ORIGINAL RESEARCH

T FFECTS OF CHROMOTHERAPY ON THE COGNITIVE

AGEDH1E
ABILITY OF OLDER ADULTS: A QUASI-EXPERIMENTAL
STUDYAGEDNTE
Emmanuel D. Paragas Jr, DNS, RN,a,b,* Abigail Therese Y. Ng, RN,a Denice Victoria L. Reyes, RNa and
Gerald Andrei B. Reyes, RNa

Objective: This study aimed to assess the effects of chromother-
apy on the cognitive ability of older adults.
Methods: This quasi-experimental pretest and posttest study was
conducted among 135 older adults in Ilocos Sur, Philippines,
between August and September 2015. The participants were
divided into three groups: red, green, and white lights, with 45
people in each group. The cognitive ability of older adults was
measured using an adapted Mini
Mental State Exam (MMSE).
Results: After the interventions, the red and green light experi-
mental groups acquired a modest increase in cognitive ability
scores against the comparison white light group (p < 0.001).
However, the effects were not significantly different between the
red and green lights postintervention (p > 0.05).
Conclusion: The chromotherapy is effective in improving the
cognitive ability of older adults. Specifically, the red and green
lights are better than the white light in increasing the cognitive
ability of older adults.
Keywords: Chromotherapy, Cognitive ability, Older adults
(Explore 2019; 15:191
197 © 2019 Elsevier Inc. All rights reserved.)

What is already known about the topic?
 The cognitive impairment among older adults is rising world-
wide. Thus, the prevalence of age-related health problems is
becoming a major public health concern.
 Chromotherapy is a centuries-old concept that was practiced
in the ancient times which could play an important role in
improving the cognitive ability of older adults.
 There is a dearth in literature and issues in the use of chromother-
apy. This present study is one of the first to explore the effects of
chromotherapy on the cognitive ability of older adults.
What this paper adds?
 Chromotherapy is effective and seems promising as an alter-
native and complementary approach in increasing the cogni-
tive ability among older adults.
 Chromotherapy had a modest effect on increasing the cogni-
tive ability of older adults that implies a high practical signifi-
cance.
 The red light is effective in increasing the recall, attention and
calculation, and language and praxis scores of older adults,
a College of Nursing, University of Santo Tomas, Espa~
na Blvd., Sampa-
loc, Manila, Philippines
b Nursing Services Department, JW Ruby Memorial Hospital, West Virginia
University Medicine, Morgantown, WV, USA
* Corresponding author.
e-mail: emmanparagasjr@yahoo.com
whereas the green light significantly improved the registration,
orientation, recall, and attention and calculation scores
among older adults.
INTRODUCTION
Aging comes with deterioration in performance of several cogni-
tive tasks that involve a variety of cognitive processes.23 Cogni-
tive impairment among older adults is rising worldwide, and it is
projected to grow proportionally in developing regions31. In
2050, the number of people older than 60 years will be
around 2 billion, or 22% of the world’s population. Projec-
tions suggest that four fifths of older adults will be living in
Asia, Africa, or Latin America34. Furthermore, older adults
with cognitive impairment visit hospitals over 3 times more
often than those admitted for other conditions.2 Thus, the
prevalence of age-related health problems is becoming a
major public health concern31.
Improving one’s memory can be one of the most intriguing
queries in contemporary memory research.6 Thus, several inter-
ventions involving the cognitive, social, and physical activity have
been growing, which may lessen the risk of cognitive decline.17
Specifically, cognitive interventions such as cognitive training pro-
grams22 and memory training interventions10 are aimed at improv-
ing the cognitive performance of older adults. It is noteworthy
that several studies exploring the effects of such interventions
have revealed that there is a great potential to modify the cognitive
abilities and brain activity among the older adults.14

