| Objective: The purpose of this study was to understand the current situation of sleep quality among rural older adults and to explore the influencing factors related to sleep quality among rural older adults in China using decision tree and logistic regression models.Based on the findings,targeted community intervention strategies are proposed to provide a basis for decision making on active aging.Methods: A cross-sectional study was conducted in Anhui Province from July to August 2021,using a stratified randomized approach,and a total of 10 villages in 2townships in M County were selected as the study site.The instruments used in the study consisted of a general condition questionnaire,Pittsburgh sleep quality index(PSQI),12-item general health questionnaire,Morse fall risk assessment scale(MFS)),and a cross-sectional study in Anhui Province.Epidata 3.1 was used to establish the database,and SPSS 26.0 was used for statistical analysis.The analysis methods included chi-square test,logistic regression analysis,and decision tree model construction.Results: A total of 1200 questionnaires were distributed in this study and 1189 valid questionnaires were returned,with a valid response rate of 99.1%.The main results were as follows.(1)Basic information:(1)Demographic characteristics: the largest proportion of survey respondents aged 70-79 years old(48.6%),the smallest proportion of ≥80 years old(16.6%),the proportion of men and women is basically the same,the education level is mainly elementary school or below;(2)Health-related behavior: 80.4% of the elderly do not smoke,the proportion of non-drinking elderly is significantly higher than that of drinking elderly,the proportion of elderly with two or more chronic diseases is 44.2%,42.3% of the survey respondents had hospitalization experience within one year before the survey,16.1% of the survey respondents visited a doctor within two weeks;(3)Economic income status: the main economic sources of the survey respondents’ families include their own labor(51.6%),children’s support(30.3%)and government subsidies(18.1%),82.4% of the survey respondents self-assessed living standard is good;(4)Sleep quality,fall and mental health level: 93.8% of survey respondents have high risk of fall,60.1% of the elderly have good sleep quality,72.7% of the elderly have good mental health.(2)Sleep quality status: The mean score of the PSQI sleep quality index scale for the survey respondents was(6.788±4.073),and the detection rate of sleep disorders was45.7% for the elderly with chronic co-morbidities and 35.2% for the elderly with noncritical co-morbidities,with statistically significant differences between the two groups(P<0.001).(3)Influencing factors Logistic regression analysis showed that a better level of mental health and a better self-rated standard of living in the chronic co-morbid group were protective factors for sleep disorders among the respondents;women and income sources such as child support and government subsidies were risk factors.The results of the analysis of the non-congenital group showed that better mental health was a protective factor for sleep disorders in the non-congenital elderly,and poorer self-rated health(compared to others around them)was a risk factor.The analysis of the factors influencing the risk of sleep disorders in all subjects revealed that better mental health was a protective factor for sleep disorders in the subjects;female,main source of income was child support,poor self-rated health,and having two or more chronic diseases were risk factors for sleep disorders in the subjects.(4)The results of the interaction decision tree model analysis: survey respondents with poor mental health,male gender,and whose source of income was mainly self-labor had the highest probability of suffering from sleep disorders,57.4%.Relatively speaking,respondents with good mental health and one or fewer chronic illnesses have the lowest probability of developing sleep disorders,with a 26.9% rate of self rated good health.Conclusion: The rate of sleep disturbance is higher in elderly with chronic comorbidities.Sleep quality of rural elderly is influenced by many factors,such as personal characteristics,health level,behavior and lifestyle.In this study,we combined logistic regression and decision tree models to screen the key influencing factors on sleep quality of the elderly,including mental health,gender,number of chronic diseases and main economic source.In contrast,the sleep quality of the elderly in the co-morbid chronic disease group was influenced by the level of mental health,self-rated standard of living,gender,and source of income.The rural communities should improve the sleep quality of the elderly effectively through strategic measures such as(1)active detection and attention to high-risk groups;(2)scientific assessment and emphasis on screening intervention;(3)health promotion and construction of a supportive environment in order to improve their quality of life. |
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