reality, along with the varied lifestyles. en­vironmental conditions. and life historiescreates the need for highly individualizednursing care.This scenario posts a challengeto the care givers especially to the nurses.

1. L'ffRODUCfIONElderly are an extremely diverse indi­

vidual who possess a broad range of abil­ities and needs in all domains of function.They continue to experience 3 varied lossof physical. mental, and independence. This

The study aimed to determine the effects of laughter on quality andhours of sleep, systolic and diastolic blood pressure among theelderly and made use of a quasi-experimental interrupted time-

series design. Feny participants were selected through purposive sampling.20 were randomly assigned to experimental group and 20 to control group.Findings revealed that in the control group the baseline mean for quality ofsleep and post intervention was average. In theexperimental group. the baselinemean for qualilY or sleep and firsl week post intervention was average, whilein the second week post intervention was good. The bours of sleep was highestin the experimental group on the second week post intervention. The mean ofsystolic and diastolic was lowest in the experimental group on the second weekpost intervenrion, There was a significilJlIdifference ill the experirnemol gtoupin the quality of sleep, hours of sleep. and systolic blood pressure betweenbaseliue and second week POSIimervcnuon, but no si_g.nincal'lldifference inthe diastolic blood pressure. There was a sigl1ificantdifference in the panernof change across the three time period in quality of sleep, hours of sleep, andsystolic blood pressure between control and experimental group, while nosigniticaot difference in the diastolic.blood pressure.Gender andeducationalanainment made 110 significant difference in ihe quality of sleep, hours ofsleep. and systolic blood pressure, while (here \\'05 a significant difference indiastolic blood pressure.

Abstract

Richard Kasenda and Susy A Jael

Effects of Laugbter on Quality and Hours of Sleep and BloodPressure among Elderly In Indonesia

--------------------------~ ...

Cnh"fnity Rtltucll JII....nal

and easily accessible intervention OU11haspositive effects on sleep quality in the el­derly. laughter relaxes the whole body. reolieves physical tension and stress. Laughterimproves the function of blood vessels andincreases blood 60\\'. which can helps pro­tect against a heart attack and other cardio­vascular problems. Laughter dissolves dis­tressing emotions. Laughter helps relax andrecharge. It reduces stress and increases en­ergy. enabling a person to stay focused andaccomplish more ( Seagel & Smith. 2014).Many older individuals have high bloodpressure arising from the vasoconstrictionassociated with aging. which produces pe­ripheral resistance (Eliopoulos. 2014). Ac­cording 10 Miller as cited by laughing Diva(2014), the benefits of laughter call decreaseblood pressure and increase blood flowthrough Ole expansion of the inner liningof arteries. A study done by Peeples (20II)found out that laughter therapy dropped 6mmHg (Peeples, 20 II). Moreover, accord­ing 10America Medical Journal and Asso­ciation for Applied and Therapeutic Humor(2013) len minutes of laughter drops 10-20mmHg in blood pressure.According 10 Touhy and Jet (2012), bloodpressure. especially systolic blood pressure,increases wiih age. with a leveling. off or de­crease of the diastolic pressure for personsabout 60 years of age and older. Arterialwall stiffening consistently increases andbaroreceptor activity decreases, which isthought to be associated with changes in cat­echolamine level. Erber (2013) stated that,over time the walls of the arteries becomeless elastic and blood pressure often inereas­es.Mauk (2014) added that as persons ageincreases. the systolic blood pressure tendsto rise. and the risk of stroke associated withhypertension also rises.

