- Email: [email protected]
Sleep quality and quality of life among the elderly people
neurology, psychiatry and brain research 19 (2013) 48–52
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/npbr
Sleep quality and quality of life among the elderly people Hatice Tel * Cumhuriyet University Health Sciences Faculty, Department of Nursing, Internal Diseases Nursing, 58140 Sivas, Turkey
article info
abstract
Article history:
Objective: To determine sleep quality and the quality of life of the elderly people. Materials
Received 19 February 2012
and methods: This study sample consisted of 187 elderly people. Data were collected with a
Received in revised form
personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-
15 October 2012
BREF-quality of life scale. Results: It was found out that sleep quality of the elderly people
Accepted 31 October 2012
was poor. It was noted that there was a close correlation between age and sleep quality and
Available online 27 November 2012
quality of life of the elderly people, and sleep quality and quality of life decreased as the age of the elderly people increased. It was explored that there was a significant difference between gender, marital status, educational status, the person with whom the elderly people lived, presence of a physical disease, diagnosis of a disease and sleep quality and
Keywords:
quality of life ( p < 0.05). Conclusions: The elderly people have a low sleep quality and there
Elderly
is a close relationship between sleep quality and the quality of life. The quality of sleep
Sleep quality
should be continued by ensuring sleep hygiene among the elderly people and thus the
Quality of life
quality of life should be increased. © 2012 Elsevier GmbH. All rights reserved.
1.
Introduction
Old age is normal, biological and universal process. Population of the world has been aging because the expected life span at birth has become longer. It is estimated that the population of the elderly people in the world will have exceeded one billion by 2020 and most of the elder population will be living in the developing countries.1,2 In Turkey, the population of the elderly people aged 65 was by 5% in 2005 and 6.1% in 2010. It is estimated that the rate of the elderly people in Turkey will have risen to 9% in 2020 and to 13% in 2050.3 People experience many physical and psychological changes in old age. One of these changes occurs in the quality and quantity of the sleep of the elderly people.4,5 Sleep problems often occur due to the changes in the sleep pattern of the elderly people in old age. Epidemiologic data indicate that sleep complaints and sleep problems increase with old age.6 It is emphasized that prevalence of the sleep disorder is higher than 50% among the community-living elderly people.7,8
Changes in the sleep characteristics and sleep problems affect the elderly people in many aspects. It is told that sleep problems frequently seen among the elderly people affect quality of sleep negatively and cause day-fatigue, cognitional weakness, deterioration in physical and psychological health, increased fall-risk and decreased quality of life.7,9–11 People's need for sleep and time spent during sleep decreases during old age.12 However, elderly people are in need of a sleep of good quality in order to perform physical and psychological functions properly and to keep their quality of life at the optimum level. Sleep is a key indicator of quality of life. Therefore, changes that occur in sleep during aging process affect quality of life negatively.9,13,14 With old age; people experience difficulty performing activities of daily living independently and become dependent upon others. Restrictions in activities of daily living of the elderly people affect their quality of life directly.15–17 Not only chronic degenerative diseases, physical disabilities, pain, cognitional disabilities, sleep problems but also problems in access to health services and use of health services, social
* Tel.: +90 532 5831830; fax: +903462191261. E-mail addresses: [email protected], [email protected]. 0941-9500/$ – see front matter © 2012 Elsevier GmbH. All rights reserved. http://dx.doi.org/10.1016/j.npbr.2012.10.002
49
neurology, psychiatry and brain research 19 (2013) 48–52
isolation, familial and domestic problems, life satisfaction and decreased life expectancy affect the quality of life of the elderly people negatively.18–20 Although there are studies on different variables thought to be affecting quality of life and sleep quality among the elderly people; the number of the studies that investigate quality of life, sleep quality and their interaction with each other is rather small. The present study was conducted in order to determine quality of life and sleep quality of the community-living elderly people and to explore the correlation between these two variables.
2.
Materials and methods
187 elderly people who lived in service area of a family health center where the study was conducted and were aged 65 years were included in the study. A total of 213 elderly people aged 65 years lived in service area of the family health center where the study was conducted. 17 of these elderly people had auditory problems, 6 had cognitional disorders and 3 did not want to participate in study; which meant that a total of 26 elderly people were not included in the study. So, 187 elderly people aged 65 years who lived in their own houses, could perform activities of daily living, did not have any auditory problems, did not have any diagnosed psychological problems and accepted to participate in the research were included in the study. Written official permission was obtained from the family health center where the study was conducted and oral informed consents of the participants were obtained. The data of the research were gathered using a personal information form, quality of sleep scale and quality of life scale through face-to-face interview technique with the elderly people at their homes.
2.1.
Personal information form
Personal information form was developed by the researchers. The form included questions about the elderly people's health status and their descriptive characteristics such as age, gender, educational status, daily sleep time, sleep pattern, presence of sleep problems, presence of chronic physical diseases, number of diseases, and drug use.
2.2.
