Associations Of Sleep Quality And Frailty Among Rural Elderly In Shandong Province

BackgroundThe aging of population is accelerating all over the world,and China is also facing the great challenge of aging population.In the process of rapid aging,frailty is becoming more and more prominent.Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors.Frailty can lead to negative health consequences,including falling,decreased activity,decreased independence and disability.Among the many factors affecting the frailty of the elderly,sleep disorder is one of the important factors.Studies have found that sleep disorders are closely related to frailty,and the elderly with sleep disorders are more prone to frailty.Activity of daily living(ADL)is an important index to measure the health status of the elderly.Studies have found the relationship between sleep quality and ADL and a relationship between ADL and frailty.Consequently,we speculate that ADL may play a mediating role in the relationship between sleep quality and frailty.Currently,most domestic research objects on the relationship between sleep quality and frailty are concentrated in elderly inpatients,elderly care institutions and urban communities.The research on rural elderly residents is still insufficient.Moreover,ADL in the relationship sleep quality and frailty in rural elderly is not clear.Therefore,it is of great significance to explore the relationship between sleep quality and frailty and the mechanism activity of daily living in rural elderly people.ObjectivesThe purpose of the study was to investigate the frailty state,the relationship between sleep quality and frailty and to examine the mediating effect of ADL on the relationship between sleep quality and frailty.It provided an effective theoretical basis for prevention and intervention of the frailty of the rural elderly,delaying the occurrence and progress of the frailty of the elderly and improving their quality of life.MethodsThis data came from the baseline survey of Shandong Province Rural Elderly Family Health Service Project in 2019.A total of 3243 rural older adults aged more than 60 years of were recruited from 3 cities(Dezhou Laoling,Jining Qufu,Weihai Rushan)between May and June 2019 in Shandong using multistage stratified cluster sampling method.The questionnaires were included a self-designed questionnaire,the Pittsburgh Sleep Quality Index(PSQI),Frailty Phenotype(FP)and Activity of Daily Living Scale(ADLS).Epidata software was used for data input,and SPSS 24.0 software was used for analysis of data.Descriptive statistical analysis was conducted for study variables,and frailty was analyzed by univariate analysis.Pearson correlation analysis was used to analyze the relationship between sleep quality,frailty and activity of daily living.The mediating effect of ADL was examined using SPSS 24.0 plugin,Process V3.3.ResultsThis study found that the frailty and pre-frailty rate of the rural elderly in Shandong Province were 17.8%and 64.7%,respectively.In terms of social demographic characteristics,the rural elderly with female,older age,lower education level and lower family income had higher scores of frailty than other elderly.In the characteristics of healthy life behavior,the frailty scores of the rural elderly with the habit of tea and taking regular physical exercise were lower,and the frailty scores of the elderly who had abstained from alcohol were higher.The rural elderly with BMI underweight or obesity,poor self-rated health status and a large number of chronic diseases had higher frailty scores,and the differences were statistically significant.There was a significant positive correlation between sleep quality and frailty(r=0.298,P<0.001).There was a significant positive correlation between sleep quality and ADL,(r=0.188,P<0.001)and ADL had a significant positive correlation with frailty(r=0.331,.P<0.001).The results of mediating effect analysis showed that the upper and lower limits of the Bootstrap95%CI of the mediating effect did not contain 0,indicating that sleep quality could not only directly affect the frailty,but also could affect the frailty through the mediating effect of ADL,and the mediating effect accounted for 16.77%of the total effectConclusion and SuggestionConclusion(1)Frailty in the rural elderly was an important issue and needed to be paid attention to by people;(2)There was a positive correlation between poorer sleep quality and frailty,that is,the worse sleep quality was,the higher frailty was;(3)ADL played a partial mediating role in the relationship between sleep quality and frailty of the rural elderly.We should pay attention to the sleep quality and ADL of the rural elderly to improve their frailty state.Suggestion(1)Pay attention to the sleep quality of the rural elderly,and actively carry out health education activities;(2)Pay attention to the frailty of rural elderly,attach importance to the pre-screening intervention of the frailty,and actively carry out help;(3)Government will establish and improve the rural medical service security system,and give financial tilt to rural medical services.