“Age is an issue of mind over matter, If you don’t mind it doesn’t matter” – Mark Twain

Advance age   could be   associated to bodily, biological and mental changes, which starts
with lifestyles and maintains for the duration of the lifestyle cycle. Aging is inspired through
bodily and environmental situations like home, neighbours, groups and societies.  Advance
age  is additionally inspired through ethnicity, gender and socioeconomic status.

It is important to distinguish the ageing process from the process of ageing. The ageing
process (‘normal ageing’) represents the universal biological changes that occur with age and
are unaffected by disease and environmental influences. For statistical and public
administrative purposes, however, old age is frequently defined as 60 or 65 years of age or
older.

According to WHO –Most developed countries have accepted the chronological age of 65
years and above as a definition of ‘elderly’ or older persons. According to UN-60+years will
be referred as the older population or elderly,Young old-Upto 75 year,Old old-Upto 85
years,Very old –Over 85 years[1]

In India, life expectancy has increased over the last 70 years. Life expectancy at birth was
36.7 years in 1951, and it is now around 67 years, according to 2012 data. As a result, India's
elderly population has increased from 5.6 percent in 1961 to 8.5 percent in 2011, and is
expected to rise to 9 percent by 2016. India currently has the world's second-largest elderly
population.[2]

Stress is unavoidable. It's an unavoidable truth of life. The types of pressures that people face
and how they respond to them, on the other hand, change throughout time. When a person is
exposed to a physical or psychological stressor, two hormonal systems are engaged to help
the person cope with the circumstance. The first is mediated by the sympathetic nervous
system's fast responses, which result in the release of adrenaline and norepinephrine into the
bloodstream. It is an instant response to stress that mediates the temporary "fight-or-flight"
response.

The hypothalamic-pituitary-adrenal (HPA) axis mediates the second hormonal response,

which is slower and more prolonged. This response is triggered by a group of neurons in the
hypothalamic paraventricular nucleus (PVN) that generate corticotropin-releasing hormone
(CRH).
The pituitary is instructed to release adrenocorticotropic hormone (ACTH) by CRH (ACTH).
The adrenal glands are stimulated to produce and produce glucocorticoids in response to
ACTH. (i.e., cortisol in humans). Once the stressor has passed, the glucocorticoids function
as a negative cycle on the pituitary gland and a number of forebrain regions, including the
hypothalamus and prefrontal cortex, eventually terminating the reaction by lowering CRH
and ACTH production and release.The brain is thus both the initiator and a significant target
of the glucocorticoid response in the context of the HPA reaction to stress.

Symptoms of stress may be Physiological:insomnia, nightmare,loss of appetite,palpitation,

frequent urination,muscle pain and tiredness and Emotional and psychological symptoms
may be anxiety, fear, frustration, depression,restlessness, poor concentration, forgetfulness
etc.[4]

Factors causing stress in old age may includes environmental stressors, physiological
stressors, social stressors and life style changes of any kind. The outcome of this induced
stress can be feeling of insecurity, rejection, need for approval and inability to cope with
changed circumstances. Interpersonal issues and organization issues also can induce
stress.[5](Sreevani.R; 2007)

Stress and ageing have a causal relationship. In recent years, scientists have conducted
experiments that show stress damage to DNA is the primary cause of wrinkles, grey hair,
and diseases that can shorten our lives.
Interpersonal therapy, psychodynamic therapy, meditation, yoga, and music therapy are all
effective therapies., Geriatric patients should be encouraged to engage in regular exercise,
abstain from various substances, including smoking, and develop hobbies to keep themselves
occupied..[6]

At the baseline evaluation, a good outcome was associated with a shorter length of the
episode and combined family system assistance. Massage therapy has been shown to be a
useful strategy in intervening in a long-term stress response and reducing cortisol levels in
numerous research conducted at the Touch Institute at the University of Miami. Men and
women over the age of 60 who had high cortisol levels scored poorly on memory tests,
according to a study.[7]

NEED OF THE STUDY

The proportion of the elderly population in society is growing by the day as the average life
span increases. In contrast to a lifetime, however, as one gets older, the risk of physical and
mental illnesses rises. Age is a significant factor in mental health. Maturity may be a period
of transition during which one must deal with not only physical ageing but also challenges to
one's mental and social well-being.
Among the various mental disorders, stress has the greatest impact on the elderly. Although
India is the second-most populous country within the world in terms of the elderly
population. [8].

