Sleep quality and related factors in older adults: A cross-sectional study

Article Type : Original/Research Papers

Authors

1 Department of Medical-Surgical Nursing, North Khorasan University of Medical Sciences, North Khorasan, Iran

2 Department of Nursing, Neyshabur University of Medical Sciences, Neyshabur, Iran

3 Shirvan School of Nursing, North Khorasan University of Medical Sciences, North Khorasan, Iran

4 Quchan School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

This study aimed to evaluate sleep quality and related factors in hospitalized older adults. In this cross-sectional study, 390 older adults were admitted to the medical and surgical departments of Musa Ibn Jafar Hospital in Quchan. The data was collected from October to March 2017. Data collection tools were the demographic information questionnaire and Pittsburgh Sleep Quality Questionnaire (PSQI). A total of 390 older adults participated in this study. The mean age of participants was 71.73 (SD=8.05) years. Of the participants, 54.6% were male, 73.8% were married, 31.5% had a diploma, and 77.4% lived in the city. Also, 67.4% of the individuals had never been hospitalized before, and 69.0% of them had a history of chronic disease. The mean sleep quality score based on PSQI in the elderly was 7.40 (SD=4.02). Among the participants, 63.8% of them had undesirable sleep quality. The age of elderly people who had undesirable sleep was significantly higher than people with desirable sleep (P=0.03). Also, there was a significant difference between undesirable and desirable sleep quality with education level (P=0.05), marital status (P<0.001), hospitalization frequency (P<0.001), and history of chronic disease (P<0.001). In sum, considering that the results of the research showed that the elderly did not have a good quality of sleep, it is recommended to provide nursing care in the inpatient wards as well as teach it to the elderly and their families to prevent sleep problems and related problems.

Keywords

1 Introduction

Sleep is a complex biological pattern and one of the essential circadian cycles [1]. This essential physiological process is required for optimum everyday performance and has a crucial stimulating influence on the body's organs. Maintaining physical strength, attractiveness, and energy levels need sleep. Inadequate sleep is linked to chronic illnesses, organ malfunction, neurocognitive problems, and higher mortality [2]. Studies have indicated that older men and women are more likely than other people to experience sleep-related issues and everyday drowsiness. About 50% of persons over 60 have complained of having trouble sleeping [3]. Only 12% of senior people did not report having sleep issues, according to other surveys, while more than 57% did. According to statistics, poor sleep is the third most frequent complaint, behind headaches and intestinal problems [4]. According to reports, 67% of senior Iranians experience sleep difficulties, and 61% experience sleeplessness [5].

Individuals' sleep habits have changed as they get older. These modifications result in sleep issues in the elderly, including early morning awakenings, trouble falling asleep, naps and afternoon drowsiness, and nighttime awakenings [4, 6]. Age-related physiological changes, stress from physical and financial limits, and chronic illnesses all affect how well older adults’ sleep. Most persons over the age of 70 lead unhealthy lifestyles and have poor sleep quality [7]. Contrary to popular opinion, the average length of a night's sleep for adults of all ages is 7 hours, according to studies by the American National Sleep Center. An increase in the amount of light sleep and a decrease in the amount of deep sleep, as well as frequent nighttime awakenings, are the causes of sleep issues in the elderly [8].

The growing aging population makes it seem important to make written plans and routinely assess their physical and mental well-being. Without a doubt, one of the most significant determinants of both physical and psychological health is sleep. Although aging is a biological process that occurs in life of everyone and is not an illness, it causes changes in the three aspects of a person's body, mind, and society [9]. However, as people age, the prevalence of insomnia and related issues rises. Therefore, the first step in managing sleep disturbances is determining their underlying cause. A change in lifestyle is one method of controlling sleep issues. Due to their frequent interactions with the elderly and their families, nurses are in a unique position to recognize the signs and causes of sleeplessness, as well as to take action to improve the situation and impart knowledge to the old and their caregivers. The purpose of this study is to assess the elderly patients hospitalized in the medical-surgical departments sleep quality and the factors influencing it.

 

2 Methods

2.1 Study design and subjects

In this cross-sectional study, 390 older adults were admitted to the medical and surgical departments of Musa Ibn Jafar Hospital in Quchan. The research subjects were people over 60 years old who were fully alert during data collection and could answer the questions.

 

2.2 Ethics consideration

The present research has been approved by Mashhad University of Medical Sciences (IR.MUMS.REC.1397.147). Ethics-related considerations, such as securing information confidentiality and obtaining written informed permission from participants, were taken into account.