The Pittsburgh sleep quality index
This index was developed by Buysse et al., and is self-rated questionnaire to measure sleep quality in clinical population.21 Ağargün conducted is its validity and reliability work in Turkey.22 This index contains 24 questions. Of these, 19 questions were self-rated questions. The roommate or partner
of the patients answered five of these questions. Question 10 is not taken into consideration during scoring. The first 18 questions include seven subcomponents (quality of sleep, sleep latency, length of sleep, sleeping habits, sleep disorders, use of sleeping pills and daytime activity disorder). Each component scores between 0 and 3 points. The total index score is between 0 and 21. This index total score of 5 and above indicates poor sleep quality.21,22
2.3.
WHOQOL-BREF-quality of life scale
This scale was developed by World Health Organization, contains 26 questions that assess generally perceived quality of life. Turkish validity and reliability trials of the scale were performed by Eser et al. Turkish Version of WHOQOL-BREF is composed of 27 questions with one extra-national-question included in the scale during validity trials. Scale measures the following domains: physical health, psychological health, social relationships, and environment. WHOQOL-BREF scores range between 0 and 20. Higher scores from the scale indicate higher quality of life.23 The data of the research were analyzed using SPSS 15.00. For the analysis of the descriptive data, descriptive statistics were used. Pearson correlation analysis was used in order to explore the correlation between age and sleep quality and age and quality of life. For the analysis of the sleep quality and quality of life in terms of descriptive characteristics, t test and variance analysis were used. For the advanced tests of the data, Benferroni test was used.
3.
Results
A total of 187 elderly people were included in this study. The age of the elderly people ranged from 65 and 82 and mean age was 72.51 5.21. 52.9% of the elderly people was women, 39.0% belonged to 65–69 age group, 51.9% was widowed, 43.9% was illiterate and 43.3% lived together with their spouses. It was found out that 64.2% of the elderly people had physical diseases and used medicines and 71.1% of those who had physical diseases had at least one physical disease, 28.9% had more than two diseases. It was observed that daily sleep time of the elderly people changed between 5 and 7 h, mean daily sleep time was 6.2 h, 78% told to have experienced sleep disorder and 73.3% had poor sleep quality. Table 1 demonstrated the correlation between age and sleep quality and quality of life of the elderly people. It was pointed out that there was a significant and positive correlation between age and sleep quality scores of the elderly people (r = .423, p = .000) and scores of the quality of sleep scale increased as age increased and, thus sleep quality decreased. It
Table 1 – The correlation between age and sleep quality and quality of life of the elderly people. Age
Sleep quality
r .423, p = .000
Quality of life Physical
Psychological
r = 341, p = .000
r = 373, p = .000
Social r = 423, p = .000
Environmental r = 394, p = .000
50
neurology, psychiatry and brain research 19 (2013) 48–52
Table 2 – Scores of sleep quality and scores of quality of life of the elderly people in terms of descriptive characteristics of the elderly people. Descriptive characteristics
Sleep quality
Quality of life
X SD
Physical X SD
6.19 2.41* 7.85 3.07 7.79 2.83 10.42 3.32* F = 15.018, p = .000
12.27 1.82 12.27 1.50 12.33 1.74 11.38 2.19 F = 1.913, p = .129
8.14 3.70* 6.87 2.08 t = 2.830, p = .005
Social X SD
Environmental X SD
12.25 2.05 12.37 1.54 12.31 2.07 11.73 2.34 F = .644, p = .587
11.68 3.85 12.95 2.79 12.10 3.18 10.69 3.78 F = 2.412, p = .068
12.98 1.91 13.05 2.07 13.14 2.42 12.65 2.36 F = .360, p = .821
11.56 1.85* 12.84 1.50 t = .123, p = .000
11.89 2.10* 12.60 1.82 t = 2.430, p = .016
11.25 3.67* 12.68 3.17 t = 2.829, p = .005
12.72 2.19 13.29 2.04 t = 1.82, p = .070
6.70 2.76 8.32 3.22* t = 3.700, p = .000
12.51 1.48 11.84 2.02* t = 2.549, p = .012
12.75 1.56 11.74 2.23* t = 3.566, p = .000
12.76 2.95 11.14 3.81* t = 3.235, p = .001
13.26 1.92 12.74 2.30 t = 1.683, p = .094
8.54 3.63* 6.15 1.50 7.44 2.91 6.92 2.60 F = 6.773, p = .000
11.52 1.70* 12.37 1.65 12.97 1.88 12.76 1.68 F = 7.560, p = .000
11.69 2.04* 12.55 1.86 12.73 2.16 12.69 1.51 F = 3.687, p = .013
11.19 3.80* 11.91 3.87 12.91 2.72 12.96 2.08 F = 2.917, p = .036
12.62 2.19 13.02 1.87 14.11 2.33* 12.65 1.64 F = 4.406, p = .005
Partner (the person with whom the elderly people lived) Spouse 6.49 2.94* Children 8.21 3.26 Alone 8.57 2.54 F = 9.054, p = .000
12.48 1.40* 11.60 1.69* 12.45 2.43 F = 5.091, p = .007
12.88 1.43* 11.50 2.03* 12.10 2.48 F = 9.692, p = .000
12.92 2.80* 11.27 4.24 10.97 2.99 F = 6.220, p = .002
13.45 1.85* 12.69 2.23 12.55 2.37 F = 3.485, p = .033
Disease COPD Hypertension Diabetes M Rheumatism Heart Diseases Goiter More than two No disease F, p
13.14 2.73 12.33 1.73 12.25 .95 12.28 2.13 10.56 1.31* 13.20.83 11.64 2.01* 12.70 1.38* F = 4.297, p = .000
13.42 1.98 12.07 2.09 12.75 1.50 12.14 69 10.12 2.60* 13.00 2.44 11.27 1.73* 13.35 1.18* F = 10.710, p = .000
13.28 1.38 12.48 2.02 14.50 1.73 9.85 4.70 9.75 4.73* 15.00 2.23 10.29 3.88* 13.22 2.52* F = 6.359, p = .00
14.57 1.71 12.96 2.19 13.25 .95 14.00 1.15 11.93 2.95* 14.60 .89 12.11 2.39* 13.56 1.45* F = 4.184, p = .000
Age 65–69 70–74 75–79 80 years Gender Female Male
Marital status Married Widowed
Educational status Illiterate Literate Primary School Secondary School
*
6.71 1.79 7.07 2.78 9.25 3.86 7.85 2.96 10.87 4.45* 6.00 2.73 8.37 2.66* 6.34 2.55* F = 6.084, p = .000
Psychological X SD
Benferroni test.
