Raudah Mohd Yunus is a Doctor of Public Health (DrPH) candidate at the University of Malaya. Her dissertation addresses the subject of elder abuse and neglect (EAN) among rural older Malaysians, with a focus on its health implications including mortality, sleep quality and chronic pain. Her other areas of interest are epidemiology, aging, longitudinal study design and refugees’ health.
Does Abuse in Late Life Cause Decline in Sleep Quality? A two-year prospective cohort study among rural older Malaysians
Background: Elder abuse and neglect (EAN) is a growing public health problem. Numerous adverse health effects of abuse in late life have been documented, including premature mortality, depression and disability. Little is known however, about the impact of elder abuse on sleep quality.
Objective: This study examines the longitudinal relationship between abuse in late life and quality of sleep among a cohort of older Malaysians.
Methods: This was a two-year prospective cohort study involving 1927 older adults in a rural Malaysian district, Kuala Pilah. A multi-stage cluster sampling strategy was employed. After two years, 1189 respondents were re-assessed. Abuse and neglect was determined using the modified Conflict Tactic Scale (CTS) while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).
Results: The prevalence of elder abuse was 8.1% (95% CI:6.9,9.3). Longitudinal analysis using generalized estimating equations showed that elder abuse led to decline in sleep quality over two years (B:0.49, 95% CI:0.17,0.58). Sub-analyses demonstrated that psychological abuse and neglect had significant longitudinal relationships with poor sleep, while other subtypes did not.
Discussion and Implications: Abuse in late life, particularly psychological abuse and neglect, worsen sleep quality. As sleep quality is an important determinant of health and a predictor of mortality among older adults, understanding its relationship with abuse is useful to clinicians and policy-makers in improving health services and upgrading preventive measures.