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      Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians

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          Abstract

          Objectives

          To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).

          Design

          This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome.

          Setting

          Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.

          Participants

          1648 community-dwelling older Malaysians.

          Results

          The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep.

          Conclusion

          The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

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          Most cited references47

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          Self-reported and measured sleep duration: how similar are they?

          Recent epidemiologic studies have found that self-reported duration of sleep is associated with obesity, diabetes, hypertension, and mortality. The extent to which self reports of sleep duration are similar to objective measures and whether individual characteristics influence the degree of similarity are not known. Eligible participants at the Chicago site of the Coronary Artery Risk Development in Young Adults Study were invited to participate in a 2003-2005 ancillary sleep study; 82% (n = 669) agreed. Sleep measurements collected in 2 waves included 3 days each of wrist actigraphy, a sleep log, and questions about usual sleep duration. We estimate the average difference and correlation between subjectively and objectively measured sleep by using errors-in-variables regression models. Average measured sleep was 6 hours, whereas the average from subjective reports was 6.8 hours. Subjective reports increased on average by 34 minutes for each additional hour of measured sleep. Overall, the correlation between reported and measured sleep duration was 0.47. Our model suggests that persons sleeping 5 hours over-reported their sleep duration by 1.2 hours, and those sleeping 7 hours over-reported by 0.4 hours. The correlations and average differences between self-reports and measured sleep varied by health, sociodemographic, and sleep characteristics. In a population-based sample of middle-aged adults, subjective reports of habitual sleep are moderately correlated with actigraph-measured sleep, but are biased by systematic over-reporting. The true associations between sleep duration and health may differ from previously reported associations between self-reported sleep and health.
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            Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.

            To assess the association between sleep problems and chronic disease in older adults. Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.
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              Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample.

              1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were associated with distinct demographic, clinical, and sleep characteristics. The PSQI, ESS, clinical rating scales, sleep diaries, actigraphy, and home polysomnography were collected from 187 community-dwelling adults (mean age 59.5 years, 47.1% women, 41.2% African Americans) as part of a study investigating novel cardiovascular risk factors. Correlations, cluster analysis, principal components analysis, MANOVA, ANOVA, and regressions were used to characterize the relationships between the PSQI, ESS, and other study variables Mean PSQI score was 6.3 (3.4), and mean ESS score was 8.2 (3.9). PSQI and ESS correlated weakly with each other (r = 0.16, p = 0.03), but segregated from each other on principal components analysis. Groups of participants categorized by either cluster analysis of PSQI and ESS scores, or by scores above or below traditional cut-off values, differed from each other on psychological/stress symptoms and quantitative and qualitative sleep diary measures, but not on actigraphic or polysomnographic measures. Specifically, higher PSQI scores were associated with female sex, greater psychological distress, and greater sleep disturbance on sleep diaries. The PSQI and ESS measure orthogonal dimensions of sleep-wake symptoms, but neither is related to objective sleep measures. The PSQI is more closely related to psychological symptom ratings and sleep diary measures than the ESS. These instruments are not likely to be useful as screening measures for polysomnographic sleep abnormalities.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: ValidationRole: Writing – original draft
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: Resources
                Role: Data curationRole: InvestigationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Resources
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 July 2017
                2017
                : 12
                : 7
                : e0180222
                Affiliations
                [1 ]Julius Centre University of Malaya (JCUM), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur
                [2 ]Department of Population Health and Preventive Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor
                [3 ]Negeri Sembilan State Health Department (JKNNS), Negeri Sembilan, Malaysia
                Universidade Federal do Rio de Janeiro, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-2129-6352
                Article
                PONE-D-17-12689
                10.1371/journal.pone.0180222
                5501458
                28686603
                ef9d94f5-b8fc-4993-9161-c03d15f014fc
                © 2017 Yunus et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 April 2017
                : 12 June 2017
                Page count
                Figures: 2, Tables: 3, Pages: 14
                Funding
                Funded by: University of Malaya Grand Challenge Programme: Preventing Elder Abuse and negleCt initiativE (PEACE)
                Award ID: GC 001D -14HTM
                Award Recipient :
                Funded by: Ministry of Higher Education High Impact Research Grant (STeMM)
                Award ID: E000010-20001
                This study was funded by the University of Malaya Grand Challenge on Preventing Elder Abuse and Neglect Initiative (PEACE) (GC001D-14 HTM) and Postgraduate Research Grant (PG104-2014A). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Sleep
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Sleep
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                People and places
                Population groupings
                Ethnicities
                Ethnic Malays
                Social Sciences
                Economics
                Finance
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Biology and Life Sciences
                Neuroscience
                Cognitive Neuroscience
                Cognitive Neurology
                Cognitive Impairment
                Medicine and Health Sciences
                Neurology
                Cognitive Neurology
                Cognitive Impairment
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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