The global population is rapidly ageing. The proportion of older adults in the world is
expected to nearly double between 2015 and 2050, from about 12% to 22%. In absolute
terms, this translates to a rise in the number of people over 60 from 900 million to 2 billion.
Elderly people face unique physical and mental challenges that must be addressed.

According to Ageing and health program (2005), there are currently 580 million people in the
world who are aged 60 years and above. This is expected to rise to 1000 million by 2020 with
over 700 million in the developing world. Older people over 60% of them live in developing
countries.
Over 20% of adults aged 65 and up suffer from a mental or neurological disease (excluding
headache disorders), and mental and neurological disorders account for 6.6 % of all disability
(disability-adjusted life years-DALYs) among people aged 65 and up. . This can result in a
state of psychosis and impaired day-to-day functioning. A major depressive episode affects
7% of the population over the age of 65. At any point in one's life, there may be multiple risk
factors for mental health issues[9].

Life stressors that are more common in later life, such as a loss of capacities and a decline in
functional ability, may affect older people. For example, older adults may have reduced
mobility, chronic pain, or other health issues that involve long-term care. Moreover, with
retirement, older people are more likely to experience events such as a drop in socioeconomic
status. All of these stressors can lead to isolation, loneliness, or psychological distress in
seniors, which may demand has an impact on physical health appropriate care.

Mental health affects physical health, and vice versa. For example, older adults with physical
health problems like heart disease have higher rates of depression than those who are in good
health. In addition, untreated depression can have a negative impact on the outcome of a heart
attack in an older person.

Elder population constitutes one of the weakest sections of society. They are not only
physically fragile but also lack in economic resources, self-esteem and social status. Globally
geriatric population was 382 million in 1980 which is hiked more than twice as large as 962
million in 2017 and it is expected to reach closely 2.1 billion by 2050. May Zhou. Aging
population a global challenge.[10]

In India, the elderly population was approximately about 104 million in 2011 according to
the Population Census. It is estimated to grow to 173 million by 2026, suggests by the United
Nations Population Fund and Help Age India.[11]

Elderly people are more prone to disease and disability, but they are physically different
about the mental health of those whom they accept. Some mental problems within this period
of life are more prevalent.[4] Some of the common physical and psychological problems are
dependency, ill health, absence of social security, loss of social role and recognition and non-
availability of opportunities for creative use of leisure. Stress is a common problem among
these. Stress and new diseases of civilization today is the growth of many physical and
mental diseases.

There are various therapies which are used to treat stress such as laughter therapy
reminiscence therapy, guided imagery technique, pet therapy, activity therapy, mediation,
Yoga and hug therapy.

Towhid Babazadeh1 , Reza Sarkhoshi2 , Farhad Bahadori3 , Fatemeh Moradi4 , Fariba

