Journal of Gerontological Nursing


Beryl L Thomas, PhD, RNC


This study anticipated that the acquisition of meditation/ relaxation skills would provide the elderly with an independent vehicle for coping with the stresses of age, loss of social and work-related roles, as well as negative responses of reactions from society.


This study anticipated that the acquisition of meditation/ relaxation skills would provide the elderly with an independent vehicle for coping with the stresses of age, loss of social and work-related roles, as well as negative responses of reactions from society.

Healthy adaptive aging, as represented by life satisfaction and self-esteem, has seldom been addressed through research. Physiological and psychological changes, associated with aging, can affect life satisfaction as well as self-esteem, and have been considered powerful stress-producing factors. Although these manifestations of the aging process may be similar in various ethnic groups, black senescence may represent additional problems.


The purpose of this study was to investigate whether black elderly females could be provided with a means for improving their perceptions of life satisfaction and self-esteem through regular practice of meditation/relaxation skills. It was anticipated that the acquisition of meditation/relaxation skills would provide the elderly with an independent vehicle for coping with the stresses of age, loss of social and work-related roles, as well as negative responses or reactions from society.

Review of Literature

Although physiological and psychosocial problems may be similar across all ethnic classifications, there are some special concerns regarding black elders. Black people have encountered racial prejudice all their lives and as they grow old are met with the added burden of age prejudice.1·2 The National Urban League3 published a significant study called "Double Jeopardy," which described the dual discrimination of ageism and racism experienced by black elderly. Since the majority of black elderly are women, a third dimension of sexism may be added to the problems of ageism and racism.2 Butler and Lewis have suggested that the problems of aging blacks may be viewed as "multiple jeopardy: age, blackness, poverty, widowhood and womanhood."4

The National Institute on Aging5 observed that elderly minority groups are less likely than their nonminority counterparts to have adequate education, money, housing, or good health. These variables are usually correlated with psychological well-being, happiness and morale.6"9

Black elderly are also more likely to experience discrimination, language barriers and difficulty in obtaining needed social services. All of these variables may have an adverse effect on the aging process and on mental health, resulting in unhealthy thresholds for stress tolerance. Although the manifestation of stress is a highly individualized process, lifelong experiences with racism may have a negative effect on the happiness and wellbeing of die individual.4'10"11

Problems may develop when stress is maintained for long periods of time. The adaptive capacities of the body are utilized to assist the individual toward a new level of functioning when stress persists. In addition, the individual is assisted to return to the prestress level (i.e. homeostasis) through adaptation.

However, adaptive energies are finite. An individual's adaptive capacity is taxed and adaptive reserves depleted when stress is not relieved after long periods of time. Minor happenings become major events, causing the body to remain mobilized in a ready state. Homeostasis remains tenuous and terminates eventually in illness or an irreversible state of exhaustion: death.12

The elderly are more frequently in a position of decreased ability to maintain homeostasis because of their diminishing adaptive capacity. It doesn't make a difference whether stress is physical or emotional, the elderly require more time to recover or return to prestress levels than when they were younger.13

Meditation/Relaxation training can be used together to provide a state of calmness and relaxation. Relaxation is denned as progressive relaxation of specific voluntary muscle groups which can lead to "quieting" the mind and the ability to center oneself.14 Meditation is defined as the systematic and continual focusing of attention on a single target, for example, the repetition of a word or sound.15·16 Mahesh Yogi (1968) identified the repetitious sound as a "mantra." The mantra is usually a two-syllable melodic sanskrit word. In this study, the mantra used was IEM.

The goal of meditation is also to quiet the mind and center oneself, thereby producing body relaxation.,5·,6 According to Archer15 meditation is easier for some people because it doesn't involve focusing on specific muscle groups. Muscle relaxation may be preferred by some people who have difficulty with meditation, and stress is specifically manifested by muscle tension. Therefore, in this study, both meditation and relaxation training were offered as a self-directed coping mechanism for stress management.

There has been a paucity of information available which addressed healthy, adaptive lifestyles for the elderly. Selfactualization and peak experiences, as suggested by Maslow,17 may not be an available option for those experiencing low self-esteem and dissatisfaction with life. The potential for maximal experiences may also be limited for those who are experiencing age, gender and racial prejudice.