The United Nations has reported that thenumber of persons 60 years old and olderworldwide is estimated to be two billion bythe year 2050 as compared with about 841million in 2013 (UN. 2013). In 1950. therewere 55 million men and women in Asiaages 65 and above. while in 2000. there were207 million. Moreover. the report claimedthat by 2050, the elderly population is pro­jeered to be 865 million. In Indonesia, in theyear 2010. there were 18.04 million elderlycitizens, and by 2020 it is estimated to reach28.8 million (Webadmin, 2012).Aging is associated with major physical,psychological and sociologi-cal change.One of these is in relation to sleep. Sleepserves to rest body or-gans. conserve ener­gy. preserve bio-rhythm and restore men­tal alertness. According to The Ameri­can Geriatrics Society (2009). elderly withsleep dis-orders are more likely to develophy-pertension. de-pression. cardiovascular.and cerebrovascular disease. Carskadonand Dement. (2005) found out that there isa strong association between steep disordersand illness or early death, The)' claimeddlat as marry as 501)1.1of older individualscomplain about sleep problems. includingdisturbed or "light" sleep. frequent awak­enings, early morning. awakenings, and un­desired daytime sleepiness, In Indonesiasleep disorders strike 500;' of people aged65 years or older who were living at home.66% or people who live in facilitated main­tenance. aud approximarely 20% -500/0 ofelderly reported insomnia (Stanley. Mickey& Patricia. 2006).Laughter is a part of everyday life, and re­cently it is receiving in-creased attention 3S aform of therapy, According to a study doneby Hac and Chang (2011), laughter therapyis considered to be useful. cost-effective.

[ffeces of uugbteroQ QuaUt) ilnd Hours ofSIC'('p and Blood Pressure among Elderly

Forty participants were selectedthrough purposive sampling, 20 were ran­domly assigned to experimental group and20 to control group. Sub-jects in the experi­mental group had the laughter therapy for 25minutes a day for two times a week, total offour (4) times in two weeks, The subjects inthe control group did not receive any inter­vention, Both the experimental group andcontrol group filled OUl the questionnaireon sleep quality .• nd hours sleep and theirblood pressure \\'35 measured

The participants were given a com­plere and detailed explanation about thenature and the purpose of the study. Theresearcher emphasized 10 the target partic­ipants tbat participa-tion is voluntary, andthat they have the freedom 10 withdrawfront the study anytime. Moreover, it wasexplained that eonfidemialuy and anonym­ity would be observed. A signed writtenconsent \\'35 A signed written consent wassecured after the explanation and before the

observation of blood pressure in thefirst .,.,.c'('1.:. ou \Vedncsd:!y, lind mce­suremcm of qun1ityond hours of sleepon the first w~l. 00. ThutSd3y

o, observenon of blood pressure on mesec-ond:wet''' on \\'cdoesdav and mea­suremem of quo1ityond hours of sleepon the second ,,"'Ccl: 00 Thursda)·.

x, intervention of laughter therapy onthe second week. on Teesday

x, intervention ofl.:!ughter therapy on I.hcsecond week, oa \Vcdn.esdIlV

0, post observation of blood p;-essureon\VcdocsclllY of !he: second week J 5minutes after imervemicn. Postlncnsuremc:nl of quality and beers ofsleep on Thursd.z.y9:00 A~f.

O-Iloitw observation of quality and hoursof sloop and blood pressure on fimweek OCI Ihc control group. 00 Tuesday

0:post observation of blood pressureon \Vedncsday of the 6rst week, 15minutes Ilfta the laughlc."l'therapyand quality and hours of sleep onThnrsday at 9:00A"'i.

sure on lh&xpcnmc-nt3i group.x, intervention of laughter therapy

im-mediately after thepre-measurement.

x, intervention of lcaghter on the firstweek. on wednesday

o. pre observation of qualtly andhours of sleep and blood pres

o.Control 0.where :

Figure J. lii/le! .>t'J/'e)~Ot~fig/Jl/1/!J2;i~1"£"1'­pt-r-ln-,cnllJ//JnclConw/ (/rol'fJExpt 0, x, X:. o. XJ x. 0,

II. METHODSThis study utilized the quasi-experimentalinterrupted time-series with pre and post­test research design. Time series design in­volves the collection of data over an extend­ed time period with multiple data collectionpoints to both before and after interventionto a single group of participants (Polit &Beck. 2010).The research design used in this study issummarized in Figure L

Research has shown that rnanyel-ders sufferfrom physiological disor-ders lhal includesleep disorder and changes in the bloodpressure. Thus. prevention and effectivetreatment of the disorder in old age can leadto sig-nlticem reduction in sleep deprive­tion, morbidity. mortality, medical illnessesand health care costs. In this study. the re­searcher has examined the effect of laughtertherapy on quality of sleep, hours of sleep.systolic and diastolic blood pressure..

