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SLEEP PROBLEMS AND THE ASSOCIATIVE FACTORS
AMONG KADAZANDUSUN ELDERLY IN KAMPUNG
RAMAYAH
Colman Juniah
Bachelor of Nursing with Honours
2010
TABLE
OF CONTENT
Content
Page
ACKNOWLEDGEMENT
i
ABSTRACT
11
INTRODUCTION
Problem Statement
Significance of Sttuly
Research Questions
Research Oh_jectives
Operational Definition
1
3
4
5
6
6
of Terms
REVIEW
LITERATURE
Sleep and Sleep Problems
Measurement of Sleep Problems
7
7
14
METHOD
Research Setting and Population
Sampling Method
Ethical Approval
Data Collection
Instrument
i.
Data Anal%'si.c
15
15
I6
17
17
18
20
RESULTS
Intrc, clnctiun
Sc,ciu-demographic I'rn/ile u/ Respunclents
Sell-rated Ilvu/th of Respondents
Bndº' Muss Inc/ex uJ'Reshc,nclents"
Sel/-rutecl aleclicul Cunclilicm n/ Res/, unclents
Lifestyle uJ'Res'hnnclents
Sleep History ol'Respondents
Lrwnrth Sleepiness Scale qfRespondents
Prevalence of Sleep I'ruhlems u/'Reshunclets
Relationships between Sc,l/=rutecl Ilealth and Sleep Problems
Relationships betiveen Joint Pain and Sleep Problems
Relationships between Hours ol'Sleep and Sleep Problems
Relationships between Light Sleeper and Sh, cp Problems
Relationships hetireen Quality c,/'Sleep and Slee/, Problems
21
2I
2I
23
23
24
25
26
28
31
31
32
32
33
33
DISCUSSION
Limitation and Recommendation
Implication
34
38
39
CONCLUSION
39
REFERENCE
40
APPENDICES
Appendix I:
47
Application
Research
Appendix
Appendix
for Ethical Clearance From
and Ethics Committee
11 : Iii/on-in Consent Form
III: Questionnaire
Format
LIST OF TABLES
Tables
Pages
Table 1: Socio-demographic Profile of Respondents
22
23
Table 2: Body Mass Index (BMI) of Respondents
Table 3: Self-Reported
Medical Conditions
of Respondents
24
Table 4: Lifestyle of Respondents
25
Table 5: Sleep History of Respondents
27
Table 6: Frequencies and percentagesof Epworth Sleepiness Scale (ESS)
of respondents (n=35)
30
Table 7: Prevalence of sleep problems of respondents (n=35)
31
Table 8: Relationships between self-rated health and sleep problems
31
Table 9: Relationships between joint pain and sleep problems
32
Table 10: Relationships between hours of sleep and sleep problems
32
Table 11: Relationships between light sleeper and sleep problems
Table 12: Relationships between quality of'sleep and sleep problems
33
33
LIST OF FIGURE
Figure
Figure 1: Self-rated Health of Respondents
Pages
23
ACKNOWLEDGEMENT
It is a pleasure to thank those who have contributed, inspired and supported in completing this
foremost,
First
I would like to thank God who made all things possible.
and
study.
I would like to extend my gratitude to my supervisor, Dr. Sidiah John Siop, for her patience and
vital guidance to the proper quantitative
study approach.
I am grateful to Dr Zabidah Putit, Co-ordinator for Nursing Research Program for her dedication
in helping students throughout this course. Not to forget, the lecturers involved in Nursing
Research course.
Thank you to the Research and Postgraduate Committee, Faculty of Medicine and Health
Science for approving the ethical clearance.
I am grateful to CAIS library for the online databasesaccount provided to students.
I owe my deepest gratitude to Kenia Kampung Ramavah, Mr. Bestan John for this support in this
family,
indebted
I
to
my
am
study.
particularly
to my father, Walter Juniah, my senior, Ronald
Sator, my friends, Floyd Tugung, Thomas Julis. Wong How Ping. Abraham Atkin Ak James, and
my colleagues,
Francisca
Emiliana,
Dayang
Zahrina,
Frannelya Ak francis for their guidance and support.