 

2.3 Data collection

To collect information, the researcher visited the hospital on all days of the week and conducted a simple random sampling of hospitalized elderly who met the criteria for entering the study. The data was collected from October to March 2017. Data collection tools were the demographic information questionnaire and Pittsburgh Sleep Quality Questionnaire (PSQI). Within 5 minutes, the objectives and methods of the research and completing the questionnaires were explained to the patient verbally and face to face, and each researcher/researcher's assistant was present when answering the samples and provided the necessary guidance if needed.

 

2.3.1 PSQI

Dr. Boyce and his colleagues at the Psychiatric Institute of Pittsburgh developed this questionnaire in 1989. This survey initially included nine items, but because question 5 had ten sub-items, there is now 19 total. The subjective quality of sleep, difficulty falling asleep, length of sleep, the efficiency of sleep, sleep disorders, use of sleep-inducing substances, and daily functioning difficulties are among the seven subscales of this questionnaire. Every question receives a score between 0 and 3. The seven factors' combined scores might be anything from 0 to 21.  A higher score denotes poorer sleep quality. Good sleep quality is defined as a score under five [10]. Validation of this tool has been done in Iran, and Cronbach's alpha coefficient was 0.89 [11].

 

2.4 Statistical analysis

The data were analyzed using SPSS software version 21 with a significance level ≤ 0.05. Descriptive statistics were used to present the frequency tables, and the two-dimensional tables were employed to describe the data related to socio-demographic characteristics reporting the frequency, percentage, mean, and standard deviation. The Kolmogorov-Smirnov test evaluated the normality of the data. Then, the data were analyzed using chi-square and independent t-test.

 

3 Results

3.1 Participants’ characteristics

A total of 390 older adults participated in this study. The mean age of participants was 71.73 (SD=8.05) years. Of the participants, 54.6% were male, 73.8% were married, 31.5% had a diploma, and 77.4% lived in the city. Also, 67.4% of the individuals had never been hospitalized before, and 69.0% of them had a history of chronic disease. The individual characteristics of the participants are presented in Table 1.

 

3.2 Sleep quality of older adults

As shown in Table 2, the mean sleep quality score based on PSQI in the elderly was 7.40 (SD=4.02). Among the participants, 63.8% of them had undesirable sleep quality.

 

3.3 The relationship between sleep quality of older adults and study variables

As mentioned in Table 1, the age of elderly people who had undesirable sleep was significantly higher than people with desirable sleep (P=0.03). Also, there was a significant difference between undesirable and desirable sleep quality with education level (P=0.05), marital status (P<0.001), hospitalization frequency (P<0.001), and history of chronic disease (P<0.001).

 

Table 1. Distribution of the relationship between sleep quality and demographic variables in the studied subjects (N=390).

 

N=390

Sleep Quality

P-value

Undesirable (n=249)

Desirable (n=141)

Age

71.73 (SD=8.05)

72.3 (SD=8.4)

70.5 (SD=7.1)

0.03*

Gender

 

 

 

 

Male

213 (54.6)

129 (51.8)

84 (59.6)

0.13**

Female

177 (45.5)

120 (48.2)

57 (40.4)

Residential location

 

 

 

 

City

302 (77.4)

193 (77.5)

109 (77.3)

0.96**

Village

88 (22.6)

56 (22.5)

32 (22.7)

Level of education

 

 

 

 

Illiterate

112 (28.7)

59 (23.7)

53 (37.6)

0.05**

Under diploma

103 (26.4)

66 (26.5)

37 (26.2)

Diploma

123 (31.5)

107 (43.0)

16 (22.7)

University education

68 (13.4)

49 (6.8)

19 (13.5)

Marital status

 

 

 

 

Single

89 (22.8)

67 (26.9)

22 (15.6)

<0.001**

Married

288 (73.8)

169 (67.9)

119 (84.4)

Other

13 (3.4)

13 (5.2)

0 (0)

Hospitalization frequency

 

 

 

 

Never

263 (67.4)

150 (60.2)

113 (80.1)

<0.001**

1-2

97 (24.9)

74 (29.7)

23 (16.3)

>2

30 (7.7)

25 (10.1)

5 (3.6)

History of chronic disease

 

 

 

 

Yes

269 (69.0)

191 (76.7)

78 (55.3)

<0.001**

No

121 (31.0)

58 (23.3)

63 (44.7)

Values are given as a number (percentage) for categorical variables and mean (SD) for continuous variables.

*P-value was obtained with an independent t-test.

**P-value was obtained with a chi-square test.

 

Table 2. Mean and frequency distribution of the sleep quality subscales of the elderly (N=390).

