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.


References
  1. World Health Organization. World report on ageing and health. Geneva: WHO; 2015. [Link]
  2. Kinsella K, He W. An aging world: 2008. International Population Reports. Suitland: US Census Bureau; 2009. [Link]
  3. Office of Population Labor and Census. [Investigating the trend of changes in the structure and composition of the country’s population and its future up to the horizon of 1430 solar: Population and health group. Tehran: Office of Population Labor and Census; 2021. [Link]
  4. Mok E, Wong F, Wong D. The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill. Journal of Advanced Nursing. 2010; 66(2):360-70. [PMID]
  5. Nanbakhsh F, Mohaddesi H, Amirabi A, Hajshafiha M, Broomand F, Bahadori F, et al. [The effect of health education on elderly weomen life quality (Persian)]. Payavard-Salamat. 2011; 5(1):47-57. [Link]
  6. Bavazin F, Sepahvandi M A. The study of the relationship between social support and social and psychological well-being among elderly people in city of Khorramabad in 2017. Nursing and Midwifery Journal. 2018; 15(12):931-8. [Link]
  7. Abdi S, Spann A, Borilovic J, de Witte L, Hawley M. Understanding the care and support needs of older people: A scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics. 2019; 19(1):195. [PMID]
  8. Bakar N, Aşılar RH. Factors affecting depression and quality of life in the elderly. Journal of Gerontology & Geriatric Research. 2015; 4(249):2. [Link]
  9. Yümin ET, Şimşek TT, Sertel M, Öztürk A, Yümin M. The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home. Archives of Gerontology and Geriatrics. 2011; 52(3):e180-4. [PMID]
  10. Rafii F, Naseh L, Yadegary MA. Relationship between self-efficacy and quality of life in ostomates. Iran Journal of Nursing (2008-5923). 2012; 25(76). [Link]
  11. Logan BB.  Heroabadi Sh. Family -Centered nursing in the Community [Sh. Heroabadi, Persian trans.]. Tehran: Iran University of Medical Sciences; 1993. [Link]
  12. Aung K, Nurumal MS, Bukhari W. Loneliness among elderly in nursing homes. International Journal for Studies on Children, Women, Elderly and Disabled. 2017; 2:72-8. [Link]
  13. World Health Organization (WHO). Social isolation and loneliness among older people: Advocacy brief. Geneva: World Health Organization; 2021. [Link]
  14. Cohen SE, Syme SI. Social support and health. Orlando: Academic Press; 1985. [Link]
  15. McDonald L, Hitzig SL, Pillemer KA, Lachs MS, Beaulieu M, Brownell P, et al. Developing a research agenda on resident-to-resident aggression: Recommendations from a consensus conference. Journal of Elder Abuse and Neglect. 2015; 27(2):146-67. [PMID]
  16. Rosen T, Pillemer K, Lachs M. Resident-to-resident aggression in long-term care facilities: An understudied problem. Aggression and Violent Behavior. 2008; 13(2):77-87. [PMID]
  17. Bushman BJ, Anderson CA. General aggression model. The International Encyclopedia of Media Psychology. 2020; 1-9. [DOI:10.1002/9781119011071.iemp0154]
  18. Botngård A, Eide AH, Mosqueda L, Malmedal W. Resident-to-resident aggression in Norwegian nursing homes: A cross-sectional exploratory study. BMC Geriatrics. 2020; 20(1):222. [PMID]
  19. Battaglia J, Lindborg SR, Alaka K, Meehan K, Wright P. Calming versus sedative effects of intramuscular olanzapine in agitated patients. The American Journal of Emergency Medicine. 2003; 21(3):192-8. [DOI:10.1016/S0735-6757(02)42249-8]
  20. Samouei R, Keyvanara M. Identifying strategies for dealing with the aging population from the perspective of health system experts: A qualitative study. Journal of Education and Health Promotion. 2022; 11:210. [PMID]
  21. Aylaz R, Aktürk Ü, Erci B, Öztürk H, Aslan H. Relationship between depression and loneliness in elderly and examination of influential factors. Archives of Gerontology and Geriatrics. 2012; 55(3):548-54. [PMID]
  22. Margari F, Sicolo M, Spinelli L, Mastroianni F, Pastore A, Craig F, et al. Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects. Neuropsychiatric Disease and Treatment. 2012; 8:347. [PMID]
  23. Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English longitudinal study of ageing. Psychosomatic Medicine. 2013; 75(2):161-70. [PMID]
  24. Kwon MJ. Convergence study on the relation between cognition, depression and aggression in the elderly. Journal of the Korea Convergence Society. 2015; 6(6):171-6. [DOI:10.15207/JKCS.2015.6.6.171]
  25. Hacihasanoğlu R, Yildirim A, Karakurt P. Loneliness in elderly individuals, level of dependence in Activities of Daily Living (ADL) and influential factors. Archives of Gerontology and Geriatrics. 2012; 54(1):61-6. [PMID]
