Prevalence and factors associated with Insomnia among Older Persons Attending Medical Outpatient Clinics at Mulago Hospital

Abstract

Background: Chronic sleep problems are very common among older persons with insomnia being the most common. It is often under-diagnosed and is often a symptom of other health problems. The population of older persons in Uganda is rapidly increasing with expectation to double to 2.5 million by 2040 hence raising need to address their concerns. Studies have documented the association between insomnia and aging. There are changes in the sleep pattern as people age, with increasing prevalence of insomnia hence need to raise concern. Insomnia among older persons results in daytime distress and impairment often accompanied by depression, anxiety and cognitive changes which are all associated with a reduced quality of life and increased mortality. Objective: This study is aimed to determine the prevalence and factors associated with insomnia among older persons attending medical outpatient clinics at Mulago Hospital. Methods: This was across sectional study that involved participants aged 60 years and above attending the medical outpatient clinic at Mulago Hospital. Using systematic random sampling, we enrolled every third older person presenting to the clinics that met the inclusion criteria until a sample size of 385 was achieved. After informed consent, a socio demographic questionnaire was used to collect social demographic data. Screening for insomnia was done using the insomnia-screening questionnaire and insomnia was identified using the insomnia severity index. Data was analyzed using SPSS version 25. Dependent variable was insomnia and the independent variables were social demographic, environmental, behavioral factors and biological factors. Results: The prevalence of insomnia illness among those aged 60 years and above was 33.5% (95% CI) using the Insomnia Severity Index. Insomnia was significantly associated with education level, alcohol use for sleep, social support, diabetes mellitus, arthritis and sleep apnea. Older persons with low education level (OR: 0.422, 95%CI: 0.229-0.777), no alcohol use for sleep (OR: 0.085; 95%CI: 0.006-1.156) and low perceived social support (OR: 0.220:95%CI: 0.125-0.385) were more likely to develop insomnia. Older persons with diabetes mellitus (OR: 0.377:95%CI: 0.204-0.696), arthritis (OR: 0.457:95%CI: 0.250-0.835) and sleep apnea (OR: 0.231:95%CI: 0.130-0.411) were also more likely to develop insomnia. Conclusion: The prevalence of insomnia in older persons was found to be significant at 33.5% and was associated with low education level, not using alcohol for sleep, low perceived social support, diabetes mellitus, arthritis and sleep apnea. Insomnia should be screened and managed among older persons.