Effectiveness of Mindfulness-based Approaches on Stress, Depression, and Serum Cortisol among Elderly in Old Age Homes

ABSTRACT

Background:

Mental health issues, particularly stress and depression, are highly prevalent among the elderly, especially those residing in old age homes. Elevated serum cortisol levels are associated with prolonged stress and depression, leading to further health complications. This study evaluates the effectiveness of a mindfulness-based approach in reducing stress, depression, and serum cortisol levels among elderly individuals in institutional care.

Materials and methodology:

This quasi-experimental study was conducted in two old age homes in Chennai. A total of 48 elderly participants (aged 60–80 years) were selected using convenience sampling and divided into experimental (mindfulness intervention) and control (routine care) groups. The 12 weeks mindfulness intervention included techniques such as 5-Senses Grounding, Body Scan Meditation, mindfulness eating, Mindful Walking and breathing space meditation. Data were collected at baseline and 12 weeks post-intervention using the Perceived Stress Scale (PSS), Geriatric Depression Scale-Short Form (GDS-SF), and serum cortisol levels.

Results:

Post-intervention, 83.33% of the experimental group reported low stress compared to 12.50% in the control group (P = 0.001). Depression also significantly improved, with 41.67% achieving expected levels in the experimental group, while 70.83% in the control group remained moderately depressed (P = 0.001). However, serum cortisol levels showed no significant reduction (P = 0.21).

Conclusion:

Mindfulness-based interventions effectively reduced stress and depression but did not significantly impact serum cortisol levels. Future research should examine longer interventions and alternative biomarkers. Nurses are key in integrating mindfulness into elderly care to enhance mental well-being.

INTRODUCTION

As the global population ages, mental health concerns among the elderly have become increasingly prominent. The World Health Organisation (WHO) reports that roughly 14% of persons aged 60 and over experience a mental disorder, with depression and anxiety being the predominant conditions.[1] Studies indicate that elderly individuals residing in old age homes are particularly vulnerable due to factors such as social isolation, loss of independence, and lack of family support.[2] A study conducted in India found that the prevalence of depression among elderly residents in old age homes was 47.8%, highlighting the urgent need for effective mental health interventions.[3]

One of the physiological indicators of stress and depression is serum cortisol, a hormone released in response to stress. Elevated cortisol levels are associated with chronic stress, anxiety, and depressive symptoms, which can negatively impact immune function, metabolism, and overall well-being.[4] Research has shown that elderly individuals with high levels of stress and depression often exhibit elevated serum cortisol levels, which can lead to further health complications, including hypertension, diabetes, and cognitive decline.[5]

Mindfulness-Based Stress Reduction (MBSR) is a promising approach widely studied for its effects on mental health. Studies have found that MBSR can significantly reduce stress and depressive symptoms among the elderly by promoting relaxation and emotional regulation.[6] In addition, research indicates that MBSR interventions can significantly reduce serum cortisol levels, thereby alleviating stress-related physiological symptoms and improving overall health. A study reported that cortisol levels decreased by 20–25% in elderly individuals practicing mindfulness-based interventions.[7] Given the high prevalence of stress and depression among elderly individuals in institutional settings, this study assesses the effectiveness of mindfulness-based approaches as essential for enhancing their mental and physiological well-being.

MATERIALS AND METHODOLOGY

This research used a quasi-experimental methodology to assess the efficacy of a mindfulness-based intervention on stress, depression, and serum cortisol levels in senior residents in nursing homes. The study was performed in two elderly care centres in Chennai and received approval from the Ethics Committee of Saveetha Medical College Hospital (O10/06/2023/IEC/SMCH). Forty-eight-year-old people, aged 60–80 years, were selected by a convenience sampling method. The participants were divided into two groups: an experimental group that underwent a structured mindfulness-based intervention and a control group that received standard treatment.

The mindfulness-based intervention was implemented over 12 weeks. It included techniques such as the 5-Senses Grounding Technique, Body Scan Meditation, Mindful Walking, Mindful Eating, and Breathing Space Meditation. Data were gathered at baseline and after 12 weeks using a socio-demographic questionnaire, the Mini-Mental State Examination (MMSE) for cognitive function evaluation, the Perceived Stress Scale (PSS) for stress level measurement, the Geriatric Depression Scale - Short Form (GDS-SF) for depression assessment, and serum cortisol levels. The gathered data was analyzed with IBM SPSS version 26.0. The Chi-square test was employed to compare categorical data, whereas independent t-tests evaluated differences in continuous variables between the two groups, and statistical significance was set as P ≤ 0.05.

RESULTS

Demographic characteristics

The mean age of the participants was 70.56 ± 5.04 years. Most were female (87.50% experimental, 66.67% control) and had school education (70.83% experimental, 66.67% control). Many were unemployed (62.50% experimental, 33.33% control) and widowed (70.83% experimental, 62.50% control). Nearly all (95.83%) lacked economic support and came from urban areas (83.33% experimental, 91.67% control) and nuclear families (83.33% experimental, 95.83% control).