© 2019 Elsevier Inc. All rights reserved. EXPLORE May/June 2019, Vol. 15, No. 3 191
ISSN 1550-8307/$36.00 https://doi.org/10.1016/j.explore.2019.01.002
 However, complementary therapies like chromotherapy could
play an important role in improving the cognitive ability of
older adults. Chromotherapy is a centuries-old concept that was
practiced in ancient Egypt, Greece, India, and China where peo-
ple had faith in the healing properties of colors. It is a system of
procedures that makes use of the visible spectrum of electromag-
netic radiation in curing ill health.3 It was believed that a per-
son’s arousal may be affected by color, while the memory may
be enhanced through arousal.24,13 Hence, several studies in the
past have explored the effects of color on memory, establishing
that color has various effects such as an increase in memory
recall,28 memory recognition,33 and memory retrieval.32 How-
ever, it is remarkable that a hypothesis about color having an
important role in human comprehension and, in effect, on
thinking and human conduct18 was put into question after a fail-
ure to replicate was reported about the color-priming effect on
the solution of anagrams.30 Although there is a dearth of litera-
ture on the use of chromotherapy, it might yield an increase
in the cognitive aspects of memory.3 This present study is one of
the first that explores the effects of chromotherapy on the cogni-
tive ability of older adults.
Chromotherapy conceptual framework
This study used the concepts from Florence Nightingale’s philos-
ophy of nursing regarding the environment.20 Nightingale pro-
posed that the nurse could manipulate the environment to
initiate a positive response from the patient. Specifically, the
effects of variety and light could transform the environment to
be more conducive for healing. Variety is the changing of envi-
ronmental factors in order to achieve a positive response, while
the light serves as one of the factors comprising the “designed
environment”.35 Hence, this idea suggests that healing is
achieved in the sense that the environment stimulates the per-
son’s well-being positively. Nightingale cited an example about
the need for changes in color and form by bringing brightly col-
ored flowers and exposing the patients to the sunlight, allowing
them to show a positive response with regard to their health con-
ditions.35 In this study, Nightingale’s philosophy about the envi-
ronment was utilized by using the combination of variety and
light through the use of chromotherapy in inducing an improve-
ment in the cognitive ability of older adults.
Aim
This study aimed to assess the effects of chromotherapy on the
cognitive ability of older adults in the province of Ilocos Sur in
the Philippines. Specifically, it was hypothesized that chromo-
therapy would significantly improve the cognitive ability of
older adults.
MATERIALS AND METHODS
Study design and participants
This study used quasi-experimental pretest and posttest design
with two experimental groups (red and green) and a comparison
group (white). The sample size estimate was determined on the
priori power analysis (medium effect size = 0.5; significance
level = 0.05; power = 80%) using G*Power software in Mac OS.
192 EXPLORE May/June 2019, Vol. 15, No. 3
A total of 135 older adults were selected through purposive
sampling. The participants were assigned into the three groups:
the red group (n = 45), the green group (n = 45), and the white
group (n = 45). Those who were 55
80 years old, able to read
and write, able to speak and understand Ilokano, and living in
Cabugao, Ilocos Sur, were included in the study. However, those
who had conditions that might cause impairment in memory,
such as but not limited to Alzheimer’s disease and dementia,
and patients with eye defects like glaucoma, diabetic retinopa-
thy, and color blindness, were excluded.
Interventions
The interventions were developed and pretested in a pilot study.
Specifically, this study used LED light for each group: (1) the
red and (2) the green for the experimental groups; (3) the white
for the comparison group. The LED lights were hung 210 cm
above the floor inside a 4 £ 4 well-ventilated room. The partici-
pants entered the room by group, and then each group was
exposed to its assigned 2500 lux LED light for 15 min. The older
adults were instructed to avoid direct eye contact with the LED
light to prevent the risk of blindness. The researchers prepared
for immediate medical assistance in case of any emergency. How-
ever, there was no noted event of any medical emergency
throughout the course of the study.
The older adults remained seated for only 15 min while being
exposed to the assigned LED light to prevent possible skin and
optical damage due to the degenerative changes as part of their
aging process. Each group was exposed to either red, green, or
white LED light for a single time. Then, the effects of the LED
lights on the cognitive ability were assessed immediately using a
valid and reliable instrument after the older adults were exposed
to their assigned intervention.
Instruments
The participants were required to provide a sociodemographic
and medical history, such as such as age, sex, year of birth, and
