll with the punches that inevitably come our way. The power of laughter is unleashed every
time we laugh. In today's stressful world, we need to laugh much more.

Stress has became a significant part of the health care environment ,the health care
administrators must address the effects of stress, and develop healthy stress management
responses . While many traditional stress management techniques may be effective ,humor is
a naturally occurring phenomenon as variable and individualized as stress .Humor helps us
make sense of understand and cope with reality as serves as a natures bio feedback ,stress
control system . Humor plays an important role in stress management and its use should be
recogonized and encouraged.1

Aging is a natural and gradual process of ,except under extreme circumstances

such as stress or grief .Aging of population is one of the most important development of the
20th century and will be one of the major challenges of the future. Stress and stress related
problems are identified more in old age.The problems of stress is often confused with the
problems of aging .But a recent study by WHO revealed that the problems of old age should
be carefully studied that there is more possibility to develop psychiatric problems like stress
disorders which are often shown by the onset of anxiety or depression4
In 1950 according to us estimates there were approximately 200 million aged(65
1

yrs) throughout the world .In 1975 their number had increased to 350 million .United
Nations projections to the year 2000 indicates that the number will increase to 590 million
and by the year 2025 to over 1100 million .That is a increase of 224 percentage since 1975.
Currently as per WHO estimates there are about 580 million older people in the world 2
A study was conducted about the social problems of the aged rural population in
India, the study reported 55 % of the old age people are being respected, 26 percentage were
neglected , 46.8 % were happy and 53.4 % were unhappy. The study revealed that stress
related problems such as depression are found commonly in the later group and the
government should take initiation for further more studies in the area.3
A study was conducted to examine the problems of old age by who in different
parts of the world by an epidemiological community survey .the survey stated that the old
age conjures up images of frustration and pity: sickness and poverty: despair and senility or
maturity and serenity : warmth and responsibility. The study revealed the risk of developing
stress disorders associated with the old age in case of late life stress. The study suggested
that ,many old people reach the end of life without ever had been mentally infirm.4

A study conducted In stress related problems recently stated that the stress and
stress related problems have various effects in the old age and the inability to adapt with the
stress is associated with the onset of anxiety and depression. Study also suggested that the
stress has been recognized as the second most prevalent psychiatric condition in the elderly
population. Psychotropic drugs are found less effective in controlling stress in old age where
as natural methods have proven more effective to cope with stress.5
Laughter is an approach that care givers can use to assist the elderly facing the
disappointments in the old age .The ability to laugh at oneself and at the others, stimulates,
trust, commitment and a positive sense of working together for both elderly and the care
giver. Laughter offers a tool for the patient , families and staff who deal with the old age in
the stress management.6

Laughter is a natural resource that can be used in managing personal and professional
2

stress. Laughter is an important skill in providing emotional support which is central to the
caring role of nursing. Effects of social stigmas and stressful hospital environment can be
reduced by laughter. Nurses should learn to integrate laughter practically and appropriately
there by facilitating emotional healing.7
Humor and laughter can be effective self care tool to cope with stress .An ability to
find humor gives as a sense of perspective on our problem. Laughter provides a release for
accumulated tension. Hence a study is required in using natural method like laughing in
stress reduction among the elderly.15

6.2
REVIEW OF LITERATURE
Review of literature on stress in old age
A study was conducted in Japan to clarify the relationship between late life and daily
life stressors in a representative sample of 10969 Japaneese subject methods. Data on 10969
elderly adults aged over 65 participated in Active health survey of health and welfare in 2000
was analyzed. The self administration questionnaire items of 21 reasons of life stressors and
mild moderate stress was examined using logistic regression analysis. A total of 21.9%of
subjects were having mild to moderate stress related problems and 9.3 % had shown onset of
depression. The study concluded that there is a significant relationship between late life and
daily life stresssors.9
A study was conducted to compare stress disorders in older adults and younger
adults with major stress disorders with psychotic features . it was a cross sectional study of
250 persons in which 142 were aged above 60 yrs and 117 from 18-59 yrs .The findings of
the study were consistent with those of community based epidemiologic survey that stress
disorders are as much as prevalent in older adults as in younger adults .14

