Volume 17, Issue 3 (Autumn 2022)                   Salmand: Iranian Journal of Ageing 2022, 17(3): 366-379 | Back to browse issues page

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Shaygan M, Hosseini F A, Bustani A, Zahedian Nasab N. Effect of Combining Adapted Physical and Artistic Activities on Feeling of Loneliness and Aggression in the Elderly Living in Nursing Homes. Salmand: Iranian Journal of Ageing 2022; 17 (3) :366-379
URL: http://salmandj.uswr.ac.ir/article-1-2279-en.html
Effect of Combining Adapted Physical and Artistic Activities on Feeling of Loneliness and Aggression in the Elderly Living in Nursing Homes
Maryam Shaygan1 , Fahimeh Alsadat Hosseini * 2, Akram Bustani3 , Noorullah Zahedian Nasab3
1- Community Based Psychiatric Care Research Center, Department of Mental Health, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
2- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran. , fhoseini221@gmail.com
3- Nursing Students, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Keywords: Aged, Loneliness, Aggression, Physical activity, Art, Nursing home
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Introduction
The phenomenon of aging and the increase of the elderly population are one of the most important challenges facing healthcare providers, family members and society, especially in the economic, social and health sectors. The psychological, social and biological changes induced by aging can cause chronic diseases, psycho-social problems and reduced physical activity in the elderly, which can affect their quality of life [8]. Moving to a nursing home is one of the most difficult experiences in the elderly, which can have many psychological disorders for them such as feeling of loneliness and aggression [11]. In general, the prevalence of loneliness and its aggravating factors among the elderly is increasing [12]. Increasing evidence shows that loneliness negatively affects the quality of life and mental and physical health of the elderly [12]. It can cause increased blood pressure, heart disease, obesity, decreased immune system function, depression, anxiety, decreased cognitive function, increased risk of Alzheimer’s disease, and mortality in the elderly.
Among the activities that can reduce the dependence of the elderly and improve their health are artistic and physical activities [27, 28]. Arts and crafts programs can reduce the dependence of the elderly and improve their cognitive function [30]. These programs are referred to as a group of activities such as handicrafts (e.g., working with thread, wood, paper, and clay) whose purpose is to improve cognitive and social performance and daily activity in the elderly [27, 31]. Considering the effectiveness of adapted physical and artistic activities on the health of the elderly [27, 28] and given that no studies were found on the effect of the combination of adapted physical and artistic activities on the feeling of loneliness and aggression of the elderly living in nursing homes, this study aims to assess the effect of the combination of adapted physical and artistic activities on the feeling of loneliness and aggression of the residents of a nursing home in Shiraz, Iran.
Methods
This is a quasi-experimental study. The study population consists of all the residents of nursing homes in Shiraz, Iran. The participants were selected using a convenience sampling method from Farzangan Nursing Home, and then randomly allocated to two control and intervention groups. The sample size was determined 72 based on the results of a previous study [28] and considering the first type error (alpha) as 0.05, second type error (beta) as 0.20, mean difference as 7.06, S1 = 12, S2 = 6, and 20% dropout rate. Due to the drop in participants during the study, 68 elderly people participated.
The data collection tools were a demographic form (surveying age, gender, educational level, and duration of living in the nursing home), UCLA Loneliness Scale [34] and Buss-Perry aggression questionnaire [36]. After data collection, data analysis was done in SPSS software,  version 22.
Results
In the present study, the mean age of the participants in the intervention group was 70.03±8.27 years, and 64.7% (n=22) were women. The mean age of the participants in the control group was 71.82±7.72, and 73.5% (n=25) were women. Based on the Mann-Whitney U test results, there was no significant difference in the loneliness scores between the two groups before the intervention, but there was a significant difference after the intervention, where the scores in the intervention group were significantly lower than in the control group (P<0.001). Based on the Wilcoxon test results, a significant difference was found between the scores of the loneliness before and after the intervention in the intervention group (P<0.001). Based on the Mann-Whitney U test results, there was no significant difference in the total score and the scores of all dimensions of aggression between the two groups before the intervention, but there was a significant difference after the intervention (P<0.05). Using the Wilcoxon test, it was found that there was a significant difference in the total score and the scores of all dimensions of aggression before and after the intervention in the intervention group (P≤0.001).
Discussion
The combination of adapted artistic and physical activities caused a significant reduction in feeling of loneliness in the elderly living in nursing homes. A study also showed that an artistic program and a combination of artistic and physical activities had a significant positive effect on the well-being of the elderly, especially in the field of social relations [40]. Art-based group therapy creates an interactive and encouraging environment for the elderly, which can reduce the feeling of loneliness in them and give hope to them [41]. The participation of the elderly in creative and artistic activities can be one of the ways to improve their participation in social networks, reconnect them with the surrounding people, and ultimately improve their mental and physical health [42]. In the present study, group art activities had a positive effect on the relationships of the elderly with each other and with the nursing home staff and, thereby, reduced their feeling of loneliness to a significant extent. Considering the high position of spirituality among the Muslim people of Iran during physical and mental crises [71, 72], the therapeutic aspects of art can help the elderly to gain more meaning in life [40]. Regarding the effect of physical activities on the feeling of loneliness in the elderly, it should also be considered that with the increase of age, the limitations on activities such as leisure and recreation activities in the elderly increase [61]; the reduction of these activities in life can affect the feeling of loneliness and its consequences [62]. In the old age, having a dynamic lifestyle with regular physical activity, is an important factor for improving the quality of life [28].
The combination of adapted artistic and physical activities caused a significant reduction in aggression of the elderly living in nursing homes. Aggressive verbal and physical behaviors are one of the most annoying behaviors that elderly patients show in long-term care centers and is associated with increased health care costs due to staff turnover and absenteeism [69]. In order to increase the understanding and attitude regarding the factors related to aggressive behaviors in the elderly, it is recommended to conduct preventive and therapeutic studies with a multidimensional nature.
5. Conclusion
The feeling of loneliness and the level of aggression in the elderly living in nursing homes can be reduced significantly by the combination of adapted artistic and physical activities through improving mobility skills, reducing negative emotions, and improving self-esteem and self-efficacy.

Ethical Considerations
Compliance with ethical guidelines
Ethical approval was obtained from the local Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1398.890). Eligible participants were informed about the study objective and the voluntary nature of their participation. Written informed consent form was filled out by all the participants. 

Funding
This study was supported by the Vice Chancellor for Research, Shiraz University of Medical Sciences, Shiraz, Iran (No. 17882).

Authors' contributions
Study conception, design, interpretation, drafting, and critical review of the article: Maryam Shaygan, Fahimeh Alsadat Hosseini, Noorollah Zahedian Nasab and Akram Bustani; Data acquisition; Noorollah Zahedian Nasab and Akram Bustani; Data analysis: Maryam Shaygan and Fahimeh Alsadat Hosseini; Read and approved the final version of the manuscript; All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
This article is the result of a research project approved by Shiraz University of Medical Sciences. The researchers hereby express their gratitude to the respected officials of Shiraz University of Medical Sciences and the nursing home, as well as the elderly who participated in this study and other people who sincerely helped us in conducting this research.


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Type of Study: Research | Subject: gerontology
Received: 2021/08/14 | Accepted: 2021/10/17 | Published: 2022/10/11
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