The Relationship Between Sleep Quality,Depression And Frail Among Elderly Patients With Type 2 Diabetes Mellitus

Objective: The purpose of this study was to investigate the status and influencing factors of sleep quality,depression and frailty in elderly patients with type 2 diabetes mellitus(Type2 Diabetes Mellitus,T2DM),and to explore the relationship between sleep quality,depression and weakness in elderly patients with T2 DM,so as to provide reference basis for nurses to help patients improve sleep quality,reduce depressive symptoms and delay weakness.Methods: In this study,a total of 411 T2 DM patients in endocrinology departments of 2Grade-III Class A general hospitals in Wuhu,Anhui Province were selected as subjects from May to October 2021 by cluster sampling method.General information questionnaire,Pittsburg Sleep Quality Index Scale(PSQI),the Center for Epidemiologic Studies Depression Scale(CES-D),and FRAIL scale were used for questionnaire survey.The collected data are entered into SPSS25.0 statistical software,and Descriptive analysis,anova,t test,Pearson correlation analysis and multiple linear regression analysis were used to analyze the data;AMOS21.0 software was used to build structural equation model,and Bootstrap method was used for further test.Results:(1)The score of PSQI,CES-D and frailty in elderly patients with T2 DM were(7.36±4.49),(12.41±9.17)and(2.76±1.72),respectively.(2)There were statistically significant differences in sleep quality and depression among different genders,education level,monthly income per capita,and social activities(P < 0.05).There were significant differences in frailty among different genders,different per capita monthly,different ages,income and different educational levels(P < 0.05).(3)The total score and seven dimensions of PSQI in elderly T2 DM patients were positively correlated with the total score of the frailty scale and the two dimensions,respectively(r=0.140 ～ 0.539,P < 0.01).It was positively correlated with the total score and four dimensions of CES-D(r=0.188 ～0.640,P < 0.01),and the total score of CES-D and four dimensions and two dimensions of the frailty scale in elderly patients with T2 DM were positively correlated(r=0.152 ～0.471,P < 0.01).(4)The results of simple linear regression analysis showed that sleep quality had a predictive effect on frailty and depression(frailty: β= 0.518,t=12.078,P <0.001;depression: β= 0.625,t=15.943,P < 0.001).The results of multiple linear regression analysis showed that sleep quality and depression had predictive effects on frailty(sleep quality: β= 0.389,t=7.085,P < 0.001;depression: β= 0.177,t=3.270,P=0.001).(5)The results of structural equation model showed that the direct effects of sleep quality on frailty and depression were 0.411 and 0.751 respectively,the direct effects of depression on frailty were 0.253,and the indirect effects of sleep quality on frailty were 0.190,accounting for 31.6% of the total effects(0.190/0.602).Conclusion:(1)The elderly T2 DM patients had poor overall sleep status,and the detection rate of depression and frailty was high.(2)Sleep quality was significantly positively correlated with depression and frail.And sleep quality was significant predict factor of depression,in addition,sleep quality,depression significant predict factors of frail.(3)Sleep quality plays an indirect effect on frail by the mediating effect of depression among the elderly patients with T2 DM.