Norliza
binti
Suut,
Phan Ling,
and
ABSTRACT
Sleep is essential for restorative
negative
impact
towards
function and sleep problems can lead to significant
health. The objective
of this
study
prevalence of sleep problems among Kadazandusun elderly
Ramayah and its associative
employed
selected
using
administered
the
lived
in Kampung
who
to sleep problems.
approach whereby descriptive,
a quantitative
used in conducting
factors contributing
is to examine
cross-sectional
This research
design was
this research. There were 35 respondents aged 60 years and above
convenience
questionnaire
interview
write,
read and
sampling
Data was collected
through
self-
method whereas those respondents who were unable to
administered
descriptive
analysed using
method.
questionnaire
method was selected. Data was
statistics and Pearson Chi-square tests. Result showed the
less
Good
health,
joint
71.4%.
than
self-rated
pain,
sleep
problems
was
of
prevalence
6 hours of' sleep. light sleep, poor quality
significant
relationships
with sleep problems.
of sleep variables
have
found
to
were
INTRODUCTION
Globally,
was 6.2 billion
the world population
number will grow up to more than 9 billion
Meanwhile,
the world's
in
U. S Department
total
of
Commerce
Economics
under
and
Statistics
(U. S Census Bureu, 2004).
Administration
Similarly
elderly population made up 7% of the world's
and the percentage is expected to rise up to 17% in the year 2050 as
population
projected
in year 2050 (U. S Census Burcu, 2004).
(65 years of age and above) will continue
elderly population
to grow as well. In 2002, world's
in 2002 and it is predicted that the
in Malaysia, the proportion
of elderly population
(60 years old and above)
is expected to be on the rise from year 2000 up to 2020 with the prediction
9.9% of Malaysia's
total population
(Department
of 6.2% to
of Statistics Malaysia cited in Ong,
2002). In relation to that, the advancement of medicine along with improved nutrition
and public health has expanded the life expectancy in Malaysia
demographic
in which there will he more elderly
transition
and thereby causes
population
in the future
(Poi, Forsyth, Chan, 2003).
Further, based on the Malaysian
expected to comprise
while
(Wong,
Chinese
majority
ethnicity
n. d. ). With
% ill
Institute of' Economic
of' the Malaysian's
Research females gender are
elderly
have the higher percentage
the increasing
numbers
1
of' elderly
population
in the future
of' elderly
in Malaysia
population
as in 2020
projection,
there will an increased demand in caring for the elderly. According
91h Malaysian
Plan (9MP), and there were 9 geriatricians,
256 occupational
to the
398 physiotherapists,
and
therapists in 2005 that are trained to care for the elderly throughout
Malaysia (9th Malaysian Plan cited in Wong, n. d. ) and the numbers of trained health
specialist for the elderly are still insufficient
to meet the demand.
While we are ageing, we will undergo several physiological
changes. Sleep pattern is
one of those changes in which ageing shorten the total amount of'sleep needed: 6 and
for
half
hour
daily
people 60 years and above (Wolkove,
of sleep
a
& Palayew, 2007). Along
the process of undergoing
changes, some elderly may developed
having difficulty
Elkholy,
Baltzan,
the age-related sleep pattern
sleep problems instead, for instance, they are
to stay asleep because they are easily awakened and consequently
having a fragmented
sleep pattern (Wolkove,
Heuvel, Furguson, & Lushington.
Elkholy,
Baltzan, & Palayew, 2007:
2004).
As mentioned before, trained healthcare giver is needed to meet the demand in caring
for the elderly especially those who is having health problems. Concerning the health
problems among elderly population,
whereby
Mitchelle,
it gives significant
Sloane, 2007).
2002, Bliwise,
sleep problems
negative
impact
is one of those affecting
towards
health (Alattar,
health
Harrington,
Sleep problems are common among elderly (Montgomery.
1993. Foley et al., 1995 cited in McCurry,
.2 .
Logsdon, Vitiello.
