Sample on Recreational Therapy Help

Does Recreational Therapy Help Reduce Stress In Elderly People?

Stress in old age people is attributed by stressed relationship between family, friends, existence of decreased finance, loss of spouse, retirement and medical issues. The existence of stress has been determined three times in relation to elderly people who are residing in community. In this respect recreational therapy can be effectively used in restoring function, maintaining health, reducing risk factors followed by maintenance of overall psychological competence. The intervention involve fitness, social interaction skills, self expression as well as therapeutic programs.

The present dissertation aims at analyzing whether recreational therapy assist in reducing stress in elderly people.

In search strategy included for searching databases are Cochrane library, Pub Med and Science direct. Further the use of inclusion and exclusion criteria has been made after deciding on the key search terms.

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Key findings: It has been determined that recreational therapy intervention has positive influence of the patient suffering from stress in physiological as well as psychological front. The therapeutic in form of music as well as aromatherapy is examined to produce calming and relaxing effect which further assist in reducing anxiety and stress. Further physical activities can help in enhancing the confidence level of the person. By expressing the views and interaction with the people the stress level can be reduced to significant level. Thus this results in enhancing the quality of life.

There must be existence of individualized outcome based activities that focuses on meeting the specific needs of the elderly people living in care home. For instance, if the patient gets more relaxed by listening of music then more focus needs to given on such therapy so that stress can be reduced.

Justification For This Literature Review

Review of literature has been conducted on the present topic. The reason for considering the literature review is in relation to gathering of up to date summary and analysis of the literature that is already available which is associated with the topic given under the study. It is further considered as the area that includes broad/comprehensive investigation along with the systematic review of the articles that have been published by research scholar. Thus section of literature review facilitates in generating written report that offers detailed summary about what is known as well as the things that are unknown on the present topic under study.

Special consideration and focus has been given on the areas that are needed to be included in the section of literature review. This includes the areas of stress that are experienced by people of old age that are living in care as well as residential home. The concept of recreational therapy along with its role in reducing stress within old age people has been analyzed. An exploration of theoretical literature that is related to recreational therapy on order to reduce stress within elderly people will be done. In the present dissertation the section also examines theoretical as well empirical literature which is associated with the topic under study. It is later followed by conduction of exploration of study for the purpose of undertaking formulation of themes as well as subthemes based on investigation.

Significance and relevance of health related topic

This topic regarding health care is of critical importance as there is a existence of various elderly patients who are residing in care or residential home. The number of these is increasing day by day thus this resulting in enhancing the problems related to stress. Therefore the role of recreational therapy can be effectively determined in managing the stress among the people in an appropriate manner. Hence the present dissertation is most likely to assist in making contribution in order to reduce stress within elderly people by employing varied aspects of recreational therapy.

Stress has been considered as most common among elderly people who resides in care and home. The symptoms of stress has been found in most of the old age people. It is found to be three times in comparison to the old age people who are living in the community. In addition to this the mostly the cases of stress experienced by old age people in care homes are unrecognized. This further results in causing numerous of issues (Burlingame and Blaschko, 2009). Following this numerous reasons have been provided by the researcher in relation to the increasing tendency of stress in care home residents. These occurs in form of fear as well as isolation. The old age people who are living in care homes suffers from various health related problems that are chronic in nature in different situations. The role of physical pain has resulted in increasing stress among care home residents (Smith, 2008). Further the pain is not effectively managed by the care workers who resides at these care homes. In addition to this residents finds difficulty in communicating with the members of staff which makes them face condition related to increased stress. There is absence of feeling in relation to autonomy or purpose of life that assist in making them feel stressed out. The presence of risk is more for the old age people who are isolated socially and have existence of a very few visitors.

Recreational therapy is also referred to as therapeutic recreation. It is based on involving the people in the activities of recreation in order to enhance the overall functioning, independence as well as overall being of the patients. It has been investigated to be enough for the purpose of satisfying specific needs of human especially for those individuals who have been institutionalized. An important feature of recreational therapy is that it can be employed to different types of settings. This includes community mental health centers, hospitals as well as adult day care programs. The recreational therapist that is one who are engaged in providing recreational therapy have focused their direction towards working for the similar goals as carried out by other disciplines. The difference exist in the fact that there is employment of interest gained by the client in order to carry out meaningful procedure.

