The Effectiveness of Warm Milk and Chamomile Tea on Anxiety

Symptomps in the Elderly

Elmeida Effendy

, Indri Meiya Br Sembiring

and Nurul Utami

Department of Psychiatry, Faculty of Medicine,Universitas Sumatera Utara. Jl. Dr. T. Mansur No.5, Indonesia

Student of Faculty of Medicine, Universitas Sumatera Utara

Resident of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara

Keywords: Anxiety, Milk, Chamomile Tea.

Abstract: The aging process will cause changes in anatomy and physiology. Generalized Anxiety Disorder is a matter

of concern about everyday problems and the anxiety, tired, difficult to concentrate, irritable, muscle tension,

and problem of sleeping. Matricaria recutita or Chamomilla recutita has been used as a traditional herb

medicine because of its soothing effects. Milk contains many amino acids tryptophan which is one of the basic

ingredients of serotonin, so the body can rest well. The purpose of this study is to invent the effect of warm

milk and chamomile tea on symptoms of anxiety in the elderly. This is an experimental analytic study, using

a pretest-posttest design with an 8-week purposive sampling technique located in Panti Jompo Karya Kasih,

Medan. 54 participants completed the HAM-A Rating Scale before and after the intervention with 18 subjects

each in the group of warm milk, chamomile tea and controls. Participants aged 60-74 years were men and

women with good cognitive abilities. Based on the results of this study, it was found that the difference in

scores before and after in the milk group was 21.56 and in the chamomile tea group it was 21.50. Through the

T-independent test also obtained the value of P is 0.59 (p> 0.05) that means there is no significant difference

regarding the provision of warm milk and chamomile tea to anxiety in the elderly.

1 INTRODUCTION

The aging process is a process of continuing

managing or sustaining naturally and generally

experienced by all living things. According to WHO,

the elderly are individuals aged 60 years and over

consisting of (1) elderly of 60-74 years, (2) age old of

75-90 years, and (3) very old age over 90 years (Indri,

2015). Meanwhile, based on the Law of the Republic

of Indonesia Number 13 of 1998 and Government

Regulation of the Republic of Indonesia Number 43

of 2014 said that the elderly are someone who is age

of 60 years and over.

Through the results of population statistics in the

world, Indonesia is one of the top five countries with

the highest number of elderly in the world. In 2014,

the number of elderly people in Indonesia became

18.71 million people and it is estimated that by 2025

the number will reach 36 million. From the results of

statistics from the North Sumatra Province Statistics

Agency in 2015, the number of elderly people

reached 945,362.

Psychological changes can occur in the elderly, what

is meant by changes of psychological in the elderly

include short term memory, frustration, loneliness,

fear of losing freedom, fear of facing death, changing

desires, depression, and anxiety.(Maryam et al.,

2008)

Anxiety, and fear are a completely natural human

condition. If this feeling occurs and last long, it

affects physical and mental health. This leads to

clinical anxiety disorder. There are many types of

treatments available to treat anxiety disturbance.

Anxiety is involved in a some of psychiatric

disorders, such as depression, panic attacks, phobias,

generalized anxiety disorder, obsessive-compulsive

disorder post-traumatic stress disorder and disorder.

Anxiety affects 16.6% of the world's population and

many efforts have been made to comprehend the

pathophysiology of the disease and its treatment.

According to the Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV-TR), anxiety is

characterized by a constant feeling of worry that

hinders the ability of a person to relax.

322

Effendy, E., Sembiring, I. and Utami, N.

The Effectiveness of Warm Milk and Chamomile Tea on Anxiety Symptomps in the Elderly.

DOI: 10.5220/0008553803220326

In Proceedings of the International Conference on Natural Resources and Technology (ICONART 2019), pages 322-326

ISBN: 978-989-758-404-6

Generalized Anxiety Disorder (GAD) is

characterized by excessive worries about problems in

daily life and the presence of anxiety, fatigue,

difficulty concentrating, irritability, muscle tension,

and problems of sleeping. GAD has a lifetime

prevalence of around 5%, with almost 9 million

affected by adults in the United States. GAD is a

recurrent disorder that often requires long-term

therapy. Current psychopharmacological treatments

for GAD include benzodiazepines and selective

serotonin-reuptake inhibitors or serotonin-

norepinephrine reuptake inhibitors (SSRIs / SNRIs),

but some patients do not respond to this therapy,

while others cannot tolerate side effects. As a result,

individuals who suffer from anxiety usually look for

complementary and integrative medicine, including

herbal medicine products to treat this.

