The relationship between Happiness with Sleep quality and Self-care ability in community-dwelling older adults

doi:10.21203/rs.3.rs-4495754/v1

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Research Article

The relationship between Happiness with Sleep quality and Self-care ability in community-dwelling older adults

https://doi.org/10.21203/rs.3.rs-4495754/v1

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Background

Population aging is one of the challenges of the future, which requires large-scale planning. Examining happiness and its relationship with the quality of sleep and self-care is an aspect that has received less attention in old age. Therefore, this study aimed to determine the relationship between happiness with sleep quality and self-care ability in community-dwelling older adults.

Methods

This is a cross-sectional correlation descriptive research. We selected 306 eligible community-dwelling older adults by multistage sampling referring to comprehensive health service centers. The Oxford Happiness Inventory (OHI), Pittsburgh Sleep Quality Questionnaire (PSQI), and The Self-care Ability Scale for the Elderly (SASE) were used to collect data. Data were analyzed using SPSS v.27 software by Spearman test, univariate and multivariate regression.

Results

The findings showed that 58% of older adults were male, 67.6% were married, and 44% were retired. Multivariate logistic regression showed a significant relationship between self-care ability (β = -1.50, p < 0.001) and sleep quality (β = 0.50, p < 0.001) with happiness.

Conclusion

The level of happiness is directly affected by the self-care ability and sleep quality. Therefore, policymakers and planners should pay more attention to the importance of happiness and its relationship to sleep and self-care ability.

happiness

sleep quality

self-care

aged

The world population is rapidly becoming old, and the health of older adults has become one of the concerns in the countries. It is estimated that more than 33% of countries have entered the state of aged society, and this ratio will increase to 42.5% in 2050 [1]. Older adults face many challenges (such as increasing chronic diseases, loneliness, increasing dependence on others, retirement, unemployment, etc.), all of which can affect their physical and mental health [2–4]. Happiness is a psychological factor for healthy aging [5].

Happiness is a kind of personal evaluation of one's own life. This term can include satisfaction with life, positive mood, and the absence of depression and anxiety, as well as increasing the sense of the meaning of life, capabilities, and scope of our thinking [6]. Several researchers in their studies concluded that there is a significant relationship between the level of happiness and the quality of sleep of people [7–9]. Happiness has a direct relationship with mental health when it improves emotional conditions and moods, increasing life satisfaction and mental health; in addition to what we know about the relationship between mental health and sleep quality, It can refer to happiness is probably related to sleep quality. [7, 10].

Age-related changes in sleep include decreasing sleep quality and duration [11, 12]. According to the research conducted, about 60% of older adults have sleep disorders [13]. Many older adults are deprived of enough sleep, and this problem can lead to an increase in the risk of accidents and suffering from various physical and mental diseases [14, 15]. The quality and quantity of sleep affect human health, social relations, and well-being [11, 12]. One of the ways to prevent and manage physical and mental problems is self-care [16].

The self-care has similarities and differences with near concepts like self-management, self-regulation, self-efficacy, and self-monitoring [17]. The World Health Organization provided a comprehensive definition of self-care and declared that self-care goes beyond the practical capacities of a person and refers to the ability of individuals, families, and communities to maintain and promote health and prevent diseases; it also refers to dealing with illnesses and disabilities, with or without the support of health care providers and the help of professionals [18]. Self-care improves health and well-being, healthcare costs, and life satisfaction [19]. Self-care encompasses a wide range of areas like prevention, improving undesirable lifestyles, better acceptance and compliance with the treatment of diseases, prevention of secondary effects of physical and mental problems, and generally reducing the costs of medical services [19–22]. According to surveys conducted in different countries, on average, 40 to 60 percent of older adults who have a low level of self-care need the help of others to perform their daily activities [23–27]. The results of some studies indicated a significant correlation between the two variables of self-care and well-being [28, 29]. Some scientists have stated that happiness is synonymous with well-being, mental well-being, and psychological well-being [30].

If the relationship between self-care and sleep quality with happiness is confirmed, healthcare professionals can use programs to improve self-care and sleep quality to affect happiness. We could not find any study that assessed the relationship between the three discussed variables in the aged population. Therefore, due to the high importance of these issues, by conducting this research, in addition to providing information to reduce the material and non-material costs incurred by older adults, their caregivers, as well as the country's healthcare system, solutions to solve the existing problems in the field of study. Therefore, this study aimed to determine the relationship between happiness with sleep quality and self-care ability in community-dwelling older adults.