The last developmental stage of an individual's life should provide a time for self-actualization. Maslow17 described self-actualization as the highest level of psychological functioning which human beings can attain. Self-actualization implies an inner motivation to express one's unique self while allowing room for continual growth and expansion. "The more we restrict our concept of old age by descriptions and implied expectations, the less self-actualized behavior we are apt to see."18

According to Maslow,17 self-actualization is most possible in older persons because it requires the wisdom and maturity acquired through facing the realities of life and acceptance of oneself. As long as the elements of self-actualization and self-esteem are present, the potential for peak experiences is available for the elderly as well as others.17·19'20

Markides and Martin21 used life satisfaction and happiness to describe the state of self-actualization. They also identified perceived health and activity levels as the strongest indices of life satisfaction. The ability to challenge life and find peaks of life satisfaction is dependent on an enduring self-system.

Can the elderly be assisted to attain greater life satisfaction and self-esteem in a society which views aging as the end of living? An optimistic approach to answering this question might be to utilize many of the same dimensions of the holistic health perspective employed for any adult age group. These parameters may include autonomy in relation to mental health and stress management, encompassing asserti veness, meditation/ relaxation, nutritional awareness, and physical fitness techniques.

These issues led to the formulation of the following hypotheses: 1) Black elderly females who regularly practice meditation/relaxation skills will report greater life satisfaction than those who do not participate in meditation/relaxation training; and 2) Black elderly females who regularly practice meditation/relaxation skills will report greater self-esteem than those who do not participate in meditation/relaxation training.


In this study, life satisfaction was defined as a cognitive measure of aspirations relative to one's achievements and progress toward goals.7 The following terms used synonymously with life satisfaction include: feelings of happiness, well-being and adequate coping skills.

Both Life Satisfaction Indexes A & B (LSIA and LSIB), developed by Neugarten et al,22 were used to measure life satisfaction. The assumptions that only the individual is the proper judge of one's well-being and the need for maintenance of self-control led to the incorporation of self-reports of personal, social and community activities to also measure life satisfaction. These self-reports included a brief report of health habits and problems.

Self-esteem was viewed as an inner assurance of personal worth based on feelings of being valued, useful and competent.7·23 The maintenance of self-control is critical to self-esteem. In this study, self-esteem was used synonymously with self-concept, self- worth, and is closely related to self-respect. Rosenberg's24 Self-Esteem Scale (SES) was chosen to measure feelings of basic self-worth.





Sample: Twenty-one urban, noninstitutionalized, black elderly females, 60 years old or more, from the James White Manor Housing for senior citizens in Newark, NJ, volunteered to participate in this study. After random assignment to the two treatment groups, Meditation/Relaxation Training (MRT) and Didactic Stress Management (DSM), demographic data was collected and frequencies of the descriptive characteristics of the subjects were compiled. Age, marital status, living arrangements, education and income were almost evenly divided between the 11 members of the MRT group and the ten members of the DSM group, (see Table 1)

Procedures: Demographic information was collected from all subjects at the time of the pretest administration of the LSIA, LSIB and SES instruments. The data included the subject's age, religion, marital status, living arrangements, occupation (present and prior to retirement), retirement year, education, and approximate yearly family income. At this time, self-reports of health and activities were also obtained. In this pretest/posttest design, all data was collected through interviews with the aid of two trained research assistants.

Both groups (MRT and DSM) met once a week in 45-minute sessions for ten weeks. The MRT group received specific meditation/relaxation training for stress management. The DSM group was given general didactic information, solely, regarding stress management. At the completion of the 10-week sessions, the LSIA, LSIB and self reports of Life Satisfaction were solicited via interview.

Meditation/Relaxation Training: Subjects in the meditation/relaxation training group were introduced to the concept of stress management during the first session. During me following nine sessions, meditation/relaxation training was practiced. The subjects were informed that a technique for reducing stress would be taught to them and that this technique was a combination of Transcendental Meditation (TM) and the Relaxation Response. ,6 Subjects were told mat relaxation induced by meditating would enable them to cope with anxiety and stress in their everyday lives.









In an attempt to reduce anticipated dropout, subjects were encouraged to attend the weekly sessions, where they would meditate together, present problems concerning their meditation and seek explanations and support for their new experiences. Subjects were instructed to practice their newly acquired techniques at home, in a quiet place, twice a day for 15 minutes.