& Teri
1998) and surveys in 1960s and 1970s done in Britain and United States showed
positive correlation between increasing age and subjective sleep problems (Swift &
Shapiro, 1993). It is estimated that 15 million
Americans
are
experiencing
some
sleep
of elderly or 50% of the older
problems
(Ancoli-Israel,
Poceta,
Stepnowsky, Matrin, & Cehrman, 1997) and unmanaged sleep problems may lead to
negative impact towards health of the elderly.
Problem Statement
As mentioned
restoration
earlier, maintaining
and sleep impairment
health (Alattar,
Harrington,
normal sleep pattern is essential fir
can leads to significant
Mitchelle,
physiologic
negative impact towards
Sloane, 2007). However,
despite of the fact
sleep problems among elderly are common, age-related sleep problems are thought to
be a normal phenomenon since it is too common and it always give a less or improper
evaluation
(Lesage & Scharf. 2007).
In 2003, a poll released by National
Sleep
Foundation (NSF) stated that 67% American elderly reported frequent sleep problems
and a small fraction (one in eight) of'670, %6have been diagnosed with sleep problems
while
the remaining
unnoticed (Anonymous,
According
to National
seven in eight were not diagnosed
with
sleep problems
or
2003).
Sleep Foundation.
undiagnosed and untreated sleep problems
may interfere with coping ability as well as complicate the treatment of age-related
3
chronic medical conditions because they found that medical condition is associated
with sleep problems (Anonymous,
2003).
Studies show similar
between medical condition
which
relationship
people experiencing
sleep problems
and sleep problems in
often associated with health problems,
or both (Goldman,
Ancoli-Israel,
Boudreau,
Cauley, Hall, Stone, & Rubin. 2008, Giron. Forsell, Bernsten, Thurslund,
Winblad, &
either physically
or psychologically,
Johan, 2002; Middelkoop,
Harrington,
Mitchell,
Adler. Williams.
elderly
Doel, Neven,
& Sloane, 2007;
Kamphusien,
Robert.
& Springer,
1996, Alattar,
Shema, & Kaplan,
1996, Moore,
& Jackson. 2002). With the increasing rate and number of world's
population,
there will
he increased in number of elderly
who suffers from
sleep problems and increased in health problem related sleep problems if it is remain
untreated.
Significance
As
of study
(Home
Medical
Equipment News. 2003) and untreated sleep problems may give significant
negative
mentioned
earlier,
sleep problems
impact towards health (Alattar,
are often
Harrington,
Mitchelle.
undiagnosed
Sloane, 2007). The prevalence
of' sleep problems was shown to be high in the developed countries such as Britain
and America,
particularly
Poceta, Stepnowskv.
in urban setting (Swift
Matt-in. & Cehrman,
1997).
4
& Shapiro,
1993, (Ancoli-Israel,
In this study,
location
semi-urban
village
to be conducted
called Kampung
Ranravah was selected as the
in order to examine the prevalence sleep problems.
The
study in relation to sleep problems in Malaysia is still inadequate. Therefore, the fact
to support the prevalence
Although
the population
whole Malaysian
information
of sleep problems
of elderly
Elderly,
in Malaysia
in Kampung
but the findings
is vague at the moment.
Ramayah does not represents the
of this research may provide the useful
regarding sleep problems in semi-urban setting, particularly
Ra, navah, Sabah. This information
the problem intervention
may enable healthcare providers
in Kamf, ung
to he aware of
programme may be taken.
Research Questions
The research questions are:
1. What is the prevalence
of sleep problems
among Kuclucunthu.cmt elderly
in
KamIntus, ' RantaYuh?
2. What are the factors contributing to sleep problems among K'ada: anchisrnt
elderly who lived in humpuuºg Run{t"uh?
Research Objectives
The general objective of this research is to examine the prevalence of sleep
problems in Kadazandusun elderly population who is living at Kumpu ng Ra,navah,
Penampang, Sabah. The specific objectives of this research are:
1. To examine the prevalence of sleep problems among Kada_umhisutir elderly in
KUnTJJNNg
Rumut"uh.
2. To identify the associative risk factors contributing to sleep problems among
Kuclu: undusrur elderly who lived in Kumpung Ra na ah.