was shown that there was a significant negative correlation between age of the elderly people and the subscales of the quality of life scale [physical health (r = 341, p = .000), psychological health (r = 373, p = .000), social relationships (r = 423, p = .000) and environmental domain (r = 394, p = .000)] and scores of all subscales of quality of life scale decreased as age increased. Table 2 demonstrated scores of sleep quality and scores of quality of life of the elderly people in terms of their descriptive characteristics. It was observed that there was a statistically significant difference in the sleep quality of the elderly people in terms of age groups ( p < 0.05) and quality of life of those in 65–69 age group was better than other age groups and quality of life of those aged 80 was worse than other age groups. It was found out that there was a statistically significant difference between gender, marital status, educational status, to live with someone, presence of a physical disease, diagnosis of a disease and sleep quality and
quality of life ( p < 0.05). Sleep quality of those female participants and those widowed was worse and their scores of physical health, psychological health and social relationships of quality of life were lower. Sleep quality of those illiterate was worse than others and scores of physical health, psychological health and social relationships of quality of life were lower than others. The elderly people who had primary school degree had higher environmental domain scores than others. The elderly people who lived together with their spouses had better sleep quality than others, and their scores of physical health and psychological health of quality of life were higher than others who lived together with their children and their scores of social relationships and environmental domain were higher than the scores of the others. The sleep quality and quality of life of those without any physical disease were better than those who had more than two physical diseases and those who had heart diseases, and their quality of life was higher.
neurology, psychiatry and brain research 19 (2013) 48–52
4.
Discussion
Sleep problems are often experienced by elderly people. It was explored in the present study that most of the elderly people had lower sleep quality and their sleep quality deteriorated as their age advanced. The studies reported that 80% of the elderly people had sleep problems at different levels and 40– 50% was not satisfied with their sleep quality and underwent chronic sleep problems.24,25 It is determined that changes that occur during old age deteriorate sleep quality and increase sleep problems with old age.6 Many studies conducted in the community indicate that poor sleep quality increases with old age and it is widespread.13,26 In the present study, the sleep quality of the elderly women was poor and their scores of physical health, psychological health and social relationships of quality of life were low. It is suggested that gender is a criterion in the assessment of the sleep quality among the elderly people and elderly women complain more about sleep problems than elderly men.24 The studies made reported that sleep quality of women was worse than sleep quality of men11,27, which was in agreement with our findings. Özyurt et al.28 told that scores of quality of life of the elderly women was lower than the elderly men and that women with lower quality of life had difficulty performing activities of daily living. Arslantaş et al. pointed out that the quality of life of the elderly women who were widowed were lower,29 which concurred with our findings. In the present study, sleep quality of the elderly people who were widowed was bad and their scores of physical health, psychological health and social relationships of quality of life were low. Also, it was detected in the studies made that the quality of life of the elderly people who were widowed was poor,28,29 which was in line with our findings. Sleep quality of those illiterate elderly people was poor and their scores of physical health, psychological health and social relationships of quality of life were low. Environmental domain scores of those elderly people who had primary school degree were higher than other elderly people. Ito et al. found out that sleep problems were more commonly seen among those elderly people whose educational statuses were lower.30 Education is an important factor for individuals to express themselves and to continue healthy living habits. The studies conducted demonstrated that as the educational status of the elderly people increased so did their quality of life and that quality of life of the illiterate elderly people was poor.29,31 Sleep quality of those elderly people who lived together with their spouses was better and their scores of physical health and psychological health of quality of life were higher than those who lived together with their children, and their scores of social relationships and environmental domain were higher than other elderly people. Leading the old age with a partner (spouse) contributes positively to an organized and supportive life style and that is why sleep quality and quality of life of those living with their spouses is better than other elderly people. The sleep quality and quality of life of the elderly people without any physical disease were better than those who had more than two physical diseases and those who had heart diseases. Improvement of the quality of life and psycho-social
51
satisfaction of the elderly people is as important as increasing their physical health.32 Often, sleep problems of the elderly people occur secondarily to the present disease.8 It is detected that presence of physical disorders during old age contributes the occurrence of the sleep problems and as the number of the physical diseases increases among the population aged 65 so does the sleep problems.33 Wu et al. suggested that the elderly people who expressed their health status better had better sleep quality and that cardiovascular diseases, hypertension, skeletal muscular diseases, endocrine and metabolic diseases, physical problems with respiratory difficulty affected sleep quality negatively.27 Chronic diseases during old age cause the individuals to lead their lives dependently and decrease their quality of life.34–36 Sleep quality and quality of life of the elderly people with heart diseases were worse than other people who were diagnosed with other illnesses. Redeker and Robert detected that sleep quality was worse among the patients with heart diseases.37 It is emphasized that improvement of physical functions may be achieved by answering sleep needs of the elderly people.8
5.
