THE EFFECT OF HEALTHY BLOOD PRESSURE MUSIC THERAPY ON REDUCING BLOOD PRESSURE OF THE ELDERLY WITH HYPERTENSION IN PANTI WERDHA
BUDI PERTIWI BANDUNG
Ibrahim Bolla, S.Kp., MM., Gunawan Irianto, dr., M.Kes., MARS., Epitasari bollaibrahim@gmail.com
Department of Maternity Nursing School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia
ABSTRACT
High blood pressure or hypertension has killed 9.4 million people worldwide, including the elderly, with 40%
of prevalence in developing countries and 35% in developed countries. Treatment of hypertension can be done with non-pharmacological treatment, that is music therapy.
The purpose of this study is to determine the effect of healthy blood pressure music therapy on reducing blood pressure in elderly with hypertension in Panti Tresna Werdha Budi Pertiwi Bandung.
This study used a quasy experiment pretest and posttest approach with control group design. The population in this study were the elderly who have hypertension at the Panti Budi Pertiwi in Bandung, which are 28 people. The sample in this study were the elderly with primary hypertension, 24 people. The study design used was case control, with 1:1 comparison of case and control, so that 12 intervention groups and 12 control groups were made.
The result shows there is an effect of healthy blood pressure music therapy on the average systolic blood pressure for the intervention and control group with a p-value of 0.001 and the mean diastolic blood pressure in the intervention and control group p value = 0.001.
It is recommended to Panti Werdha Budi Pertiwi Bandung to involve healthy blood pressure music therapy into a treatment program on reducing blood pressure by doing this therapy for 30 minutes once a week.
Keywords: Hypertension, Music Therapy, Elderly
INTRODUCTION
Aging of population (population aging) or increasement of the elderly population (over 60 years) percentage from the total population has occurred throughout the world. The elderly population percentage of the total world population will raise from 10% in 1998 to 15% in 2025. The population of the elderly in Asia and the Pacific is predicted increasing rapidly from 410 million in 2007 to 733 million in 2025, and also predicted to reach 1.3 trillion in 2050 (Fatmah, 2010).
It is also occurred in Indonesia as a developing country. Based on population projection data in 2017, there are 23.66 million elderly people in Indonesia (9.03%). It also predicts that the number of elderly population in 2020 (27.08 million), 2025 (33.69 million), 2030 (40.95 million) and 2035 (48.19 million) (Kemenkes, 2017).
The phenomenon of increasing number of elderly occurs due to several factors such as health status improvement, technology and medical services improvement, epidemiological transition
from infectious diseases to degenerative diseases. It also affects aspects of life through physical, biological, psychological, and social changes or conflicts in degenerative diseases due to the aging process (Fatmah, 2010).
In the clinical side, one of diseases that is often suffered elderly is hypertension. The prevalence of disease in elderly are COPD 9.4%, stroke 67%, hypertension 63.8%, arthritis 54.8%, cancer 5%, diabetes mellitus 3.5%, coronary heart disease 3.2%, heart failure 1 , 1%, kidney stones 1.1%, and kidney failure 0.6% (RISKESDAS, 2013). From these data, hypertension is also a problem that is often faced by elderly patients, with a prevalence of around 60-70%.
Hypertension can be said as the cause of various severe diseases. Hypertension cause no symptoms but has the potential to generate various diseases in blood vessel organs. Most of stroke, kidney and heart sufferers also had hypertension (Herlambang, 2013). If severe hypertension or chronic not treated well, it can cause several
symptoms such as headaches, fatigue, nausea, vomiting, shortness of breath, anxiety, blurred vision and has risk of elderly collapse, which occurs due to damage to the brain, eyes, heart and kidneys (Herlambang, 2013 ). Due to one of the symptom is risk of elderly collapse, this will impact to reduce the life quality become a drawback for the family, that elderly can not do anything alone, and must be assisted by the family or nurse so that this hypertension problem must be solved.
Treatment for hypertension can be done with non-pharmacological treatment. Many types of non- pharmacological treatments such as music therapy.
Many types of music therapy are used to control blood pressure such as classical, instrumental, traditional, and healthy blood pressure music.
Interventions with music therapy for hypertension were chosen because this therapy is instinctive so it will enter the brain without cognitive pathways, and the most important thing is music therapy does not require guidance of high intellectual function to run effectively. Music is known as a safe, inexpensive and effective non-pharmacological relaxation stimulus (Solehati & Kosasih, 2015). Music as one of the complementary therapies, is included as alternative expected that hypertension sufferers can achieve a relaxed state and a stable emotional state of the patient, so that blood pressure is also stable (Djohan, 2009).
The elderly population in Panti Tresna Werdha Budi Pertiwi Bandung are 28 of people with 25 people are elderly with hypertension. Based on the results of interviews with health workers at the orphanage, the action usually taken for the hypertension is only giving collaboration of anti- hypertensive drugs (amlopidin) and it is recommended to make them not to be too stressed.