Based on limited research shows that chamomile

and some of its flavonoid components may have

anxiolytic and antidepressant activity. Chamomile tea

and flavonoids consist in it, namely apigenin which

binds to benzodiazepine receptors in the brain so that

it can deal with anxiety disorders, depression, and

impaired sleep quality. Chamomile's side effect

profile may be very attractive to patients who cannot

tolerate SSRI / SNRI, or those who prefer natural

products or reject conventional pharmaceutics

because of stigma and other socio-cultural reasons.

Chamomile contains flavonoids, which exert

benzodiazepine-like activity and also have

phosphodiesterase inhibitory action, which leads to

increased he levels of cAMP. Milk contains many

amino acids tryptophan which is one of the basic

ingredients of serotonin. Increasing awareness of

nutritional needs for parents preventing mental

decline and nutritional status can greatly improve the

quality of life in the elderly.

Chamomile tea has the action of

phosphodiesterase inhibition, which leads to increase

in cAMP level. A recent study evaluates standard of

efficacy extract of Matricaria recutita (L), compared

to placebo for eight weeks in Indonesia patients with

mild to moderate GAD (DSM-IV). There are

statistically significant reduction in HAMA scores in

the group treated with extracts compared with

placebo treated group.

Study was conducted by Jun et al. in 2016, in 38-

week randomized placebo-controlled trial, found that

among respondents with chamomile tea therapy, the

difference magnitude (about 50%) in time to relapse

between chamomile and placebo. Research

conducted in January et al. in 2009 found that there

was a significantly greater reduction in total score of

HAM-A during chamomile therapy versus placebo (p

= 0.047). The results found that chamomile may have

simple anxiolytic activity in patients with mild to

moderate.

According to Miller, 2009 drinking warm milk

before going to bed can help ease sleep and become

an alternative choice to reduce sleep disorders in the

elderly. Milk contains many amino acids tryptophan

which is one of the basic ingredients of serotonin, so

it is recommended to drink milk before bed so that the

body can rest well. (Widodo et al., 2015)

Anxiety is uneasiness feeling, nervousness and

fear, which can lead to a serious mental illness.

Common anxiety symptoms are assessed using the

Hamilton Anxiety Rating Scale (HAM-A), a

commonly used measure of observer results that is

well validated.

Very few studies have been carried out to date that

evaluate the long-term safety and efficacy of herbal

medicines for anxiety. No further researchers have

been found related to the effectiveness of warm milk

to anxiety in the elderly.

Based on this background, the researchers

concluded that further studies are needed to clarify

whether long-term chamomile extract and milk can be

developed into a safe and effective therapeutic agent

for the treatment of GAD in the elderly. the difference

in the effectiveness of warm milk and warm

chamomile tea still requires more explanation about

the handling of anxiety disorders in the elderly so that

researchers want to do further research.

2 MATERIALS AND METHODS

2.1 Study Area

The sample in this study was taken using a purposive

sampling technique. The research subjects were the

elderly at the Karya Kasih Panti Jompo who met the

inclusion criteria. (Figure 1).

2.2 Procedures

This study will compare the effectiveness of giving

warm milk and warm chamomile tea to anxiety in the

elderly. Milk used is elderly milk according to the age

of the respondent and chamomile tea used is

processed tea from chamomile flowers. In this study,

before the intervention will be carried out an

assessment of anxiety for all respondents. After the

intervention was carried out for 8 weeks, an

assessment of anxiety will be carried out in all

respondents and compared to the results of the

assessment between the two groups that have been

The Effectiveness of Warm Milk and Chamomile Tea on Anxiety Symptomps in the Elderly

323

Figure 1: Location Yayasan Sosial Karya Kasih, Jl.