EJft'fIJ of Lllughter on QuaJily and Hours ofSIet'p and Blood Pr(>5SUI't' among Eld~rly

Cnh'fnity Rtltucll JII....lUIl

Difference in the Quality of Sleep. Hours of Sleep. Blood Pressure Be-tween the Baselineand Post Intervention in the Experimental GroupTable 2iJillelt'.I1ct> IiI the Qua/llj' o/"Jlc>cy~HOUfS a/:Sl~ Jj5'toh,: iNlD O.!;b'lolic B/0tJd P./'e»1Jrt:>

Table I.£Jcscnpt/pe St:lllsttCs af'Oll3lily of'SIc.". NOlI""of'SI",p- Systolic om! £Ji.1.Stol/CBloodPrt:>.f.fU.l~/ame CO/I/m/ //lld El'fJet'liIlCYlld/ Gtvu/1.

Baseline Post tst Post 2nd'I\'C'ck week

M SO M SO M SOControQuaUtyof 10.80 2.73 t055 2.66 )0.15 1.66sleepHours of 6.40 1.23 6.•5 L13 6.35 1.27sleepDiastolic 81.50 7.45 79.75 752 82.25 7.34ExrulmcntalQuaUtyof 11.05 2.26 12.50 L88 L,,-05 1.19sleepHours of 5.75 1.33 6.m L03 7.00 1045sleepSystolic 121:50 9.25 lIS.IS 9.36 114.75 7.69Diastolic 80.75 7.99 79.50 7.59 n.75 7.16LrJ,'cIJd: hil; jJ·/20tXXI 1.1./.;

The data in Table I reveals that the mean for quality of sleep and hours of sleepare highest in the experimental group 011 the second week after the intervention. Also. themean of systolic and diastolic are lowest in the experimental group on the second vleckafter the intervention. This result of the study shows that laughter therapy im-proved thequality of sleep from fair to good and increased the hours of sleep and decreased the val­ues of systolic and diastolic. The quality of sleep in the control group did not improvedstaristically from a rating of fair, how-ever, the quality of sleep of the participants from theexperimental had improved from fair to good after the laughter therapy.

Quality of Sleep, Hours of Sleep. Systolic and Diastolic Blood Pressure

III. RESULTS

conduction of (he study. Fifteen minutes after (he last inrerventicn. debriefing wasdone bythe researcher. The participants were allowed to express their feeling and thoughts aboutthe study,

[ffeces of uugbteroD QuaUt) ilnd Hours ofSIC'('p and Blood Pressure among Elderly

DitTerenc-ein the Pattern of Cbange across the Three Time Period Be-tween Controland Experimental Group in the Hours of Sleep

Quality 27.62 2 13.81 20.6.00 .35ofSIC'C'pQuality 68.72 1.5 44.33 49.7 ,00 .57cfsleep'group

Source ss af i\iSS F P E2

DitTerenc-ein the Pattern of Change across- the Three Time Pe-riod Be-tween Controland Experimental Group in the Quality of Sleep The result in Table J shows that therewas a significam interaction of'time and group (Iinle·gfoup) for quality of sleep, F=49,71,p=,OO. 111isindicates that the difference in the pattern of change in quality of sleep acrossihe three lime period is significantly different between me conrrol and experirnenrat group,Further, it was noted that in the three time period in the ex-perimental group the pattern ofchange for quality of steep is increas-ing from baseline to post intervention second weekwhile in the control group it is decreasing from baseline to post intervention second week.Table 3OIIl(!J"lfllceIiI !he AIIIC>h/o/'cnillJ.!,Tc'ACt'Ob' lite IIJI~ Iii/Ie>Pt'riod 8c'/,,'('('/) C'(JI/III'}/ilfld£rp:ri,nCElhll Gm!¥, illlbt' QU.'1I/1y()/._S1«p

··5jgat.OJThe result in Table 2 shows that there was 3 significant difference in the experimen­

tal group between baseline and second week POSI intervention specifically on the quality ofsleep, hours of sleep. and systolic blood pressure. However. the data reveals that there wasno significant difference in the diastolic blood pressure.

