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The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults
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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults

Ahrin Kim1, Oksoo Kim2
Korean Journal of Adult Nursing 2015;27(2):211-222.
Published online: April 30, 2015

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Corresponding author: Kim, Ahrin Department of Nursing, Cheongju University, 298 Daeseong-ro, Cheongwon-gu, Cheongju 363-764, Korea. Tel: +82-43-229-7932, Fax: +82-43-229-8969, E-mail: arkim@cju.ac.kr
• Received: January 19, 2015   • Accepted: April 11, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to test the model for sleep in community-dwelling older adults. The hypothetical model basedonasenescent sleepmodel was constructedusingthemultipleinfluencingfactorsof sleep and associated adverse outcomes of changes in sleep in the older adults.
  • Methods
    Data were collected from 203community-dwellingolderadultslivinginKorea, andanalyzedusingIBM SPSS21.0andAMOS21.0.
  • Results
    Increased ageandmultiplecomorbidities wereassociatedwithdecreasedphysical activities. Decreasedphysical activities were associatedwithsmaller social networks, and smaller social networks were associatedwithhigher level of loneliness. Multiple comorbidities, decreased physical activities, larger social networks, and higher level of loneliness were associated with maladaptive sleep hygiene. Decreased physical activities, higher level loneliness, andshorter actual sleepdurationwere associated with worse sleepquality. Smaller social networks and shorter actual sleepdurationwereassociatedwithlower cognitivefunctions. Smallersocial networks, higher loneliness, andworse sleepqualitywere associatedwithmoreseveredepressivesymptoms.
  • Conclusion
    These findings suggest that the sleepimprovement interventions not onlywithphysical perspectives but psychosocial ones for older adults may improve depressive symptoms as well as sleep quality.
  • Key Words: Aged; Sleep; Cognition; Depression
Figure 1.
Conceptual model for sleep in community-dwelling older adults.
kjan-27-211f1.jpg
Figure 2.
Path diagram for the final model.
kjan-27-211f2.jpg
Table 1.
Descriptive Statistics of the Observed Variables (N=203)
Variables Categories M±SD Range Skewness Kurtosis
Sleep Sleep duration (minutes) 405.10±86.64 171.67~685.33 0.36 0.47
Sleep quality 9.23±3.67 2~18 0.30 -0.52
Influencing factors of sleep Age (year) 75.86±6.06 65~91 0.26 -0.29
Comorbidity 1.05±0.96 0~5 0.87 0.95
Physical activity 730.07±1,083.21 0~7,144 2.95 10.40
(MET-min per week)        
Social network 10.61±6.28 0~26 0.20 -0.92
Loneliness 41.44±11.03 20~75 0.38 -0.19
Sleep hygiene 22.65±5.98 13~44 0.99 0.80
Adverse outcomes of changes in sleep Cognitive function 25.39±3.48 12~30 -1.06 1.51
Depression 4.99±4.07 0~14 0.47 -0.99
Table 2.
Comparison of Model Fit for the Modified Model to the Hypothetical Model
Fit Index x2 (p) df Normed x2 SRMR GFI IFI CFI RMSEA
Modified model (final model) 40.37 (.014) 23 1.76 .07 .97 .94 .94 .06
               
Hypothetical model 28.598 (.001) 10 2.86 .04 .98 .94 .93 .10
Acceptable criteria p .01 ＞   2~3 ＜ .10 ＜ .90 ＞ .90 ＞ .90 ＞ .05: Excellent ≤ .05~.08: Good
              .08~.10: Moderate

Df=degree of freedom; SRMR=standardized root mean square residual; GFI=goodness fit Index; IFI=incremental fit index; CFI=comparative fit index; RMSEA=root mean square error approximation.

