الفهرس 
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Abstract
The 2019 Coronavirus disease is considered one of the worst pandemics in recent centuries
that affected all individuals’ especially older adults globally and in the African region.
According to the WHO Regional Director for Africa 2020, more than 17,000 older adults aged
above 60 years lost their lives due to the COVID-19 pandemic, which represents over 50% of
the COVID-19 deaths in the African region. The World Health Organization revealed that older
adults are more likely to develop serious complications from COVID-19 infection, and their
death rates increase extremely with age. This could be attributed to several factors, such as
decreased immunity and the increased possibility of pre-existing chronic diseases, as well as a
higher level of dependence on other people to care for them due to frailty and disability.
In addition, with ageing, the higher possibility of living alone and lower psychological
resilience become more common. This situation become more worse during COVID-19 due to
the status of lockdown and the infection control precautions imposed by international and
national authorities to prevent the spread of infection. All these circumstances result in a global
atmosphere of psychological distress among older adults, such as anxiety and depression
correlated with fears of getting infected, social isolation, financial distress, and future
uncertainty.
Moreover, psychological distress and unpredicted drastic changes in daily life caused by
the COVID-19 pandemic can have detrimental impacts on sleep quality and cause difficulty
falling asleep or maintaining sleep. On The other hand, sleep deprivation makes older adults
more emotionally aroused and sensitive to stressful events caused by the COVID-19 pandemic.
Thus, special concern is needed by gerontological nurses to investigate the association between
them to decrease the consequences of psychological distress and poor sleep quality among
community-dwelling older adults and improve their quality of life during COVID-19.
The aim of this study was to:
- Identify the relationship between psychological distress and sleep quality among
community dwelling older adults during Covid-19 pandemic.
Materials and Method
Research design:
- Descriptive correlational research design was followed in the present study.
Setting:
- The study was conducted at four Alexandria post offices, namely El-Mandara,
El-Mansheya, Muharram Beck, and Toson, which are affiliated to the Ministry of
Communications and Information Technology, Egypt.
Subjects:
- A convenient sample of 230 community dwelling older adults were included in the
present study, aged 60 years and above, able to communicate effectively, accepted to
participate in the study, and those who were available in the selected post offices at the time of the data collection.
Tools of the study:
Five tools were used for data collection
Tool I: Older adult`s socio-demographic and health profile structured
interview schedule.
The researcher developed this tool, to assess Socio-demographic characteristics
of the study subjects and their health.
Tool II: Kessler psychological distress scale (k10)
This tool was developed by Kessler et al., (2002). It is a self-reported scale to measure
psychological distress which used to identify those who need further assessment for anxiety
and depression.
Tool III: Pittsburgh Sleep Quality Index (PSQI)
The Pittsburgh Sleep Quality Index (PSQI) was developed by Buysse et al. (1989) to assess
sleep quality and disorders within the past month.
Tool IV: Coronavirus Anxiety Scale (CAS)
This tool was developed by Sherman (Lee, 2020). It is a 5- item scale to assess
dysfunctional anxiety associated with the coronavirus crisis.
Tool V: Geriatric Depression Scale shortened form (GDS-SF)
This scale was developed by Yesavage et al., (1982), and it consists of 15 statements to
assess the presence of depression in older adults.
Method
- Approval from the Ethical Committee, the Faculty of Nursing, and Alexandria University
to conduct the study was obtained. Also, official permissions to conduct the study were
obtained from the director of the General Administration of the Alexandria Postal District
and the directors of the selected post offices after explaining the purpose of the study.
- Tool I, Socio-demographic and Health Profile Structured Interview Schedule was
developed by the researcher to assess socio-demographic and clinical data of the study
subjects.
- Tool II, Kessler Psychological Distress Scale (K10), was translated by the researcher into
an Arabic and tested for its content validity and reliability
- The Arabic versions of Tool III (Pittsburgh Sleep Quality Index), Tool IV (Coronavirus
Anxiety Scale) and Tool V (Geriatric Depression Scale Shortened Form) were used in this
study to assess sleep quality and dysfunctional anxiety associated with the coronavirus
crisis, and depression respectively.
- A pilot study was carried out on 10% of the study subjects and they were not included in the study sample.
- The study subjects who fulfilled the inclusion criteria were interviewed individually by the
researcher in the waiting area of the post office either before or after receiving their
pension. The time of data collection ranged from the first of April 2022 to mid of August
2022.