locality. A checklist was also used to identify the following dis-
eases: Alzheimer’s, dementia, diabetic retinopathy, Huntington’s
chorea, amnesia, delirium, vascular stroke, schizophrenia, and
brain trauma.
Furthermore, the study adapted the Mini
Mental State Exam
(2nd ed.), Standard Version, to identify the cognitive ability of
the older adults. Psychological Assessment Resources (PAR)
states that the MMSE is well-known to aid in clinical cognitive
mental state examination. A forward translation to Ilokano and a
back-translation to English were performed by two independent
professional translators. Then, the final Ilokano version of the
MMSE was validated by a panel of experts: a psychologist, a psy-
chiatric nurse, and a psychiatrist with a scale-level content valid-
ity index of 1.00. The panel-modified Ilokano version acquired a
Cronbach’s alpha of 0.88 after it was pilot-tested among 45 older
adults.
The MMSE examines the older adult’s mental state on these
specific areas: (1) orientation to time and place; (2) capacity to
register and recall information through familiarization of three
unrelated objects; (3) attention and calculation abilities by being
asked to subtract or add seven from 100; (4) naming ability by
being asked to identify the name of an object that the interviewer
is pointing at; (5) repetition by being asked to repeat certain
Effects of Chromotherapy on the Cognitive Ability of Older Adults
sentences mentioned by the interviewer; (6) comprehension by
being asked to point out a geometric figure that is similar to a
picture to which the interviewer is referring; (7) reading, writing,
and drawing by being asked to write a sentence and copy two
intersecting figures in the stimulus page. One point is given for
each correct answer, with a perfect score being 30 points. Higher
scores represent better mental states in the older adults. Specifi-
cally, the interpretation of the scores are as follows: a score of
0
17 indicates severe cognitive defect, a score of 18
23 signifies
mild cognitive impairment, and a score of 24
30 implies no
cognitive impairment.7
Data collection
The Senior Citizen Center in the town of Cabugao, Ilocos Sur,
served as the clinical site for pilot testing among 45 older adults.
Also, the actual data collection was conducted in the same clini-
cal site between August and September 2015.
The data collection (Fig. 1) was conducted in a 4 £ 4 well-ven-
tilated room. Excluding the participants from the pilot testing,
the actual data collection was conducted over two consecutive
Sundays. Specifically, there were two separate sessions on the
first Sunday: the morning group was assigned to the white com-
parison group (n = 45), while the afternoon group was
assigned to the green experimental group (n = 45). Subse-
quently, the second Sunday group was allocated to the red
experimental group (n = 45). All of the participants were
blind to whether they belonged to an experimental group or
the control group to minimize bias. Overall, the experimen-
tal and control groups received pretesting for cognitive per-
formance and exposure to the assigned intervention, and
participants received a posttest of their cognitive performance
immediately after the intervention.
Fig. 1. The flow of participants for each stage in this study.
Effects of Chromotherapy on the Cognitive Ability of Older Adults
Ethical considerations
The study was approved by the Ethics Review Board in the Col-
lege of Nursing at the University of Santo Tomas (USTCON-
2015-SR31), and the office of the mayor of Cabuago, Ilocos Sur.
Also, the study was conducted in accordance with the Helsinki
Declaration of 1995. A signed informed consent was secured
from all of the participants, with an assurance of privacy, ano-
nymity, and confidentiality. In addition, the researchers
obtained permission from the office of the PAR to use and trans-
late the MMSE into Ilocano.
Data analyses
The descriptive statistics were used to describe the demographics
of the participants. The mean was used to establish the average
of the pretest and posttest scores in the MMSE among the three
groups. Paired t-tests were utilized to determine significant differ-
ences between the pretest and posttest scores for each group.
ANOVA determined the significant differences among the post-
test scores of the three groups. Then, Tukey’s test was used in the
post hoc analysis. The level of significance was set at the p-value
 0.05. The statistical analyses were performed using IBM SPSS
Statistics (IBM Corp., Armonk, NY) Version 21.0 and Review
Manager (RevMan; Copenhagen: The Nordic Cochrane Centre,
The Cochrane Collaboration) for Mac OS X, Version 5.3.
RESULTS
Participant characteristics
A total of 135 older adults were found to be eligible to partici-
pate in the study from the 150 who were screened prior to data
collection (Fig. 1). These older adults were non-randomly
EXPLORE May/June 2019, Vol. 15, No. 3 193
Table 1. Characteristics of older adults across the three groups
Demographic Red light Green light White light p-value
Age (y), mean (§SD) 67.56 (§ 7.21) 67.16 (§ 7.55) 66 (§ 6.64) 0.56a
Sex
Male, n (%) 13 (29) 12 (27) 16 (14.5) 0.63b
Female, n (%) 32 (71) 33 (73) 29 (18.8)
a
ANOVA.
b
X2 test.

