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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. |