Operational
Definition
of Terms
Sleep problems
Sleep problems is generally defined as too little sleep (insomnia),
(hypersomnia),
too much ol'slcep
and disturbed episodes of sleep during nighttime and sleep problems
include any sleep disorders, sleep disturbances, and sleep complaints.
Elderly
Elderly in this study is defined as people who aged 60 years and above.
'6ý
LITERATURE
REVIEW
Sleep and Sleep problems
Sleep is essential in everyday's
restorative
specific,
functions
(Wolkove,
adequate sleep could
life because it is a vital physiological
Elkholy.
Baltzan, & Palayew, 2007). To he more
levels of activity
restore our normal
balance among parts of the nervous system (Koizer,
and sleep impairment
Harington, Mitchelle.
can have significant
on sleep deprivation
& Buckley.
2002), normal sleep pattern
individual's
ability
and normal
Erb, Berman, & Snyder, 2004)
impact
negative
on health
(Alattar,
Sloane, 2007).
Based on the studies
Fanning, Attwood,
process fiir
(Pitcher
1998 cited in Moore,
is important
Huffcutt,
Adler,
to be maintained
to concentrate, affect attention,
Baum, Buysse, Prigerson,
&
Kupfer. & Reynolds,
the study of sleep as a mediator of stress-immune
1996, Leonard,
Williams,
& Jackson
because it affects on
and mood. Another
study (Hall.
1998 cited in Moore et. al. 2002) on
relationship
reported that sleep also
affects one's immune functions. But, as we aged, the physiological
changes within our body will affect body's functional
and psychological
pattern such as sleep in which
amount of sleep is shortens to 6 and a half hour daily fºrr people 60 years and above
(Wolkove.
Elkholy,
Baltzan, & Palayew, 2007).
.7
.
However,
(Vitiello
cited in National
Sleep foundation,
demonstrates the amount of sleep needed remained
2009) reviewed that research
constant throughout
adulthood,
but our sleep pattern, called sleep architecture changed with age and it may contribute
to sleep problems. Furthermore,
older people tend to spent more time in light stages
of sleep than in deep stages and they are prone to have trouble in falling
well
as maintaining
asleep (Vitiello
cited in National
Sleep Foundation,
findings were reported (Dement, Miles, & Carskadon,
Similar
Czeisler,
2000 cited in Giron,
asleep as
Forsell, Bernsten, Thorslund,
2009).
1982: Dijk, Duffy,
Winblad,
&
& Fastbom,
2002) whereby old people get less time asleep though more time spent in bed and
easily aroused from sleep than young age.
As mentioned earlier, sleep problems may develop
throughout
ageing and it can he
divided mainly into 3 basic types: too little or inadequate amount of sleep (insomnia):
too much sleep or excessive sleepiness (hypersomnia):
interfere with sleep (parasomnia)
be further divided
(Montgomery,
of Sleep Disorder (American
Montgomery.
2002). Among
2002: Stores & Wiggs, 2001). It can
Sleep Disorder Association,
the 3 basic types of' sleep problems,
sleep problems
with estimation
(Ohayon. 2002 cited in McCrae. Rowe. Tierney,
2005).
episodes that
and listed into nearly 90 sleep disorder as it is in International
Classification
most common
and disturbed
It is almost similar
15%-65%
Dautovich,
prevalent
2001 cited in
insomnia
among elderly
Definis. & McNamara,
to that in several studies cited in Tung-Ping,
+8ý
is the
Shuang-
Ruang, & Pesus (2004)
whereby
of insomnia
prevalence
10%-60%
estimated
in
elderly community.
It is estimated 15 million
sleep problems
of elderly or 50% of older Americans
(Ancoli-Israel,
Poceta, Stepnowsky,
Matrin,
experiencing
& Cehrman,
1997). It
found
that, the prevalence of sleep problems was 28.7% in a longitudinal
was
of prospective data on sleep complaints
1999). Their finding
noninstitutional
to a cross sectional
on drug use and clinical
study in sleep
correlates
with
641
ized respondents whereby the prevalence of sleep problems was about
33% (Giron, Forsell. Bersten. Thorslund,
Potential
population (Roberts, Shema, George, &
is almost similar
in a very old population
problems
study
and associated risk factors in an older cohort
with 2380 respondents in noninstitutionalized
Kaplan,
some
causes of' sleep
problems
interrelated
between
pharmalogic
events ((; iron,
among
physiological,
Forsell.