Conclusions
Sleep quality decreases with old age and poor sleep quality affects quality of life negatively. Therefore, sleep quality and quality of life should continuously be assessed in the care of the elderly people and plans should be made in order to keep a good sleep quality and a better quality of sleep.
6.
Limitations of the research
The research was conducted with the community-living elderly people. Studies in which the correlation between sleep and quality of life of the elderly people selected according to certain clinical diagnosis is evaluated for a longer time and with repeated measurements may be designed.
Conflict of interest statement The author has declared no conflicts of interest.
references
1. Meisheri YV. Geriatric services-need of the hour. Journal of Postgraduate Medicine 1992;38:103–5. 2. Canbaz S, Sunter AT, Dabak S, Peksen Y. The prevalence of chronic diseases and quality of life in elderly people in Samsun. Turkish Journal of Medical Sciences 2003;33:335–40. 3. Kutsal YG. Aging world. Turkish Journal of Physical Medicine and Rehabilitation 2006;52:6–11. 4. Roepke SK, Ancoli-Isreal S. Sleep disorders in the elderley. Indian Journal of Medical Research 2010;131:302–10. 5. Espiritu JR. Aging-related sleep changes. Clinics in Geriatric Medicine 2008;24:1–14. 6. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews 2002; 6:97–111.
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7. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995;18:425–32. 8. Rao V, Spiro JR, Samus QM, Rosenblatt A, Steele C, Baker A, et al. Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study. International Journal of Geriatric Psychiatry 2005;20:956–66. 9. Reid KJ, Martinovich Z, Finkel S, Statsinger J, Golden R, Harter K, et al. Sleep: a marker of physical and mental health in the elderly. American Journal of Geriatric Psychiatry 2006;14:860–6. 10. Atay T. Sleep in old age. Turkiye Klinikleri Journal of Psychiatry 2001;2:91–7. 11. Ramsawh HJ, Stein MB, Belik SL, Jacobi F, Sareen J. Relationship of anxiety disorders, sleep quality, and functional impairment in a community sample. Journal of Psychiatric Research 2009;43:926–33. 12. Eser I, Khorshid L, Cınar S. Sleep quality of older adults in nursing homes in Turkey: enhancing the quality of sleep improves quality of life. Journal of Gerontological Nursing 2007;33:42–9. 13. Hoffman S. Sleep in the older adult: implications for nurses. Geriatric Nursing 2003;24:210–4. 14. Kryger M, Monjan A, Bliwise D, Ancoli-Israel S. Sleep, health, and aging: bridging the gap between science and clinical practice. Geriatrics 2004;59:24–6. 15. Kunter NG, Ory MG, Baker DI, Schechtman KB, Hornbrook MC, Mulrow CD. Measuring the quality of life of the elderly in health promotion intervention clinical trials. Public Health Reports 1992;107:530–9. 16. Akgün HS, Bakar Ç., Budakoğlu İ.. Health and mental status and daily living activities of 65 years and over hospitalized patients at Baskent University Hospitals network. Turkish Journal of Geriatrics 2004;7:133–8. 17. Tel H, Tel H, Sabancıoğulları S. Status of maintenance of activities of daily living and experience of loneliness in elder than 60 years old living at home and in institutions. Turkish Journal of Geriatrics 2006;9:35–40. 18. Telatar TG, Özcebe H. Elderly population and increasing quality of life. Turkish Journal of Geriatrics 2004;7: 162–5. 19. Kurtuluş Z, Yıldız H, Pınar P. Use of quality of life associated with health in geriatrics. Accumulation in Health 2006;1: 21–5. 20. Kaya M, Aslan D, Vaizoğlu SA, Doruk C, Dokur U, Biçici V, et al. Features of quality of life and the affecting factors of the individuals who were 65 and lived in a neighborhood of Keçiören country of Ankara province. Turkish Journal of Geriatrics 2008;11:12–7. 21. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 1989;28:193–213.
