The Progressive Muscle Relaxation and Deep Breathing as Effective Procedures in Reducing the Stress Levels on Older People

The world population and proportion of elderly people at present are increasing. The increasing population of the elderly people needs special attention because elderly people included in the group of a population at risk. A population at risk is the group with certain characteristics that able to generate health issues. The changes in physical capability are able to infl uence the entire body’s functions and capabilities. One of the occurring changes is the aging process embodied as psychosocial changes. The psychosocial changes also able to induce a stress in elderly people. One of the complementary and alternative nursing management is through the therapies of a progressive muscle relaxation and a deep breathing. Progressive muscle relaxation and deep breathing do not cause side effects, do not require additional cost, and can be performed individually as well as do not require routine training from the instructor, able to reduce the heart rate and able to relax the body. ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY

These interventions can be done by nurses or caregivers in service institutions or nursing home which performed in accordance with the determined SOP (Standard Operational Procedure).This research is aimed to determine the effectiveness of progressive muscle relaxation and deep breathing to reduce the stress on elderly people in the Hanna Nursing Home Yogyakarta.There were 40 elderly people who live in Hanna Nursing Home involved in this study.This research method was a Quasi Experimental design with pre and post test without control group design.The sample tehcnique in this study was quota sampling which considers either inclusive or exclusive criteria.The instrument of the study was DASS instrument to measure the stress levels of elderly people.The measurement results of the stress function of elderly people through the utilization of DASS show that there was a decline of mean value in about 4.4 points.From the paired t-test, 0.000 p-values were acquired.The results of the bivariate test by using the DASS instrument showed that the interventions of progressive muscle relaxation and deep breathing in reducing the stress of elderly people in Hanna Nursing Home Yogyakarta were effective.

INTRODUCTION
The world population and proportion of elderly people at present are increasing.United

Nations Department of Economic and Social
Affairs/Population Division (2015) mentioned that in 2015, the population of elderly people in the world are 901 million people with 12.3% of the entire populations.The > 60 years old population has experienced 3.26% growth every year.
Indonesia is a country with 8.9% of elderly people population in the world (1).The 2013 -population of elderly people in Indonesia is 8.9%, it is predicted that in 2015; the number will increase to 21.4% and in 2100 will grow into 41% (2).
The results of population projection in the 2010-2035 period are indicating that Indonesia has entered the aging era, it is predicted that there will be 10% of >60 years old population in 2020 (2).Yogyakarta Special Province (DIY) is the region with the highest elderly people population in Indonesia which amounted to 13.4% (2).The province with the highest proportion of elderly people in Yogyakarta Special Province (14.02%) (3).These conditions have made the Yogyakarta Special Province to be included as the region that enters the era of the aging structured population due to the population of >60 years old which has exceeded 7 percent rate.

MATERIALS AND METHOD
This research was quantitative research using the Quasi-experimental study.This

RESULTS AND DISCUSSION
The characteristics of respondent include the age and stress levels of elderly people in Hanna Nursing Home Yogyakarta.
According      To perform the progressive muscle relaxation and deep breathing in routine behavior for 15 minutes every day to reduce stress.
research was pre and post without control group design to determine the effectiveness of progressive muscle relaxation and deep breathing towards the stress levels of elderly people.The population of this research was 40 elderly people who live in Hanna Nursing Home -Yogyakarta.The criteria of research sample were the > 60 years old elderly people, willingly become the research subject by using informed consent, present during the research implementation, the elderly people who have a mental disorder, the elderly people who have joints movement disorder and post-stroke.The sampling technique was quota sampling by consistently referring to the research sample criteria which resulted in 20 elderly people.The bivariate test used in this study was paired t-test because distributed normally through the utilization of DASS instrument.

(
55%).According to Miller (2012), there are several factors that influence the stress on elderly people, including the loss of life-partner, loss of a friend, pension, chronic disease, away from their families, and wrong perception about old age.These conditions occurred in some elderly people in the nursing home because all the elderly people are far from their families and some of them are already left by their lifepartners.According to Indriana, Kristiana, Sonda, Intanirian (2010), the 5 major factors that produce stress on elderly people in nursing home are the change in daily activities, the change in family gathering, the death of life-partner, the death of family members, and the change in selecting the determining the quantity of sports or vacation, and the change in occupation.According to Table 2, the stress scores (Pre and Post) decrease from the average 16.10 into 11.70 after the interventions of Progressive Muscle Relaxation and Deep Breathing, as also occurred on the median values which having a decrease from 17.5 to 13 after the interventions are provided.

There were the differences of mean values by 4 .
4 points.The results of hypothesis test resulted in 0.000 p values which mean that there was a signifi cant difference in stress scores in before and after the interventions of progressive muscle relaxation and deep breathing are conducted.According to the analysis of stress scores data of elderly people in before the interventions were conducted, most of the elderly people are having light and medium stress, which amounted to 35%.The mean value of stress scores on elderly people is 16.10 which categorized as light stress.According to the interview results with the elderly people, the reasons of the stress experienced by the elderly people are because they frequently being awake at night due to certain thoughts but being uncertain of what kind of those thoughts are, uncomfortable feeling but not aware of the causes, felt pressured, and homesick.Elderly people are the vulnerable population, the vulnerability can be caused by the physical limitations and the causes sourced from environmental conditions, the personal source (human capital), and the bio-psychosocial sources (diseases and genetic tendencies) (4).Stress is the response of someone towards the demands that able to put them in a tense situation, infl uencing the emotion and health condition of someone (12).The main sources of the stressor on elderly people include the normal aging process that disrupts the physical function, the activities, change of look, social loss, environment, change of role, and the death of the most-loved person (9).The psychosocial change also causes the stress on elderly people (7).According to the data analysis of the stress scores of elderly people, after the interventions were conducted, the stress levels of elderly people are mostly categorized in a normal condition which amounted to 55%.The mean value of stress scores on elderly people is 11.70 which included in the normal category.There is an increase of the mean value of stress scores by 4.4 points.In category, the average stress levels of elderly people are also changed that before categorized in light and medium stress which now changed into experience non-stress condition.The interventions conducted by the researcher were in accordance with the theory regarding progressive muscle relaxation which mentions that the relaxation is one of the techniques in the therapy of behavior performed on someone during the tense and relaxed condition.In the time when body and mind are relaxed, the muscle tension is having a relaxation (13).The relaxation techniques that frequently used are muscle relaxation, relaxation with guided imagery, and the relaxation response of Benson.The aim of relaxation practice is to produce a response that able to fi ght a stress response.If the aim is achieved, thus, the hypothalamus activity will adjust and the declining

CONCLUSION
The age of respondents was mostly categorized in the old age category.The elderly people stress levels in before the interventions were mostly categorized in light and medium stress.The stress levels of elderly people in after the interventions were mostly categorized in the normal category.The implementations of progressive muscle relaxation and deep breathing interventions were effective in reducing the stress of elderly people.SUGGESTIONAccording to the research that has been conducted, the suggestions are as follows:For the Head of Hanna Nursing Home a.YogyakartaTo develop the Standard Operational Procedure (SOP) regarding the progressive muscle relaxation and deep breathing to be used as one of the nursery interventions to reduce the stress on elderly people.Elderly People b.

Table 2 . Respondent Characteristics in Accordance with the Stress Scores (Pre and Post) in Hanna Nursing Home Yogyakarta (n=20) in Mei 2017.
non-invasive and affordable relaxation techniques are able to reduce the stress levels in patients who underwent the intradialytic treatment.