  26. Haugan G, Drageset J, André B, Kukulu K, Mugisha J, Utvær BKS. Assessing quality of life in older adults: Psychometric properties of the OPQoL-brief questionnaire in a nursing home population. Health and Quality Of Life Outcomes. 2020; 18(1):1-14. [PMID]
  27. Moody E, Phinney A. A community-engaged art program for older people: Fostering social inclusion. Canadian Journal on Aging. 2012; 31(1):55-64. [PMID]
  28. Battaglia G, Bellafiore M, Alesi M, Paoli A, Bianco A, Palma A. effects of an adapted physical activity program on psychophysical health in elderly women. Clinical Interventions in Aging. 2016; 11:1009-15. [PMID]
  29. Later Life  Training. Active for later life: Promoting physical activity with. Northumberland: Later Life  Training; 2019. [Link]
  30. Tae-Yong J, Bo-Ra P, Yeong-Ae Y. [Effects of occupational therapeutic craft activity on improvement cognitive function and hand function in acute patients with stroke (Korean)]. Journal of the Korea Academia-Industrial Cooperation Society. 2017; 18(5):355-65. [Link]
  31. Kim D. The effects of a combined physical activity, recreation, and art and craft program on ADL, cognition, and depression in the elderly. Journal of Physical Therapy Science. 2017; 29(4):744-7. [PMID]
  32. Kojima G. Prevalence of frailty in nursing homes: A systematic review and meta-analysis. Journal of the American Medical Directors Association. 2015; 16(11):940-5. [PMID]
  33. Buckinx F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyère O. Burden of frailty in the elderly population: Perspectives for a public health challenge. Archives of Public Health. 2015; 73(1):19. [PMID]
  34. Russell DW. UCLA loneliness scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment. 1996; 66(1):20-40. [PMID]
  35. Værøy H. Aggression questionnaire scores in extremely violent male prisoners, male bodybuilders, and healthy non-violent men. Open Journal of Psychiatry. 2013; 3(3):293-300. [DOI:10.4236/ojpsych.2013.33029]
  36. Samani S. [Study of reliability and validity of the Buss and Perry’s aggression questionnaire (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2008; 13(4):359-65. [Link]
  37. Zarei S, Memari AH, Moshayedi P, Shayestehfar M. Validity and reliability of the UCLA loneliness scale version 3 in Farsi. Educational Gerontology. 2016; 42(1):49-57. [Link]
  38. Buss AH, Perry M. The aggression questionnaire. Journal of Personality and Social Psychology. 1992; 63(3):452-9. [DOI:10.1037/0022-3514.63.3.452]
  39. Roswiyani R, Kwakkenbos L, Spijker J, Witteman CLM. The effectiveness of combining visual art activities and physical exercise for older adults on well-being or quality of life and mood: A scoping review. Journal of Applied Gerontology. 2019; 38(12):1784-804. [PMID]
  40. Roswiyani R, Hiew CH, Witteman CLM, Satiadarma MP, Spijker J. Art activities and qigong exercise for the well-being of older adults in nursing homes in Indonesia: A randomized controlled trial. Aging & Mental Health. 2020; 24(10):1569-78. [PMID]
  41. Moon BL. Art-based group therapy: Theory and practice. Illinois: Charles C Thomas Publisher; 2016. [Link]
  42. Greaves CJ, Farbus L. Effects of creative and social activity on the health and well-being of socially isolated older people: Outcomes from a multi-method observational study. The Journal of the Royal Society for the Promotion of Health. 2006; 126(3):134-42. [PMID]
  43. Dadswell A, Bungay H, Wilson C, Munn-Giddings C. The impact of participatory arts in promoting social relationships for older people within care homes. Perspectives in Public Health. 2020; 140(5):286-93. [PMID]
  44. Schrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health. 2019; 19(1):74. [PMID]
  45. Hämmig O. Health risks associated with social isolation in general and in young, middle and old age. PLoS One. 2019; 14(7):e0219663 [PMID]
  46. Kobayashi LC, Steptoe A. Social isolation, loneliness, and health behaviors at older ages: Longitudinal cohort study. Annals of Behavioral Medicine. 2018; 52(7):582-93. [PMID]
  47. Luo Y, Waite LJ. Loneliness and mortality among older adults in China. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences. 2014; 69(4):633-45. [PMID]
  48. Pels F, Kleinert J. Loneliness and physical activity: A systematic review. International Review of Sport and Exercise Psychology. 2016; 9(1):231-60. [Link]
  49. Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association. 2011; 30(4):377-85. [PMID]
  50. de Koning J, Richards S, Stathi A. Loneliness, social isolation, and objectively measured physical activity in rural-living older adults. Journal of Aging and Physical Activity. 2019; 28(3):467-77. [DOI:10.1123/japa.2019-0027] [PMID]