Stress and depression levels

In the pretest, the experimental and control groups exhibited moderate stress levels (P = 1.00, NS). However, post-test results revealed a significant reduction in stress within the experimental group, with 83.33% reporting low-stress levels (P = 0.001). In contrast, 87.50% of the control group reported moderate stress (P = 0.001). The experimental group showed a significant difference between pretest and post-test stress levels (t = 20.96, P = 0.001), whereas the control group showed no significant change (t = 1.64, P = 0.11) [Table 1].

Table 1.

Comparison of pretest and post-test levels of stress score

Group	n	Pretest Mean±SD	Post-test Mean±SD	Mean Difference Mean	Student’s paired t-test
Experimental	24	22.79±2.11	11.38±2.20	11.41	t=20.96 P=0.001*** DF=23, (S)
Control	24	21.75±3.07	21.08±2.89	0.67	t=1.64 P=0.11 DF=23, (NS)

P>0.05 not significant, ***Highly significance. DF=Degrees of Freedom, S=Significance, NS=Not significance; SD=Standard Deviation

In the pretest, both experimental and control groups had moderate depression (P = 0.17, NS). Post-test results showed a significant improvement in the experimental group, with 41.67% reporting normal depression levels (P = 0.001). In contrast, the control group had 70.83% with moderate depression. The experimental group showed a significant pretest-post-test difference (t = 13.50, P = 0.001), while the control group showed no significant change (t = 1.81, P = 0.08) [Table 2].

Table 2.

Comparison of pretest and post-test levels of depression score

Group	n	Pretest Mean±SD	Post-test Mean±SD	Mean Difference Mean	Student’s paired t-test
Experimental	24	9.96±1.30	4.92±1.10	11.41	t=13.50 P=0.001*** DF=23, (S)
Control	24	9.62±1.88	9.37±1.81	0.67	t=1.81 P=0.08 DF=23, (NS)

P>0.05 not significant, ***Highly significance. DF=Degrees of Freedom, S=Significance, NS=Not significance, SD=Standard Deviation

Serum cortisol levels

Regarding serum cortisol level, no significant difference in serum cortisol levels was observed between the experimental and control groups (P = 0.86) in the pretest. Post-test results showed a significant difference, with the experimental group having lower cortisol levels (10.05 ± 3.17) compared to the control group (11.70 ± 3.06) (P = 0.21). Both groups showed no significant pretest-post-test change (experimental: P =0.24, control: P =0.83).

DISCUSSION

Stress and depression levels

The study found that the mindfulness-based intervention significantly reduced stress and depression among elderly individuals in old age homes. In the post-test, the experimental group showed a substantial stress reduction, with 83.33% reporting low-stress levels, compared to only 12.50% in the control group (P = 0.001). This finding aligns with recent research by Javadzade N et al. (2024),[8] which reported reduced stress levels among elderly individuals participating in a mindfulness program. Similarly, depression levels in the experimental group, with 41.67% reporting normal depression levels post-intervention, compared to only 29.17% in the control group (P = 0.001). This reduction in depression is consistent with findings from other studies, such as one by Belliveau C et al. (2021),[9] which showed a 30% decrease in depression scores following mindfulness-based interventions.

Serum cortisol levels

In contrast to the improvements in stress and depression, the mindfulness intervention did not significantly change serum cortisol levels. The experimental and control groups showed no significant pretest-post-test differences (experimental: P =0.24, control: P =0.83). The experimental group had slightly lower cortisol levels post-intervention (10.05 ± 3.17), but this difference was not statistically significant compared to the control group (11.70 ± 3.06) (P = 0.21). The lack of significant changes in cortisol levels may be due to long-term stay, individual variability in response, or the duration and intensity of the mindfulness intervention being inadequate to produce a detectable physiological effect. This finding suggests that mindfulness may effectively reduce psychological symptoms, but its impact on cortisol levels might require more intensive intervention.

Recommendations

Future studies can incorporate longer durations, more intensive mindfulness-based interventions, and a larger sample size to assess their impact on cortisol levels. In addition, exploring other biomarkers of stress and depression, alongside psychological measures, could provide a more comprehensive understanding of the physiological benefits of mindfulness in elderly populations.

CONCLUSION

Nurses play an essential role in implementing and promoting mindfulness-based interventions for elderly individuals in long-term care settings. By incorporating mindfulness practices, nurses can help reduce stress and depression, improving the overall well-being of elderly residents. Their involvement in patient education and ongoing support enhances the effectiveness of such interventions, fostering a holistic approach to mental health care.

Conflicts of interest

There are no conflicts of interest

Funding Statement

Nil.