Characterization and factors associated with sleep quality among rural elderly in China
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.
Section snippets
Subjects
In our study, subjects were selected through a two-stage random sampling process. First, 3 of the 16 districts of Anhui Province, a large province in mid-east China, were randomly selected. Twenty villages were then randomly selected from each participating district using the stratified-cluster random sampling method. A total of 2700 subjects (aged ≥60) were sampled from these areas during the period of 2009–2010. Questionnaire-based face-to-face interviews were conducted and 2416 subjects
General data
Table 1 shows the demographic information of the participants. A total of 2416 rural elderly were interviewed in this survey, of whom 1169 (48.4%) were male and 1247 (51.6%) were female. The participants’ ages ranged from 60 to 98 years, with a mean of 68.44 ± 7.01 years. Among the participants, 67.4% were married and 74.0% were living with family members or others. A majority of the participants had received at most a primary school education (91.3%). In terms of economic status, 75.7% of the
Discussion
Nearly half of the participants in this study reported poor sleep quality, which suggests that poor sleep should be considered an important public health concern for this population. To further characterize whether age and BMI have any effects on sleep quality, we observed that age interfered with the sleep quality of this population. We also ascertained that the factors influencing sleep quality include chronic disease, ADL, type and quantity of staple food, PCS, and MCS. Therefore, three main
Conclusion
Relatively few studies have been conducted on sleep quality among the Chinese elderly. Hence, this work enriches the understanding of sleep quality in China. Our findings revealed that nearly half of the Chinese rural elderly suffer from poor sleep quality, and that the influencing factors involved include age, physical and mental health, and nutrition. These factors can be addressed by providing comprehensive interventions. Despite the limitations of this study, it is still an important step
Conflict of interest statement
None.
Acknowledgements
The authors would like to thank the physicians at Wannan Medical College and Anhui Medical University for the support of the study. In addition, the authors would like to thank the rural elderly who responded to the health survey and the employees of the Anhui Medical University who participated in the research. This study was supported by Grants for Scientific Research from Anhui Medical University.
References (39)
Sleep and its disorders in aging populations
Sleep Medicine
(2009)- et al.
Nocturia and disturbed sleep in the elderly
Sleep Medicine
(2009) - et al.
The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research
Psychiatry Research
(1989) - et al.
Association between number of comorbid conditions, depression, and sleep quality using the Pittsburgh Sleep Quality Index: Results from a population-based survey
Sleep Medicine
(2010) - et al.
The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population
Journal of Clinical Epidemiology
(2005) - et al.
Anxiety symptoms and objectively measured sleep quality in older women
American Journal of Geriatric Psychiatry
(2009) - et al.
Factors associated with poor sleep and health-related quality of life
Medicina (Kaunas)
(2008) - et al.
Impact of obstructive sleep apnea on cognitive performance
Arquivos de Neuro-Psiquiatria
(2011) - et al.
Benzodiazepine use and quality of sleep in the community-dwelling elderly population
Aging and Mental Health
(2010) - et al.
Research about the sleep disorder and influencing factors of the aged among 22 provinces
Journal of North China Coal Medical College
(2006)
Sleep problems and social support: Frailty in a Brazilian Elderly Multicenter study
Revista Latino-Americana de Enfermagem
Sleep and sleep disorders in older adults
Neuropsychology Review
Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer
Oncology Nursing Forum
Sleep quality of older adults in nursing homes in Turkey: enhancing the quality of sleep improves quality of life
Journal of Gerontological Nursing
Short sleep duration is associated with increased obesity markers in European adolescents: Effect of physical activity and dietary habits. The HELENA study
International Journal of Obesity (London)
Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson's disease
Journal of Neurology
Cardiovascular disorders associated with obstructive sleep apnea
Advances in Cardiology
Quality of sleep in patients with chronic low back pain: A case-control study
European Spine Journal
Psychosocial correlates of aspects of sleep quality in community-dwelling Irish older adults
Aging and Mental Health
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These authors contributed equally to this work.