Table 2. Overall MMSE mean scores of older adults in the three groups
MMSE mean score (§SD)
Group Pretest (before the intervention) Posttest (immediately after the intervention) t-value (p-value) SMD (95% CI)
Red light (n=45) 25.02 (§ 3.98) 27.24 (§ 2.46) ¡3.90 (0.001) 0.67 (0.25
1.09)**
Green light (n=45) 24.29 (§ 5.16) 27.28 (§ 2.75) ¡4.49 (0.001) 0.84 (0.41
1.27)**
White light (n=45) 25.24 (§ 4.48) 25.64 (§ 3.91) ¡0.68 (0.50) 0.09 (¡0.32
0.51)
MMSE, Mini mental state exam; SMD, Standardized mean difference; CI, Confidence interval.
** Statistically significant at p <0.001.

assigned equally to the three groups. The mean age of the older that both the red and green light groups obtained significantly
adults were 67.56 § 7.21, 67.16 § 7.55, and 66 § 6.64 in the higher posttest scores when compared to the white light group
red, green, and white light groups, correspondingly. On the (p <0.05). However, no significant difference was found between
other hand, the majority of the participants were female in the posttest scores of the red and green light groups (p >0.05).
the red (71%), green (73%), and white (64%) groups. Both the A comparison of the mean scores of the older adults for each
age and sex in the three groups were found to have no significant MMSE subset was analyzed to further examine the effects of
differences (p >0.05; see Table 1). chromotherapy (Table 4). On the one hand, the older adults in
the red light group acquired a significant change in their posttest
scores specifically in the recall (p <0.001), attention and calcula-
Effects of chromotherapy on the cognitive ability of older
tion (p <0.05), and language and praxis (p <0.05). On the other
adults
hand, the green light group obtained a significant increase in
There were significant differences identified in the overall
four out of five MMSE subsets, such as registration (p <0.001),
MMSE mean scores in both the red and green light groups
orientation (p <0.001), recall (p <0.001), and attention and cal-
before and immediately after their corresponding interventions
culation (p <0.05). However, the white group only attained a sig-
(p <0.001) (Table 2). However, no significant increase was found
nificant change in the recall subset (p <0.05).
in the white light group (p >0.05) (Table 2).
The older adults among the three groups were grouped
The results of the ANOVA (table not shown) revealed no sig-
according to the severity of cognitive impairment based from
nificant difference among the overall pretest MMSE mean scores
their MMSE mean scores (Table 5). It was remarkable that those
of older adults in the three groups (F ratio = 0.54; df = 2,134;
who have severe cognitive impairment before being exposed to
p >0.05). However, a significant change was found among the
chromotherapy significantly improved to mild cognitive
MMSE mean scores of older adults in the three groups after they
impairment (M = 23.73; SD = 4.52; p <0.001), while those older
received their corresponding interventions (F ratio = 5.76;
adults with mild cognitive impairment prior to the intervention
df = 2,134; p <0.05). Tukey’s post hoc analysis in Table 3 revealed
attained a significant increase to no cognitive impairment
(M = 26.28; SD = 3.15; p <0.001), and those who have no cog-
Table 3. Comparison of the cognitive ability scores between groups nitive impairment remained the same after being exposed to
post-interventions chromotherapy (M = 27.58; SD = 2.75; p >0.05).
MMSE posttest
Variable Mean p-valuea SMD (95% CI)
difference DISCUSSION
This quasi-experimental study is one of the first to explore the
Red light vs. Green light 0.53 0.69 ¡0.02 (¡0.43
0.38)
effects of chromotherapy on the cognitive ability of older adults.
Red light vs. White light 1.60 0.04 0.49 (0.07
0.91)*
In the initial assessment, the mean MMSE scores of each group
Green light vs. White light 2.13 0.004 0.48 (0.07
0.90)*
were greater than 24, which suggests that they had no cognitive
MMSE, mini mental state exam; SMD, standardized mean difference; CI, confidence
impairment (Table 2). However, when the subjects from the
interval.
a
Tukey’s test. three groups were grouped according to their respective mean
* Statistically significant at p <0.05. scores, there were older adults who have mild, severe, and no

