Sleep Quality among the Elderly in 21st Century Shandong Province, China: A Ten-Year Comparative Study

Abstract

Background: Despite the enormous changes observed in China since entering the 21st century, little is known about changes in sleep quality among older adults. Aims: The purpose of this study is to explore the changes, features, and influence factors of sleep quality among the elderly in a ten-year period, providing evidence for sleep-quality enhancement. Methods: The data were obtained from the data of epidemiological sampling surveys on mental disorders in Shandong province in 2004 and 2015. A total of 4451 subjects (aged ≥ 60 years) in 2004 and 10,894 subjects (aged ≥ 60 years) in 2015 were selected by the multistage stratified sampling method. The demographic information and Pittsburgh Sleep Quality Index (PSQI) were collected. Results: The adjusted 1-month prevalence of poor sleep in 2015 was 22.5% (95%CI:21.7–23.3), which is lower than that in 2004 (24.8%) (95%CI:23.5–26.0, p = 0.002). The total score of the PSQI in 2015 (4.74 ± 3.96) was lower than that in 2004 (4.97 ± 4.18, p = 0.002). In 2015, a binary multi-factor logistic and stepwise regression analysis showed that being female, living in a rural area, living alone, being older, spending less years in school, and being jobless/unemployed made the participants more likely to develop poor sleep (p < 0.05, p < 0.01). Conclusions: In 2015, the overall sleep quality of the elderly (aged ≥ 60) in Shandong province was significantly improved compared to 2004. After more than 10 years, the characteristics of the elderly with sleep disturbances in Shandong province has changed. Therefore, more attention should be paid to gender, location of residence (rural or urban), living arrangement, age, education, occupation, and other factors to improve the sleep quality of the elderly.

The relationship between childhood adversity and sleep quality among rural older adults in China: the mediating role of anxiety and negative coping

“…Second, differences in sleep quality among older adults with different educational levels may be due to the fact that well-educated older adults have a higher sense of wellness and are more likely to access healthcare knowledge, which in turn leads to a better sleep state [ 57 ]. Third, the poorer sleep quality in widowed older adults and those living alone than in others may be related to loneliness and lack of social support leading to mood disorders, which in turn may cause reduced sleep efficiency and quality [ 58 ]. Finally, having a chronic disease is also a risk factor for poor sleep quality in older adults, which may be related to the physical discomfort caused by chronic diseases, the side effects of medications, and the associated financial pressure and psychological burden [ 59 ].…”

“…Early life experiences, such as abuse, poverty, or the death of a parent, can affect sleep not only in childhood and adolescence but also in adulthood [ 60 , 61 ]. Childhood is an important phase for significant development of the hypothalamic-pituitary-adrenal (HPA) axis and the brain [ 58 ], and adverse events experienced during childhood can lead to long-term changes in the HPA axis response to stress (e.g., hyperactivity) and interfere with normal neurodevelopment in childhood and adolescence [ 62 ], increasing the risk of developing psychiatric disorders such as depression and post-traumatic stress disorder, which indirectly affect sleep in adulthood [ 63 ]. In addition, people exposed to ACEs are more likely to adopt unhealthy lifestyles and behaviors [ 64 , 65 ], and these changes may directly affect the sleep-wake cycle and lead to sleep problems.…”

The left temporal transverse cortex is affected by poor sleep quality, which in turn contributes to depressive symptoms in older adults

“…Examining the elements that have an effect on sleep quality will assist us in formulating more effective preventive strategies, and prior research has uncovered a variety of elements that may lead to inadequate sleep quality, such as diabetes [ 4 ], menopausal syndrome [ 5 ], vitamin D deficiency [ 6 ], overweight/obese [ 7 ], not being married, having a low personal income [ 8 ], being female and living in a rural area [ 9 ]. In addition, some articles also pointed that mental health disorders could predict decreased sleep quality.…”