While routine activities carried out are gymnastics.
In Panti Tresna Werdha Budi Pertiwi Bandung,
there are also other routine activities, such as once a week all the elderly participate in playing angklung.
The orphanage said there is no healthy blood pressure music therapy before. Based on the above phenomenon, researcher are interested in conducting a study on the Effects of Healthy Blood Pressure Music Therapy on Reducing Blood Pressure in Elderly with Hypertension in Panti Tresna Werdha Budi Pertiwi Bandung.
METHOD
This study design used a quasy experiment pretest and posttest approach with control group design.
The population in this study were the elderly with hypertension in Panti Budi Pertiwi Bandung, which has 28 people and 25 elderly with primary hypertension and 3 elderly with secondary hypertension. Because there were 25 respondents with primary hypertension, the study design used was case control, with a case and control comparison using 1: 1 (Nugrahaeni & Mauliku, 2011) which is 12:12, with 12 of intervention groups and 12 of control groups with several criteria.
The instruments used in this study were healthy blood pressure music therapy, researcher used MP3 and headphone with several music types of healthy blood pressure such as Healthy Blood Pressure - Binaural Beat (30 minutes duration) and Healthy Blood Pressure - Isochronic (30 minutes duration).
Measurement instrument for blood pressure is mercury sphygmomanometer.
In this study there are two types of analysis used which are univariate and bivariate analysis.
Univariate analysis explains or describes the characteristics of each research variable.
Independent tests are used to test the mean differences between two independent groups.
RESULT
Table 1 The Average Blood Pressure Before Healthy Blood Pressure Music Therapy Treatment to Intervention and Control Groups
Group Variable N Mean Blood
Pressure
Std. Dev Min - Max 95%Cl Intervention Sistolic 12 156,17 156,17
93,38
7,408 142 - 170 151,46 – 160,87
Diastolic 93,38 3,460 90 - 100 91,64 – 96,03
Control Sistolic 12 158,33 158,33
96,50
9,374 140 - 170 152,38 – 164,29
Diastolic 96,50 1,931 94-100 95,27 – 97,73
Based on Table 1, it shows the average blood pressure before healthy blood pressure music therapy treatment to the intervention group was
156,17
93,38 mmHg with standard deviation of sistolic dan diastolic is 7,408 and 3,460. The lowest systolic is 142 and the highest systolic is 170, the lowest diastolic is 90, the highest diastolic is 100. From the estimated interval it was concluded that 95% are believed to have an average systolic blood pressure between 151.46 mmHg up to 160.87 mmHg and
diastolic blood pressure between 91.64 mmHg up to 96.03 mmHg. Whereas average blood pressure in the control group 158,33
96,50 mmHg, with standard deviation of sistolic dan diastolic is 9,374 dan 1,931.
The lowest systolic is 140 and the highest systolic is 170, the lowest diastolic is 94, the highest diastolic is 100. From the estimated interval it is concluded that 95% are believed to have an average systolic blood pressure between 152.38 mmHg to 164.29 mmHg and diastolic blood pressure between 95.27 mmHg up to 97.3 mmHg.
Table 2 The Average Blood Pressure After Healthy Blood Pressure Music Therapy Treatment to the Intervention And Control Groups
Group Variabel N Average Blood
Pressure
Std. Dev Min - Max 95%Cl Intervention Sistolic 12 125,83 125,83
86,17
10,836 100-140 118,95 – 132,72
Diastolic 86,17 3,664 80-90 83,84 – 88,49
Control Sistolic 12 149,17 149,17
96,83
4,218 142 – 158 146,49 – 151,85
Diastolic 96,83 2,167 94 – 100 95,46 – 98,83
Based on Table 2, it shows that the average blood pressure after healthy blood pressure music therapy was given to the intervention group, i.e.
125,83
86,17 mmhg with standard deviation of sistolic dan diastolic is 10,836 dan 3,664. The lowest systolic is 100 and the highest systolic is 140, the lowest diastolic is 80, the highest diastolic is 90. From the estimated interval it is concluded that 95% are believed to have an average systolic blood pressure between 118.95 mmhg to 132.72 mmhg and diastolic blood pressure between 83.84 mmhg up to
88.49 mmHg. Whereas average blood pressure in the control group 149,17
96,83 mmhg, with standard deviation of sistolic dan diastolic is 4,218 dan 2,167.
The lowest systolic is 142 and the highest systolic is 158, the lowest diastolic is 94, the highest diastolic is 100. From the estimated interval it was concluded that 95% are believed to have an average systolic blood pressure between 146.49 mmHg up to 164.29 mmHg and diastolic blood pressure between 95.27 mmHg up to 97.3 mmhg.
