Sleep disturbances are common among older adults. The objective of this study is to determine whether the activity of inside walking by older individuals residing in the old age home improves the quality of their sleep. Pashupati Briddhaashram (old age home) from Kathmandu is the facility selected for this study. This study uses a pre-post quasi-experimental design of 36 older individuals who voluntarily participated utilizing the Pittsburgh Sleep Quality Index (PSQI) to measure the quality of individuals’ sleep. In this program older residents walked three times per week for four weeks with the researchers or other assigned Briddhaashram Officers. Results show that after one months of walking, the Global PSQI score changes from 331 to 274. This statistically significant result shows that walking is sufficient to improve the nighttime sleep quality of the participants. Moreover, nighttime sleep quality improved regardless of gender. Further analysis of several PSQI components shows that sleep latency, sleep duration, subjective sleep quality, habitual sleep efficiency and sleep disturbance were also found to improve significantly. These findings cannot be generalized to whole population, further in depth study in a large sample size with control group is required.
There is no universal way of defining when a person becomes old. Factors like biological, psychological, chronological and social play an important role when a person is considered old. For all practical purposes, 60 years old is considered as a cutoff point to refer to the older population in developing countries [1]. Changes in physical, mental and social aspects is experienced as people age [2]. One such a change is seen on the quality of sleep [3]. Changes in sleep duration, pattern and quality differ with age [4]. These changes in sleep patterns are reflected in the common sleep-related complaints of older adults, such as taking longer to fall asleep, waking more often and being sleepy during the day. Sleep disorders can result in tiredness, fatigue, depression, greater anxiety, irritability, pain sensitivity, muscle tremors, immunosuppressant and lack of daytime alertness [5,6].
The prevalence of sleep disturbances increases with age. Studies show more than 50% of people over the age of 65 experience sleep disturbances [7,8]. Poor sleep quality also becomes common during old age [9,10]. Sleep disturbances and the occurrence of illnesses or death are highly correlated [11]. Physical inactivity has been identified as a risk factor leading to many chronic diseases. One study also demonstrates that greater physical activity is associated with longevity and an Improved Quality of Life (QOL) [12]. The importance of physical activity in older adults, however, has often been neglected and given a lower priority compared to physical activity in the general population. One study found physical activity can even lower the death rate in people aged seventy to eighty-five years [13].
Walking is an affordable physical activity for older adults. Very little is known about what types of walking improve sleep the most, how much walking is needed to improve sleep and what time of day is best for walking to improve sleep in people with insomnia. Walking is a convenient, inexpensive, safe and effective exercise that can be undertaken by almost all people, at almost any time and in almost any place [13]. Most people can walk. Individuals are generally not hurt by walking and walking has benefits for wellness. Piepkorn determined that as little as 30 minutes of walking may be sufficient to keep individuals moderately physically active [14]. Very little research is carried out focusing older adults of Nepal [15-17]. More than 80% of older individuals still live with their children and many who are not cared for by their children prefer to live in a Briddasharam (Homes for elderly) run by government, religious community or community people [18]. Therefore, the main objective of this study is to study whether the activity of walking inside the Briddashram by individuals who reside there will improve the quality of their sleep.
Characteristics | Number | Percentage | Mean | Range |
Age (Years) | 75.2 (±8.5) | 65-87 | ||
65-69 | 7 | 19.4 | ||
70-74 | 12 | 33.3 | ||
75-79 | 11 | 30.6 | ||
80+ | 6 | 16.7 | ||
Sex | ||||
Male | 13 | 44.4 | ||
Female | 17 | 55.6 | ||
Marital Status | ||||
Widow/widower | 21 | 75.0 | ||
Married but living separately | 7 | 19.4 | ||
Never Married | 2 | 5.6 | ||
Literacy Status | ||||
Literate | 8 | 22.2 | ||
Illiterate | 28 | 77.8 |
Table 1: General characteristics of respondents.