The following is an outline of the instructions:

1. Select a suitable place (quiet atmosphere, dim lighting) and comfortable chair with feet flat on the floor, arms relaxing comfortably in your lap and hands unclasped.

2. Allow your eyes to close and take two or three deep breaths.

3. While deep breathing, imagine entering a quiet place (scene of your choice, ie forest, seashore, pleasant room, etc.).

4. Initiate progressive relaxation skills:

a. Repeat the following phases while continuing to breathe deeply and slowly, silently say to yourself:

my feet are warm and heavy

my legs are warm and heavy

my abdomen is warm and heavy

my back is warm and heavy

my heart beat is calm and regular

my lungs are breathing freely and deeply

my hands are warm and heavy

my arms are warm and heavy

my shoulders are warm and heavy

my neck is relaxed and comfortable

my forehead is cool and comfortable

my head is drained of all negative thoughts.

b. The mantra (DEM) is introduced and syncopated with breathing (as in the Progressive Relaxation), then allowed to take its own rhythm. This repetitious mental device is to occur in a state of passive volition and should not be forced.

c. When aware of wandering or intruding thoughts, go gently back to repeating the mantra.

After instructions in these techniques, the subjects and trainer sat silently for approximately 15 minutes. At the end of that period, subjects were instructed to stop meditating and sit quietly with their eyes closed for about two minutes. They were further instructed to slowly "reenter" the room. They were encouraged to share their feelings regarding the experience. In conclusion, the subjects were thanked for attending the session, encouraged to practice the skills at home and reminded to meet the following week at the same time.


A one-way analysis of covariance (ANCOVA) was used to compare group means of the Meditation/Relaxation Training (MRT) and the Didactic Stress Management (DSM) groups, after the ten-week sessions. Statistical significance was identified for life satisfaction and selfesteem for the Meditation/Relaxation Training Group (see Tables 2-4). Life satisfaction and self-esteem were further supported by the data from the selfreports.

Self-Reports: provided die subjects with me opportunity to identify their own perceptions of well-being and happiness through their identification with health and activity levels. The pretest self-reports on health problems and activities were identified almost equally in both groups. Arthritis and high blood pressure were the two most frequently cited problems. A variety ci personal , social and community activities were also reported, including card playing, gardening, and church activities.

After the ten-week sessions, very few changes in health and activities were reported for either group. There was a slight increase in card arid game playing and not much change identified in health patterns and problems which were equivalent for both groups.


The results of this study indicated that the black elderly women who participated in the practice of meditation/relaxation skills (MRT group) during the ten-week group sessions reported greater evidence of life satisfaction and self-esteem than those who did not participate in these group skills (DSM group).

The MRT group accepted the training sessions without any visible untoward effects. The skills were practiced at the end of each group session to ensure a quiet environment, uninterrupted by late arrivals. Group members always reported feelings of "peacefulness and quietness" after meditating and relaxing.

Even though the MRT group members participated cooperatively in learning the meditation/relaxation skills, no interest was reported in practicing the skills away from the group. The general consensus of opinion was the preference to practice the meditation/relaxation skills only with the researcher. Therefore, there is some concern regarding the lasting effects of the improvement of life satisfaction and self-esteem for these elderly women without daily practice and use of the skills for stressful occasions.

In the DSM group, homework assignments were also uncompleted. The request to develop their personal goals for managing stress away from the group process was not fulfilled, without explanations from the elder women. These personal goals were developed throughout the subsequent group sessions with input from all of the group members.

It may have been unrealistic to expect the elderly participants to behave as "school children." However, the decision of both groups to continue to meet together as a support group can only be viewed as a positive outcome of this study.

Although statistical significance was identified, only a minimal posttest increase in social activities was noted through the self- reports from both groups. Speculation regarding these minimal changes included the following rationale.

First, the simple pleasures cited by the elderly women may indicate that they were living their lives to the fullest regardless of low income, specific problems related to poor health and loss of significant persons. It could be possible that adequate perceptions of life satisfaction and self-worth were relevant to their "survival mechanism" in our discriminating society. This survival mechanism would permit an individual to take pleasure in simple activities even when numerous deficits in criteria for life satisfaction and good health are identified. For example, our society designates a high correlation of wellbeing with high levels of education, employment, income, housing, etc., which was not evident in this elderly sample.