22. Ağargün M, Kara H, Anlar Ö.. Validity and reliability of Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry 1996;7:107–15. 23. Eser E, Fidaner H, Eser SY, Elbi H, Göker E. Psychometric properties of WHOQOL-100 and WHOQOL-BREF. Journal of Psychiatry Psychology Psychopharmacology 1999;7:23–40. 24. Kaymak SU, Peker S, Cankurtaran E.Ş., Soygür H. Sleep problems in the geriatric population. The Journal of Academic Geriatrics 2010;2:61–70. 25. Wolkove N, Elkholy O, Baltzan M, Palayew M. Sleep and aging. 1. Sleep disorders commonly found in older people. Canadian Medical Association Journal 2007;176:1299–304. 26. Zeitlhofer J, Schmeiser-Rieder A, Tribl G, Rosenberger A, Bolitschek J, Kapfhammer G, et al. Sleep and quality of life in the Austrian population. Acta Neurologica Scandinavica 2000;102:249–57. 27. Wu CY, Su TP, Fang CL, Chang MY. Sleep quality among community-dwelling elderly people and its demographic, mental, and physical correlates. Journal of the Chinese Medical Association 2012;75:75–80. 28. Özyurt BC, Eser E, Çoban G, Akdemir SN, Karaca İ., Karakoç Ö.. Evaluation of the factors that affected the quality of life of the elderly residents of Muradiye region of Manisa province. Turkish Journal of Geriatrics 2007;10:117–23. 29. Arslantaş D, Ünsal A, Metintaş S, Koç F, Arslantaş A. Life quality and daily life activities of elderly people in rural areas, Eskişehir (Turkey). Archives of Gerontology and Geriatrics 2009;48:127–31. 30. Ito Y, Tamakoshi A, Yamaki K, Wakai K, Kawamura T, Takagi K, et al. Sleep disturbance and its correlates among elderly. Japanese Archives of Gerontology and Geriatrics 2000;30:85–100. 31. Çalıştır B, Dereli F, Ayan H, Cantürk A. Life quality of the elder people living in the city centre of Muğla. Turkish Journal of Geriatrics 2006;9:30–3. 32. Matsuo M, Nagasawa J, Yoshino A, Hiramatsu K, Kurashiki K. Effects of activity participations of the elderly on quality of life. Yonago Acta Medica 2003;46:17–24. 33. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: results of the 2003 national sleep foundation sleep in America survey. Journal of Psychosomatic Research 2004;56:497–502. 34. Ulusel B, Soyer A, Uçku R. Dependency levels of daily life activities among the elderly people who lived together with the society and the effecting risk factors. Turkish Journal of Geriatrics 2004;7:199–205. 35. Güneş G, Demircioğlu N, Karaoğlu L. Daily life activities of the elderly women who lived in the city center of Malatya province and their social and psychological function levels. Turkish Journal of Geriatrics 2005;8:78–83. 36. Neubauer DN. Sleep problems in the elderly. American Family Physician 1999;59:2551–8. 37. Redeker NS, Hilkert R. Sleep and quality of life of stable heart failure. Journal of Cardiac Failure 2005;11:700–4.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/npbr
Sleep quality and quality of life among the elderly people Hatice Tel * Cumhuriyet University Health Sciences Faculty, Department of Nursing, Internal Diseases Nursing, 58140 Sivas, Turkey
article info
abstract
Article history:
Objective: To determine sleep quality and the quality of life of the elderly people. Materials
Received 19 February 2012
and methods: This study sample consisted of 187 elderly people. Data were collected with a
Received in revised form
personal information form, Pittsburgh Sleep Quality Index and Turkish Version of WHOQOL-
15 October 2012
BREF-quality of life scale. Results: It was found out that sleep quality of the elderly people
Accepted 31 October 2012
was poor. It was noted that there was a close correlation between age and sleep quality and
Available online 27 November 2012
quality of life of the elderly people, and sleep quality and quality of life decreased as the age of the elderly people increased. It was explored that there was a significant difference between gender, marital status, educational status, the person with whom the elderly people lived, presence of a physical disease, diagnosis of a disease and sleep quality and
Keywords:
quality of life ( p < 0.05). Conclusions: The elderly people have a low sleep quality and there
Elderly
is a close relationship between sleep quality and the quality of life. The quality of sleep
Sleep quality
should be continued by ensuring sleep hygiene among the elderly people and thus the
Quality of life
quality of life should be increased. © 2012 Elsevier GmbH. All rights reserved.
1.
