Characterization and factors associated with sleep quality among rural elderly in China

Abstract

This article elucidates on sleep quality characterization and its associated factors among the Chinese elderly in the rural areas of Anhui province. We conducted a questionnaire survey on 2700 elderly individuals, from whom we obtained 2416 valid responses. The sleep quality, health-related quality of life (HRQoL), and functional status of the subjects were assessed using the Pittsburgh Sleep Quality Index (PSQI), Short Form-36 (SF-36), and Activities of Daily Living (ADL) scales. Body Mass Index (BMI) was obtained by measuring the height and weight of the subjects. The results showed that 49.7% of the participants slept poorly. Binary logistic regression analysis indicated that chronic disease, advanced age, low quantities of staple food (g), rice as major food, poor Physical Component Summary (PCS), poor Mental Component Summary (MCS), and significant dysfunction of ADL were predictors for poor sleep quality. However, no association was found between BMI and sleep quality. As half of the rural elderly in China were found to suffer from poor sleep quality, comprehensive measures should be undertaken to improve this situation.

Introduction

Population aging has been a global concern since the late 20th century, and China is no exception. According to the Sixth Census data taken in 2010, 178 million Chinese are aged 60 or over, accounting for 13.26% of the total population. This number represents a 2.93% increase from the year 2000 (China National Census, 2011). As population aging continues, social economy and public health are faced with great challenges. One of these challenges facing the aging population in particular is poor sleep quality.

Sleep is a vital physiological process with important restorative functions (Crowley, 2011). However, significant quantitative and qualitative sleep-related changes occur as we age. In fact, Eser, Khorshid, and Cinar (2007) observed that 60.9% of the older people slept poorly. Chen, Yue, and Li (2006) also found that 49.9% of the elderly Chinese slept poorly. Several studies have demonstrated that sleep problems may lead to substantially impaired health, cognitive decline, and reduced quality of life (Bawden et al., 2011, Gómez-Esteban et al., 2011). Thus, the sleep problems of the elderly are an important matter.

Poor sleep is caused by a variety of factors. Physical illness has been associated with sleep quality. Several studies have found that elderly individuals with chronic diseases are more likely to sleep poorly (Lurie, 2011, Marty et al., 2008). Recently, the influence of psychological factors on sleep quality has attracted considerable research interest. Spira, Stone, Beaudreau, Ancoli-Israel, and Yaffe (2009) suggested that elevated anxiety symptoms were independently associated with poor sleep. Paudel et al. (2008) found that depressive symptoms had a strong, graded association with subjective sleep disturbances. Social factors have been associated with sleep problems as well. Costa, Ceolim, and Neri (2011) noted that the elderly individuals who had reported having sleep problems received lower levels of social support than those that did not report such problems. In addition, life-style and nutrition also affect sleep problems. However, the associations between sleep problems and age and BMI remain unknown.

China is a distinct developing country. Its rural areas have larger aging populations than its cities, possibly a result of rapid urbanization and large-scale migration of younger adults to urban areas. This mass departure of young labor force has left many rural elderly with the burdens of heavy agricultural work and looking after grandchildren left behind by sons and daughters who have migrated to the city. These elderly left behind in rural villages may also experience loneliness and other negative emotions because of separation from their loved ones. Underdeveloped economies and failed heath care coverage may also contribute to various diseases and sleep disturbance among the elderly in rural areas. However, the sleep complaints of members of this demographic have been largely neglected or overlooked.

Most studies on sleep quality have focused on children, adolescents, and patients (Enderlin et al., 2011, Mesquita and Reimão, 2010, Paavonen et al., 2009). Thus, there is a lack of epidemiological studies on the rural elderly in China. In this study, we aimed to fill this knowledge gap. This cross-sectional study aimed to describe the sleep quality of the rural elderly from different socio-demographic statuses. We also examined the associations between sleep quality and age and BMI, as well as the influence of several factors on sleep quality.