养老机构老年人睡眠轨迹及其预测因素研究

Trajectories and predicting factors of sleep among the elderly in nursing homes

目的:调查养老机构老年人睡眠的异质性轨迹并分析其预测因素。方法:通过阿森斯睡眠量表、广泛性焦虑量表简版、患者健康问卷、主诉疼痛分级法、社会网络量表、社会活动参与问卷等对353名养老机构老年人进行调查,并于首次调查后6个月、12个月时随访老年人睡眠状况。采用潜类别增长分析拟合老年人的睡眠轨迹。结果:对完成至少两次调查的277名老年人拟合出4条睡眠轨迹,分别为睡眠良好组(78.0%)、失眠加重组(9.0%)、失眠改善组(7.9%)、持续严重失眠组(5.1%);Logistic回归分析显示,年龄、抑郁、疼痛、活动参与及社会网络是失眠加重轨迹的预测因素。结论:养老机构老年人的睡眠存在异质性,年龄越大、抑郁程度越高、活动参与度越低、疼痛感越强的老年人越有可能出现失眠加重的趋势,社会网络越差的老年人越偏向于持续严重失眠。护理人员应识别养老机构中不同睡眠轨迹的老年人,采取科学有效的靶向干预措施改善其睡眠状况,提高其生活质量。

Objective:To explore the heterogeneous trajectories and the predicting factors of sleep among the elderly in nursing homes.Methods:A total of 353 elders from 27 nursing homes were surveyed using the Athens Insomnia Scale,Generalized Anxiety Disorder Scale,9-item Patient Health Questionnaire,Verbal Rating Scale for pain,Lubben Social Network Scale and Activity Participation Questionnaire at baseline and after 6 months and 12 months during the follow-up period.The sleep trajectories of the elderly were explored by Latent Class Growth Analysis.Results:A total of 277 participants completed at least two surveys and the data was included in the analysis.Four sleep trajectories were identified:good sleep(78.0%),insomnia and deteriorated(9.0%),insomnia but improved(7.9%)and maintaining severe insomnia(5.1%);the results of Logistic regression analysis showed that age,depression,pain,activity participation and social network could predict sleep trajectories.Conclusion:The heterogeneous trajectories existed in the sleep of elders in nursing homes.Those who were older,more depressed,with lower activity participation and with more serious pain,were more likely to worsening their insomnia.Participants with less social network tended to suffer maintaining more severe insomnia.It is necessary to identify different sleep trajectories among the elders in nursing homes,and effective targeted interventions should be taken to improve their sleep status and the quality of life.