Introduction
Old age is normal, biological and universal process. Population of the world has been aging because the expected life span at birth has become longer. It is estimated that the population of the elderly people in the world will have exceeded one billion by 2020 and most of the elder population will be living in the developing countries.1,2 In Turkey, the population of the elderly people aged 65 was by 5% in 2005 and 6.1% in 2010. It is estimated that the rate of the elderly people in Turkey will have risen to 9% in 2020 and to 13% in 2050.3 People experience many physical and psychological changes in old age. One of these changes occurs in the quality and quantity of the sleep of the elderly people.4,5 Sleep problems often occur due to the changes in the sleep pattern of the elderly people in old age. Epidemiologic data indicate that sleep complaints and sleep problems increase with old age.6 It is emphasized that prevalence of the sleep disorder is higher than 50% among the community-living elderly people.7,8
Changes in the sleep characteristics and sleep problems affect the elderly people in many aspects. It is told that sleep problems frequently seen among the elderly people affect quality of sleep negatively and cause day-fatigue, cognitional weakness, deterioration in physical and psychological health, increased fall-risk and decreased quality of life.7,9–11 People's need for sleep and time spent during sleep decreases during old age.12 However, elderly people are in need of a sleep of good quality in order to perform physical and psychological functions properly and to keep their quality of life at the optimum level. Sleep is a key indicator of quality of life. Therefore, changes that occur in sleep during aging process affect quality of life negatively.9,13,14 With old age; people experience difficulty performing activities of daily living independently and become dependent upon others. Restrictions in activities of daily living of the elderly people affect their quality of life directly.15–17 Not only chronic degenerative diseases, physical disabilities, pain, cognitional disabilities, sleep problems but also problems in access to health services and use of health services, social
* Tel.: +90 532 5831830; fax: +903462191261. E-mail addresses: [email protected], [email protected]. 0941-9500/$ – see front matter © 2012 Elsevier GmbH. All rights reserved. http://dx.doi.org/10.1016/j.npbr.2012.10.002
49
neurology, psychiatry and brain research 19 (2013) 48–52
isolation, familial and domestic problems, life satisfaction and decreased life expectancy affect the quality of life of the elderly people negatively.18–20 Although there are studies on different variables thought to be affecting quality of life and sleep quality among the elderly people; the number of the studies that investigate quality of life, sleep quality and their interaction with each other is rather small. The present study was conducted in order to determine quality of life and sleep quality of the community-living elderly people and to explore the correlation between these two variables.
2.
Materials and methods
187 elderly people who lived in service area of a family health center where the study was conducted and were aged 65 years were included in the study. A total of 213 elderly people aged 65 years lived in service area of the family health center where the study was conducted. 17 of these elderly people had auditory problems, 6 had cognitional disorders and 3 did not want to participate in study; which meant that a total of 26 elderly people were not included in the study. So, 187 elderly people aged 65 years who lived in their own houses, could perform activities of daily living, did not have any auditory problems, did not have any diagnosed psychological problems and accepted to participate in the research were included in the study. Written official permission was obtained from the family health center where the study was conducted and oral informed consents of the participants were obtained. The data of the research were gathered using a personal information form, quality of sleep scale and quality of life scale through face-to-face interview technique with the elderly people at their homes.
2.1.
Personal information form
Personal information form was developed by the researchers. The form included questions about the elderly people's health status and their descriptive characteristics such as age, gender, educational status, daily sleep time, sleep pattern, presence of sleep problems, presence of chronic physical diseases, number of diseases, and drug use.
2.2.
The Pittsburgh sleep quality index
This index was developed by Buysse et al., and is self-rated questionnaire to measure sleep quality in clinical population.21 Ağargün conducted is its validity and reliability work in Turkey.22 This index contains 24 questions. Of these, 19 questions were self-rated questions. The roommate or partner
of the patients answered five of these questions. Question 10 is not taken into consideration during scoring. The first 18 questions include seven subcomponents (quality of sleep, sleep latency, length of sleep, sleeping habits, sleep disorders, use of sleeping pills and daytime activity disorder). Each component scores between 0 and 3 points. The total index score is between 0 and 21. This index total score of 5 and above indicates poor sleep quality.21,22
2.3.
WHOQOL-BREF-quality of life scale
This scale was developed by World Health Organization, contains 26 questions that assess generally perceived quality of life. Turkish validity and reliability trials of the scale were performed by Eser et al. Turkish Version of WHOQOL-BREF is composed of 27 questions with one extra-national-question included in the scale during validity trials. Scale measures the following domains: physical health, psychological health, social relationships, and environment. WHOQOL-BREF scores range between 0 and 20. Higher scores from the scale indicate higher quality of life.23 The data of the research were analyzed using SPSS 15.00. For the analysis of the descriptive data, descriptive statistics were used. Pearson correlation analysis was used in order to explore the correlation between age and sleep quality and age and quality of life. For the analysis of the sleep quality and quality of life in terms of descriptive characteristics, t test and variance analysis were used. For the advanced tests of the data, Benferroni test was used.
3.
