Sleep Status of People in Nursing Home and Related Factors

Background: Sleeping problems in the elderly are an important health problem in the growing elderly population and an important public health problem that needs to be solved in order to improve the quality of life and improve health conditions. Aim: Investigation of sleep status and related factors in the elderly residing in nursing homes. Methodology: In this cross-sectional study, 124 elderly individuals were taken. The research data were collected using an introductory information form. Number, percentage distributions, mean, standard deviation, t test and oneway variance analysis were used in the analysis of the data. Results: 50.8% of the elderly participated in the survey, 44.4% are in the 71 to 80 age group, 30.6% are not illiterate, 81.5% have at least one chronic illness, of the patients are hypertension. It was determined that 58.1% of the elderly individuals had a sleeping problem, 60.5% slept for 1 to 5 hours a day, 65.3% slept during daytime and 63.7% did not feel rested after waking up. Conclusions: The vast majority of elderly people living in nursing homes are experiencing sleep problems. It is important for elderly people to be educated and counseled in order to solve the sleeping problem and for the elderly people to be aware of the behaviors that may cause sleeping problems to prevent/reduce the sleeping problem.


Introduction
Sleeping problems in the elderly are an important health problem in the growing elderly population and an important public health problem that needs to be solved in order to improve the quality of life and improve health conditions. Senile; It is a period when physical and mental problems arise. Sleep, which is important for life together with loss of function that occurs in all organs and systems, is also affected by the aging process [1]. When sleep disorder is not treated; Daytime drowsiness, fatigue, irritability, increased pain sensitivity, muscle tremors, decreased mental function, anxiety, depression, general health and functional impairment. This may lead to decreased quality of life and increased mortality in elderly individuals [2].
It has been reported that 30% to 60% of the prevalence of sleep disorders is in studies conducted [3,4]. It is not known whether the sleep disturbances seen in the elderly are due to individual differences or aging process. Epidemiological studies indicate that sleep disturbances increase with age and that elderly individuals living in institutions have more sleep disturbances than older elderly people, up to 65% [5][6][7].
An important point of the insomnia problem in the elderly population is the changes in lifestyle. Reduced physical activity leads to homeostatic factors not being sufficient, at least the basic element for sleep. Evaluation of the elderly person in terms of sleep and the identification of interchangeable risk factors is the most basic approach in preventing sleep problems. Having the opportunity to observe the elderly individual and the environment they live in, the health care provider has the opportunity to recognize the risks that may cause the sleeping problem in the elderly and to take the necessary precautions. One of the most important protective measures for the sleep problem is to determine the physiological changes that occur due to age and cause insomnia and take the necessary precautions.
In this context, the health care workers assessing elderly individuals, especially the elderly person's mobility and avoidance from behaviors that may cause insomnia, will be able to identify current and potential risks and take necessary precautions to provide training and counseling for them.

Methods
The data of this cross-sectional study were obtained from aged residents living in a public nursing home in Ankara City Center between March-June 2015. A total of 220 elderly individuals are living in the nursing home and all of the 124 elderly individuals who are dependent on the bed, demented persons (the institutional health records and the doctors of the institution are taken into consideration) and/the sample was not selected. In order to be able to work, permission was obtained from elderly individuals by informing the institution from which the research was conducted and the purpose of the work. The research data were collected by face-to-face interviewing with the participants taking volunteer-based considerations into account. The research data consist of 28 questions developed by the

Journal of Gerontology & Geriatric Research
researchers; Data collection form that questions the demographic information, health status, social activity and social relations of elderly individuals.
Statistical package for social sciences (SPSS) 20.0 software was used for statistical analyses. Descriptive statistics, t-test were used in the analysis of the data. Statistical significance was accepted as p<0.05.
Inclusion criteria: in this study were included the elderly communicable individuals without neurological disorders, dementia, and bed dependent.
Exclusion criteria: The elderly individuals who have neurological disorders, dementia, bed dependent, and noncommunicable were not included in the study.  62.3% of the elderly are physical and 62.6% of them have good mental health. A little more than half of the elderly (52.9%) expressed satisfaction with their life, and 75% stated that they usually did not perform regular physical regular activities during the day (Table 1).
It was found that 60.5% of the elderly individuals who participated in the study did sleep 1 to 5 hours, 65.3% were not sleeping during daytime, 62.1% had difficulty sleeping, 58.1% had sleep problems, 63.7% she said she did not feel rested after she woke up (  It was found that 65.3% were not sleeping during daytime, 62.1% had difficulty sleeping, 58.1% had sleep problems, 63.7% She said she did not feel rested after she woke up (Figure 1). A statistically significant difference was found between the average scores of sleep characteristics according to life satisfaction of elderly people living in nursing homes (p<0.05) ( Table 3).