The role of therapy of recreation greatly assist in restoring functions, maintaining overall health, reducing the risk as well as maintaining the overall psychosocial competence. The interventions are related to fitness, movement activities, exercising, self expression, cognitive stimulation, therapeutic programs for behavioral as well as psychiatric symptoms and social interaction skills. In accordance with the study carried out by Buettner and Fitzsimmons, 2007 it has been investigated that there is existence of two kinds of recreational activities in case of nursing homes. The first includes therapeutic activities that are based on attaining behavioral as well as functional goals (Buettner and Fitzsimmons, 2007). Similarly another activity type is in relation to home like or everyday. Such depends on the daily routines of the people and aims at offering entertainment as well as diversion.

Research that has been carried out by Vole and Parks 2007 has reflected that therapeutic recreation services has greatly benefited the old age people who are residing in care home. The Frail older adults who have gained exercise program as a part of recreation found themselves to be cardiovascular ally fit, decreased blood pressure and overall flexibility (Voelkl and Parks, 2007). The therapy in relation to interdisciplinary programs results in improving opportunities towards reintegration with the community. Study conducted by Martindale 2008 has demonstrated that participation in nature on the basis of recreation therapy. This is because it results in decreasing loneliness which is followed by increasing affiliation with other members of care home (Martindale, 2008).

Search Strategy

The strategy for search in the present dissertation has been based on investigating whether or not recreational therapy assist in reducing the stress within elderly people. This has been conducted by linking the topic to framework of PICO. The aim of the search strategy is to provide brief overview in relation to key words, selection of relevant databases and also inclusion and exclusion criteria (Schwester, 2011). It focuses on evaluating the reason behind carrying out the study on recreational therapy and its impact on old age people. An indication will be made regarding the results by representing the numbers and types of research studies that has to be involved. The literature will facilitate in addressing the research question so as to meet the desired aims and objectives regarding investigating whether or not recreational therapy assist in reducing the stress level in old age people. Therefore it can be determined that search strategy will assist in ensuring systematic approach that is taken into account for the purpose of ensuring the credibility of literature. This would further act as an aid in adhering towards systematic procedure for moving towards an explicit and more focused investigation.

PICO framework

PICO framework has been considered as the section of methodology that assist in carrying out the entire research plan in an appropriate and coordinated manner. The framework is an acronym in which P stands for patient population or problem (P), I is the intervention, C stands for comparison and O is outcomes (Ishibuchi and Yamamoto, 2004). The framework of PICO can be used for the purpose of searching databases. The PICO framework for the present research that aim to assess whether or not recreational therapy would assist in reducing stress in old age people is enumerated below:

Population or patient problem (P): It is referred to as the aspect of framework that assist in formulating the research question for the particular study. Through this understanding can be created in relation to the problem that are experienced by the patients or the situation of larger population (Cronin, Ryan and Coughlan, 2008). In the present dissertation population for the study is the elderly people in residential home or care home and the problem is related to stress.

Intervention (I): It is another major step of PICO framework that aims at clarifying the investigation in relation to the different steps that can assist in resolution of the problem in an appropriate manner. Here in the present dissertation the intervention that can be used is recreational therapy. Thus it can be taken into account as a recommendation for elderly patients that are residing in care home (Dochartaig, 2007).

Outcome (O): This can be regarded as the final outcome where the focus of the researcher is on investigating the possibility of enhancing the overall condition that is being experienced by the patients (Booth, Papapiounnou and Sutton, 2012). Thus in accordance with the research question the outcome will be reducing the stress, reducing the anxiety as well as measuring the critical sign.