This study is descriptive-correlational research on community-dwelling older adults (above 60 years). We collected the list of all health centers affiliated with the Tehran University of Medical Sciences.

Participants

The sampling method was a multistage cluster type. First, we randomly chose several centers from all the healthcare centers on the list and then selected 306 older adults in each center (20% more than the sample size allocated to each center). We explained the objectives to the participants; if they wished, we invited them to cooperate by phone and obtained informed consent. Finally, we asked them to fill out informed consent and questionnaires self-report.

We calculated the sample size of 306 older adults (α = 0.05, β = 0.20, R² = 0.1). First, we calculated that 150 older people, taking into account 20% incompleteness of the data, the final sample size was equal to 188 people. The sample size was 306 people to increase the validity of the study.

The inclusion criteria include vision and hearing health (checking the health record and asking themselves), cognitive and psychological health (according to the health record), no known cancer or a history of severe heart failure or stroke. Exclusion criteria included unwillingness to cooperate and an incomplete questionnaire (there was no incomplete questionnaire).

Measurements

Demographic profiles include age, gender, marital status, education, and employment status.

Oxford Happiness Inventory (OHI): The Oxford Happiness Questionnaire (OHI) was also used to evaluate the level of happiness. This questionnaire has 29 questions. The theoretical basis of this questionnaire is Argyle and Crosland's definition of happiness. This questionnaire includes five components: life satisfaction, self-esteem, active well-being, self-satisfaction, and positive mood. Questionnaire questions are scored based on a four-point spectrum (from zero to 3) and measure the level of individual happiness. The highest score that the respondent can get from this questionnaire is 87, which represents the highest level of happiness, and the lowest score on this scale is zero, which confirms that the subject is unhappy with life and depressed. Argyle et al. obtained Cronbach's alpha coefficient of 0.90, and Farnham and Bruin obtained Cronbach's alpha coefficient of 0.87 with 101 samples [31]. The reliability of the Persian version inventory was 0.92 to 0.93 [32, 33]. Past studies confirmed the face and content validity of OHI in older adults; the reliability coefficient of the subscales was obtained in the range of 73 to 78% by calculating Cronbach's alpha [34].
Pittsburgh Sleep Quality Questionnaire (PSQI): The Pittsburgh Sleep Quality Questionnaire (PSQI) was used to check sleep status. This questionnaire was compiled by Bais et al. at the Pittsburgh Institute of Psychiatry. Their study showed that a score greater than five has a diagnostic sensitivity of 89.6 and a specificity of 86.5. Pittsburgh sleep quality questionnaire includes nine questions and seven components. The components include the subjective quality of sleep, sleep delay, sleep duration, sleep effectiveness, sleep disorders, use of sleep-inducing drugs, and inappropriate function. This questionnaire examines the quality of sleep in the last four weeks. The individual's score for each component is between 0 and 3, and the total scores of the components form the total score of the questionnaire. The range of scores is between 0 and 21, and a score higher than 6 indicates poor sleep quality. The score of the seven components of the Pittsburgh index has a reliability coefficient (Cronbach's alpha) equal to 0.83, which shows that each of the seven components measures a specific aspect of the overall structure of sleep quality [35, 36]. The Persian version of the questionnaire was prepared by Farahi Moghadam et al. and confirmed by Gholi Mazerji et al. Its Cronbach's alpha was 0.65 [37, 38].
The Self-care Ability Scale for the Elderly (SASE): The self-care ability questionnaire of older people (SASE) is also used to evaluate self-care ability [39]. Soderham and his colleagues designed SASE. SASE consists of 17 questions about daily life activities, well-being, mastery, determination, determination, loneliness, and dressing. The answer to each question is based on a Likert scale and is rated from 1 (strongly agree) to 5 (strongly disagree). The highest and lowest scores are 85 and 17. Cut of the point is 69 (< 69 indicates low self-care ability, > 69 indicates high self-care ability). The SASE dimensions include the ability to take care of personal responsibilities, the ability to take care of goals, and the ability to take care of health. Cronbach's alpha coefficient was 0.68 to 0.88 [40]. The Cronbach's alpha for the Chinese version was 0.89, the Italian version (0.72 to 0.90), Norwegian (0.85), Turkish (0.90 to 0.91), and the Persian version was 0.73 [41–44]. Tamizkar et al. (2019) also found 0.80 Cronbach's alpha coefficient in older people [27].