Results
A total of 187 elderly people were included in this study. The age of the elderly people ranged from 65 and 82 and mean age was 72.51 5.21. 52.9% of the elderly people was women, 39.0% belonged to 65–69 age group, 51.9% was widowed, 43.9% was illiterate and 43.3% lived together with their spouses. It was found out that 64.2% of the elderly people had physical diseases and used medicines and 71.1% of those who had physical diseases had at least one physical disease, 28.9% had more than two diseases. It was observed that daily sleep time of the elderly people changed between 5 and 7 h, mean daily sleep time was 6.2 h, 78% told to have experienced sleep disorder and 73.3% had poor sleep quality. Table 1 demonstrated the correlation between age and sleep quality and quality of life of the elderly people. It was pointed out that there was a significant and positive correlation between age and sleep quality scores of the elderly people (r = .423, p = .000) and scores of the quality of sleep scale increased as age increased and, thus sleep quality decreased. It
Table 1 – The correlation between age and sleep quality and quality of life of the elderly people. Age
Sleep quality
r .423, p = .000
Quality of life Physical
Psychological
r = 341, p = .000
r = 373, p = .000
Social r = 423, p = .000
Environmental r = 394, p = .000
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neurology, psychiatry and brain research 19 (2013) 48–52
Table 2 – Scores of sleep quality and scores of quality of life of the elderly people in terms of descriptive characteristics of the elderly people. Descriptive characteristics
Sleep quality
Quality of life
X SD
Physical X SD
6.19 2.41* 7.85 3.07 7.79 2.83 10.42 3.32* F = 15.018, p = .000
12.27 1.82 12.27 1.50 12.33 1.74 11.38 2.19 F = 1.913, p = .129
8.14 3.70* 6.87 2.08 t = 2.830, p = .005
Social X SD
Environmental X SD
12.25 2.05 12.37 1.54 12.31 2.07 11.73 2.34 F = .644, p = .587
11.68 3.85 12.95 2.79 12.10 3.18 10.69 3.78 F = 2.412, p = .068
12.98 1.91 13.05 2.07 13.14 2.42 12.65 2.36 F = .360, p = .821
11.56 1.85* 12.84 1.50 t = .123, p = .000
11.89 2.10* 12.60 1.82 t = 2.430, p = .016
11.25 3.67* 12.68 3.17 t = 2.829, p = .005
12.72 2.19 13.29 2.04 t = 1.82, p = .070
6.70 2.76 8.32 3.22* t = 3.700, p = .000
12.51 1.48 11.84 2.02* t = 2.549, p = .012
12.75 1.56 11.74 2.23* t = 3.566, p = .000
12.76 2.95 11.14 3.81* t = 3.235, p = .001
13.26 1.92 12.74 2.30 t = 1.683, p = .094
8.54 3.63* 6.15 1.50 7.44 2.91 6.92 2.60 F = 6.773, p = .000
11.52 1.70* 12.37 1.65 12.97 1.88 12.76 1.68 F = 7.560, p = .000
11.69 2.04* 12.55 1.86 12.73 2.16 12.69 1.51 F = 3.687, p = .013
11.19 3.80* 11.91 3.87 12.91 2.72 12.96 2.08 F = 2.917, p = .036
12.62 2.19 13.02 1.87 14.11 2.33* 12.65 1.64 F = 4.406, p = .005
Partner (the person with whom the elderly people lived) Spouse 6.49 2.94* Children 8.21 3.26 Alone 8.57 2.54 F = 9.054, p = .000
12.48 1.40* 11.60 1.69* 12.45 2.43 F = 5.091, p = .007
12.88 1.43* 11.50 2.03* 12.10 2.48 F = 9.692, p = .000
12.92 2.80* 11.27 4.24 10.97 2.99 F = 6.220, p = .002
13.45 1.85* 12.69 2.23 12.55 2.37 F = 3.485, p = .033
Disease COPD Hypertension Diabetes M Rheumatism Heart Diseases Goiter More than two No disease F, p
13.14 2.73 12.33 1.73 12.25 .95 12.28 2.13 10.56 1.31* 13.20.83 11.64 2.01* 12.70 1.38* F = 4.297, p = .000
13.42 1.98 12.07 2.09 12.75 1.50 12.14 69 10.12 2.60* 13.00 2.44 11.27 1.73* 13.35 1.18* F = 10.710, p = .000
13.28 1.38 12.48 2.02 14.50 1.73 9.85 4.70 9.75 4.73* 15.00 2.23 10.29 3.88* 13.22 2.52* F = 6.359, p = .00
14.57 1.71 12.96 2.19 13.25 .95 14.00 1.15 11.93 2.95* 14.60 .89 12.11 2.39* 13.56 1.45* F = 4.184, p = .000
Age 65–69 70–74 75–79 80 years Gender Female Male
Marital status Married Widowed
Educational status Illiterate Literate Primary School Secondary School
*
6.71 1.79 7.07 2.78 9.25 3.86 7.85 2.96 10.87 4.45* 6.00 2.73 8.37 2.66* 6.34 2.55* F = 6.084, p = .000
Psychological X SD
Benferroni test.