Electronic Search

In order to access the current information on the subject matter of study that is related to role of recreational therapy in reducing stress in old age patients living in care home intense electronic search has been done. This is required to be carried out for the purpose of gaining the relevant studies on the subject under the study (Terre, 2006). Therefore with the use of database journal articles written by various scholars on stressed out old age people as well as recreational therapy can be investigated in an effective manner. The database used for the present study is as follows:

Science Direct

Science direct is taken as database that offers full access to the texts that has been investigated to be on the basis scientific as well as medical related literature. The database offered by this is around 11000 journal articles that have been taken from 2500 journals (Science Direct, 2013). It also consist of set of 20000 books.

Google scholar

The role of Google scholar is effective in allowing the user to search digital copies of the articles in different formats that can be library as well as online format. It index the full text journal articles, books along with the documents that are considered as scholarly.

The Cochrane Library

The provided database offer articles that are related to health care specialties as well as medical area (The Cochrane Library, 2013). The particular library has been provided by the Cochrane Collaboration. It act as a source through which full length methodological studies can be accessed.

Pub Med

There is inclusion of approximately 23 million citations that have been taken out from biomedical literature that exist on Medline, journals as well as online books that are regarding life science. In addition to this further there is existence of full text content along with links to particular study.

Key Search Terms

Search terms are referred to as variables that facilitates the researcher in defining a search that is in relation to impact of recreational therapy in reducing the stress in old age people that are residing in care home. The search terms for the present dissertation acts as an aid in conducting the research on the implementation of recreational theory in treating old age people in reducing their stress level. The terms of search would assist the researcher in carrying the study in smooth manner on the journal articles. Avoidance has been made regarding the use of list of references that are unmanageable as well as large. This has been done for the purpose of reducing unnecessary chaos that can hamper the overall research (Saltikov and Josette, 2012). Thus there is existence of various search terms that can be used for the purpose of studying the impact of recreational therapy in reducing the stress level in old age people that are living in care home.

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Inclusion and exclusive criteria

The criteria for inclusion and exclusion are the one that facilitates in carrying out the research study on the topic related to whether or not the recreational therapy assist in reducing stress in old age people. Therefore the inclusion criteria are those attributes that needs to be taken care off. This makes sure that the researcher paper that meets the criteria for inclusion are taken for the purpose of study. On the contrary the criteria for exclusion determines the research paper that needs to be disqualified from the investigation (Phelps, Fisher and Ellis, 2007). Thus while conducting the research study there is adherence to both criteria for inclusion as well as exclusion on the given topic of whether the recreational therapy has impact on the reducing the stress of the old age patients that are residing in care home.

By making use of these criteria the overall credibility along with the reliability aspect of the research can be effectively enhanced. This is needed for the purpose of assisting in making search as well as the selection of articles that are related to the subject matter under study that aims at analyzing the impact of recreational therapy in reducing the stress in old age patients. This would assist in ensuring that exact answer are obtained (Maltby, Williams and Day, 2014). Inclusion as well as exclusion criteria assist the researcher in making sure that final as well as appropriate selection of literature has been made. Thus this assist in carrying out suitable review and analysis that could act as an aid in achieving the objectives of the investigation.On of the major criteria for inclusion is English language which is majorly because of searching the relevant studies for the investigation. With the assistance of English language the researcher can increase the awareness of oneself in relation to the studies that have been carried out on recreational therapy in elderly patients who are living in care homes (Lyson and Doueck, 2009). It is difficult for the researcher to translate the text that is written in other languages into English. Similarly the studies that haven been carried out before 2002 does not provide updated information in relation to impact of recreational therapy in reducing the stress in old age patients that are living in care home.

Rationale for selection final research papers

The selection of research paper has been made on the basis of above criteria specified. This include inclusion and exclusion criteria as well as their relevancy with the topic under the study. The literature that are relevant to the subject matter that is whether recreational therapy assist in reducing the stress in old age people have been taken into consideration for the purpose of carrying out study in an appropriate manner. Further this has result in drawing valid conclusion for the research findings.