Shariat5 , (2014-2015 )[12]Prevalence of depression, anxiety and stress disorders in elderly
people residing in Khoy, Iran. This cross-sectional study was done on 383 elderly people
referred to health centers in Khoy County. A random cluster sampling was used in this study
where each health care is considered as a cluster. The Depression, Anxiety, Stress Scale 21
(DASS-21) standard questionnaires was used for data collection. The SPSS software was
used for all computations. Data were analyzed using descriptive statistic, t-test, and one-way
ANOVA. P < 0.050 was determined to be significant. Results: The results of this study
showed that 1.3% of the elderly people suffer from very severe stress, 1.3% from severe
depression, and 3.1% from severe anxiety.
Geetha Mani, Sharath Udayakumar, Kalaivani Annamalai, D Jegadeesh
Ramasamy(2014)[13]Perceived levels of stress and its correlates among residents of old age
home in Kanchipuram District, Tamil NaduThe elderly in old age homes are a distinct
population with lack of family and social support contributing to an increased prevalence of
stress. This study was carried out to assess the perceived stress among inmates of an old age
home in Kanchipuram District, Tamil Nadu.A descriptive, cross-sectional study was
conducted among 100 inmates of an old age home in Kanchipuram District, Tamil Nadu
between May and July 2012, using a semi-structured questionnaire. Perceived levels of Stress
among elderly were assessed using the perceived stress scale-10.  Results was 18% of the
participants had high stress scores and 60% had moderate stress scores. Gender, co-living
status with spouse was found to be significantly associated with stress scores. 

Limited studies are available in india for prevalence of stress among elderly.This study will
be of great help in implementing health services to address stress among the elderly.Hence an
efforts is being made through the present study to provide information on prevalence of stress
among elderly in selected areas of District Mohali,Punjab.

Review of literature-

A review of literature on the research topic makes the researcher familiar with the

existing studies and provides a foundation upon which to base new knowledge. It
involves the systematic identification, location, scrutiny and summary of written
materials that contain information on a research problem. A review of literature related
to these aspects has been presented in this chapter under two major dimensions;

2.1 Literature on Level of Stress.

2.2 Literature on Coping Strategies adopted by elderly

Bince Varghese*, Saniya Susan Issac*, Jubin Varghese(2020) A Descriptive Study to

Assess the Level of Stress among Elderly People Residing at Old Age Homes, Uttar Pradesh
(India) This study aimed to determine the level of stress among elderly people in selected old
age homes and to find out various factors associated with it. A quantitative research approach
with non-experimental survey design was used to conduct the study in selected Old age
homes of Uttar Pradesh. Non-probability purposive sampling technique was employed to
select 30 elders. A standardized Perceived Stress Scale containing 10 items were used for
assessing the level of stress among the subjects. Data was analyzed using SPSS version 25.
Results of the study was 46.7% elders who reside at old age homes had moderate stress
followed by 30% high level of stress and 23.3% low stress. (Varghese B, Issac SS,
Varghese J. A descriptive study to assess the level of stress among elderly people
residing at Old Age Homes, Uttar Pradesh (India). International Journal of Research
and Review. 2020; 7(11): 392-395)

Elsa sanatombi Devi(2007) a study was conducted to determine the perceived depressive

feeling experienced by elderly client above the age of 60 years. The aim of the study to assess

depressive feeling from the 100 clients from udhyavara village. By using of non probability

convenior sampling technique and by using of demographic, socio economic status scale. The

individual scoring mild stress( 0-10), moderate stress( 11-21), severe depression(22-32). The

result of this study, majority of perceived depressive feeling experienced by 50% of elderly

clients ( between the age group of 60-69 years). Out of 100 elderly clients 16 were

hypertensive people.www.indiatigether. Org/2 008/mar/soc-oldage.hmtl

R. Sreevani (2007) a study was conducted about emotional problems among elderly people.
She has selected 50 elderly people , by using of questionare and demographic data sheet, she
shows that 60-70years elders are having 54% of emotional problems, 71-80 years elders are
having 32% of emotional problems, 80 years elders ae having 14% of emotional problems.