The main results revealed from the study were as follows:
- The age of the study subjects ranged from 60 up to 83 years, with a mean age of 68.32 ± 6.08
years. More than half 53% of the study subjects were males, and 54.8% were married. Illiteracy
was prevailing among 27.4% of the study subjects, while 5.7% were able to read and write,
22.2% completed primary education, 22.6% ended secondary and 22.2% graduated from
university education.
- Regarding occupation prior to retirement, most of the study subjects were employees 37.0%,
as well most of them 84.3% did not have current work, and 63.5% had inadequate income.
- The majority of the study subjects 79.1% had chronic diseases and consumed prescribed drugs,
while 65.7% consumed non-prescribed drugs. In addition, around one-third of the study
subjects 30.9% had a previous history of hospitalization.
- It was reported that 80.4% of the study subjects suffered from psychological problems due to
the COVID-19 pandemic. Also, they reported mean percent score of psychological distress as
29.18 ± 15.40.
- As regards overall sleep quality, more than three-quarters 78.7% of the study subjects were
bad sleepers during the COVID-19 pandemic, while one-fifth 21.3% of them were good
sleepers, with a mean percent of 38.90±19.94. Concerning sleep domains, the highest mean
percent score of sleep problems is related to the daytime dysfunction 58.12 ± 29.87, while the
least affected sleep domain is the use of sleeping medication domain with mean 4.35 ±13.95.
- Low levels of dysfunctional coronavirus-related anxiety were reported by 92.2% of the study
subjects, while 7.8% reported high levels of dysfunctional coronavirus-related anxiety, with a
total mean percent of 18.91± 16.51. Although, 35.2% of the study subjects reported no
depression, 29.1% of them reported mild depression, moderate depression (20.9%), and severe
depression 14.8%, with a total mean percent of 45.16 ± 26.23.
- Highly significant positive correlations were observed between overall sleep quality and its
subdomains among study subjects and psychological distress, COVID-19 related anxiety, and
depression. This means that the higher levels of psychological distress, COVID-related anxiety,
and depression, the higher levels of sleep problems among the study subjects P<0.001.
- A statistically significant association was found between the presence of chronic diseases
among the study subjects and poor sleep quality U = 3040.0, P = 0.001. Also, there was a
statistically significant relationship between the consumption of drugs either prescribed or nonprescribed
among the study subjects and poor sleep quality U = 3040.0, P = 0.001, U = 4820.50,
P = 0.017, respectively.
- There were statistically significant relationships between the mean of psychological distress,
overall sleep quality among study subjects and their socio-demographic characteristics, such as
gender p=0.011, p=0.001, marital status p=0.003, p <0.001, level of education p <0.001, p=
0.002 and occupation prior to retirement p<0.001, p= 0.001 respectively.
- Also, a statistically significant relationship was observed between the mean of COVID-19-
related anxiety and some aspects of the study subjects’ socio-demographic characteristics, such as gender p<0.001, marital status p<0.001, and occupation prior to retirement p=0.008.
Furthermore, a statistically significant relationship was observed between the mean of
depression and some aspects of the study subjects’ socio-demographic characteristics, such as
age p= 0.007, gender p=0.002, marital status p <0.001, level of education p<0.001, occupation
prior to retirement p<0.001, and current work status p=0.007.
Conclusion:
Based on the results of the present study, it can be concluded that a statistically significant
relationships were found between psychological distress, COVID-related anxiety, depression
and sleep quality among community dwelling older adults during Covid-19 pandemic. For
illustration, the higher the levels of psychological distress, COVID-related anxiety, and
depression among community-dwelling older adults during the COVID-19 pandemic, the
higher the levels of sleep problems. Also, personal factors like age, gender, marital status, level
of education, and occupation prior to retirement were found to be significant predictors of
psychological distress and poor sleep quality during the period of the COVID-19 pandemic.
In the light of the current study findings, the following recommendations are
suggested:
– Gerontological nurses should use valid tools to assess psychological distress, anxiety, and
depression among older adults in order to identify those who are at higher risk of
developing psychological disorders.
– Sleep patterns should be monitored continuously by gerontological nurses to determine
those who are bad sleepers and implement measures to enhance sleep quality among older
adults.
– In service training programs should be conducted by gerontological nurses to all health
team and nursing staff who care for older adults about the role of psychological status
during disaster in sleep quality among older adults and how to control this relation through
suitable nursing interventions.
Recommendations for further studies:
• A descriptive study to identify several coping strategies as moderating factor in the
relationship between perceived stress and sleep quality in older adults during the COVID-
19 pandemic.
• Effect of nursing educational program on psychological distress and sleep quality among community-dwelling older adults during COVID-19 pandemic.