Results Of Literature Search And Discussion Of Findings

The particular section focuses on thorough discussion on the problem under research along with the question problems followed by the issues that have reflected in the introduction as well as background section. Under this section the findings will be discussed in a way that it links to overall purpose of search that assist in achieving overall aim and objective. Thus the given section is about having brief insight related to the findings that are derived on determining whether recreational therapy helps elderly people to reduce their stress or not. Thorough focus has been given on the development of brief discussion in order to put emphasis on the views that have been demonstrated by the author along with the findings regarding the ways to link them. The themes that have been formulated are presented in structured manner. This is carried out by undertaking critical review for the purpose of drawing new insight so as to gather relevant information (Gerrish and Lacey, 2013). In addition to this CASP tools has been used in order analyze the research paper critically. This tool will aid in judging the overall quality of the research studies.

Stress areas faced in old age patients living in care home

The feeling of stress has been determined in the people belonging to different age groups. It is most common that individual get stressed out during the problem handling, strange situations and avoiding danger. The stress feeling is commonly determined in the people of old age and it is often found to go undiagnosed.

Stress is part of life that can be experienced at any age. It has been found that stress is categorized into two different types. It can be physical as well as emotional. The impact of physical stress can be clearly defined. Further emotional stress is more subtle only if it is chronic. Its consequences can be harmful for the people of old age (Snethen, McCormick and Van Puymbroeck, 2012). Stressed out brains sounds like alarm that releases harmful hormones like cortisol as well as adrenaline. As one grows older there is a presence of wide number of factors that can result in causing detrimental impact on the quality of life. It leads to increasing stressful situations for adult population. The stress can be found in various forms such as loss of friends and family members, lack of unemployment that can result in causing financial problems. In this regard old age patients can experience reduce incident of life satisfaction. The situation stress is found to be undiagnosed because of various reasons. It most of the condition it is unable to recognize the symptoms of stress. Even if they do then also they feel hesitated in sharing the feelings with the doctors (Ackerson, 2007). Different adults may feel reluctant in seeking treatment as they face symptoms of anxiety in their lives. The patients and physicians might miss the diagnosis of stress on account of other medical conditions that are being experienced by them.

In elder people stress come from chronic illness, disability or loss of spouse. Other sources of stress includes money, change in living situation or certain family problems. The stress is faced by the residents who have newly arrived in care home. This is because they have lot of anger as well as resentment on the relatives they have left. Thus they suffer from stress even though they have been introduced to the new roommates. The new place is much confined and it is difficult for old age people to plant trees, paste pictures of their grand parents and other personal objects etc (Vink and, 2013). Thus this results in creation of more stress in them. Further this becomes stressful for the old age people to make amendments in their time schedules. Although the elderly people are asked to sit wherever they want but still they miss their home which act as a major source through which stress is created within them. Further there is stress related to learning regarding where to move, ways they can seek treatment and other facilities.

In similar manner Abuse and neglect can also be regarded as major source of stress that are being experienced at old age. This results in increasing worry as well as anxiety. They are the signs reflects loss of memory or illness.

After effects of stress in old age patients living in care homes

Stress has negative impact on the health of the elderly people. It has been found that stress has negative impact on the brain. This ages the brain of the person who is suffering from tension. In addition to this stress can result in causing issues related to vision as well as hearing loss. The speeding up of heart rate, increasing blood pressure as well as production of stress hormone can result in causing vision and hearing loss (Creswell and, 2012). Further if the production of stress hormone that is adrenaline can lead to constriction of blood vessels that decrease hearing as well as vision in the old age people who are living in care home.

The old age people who are suffering from stress eat poorly, drink more and exercise less. They rely on medication to a greater extent. A study has been carried out by Heffner (2012) under the title that is neuroendocrine effects of stress on immunity in the elderly: implications for inflammatory diseases (Heffner, 2011). The present report is a review in which the view points of different authors have been effectively examined so as to reach final conclusion. It has been determined that age related changes in immune function leave older adults at risk for host of inflammatory diseases. The study highlights that stress has harmful effects on neuroendocrine as well as immune function. This may further combine with age to enhance the risk of diseases in older adults. The particular review highlights the evidence for the impact of age as well as stress on neuroendocrine regulation of inflammatory process that may result in increasing the inflammatory diseases at older ages. It can be critically assessed that the present study has certain limitation that is information in abstract is not sufficient to determine the findings of the review. Further the aim of the study has not be stated clearly which has reduced its quality.