194 EXPLORE May/June 2019, Vol. 15, No. 3 Effects of Chromotherapy on the Cognitive Ability of Older Adults
 Mean a Difference
cognitive impairments (Table 5). On the one hand, it is notewor-

¡0.42 (0.01)*
(p-value)
thy that after the interventions the red and green lights acquired

¡0.04 (0.77)
¡0.00 (1.00)

¡0.00 (1.00)
0.07 (0.68)
a modest increase in the MMSE mean scores against the compar-
ison white light (Table 3). On the other hand, those older adults
with severe and mild cognitive impairment prior to chromother-
apy significantly improved to the level of mild and no cognitive
impairment, respectively (Table 5). These findings corroborated
White Light

2.64 (§ 0.83)
8.91 (§ 1.65)
2.40 (§ 1.01)
3.82 (§ 1.50)
7.87 (§ 1.08)
Post-test M
the significant effects of chromotherapy in the improvement of
(SD)
the cognitive ability among older adults.
In chromotherapy, the color is a form of an electromagnetic
energy and visible light. When the energy enters the cones (pho-
toreceptors) in the retinas, it is translated into colors, which then
2.60 (§ 0.78)
8.91 (§ 1.47)
1.98 (§ 1.16)
3.82 (§ 1.70)
7.93 (§ 1.05)
stimulate the pituitary and pineal glands to produce some hor-
Pre-test M
(SD)

mones that affect various physiological processes such as tuning

the coordination of organ functions and controlling behavioral
rhythms.3,5,8 Specifically, the hormones serotonin and endor-
phins are believed to be produced in response to the light
Mean a Difference

energy; these hormones maintain one’s psychological well-being

¡0.42 (0.001)**
¡1.22 (0.001)**
¡0.78 (0.001)**

and balance mood, feelings, and behaviors.4,9,29 In this study,

¡0.69 (0.01)*
(p-value)

¡0.38 (0.06)

the chromotherapy was used to improve the cognitive ability of

older adults. Specifically, the red light was found to be effective
in increasing the recall, attention and calculation, and language
and praxis scores of older adults, while the green light enhanced
the registration, orientation, recall, and attention and calculation
Green Light

2.96 (§ 0.21)
9.42 (§ 1.08)
2.69 (§ 0.67)
4.51 (§ 1.36)
8.20 (§ 0.87)
Post-test M

scores. However, the white light was only effective in increasing

(SD)

the recall scores in the MMSE (Table 4). The color plays a vital
part in enhancing our attention level, which in turn helps the
memory to be stored in more permanent storage16,21. Further-
more, the hormones produced in response to color may contrib-
Comparison of the mean scores of older adults for each MMSE subset in the three groups

2.53 (§ 0.73)
8.20 (§ 1.90)
1.91 (§ 1.16)
3.82 (§ 1.61)
7.82 (§ 1.17)

ute to alertness and emotional arousal, which have a significant

Pre-test M

relationship with memory.19,16 Specifically, a better retention in

(SD)

long-term recall was found for those with a high level of emo-
tional arousal as well as improvement in short-term and long-
term memory.12,32 The results in this study support the effective-
ness of color therapy in improving the memory of older
Mean a Difference

¡0.64 (0.001)**

adults.32,19,16,6
¡0.64 (0.02)*
¡0.36 (0.04)*
(p-value)
¡0.18 (0.25)
¡0.40 (0.09)