Discussion
Sleeping problems in the elderly can be caused by age-related problems and the physical characteristics of the living environment.
Elderly living with sleep problems for any reason; Social isolation and depression. 50.8% of the elderly participated in the study, 44.4% in the age group of 71-80, when their socio demographic characteristics are examined; It is expected that the education level of the elderly will be low if the average age of the elderly is (77 ± 8.2), 30.6% is not literate, and the value determined by the average age of the elderly (77 ± 8.2). The elderly people stated that 63.7% of them passed their pension, 70.2% said they had social security. The continuing lives of the elderly individuals, who are increasing day by day in our country and our country, and their increasing social and economic standards depend on serious monetary costs. The vast majority of the elderly has any health insurance; Depending on their working life, they may be included in a social security institution and in any case, such a situation can be considered as a great opportunity in terms of elderly health services and free medication. 81.5% of the elderly people are chronic diseases, 85.3% of them use continuous medication and 45.7% of them use 6 or more medicines.
As a result of Tokem's work; 5.3% of the elderly were treated with one drug, 21.1% with two drugs, 26.3% with three drugs and 10.5% with five drugs [8]. As a result of his work in Arslan's nursing home [9]; 16% of them used 1 to 2 drugs, 16.7% used 3 drugs, 16.7% used 4 drugs and 16.7% used 5 drugs. 62.3% of the elderly are physical and 62.6% of them have good mental health. A little more than half of the elderly (52.9%) expressed satisfaction with their life (Table 1). According to this finding, it is noticed that the majority of the elderly qualifies the health level as good and moderate. In a study conducted by Koç et al. 46.2% of the elderly stated that they perceive their health as good and 6.4% perceive it as bad [10]. In a study conducted by Bayik et al. in a health center area in Izmir in 2004, 42.5% of the 167-yearolds considered their health very good and good [11].
In many studies conducted in our country, the health perception of the elderly is evaluated and as the age progresses, the perception of health by the effects of age-related physiological changes is perceived worse by the elderly. Having any social security of the elderly and having a good income situation affects the perception of health positively and therefore it is important to be able to initiate health related behavior change in the elderly and to make this change into a lifestyle.  Table 3: Characteristics of sleep patterns of elderly individuals (n=124).
It was found that 60.5% of the elderly individuals who participated in the study did sleep 1 to 5 hours, 65.3% were not sleeping during daytime, 62.1% had difficulty sleeping, 58.1% had sleep problems, 63.7%. She said she did not feel rested after she woke up. Malakouti et al. reported that they had a sleeping problem at a high rate of 86.2% of the elderly [12]. In the study conducted by Fadıloğlu et al. who live in the nursing home, the average sleep quality score was 8.02 ± 2.87 and 77% of the elderly were found to have poor sleep quality [13]. It is stated that sleep problems are more prevalent in elderly people living in long-term nursing homes such as nursing homes [14]. It is thought that sleep problems may also be caused by side effects of medications used. It was determined that the elderly was not afraid to fall (65.3%), (34.7%). Yeşilbalkan and Karadakovan reported that 59.9% of the elderly were afraid of falling [15]. The findings of this study are similar. Meriç and Oflaz reported that the majority of the elderly was afraid to fall and that they were restricting themselves in their daily activities [16]. The elderly was afraid of falling and thus restricted themselves to fulfill their daily life activities [17]. We may think that the elderly is afraid of falling, and therefore that bringing restrictions on their daily lives may lead to problems in fulfilling the individual needs of the elderly, and may lead to further problems as a result of movement limitation in the course of the proceeding. Fear of falling can be considered as an important condition that increases the risk of falling as well as causing the elderly to limit their activities. This finding highlights the importance of addressing the fear of falls in the elderly and falling fear of developing independence in daily life activities.
It has been determined that 49.6% of elderly individuals have fallen within the last year. Fisher et al. reported an annual fall rate of 55.0% in the elderly [18]. Cosart reported fall rate as 48% [19] [22,23]. Our study finds similarities with studies done in our country and abroad. These findings show that dropping out in the elderly is a common problem. We can say that falls and related problems in the elderly are important and priority problems. It is observed that the oldest people who fallen have the lowest number of banyoda (51.7%) and then fallen in the room, corridor and garden respectively. Unlike study findings, Deprey's study reported that the elderly fell most in bedrooms and then in bathrooms, kitchens, and living rooms [24]. This may be due to the fact that the study was conducted abroad and May depend on the differences in domestic characteristics. Cosart similarly reported that my work fell most of the elderly [19]. Older people often fall into the bathroom, which can be attributed to the fact that the elderly individual is alone in his/her privacy. When elderly individuals are evaluated for falling, we can say that the riskiest area is the bathroom.

Conclusions and Implications
The results of this study show that the elderly people have difficulty sleeping, have sleeping problem, and they did not feel rested after waking up. It is important the elderly people to be educated and counseled in order to solve the sleeping problem. Also, it is considered the elderly people to be aware of the behaviors that may cause sleeping problems to prevent/reduce the sleeping problem.