Variables | Global PSQI | Components of Global PSQI | ||||||
Subj. Sleep Quality | Sleep Latency | Sleep Duration | Habitual Sleep Efficiency | Sleep Disturbance | Use of Sleep Meds | Daytime Dysfunction | ||
Pre-walk | 331 | 62 | 65 | 72 | 59 | 44 | 17 | 12 |
Post-walk | 274 | 53 | 49 | 56 | 50 | 38 | 16 | 10 |
Percent improvement | 20.3% | 14.5% | 24.6% | 22.2% | 11.9% | 13.6% | 5.9 | 16.7 |
Paired sampled correlation | 0.835 | 0.587 | 0.728 | 0.793 | 0.902 | 0.902 | 0.988 | 0.939 |
p | 0.001* | 0.000* | 0.000* | 0.003* | 0.007* | 0.012* | 0.235 | 0.121 |
Variables | Global PSQI | Components of Global PSQI | ||||||
Subj. Sleep Quality | Sleep Latency | Sleep Duration | Habitual Sleep Efficiency | Sleep Disturbance | Use of Sleep Meds | Daytime Dysfunction | ||
Pre-walk | 331 | 62 | 65 | 72 | 59 | 44 | 17 | 12 |
Post-walk | 274 | 53 | 49 | 56 | 50 | 38 | 16 | 10 |
Percent improvement | 20.3% | 14.5% | 24.6% | 22.2% | 11.9% | 13.6% | 5.9 | 16.7 |
Paired sampled correlation | 0.835 | 0.587 | 0.728 | 0.793 | 0.902 | 0.902 | 0.988 | 0.939 |
p | 0.001* | 0.000* | 0.000* | 0.003* | 0.007* | 0.012* | 0.235 | 0.121 |
With the increasing life expectancy ageing is a worldwide issue of importance and less active lifestyle has created a variety of physical, mental, social and economic problems [15,20-22]. Sleep disorder in old age is a very common phenomenon but it is not understood well whether it can be improved through simple physical activities like walking. This study found, after a month long walking activity baseline combined global PSQI score of 331 dropped to 274. This decrease in PSQI score (by one fifth) was statistically significant showing one month’s walking was improved the quality nightmare sleep of participants. It was significant for both male and female when calculated separately. A similar study carried out by Brightman shows decrease in PSQI score means walking was good for sleep but the result was not statistically significant [23]. His study carried out in Nepal also shows the result was not significant to improve sleep quality.
Further analyzing the seven components of PSQI scale sleep latency, sleep duration, subjective sleep quality, habitual sleep efficiency and sleep disturbance were found improved significantly. On the other hand there was not significant improvement in the sleep quality on two components use of sleep medicine and day time dysfunction. Similar to this study of Brightman shows sleep latency, sleep duration and sleep disturbance improved significantly [23]. Thus, for this particular sample, causal walking in the area inside the Pashupati Briddashram three times per week for one month significantly improved the participants’ self-perceived aggregate sleep quality scores. Therefore, this research confirms the results of previous research [24-29] that indicates walking improves nighttime sleep quality for older adults. Further, this result is consistent with the study of Ferris et al., [30] King et al., and Elavsky et al., that supported the effectiveness of physical activity on quality of sleep [30-32]. In addition, Rahmaninia et al., reported that a walking program of 8 weeks was effective in improving the quality of sleep of the older adults [33].
There are some considerations that may have constituted limitations in this research. These factors might have limited the possible inferences that can be made from these results. First, this is one time quasi experimental study and causality cannot be assumed. Second, participants were not selected randomly and each volunteer participant was their own control. Third, the use of this pre-post quasi-experimental design may affect the results and influenced the ability to make inferences to the greater population of older adults. Fourth, the sample size was not calculated using any standard sample size calculation formula. Fifth residents were not monitored at all times during the day time and there was not control group. They may have napped or been physically active on their own. So, it’s difficult to say whether the actual change was from walking alone. Sixth, Face to face interview may have some biased while reporting their perception.
The findings of this research clearly show that walking improve nighttime sleep quality of older adults. This finding can’t be generalized to whole population, further in-depth study in a large sample size is required with control group.
We would like to express our sincere gratitude to University Grant Commission, Sanothimi Bhaktapur for financial support to carry out this research.
Citation: Chalise HN, Lamsal U (2017) Walking and Sleep Quality of Nepalese Older Adults Residing in an Old Age Home. J Gerontol Geriatr Med 3: 016.
Copyright: © 2017 Hom Nath Chalise, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.