Table 3.
Path Coefficients and Standardized Direct, Indirect, and Total Effect for the Final Model (N=203)
Endogenous variables Exogenous variables β t p SMC Standardized direct effect (p) Standardized indirect effect (p) Standardized total effect (p)
Comorbidity Age .14 2.19 .029 .02 .14 (.095)   .14 (.095)
Physical activity Age -.20 -3.06 .002 .09 -.20 (.046) -.03 (.041) -.23 (.030)
Comorbidity -.19 -4.18 ＜.001   -.19 (.025)   -.19 (.025)
Social network Comorbidity -.16 -3.23 .001 .10 -.16 (.169) -.05 (.012) -.21 (.085)
Physical activity .23 4.21 ＜.001   .23 (.017)   .23 (.017)
Loneliness Social network -.66 -13.30 ＜.001 .43 -.66 (.034)   -.66 (.034)
Sleep hygiene† Comorbidity -.23 -3.70 ＜.001 .22 -.23 (.014) -.02 (.526) -.25 (.009)
Physical activity .31 6.08 ＜.001   .31 (.016) -.05 (.016) .26 (.038)
Social network -.39 -4.36 ＜.001   -.39 (.023) .19 (.099) -.20 (.063)
Loneliness -.29 -4.16 ＜.001   -.29 (.077)   -.29 (.077)
Sleep duration Physical activity -.12 -2.80 .005 .01 -.12 (.440)   -.12 (.440)
Sleep quality† Physical activity .20 3.85 ＜.001 .21 .20 (.013) .07 (.141) .27 (.005)
Loneliness -.31 -5.50 ＜.001   -.31 (.015) -.04 (.298) -.35 (.013)
Sleep hygiene .15 2.29 .022   .15 (.342)   .15 (.342)
Sleep duration .14 2.39 .017   .14 (.011)   .14 (.011)
Cognitive function Age -.14 -2.24 .025 .24 -.14 (.147) -.06 (.031) -.21 (.041)
Physical activity .20 4.12 ＜.001   .20 (.072) .05 (.106) .25 (.038)
Social network .31 4.28 ＜.001   .31 (.010)   .31 (.010)
Sleep duration .21 3.16 .002   .21 (＜ .001)   .21 (＜ .001)
Depression Social network -.33 -4.84 ＜.001 .42 -.33 (.002) -.22 (.045) -.56 (.001)
Loneliness .29 4.06 ＜.001   .29 (.072) .06 (.056) .35 (.025)
Sleep quality -.17 -2.98 .003   -.17 (.045)   -.17 (.045)

x2=40.37 (df=23, p=.014), Normed x2=1.76, SRMR=.07, GFI=.97, IFI=.94, CFI=.94, RMSEA=.06; β=standardized regression weight; t=estimate for path coefficients; SMC=squared multiple correlation (R2);

†Reverse coded

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    The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults
    Korean J Adult Nurs. 2015;27(2):211-222.   Published online April 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.2.211
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    The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults
    Korean J Adult Nurs. 2015;27(2):211-222.   Published online April 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.2.211
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    The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults
    Image Image
    Figure 1. Conceptual model for sleep in community-dwelling older adults.
    Figure 2. Path diagram for the final model.

    Figure 1.

    Figure 2.

    The Path Model based on Senescent Sleep Model for Sleep in Community-dwelling Older Adults

    Descriptive Statistics of the Observed Variables (N=203)

    Variables Categories M±SD Range Skewness Kurtosis
    Sleep Sleep duration (minutes) 405.10±86.64 171.67~685.33 0.36 0.47
    Sleep quality 9.23±3.67 2~18 0.30 -0.52
    Influencing factors of sleep Age (year) 75.86±6.06 65~91 0.26 -0.29
    Comorbidity 1.05±0.96 0~5 0.87 0.95
    Physical activity 730.07±1,083.21 0~7,144 2.95 10.40
    (MET-min per week)        
    Social network 10.61±6.28 0~26 0.20 -0.92
    Loneliness 41.44±11.03 20~75 0.38 -0.19
    Sleep hygiene 22.65±5.98 13~44 0.99 0.80
    Adverse outcomes of changes in sleep Cognitive function 25.39±3.48 12~30 -1.06 1.51
    Depression 4.99±4.07 0~14 0.47 -0.99

    Comparison of Model Fit for the Modified Model to the Hypothetical Model

    Fit Index x2 (p) df Normed x2 SRMR GFI IFI CFI RMSEA
    Modified model (final model) 40.37 (.014) 23 1.76 .07 .97 .94 .94 .06
                   
    Hypothetical model 28.598 (.001) 10 2.86 .04 .98 .94 .93 .10
    Acceptable criteria p .01 ＞   2~3 ＜ .10 ＜ .90 ＞ .90 ＞ .90 ＞ .05: Excellent ≤ .05~.08: Good
                  .08~.10: Moderate

    Df=degree of freedom; SRMR=standardized root mean square residual; GFI=goodness fit Index; IFI=incremental fit index; CFI=comparative fit index; RMSEA=root mean square error approximation.