.000"

.0621.987.167.999.25

.001"-3.7711.46

L457.69

8.25J l·1.7577.75

1.335.75122,5080.75

.000"·5.62:1.1914.0511.05QuaUtyof sJC'C'pHoursSys.tolicDiastolic

pM SO M SOBaseline Past znd week

EJft'fIJ of Lllughter on QuaJily and Hours ofSIet'p and Blood Pr(>5SUI't' among Eld~rly

Cnh'fnity Rtltucll JII....lUIl

There \\'<IS 110 Sigllific.aOIintcractienef ume and group (thue·group) for diastolic blood

Difference In 'he.' Pattern of Change across the Three Tlme Peliod Be-tween Controland Experlmental Group 1nthe DlasloUc Blood Pressul'e

SS,S'"II oj SqU(U7S. df.dcgreeso!Frccdo".,tv15S-Alc(J" SUUIofSqllttrer, E2·P(JrlittlEJnSquarl'

The result show'S that thCTC' 'W;lSa significant interaction of time and group (timc~group) for systolicblood prC'SSure,F(2)=29.88.p=.OO_This im-plies thai the difference in the.'pattern of change in S)'S­tolic blood pre.'ss.ureacross the three time period is different between the control and experimentalgroup. Further, it was noted that in the three time period in the experimental group the pattern ofchange in the sysrotic blood pressure is significaJltJy decreasing from baseline 10post inter­vention second week, while in the,control group the pattern of change is almost the sameacross the three time period.

SAL76411.66

.44.00S)'.stolic .26L.25 2 140.62 25.96systolic 3.23.71 2 161.67 29.88"groupError(systolic)

AD.00Source 55 df ~1SS f ParUalEta2p

/.)illi'rcncc /n Ih(.' A!/terll o/'Ch,'1I1SCACI"l'J.$$·/hc/hll'l' 7i/lle .Period .Pt'hn'{.'11COil/mIl/fIt!£rpeni})f'Olil! Croue Ii) loe ')JlJto!ll.· Blood P!'I;'SYUI't?

Table 5

Dlffen:nce in the Pattern of Change Across the Three Ttme Period Be-tween Control and Exrer­Imentel Grour in the:Systolic Blood Pt($sure

5S-SUIIIofSqllnres. df-tltgn·i;'S ofFr~f_d(Jt",MSS-,\1I'QIISUI1, ofSqunres, El·Pnrti(JiEtaSqullrn

'fable-4show'Sthat there Vr"8Sasignificant interaction ofume and group (time'group} (or hours o(sleep, F = 11.58.p=.OO. This indicates that the: pattern of change in hours of sleep across the threetime period isdifferent between the control and espertrnemal group. Further, it was noted that inthe three time period in the experimental group the pattern of change cfhcurs cf sleep is tncreestngfrom baseline 10 post lruerwntjon second week 'while.'in the control group the pattern of change isdecreasing from post intervention first week to post Intervention second week.

Hours 8.60 .....S 5.79 11.58 .00 .13of slc."tp·groupError 28.2 76 .37(Hoursof sleep)

Hours 7.20 1 3.60 9.70 .00 .20of Sleep

Table 4j)j/Jewo« in loe hllern of Ch<lnp ACf'OSSIne Inrt't' Jiille11lnOdOeluwn Control ://Jd£rf)t>rfllleJilill GNue iN IheHOlln o/:s7t"ePSource SS df ~1SS F P Etal

[ffeces of uugbteroQ QuaUt) ilnd Hours ofSIC'('p and Blood Pressure among Elderly

M SO M SO P VIB:L~(,IncQuaiuy 11.00 1_10 11.10 2.33 -.09 .87 NSo 5 C<pHours 5.60 LtH 5.90 .99 -.49 .10 NSSystolio t24.0 8.~3 11(,0 10.2 .7t .93 1'SDiasLolic 80.50 6.43 8LOO 9.66 -.13 J2 NSPest-tnt 1sLQuality 12.40 1.50 11.60 2.21 -.23 .eo NSof sleepHours 6.20 1.31 6.40 .69 ·.42 .OS NSSystolic 121.0 8.09 t t5.5 to.t 1.3 .57 NS

U.iHnilYR_"-h J... r...1 "01.... , III :-;.. 1

Dlffertnce 10Three-TIme PerIod 10the Quality of Sleep. Hours of Sleep , Systolic andDiastolic Blood Pressure Considering Gender and Educatlcnal Attalnment.