Previous studies have shown that each color produces differ-

ent psychological effects, and age is an important factor affecting
emotional behaviors in response to the color1. The MMSE
scores of both the red and green light groups were found to have
a significant increase against the white light after the intervention
2.69 (§ 0.73)
9.36 (§ 0.83)
2.56 (§ 0.79)
4.24 (§ 1.21)
8.40 (§ 0.72)
Red light

(Table 3). This finding corroborates the effectiveness of the red

Post-test M

and green lights in improving the cognitive ability of older

(SD)

MMSE, Mini mental state exam; M, Mean; SD, Standard deviation

adults. Although the green light obtained a larger effect size than
the red light, the effects were not significantly different between
the two colors (Table 3). The green color brings psychological
2.51 (§ 0.82)
8.96 (§ 1.26)
1.91 (§ 1.04)
3.60 (§ 1.78)
8.04 (§ 1.09)

and emotional harmony that could help stabilize emotions and

Pre-test M

provide a soothing influence in the mind and body, whereas the

(SD)

red color stimulates the release of adrenalin to provide greater

energy and stimulation, helping to energize all the organs and
** Statistically significant at p <0.001.
* Statistically significant at p <0.05.

the senses27. However, a number of studies claim warm colors

especially both the red and green lights could help stimulate
Attention and calculation

one’s brain activity to increase the perceived activation levels

Language and praxis

and vigilance, which have a significant relationship with the

improvement of memory11,15,25,26. Furthermore, it is believed
MMSE subsets

paired t-test.

that chromotherapy uses seven colors of the spectrum to

Registration
Orientation
Table 4.

