الفهرس 
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Abstract
Elders are exposed to many stressors which usually lead to stress, anxiety and high blood pressure, especially those who residing in assisted living facilities. This may be due to family separation, loss of social contact, relocation and the home routine. Ineffective coping of stress and anxiety has many negative consequences as increase blood pressure which leads to chronic diseases as diabetes, heart disease, and physical symptoms as irritability, fatigue, headache and sleep disturbance.
Progressive muscle relaxation (PMR) is a deep relaxation technique that has been effectively used to control stress and anxiety, and elevated BP. Progressive muscle relaxation is based upon the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation phase with release of the tension.
The aim of the study is to
Determine the effect of progressive muscle relaxation technique on blood pressure, anxiety, and stress levels among elders in assisted living facilities.
Research hypothesis:
Elders residing in assisted living facilities who receive progressive muscle relaxation technique exhibit lower anxiety and stress levels, as well as controlled blood pressure than those who do not.
Materials and Method
This study followed a quasi experimental research design. The study was carried out in three governmental homes for elderly persons in Alexandria namely; Dar El Hana, Dar El Hedaya, and Dar El Wedad.
The study was included 60 of the elders residing in the above mentioned settings and fulfilling the following criteria: aged 60 years and more, able to communicate effectively, with no or mild cognitive impairment, with blood pressure above 140/ 90 mm/Hg, suffered from mild or moderate levels of anxiety and stress.
Tools of the study: In order to collect the necessary data, four tools were used by the researcher.
Tool I: Mini Mental Scale Examination (MMSE):
The scale is used to assess the elders’ cognitive status. The MMSE consists of 10 items covering 30 questions that investigate memory, orientation, attention and calculation, naming, repetition, registration, and language.
Tool II: Beck Anxiety Inventory (BAI)
It is used to measure the severity of an individual’s anxiety. The Beck Anxiety Index includes 21 items. Each item was rated on a 4-point rating likert scale.
Tool III: Perceived Stress Scale (PSS):
It is used to assess the level of stress. This scale includes 14 questions. Each question is rated on a 5- point likert scale.
Tool IV: Older adults Socio-demographic and Clinical Data Structured Interview Schedule: This tool was developed by the researcher to collect the following information:
A- Socio-demographic characteristics: as age, sex, marital status, educational level, occupation before retirement and income.
B – Clinical data: as the presence of medical problems; onset and duration of the disease, treatment regimen, number and reason of previous hospitalization during the last year.
Method:
- A survey of all residents in the three governmental elderly homes was done by the researcher using Tool I (MMSE), Tool II (BAI) and Tool III (PSS) to identify those fulfilling the study criteria;
Their number amounted to 60. They were divided into two equal groups (study and control). Tool IV was developed by the researcher and used to collect data about the older adults’ socio-demographic characteristics and clinical data.
- Progressive muscle relaxation technique was performed individually in 12 sessions during four weeks; three sessions per week. Each session took about 20 minutes.
- PMR program involves tensing and relaxing groups of body muscles from head to toes: Face muscles, Arm and shoulder muscles, Sternum muscles, and Leg muscles.
- Study subjects were evaluated before and immediately after the program implementation to assess anxiety level using tool II (Beck Anxiety Inventory), Stress level using tool III (Perceived Stress Scale) and Blood pressure level using the same sphygmomanometer and stethoscope. Subjects in the control group were evaluated twice at the same time of the study subjects.
- Data was collected during a period of two months starting from the first of April to the end of May 2018.
- The Statistical Package for social Science (SPSS) was utilized for data analysis and tabulation. The level of significance for this study was 0.05 level.
• The main results obtained were as follows:
- The age of the study elders ranges from 60 up to 89, years with a mean age of 72.3±4.64 years and 77.6±3.93 years for the study and control groups respectively; Females constituted 66.7% for the study group and 60.0% for the control group.
- 20% and 23.3% are illiterates in the study and control groups respectively; while 23.3% of the study and 16.7% of the control group can read & write. The rest in both study and control groups respectively had either primary education (16.7%, 3.3 %) or secondary education (20%, 30%). Those who reported having intermediate education were 20% in the study group and 26.7% in the control group.
- More than one third of the study and control groups (36.7%, 40% respectively) were house wives. Employees were presented by 26.7% and 40% among study and control groups respectively.
- The monthly income is reported to be adequate by 60% and 56.7% of the study and control groups respectively and for the rest in both groups it is inadequate.
- The majority of the study and control groups 80% and 86.7% respectively reported that they do not practice any type of exercise.
- Cardiovascular or endocrine (mainly DM) was reported by 40% and 46.6% of the study group compared to 50% and 63.3% respectively for those in the control group.
- Beside hypertensive drugs, are Hypoglycemics 23.4%, anticoagulants 15%, vitamins 13.3% and cortisol/hormones drugs 11.6 % among study group. 31.7%, 18.3%, 6.7%, 6.7% respectively in the control group.
- According to the inclusion criteria; all participants in the study and control groups suffer from high blood pressure i.e. more than 140/90 mm/Hg. In the control group80% had still high blood pressure; and only six elders (20%) had normal blood pressure.
- Concerning the anxiety level before the implementation of the program; as regard the control group at the time of selection 60 % had mild level of anxiety; and the rest (40 %) had moderate level of anxiety. After a month elders with mild anxiety decreased from 60% to 53.3% and those with moderate anxiety increased from 40% to 46.4%.
- Regarding the stress level, concerning the control group the table shows that 80% of the elders had moderate level of stress and the rest (20 %) had mild stress, after a month, a drastic change was observed in stress level of control group. While those with moderate level of stress increased from 80% to 96.7% and one (3.3%) had severe level of stress.