Monginsidi No.Ujung, Anggrung, Medan Polonia, Kota

Medan, Sumatera Utara 20157.

determined. This research was conducted for 8 weeks

(5 August 2018 - 5 October 2018). The sample in this

study was taken using a purposive sampling

technique where the researcher chooses respondents

in subjective and practical considerations

(Sastroasmoro, 2017). The research subjects were the

elderly in the Panti Jompo Kasih Kasih who met the

inclusion criteria. The minimum required sample size

is calculated based on the unpaired numerical

comparative formula of two groups of one

measurement (Dahlan, 2016). The criteria for drop

out and must be excluded from the study is the

frequency of treatment received by respondents is less

than 80%. Patients are excluded from the trial if they

have a current diagnosis major depressive disorder,

bipolar disorder, panic disorder, phobic disorders,

obsessive compulsive disorder disorders, post-

traumatic stress disorder, acute stress disorder,

induced substances anxiety disorders, psychosis,

dementia, or substance abuse or internal dependence

overtake 3 months. Other exclusion criteria are

unstable medical conditions, liver or kidney

insufficiency, malignancy, abnormal serum

thyrotropin level ≥ 5 μIU / ml,or known sensitivity for

chamomile, a plant from the asteraceae, mugwort, or

birch pollen family. Use of anxiolytics,

antidepressants, mood stabilizers, sedatives, is not

permitted.

Patients are given approval based on ethical

standards research ethics commission. Psychiatric

history is obtained by using ICD-10 mini interview

format. Evaluation of medical history, physical

examination, which includes inspection blood

pressure, pulse, and weight were obtained at each

study visit.

Data was collected from direct measurements of

anxiety using HAM-A questionnaire. The Hamilton

Anxiety Rating Scale is a clinician-rated evaluation

whose purpose is to analyze the severity of anxiety.

The scale is intended for adults, adolescents, and

children and should take approximately ten to fifteen

minutes to administer. The Hamilton Anxiety Rating

Scale is composed of fourteen items. A score of 17 or

less indicates mild anxiety severity. A score from 18

to 24 indicates mild to moderate anxiety severity.

Lastly, a score of 25 to 30 indicates a moderate to

severe anxiety severity. After 8 weeks of treatment in

the group of warm milk, chamomile tea and the

control group, data analysis will be carried out.

2.3 Data Analysis

The minimum sample size required is calculated

based on the unpaired numerical comparison formula

of the two groups in one measurement. The number

of samples needed was 18 people in each treatment

group by giving warm milk, chamomile tea and the

control group.

The data obtained were analyzed using SPSS

statistical test software. Then the analysis was carried

out using an independent T-test.

3 RESULTS AND DISCUSSION

This study was conducted on 54 elderly people,

namely 18 people were given warm milk

intervention, 18 people were given intervention of

chamomile tea, and 18 people as a control group. The

frequency distribution of respondents included

gender, type of treatment, and anxiety before

intervention. The following describes the frequency

of respondents based on gender, type of treatment,

and quality of sleep before intervention.

Table 1: Subjects characteristics.

Characteristics

Frequency

Percent (%)

1. Sex

Male

42,6

Female

57,4

Total

100

2. Intervention

Milk

33,3

Chamomile tea

33,3

Control

33,3

Total

100

3. Baseline General Anxiety Disorder

Mild

5,6

Moderate

94,4

Total

100

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324

Based on table 4.1 shows that the number of male

respondents is 23 people (42.6%) and women as

many as 31 people (57.4%). The number of

respondents in each type of treatment is the same,

namely 18 people (33.3%). In addition, from the data

concerning respondents' anxiety before being given

an intervention, respondents who had anxiety in the

mild category were 3 people (5.6%) and those who

had seang anxiety as many as 51 people (94.4%).

Table 2: Differences in HAM-A on intervention group at

baseline before get the chamomile, milk and control at the

end of week 8.

Type Of

Treatment

Pre

test

(Mean)

Frequency

Post test

(Mean)

Frequency

1. Milk

(n=1)

Mild

20.00

18.33

Moderat

23.70

22.37

2. Chamomile tea (n=18)

Mild

18.66

Moderat

23.88

22.06

3. Control (n=18)

Mild

18.50

Moderat

23.62

24.11

Total

Based on table 4.2 shows the average anxiety in

the elderly before intervention, namely 17 people in

the warm milk group, 18 in the chamomile group, and

16 people in the control group. Likewise, it can be

seen in the Delayed Score column, the moderately

denied elderly, which is 15 people in the warm milk

group, 15 in the chamomile group, and 18 in the

control group. Through this table, it can be seen that

the number of elderly questioned at a mild level is

maintained, but there is an increase in the number of

moderately complex elderly in each group given

intervention.

Table 3: Differences in HAM-A scores on warm milk group

at baseline and the end of week 8.

Mean (SD)

p value

Pre test (n=18)

23.50 (2.09)

0.001

Post test (n=18)

22.00 (2.19)

*T-independent test

Based on table 4.3 shows that the average score

after giving intervention is a decrease of 23.50 to

22.00. Based on the results of the T-dependent test p

value 0.001 (p <0.05) which means that there is a

significant effect on the provision of warm milk to

anxiety in the elderly, there is a significant increase

after the intervention of warm milk.