PERCEIVED STRESS AND

DEPRESSION AMONG
ELDERLY PEOPLE
RESIDING AT OLD AGE
HOME
Karpagavalli Nageswaran1
and Suresh Ray2
1,2BharatiVidyapeeth Deemed
University College of Nursing
ARTICLE INFO
ABSTRACT

Introduction: Depression is a common

public health issue with the increasing
life expectancy
world wild and depression is associated
with morbidity as well as disability
among the elderly. The
aim of the study was, to assess the
perceived stress and depression among
elderly people residing at
selected old age homes. Methodology:
Descriptive survey design and purposive
sampling used in
the study. 200 subjects who met
sampling criteria. The tool consists of
three sections, section A:
demographic variables, section B:
perceived stress scale and section C:
geriatrics depression scale.
Conclusion: The results are 48.5% of
samples had slightly higher than
average level of perce

PERCEIVED STRESS AND

DEPRESSION AMONG
ELDERLY PEOPLE
RESIDING AT OLD AGE
HOME
Karpagavalli Nageswaran1
and Suresh Ray2
1,2BharatiVidyapeeth Deemed
University College of Nursing
ARTICLE INFO
ABSTRACT

Introduction: Depression is a common

public health issue with the increasing
life expectancy
world wild and depression is associated
with morbidity as well as disability
among the elderly. The
aim of the study was, to assess the
perceived stress and depression among
elderly people residing at
selected old age homes. Methodology:
Descriptive survey design and purposive
sampling used in
the study. 200 subjects who met
sampling criteria. The tool consists of
three sections, section A:
demographic variables, section B:
perceived stress scale and section C:
geriatrics depression scale.
Conclusion: The results are 48.5% of
samples had slightly higher than
average level of perce
The journal named “Health Action” (2007) published a cover story on “Common geriatric
problems”. In this article clearly stated that one problem as stress. Common sources of stress
for the elderly included, change of life style and financial status after retirement, caring for
grand children, caring for a sick spouse, death of relatives, beloved or close friends,
deterioration of physical abilities and chronic illness, worries for not being able to live
independently and worries for institutionalization. Management for this stress includes, share
their difficulties and feelings, an active social life, healthy life style and relaxation exercises
are all useful ways to handle stress, engaging in volunteer work is a means to help those who
are less fortunate, positive thinking and can seek professional’s help. Mental health disorders
are a major problems and threat to older adults and their families. It is estimated that as many
as 15%-20% of elderly have a mental or psychiatric disorders that is significant enough to
require evaluation and treatement. www. medscape.com
 1 2
Karpagavalli Nageswaran and Suresh Ray (2016)perceived stress and depression
among elderly people residing at old age home. The aim of the study was, to assess the
perceived stress and depression among elderly people residing at selected old age homes.
Descriptive survey design and purposive sampling used in the study. 200 subjects who
met sampling criteria. The tool consists of demographic variables, perceived stress scale
and geriatrics depression scale. The results are 48.5% of samples had slightly higher than
average level of perceived stress, 58.5% of samples had mild level depression.
Saba Yasien, Tabassum Alvi (2018) conducted this cross-sectional study which aimed to
assess the level of stress and association of coping strategies with perceived stress
among the sample of 200 medical students aged between18 to 26 years participated.
Demographic

questionnaire, perceived stress scale and brief cope scale were administered. Descriptive

statistics, t-tests and multiple hierarchal regression was employed for statistical analysis.

Findings indicated that 29% of the medical students were found to be less stressed, 26%
were moderately stressed and 20% were highly stressed. There was no gender difference
in the level of stress. Coping strategies of self-blame and denial emerged as significant
positive predictors of stress. Beside healthy coping strategies, they are using
maladaptive coping strategies. 

Parveena A.,KarthikeyanG.(2018) conducted a study to determine the prevalence and

patterns of depression, anxiety and stress among 400 school going adolescents studying
in

classes 10th to 12th of Tirunelveli district, Tamilnadu, India. Depression, anxiety and
stress were assessed by using DASS21 questionnaire. The results revealed that the
prevalence of depression, anxiety and stress was 73.6%, 86.5% and 24.7% respectively.
Depression,Anxiety, and stress were significantly observed more among 10th class
students as compared to other classes.