A study was conducted to determine the prevalence and level of stress and stress
disorders and the influence of demographic characteristics on the symptoms in elders

residing in rural Taiwan. Also the , association was explored between stress disorders and life
stressors in the Taiwanese elderly stress inventory (TESI).A cross sectional design utilizing
face to face administered instruments was used. A total of 195 older community residents
participated in the study .Levels of stress were measured by stress test, 57% of the subjects
had a score of 7 indicating that the majority is under some kind of stress. The study
alsoElders who are staying alone or those who are living in any institutionalized settings
other than the family were found to have relatively high stress levels when compared to
those living with the spouse and family.8
Review of literature on laughter therapy in reduction of stress
Stress and stress related problems have became a severe issue in the health
care system .A study was focused on evaluating the effects of laughter therapy on the elderly
people with stress disorders in a subtropical climate area .The design used was experimental
design . For the experimental group, patients sat to watch humorous video cartoons .The
course was administered for 50 minutes per day and lasted for five days . The control group
didnt received any treatment .Results showed that stress symptoms were significantly
reduced in the experimental group at post test but no significant decline was found in control
group.17
A study was conducted to know the effect of humor on the wellbeing of the older
adults. The study suggested that laughter releases excessive physical and psychological
energy, and it reduces stress. The study also suggested that laughter can be used as a skillful
nursing intervention That can enhance the overall wellbeing of the older adults. The study
found that nurses should be encouraged to explore the use of humor and laughter with the old
age in order to cope with the everyday stress.10
A study conducted in Florida state university examined the relationship between
humor and coping strategies of stress .A structural equation model with latent variable was
specified for the two variables .Participants completed the multidimensional junctional
assessment questionnaire of coping humor scale . The relationship between the coping
strategies and humor was statistically significant The study found out that humor can be used
as a coping strategy of stress for older adults.11

A study was conducted to examine the relation of laugher and stress .The method
used for the study was questionnaire method. The subjects under study viewed
humorous and sad cartoons. Mood was significantly altered after the sad cartoon.
Coping humor, part of the sense of humor questionnaire, was associated with less
negative mood ratings after the sad cartoon. In terms of main effects, only a modest
change in the mood was found after the humorous cartoon with a more positive
moderating. The authors suggest that coping humor serves a protective psychological
function helping screen the person from negative stimuli and thus from negative
reaction. Attentional bias towards humor serves a different protective psychological
function by helping the person focus on mood enhancing stimuli in the environment.12

Laughter facilitates the adaptive response to stress by increasing the

psychological distance from distress and by enhancing social relations .To test thes
hypothesis the researcher related measures of bereaved adults . Laughter and smiling 6
months post loss to measure of their (a) subjective emotion and dissociation from
distress, (b) social relations (c) responses they evoked in others. Laughter involves
orbicularis oculi muscle action, related to self reports of reduced anger and increased
enjoyment, the dissociation of distress, better social relations and positive responses
from strangers. The study revealed that laughter can reduce stress and increase the
quality of life in older adults.13

A co relational descriptive study examined the relationship between the uses of

humor and reduction of stress as measured by perceived health .The sample of this pilot
study consisted of 24 volunteers from a senior citizen community centre who are
ambulatory adults over 61 years old . Subjects were administered questionnaires which
consisted of a demographic data sheet , the situational humor response questionnaire ,
coping humor scale ,current health subscale and life satisfaction index. The findings
suggested that humor is the one phenomenon which influences the older adults in
coping stress.16
A study was conducted to examine the effects of humor and laughter on physical
5

health. Findings of the study suggested that there is a significant correlation has been
found between trait measures of humor and stress. The study evidenced stress
moderating effects of humor on physical health variables.5

6.3

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of laughter therapy in reduction of stress among elderly
people at selected old age homes, Bangalore.

6.4

OBJECTIVES OF THE STUDY

1.To assess the level of stress among elderly people.
2. To find out the effectiveness of laughter therapy in terms of reduction of stress
3. To find out the relationship between level of stress and laughter therapy

4.To find out the association between level of stress and selected demographic variable

6.5

OPERATIONAL DEFINITIONS
Effectiveness: In this study effectiveness refers to the extent to which laughter therapy has
achieved the desired effect in terms of reduction of post test stress score of the subjects
studied
Stress: In this study stress denotes the state that

causes physical, psychological and

psychosocial disturbances an its levels can be detected using stress test (stress response
scale)
Laughter therapy: In this study laughter denotes to the use of laughter as a regular exercise
for a fixed time and period , where its effects (reduction of stress) can be seen in post test
6

scores after completing the course of exercise.