TIle result shows that therewas no Significant difference on quality of sleep, hours ofsleep. systolic and diastolic blood pressure in the baseline and second week post interven­lion. when gender was considered. W11i1ethere was IlOsiglliticant diO'erence in ihe qualityof sleep, hours of sleep. and systotic blood pressure in the first week post interventionwhen gender was considered, it is noteworthy th31 there was a signiflcant difterence in thediastolic blood pressure. Further. that thediastolic mean was higher in male than in femaleduring the first week post lntcrvenuoa and thill thedJtrel'eocewas srarisdcally significallt.Table 7(Je/ltfe/·£)/IJc;'w/lce.'J~IiI Ine 7nlW-llille 1't'./,llxI a/tile (.)Ullb(y o/Ji'et'p.HoulS ol'Sleep. Sfi·lo/i{'lill(/Oil).)'-IO//'" BI(}()(I Prt:.f$1I1t:On Erpc.'I'Iill(;'III/fl GIrJIlp.

Male Female-

-groupError J 060.00 16 11.84(Diastolic)SS·St-llnO[SqU(II1'S.df~(-'grw:roj FI\~eIJon',C\,1SS-J\lealr 5unl of Squares

.061.0953.962t09.91DiastolicJj1.11i4j)1:(S.}5D13S(OUC

Partial Ela2 Squ:ln'.619

p

O///ere/ICC /i; loe Pilllc!"!1t)/'CO;111J'CAclt)$.S' Inc l/JteC liiJJe Pen(M De/1Vee11 C-D/llfOI(1ntfErpcrlincnln/ (t'mllp inlo/:' J)"'lsio!tc $IQ(){/ J'Jr.:r,fflI'C,Source SS df MSS F

Table 6

pre,<sure. F(2) =2.47.p=.09. This impli es that the difference in the pattern of change in di­astolic blood pressure across the three trine period is not different between the control andexperimental group. Fur-ther, il 'vas noted thal in the three time period in the experimentalgroup the pattern is decreasing from baseline to post intervention second week, while inthe comrol group the pauern of change is decreasing, from baseline to post inle.I'venljon firstweek white increasing from post intervention first week to POSlintervention second week.

EJft'fIJ of Lllughter on QuaJily and Hours ofSIet'p and Blood Pr(>5SUI't' among Eld~rly

Cnh'fnity Rtltucll JII....lUIl

Among the elderly, laughter can significant1y inlprove the quality of sleep and increasehours of sleep and could decrease llie systolic blood pres-sure. Althougll, the decreaseiJI the diastolic blood pressure \V3SnOLstatistically signifle.aru. it is nOlcwonhy lha( therewas a decrease in its value. The result also implies Ihat the more the client experiencelaughter then the more it can improve the quality or sleep, the higher will be the hoursof Sleep. and the higher will be the decrease in the systolic and dlac;tolic blood pressurevalues. TIle result of the study is consistent with the ffndings of lhe study of Ko and YOUIl(20 II). Their study found out that laughler therapy has posilive effects on the qualilvof sleep. Moreover, Stacy (20 II) claimed tho! I, minufes of laughter is equal 10 thebenefits of tWO hOUN or sleep. Further, the result ofthe study suppons (heclaim of Preidt(2014). Ghodsbin, Ahmadi, Jahanbin, and Shariff (2015). According 10 them laughterlowers the blood pressure and increases blood flo\....Moreover, accol'du1g to research thaiwas conducted by O'riordan (2008) subjects who laughed had reduced tl,eir syslolic blood

f:re,ssure for more than 6 mmHg, Moreover. a study (lone in Japan byMiller and Knepper2014) reveals that laughter can drop 5 to 7 nllnJ{q in systolic blood pressure. 10"'ellngthe likelihood of blood vessel stiffness, America Medical Journal added (2013) Ihal lenminutes oflaughler drops 10-20mmHg in blood pressure. Epstein (2014) stated eldertv areat a higher ris~ of having high blood pressure. and laughter helps 10balance or lower bloodpressure by Increasing vascular blood tlcw.