Winblad, & Fastborn, 2002).
elderly
medical,
Bernsten.
are multiftºctorial
psychiatric,
Thorslund,
and
psychosocial,
Winhlad,
&
it is
and
Fasthorn,
2002). A survey done in Britain and the United States during the 1960s and I 970s III
Swift
and Shapiro
subjective
(1993),
sleep problems.
increasing
However,
age showed
the finding
study in prospective data on sleep complaints
a positive
is contradictory
correlation
with
to the longitudinal
and associated risk factors in an older
cohort conducted by Roberts. Shema. & Kaplan ( 1999) in which increasing ageing is
9
not a factor for both insomnia and hypersomnia
as both insomnia and hypersomnia
were being measured as indicator of sleep problems for their study.
According
to Swift and Shapiro (1993) on sleep and sleep problems in elderly people,
women was found more prevalent towards sleep problem compared to men and sleep
laboratory
showed women are more sensitive to noise arousal. Similar
done by Roberts, Shema, & Kaplan (1999) and Giron,
Winblad.
& Fastbom (2002) whereby
men, particularly
Unmarried
Forsell, Bernsten, Thorslund,
women reported
more sleep problems
than
insomnia.
status among elderly was found to be correlated
problems (Roberts, Shema, & Kaplan,
care: a North
to the study
Carolina
family
conducted by Alattar, Harrington,
with prevalence of sleep
1999). A study in sleep problems in primary
practice
research network
Mitchell.
(NC-FP-RN)
that was
& Sloane (2007) found a similar result in
which unmarried elderly and elderly who are living alone reported more prevalent of
sleep problems.
Pertaining
to the prevalence of sleep problems among elderly who
are living alone, isolation was considered as correlates of sleep problems in study of
sleep problems
in a very old population:
Forsell, Bernsten. Thorslund,
drug use and clinical
Winhlad, & Fastbom, 2002).
. ioý
correlates
(Giron,
Educational
level was found to be correlated
(Roberts, Shema, & Kaplan.
1999; Alattar,
Roberts, Shema, & Kaplan (1999)
with sleep problems
Harrington,
found a significant
Mitchell,
in both studies
& Sloane, 2007).
relationship
between sleep
problems and low education level respondents. In relation to that, result from Alattar,
Harrington,
Mitchell,
& Sloane (2007) also showed elderly with higher educational
level were less likely
to report
sleep problems.
A Study by Alattar,
Harrington,
& Sloane (2007) also found that respondents with elevated body mass index
Mitchell,
were more likely to report sleep problems.
(BMI)
of' chronic
numbers
(Giron,
is correlated
Condition
Medical
Forsell,
conditions
with sleep problem
Winblad,
showed those elderly with medical condition
more likely
to the prevalence
correspond
Bernsten, Thorslund,
to have sleep problems.
in which
the presence higher
of' sleep problems
& Fastborn, 2002). Their
findings
of heart problem, tumors and pain were
Similar
findings
were reported by Roberts,
Shema, & Kaplan (1999) in which association between sleep problems and old age is
primarily
due to chronic health problems.
According
to Swill and Shapiro ( 1993), physical illnesses or medical illnesses cause
discomlört
which may lead to sleep problems and older people seldom voice it out.
The medical illnesses include heart problems such as nocturnal
left
ventricular
failure,
tachyarrhythmias
'11
causing
angina
dyspnea caused by
and
palpitation;
problems such as gastro esophageal reflex disease, peptic ulcer, and
gastrointestinal
constipation;
respiratory problems such as exacerbation of chronic obstructive
disease; and musculoskeletal
airway
problems causing skeletal pain such as ostcoarthritis
and
osteoporosis (Swift & Shapiro. 1993).
Pertaining
to the sleep problems
Mitchell,
Harrington,
Springer,
1996)
reported
that
pain
especially
few studies (Alattar.
condition,
& Sloane, 2007: Middelkoop,
increased the risk of having
hynoptics
related medical
Doel, Neven, Kamphuisen,
musculoskeletal
and it is relieved
sleep problems
in elderly
pain
with
sedatives or
in order to improve sleep. However, a number of studies (Lesage & Scharf,
2007, Giron.