  51. Newall NEG, Chipperfield JG, Bailis DS, Stewart TL. Consequences of loneliness on physical activity and mortality in older adults and the power of positive emotions. Health Psychology. 2013; 32(8):921-4. [DOI:10.1037/a0029413] [PMID]
  52. Angus J. A review of evaluation in community based art for health activity in the UK. London: Health Development Agency; 2002. [Link]
  53. Everitt A, Hamilton R. Arts, health and community: A study of five arts in community health projects [Internet]. 2003 [Uptadet 2014 August 19]. [Link]
  54. Buckley C, McCarthy G. An exploration of social connectedness as perceived by older adults in a long-term care setting in Ireland. Geriatric Nursing. 2009; 30(6):390-6. [PMID]
  55. Crockett T. Expressive arts therapy and the loneliness epidemic-A critical review of literature [MSc thesis]. Cambridge: Lesley University; 2020. [Link]
  56. Wilson C, Dadswell A, Munn-Giddings C, Bungay H. The role of participatory arts in developing reciprocal relationships amongst older people: A conceptual review of the literature. The Journal of Aging and Social Change. 2019; 9(4):1-16. [DOI:10.18848/2576-5310/CGP/v09i04/1-16]
  57. Roberts TJ. Nursing home resident relationship types: What supports close relationships with peers & staff? Journal of Clinical Nursing. 2018; 27(23-24):4361-72. [PMID]
  58. Raineri ML, Cabiati E. Kitwood’s thought and relational social work. European Journal of Social Work. 2015; 3:1-17. [Link]
  59. Shamsaei F, Cheraghi F, Esmaeili R, Mohsenifard J. Explanation of loneliness in the elderly and comparison with psychosocial development theory: A quantitative study. Journal of Education and Community Health. 2014; 1(2):30-8. [DOI:10.20286/jech-010230]
  60. Hauge S, Kirkevold M. Older Norwegians’ understanding of loneliness. International Journal of Qualitative Studies on Health and Well-being. 2010; 5(1):4654. [PMID]
  61. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging. 2004; 26(6):655-72. [PMID]
  62. Cacioppo J, Cacioppo S. The phenotype of loneliness. The European Journal of Developmental Psychology. 2012; 9(4):446-52 [PMID]
  63. Haugen T, Säfvenbom R, Ommundsen Y. Sport participation and loneliness in adolescents: The mediating role of perceived social competence. Current Psychology. 2013; 32:203-16. [DOI:10.1007/s12144-013-9174-5]
  64. McAuley E, Blissmer B, Marquez DX, Jerome GJ, Kramer AF, Katula J. Social relations, physical activity, and well-being in older adults. Preventive Medicine. 2000; 31(5):608-17. [PMID]
  65. de Koning J, Richards SH, Wood GER, Stathi A. Profiles of loneliness and social isolation in physically active and inactive older adults in rural England. International Journal of Environmental Research and Public Health. 2021; 18(8):3971. [PMID]
  66. Delle Fave A, Bassi M, Boccaletti ES, Roncaglione C, Bernardelli G, Mari D. Promoting well-being in old age: The psychological benefits of two training programs of adapted physical activity. Frontiers in Psychology. 2018; 9:828. [PMID]
  67. Voyer P, Verreault R, Azizah GM, Desrosiers J, Champoux N, Bédard A. Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities. BMC Geriatrics. 2005; 5(1):1-13. [PMID]
  68. Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Personality and Social Psychology Review. 2011; 15(3):219-66. [PMID]
  69. Jaberi A, Momennasab M, Cheraghi M, Yektatalab S, Ebadi A. Spiritual health as experienced by muslim adults in Iran: A qualitative content analysis. Shiraz E-Medical Journal. 2019; 20(12):e88715. [DOI:10.5812/semj.88715]
  70. Shaygan M, Shayegan L. Understanding the Relationship between spiritual well-being and depression in chronic pain patients: The mediating role of pain catastrophizing. Pain Management Nursing. 2019; 20(4):358-64. [PMID]
  71. Chapin Stephenson R. Promoting well-being and gerotranscendence in an art therapy program for older adults. Art Therapy. 2013; 30(4):151-8. [Link]
  72. Alders A, Levine-Madori L. The effect of art therapy on cognitive performance of hispanic/latino older adults. Art Therapy. 2010; 27(3):127-35. [Link]
  73. Eksell BM. Creativity as a means of expression of emotions by older adults [PhD Dissertation]. Minneapolis: Walden University; 2015. [Link]
  74. Skov V. Integrative art therapy and depression: A transformative approach. London: Jessica Kingsley Publishers; 2015. [Link]
Type of Study: Research | Subject: gerontology
Received: 2021/08/14 | Accepted: 2021/10/17 | Published: 2022/10/11
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