Kumar S., Akoijam B.(2017) conducted this cross-sectional study to determine the
prevalence of depression, anxiety, and stress among 830 higher secondary school
students of Imphal and to assess the association between depression, anxiety, and stress
with selected variables The study tool used was a questionnaire containing DASS
(Depression Anxiety Stress Scale) and socio demographic characteristics. Results
revealed that the prevalence of depression, anxiety, and stress were 19.5%, 24.4%, and
21.1%, respectively. In total, 81.6% of the respondents had at least one of the studied
disorders and 34.7% of the respondents had all the three negative states.

Essel G,Owusu P (2017) examined the impact of stress on students’ academic

performance and stress management among students of Seinajoki University of Applied
Sciences by distributing questionnaires to two students group consisted of Finnish and
international students. A quantitative method was used for gathering and analyzing the
data. The results obtained showed that Conflicts with parents took the least percentage
with 25%, Working with new people had the greatest percentage of 82%. % followed by
troubles with boyfriends and girlfriends with 40% and apartment or roommate conflicts
was next with 35%.

Prabhu SG., Shekhar R.(2017) investigated the Perceived Stress, PSS, to understand
the gender differences in level of PSS and resilience among 206 school going
adolescents from grades 8 th to 10th of the four schools in Mangaluru city of Southern
India. A cross sectional descriptive research design was used. Data were collected
through self administered scales. Descriptive statistics and ttest were applied. The results
showed that the mean age of the study sample was 14.10 (±0.896) years. The mean score
for Perceived Stress (17.71), PSS (5.6922) , Family support (5.9551) ,Support from
friends (5.5097) ,Support from significant others (5.7193) Adolescents had mild level of
perceived stress, high PSS, and moderate resilience

Singh R. (2016) conducted the present study to investigate the stress in relation to

psychological hardiness, gender, locale-wise, differences in various dimensions and

components of stress among 200 adolescents(100 rural and 100 urban) studying in 10+1
and 10+2 classes in four schools of the Muktsar Sahib District of Punjab. Dr. Abha Rani
Bisht&#39;s Battery of Stress Scales and Nowack&#39;s Psychological Hardiness Scale
were employed to collect the data. Results reported that the value of mean score for
existential stress for school going male adolescents was found to be 267.40 and that for
school-going female adolescents was found to be 319.25.The value of mean score for
Existential Stress for school going urban adolescents was found to be 306.52 and that for
school going rural adolescents, it was 280.12.The value of mean score for Frustration
component of stress for school-going urban adolescents was 1013.50 and for rural
adolescents was 963.88.The value of Pearson&#39;scoefficient of correlation was found
to be - 0.139, which was significant at 0.05 level.Therefore, there was significant
negative correlation between Stress and Psychological Hardiness.

Kishore J.Kohli C. (2015) conducted the cross-sectional study to assess the prevalence
of stress and stress causing factors among 397 school adolescents of Delhi. Simple
random sampling sampling technique was used in the study. A pretested self
administered questionnaire was used for the data collection. The findings revealed that
348 (87.6%) were positive for stress. Stress was present among 139 (89.7%) female
students and 209 (86.4%) male students.

Review related to adopted coping strategies

Hema, (2010), conducted a study to assess the effectiveness of selected relaxation

techniques to reduce the level of stress among senior citizens residing in selected old age
home, at Coimbatore. The pre experimental design was used for the study and 60 senior
citizens. Modified stress assessment rating scale, which was used before and after
structured teaching programme. There is significant difference between pretest and post
test stress score (‘t’value=23.715, p< 0.05). The Mean score of pretest and post test level
of stress were 83.25(SD+ 11.75) and 49.6 (SD+ 10.09). Results of inferential statistics
(chi square valueX2 = 23, p< 0.05) identified that dissatisfaction (or) lack of support
system is the major predictor of distress among satisfaction (or) lack of support system
is the major predictor of distress among senior citizens living in old age home.