Another study has been carried out Tsukamoto and Machida (2012) under the title that is effects of life events and stress on neutrophil functions in elderly men. The research has been conducted using the sample size of 81 men aged over 60 years. The study highlights that psychological stress can result in decreasing the neutrophil function in elderly individuals. This can further cause infectious diseases. The study has investigated the relationship between neutrophil function measured using nitroblue tetrazolium reduction test. The present study possess makes use of method such as survey (Tsukamoto and Machida, 2012). From the outcome of the study it has been determined that chronic psychological stress because of life events decreases neutrophil functions among elderly men. It can be critically analyzed that study possess certain limitations that is does not include elderly female individuals. Further the study does not clarify the effect of stress induced alterations in humoral factors on neutrophil functions in elderly. In addition to this the aim of the study has not be states clearly which makes difficult for the researcher in investigating for the accomplishment of the objectives.

The study carried out by Heffner (2012) studied the effects of stress on immunity whereas on the contrary the investigation conducted by Tsukamoto and Machida (2012) studied the effects of stress on neutrophil functions in elderly men. Both the researches makes use of different methods in order to investigate the subject matter under the study. Further it has been critically assessed that former study has made use of review so as to reach at the appropriate conclusion. Both the studies has similarity that is they investigate the effects of stress on the elderly.

Concept of recreational therapy in care homes

A study has been carried out by Velde, Cipriani and Fisher (2005) under the title resident and therapist views of animal assisted therapy: implications for occupational therapy practice. In order gain better insight to this the author carried a literature review in which three qualitative studies were analyzed for the purpose of knowing the perception of therapist and clients in relation to animal assisted therapy. In addition to this lifestyle performance model was employed so as to analyze the positive outcomes of animal assisted therapy with respect to occupational therapy (Velde, Cipriani and Fisher, 2005). It has been explored by the author that animals can be used effectively as an occupational therapeutic intervention. Using this can facilitate in specific social responses. Use of pets is made for the purpose of facilitating occupational based activities. This is because it has become important part in order to offer responsive environment to the individuals who are residing in residential care. The study has highlighted that recreational therapy is effective in reducing the stress. Further this investigation reflects the effectiveness of animal assisted therapy as recreational therapy in reducing the stress. It has been critically assessed that study has been limited to three cases.

A study was carried out by Hunter and Gillen, (2009)under the title that is stress copying mechanisms in elderly adults: an initial study of recreational and other copying behaviors in nursing home patients. The sample size of 32 residents of nursing home was taken in order provide description regarding usage of stress copying mechanism (Hunter and Gillen, 2009). The most common copying responses includes various aspects such as prayer, listening to music, talking to friends as well as family followed by reading along with watching television and reading. There are certain limitations of the study that it does not includes the methods used for the study. Further abstract is insufficient of providing information in relation valid conclusion drawn from the investigation.

Study conducted by Velde, Cipriani and Fisher (2005) focuses on analyzing the literature review so that implication of occupational therapy can be determined in an effective manner. However the research conducted by Hunter and, 2009 determines the stress copying mechanisms in elderly adults. Further the copying mechanism have been reflected so as to reduce the stress among old age patients that are residing in care home. Both the studies have examined the role of recreational therapy in minimizing the impact of stress in elderly patients.

The main purpose of the recreational therapy program is to assist the people in care homes for copying up with free time , deal with symptoms that are related to disease or illness in addition to the individual opportunities in order to help them to reintegrate with the society. The intervention of recreational therapy assist in restoring the function, maintaining overall health, maximizing the health risk factors that are followed by bringing psychosocial competence (Sharkey and Sharkey, 2012). The role of recreational therapy is critical ion reducing the stress level as well as depression that occurs in the elderly people who are living in care home. With respect to care home setting that are developed for old age patients, the activities regarding the leisure and recreation are meant to distract the residents from the limitations, disabilities and discomfort that is being experienced by them for the purpose of ensuring continuous improvement. In the similar manner the use of group treatment plays an important role in relieving an individual from stress.