was shown that there was a significant negative correlation between age of the elderly people and the subscales of the quality of life scale [physical health (r = 341, p = .000), psychological health (r = 373, p = .000), social relationships (r = 423, p = .000) and environmental domain (r = 394, p = .000)] and scores of all subscales of quality of life scale decreased as age increased. Table 2 demonstrated scores of sleep quality and scores of quality of life of the elderly people in terms of their descriptive characteristics. It was observed that there was a statistically significant difference in the sleep quality of the elderly people in terms of age groups ( p < 0.05) and quality of life of those in 65–69 age group was better than other age groups and quality of life of those aged 80 was worse than other age groups. It was found out that there was a statistically significant difference between gender, marital status, educational status, to live with someone, presence of a physical disease, diagnosis of a disease and sleep quality and
quality of life ( p < 0.05). Sleep quality of those female participants and those widowed was worse and their scores of physical health, psychological health and social relationships of quality of life were lower. Sleep quality of those illiterate was worse than others and scores of physical health, psychological health and social relationships of quality of life were lower than others. The elderly people who had primary school degree had higher environmental domain scores than others. The elderly people who lived together with their spouses had better sleep quality than others, and their scores of physical health and psychological health of quality of life were higher than others who lived together with their children and their scores of social relationships and environmental domain were higher than the scores of the others. The sleep quality and quality of life of those without any physical disease were better than those who had more than two physical diseases and those who had heart diseases, and their quality of life was higher.
neurology, psychiatry and brain research 19 (2013) 48–52
4.
Discussion
Sleep problems are often experienced by elderly people. It was explored in the present study that most of the elderly people had lower sleep quality and their sleep quality deteriorated as their age advanced. The studies reported that 80% of the elderly people had sleep problems at different levels and 40– 50% was not satisfied with their sleep quality and underwent chronic sleep problems.24,25 It is determined that changes that occur during old age deteriorate sleep quality and increase sleep problems with old age.6 Many studies conducted in the community indicate that poor sleep quality increases with old age and it is widespread.13,26 In the present study, the sleep quality of the elderly women was poor and their scores of physical health, psychological health and social relationships of quality of life were low. It is suggested that gender is a criterion in the assessment of the sleep quality among the elderly people and elderly women complain more about sleep problems than elderly men.24 The studies made reported that sleep quality of women was worse than sleep quality of men11,27, which was in agreement with our findings. Özyurt et al.28 told that scores of quality of life of the elderly women was lower than the elderly men and that women with lower quality of life had difficulty performing activities of daily living. Arslantaş et al. pointed out that the quality of life of the elderly women who were widowed were lower,29 which concurred with our findings. In the present study, sleep quality of the elderly people who were widowed was bad and their scores of physical health, psychological health and social relationships of quality of life were low. Also, it was detected in the studies made that the quality of life of the elderly people who were widowed was poor,28,29 which was in line with our findings. Sleep quality of those illiterate elderly people was poor and their scores of physical health, psychological health and social relationships of quality of life were low. Environmental domain scores of those elderly people who had primary school degree were higher than other elderly people. Ito et al. found out that sleep problems were more commonly seen among those elderly people whose educational statuses were lower.30 Education is an important factor for individuals to express themselves and to continue healthy living habits. The studies conducted demonstrated that as the educational status of the elderly people increased so did their quality of life and that quality of life of the illiterate elderly people was poor.29,31 Sleep quality of those elderly people who lived together with their spouses was better and their scores of physical health and psychological health of quality of life were higher than those who lived together with their children, and their scores of social relationships and environmental domain were higher than other elderly people. Leading the old age with a partner (spouse) contributes positively to an organized and supportive life style and that is why sleep quality and quality of life of those living with their spouses is better than other elderly people. The sleep quality and quality of life of the elderly people without any physical disease were better than those who had more than two physical diseases and those who had heart diseases. Improvement of the quality of life and psycho-social
51
satisfaction of the elderly people is as important as increasing their physical health.32 Often, sleep problems of the elderly people occur secondarily to the present disease.8 It is detected that presence of physical disorders during old age contributes the occurrence of the sleep problems and as the number of the physical diseases increases among the population aged 65 so does the sleep problems.33 Wu et al. suggested that the elderly people who expressed their health status better had better sleep quality and that cardiovascular diseases, hypertension, skeletal muscular diseases, endocrine and metabolic diseases, physical problems with respiratory difficulty affected sleep quality negatively.27 Chronic diseases during old age cause the individuals to lead their lives dependently and decrease their quality of life.34–36 Sleep quality and quality of life of the elderly people with heart diseases were worse than other people who were diagnosed with other illnesses. Redeker and Robert detected that sleep quality was worse among the patients with heart diseases.37 It is emphasized that improvement of physical functions may be achieved by answering sleep needs of the elderly people.8
5.
Conclusions
Sleep quality decreases with old age and poor sleep quality affects quality of life negatively. Therefore, sleep quality and quality of life should continuously be assessed in the care of the elderly people and plans should be made in order to keep a good sleep quality and a better quality of sleep.
6.
Limitations of the research
The research was conducted with the community-living elderly people. Studies in which the correlation between sleep and quality of life of the elderly people selected according to certain clinical diagnosis is evaluated for a longer time and with repeated measurements may be designed.
Conflict of interest statement The author has declared no conflicts of interest.
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