David M. Almeida., (2005), conducted a study on Resilience and Vulnerability to Daily

Stressors Assessed via Diary Methods Research on daily stressors has benefited from
diary in Pennsylvania. Which used a telephone-diary design, highlight how people’s age,
gender, and education and the presence or absence of chronic stressors in their lives
predict their exposure and reactivity to daily stressors. Respondents reported
experiencing on average at least one stressor on 40% of the study days and multiple
stressors on 10% of the study days. Approximately 30% of the reported stressors
involved some sort of loss (e.g., of money), nearly 37% posed danger (e.g., potential for
future loss), and 27% were frustrations or events over which the respondent felt he or
she had no control.

Coping-Jeannine L .M. Liddleet. al., (2014), conducted a study on the conceptualizing

older women’s participation in art and craft activities. The result explores the nature of
older women’s participation in art and craft activities and conceptualizes links between
participation in these activities and health and wellbeing in late life .By participating in
art and craft activities, older women find purpose in their lives, contributing to their
subjective wellbeing whilst helping and being appreciated by others.

Sunjin Nancy Choe (2014), conducted a qualitative study on qualities and features of
art apps for art therapy. The study included a questionnaire survey of 4 art therapists
using ipads with clients in therapy and 4 separate focus groups with 15 art therapist
participants. The focus group participants engaged in art directives with mine art making
apps identified as potentially useful in art therapy. The results revealed that while no
single commercial art app satisfied the needs of all art therapists and potential clients,
three distinct qualities and 6 concrete features of an “ideal” art app for art therapy. While
the findings revealed unlimited possibilities for the meaningful use of digital art media
in art therapy, they also acknowledge how the unique characteristics of digital art media
will require carefully considered limitations and restrictions.

Tinker A.M. et. al., (2008),conducted a study on creativity in later life to assess the
social interaction, quality of life, and their well being in late life. The study revealed
that, the ability to be creative may be one such strategy, and examines current public
health policy related to creativity in old age with the aim of highlighting some important
issues. The study presented that creative activity could be a useful tool for individuals
and society.

Frances Reynolds (2008), conducted a study on the visual art making as a leisure
activity on old age subjective well being. This study examined old age motives for
visual art making. Thirty two participants aged 60-86 years old were interviewed 12
lived with chronic illness, 20 reported good health. Nearly all had taken up art after
retirement; 2 had since become professional artists. Participants described their art
making as enriching their mental life, promoting enjoyment of the sensuality of colour
and texture, presenting new challenges. It encouraged attention to the aesthetics of the
physical environment, preserved equal status relationships, and created opportunities for
validation.

Darryl R. Haslam., (2006), conducted study on the practice patterns and attitudes on
family play therapy. There were 442 responses, the sample was predominantly female
(88.4%) which was surprisingly consistent report of APT’s gender Family Play Therapy
 88 composition among play therapists (e.g., female = 89.7%). As far as ethnicity
(n=294), the sample was largely White/Caucasian therapists (89.5%) with relatively few
from other ethnic or cultural backgrounds. The mean age for the sample was 45 years
(SD= 11.7) and a range of 24 to 73 years. Most participants (79%) were between ages
30 and 59, with the largest age range being those in their 50s (30.0%). The vast majority
of participants held masters degrees 19(78.9%) with 17.3% having doctoral degrees. The
average years of clinical practice was 11.2 (SD= 8.6), with a range of 0 to 45 years.
Specifically, 57.9% of the group had been in practice for 10 years or less, while 28.4%
had been in practice between 11 and 20 years and 9.6% for 21 to 30 years.

Chapter3

Methodology

Chapter3

Methodology

The chapter deals with the comparative study of methodology includes the research
approach ,research design, research setting, population, sample, criteria for sample
selection ,sample size, and sampling procedure, validity, reliability, data collection procedure
and plan for data analysis. Research methodology is a way to systematically solve the
research problem. It may be understood as a science of studying how research is done
scientifically.

Research Approach

Descriptive Research Aapproach will be used.