Thus there is sufficient need for nursing home to ensure that appropriate recreational therapy is being offered to old age patients. But it has been found that nurses put in less efforts on the nursing intervention. It has been determined that therapeutic recreation must be provided by Occupational Therapists as well as Physiotherapists. Further their role in assisting individual regarding development of positive self image along with adjusted disabilities is crucial (Orsega-Smith and, 2004). Therapeutic recreation can be determined as the critical section of the patient care that emphasize on using recreation as well as leisure activities for the purpose of attaining health associated targets. In case of old age patient therapeutic recreation can be utilized as provision for continuous care which is followed by inpatient as well as outpatient rehabilitation. From the analysis of research it can found that recreational therapies are critical in reducing the stress in old age patients that are living in care home.

Role of recreational therapy to reduce stress in elderly people living in care homes

Music therapy

A study conducted by Wall and Duffy (2010) under the title that is effects of music therapy for older people with dementia. The aim of the research is to explore the ways in w3hich music therapy influences the behavior of older people with dementia. The researcher has conducted comprehensive review of literature by making utilization of databases including CINAHL, psycINFO as well as MEDLINE. The research has been limited to articles in English as well as peer reviewed journals dating 2003-2009. The review of thirteen studies have been made through which it has been determined that music therapy influences the behavior of old age people with dementia in a positive manner minimizing the level of agitation. Critical evaluation of the study can be carried out. A fair attempt has been made to answer the question in an effective manner (Wall and Duffy, 2010). In addition to this the paper selected were apt to the study. It would be reasonable to assemble the findings of the review as the researcher lacked in conducting quality assessment of the studies included. Delay was made in checking out the preciseness of the outcomes. However it can be seen that clear results can be applied to the local population.

The limitation of the research was that the authors only took thirteen studies for the review. This has limited the scope of study. Further only three online databases were referred. This act as major limitation as there were other databases that could be referred in order to gather more literatures. Apart from this, the literatures written in English were only taken into account. But there is a possibility that critical information may be available in other languages that are left due to inclusion criteria. It has found that the mood of the mood and socializing skills of the participants have enhanced positively. Thus there is requirement to make sure that soothing music has to be selected. It has been found that the music therapy plays effective role in stress management.

Another study has been carried out by Kemper and Danhauer (2005) under the title music as therapy. Music has been widely used for the purpose of enhancing the well being, reduce stress and distract patients from unpleasant symptoms. Music appears to exert direct physiologic effects through the autonomic nervous system. Music is low cost intervention that reduces surgical, procedural, acute as well as chronic pain. The quality of life for patients, receiving palliative care, enhancing sense of comfort as well as relaxation can be enhanced music (Kemper and Danhauer, 2005). It has been found that music is cost effective way through which stress can be reduced in the patients. It has been inferred from the study that music is widely used to promote a sense of well being and to distract patients from pain and other unpleasant symptoms. Further with the assistance of music mood can be improved, anxiety and pain can be decreased. Music can further enhance care giving behavior.

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On comparing the studies discussed above it has been determined that role of music is critical in reducing the level of stress in old age patients who are living in care home.

Yoga therapy

A study has been carried out by Woodyard, (2011) under the title that is exploring the therapeutic effects of yoga and its ability to increase quality of life. The objective of the study is to assess the findings of selected articles with respect to therapeutic effects of yoga. It also aims at providing comprehensive review of benefits of regular yoga practice (Woodyard, 2011). Results have been gained from the study that yogic practice enhances muscular strength, body flexibility, reduce stress, anxiety, depression, improve sleep, chronic pain and enhances the overall well being and quality of life. Different methods have been used in order to locate research studies that have examined therapeutic effects of yoga. From the study it can be examined that mental problems such as depression, anxiety and stress can be reduced through yoga.

