This study conducted a cognitive function screening for elderly adults living in pension institutions, and adopted the highly valid and reliable GDS as the main assessment tool for evaluating depression and its influencing factors among elderly adults without cognitive dysfunction. The findings of this study can be characterized as a good representation of the population (and thus bearing high information reliability). The conclusions drawn also have strong generalizability. The results of this study showed that the depression rate among elderly adults without cognitive dysfunction living in pension institutions in Northeastern China was 21.7%, which is much lower than that in Beijing (n = 107, 32.71%) [14] and Guangdong Province (n = 379, 38.5%) [15]. The depression rate among elderly adults with poor sleep quality was 31.1%, which was significantly higher than that among elderly adults with good sleep quality (12.3%). The results were similar to those pertaining to elderly adults living in pension institutions in Beijing [14].
Similarly, Dai and Li et al. found a significant negative correlation between sleep quality and depression [5, 14]. However, there was no study to discuss whether there were differences in depression influencing factors among the elderly with different sleep quality. This study hopes to further analyze the influencing factors of depression in the elderly with different sleep quality and provide more specific measures. The following will reveal accordingly based on sleeping quality.
For the elderly with good sleep quality, spousal support and care can reduce the incidence of depression: indeed, the incidence of depression in widowed elderly adults was significantly higher than that among married elderly adults [16]. Divorced elderly adults or those in poor marriages are also more likely to suffer from mental health problems and increased depression [17]. However, one study has shown that there was no relationship between depression and marital status [18]. It may be because the nature of the pension institution is different from that of home-based pension. Even if the elderly (in pension institution) has a spouse, they cannot be accompanied for a long time.
Regular exercise can strengthen the body and increase the opportunity to communicate with others while exercising, thereby sustaining feelings of pleasure among elderly adults [19]. However, there are some risks in physical exercise in the pension institution [20]. At present, there were also control experiments of physical exercise in the pension institutions. Although the conclusion shows that exercise can alleviate the depression of the elderly. But the sample size of the study was small and the exercise mode was only a single Taiji exercise. It can not prove the safety and effectiveness of physical exercise [21]. Therefore, this conclusion needs to be treated with caution. The implementation of physical exercise in the pension institutions requires the supervision and guidance of a professional rehabilitation team, which most of the pension institutions are lack of. In this study, various physical exercise for elder in pension institutions are carried, which include table tennis, running, dancing and etc. In the future, with the guidance of professional teams, we could carry out research focusing one form of sports.
Elderly adults who often experienced body aches had a higher risk of depression. Body aches are likely to increase discomfort among elderly adults, which in turn can affect their daily activities and increase their negative emotions. Some studies show that there is a relationship between the degree of physical pain and depression in the elderly [22]. However, others are indicating no correlation in such relationship as high tolerance of pain, reduced sensitivity to pain, and elderly people subjectively thinking the pain is the natural result of the age could also be the possibilities [23]. Nevertheless. It is essential to pay attention to the physical pain of the elderly. Meanwhile, we should encourage the elderly to honest about the pain level so that medical personnel could provide corresponding measures to release the pain. Painkiller could be provided according to the standard. Taking medication without medical advice creates risk at the same time. There are adverse reactions in the elderly after self medication [24]. We cannot encourage the elderly to use drugs blindly without the professional guidance of doctors in order to alleviate the pain. Therefore, this conclusion needs more detailed verification.
For elderly adults with poor sleep quality, loneliness is an important risk factor of depression. Insomnia can increase elderly adults’ sense of loneliness, which is likely to cause depression [14]. Similarly, chewing ability has an impact on depression among elderly adults with poor sleep quality. Therefore, we should pay close attention to the chewing ability of elderly adults. Pension institutions should provide soft food to elderly adults based on their chewing ability. These institutions should also conduct regular physical examinations of elderly adults, supervise the rational and timely use of drugs among elderly adults with chronic diseases, and formulate measures to reduce disease-related psychological burdens for elderly adults, thereby reducing the incidence of depression among elderly adults living in pension institutions. Under the present conditions in China, the majority elders choose to live at home together with their spouse or children. Only a small portion of elder Chinese are living in pension institutions. With no massive markets, pension institutions in China lack of systemic management and professional nursing staff. There is also a lack of professional guidance regarding elderly depression treatment. In such case, we need to make continuous contributions to further develop comprehensive pension instituions.
There were some limitations in our study. First, measures for some of the factors, such as smoking and chewing ability, were simplistic and broad, and therefore could have weakened our assessments of their effects. Second, although the present study was a population-based study on depression among elderly adults with different sleep quality in pension institutions in Northeastern China, it was limited by its cross-sectional design. Third, loneliness was not evaluated by the scale in the present study, and will be considered in the future. Therefore, all conclusions drawn from this study should be confirmed in a future prospective study.
In conclusion, this study is the first to assess depression among elderly adults with different sleep quality in pension institutions in Northeastern China and to clarify its associated factors. Our results revealed that the prevalence of depression differentiated among elderly adults according to their sleep quality. Marital status, chronic disease, regular exercise, body aches, filial piety, and chewing ability had considerable effects on depression among elderly adults with good sleep quality. By contrast, loneliness, self-care, chewing ability, and chronic disease had considerable effects on depression among elderly adults with poor sleep quality. Our findings suggest that there should be a focus on the maintenance of health status and psychological factors to reduce the incidence of depression among elderly adults in pension institutions.