Statistical analysis

We checked the collected data to identify and remove unusual and outlier values. Statistical indices describe quantitative data such as frequency, frequency percentage, mean and standard deviation, median, and interquartile range. Also, demographic variables were described in the form of numbers and percentages. We use Spearman's correlation test to investigate the relationship between quantitative variables due to the non-normal distribution of the tested variables (Table 2). We analyzed data to evaluate the relationship of independent variables; self-care and sleep quality, on the dependent variable. A regression model was used to score people's happiness. First, the univariate logistic regression model was implemented to investigate the relationship of the mentioned independent variables on the dependent variable. Then multivariable logistic regression model to eliminate the effect of variables; Age, sex, education, and marriage were used as confounders on the effect value of each independent variable. The results are reported in the form of effect coefficient values and 95% confidence intervals. The level of significance was considered 0.05 in all the tests performed. SPSS v.27 was also used for data analysis.

The mean age of participants was 68 ± 7.2 years (range: 60 and 86 years). 58% of older people were male. The employment status of 44% of the participants was retired. 40% of older adults were literate. Table 1. shows full details of each of the demographic variables.

Table 1

Demographic characteristics of participants
Variables		F (%)
Marriage status	Single	32 (10.5)
	Married	207 (67.6)
	Divorced	12 (3.9)
	Widow	55 (18)
Occupation status	Unemployed	94 (30.7)
	Employed	77 (25.2)
	Retired	135 (44.1)
Education	Illiterate	15 (4.9)
	Primary	126 (41.2)
	High school	90 (29.4)
	Diploma	44 (14.4)
	University	31 (10.1)

The normality findings showed that happiness, sleep quality, and self-care ability did not have a normal distribution (Table 2). Therefore, Table 3 shows the median and interquartile range of happiness, sleep quality, and self-care ability.

Table 2

The results of the normality test of the variables
Variables	Shapiro-Wilk Test	Skewness	Kurtosis	P
Happiness	9.59	0.14	0.27	< 0.001
Sleep Quality	0.92	0.50	-0.40	< 0.001
self-care ability	1.12	-0.44	-0.67	< 0.001
Age	0.98	0.68	-0.57	< 0.001

Table 3

Descriptive statistics of the variables
Variables	Median (Interquartile range)	Min	Max
Happiness	33 (20.25)	4	84
Sleep Quality	7 (6)	0	19
self-care ability	65 (17)	36	83

Correlation between main variables and age

Table 4 shows the results of Spearman's correlation between age, happiness, sleep quality, and self-care ability. Based on these results, sleep quality had a significant correlation with the happiness score of people (r=-0.359; p < 0.001). A score higher than 6 indicates poor sleep quality. Also, the self-care score showed a positive and significant relationship with the happiness score (r = 0.289; p < 0.001). The older people's age has no significant correlation with other variables. Although the sleep quality variable showed a negative and weak relationship with the self-care score, this relationship was not statistically significant (r=-0.103; p = 0.07).

Table 4

Correlation between the happiness, sleep quality, self-care, and the age
Variables	Happiness	Sleep Quality	Self-care ability	Age
Happiness	1	-	-	-
Sleep Quality	-0.359^**	1	-	-
Self-care ability	0.289^**	-0.103	1	-
Age	0.110	0.067	0.017	1
** P < 0.001

The relationship between happiness with sleep quality and self-care ability

Table 5 reports the results of univariate and multivariate logistic regression models to investigate the relationship between sleep quality, self-care variables, and happiness. Based on the results of this table, the increase of each unit of the sleep quality score on average decreases the happiness score by 1.5 units, which effect can be seen even after controlling the confounding variables in the multivariate regression. On the other hand, the increase of each unit of the self-care score causes an average increase of 0.47 units in the happiness score. These effects reach 0.5 units with controls for the confounding variables.

