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

PLOS ONE, Dec 2019

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

July Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians Raudah Mohd Yunus 0 1 Syeda Wasfeea Wazid 0 1 Noran N. Hairi 0 1 Wan Yuen Choo 0 1 Farizah M. Hairi 0 1 Rajini Sooryanarayana 0 1 Sharifah N. Ahmad 0 Inayah A. Razak 0 Devi Peramalah 0 1 Suriyati A. Aziz 0 Zaiton L. Mohamad 0 Rosmala Mohamad 0 Zainudin M. Ali 0 Awang B. Awang Mahmud 0 1 0 Editor: Jerson Laks , Universidade Federal do Rio de Janeiro , BRAZIL 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 ☯ These authors contributed equally to this work; * raudah; yunus@gmail; com - OPEN ACCESS Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: 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 (PG1042014A). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Objectives Design Setting Results Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia. Participants 1648 community-dwelling older Malaysians. 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 ªno abuseº, ª1 type of abuseº and ª2 types or Competing interests: The authors have declared that no competing interests exist. moreº. 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. Introduction Elder abuse and neglect (EAN) is increasingly becoming a global health concern. The World Health Organization (WHO) has defined EAN as `a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person'[ 1 ]. There are five subtypes of elder abuse±physical, psychological, financial, sexual and neglect [ 2 ]. Worldwide prevalence of EAN was estimated at 3.2% to 27.5% [ 3 ]. In Malaysia, one study reported a 12-month prevalence of 9.6% among urban elders [ 4 ] while another reported a lifetime prevalence of 8.1% among those in the rural area [ 5 ]. Numerous adverse effects of abuse in late life±across different health domainsÐhave been documented. These include premature mortality [ 6, 7 ], depression [8], increased utilization of health services [ 9, 10 ], metabolic syndrome [11], musculoskeletal pain, suicidal ideation, anxiety, incontinence and gastro-intestinal symptoms [ 12 ]. Nevertheless, many health-related outcomes of EAN remain unexplored. A conceptual framework by Anetzberger on the health effects of elder abuse has categorized them as physical, psychological, behavioural and social [ 13 ]. Quality sleep is one of the key determinants of good health. Its importance is more prominent among older adults, as sleep disorders and sleeping difficulties become more pervasive with aging [ 14 ]. Poor sleep has been found not only to predict mortality [ 15, 16 ] and nursing home placement among older individuals [16], but it was also associated with obesity [ 17 ], cognitive decline [ 18 ] and diabetes [ 19 ]. Despite this, the relationship between abuse experience in late life and sleep quality has not been adequately explored. Olofsson et al reported that older Swedish victims of physical and psychological abuse were more likely to experience sleeping problems than those who were not abused [ 12 ]. Other than this, there has been no investigation to corroborate this finding and whether or not it is replicable across different populations remains a question. The (...truncated)


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Raudah Mohd Yunus, Syeda Wasfeea Wazid, Noran N. Hairi, Wan Yuen Choo, Farizah M. Hairi, Rajini Sooryanarayana, Sharifah N. Ahmad, Inayah A. Razak, Devi Peramalah, Suriyati A. Aziz, Zaiton L. Mohamad, Rosmala Mohamad, Zainudin M. Ali, Awang B. Awang Mahmud. Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians, PLOS ONE, 2017, Volume 12, Issue 7, DOI: 10.1371/journal.pone.0180222