Second, minimal changes in the selfreports of life satisfaction could be viewed as adequate levels of life satisfaction, prior to their exposure to this study, due to their living arrangements. The protection of subsidized housing for senior citizens in a high crime area, may have been a positive influence on the feelings of well-being of these elderly women. Living within the housing complex, has enabled these elders to pursue social and community activities that may have been prohibitive during regular employment and residence in housing not scaled to their income.

These factors suggest that the coping skills of the elderly persons may have already been adequate. Although the reliability and validity of the instruments used to measure life satisfaction and self-esteem were appropriate and relevant to the elderly, they may not have represented information which considered the diversity of black culture. Therefore, for replication of this study, coping skills should be measured as well as relevance of the instruments to black culture and ethnicity.


It must be recognized that the sample was small and all subjects in this study were derived from the James White Manor Housing complex. Therefore, the results obtained were not necessarily generalizable to other black elderly females.


  • 1 . Dowd J, Bengston V: Aging in minority populations: An examination of the double jeopardy hypothesis. J Gerontol 1978; 33(3):427-436.
  • 2. Jackson M, Wood JL: Aging in America: Implications for the black aged. Washington, DC: National Council on Aging, 1976.
  • 3. National Urban League. Double jeopardy: The older negro in America today. New York: National Urban League, 1964.
  • 4. Butler RN, Lewis MI: Aging and mental health: Positive psychosocial and biomedical approaches. St. Louis: CV. Mosby Company. 1982.
  • 5 . National Institute on Aging . Epidemiology of Aging. Bethesda, Maryland: United States Department of Health and Human Services, 1980.
  • 6. Campbell A. Converse PE. Rodgers WL: Quality of American Life. New York: Russell Sage Foundation, 1976.
  • 7. George L: The happiness syndrome: Methodological and substantive issues in the study of social-psychological well-being in adulthood. Gerontologist 1979: 19, 210.
  • 8. Larson R: Thirty years of research on the subjective well-being of older Americans. J Gerontol 1978: 33(1): 109- 125.
  • 9. Lawton M: The dimensions of morale. In Kent D, Kastenbaum R, Sherwood S (eds.). Research, planning and action for the elderlv. New York: Behavioral Publications, 1972.
  • 10. Gioiella EC. Bevil CW: Nursing care of the aging client. Norwalk, Connecticut: Appieton-Century-Crofts. 1985.
  • 11. Manuel RC (ed. ): Minority aging. Westport, Connecticut: Greenwood Press, 1982.
  • 12. Selye H: 7"Ae stress of life. (Revised edition). New York: McGraw Hill Book Company. 1976.
  • 13. Woodruff DS, Birren JE (eds.): Aging: Scientific perspectives and social issues. New York: D. Van Nostrand Company, 1975.
  • 14. Jacobsen E: Progressive relaxation. Chicago, University of Chicago Press, 1964.
  • 15. Archer J: Managing anxiety and stress. Muncie, Indiana: Accelerated Development, Inc. 1982.
  • 16. Benson H: The relaxation response. New York: The Hearst Corporation, Avon Books, 1975.
  • 17. Maslow A: Religions, values and peak experiences. New York: The Viking Press. 1970.
  • 18. Ebersole P, Hess P: Toward healthy aging: Human needs and nursing response. St. Louis: CV. Mosby Company, 1981.
  • 19. Erb ED, Hooker D: The psychology of the emerging self, (2nd edition). Philadelphia: EA. Davis Company, 1971.
  • 20. Yurick AG. Robb SS, Spier BE, Ebert NJ: The aged person and the nursing process. New York: Appleton-Century-Crofts. 1980.
  • 21. Markides D. Martin H: A casual model of life satisfaction among the elderly. J Gerontol 1979; 34:86.
  • 22. Neugarten BL. Havighurst RJ. Tobin SS: The measure of life satisfaction. Journal of Educational Psychology 1961; I6(I):I34-143.
  • 23. Breytspraak LM. George LK: Measurement of self-concept and self-esteem in older people. State of the art. Experimental Aging Research. 1979; 5(2):I37-I48.
  • 24. Rosenberg M: Society and the adolescent self-image. New Jersey: Princeton University Press. 1965.










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