improve mental being, and all have the ability to affect body
Recall

vibrations and frequencies, which in turn affect health, welfare,

a

and harmony. The red and green lights are included in this

Effects of Chromotherapy on the Cognitive Ability of Older Adults EXPLORE May/June 2019, Vol. 15, No. 3 195
Table 5. Overall MMSE scores of older adults in the three groups according to severity of cognitive impairment
Severity of cognitive impairment n (%)
Severe cognitive impairment 11 (8.1)
Mild cognitive impairment 39 (28.9)
No cognitive impairment 85 (63)
MMSE, Mini mental state exam; M, Mean; SD, Standard deviation
a
paired t-test.
** Statistically significant at p <0.001.
y
Mild cognitive impairment (18
23).
z
No cognitive impairment (24
30).
spectrum of colors but not the white light, which possibly
explains the ineffectiveness of the white light in this study on
improving the mental states of older adults27.
In this study, the concepts present in the philosophy of nurs-
ing regarding the environment20 form the basis of the therapeu-
tic effect of chromotherapy in improving the cognitive ability
among older adults. Specifically, the nurse could manipulate the
environment of the patients to initiate a positive response from
the patients. The effects of color and light present in the chro-
motherapy provided an environment that is conducive to
enhancing the attention level and alertness of the older adults,
which led to significant improvement in their cognitive ability.
Therefore, the findings suggest that nurses could initiate a posi-
tive response to health from their patients through the manipula-
tion of environment.
The study has some limitations. The participants were chosen
purposively using nonrandom sampling, which could result in
selection bias. This study strictly followed the set inclusion and
exclusion criteria for all the participants and established the simi-
larity in their demographic characteristics to minimize the bias.
Furthermore, the internal factors concerning the memory reten-
tion of participants, such as emotions, mood, and past experien-
ces, were not assessed prior to data collection, which could lead
to maturation bias. However, the average baseline scores before
the intervention were acquired by only one of the researchers,
who was trained to use the valid and reliable MMSE tool. More-
over, the participants were unaware of group allocation to pre-
vent them from influencing the results or the Hawthorne effect.
The analysis of MMSE scores according to severity of cognitive
impairment should be interpreted with caution due to a small
sample size of older adults with mild and severe cognitive
impairment among the three groups. However, despite the small
sample size, this study revealed modest effect sizes of the inter-
ventions after addressing several biases.
CONCLUSION
The chromotherapy is effective in improving the cognitive abil-
ity of older adults. Specifically, both the red and green lights
were found to be more effective when compared to the white
light. The red light enhanced the recall, attention and calcula-
tion, and language and praxis scores of older adults, whereas the
green light improved the registration, orientation, recall, and
attention and calculation scores among older adults. However,
the white light was only effective in the recall scores. Thus, this
196 EXPLORE May/June 2019, Vol. 15, No. 3
Red, Green, and White groups (n = 135)
Pre-test M (SD) Post-test M (SD) Mean a Difference (p-value)
14.55 (§ 2.46) 23.73 (§ 4.52) y ¡9.18 (0.001) **
21.49 (§ 1.68) 26.28 (§ 3.15) z ¡4.80 (0.001) **
27.73 (§ 1.86) 27.58 (§ 2.75) z 0.15 (0.61)
study recommends the use of chromotherapy to increase the
cognitive ability among older adults.
Practice implications
The nurses could control the environment to initiate a positive
response from their patients. Specifically, chromotherapy could
provide an environment that is favorable to enhancing the atten-
tion level and alertness of older adults which could lead to the
improvement in their cognitive ability. Thus, this innovative
approach could be adopted by nurses in the community and
long-term care facilities. Furthermore, this study adds to the
nursing literature about the positive effects of chromotherapy
among older adults in enhancing their cognitive ability. How-
ever, further research is needed on a larger sample size and vari-
ous settings to ascertain the effects of chromotherapy on the
cognitive ability of older adults.
DISCLOSURE OF INTEREST
The authors report no conflict of interest.
ACKNOWLEDGMENTS
The authors are grateful to the people of Senior Citizen Center
at Cabugao, Ilocos Sur, most especially to the senior citizens for
participating in this study. The authors would also like to express
their gratitude to the validators and translators of the instru-
ments used in this study as well as to the research board and
ethics review board in the College of Nursing at the University
of Santo Tomas for the approval of the study protocol.
SUPPLEMENTARY MATERIAL
Supplementary material associated with this article can be found,
in the online version, at doi:10.1016/j.explore.2019.01.002.
REFERENCES
1. Aktekın DB, Şımşek Y. A new model for chromotherapy applica-