Table 4: Differences in HAM-A scores chamomile tea

group at baseline and the end of week 8.

Mean (SD)

p value

Pre test (n=18)

23.88 (1.77)

0.001

Post test (n=18)

21.50 (1.54)

* T-independent test

Based on table 4.4 shows that the average score

after administration of intervention has decreased

which is 23.88 to 21.50. Based on the results of the T-

dependent test p value 0.001 (p <0.05) which means

that there is a significant effect on the administration

of chamomile tea to anxiety in the elderly.

Table 5: Differences in HAM-A scores control group at

baseline and the end of week 8.

Mean(SD)

p value

Pre test (n=18)

23.05(2.20)

0.001

Post test (n=18)

24.11(1.81)

* T-dependent test

Based on table 4.5 shows that the average score of

anxiety assessment after 8 weeks in the control group

experienced an increase of 23.05 to 24.11. Through

these results it can be said that respondents who were

not given intervention experienced worsening

worries.

Table 6: Differences in HAM-A score in Milk group

changes between two groups.

Type of

treatment

Mean(SD)

p value

Milk

22.00(2.196)

0.003

Control group

24.11(1.811)

* T-dependent test

Based on table 4.6, the mean score before and

after in the milk group is 22.00, while in the control

group 24.11. In the T-independent test there were

significant differences regarding changes in anxiety

in the milk group and the control group (p = 0.003).

Table 7: Differences in HAM-A score in tea chamomile

group changes between two groups.

Intervention

Mean(SD)

p value

Teh Chamomile

21.50(1.543)

0.001

Control

24.11(1.811)

* T-independent test

The Effectiveness of Warm Milk and Chamomile Tea on Anxiety Symptomps in the Elderly

325

Based on table 4.7 shows the mean before and

after in the chamomile tea group is 21.50, while in the

control group 24.11. In the T-independent test there

were significant differences in anxiety in the elderly

chamomile tea group and the control group (p =

0.001).

Table 8: Differences in HAM-A scores between General

anxiety disorder who received low anxiety with the addition

therapy and who only received chamomile tea and milk at

the end of week 8.

Intervention

Mean (SD)

p value

Milk (n=18)

21.86 (2,32)

0.59

Chamomile tea (n=18)

21.50 (1,54)

*T-independent test

Based on table 4.8 shows that the mean score

before and after in the group giving warm milk is

21.86 and in the chamomile tea group is 21.50. Based

on the results of the T-independent test showed that

there was no significant difference regarding the

administration of warm milk and warm chamomile

tea to anxiety in the elderly.

Changes in the elderly include physical, social and

psychological changes. Psychological changes in the

elderly include short term memory, frustration,

loneliness, fear of losing freedom, fear of facing

death, changing desires, depression, and anxiety.

(Maryam et al., 2008)

Based on the results of statistical analysis

conducted, it can be concluded that there is a

difference in the group of elderly who get the

chamomile, milk and controls before the intervention

test was performed on the HAM-A questionnaire

assessment. Based on table 8, it was found that the

difference in scores before and after in the milk group

was 21.56 and in the chamomile tea group it was

21.50. Through the T-independent test also obtained

p value of 0.59 (p> 0.05) which means that there is no

significant difference regarding the provision of

warm milk and chamomile tea to anxiety in the

elderly. But there is a difference between pre and post

feeding, namely the initial score of giving warm milk

23.50 to 22.00 while the initial score of giving

chamomile tea 23.88 to 21.50. These results can be

concluded that this study is in accordance with a study

conducted by Jun et.al in 2016 which tested

chamomile and placebo. But the effectiveness of

anxiety about giving milk is still difficult to get

supporting references that can be a reference in

explaining the comparisons made in this study. But

based on the results shown there were significant

changes in anxiety given the treatment of the

chamomile and warm milk every day for 8 weeks.

As an expected conclusion this study can be used

as a reference material in handling anxiety in the

elderly and provide additional knowledge of patients

and families to improve anxiety in terms of non-

pharmacological.

ACKNOWLEDGEMENTS

We would like to thanks to the elderly as our

participant in Pnti Jompo Karya Kasih. Thanks also

to psychiatric residents of faculty of medicine of the

Universitas Sumatera Utara. Therefor we can finish

this research.

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