Sleep Quality And Cognitive Frailty Among Rural Older Adults In Shandong:The Mediating Role Of Leisure Activities

BackgroundPopulation aging continues to deepen,especially in rural areas.Health problems of rural older adults have gradually become the focus of the cause of aging.Cognitive frailty is a syndrome with both physical weakness and cognitive dysfunction.It is important to pay attention to the current situation of cognitive frailty and carry out effective interventions to promote the health of older adults.The sleep quality of older adults is generally poor.Some studies have shown that sleep quality is closely related to physical weakness or cognitive dysfunction,but there are few studies on the relationship between sleep quality and cognitive frailty in rural older adults and there are fewer studies on the impact of sleep quality dimensions on cognitive frailty.Participation is one of the three pillars of active ageing,and participation in leisure activities is an important type of participation.Some studies have pointed out that leisure activities are related to sleep quality and have a significant impact on cognitive frailty.But there is no research on the relationship between the three.Moreover,previous researches mainly based on cross-sectional research,lacking cohort research,which is not conducive to the study of the relationship between variables and the exploration of relevant impact mechanisms.ObjectivesThis study aimed to know the current situation and changes in cognitive frailty,sleep quality and leisure activities of rural older adults in Shandong and to explore the relationship between sleep quality and cognitive frailty and the mediating role of leisure activities in it,so as to provide reference basis for formulating cognitive frailty intervention measures from the perspective of sleep and leisure activities.MethodsUsing the method of multi-stage stratified random sampling,the baseline survey was completed in 2019 and the follow-up survey was completed in 2020 in Rushan,Qufu,and Laoling of Shandong Province.2782 participants were finally included in the analysis.Epidata3.0 was used for data entry.Statistical analysis was achieved through Stata15.0 and SPSS25.0.The chi-square test was used to describe cognitive frailty,sleep quality and leisure activities of older adults with different characteristics.The changes between two years were analyzed by using Paired chi-square test.The relationship between sleep quality and cognitive frailty was explored by using Generalized Estimating Equation(GEE).The mediating role of leisure activities between sleep quality and cognitive frailty after one year were explored by using the generalized structural equation model and Bootstrap test.ResultsIn the baseline survey in 2019 and the follow-up survey in 2020,the incidences of cognitive frailty among rural older adults in Shandong were 7.08%and 7.44%,respectively.The incidences of poor sleep quality were 47.70%and 59.02%.The proportions of older adults with low-level leisure activities were 51.29%and 55.25%.The differences in sleep quality and leisure activities between two years were statistically significant(χ2=158.200,P<0.001;χ2=12.820,P<0.001).The results of multivariate GEE analysis showed that the elderly with poor sleep quality had a higher probability of cognitive frailty(OR=1.3 8,P=0.002).Poor abnormal subjective sleep quality(OR=1.48,P<0.001),sleep latency(OR=1.60,P<0.001),low sleep efficiency(OR=1.49,P<0.001),hypnotic drug use(OR=2.07,P<0.001)and daytime dysfunction(OR=1.48,P<0.001)were risk factors for cognitive frailty.The relationship between sleep time dimension and cognitive decline was not statistically significant in multivariate models(P>0.05).Leisure activities can mediate the relationship between sleep quality and cognitive frailty after one year(a*b=0.219,OR=1.25,P=0.007),and the proportion of mediating effect was 26.76%.After adjusting leisure activities,cognitive frailty and other covariates of baseline,the intermediary effect was still significant(a*b=0.202,OR=1.22,P=0.022),and the proportion of intermediary effect was 35.58%.Conclusions and suggestionsConclusionsThe incidence of cognitive frailty among rural older adults in Shandong Province was relatively high,with no significant change in two years.The incidence of poor sleep quality was high,and the incidence of poor sleep quality in 2020 was significantly higher than that in 2019.The participation level in leisure activities was generally low,and the proportion of older adults with low-level leisure activities in 2020 was significantly higher than that in 2019.Poor sleep quality was a risk factor for the cognitive frailty of older adults in rural areas of Shandong Province.Sleep efficiency and sleep latency were closely related to cognitive frailty,while sleep time was not significantly related to cognitive frailty.Sleep quality could not only directly affect cognitive frailty after one year,but also indirectly affect cognitive frailty through the mediation of leisure activities.SuggestionsPay attention to the current situation of cognitive frailty of rural older adults.Strengthen the recognition of cognitive frailty of rural older adults and the management of key groups.Pay attention to the "quality" and "quantity" of sleep of older adults and its impact on cognitive frailty and leisure activities.Carry out non-drug intervention for the elderly with poor sleep quality.Attach importance to the role of leisure activities in preventing and controlling the cognitive frailty of rural older adults.Promote the participation level in leisure activities and raise the leisure awareness of rural older adults from three aspects of society,family and individual.