tion. Color Res Appl. 2012;37(2):154–156.
2. Alzheimer’s Association. Characteristics, costs and health service use for
medicare beneficiaries with a dementia diagnosis: report 1: medicare current
beneficiary survey. Chicago: Alzheimer’s Association; 2009.
3. Azeemi STY, Raza M. A critical analysis of chromotherapy and its scien-
tific evolution. Evid-Based Complement Altern Med. 2005;2(4):481–488.
4. Chiazzari S. The complete book of color. Barnes & Noble; 1998.
Effects of Chromotherapy on the Cognitive Ability of Older Adults
 5. Drouyer E, Rieux C, Hut RA, Cooper HM. Responses of suprachias-
matic nucleus neurons to light and dark adaptation: relative contri-
butions of melanopsin and rod
cone inputs. J Neurosci. 2007;27
(36):9623–9631.
6. Dzulkifli MA, Mustafar MF. The influence of colour on memory
performance: a review. Malays J Med Sci: MJMS. 2013;20(2):3.
7. Folstein MFFS. “MMSE”. A practical method for grading the cogni-
tive state of patients for clinician. J Psychiatry Res. 1975;12:189–199.
8. Garala K, Basu B, Bhalodia R, Mehta K, Joshi B. Alternative to drug
delivery system: chromotherapy. Drug Invent Today. 2009;1(2):130–134.
9. Gerber R. Vibrational medicine for the 21st century. Piatkus; 2000.
10. Gross AL, Parisi JM, Spira AP, et al. Memory training interventions
for older adults: a meta-analysis. Aging Mental Health. 2012;16
(6):722–734.
11. Grote V, Kelz C, Goswami N, Stossier H, Tafeit E, Moser M. Car-
dio-autonomic control and wellbeing due to oscillating color light
exposure. Physiol Behav. 2013;114:55–64.
12. Heuer F, Reisberg D. Emotion, arousal, and memory for detail. In:
Proceedings of the the handbook of emotion and memory: research and the-
ory. 1992151–180.
13. Huchendorf L. The effects of color on memory. UW-L J Undergrad
Res. 2007;10:1–4.
14. Karbach J, Schubert T. Training-induced cognitive and neural plastic-
ity. Front Hum Neurosci. 2013;7(48):1–2.
15. Kim DY. The interactive effects of colors on visual attention and work-
ing memory: In case of images of tourist attractions. In: Proceedings of the
international CHRIE conference-refereed track. 1. 2010. Retrieved from;
http://scholarworks.umass.edu/refereed/CHRIE_2010/Saturday/1.
16. MacKay DG, Ahmetzanov MV. Emotion, memory, and attention in
the taboo Stroop paradigm: An experimental analogue of flashbulb
memories. Psychol Sci. 2005;16(1):25–32.
17. Mangialasche F, Kivipelto M, Solomon A, Fratiglioni L. Dementia
prevention: current epidemiological evidence and future perspective.
Alzheimer’s Res Ther. 2012;4(1):6.
18. Mehta R, Zhu RJ. Blue or red? Exploring the effect of color on cog-
nitive task performances. Science. 2009;323(5918):1226–1229.
19. Naz KAYA, Helen H. Color-emotion associations: Past experience
and personal preference. In: Proceedings of the AIC 2004 color and
paints, interim meeting of the international color association. 5, Jose Luis
Caivano; 2004:31.
Effects of Chromotherapy on the Cognitive Ability of Older Adults
20. Nightingale F. Notes on nursing: what it is and what it is not. New
York: D. Appleton and Company; 1860.
21. Pan Y. Attentional capture by working memory contents. Can J Exp
Psychol/Revue canadienne de psychologie experimentale. 2010;64(2):124.
22. Reijnders J, van Heugten C, van Boxtel M. Cognitive interventions
in healthy older adults and people with mild cognitive impairment:
a systematic review. Ageing Res Rev. 2013;12(1):263–275.
23. Reuter-Lorenz PA, Park DC. Human neuroscience and the aging mind:
a new look at old problems. J Gerontol: Ser B. 2010;65(4):405–415.
24. Roozendaal B. Stress and memory: opposing effects of glucocorti-
coids on memory consolidation and memory retrieval. Neurobiol
Learn Mem. 2002;78(3):578–595.
25. Sch€afer A, Kratky KW. The effect of colored illumination on heart
rate variability. Complement Med Res. 2006;13(3):167–173.
26. Schaefer A, Kratky KW, Schulmeister K. The effect of colored illu-
mination on breathing rate and cardiorespiratory dynamics. JAMS
2009;1–11.
27. Sembian N, Aathi MK. Chromo therapy: healing power of colors.
i-Manager’s J Nurs. 2015;5(4):6.
28. Smilek D, Dixon MJ, Cudahy C, Merikle PM. Synesthetic color
experiences influence memory. Psychol Sci. 2002;13(6):548–552.
29. Smith T. British medical association complete family health guide. Dorling
Kindersley; 2000.
30. Steele KM. Failure to replicate the Mehta and Zhu (2009) color-
priming effect on anagram solution times. Psychonom Bull Rev.
2014;21(3):771–776.
31. Van Lerberghe W. The world health report 2008: primary health care:
now more than ever. World Health Organization; 2018.
32. Vernon D, Lloyd-Jones TJ. The role of colour in implicit and
explicit memory performance. Q J Exp Psychol Sect A. 2003;56
(5):779–802.
33. Wichmann FA, Sharpe LT, Gegenfurtner KR. The contributions of
color to recognition memory for natural scenes. J Exp Psychol: Learn
Mem Cognit. 2002;28(3):509.
34. United N. Department of Economic and Social Affairs Population Divi-
sion: World Population Ageing 2009. New York: United Nations;
2009. 11.
35. Zborowsky T. The legacy of Florence Nightingale’s environmental
theory: nursing research focusing on the impact of healthcare envi-
ronments. HERD: Health Environ Res Des J. 2014;7(4):19–34.
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