Elderly people: In this study elderly peoples are those who comes under the age group of
65-75 years of age.

6.6

HYPOTHESIS
H1.

There will be significant difference between the mean pretest and post test stress
Score of the subjects studied.

H2.

There will be significant relationship between level of stress and laughter therapy.

H3

There will be significant association between level of stress and selected

demographic variables.

6.7

ASSUMPTIONS
The study assumes that
1. Level of stress among old age people is comparatively high for those who are
residing in old age homes than the others.
2. Level of stress can be measured using appropriate tool.
3. Laughter therapy had been found useful in relieving stress.

6.8

DELIMITATIONS
The study is limited to:
1. The study is limited to old age men and women who are aged above 65yrs.
2. The study is limited to elderly people residing at selected old age homes, Bangalore.
3. .The study is limited to elderly people who can read and write Kannada and English

6.9

PROJECTED OUTCOME
1. The study may help in exploring effectiveness of laughter therapy in
reduction of stress among elderly people residing at old age homes.
2. The study will help to identify the level of stress in elderly people.

METHODS AND MATERIALS

7.1

SOURCE OF DATA

The data will be collected from old age people who

are residing at selected old age homes, Bangalore.

SAMPLING CRITERIA
Elderly people :

INCLUSION CRITERIA

1. who are residing at selected old age homes,

Bangalore
2. who are willing to participate in the
study.
3. who are available at the time of study.
4. who are mentally and physically fit for the study.
5.who can read and write Kannada..

EXCLUSION CRITERA

Elderly people :
1. who are not willing to participate in the
2.

study.
who are not available at the time of the
study.

7.2.2

RESEARCH DESIGN

Quasi experimental study.

7.2.3

VARIABLES UNDER STUDY

Independent variable; Laughter therapy.

Dependent variable; Stress.
Extraneous variable; Age, sex, marital status,

7.2.4

SETTING:

7.2.5

SAMPLING TECHNIQUE

7.2.6

SAMPLE SIZE

Present environmental condition.

The study will be conducted in selected old age
homes, Bangalore.

Simple random sampling.

Sample consists of ; 60 elderly people who are
residing at Selected old age homes, Bangalore.

7.2.7

Appropriate structured questionnaire is used to

TOOL OF RESEARCH

collect data from elderly people.

Structured questionnaire schedule consists following
section:
Section A: deals with the demographic variables of
elderly people residing at selected old age homes,
Bangalore.
Section B:. Structured questionnaire (to assess the
level of stress among old age people residing at
selected old age homes )

7.2.8

1.A prior permission will be obtained from the

COLLECTION OF DATA

old age home authority for collecting the required

data.
2.Informed consent will be obtained from the elderly

people
3.Duration of data collection is 30 days.

7.2.9

METHOD OF DATA

The data collected will be analyzed by using

ANALYSIS AND

descriptive and inferential statistics.

PRESENTATION

Descriptive

Statistics:

Frequency

and

percentage for data analysis of demographic

data, central tendency and standard deviation
will be used for assessing the level of stress

in old age.
Inferential Statistics: Chi- square test will
be used to find out the association between
stress and selected demographic variables.
And paired t test will be used for assessing
the effectiveness of laughter therapy.

7.3

DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR ANY
OTHER HUMANS OR ANIMALS? IF SO,PLEASE DESCRIBE
BRIEFLY.
YES.

7.4

HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION
1. Ethical clearance will be obtained from the research committee of
Smt.Nagarathnamma college of nursing.
2. Permission will be obtained priorly from the authority of Smt Nagarathnamma college
10

of nursing.
3. Consent will be taken priorly from the elderly people who are who are willing to
participate in the study.