Table 3 The Effect of Healthy Blood Pressure Music Therapy on Average Blood Pressure in the Intervention and Control Groups
Group Variable N Average Average Gap Standard
Deviation
P value
Intervention_Post_Test Sistolic 12 125,83 30,34 10,836 0,000
Control_Post_Test Sistolic 149,17 9,16 4,218
Intervention_Post_Test Diastolic 12 86,17 7,21 3,664 0,000
Control_Post_Test Diastolic 96,83 0,33 2,167
The results of the analysis in Table 1.3 found that the average blood pressure in elderly with hypertension after healthy blood pressure music therapy treatment in the intervention group was
125,83
86,17 mmHg, and average blood pressure in the
control group is 149,17
96,83 mmHg. So there is a decrease in systolic blood pressure with a difference of 39.66 and diastolic with a difference of 52.34 between groups.
The average gap between before and after in
mmHg, diastolic post 7.21 mmHg. While average gap before and after in the systolic control group was 9.16 mmHg post, diastolk post 0.33 mmHg.
Statistical test results obtained after systolic blood pressure in the intervention group and the control group p value = 0,000, p ≤ α (α = 0.05), meaning Ho is rejected and it can be concluded that there is a significant effect of systolic blood pressure in the elderly given hypertension healthy blood pressure music therapy in the intervention and control groups. Statistical test results of diastolic blood pressure in the intervention group and the control group p value = 0,000, p ≤ α (α = 0.05), it means that Ho is rejected and it can be concluded that there is a significant influence on diastolic blood pressure in the elderly with hypertension after therapy healthy blood pressure music given in the intervention and control groups.
DISCUSSION
1. The Average of Blood Pressure Before Healthy Blood Pressure Music Therapy Treatment to the Intervention Group and Control Group
Factors that effects elderly are mainly reduction of renin levels due to decreased nephrons due to aging. This causes hypertension that lasts continuously. Another factor is the increased sensitivity to sodium intake. The longer age the more sensitive of increasing or decreasing of potassium levels. Decreased elasticity of peripheral blood vessels due to aging will increase peripheral vascular resistance which ultimately results in systolic hypertension.
Changes in atheromotous due to aging causes endothelial dysfunction which continues to form various cytolines and other chemical substances which also cause sodium resorption in the kidney tubules, increasing on process of peripheral vascular sclerosis and other conditions that result in an increase in blood pressure (Hadi &
Martono, 2008). Hypertension in the elderly at the Panti Werda Budi Pertiwi Bandung is also caused by other factors such as lack of family visits, stress, anxiety, even though there are regular gymnastics activities every week but not all of them participate in the activities which results in lack of activity Even though the dietary habit is taken care of by the orphanage staff, the average respondent often go to store and choose to consume food with high salt content such as snack using MSG.
2. The Average of Blood Pressure After Healthy Blood Pressure Music Therapy Treatment to the Intervention Group and Control Group
According to Eka (2009) healthy blood pressure music can helps hypertension because this music specifically designed for those with hypertension and heart problems. Music will stimulate the hypothalamus so that it will produce a feeling of calm that will affect the production of endorphins, cortisol and catecholamines in the mechanism of regulating blood pressure. Music stimulation can activate the limbic system associated with emotions, when the limbic system is activated then the individual becomes relaxed (Djohan, 2006).
3. The Effect of Healthy Blood Pressure Music Therapy on Average Blood Pressure in the Intervention and Control Groups
Healthy blood pressure music is the music specifically designed using brain wave technology that creates relaxing or relaxing, this brain wave therapy is accompanied by music for relaxation, or natural sounds. The relaxing effects of music therapy and brain wave stimulation can enlarge and flex the blood vessels so that blood has good circulation functions throughout the body (Eka, 2009). After doing healthy blood pressure music therapy in elderly with hypertension in Panti Werda Budi Pertiwi Bandung for 30 minutes a day in 1 week, respondent said they felt more comfortable, calmer, had less dizziness and after measuring the intervention by researchers, the blood pressure reduces, with an average of blood pressure in the intervention group was 125,83
86,17
mmHg and it includes on the category of prehypertension.
CONCLUSION
Based on the results of study and data analysis on 24 respondents with 12 respondents in the intervention group and 12 respondents in the control group in the elderly with hypertension in Panti Budi Pertiwi Bandung 2018, the following conclusions can be drawn.
1. The average blood pressure of elderly with hypertension before healthy blood pressure music therapy given in the intervention group with average 156,17
93,38 mmhg includes on category 1 hypertension and in the control group with
average blood pressure 158,33
96,50 mmhg includes on category 1 hypertension
2. The average blood pressure of elderly with hypertension after healthy blood pressure music therapy given in the intervention group with average 125,83
86,17 mmhg includes on
prehypertension category and in the control group with average blood pressure 149,17
96,83 mmhg includes on category 1 hypertension.
3. There is a effect of healthy blood pressure music therapy to average systolic blood pressure in the intervention and control groups with p value 0,000 and the diastolic blood pressure average in the intervention and control groups p value = 0,000
It is recommended to the orphanage of Panti Werdha Budi Pertiwi Bandung to include this healthy blood pressure music therapy as treatment program to reduce blood pressure by doing this therapy for 30 minutes once a week.
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