Forsell. Bernsten, Thorslund,
usage of sedatives or hypnotics
Winblad,
& Fastborn. 2002) shows that
increased the risk of experiencing
sleep problems
because of its side effects. Apart from that, hypnotic-sedative
medications
treating
insomnia
chronically
discontinuation
existing
sleep problems
hynnotic-sedatives,
antidepressants),
benzodiazepines
cause rebound
(Giron, Forsell. Bernsten, Thorslund,
Study by (; iron, Forscll. Bcrnsten, Thorslund,
that
&
other
(BIDS)
fiillowing
& Fastbom. 2002).
Winblad, and Fastborn (2002) reported
psychotropics
and nonpsychotropic
Winhlad,
used in
(neuroleptics,
anxiolytics,
drugs were related to sleep problems
accounted to 78.0010for hypnotic-sedatives
problems whereas ?O°° in anxiolytics as psychotropics
12
and
and
that caused sleep
for
44"0
in
diuretics
and
drugs. Similar findings
nonpsychotropic
which
sleep
problems
benzodiazepines.
hypnotic-sedative
related
According
were found in Swift and Shapiro (1993) in
to both studies, benzodiazepines
residual sedation. Specifically,
and unwanted
eliminate half-life
are
of benzodiazepines
most
likely
benzodiazepines
sensitivity
to
can cause oversedation
take longer time to
(Giron, Forsell, Bernstcn, Thorslund,
& Fastbom, 2002) and the pharmacokinetics
due
of henzodiazepines
Winhlad,
increased
with age (Swift & Shapiro, 1993).
Self-rated health used as a health measurement indicator for both studies (Alattar,
Harrington, Mitchell, & Sloane. 2007; Giron, Forsell. Bernsten, Thorslund, Winblad,
& Fastbom, 2002) are found to be related to prevalence of' sleep problems. Their
result showed there was association between poor self-rated health and prevalence of
sleep problems.
Alattar,
Harrington.
correlated
with
Middelkoop.
sleep quality
Mitchell,
and Sloane (2007)
sleep problems,
particularly
Doel, Neven. Kamphuisen,
was correspond
found the overall
number
of' awakenings.
sleep quality
Similarly
in
and Springer (1996) found that subjective
to sleep problems.
onset.
13
particularly
self-estimated
sleep
Measurement of Sleep Problems
Most studies included the sign and symptom of insomnia as part of measuring sleep
experiencing trouble in falling asleep and frequent sleep
problems, particularly
awakenings during night time for the past 2 weeks (Alattar, Harrington, Mitchell, &
Sloane, 2007; Giron, Forsell, Bemsten, Thorslund, Winblad, & Fastbom, 2002:
Middelkoop, Doel, Neven. Kamphuisen, & Springer 1996; Goldman, Ancoli-Israel,
Boudreau, Cauley, Hall. Stone, Rubin, Satterfield, Simonsick, Newman, 2008;
Roberts, Shema, & Kaplan, 1999).
Some of the studies included additional
measurement of sleep problems
such as sign
and symptom of hypersomnia (Roberts, Shema. & Kaplan, 1999), Excessive Daytime
Sleepiness
(EDS)
(Middelkoop,
Doel,
Neven,
Restless Leg Syndrome (RLS). Obstructive
(Alattar,
Bernsten,
Harrington,
Thorslund.
Psychopathological
To summarize,
and gender,
health,
Mitchell,
body
consumption,
Winblad,
Kamphuisen,
1996),
Sleep Apnea Sydrome (OSAS), and SIDS
& Sloane, 2007). However,
and
Springer,
&
Fasthorn
(2002)
study in Giron.
used the
Forsell,
Comprehensive
Rating Scale to identify sleep problems.
several studies showed there are correlation
age, marital
mass
status, educational
index,
medication
medical
level,
conditions,
sedative-hynoptic,
"14.
living
between sleep problems
arrangement,
cigarette
and quality
smoking,
of' sleep.
self-rated
alcohol
In addition,
the
prevalence of sleep problems in most studies were being measured by using sign and
symptom of insomnia, particularly trouble of falling asleep and frequent nighttime
awakening as indicator.