Another study conducted by Granath and, (2006) under the title that is stress management: a randomized study of cognitive behavioral therapy and yoga. The investigation has been carried out by taking sample of 26 women and 7 men from a large Swedish company. In this study the stress management program based on cognitive behavioral therapy principles was compared with kundaliniyoga program (Granath, J. and, 2006). The groups were were divided into two groups of different forms of intervention that is total 4 groups were selected. Psychological and physiological measurement that have been obtained before and after treatment reflected significant improvements. But no significant difference was found between the 2 programs. From the results it can be indicated that both cognitive behavior and yoga are effective for stress management. There are certain limitation of the research that is related to the inadequacy of the abstract. This is because there is absence of aim in the abstract which does not offer clear picture of the study.

On comparing the studies it has been gained that yoga can effectively be used in reducing the stress in old age people. The study carried out by Woodyard explores the therapeutic effects of yoga and its ability in increasing the quality of life. Here the researcher carried out analysis of findings for the purpose of drawing valid conclusion. However the research carried out by Granath and, explores that yoga therapy plays effective role in managing the stress. The author conducted primary survey so as to analyze the preferences of the people.

Spending time with pets

A study has been carried out Richeson, (2003) on effects of animal assisted therapy on agitated behaviors and social interaction of older adults with dementia. The present study was examined using Cohen- Mansfield Agitation Inventory as well as Animal-Assisted Therapy flow sheet. Pilot study was carried out with 15 nursing home residents along with dementia participated in daily AAT intervention for three weeks (Richeson, 2003). It has been found from the study that animal assisted therapy can be effectively used as intervention in reducing the stress level in elderly patients. The results of the findings reflects statistically significant decrease in agitated behavior as well as significant increase in social interaction pretest to post test. There are certain limitations of the study that is the aim of the research has not been specified clearly. Further the abstract is not adequate in determining the findings from the investigation.

Another study has been conducted by Velde, Cipriane and Fisher, (2005) under the title that is resident and therapist views of animal assisted therapy: implications for occupational therapy practice. It has been examined from the study that animal assisted therapy offers wide variety of settings. This study has reviewed different literatures so as to investigate the perspective regarding the therapy in reducing the stress among old age people. Three qualitative case studies were analyzed to explain the perception of clients and therapists in relation to animal-assisted therapy (Velde, Cipriani and Fisher, 2005). From the investigation it has been concluded that companion animals play key role in lowering down the stress as well as anxiety. The benefits of lowering stress level has been determined on account of calming influence of dog, its ability to alert distress experienced by clients followed by increased communication as well as interaction. It has been found that reduction in anxiety score has been is twice higher rate when patients spent time with pets as part of therapeutic recreation. There are certain limitations of the study that is study is limited to three cases. The direct interaction with the investigation limited their synthesis of the case studies with the literature and theory presented. Further the data collection was limited to primary interview as well as observation. It has critically examined that due to absence of research literature AAT from an occupational therapy perspective did not grant for verification of the conclusions by other investigators.

On comparing and contrasting the studies it has been determined that study carried out be Richeson carried out pilot study for the purpose of determining the impact of animal assisted therapy in reducing the stress. On the other hand the investigation conducted by Velde, Cipriane and Fisher makes use of primary interview as well as observation in order to investigate the reduction of stress level while assisting animals. It has been critically examined that both the studies have resulted that role of animal assisted therapy is crucial in reducing the stress and anxiety in the old age patients to a greater extent.

Art therapy

Recreational therapy in form of art and craft session can be critically appraised to reduce to stress. Under this various therapies can be used by the individual. This include flower arrangement, furniture making, painting, sketching, stained glass window production and weaving can assist in relieving one from tension and stress. In accordance with the news article written by Hodges, (2013) it has been explored that drum therapy can be effectively used in order to reduce the stress that is related to situations and depression that is experienced by the patients (Hodges, 2013). This is taken into account for the purpose of bringing improvement in overall mental as well as physical health. Here the group sessions have been determined to last from 30 minutes to an hour. This include teaching therapeutic techniques in order to bring reduction in anxiety as well as stress.

