We slept badly but we did not take pills

A pioneering study done with older adults in Macau shows that there is a large percentage of poor sleep. The problem is aggravated because very few take pills. The authors speak of "serious attempts" to improve access to treatment in Macau

By: João Paulo Meneses 


The first study that investigated the prevalence of sleep disturbances and their correlates and associations with quality of life of older adults in Macau shows that 38.1 per cent of the participants reported at least one type of sleep disturbance. 

The results are considered “broadly consistent with the results from earlier surveys in the older adults” outside Macau. 

More problematic is the finding that only 9.9 per cent of the older adults with sleep disturbances in this study reported taking “sleeping pills.” According to the (nine) authors of the research, “the low treatment rate may be due to two reasons. There are no sleep clinics in Macau and medical practitioners less frequently inquire about sleeping problems due to the inadequate emphasis on this area in medical education.” 

But the team of researchers don’t ignore that “many Chinese older adults and their guardians may hesitate to consult clinicians for sleep disturbances because they do not regard sleep disturbances as a medical condition.” 

The work does not end without a recommendation to the care of the health authorities of Macau: “considering the harmful consequences of sleep disturbances and their low treatment rate found in Macau older adults, serious attempts should be made to diagnose sleep disturbances early and improve access to treatment in Macau.” 

The study 

The group of experts started this study with several objectives: not only “to examine the prevalence of sleep disturbances,” but also “the difficulty of maintaining sleep, and early morning awakening, their socio-demographic and clinical correlates, and quality of life in older adults in Macau.” 

The study was conducted between September and November 2015 in 11 nursing homes. All residents in the selected nursing homes “were consecutively recruited if they were aged 50 years or above, were of Chinese ethnicity, fluent in Cantonese or Mandarin languages, and were able to communicate adequately and comprehend the purpose of the study”. These were joined residents living in the community from neighbouring social centers in the same districts. 

The 451 (203 from the community and 248 from nursing who accepted to participate) answered these questions: Do you have difficulties in falling sleep? Do you have difficulties in maintaining sleep and wake up often? and Do you wake up in the midnight or early morning and have difficulties in falling sleep again? 

The results 

The frequency of difficulty initiating sleep, difficulty maintaining sleep and difficulties in falling sleep again for early morning awakening was 18.6, 31.3, 23.9 per cent respectively. Those who revealed at least one type of sleep disturbance was 38.1 per cent. Finally the number of patients with sleep disturbances reported taking “sleeping pills”: 9.9 per cent. 

The prevalence of difficulty initiating sleep was 21.1 per cent in females and 9.3 per cent in males, while the corresponding figures of difficulty maintaining sleep were 35.2 per cent and 16.6 per cent, and those of early morning awakening were 27.3 per cent and 11.4 per cent, respectively. “Women live longer than men, which may explain the differences in age and gender between the community-dwelling and nursing home samples.” 

Nine authors, five from Macau 

Prevalence of Sleep Disturbances and Their Associations With Demographic and Clinical Characteristics and Quality of Life in Older Adults in Macao was prepared by nine authors, five of them from Macau: Bernice O. C. Lam Nogueira, Lu Li, Kenny Kuok, LI-Rong Meng and Linda Tran. 

Of these five, three have links to the School of Health Sciences, Macau Polytechnic Institute: Bernice Lam is Associate Professor, LI-Rong Meng is Professor and Kenny Kuok is Lecturer. Lu Li is from Unit of Psychiatry, Faculty of Health Sciences, University of Macau and Linda Tran is Vice-President, Macao Sino-Portuguese Nurses Association. 

The remaining four authors cross points as far as Australia and the United States. 

There is also a researcher from Hong Kong and another from China (Sun Yat-Sen University, Guangzhou). 

The paper was published in Perspectives in Psychiatric Care magazine.