Table 5

The relationship between happiness with sleep quality and self-care ability
Variables	Reg. Logistic Model	β	T	p	95% Confidence Interval
Sleep Quality	Univariate	-1.50	-6.7	< 0.001	-1.06 to -1.95
Sleep Quality	Multivariate^*	-1.52	-6.68	< 0.001	-1.06 to -1.95
Self-care ability	Univariate	0.47	5.21	< 0.001	0.29 to 0.65
Self-care ability	Multivariate	0.50	5.33	< 0.001	0.31 to 0.68
* Regression logistic model by controlling the effect of age, gender, education, and marriage on happiness

this study aimed to determine the relationship between happiness with sleep quality and self-care ability in community-dwelling older adults. The results showed that better sleep quality had a direct and positive relationship with the more favorable state of happiness of people; the increase of each unit of the sleep quality score decreases the value of the happiness score by 1.5 units. This relationship can be seen even after controlling confounding variables in multivariate regression. This result is in line with the results of the studies of Kerami et al., Wang et al., and Zhang et al. [7, 45, 46]. The studies of Badri et al. and Gyasi et al. also concluded that improving the state of sleep is related to improving the state of happiness of people [47, 48].

In addition, the results of the present study showed that the self-care score had a positive and significant relationship with the happiness score; so the increase of each unit of the self-care score on average caused an increase of 0.47 units in the happiness score, and this effect value reached 0.5 units after controlling the confounding variables. In this regard, Turk et al. assessed the relationship between self-care ability and happiness of 400 older people living in eastern Turkey and stated that there is a positive and significant relationship between happiness and self-care ability in older adults; therefore with the increase of each unit of the self-care score, an average of 0.67 units added to the happiness score [49]. In explaining these results, we could say that older people can do their daily activities independently and care for themselves alone, which can bring them satisfaction and happiness. Also, Uraki et al. concluded that with self-care training, older adults can live their lives with more hope and happiness in their study on 40 older people hospitalized in aged care centers [28]. In addition, the results are consistent with the findings of other studies; For example, in their intervention study to teach self-care topics to 60 patients undergoing coronary artery bypass grafting, Lebetut et al. found that self-care education for patients undergoing coronary artery surgery had a positive effect on their well-being and resilience. Therefore it is necessary to pay attention to such educational interventions for patients [50]. Thus, according to the available evidence, it can be said that performing self-care can lead to more happiness; And by nature, happy people also have a better quality of life [51].

Self-care is a set of behaviors that lead to maintaining a healthy balance and quality of life (e.g. personal hygiene and, a healthy and nutritious diet); Also, self-care can lead to health and well-being through emotional and cognitive growth, calming the mind, and maintaining self-awareness [52]. Self-care can lead to improved sleep [53]. It has been stated that good sleep can improve life satisfaction, positively affecting a person's evaluation of life [54]. On the contrary, sleep problems are related to depression disorders [55]. Depression is at the other end of the happiness spectrum, so the relationship between good sleep and happiness can be justified.

Limitations

The current study also has limitations: the type of cross-sectional study, from which causal inference is not possible, and the coronavirus epidemic, which led to a decrease in the quality and speed of collecting samples.

The findings indicated a significant positive relationship between happiness with self-care ability and sleep quality of older adults. Therefore, we recommend that the policymakers and planners of the health system consider the necessary educational interventions in line with the importance of happiness, sleep hygiene, and self-care ability of older people.

Tehran University of Medical Sciences (TUMS)

Oxford Happiness Inventory (OHI)

Pittsburgh Sleep Quality Questionnaire (PSQI)

The Self-care Ability Scale for the Elderly (SASE)

Acknowledgments

We sincerely thank and appreciate all the old participants who helped us with their utmost patience, sense of cooperation, and empathy during this research. In addition, we are grateful to the Students' Scientific Research Center of TUMS.

Author contributions

M.B., P.F.A., and F.Sh. were involved in the original conception and design of the study. K.K and M.S. data collection and statistical analysis. F.S. and P.F.A. prepared the initial. All authors read and approved the final manuscript.

Funding

A specific project grant does not fund this study.

Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical concerns but are available from the corresponding author upon reasonable request.

Ethical considerations

This study was confirmed by the Ethics Committee of Tehran University of Medical Sciences (Ref. code: IR.TUMS.SPH.REC.1401.300). We explained the objectives to the participants and obtained informed consent.

Consent for publication

Not applicable.

Competing interests

The authors have no financial and non-financial competing interests to disclose.

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No competing interests reported.

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The relationship between Happiness with Sleep quality and Self-care ability in community-dwelling older adults

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Abstract

Background

Methods

Results

Conclusion

Introduction

Methods

Participants

Measurements

Statistical analysis

Results

Correlation between main variables and age

The relationship between happiness with sleep quality and self-care ability

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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