A descriptive cross-sectional study was conducted in all (n = 20) elderly homes in the Galle district of Sri Lanka which were registered under the Social Services Department from August 2019 to November 2019. Ethical approval for the study was obtained from the Ethical Review Committee of the Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka. All the institutions for the elderly people in the Galle District were selected for the study. All the elders 60 years and older and who were living in elderly homes for more than a year at the time of the study, were recruited by using a convenience sampling method. Elders who were living in an elderly home for less than 1 year, aged less than 60 years, those who were diagnosed with neurological illnesses, major psychiatric illnesses, depression and malignancy were excluded from the study after confirming with the diagnosis card or inquiring about the past medical history and long-term drug treatment that they were on. Subjects who are bedridden and severely ill and subjects with severe visual or hearing impairment were also excluded from the study after individual assessment by the investigator. Informed written consent was obtained from each of the participants who were willing to participate in the study.
In this study all the data were obtained through face-to-face interviews by the investigator using a pretested interviewer administered questionnaire. There were 05 Tamil nationals in the study sample and they were fluent in Sinhala since Galle district is mostly a Sinhala language speaking area. Data on basic information including socio demographic data, education, substance usage, satisfaction about the elderly home, period of stay and details on health condition were collected.
When data was collected, there were 23 elderly homes in Galle District registered under the Social Service Department [19]. One elderly home was closed by the time of data collection, one elderly home was reserved for Buddhist clergy and one for mentally handicap elders. Permission was not granted to collect data from the elderly home reserved for Buddhist clergy and data collection from the home for mentally handicap elders was omitted. Therefore, all the remaining 20 elderly homes were included in the study. Based on exclusion criteria,78 subjects were excluded from the study. Therefore 324 eligible subjects were identified and of those 310 subjects consented to participate in the study.
Data on depression was collected using the validated Sinhala form of the short version of Geriatric Depression Scale (GDS) [20, 21]. The short version of GDS consists of 15 items and it indicated the presence of depression when answered positively while the rest of the questions (numbers 1, 5, 7, 11, 13) indicated depression when answered negatively. Depending on age, education and complaints, scores of 0–4 are considered normal, 5–8 indicate mild depression, 9–11 indicate moderate depression and 12–15 indicate severe depression. The validated Sinhala version of GDS was found to have 73.3% of sensitivity and specificity when evaluated against diagnostic criteria [21].
Validated Sinhala version of Pain Catastrophizing Scale (PCS) [22, 23] was used to collect data about physical and psychological pain. PCS is used to quantify the catastrophic thinking related to pain. The PCS instructions ask participants to reflect on past painful experiences, and to indicate the degree to which they experienced each of 13 thoughts or feelings when experiencing pain, on 5-point scales with the end points 0 = not at all and 4 = all the time. The PCS yields a total score and three subscale scores assessing rumination, magnification and helplessness. The PCS total score is computed by summing responses to all 13 items. PCS total scores range from 0 to 52 and > 20 of score indicates a considerable catastrophizing pain. The PCS subscales are computed by summing the responses to the following items: Rumination: Sum of items 8, 9, 10 and 11, Magnification: Sum of items 6, 7 and 13, Helplessness: Sum of items 1, 2, 3, 4, 5, and 12.
Pittsburgh Sleep Quality Index (PSQI, validated Sinhala version) [24] was used to collect data on sleep of the elders and for both validated Sinhala versions were used. PSQI is a widely used standardized instrument to assess sleep quality in clinical and research settings. It was developed as a standardized measure of sleep quality which can be used in clinical practice. The PSQI assesses sleep quality during the previous month. It consists of 19 self-rated questions which are scored to obtain a total score. The 19 items are grouped into seven components which are added to give the total score. The range of score is 0–21. Higher scores indicate worse sleep quality. The validated Sinhala version of PSQI has good internal consistency (Cronbach’s alpha = 0.85).
In data analysis, descriptive data were presented as mean and standard deviation (SD) or median unless stated otherwise. Frequencies and crosstabs were used to assess the prevalence of depression, catastrophizing pain and sleep disorders as numerical and categorical variables. Pearson’s bivariate correlation model was used when examining the association between depression and other variables recorded as continuous numerical variables. Pearson’s Chi square test was used to detect differences in categorical variables. Two-tailed p value less than 0.05 was considered as the level of statistical significance (p < 0.05).