The result also hnplies that gender made a sig.nific.anlinfluence on the diastoticblood pressure, but not with thequaJity of sleep, hours of steep, and systolic blood pressureamong theelderly, TIle study done byAbel as cited by Capps (2014) found Ihal, there was nosignificant genderditlercnce on measure of sense ofhunior, TIle result of the study done- bySilva, Andersen. De Melto, Biuencoun, Pel1.t2ZOnndTuflk (2008) also lbund no significantdifferellccs between genders in the percelltage or REM sleep and sleep efficiencY. TIleresult of this study also supports that sex differences were noted with males having highersystolic blood pressure and diastolic blood pressure than the females (Jervase, Barnabas.Enlcka.&Osondu, 20) 3). The resuh inlplies that educationcl auainmemmadea Sig,llificallteffect on the diru.10lic blood prcssw'e but "lade £10 influence on quality of sleep, 1,0ul'5 of

IV,DISCUSSION

rti)tller h.'.!iUIb.h:VI?-liJaJ(nal lIiCii: WilS n6 SignuicUu{ u1f1ci?iicc iii tile qUillity uJ :,I&jland blood pressure in three-lime period when educational anainmem was considered.

The mean in the baseline, POStin-tervention first week and second week are nOIsignificant ill all levels of education. TIU!mean for (he category "no school" and "cojlege"were decreased from baseline to post intervention particulaily <luringthe second week, butthe mean of elemental)' and hign school was slightly increased.On we other hand the result also showed thet there was no significant difference in lhesystolic blood pres-sure in three times period for no school. eleillentary, high school andcollege. The mean for the category. no school. high school. and college were increasedfrontbaseline to post inter-vention second week, but for elemen-tary there \\'tIS a decreasebut. not sig-ni(icrull.

Diastolic SO.50 4.37 7S.50 10.0 .57 .02 SibPost-trn 2ndQuality 14.10 .73 14.00 1.36 .IS .15 NSof sleepHoutS 7.10 1.10 6.~ 1.79 .30 .32 NSSystolic 116.0 7.37 113.5 6.18 .71 .92 NSDiastolic 79.00 6.14 16.50 8.18 .77 .38 NS

[ffeces of uugbteroQ QuaUt) ilnd Hours ofSIC'('pand BloodPressure among Elderly

Capps, D (2014) l.aughter ever after minis try of goodhumor, Retrievedfrom hltps:!1 books.google.com.plsbookszid= IQZh

America Medical Journal and AATH(2013). 37 University and journal based research on laughter youshould knowabout. retrieved from hllp:JlrialhlLword press.comJ2013104112137-university-and-journal-based-research-on-laughter-you-should­know-about/

REFERE:'<CES

Nurse educators need 10 empha­size in their teaching the beneficiat effectsof laughter to sleep and blood pressure.Nurse practitioners need to include laughtertherapy 35 part of their intervention to theelderly clients and to encourage elderly tomake laughter as their lifestyle. Health careadministrators should provide a nurse whowill take an active role in creating and im­plementing laughter therapy pro-gram.

For future research. the study can be rep­licated utilizing a higher number of popu­lation and a longer period of imp1ementinglaughter therapy, ]t is also recommended 10consider the amount of laughter exerted bythe panicipants, the type of personality ofthe participants. and to utilize other formsof laughter therapy. Moreover, it is recom­mended to utilize other population groupsto strengthen and widen the empirical evi­dence of laughter therapy.

RECOIIHIENDATIONS

Based on the findings of the s(udy, theresult implies that laughter therapy can im­prove the quality of sleep, increase the hoursof sleep. and decrease the value of systolicand diastolic blood pressure among the el­derJy. Moreover. the more is the laughter ex­perience. the better is the quality and hoursof sleep. and the higher is the reduction inthe systolic blood pressure. Gender and ed­ucational attainment as a modifying variablemade no significant difference in the qual­ily and hours of sleep, and 10 the systolicblood pressure. On the other hand. genderand educauonal auaiumem made signifi­cant changes in the dias-tolic blood pressureamong the elderly.