 

Mean (SD)

No problem

Moderate

Serious

Very serious

Subjective quality of sleep

1.42 (SD=0.93)

60 (15.4)

172 (44.1)

94 (24.1)

64 (16.4)

Delayed falling asleep

2.41 (SD=1.83)

62 (15.9)

161 (41.3)

100 (25.6)

67 (17.2)

Sleep duration

0.98 (SD=0.88)

114 (29.2)

210 (53.8)

25 (6.4)

41 (10.5)

Sleep disorder

1.42 (SD=0.60)

9 (2.3)

220 (56.4)

146 (37.4)

15 (3.8)

Use of sleeping pills

1.01 (SD=0.64)

257 (65.9)

57 (14.6)

36 (9.2)

40 (10.3)

Daily dysfunction

0.98 (SD=0.91)

172 (44.1)

112 (28.7)

72 (18.5)

34 (8.7)

Sleep efficiency

1.03 (SD=0.67)

249 (63.8)

66 (16.9)

29 (7.4)

46 (11.8)

Total

7.40 (SD=4.02)

 

 

 

 

Values are given as a number (percentage) for categorical variables and mean (SD) for continuous variables.

 

4 Discussion

The average sleep quality score of the elderly in this study, which was undertaken to identify the quality of sleep and the factors impacting it in those hospitalized in the internal and surgical departments, indicates poor sleep quality. 63.8% of older people report having undesirable sleep quality.

The results of this study demonstrated that as people get older, their sleep quality deteriorates. The findings of several further studies on the subject of elderly sleep quality revealed that as people age, their sleep quality degrades [12-14]. It can be argued that aging and emotional strains brought on by events like a family member's death or retirement are to blame for the fact that the majority of older people experience frequent waking up during the night. A person's ability to get a good night's sleep is negatively impacted by the use of medications for the treatment and management of chronic illnesses, which also raises their risk of developing primary sleep disorders and chronic insomnia [15].

Living with family considerably improved sleep quality compared to living alone or living apart from family for other reasons. Several research that went in this manner revealed that married people have better sleep quality [15-17]. The family's capacity to provide emotional and psychological support is the cause. Healthcare professionals should use strategies that encourage ties among older members of the family because there is a substantial link between the quality of family relationships and sleep quality.

According to the findings of the study, elderly patients who had been hospitalized more than twice had considerably better sleep than elderly patients who had never been in a hospital. The study by Borji et al. also revealed that the elderly's sleep quality declines as the number of hospitalizations rise [15]. Patients who are hospitalized for a long time have disrupted sleep at night, and hospitalization exacerbates these alterations. Also, the results of the current study revealed a substantial association between the average sleep quality score and chronic diseases, which is consistent with the findings of several studies that demonstrate how having a chronic illness impacts sleep quality [13, 14].

Considering the age of the subjects, their impatience in answering the questions was one of the most important limitations in completing the questionnaires. Also, the patient's mental state, resting time, and pain were involved and effective in completing the questionnaire, which could not be controlled and changed by the patient's condition and the environment. Considering that the findings indicated a low quality of sleep in most of the elderly, it is suggested that future studies should also investigate the quality of sleep in different groups of the elderly (elderly living in nursing homes, healthy elderly, etc.).

 

4.1 Limitations

One of the limitations of this research is that some of the questions in the questionnaire remain unanswered or the inability of the elderly to answer the questions. It is suggested that shorter questionnaires should be used for studies on the elderly in future research or that data collection should be done in a place such as health centers or geriatric cohort centers.

 

4.2 Recommendations for future research

Further experimental investigations on strategies to enhance the elderly's sleep quality are advised. Also, it is proposed that shorter questionnaires be used for studies on the elderly in future studies due to the length of the existing questionnaire and the old being weary of filling it out.

 

5 Conclusions

In sum, considering that the results of the research showed that the elderly did not have a good quality of sleep, it is recommended to provide nursing care in the inpatient wards as well as teach it to the elderly and their families to prevent sleep problems and related problems.

 

Acknowledgements

Not applicable.

 

Authors’ contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: MST, MS, AH, BP; Drafting the work or revising it critically for important intellectual content: MST, MS, AH, BP; Final approval of the version to be published: MST, MS, AH, BP; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MST, MS, AH, BP.

 

Funding

Self-funded.

 

Ethics approval and consent to participate

The present research has been approved by Mashhad University of Medical Sciences (IR.MUMS.REC.1397.147). Ethics-related considerations, such as securing information confidentiality and obtaining written informed permission from participants, were taken into account.

 

Competing interests

We do not have potential conflicts of interest with respect to the research, authorship, and publication of this article.

 

Availability of data and materials

The datasets used during the current study are available from the corresponding author on request.

 

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (CC BY-NC 4.0).

© 2023 The Author(s).

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Volume 1, Issue 2
July 2023
Pages 59-63
  • Receive Date: 12 April 2023
  • Revise Date: 20 April 2023
  • Accept Date: 23 April 2023
  • First Publish Date: 27 July 2023
  • Publish Date: 27 July 2023