METHOD
This research employed a quantitative approach whereby descriptive, cross-sectional
design was used in order to examine the prevalence of' sleep problems among
Kadazandusun elderly who lived in Kampung Ramayah. Despite of' time constraint,
design.
Data was gathered and analysed using
cross sectional was chosen as research
descriptive statistic to identify if there is any relationships between variables that
associated with prevalence of sleep problems.
Research Setting and Population
The samples selected in this research were those Kadazandusun elderly aged 60 years
and above in Kunr/nnng Rumut"uh who are living
the official
website
(Penampang
situated at N. 20 mukim
District
in semi-urban village. According
Council,
III in Pcnarnpang district
200K), Kcnnjnmg
and majority
to
Runmur-uh is
of its population
is
Kuc/u: urn/usrur ethnic. There are total of 300 people aged 60 years old and above
living in Kumhung Rumat"uh in which by gender, there are 135 male whereas 165 of
them are women
(verbally
spoken to ketrru kcunlning).
.
15.
By race, two of the total
population
is Chinese and one is Malay.
Out of the 300 total population,
11.6%
(n=35) of them were selected as respondents for this research.
Sampling Method
Convenient sampling method was used in selecting the respondents in this research
because of unavailability of documented name lists along with the house location or
for
each older people aged 60 years and above who lived in Kampung
address
Ramayah. Without those information, respondents were selected based on the known
resources of older people aged 60 years and above From relatives or neighbours.
There were several inclusion and exclusion criteria toordata collection:
Inclusion Criteria
1. Respondents aged 60 years and above
2.
Kadazandusun ethnicity
Exclusion Criteria
1. Those elderly who are not able to give consent. For example:
a)
Cognitively
impaired
Ethics
Upon submission and reviewed of proposal, ethical approval was signed by Research
Ethics
Committee
Kampung
of
of Kampung
Faculty
older
Medicine
and permission
there will
obtained.
Sciences.
Next,
Ketua
be research conducted
With permission
data was gathered and that included
60 years and above by gender
people
Health
and
Ramayah was informed
along with ethical approval
from Ketua Kampung.
of
and helped
the total population
and race. Upon
interviewing
of
and
by
respondent as an agreement to participate in
was
signed
explanation given, consent
this research.
Data collection
for collecting
The duration
began on 31%!May 2009 until 7 July 2009 at lea n/nini
Ra, navah. Data was gathered from home to home despite of' no documentation
for
list
the
along
with
address
name
each elderly
in Kwnpung
were greeted and asked for any residents that fulfilled
for
Rununvuh. Residents
the criteria for respondents. For
those respondents who w ere able to read and write, data were collected through selfadministered
able
to
questionnaire
read
questionnaire
and
write,
method. On the other hand, respondents who were not
data
was
collected
method.
17
through
interview
administered
Instrument
The instrument used in this study was a self-administered questionnaire. It was
chosen as instrument because of its simplicity and as well as low cost instrument
instead of using high technology instrument such as polysomnorgraphy. Apart from
that, it is less time consuming. Prior to data collection, pilot test was done to test For
the reliability
coefficient
of Epworth Sleepiness Scale and the result showed
Cronbach's Alpha of 0.7.
The questionnaire consists of 7 sections: Section A-
section G-
data. section E3
measurement of body mass index (BMI):
self-rated health: Section Cself-reported
demographic
medical condition:
Section E-
lifestyle:
Section D
Section F sleep history:
--
and
Epworth sleepiness scale (ESS).
Section A contains the respondent's
demographic
level
and living arrangement.
status, educational
using I to 10 scale in which
data such as gender, age, marital
Section B contains sell=rated health
I is very poor and 10 is very good. Section C contains
the height (in meter) and weight (in kg). Section D contains 5 medical conditions
that
include hypertension, heart problem, joint pain, diabetes mellitus, and others. Section
E is divided into 2 questions pertaining to alcohol consumption
,
18ý
and cigarette smoke.