Abstract
ObjectivesTo examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).DesignThis 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.SettingKuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.Participants1648 community-dwelling older Malaysians.ResultsThe 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.ConclusionThe 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.
Highlights
Elder abuse and neglect (EAN) is increasingly becoming a global health concern
Confirmatory factor analyses revealed that one factor Pittsburgh Sleep Quality Index (PSQI) scale with three components was most suitable
As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment
Summary
Elder abuse and neglect (EAN) is increasingly becoming a global health concern. There are five subtypes of elder abuse–physical, psychological, financial, sexual and neglect [2]. Numerous adverse effects of abuse in late life–across different health domains—have 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]. 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]
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