Research Design-

Comparative Research Design will be used.

Setting of The Study

The study will be conducted in the selected areas of District Mohali, Punjab.

Population

All elderly between the age 65years and above.

Sample And Sampling Technique

The sample will consist of 100 elderly people residing in selected areas of District Mohali,
Punjab.

Inclusion Criteria

The study includes elderly who will be:

 Between the age group of 65 years and above.

 Present at the time of data collection.
 Willing to participate in the data collection.

Exclusion Criteria-

 The study excludes elderly who will be mentally sick and challenged.
 unavailable during the data collection.

Resarch Variables-

 Stress and coping strategies

Development Of The Tool-

 Section A - Socio-Demographic variables.

 Section B - Perceived stress scale
 Section C - Self structured checklist to assess the adopted Coping Strategies
among elderly.

Validation of the tool –

The validity of tool will be determined by experts opinion.

Reliability of the tool-

 Perceived stress scale is a classical stress assessment instrument.

 The Self structured checklist to assess the adopted coping strategies among
elderly.The reliability will be determined by split half method

Pilot Study-
 The study will be conducted on 10 subjects from the selected areas of District Mohali,
Punjab to assess the feasibility in conducting the main study and to obtain information for
improving the project.

Ethical consideration –

 Approval will be taken from ethical and research committee of SPHE College of Nursing
Gharuan ,Mohali, Punjab.
 Permission from concerned authority will be taken to conduct the study.
 Written informed consent will be taken from the subject.
 Confidentiality of information will be maintained.

Plan for Data Analysis-

Analysis and interpretation of data will be done according to the objectives by using
descriptive and inferential statistics.

7.https://www.stressmanagement.co.uk/stress/stress-in-elderly.html

8 Alexopoulos GS. Depression within the elderly. The Lancet. 2005 Jun 4;365(9475):1961–

70.

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https://www.chinadaily.com.cn/a/201904/09 /WS5cabe02da3104842260b50cb.html.

11. Vikaspedia. Senior Citizens - status in India. 18th March 2020. Available from:
https://vikaspedia.in/social-welfare/seniorcitizens

12.Babazadeh T, Sarkhoshi R, Bahadori F, Moradi F, Shariat F, Sherizadeh Y.

Prevalence of depression, anxiety and stress disorders in elderly people residing in

Khoy, Iran (2014-2015). J Anal Res Clin Med 2016; 4(2): 122-8. Doi:

10.15171/jarcm.2016.020

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correlates among residents of old age home in Kanchipuram District, Tamil Nadu. Med J DY
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Frances Reynolds.(2008).Exploring the influences of visual art-making as a

leisure activity on older womens subjective well-being. International Journal Of

Nursing Studies.7,30-38

Tinker A.M. (2014).Creativity in later life. International journal of nursing

studies.8,46

David.M.Almeida(2005) conducted study on Resilience and Vulnerability to

Daily Stressors Assessed via Diary Methods Research on daily stressors.retrievedfrom

URL:http://www.dnaindia.com/mumbai/report_indiamay-be-hub-of-chronic

illness_1183979.

Hema,(2010).assess the effectiveness of selected relaxation techniques to reduce

the level of stress among senior citizens residing in selected old age home,

retrievedfrom. URL: http://www.nimh.nih.gov/health/publications /stress/complete-

index.shtml

Darryl R. Haslam., (2006) conducted study on the practice patterns and attitudes

on family play therapy.retrievedfrom URL:http.//www.ncbi.nlm.nih.gov/pubmed

Karpagavalli Nageswaran1 and Suresh Ray2 1,2Bharati Vidyapeeth Deemed University

College of Nursing International Journal of Recent Scientific Research Vol. 7, Issue, 6,
pp. 11608-11611, June, 2016

Sunjin Nancy Choe. (2014).An exploration of the qualities and features of art

apps for art therapy. International Journal Of Nursing Studies.9,14-16