V.CONCLUSION

sleep. and svstolic blood pressure amongthe elderly. The result of the study is nolconsistent with the results in previous relatedstudies done. Accordine to study done byPatel Grandner, Xie, Branas, Goonerntne(20Ii\) they found that poor sleep.qualily (sstrongly associated ,yuh education. Theirstudy suggests ilUll education is signific3nl1ymediated only to those with low education.In addirion, study done by Eder, Zou,Grote. and Bedner (2011) found that lowereducational attainment 'V3S associated withsleep problems. The research study thatwas conducted by Zawisza, Adamczyk.Galas, and B~ska (2014) found out thatthe level of education has an effect in thesleep duration, The lower the education theextreme is the sleep duration ~ 5 or hours!day). 9 hourslday). On the other hand. theresult of this study supports the researchdone by Gulliford. Mahabir and Rocke(2003) that there is no association of systolicblood pressure with education in women,\Vhile in men there was weak evidencelhal the prevalence of hypertension wasnot associated with educational anainment,There is no consistent association betweeneducation and blood pressure in men,

EJft'fIJ of Lllughter on QuaJily and Hours ofSIet'p and Blood Pr(>5SUI't' among Eld~rly

Cnh"fnity Rtltucll JII....lUIl

Ko. H. J and Youn. C, H. (2011). Effects of

Jervase E, Barnabas, D. Emeka.A, Osondu.N(20 13). Sex differences dnd rei.tionship between blood pressureand age among the Ibos OfNigeria. Retrieved from hup:llispub.comlIJBN3/2f3743

Hae- J. K. & Chang- H Y (201 I). Origi1131Article :Effects of laughtertherapy on depression. congitionand sleep among the community-dwelling elderly

Gulliford, Me. D Mahabir and B Rocke(2003). Socioeconomic inequalityin blood pressure and its determinants: cross-sectional da-ta fromTrinidad and TobagoRetrieved from: htl]>S:11www. google.com,ph/url?sa=t&rct=j&q=&esre=s&source=\veb&cd= I&cad=rja&uact=8&\'ed=OCB\\'QFjAA&u('-hup%3A%21-~.2f",\V\v.nalW'C.colll%2FjhhO/.2Fjourl1al~'n2Fv18°'o2Fn1%2Fpdt"/o2FtOO1638a.pdt%3Foriginu/oJOpublica-lioll_ del.il&.i=lekPVeH405DX8gWm04l YCA&usg=AFQjCNEb-8frH98I B70eibE6z8ftpVtaXA&b\'m=b\'.88528373.d.dGc

of elderly people referring 10 Jahandidegan Community Center inShiraz, Iran. 2014: A RandomizedControlled Trial. Retrieved from:hltp:II"·\V\\'.ncbi.nlm.nih.gov/plllC/articles1PMC4280555!

Epstein. S (2014). Health benetusoflaughter for seniors: It's no joke.Retrieved front : http://\\,\V\v.reureathome.com/eewvbenefits-laughter-seniors!

Erber. J. T (20 13). Aging & Older Adulthood (3rd Ed.). Wiley-Blackwell, AJohn Wiley & Sons. lnc., Publicotion

Ghodsbin, F.Ahmadi, Z, S. Iron Jahanbin,I. Sharif F (2015).The effects oflaughter therapy on general health

Eliopoulos. C (2014). GerontologicalNursing (8th Ed). Wolters Kluwerhealth. lippincott, Williams &Wilkins.

Eder D. N. Zou, D. Grote L Hedner J(2011). Self-reported features ofsleep, utilization of medicalre-sources. and socioeconomic posirion: a Swedish population survey.

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HbxsoeIC&pg=PAI6&lpg=PA l6&dq=l.ughter+has+llo+significam« differcnce+()11 ! gel)der&source=bl&ots=KjITu6w3tT&sig=rznFKJ6cEk _PzBlP09IgVIYhglo&hl=en&s.=X&ei=Af32VKmqMsK2mAWpkYGoCQ&ved=OCDcQ6AEwBJ!,#\"-Ollep-age&q-'3ughle ....(~20haSOle.l0Ilo%20si~llificMt%20differencc%20on%10gclldcl'&' ....false

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