    Path Coefficients and Standardized Direct, Indirect, and Total Effect for the Final Model (N=203)

    Endogenous variables Exogenous variables β t p SMC Standardized direct effect (p) Standardized indirect effect (p) Standardized total effect (p)
    Comorbidity Age .14 2.19 .029 .02 .14 (.095)   .14 (.095)
    Physical activity Age -.20 -3.06 .002 .09 -.20 (.046) -.03 (.041) -.23 (.030)
    Comorbidity -.19 -4.18 ＜.001   -.19 (.025)   -.19 (.025)
    Social network Comorbidity -.16 -3.23 .001 .10 -.16 (.169) -.05 (.012) -.21 (.085)
    Physical activity .23 4.21 ＜.001   .23 (.017)   .23 (.017)
    Loneliness Social network -.66 -13.30 ＜.001 .43 -.66 (.034)   -.66 (.034)
    Sleep hygiene† Comorbidity -.23 -3.70 ＜.001 .22 -.23 (.014) -.02 (.526) -.25 (.009)
    Physical activity .31 6.08 ＜.001   .31 (.016) -.05 (.016) .26 (.038)
    Social network -.39 -4.36 ＜.001   -.39 (.023) .19 (.099) -.20 (.063)
    Loneliness -.29 -4.16 ＜.001   -.29 (.077)   -.29 (.077)
    Sleep duration Physical activity -.12 -2.80 .005 .01 -.12 (.440)   -.12 (.440)
    Sleep quality† Physical activity .20 3.85 ＜.001 .21 .20 (.013) .07 (.141) .27 (.005)
    Loneliness -.31 -5.50 ＜.001   -.31 (.015) -.04 (.298) -.35 (.013)
    Sleep hygiene .15 2.29 .022   .15 (.342)   .15 (.342)
    Sleep duration .14 2.39 .017   .14 (.011)   .14 (.011)
    Cognitive function Age -.14 -2.24 .025 .24 -.14 (.147) -.06 (.031) -.21 (.041)
    Physical activity .20 4.12 ＜.001   .20 (.072) .05 (.106) .25 (.038)
    Social network .31 4.28 ＜.001   .31 (.010)   .31 (.010)
    Sleep duration .21 3.16 .002   .21 (＜ .001)   .21 (＜ .001)
    Depression Social network -.33 -4.84 ＜.001 .42 -.33 (.002) -.22 (.045) -.56 (.001)
    Loneliness .29 4.06 ＜.001   .29 (.072) .06 (.056) .35 (.025)
    Sleep quality -.17 -2.98 .003   -.17 (.045)   -.17 (.045)

    x2=40.37 (df=23, p=.014), Normed x2=1.76, SRMR=.07, GFI=.97, IFI=.94, CFI=.94, RMSEA=.06; β=standardized regression weight; t=estimate for path coefficients; SMC=squared multiple correlation (R2);

    †Reverse coded
    Table 1. Descriptive Statistics of the Observed Variables (N=203)

    Table 2. Comparison of Model Fit for the Modified Model to the Hypothetical Model

    Df=degree of freedom; SRMR=standardized root mean square residual; GFI=goodness fit Index; IFI=incremental fit index; CFI=comparative fit index; RMSEA=root mean square error approximation.

    Table 3. Path Coefficients and Standardized Direct, Indirect, and Total Effect for the Final Model (N=203)

    x2=40.37 (df=23, p=.014), Normed x2=1.76, SRMR=.07, GFI=.97, IFI=.94, CFI=.94, RMSEA=.06; β=standardized regression weight; t=estimate for path coefficients; SMC=squared multiple correlation (R2);

    Reverse coded

    Table 1.

    Table 2.

    Table 3.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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