The relationship between sleep quality, inappropriate medication use and frailty among older adults in aged care homes in Malaysia

Abstract

Poor sleep quality is prevalent among older adults and is compounded by frailty and polypharmacy. This descriptive, cross-sectional study examines the associations between sleep quality, inappropriate medication use and frailty. The study was conducted among 151 residents of 11 aged care homes in three states in Malaysia; convenience sampling was used. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and Groningen Frailty Indicator (GFI) was used to assess frailty. Medication appropriateness was assessed using Drug burden Index (DBI), Potentially Inappropriate Medications (PIMs) and Potentially Inappropriate Prescriptions (PIPs). Most of the subjects (approximately 95%) reported poor sleep quality, as measured by a cut-off of global PSQI score of ≥ 5. With a second cut-off at 10, just over half (56%) reported moderately poor sleep quality followed by 39% who had very poor sleep quality. Most (90%) denied taking medication to improve their sleep during the previous month. There was no statistically significant association between medication inappropriateness (PIMs, PIPs, DBI) and global PSQI score. However, the average number of PIM was associated significantly with sleep efficiency (a measure of the actual ‘sleep to total time spent in bed) (p = 0.037). The average number of PIP was associated with subjective sleep quality (p = 0.045) and the use of sleep medications (p = 0.001), and inversely associated with sleep disturbance (0.049). Furthermore, frailty correlated significantly with poor overall sleep quality (p = 0.032). Findings support the need for medication review to identify and reduce PIMs and optimise prescriptions to improve sleep quality and hence, related health outcomes among residents of aged care homes.

Sleep quality and its predictors among waiters in upscale restaurants: A descriptive study in the Accra Metropolis

“…It is likely that due to the home chores and family responsibilities sometimes female waiters perform such as preparing family meal and caring for children, they may be experiencing early sleep time and waking up and longer sleep latency [ 49 ]. Our finding where non-prescription drug use predicted quality of sleep among the waiters elucidates the view that use of non-prescribed drug may affect sleep and subsequently reduce the health-related quality of life [ 50 ]. This could possibly be that these non-prescription drugs were self-medicated to treat sleep problems or body aches from stress associated with waiting work [ 51 ].…”

“…and longer sleep latency [49]. Our finding where non-prescription drug use predicted quality of sleep among the waiters elucidates the view that use of non-prescribed drug may affect sleep and subsequently reduce the health-related quality of life [50]. This could possibly be that these non-prescription drugs were self-medicated to treat sleep problems or body aches from stress associated with waiting work [51].…”

Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress

“…One potential mechanism was psychological disorder explained how sleep quality impact frailty was through inadequate activity. Previous literatures suggested that poor sleep quality would result in depression and decreased physical activity, increasing the risk of negative health conditions [ 52 , 53 ]. In particular, a longitudinal study suggested that long sleepers were characterized with inadequate activity and muscle strength, and slow walking speed which contributing to frailty [ 54 ].…”

Prevalence of Drug-Related Problems and Complementary and Alternative Medicine Use in Malaysia: A Systematic Review and Meta-Analysis of 37,249 Older Adults

“…The 27 studies included in the systematic review represented a pool of 37,249 patients, 29,342 of whom were further included in the meta-analysis. Fourteen studies were conducted in the Central region of Malaysia [6,13,[16][17][18][19][20][21][22][23][24][25][26][27], three in the Northern [14,28,29] and Eastern Regions each [11,30,31], and one in Borneo [15]. Three of them were nationwide studies [32][33][34], while the remaining three studies did not specify the participants' regions [35][36][37].…”