LIST OF REFERENCES:
1. Woodhouse D.K : Humor in dealing with stress : Nursing administration
journal:1993;18(1):80-9, Available from URL.http.pubmed.com.
2. Anupam A, Sharma O.P : The international year of older persons, Journal of
Indian
Medical Association, 1999 :91 ; 4
3. Charan Singh: Social problems of the aged in rural population of India,
Journal of
Community medicine: 1995 : 20(1) :247.
4. W H O Health forum : 1999 : 11(1) : 25
5. Sely H : The stress of life , Mc Grow hill book company publications, New
York, 1965,

Page no:142.
6. Wooten P : Journal of geriatric nursing, Sept- Oct 13(5) : 267 .Available from
URL.http.www.pubmed.com.
7. Davidhizar

: Humor : No geriatric nurse should be without it ; Journal: Geriatric

nursing ; Sept-oct ; 13(5) :276-8. Available from URL:http://www.pubmed.com

8. Wang JJ :Prevalence and correlates of stress in elderly, Available from
URL.http.www.pubmed.com
9. Kaji T ,Mishima K : Relationship between late life and life stressors ;2010 May 18
;Available from URL.http.pubmed.com.
11

10. Tennant K.F : Journal Gerontol Nursing , Laugh it off : 1990 December ; 16(12) 11- 17 Available from URL:http://www.pubmed.com
11. Celso B.G ,Ebner G ,Brukhead EJ: Humor coping in older adults residing in assiasted
living facilities: Journal; Aging Mental Health;2003 November< 7(6):438-45.
Available from URL:http://www.pubmed.com
12. Moran C.C , Massam M .M : Behavioural medicine , Spring publications , page
No 42-48, Available from URL:http://www.pubmed.com
13. Martin R.A : Psychol Bull : Humor ,Laughter and Physical health , 2001 July : 127(4):
504-19
14. Flint A, Peasley C,: Geriatric psychiatry ,2010 May 18 (5)404-12 ,Available from
URL.http.www.pubmed.com.

15. Paquet J B : Laughter and stress management :1993 November-December ;15(6):1317 Available from URL:http://www.pubmed.com
16. Simon J M ;Journal Issues Of Mental Health Nursing ; Humor and its relationship to
Perceivedhealth,1990;11(1): 7-31 ,Available from:

URL:http://www.pubmed.co

17. Seaward B L : Humor healing potential: Health programme :Available from

URL.http.www.pubmed.com

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13

SIGNATURE OF THE
CANDIDATE

CHITHRA P.K

10

REMARKS OF THE GUIDE

Recommended

11

NAME AND DESIGNATION

11.1

GUIDE

11.2

SIGNATURE

11.3

CO-GUIDE

11.4

SIGNATURE

11.5

HEAD OF THE DEPARTMENT

11.6

SIGNATURE

12

REMARKS OF THE CHAIRMAN

OR PRINCIPAL

12.1

SIGNATURE

PROF.YASHODAMMA
DEPT.MENTAL HEALTH
NURSING
Smt. NAGARATHNAMMA
COLLEGE OF NURSING,
BANGALORE
MR. DHANPAL . H.N
LECTURER, PSYCHIATRIC
NURSING.

14

PROF.YASHODAMMA
DEPT.MENTAL HEALTH
NURSING
Smt. NAGARATHNAMMA
COLLEGE OF NURSING,
BANGALORE

Recommended

Rajiv Gandhi University of Health Sciences, Karnataka

Curriculum Development Cell
CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Registration number
Name of the candidate
Address

Ms.chithra p.k
89/90,soldevanahalli,hesarghatta main
road,Bangalore-90

Name of the institution

Smt.Nagarathnamma college of nursing

Course of study and subject

M.sc.in Mental Health Nursing

Date of admission to course

Title of the topic

2-11-2009

A study to assess the effectiveness of laughter

therapy in reduction of stress among elderly people at
selected old age homes, Bangalore

Brief resume of the intended work

Attached

Signature of the student

Ms.chithra p.k

Guide name

Prof.M.V.Yashodamma

Remarks of the guide

Co-guide name

Mr. Dhanpal H.N

Signature of the co-guide

HOD Name

Prof.M.V.Yashodamma

Signature of the HOD

Principal Name

Prof.M.V. Yashodamma

Principal mobile number

Principal e-mail ID

9845281432
yashodamma@acharya.ac.in

Remarks of the principal

Principal signature

15

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