On the other hand study has been carried out by Brook, (2013)which has reflected that the recreational therapy in form of exercise has not been found so effective in treating stress in elderly patients who are living in care home. In similar manner recreation in form of social engagement has been determined to be quite promising in nature but its is unproven (Brook, 2013). In addition to this the concept of outdoor activities along with exercise is not much employed on old age people who are frail, less fit as well as weak.

On comparing the studies it has been determined that both the studies have opposite views regarding the use of art therapy in reducing the stress level. The former research conducted by Hodges reflects that use of drums can result in lowering down the stress level among old age patients. However the study of Brook showed that recreational therapy in form of exercise does not play key role in reducing the stress and anxiety among the patients who are living in care home.

There is existence of provision in relation to recreational therapy in maximizing the overall emotional, social, cognitive and spiritual well being of the old age people. The therapist assessed needs of resident, develop individual plan and to ensure delivery of essential programs and services to everyone. The major aim of the recreational therapy is to make sure that appropriate opportunity is provided to elderly people in care home. Further its goal is to ensure that old age people enjoy their life to fullest and maximize their overall abilities followed by increasing overall enjoyment level.

Recommendations For Practice

After the completion of findings and discussion chapter the next section of dissertation is recommendations. Based on the discussion, it has been gained from various therapeutic interventions along with recreational therapy are effective in lowering down stress in old age patients. However till scope can be seen in increasing the effectiveness of therapy. Taking such into account various recommendations are provided so as to make recreational therapy more efficient.

From the findings it can be suggested to increase usage of individualized outcome based activities for old age patients in care home. In addition to this there is requirement to bring individualized outcome based activities that are focused in order to meet the specific needs of the old age patient who are residing in care home. This can be conducted by ensuring activity programs that are part of recreational therapy become smaller. Further they must be designed particularly for the purpose of meeting the requirements of the resident population. For instance, in case if particular patient gets relaxation by listening music and doing yoga rather than getting involved in creative activities then for such patients more focus has to be given on these therapies. Hence it is recommended to care home to take interest in all the elderly patients and note their recreational therapy so as to provide them same. This would assist in meeting their requirements in an effective manner.

Another recommendation is that care home needs to provide proper training to employees in the field of recreational therapy so that stress possessed by old age group can be reduced. The health care workers who are well informed and trained have expertise in offering recreational interventions to the old age people (Aigen, 2013). This is essential for the purpose of providing proper care to the elderly people. In addition to this there is need for existence of inter disciplinary team so that special as well as multiple requirements of the patients can be known in an effective manner. Thus best recreational therapy can be provided to them. This team can include physiotherapist, professionals and other psychologist who can train elderly people the ways to engage themselves in art and craft activities. Inter disciplinary team of the professionals who belongs to various areas can work together so as to offer various therapeutic intervention to elderly patient that can assist in reducing stress in an effective manner.

Along with this there is need to employ non pharmacological interventions in form of therapeutic intervention. These should be promoted by the members of staff of nursing home and other consulting medical providers. The acts must be taken into consideration before the prescription of medication has been provided. Apart from different medication focus should be given on the recreational therapies as they do not have any harmful impact on the physical health of the elderly patients. The activities of recreational therapies includes music, fitness as well as creative must given more attention as they are effective in offering physiological as well as psychological influences on the patient (Eliopoulos, 2013).

It is essential to give special consideration to choices of individual as well as interest of patients in their therapeutic intervention of recreational therapy but suggestion can be provided regarding the focus on the organization of group activities. In order to reduce stress group programs can be organized and elderly people can be involved in the social activities so that their stress level can be reduced. It is necessary for care home to organize group activities for the purpose of increasing interaction of elderly people with one another. This would assist them in relieving the stress to a greater extent. With the assistance of communication and self expression the condition of one suffering from stress can be improved. Further by establishing interaction stress can be relieved greatly among the elder

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