Author Guideliness – Nutrix Journal 1

THE RELATIONSHIP OF QUALITY SLEEP WITH COGNITIVE

FUNCTIONS IN THE ELDERLY IN BPSLUT
SENJA CERAH MANADO
1 2
Irene Hutagalung , Priscillia Merylin Saluy

1. Student, Faculty of Nursing, Klabat University, Jl. Arnold Mononutu, Minahasa Utara 95371, Indonesia
2. Lecturer, Faculty of Nursing, Klabat University, Jl. Arnold Mononutu, Minahasa Utara, 95371, Indonesia

E-mail: irenehutagalung22@gmail.com psaluy@yahoo.com

Abstract

The Elderly is someone who has reached the age of more than 60 years. At the attainment of old age, a person will
experience several changes, namely the process of slowly disappearing the ability of the tissue to repair itself, while
maintaining normal function so that it cannot survive infection and repair damage. The purpose of this study was to
determine whether there was a significant relationship between sleep quality and cognitive function among the
elderly at BPSLUT Manado. This research type is the descriptive correlation with cross-sectional approach. 56
elderly as respondents in this study were selected through purposive sampling. Data were collected using a
questionnaire and analyzed using the Spearmen Correlation test. After analyzing the data, it was found that the
value of P-value = 0.172>0.05, so it could be concluded that there was no significant relationship between sleep
quality and cognitive function. The results of tests conducted on the elderly with good sleep quality (19.6%). For
cognitive function is (67.9%) had a severe dementia. Based on the results, the researchers recommended that the
elderly management department of BPSLUT Senja Cerah Manado pay more attention to aspects that support the
improvement of cognitive function in the elderly so that they do not decline. Recommendations are also for future
researchers to pay more attention to aspects that support improving cognitive function in the elderly so that they do
not decline.

Keywords: Sleep Quality, Cognitive Function, Elderly.

Abstrak

Lansia adalah seseorang yang telah mencapai usia lebih dari 60 tahun. Pada pencapaian usia lanjut ini seseorang
akan mengalami beberapa perubahan yaitu proses menghilangnya secara perlahan kemampuan jaringan untuk
memperbaiki diri, sekaligus mempertahankan fungsi normal sehingga tidak dapat bertahan terhadap infeksi dan
memperbaiki kerusakan. Tujuan dari penelitian ini adalah untuk mengetahui apakah ada hubungan yang signifikan
antara kualitas tidur dengan fungsi kognitif pada lansia di BPSLUT Manado. Jenis penelitian ini adalah desktiptif
korelasi dengan pendekatan cross sectional. 56 lansia menjadi responden dalam penelitian ini yang dipilih melalui
purposive sampling. Data dikumpulkan menggunakan kuesioner dan dianalisis menggunakan uji Spearmen
Correlation. Setelah dilakukan analisis data didapatkan nilai Pvalue = 0,172>0,05 sehingga bisa disimpulkan
bahwa tidak ada hubungan yang signifikan antara kualitas tidur dengan fungsi kognitif. Hasil uji yang dilakukan
pada lansia dengan kualitas tidur baik yaitu (19.6%). Untuk fungsi kognitif yaitu (67,9%) memiliki penurunan daya
ingat yang berat. Berdasarkan hasilnya peneliti merekomendasikan kepada bagian pengurus lansia BPSLUT Senja
Cerah Manado untuk lebih memperhatikan aspek-aspek yang mendukung peningkatan fungsi kognitif pada lansia
agar tidak menurun. Rekomendasi juga bagi peneliti selanjutnya untuk lebih memperhatikan aspek-aspek yang
menunjang untuk meningkatkan fungsi kognitif pada lansia agar tidak semakin menurun.

Kata Kunci: Kualitas Tidur, Fungsi Kognitif, Lansia.

Author Guideliness – Nutrix Journal
Introduction
The Elderly is someone who has reached the age of more
than 60 years, the age classification is categorized as
middle aged elderly aged 45 to 59 years, pre-elderly
aged 60 to 74 years, elderly aged 75 to 90 years, very old
age over 90 years. At the attainment of old age, a person
will experience several changes, namely the process of
slowly disappearing the ability of the tissue to repair
itself, while maintaining normal function so that it
cannot survive the infection and repair the damage
suffered (Maryam, 2012). World Health Organization
(WHO) there were 600 million elderly people in 2012
worldwide. The results of population data for 2010 show
that the number of elderly people in Indonesia will
continue to increase by around 450 thousand people
every year (Badan Pusat Statistik, 2015).
Based on their age, most of the elderly in Indonesia are
young elderly aged 60-69 with a total of 10.75 million
people. The number of elderly people who are over 60
years old is estimated to increase to 27.1 million in 2020,
and in 2025 to 33.7 million people, and most recently in
2035 there will be 48.2 million elderly people
(Kemenkes, 2017).
An elderly person will experience various changes that
occur in him, one of which is sleep patterns. The elderly
will have difficulty sleeping at night and they will
replace their nighttime sleep with sleeping during the day
(Sunaryo, 2013). Most elderly who have problems
starting to sleep, and are often awake at night without
cause, will feel tired when they wake up in the morning
(Dewi, 2014). Sunaryo (2013) states that if the
fulfillment of sleep in the elderly is not fulfilled, it will
have an impact on disorders such as physical fatigue and
mental stress, dull skin, depression, cardiovascular
disease, diabetes, and decreased cognitive abilities. In
this condition, it will worsen the cognitive function of the
elderly. Insufficient sleep quality in the elderly will cause
damage to memory and cognitive abilities, so if this
continues to occur it will have an impact on high blood
pressure, stroke, heart attack, and even psychological
problems and even depression (Potter & Perry, 2012).
Cognitive can be defined as someone's belief about
something that is obtained from the thought process. The
thought process begins with acquiring knowledge and
then processes that knowledge through memory,
understanding, assessing, imagining and speaking
(Agustina, 2014). According to Wreksoatmodjo (2014),
there is a disturbance in cognitive function that begins
with memory deterioration such as forgetfulness (Forget
Fulnes), which is the mildest cognitive disorder, which
can then progress to mild cognitive impairment (Mild
Cognitive Impairment-MCI) at this stage a person will
experience short-term memory, and activity levels that
begin to decline. Then those who experience severe
cognitive. impairment or dementia are someone who has
memory problems now and in the past, disorientation,
impaired perception, even difficult for someone to be
part of their family. In general, someone who enters the
elderly experiences a decline, especially in cognitive
2
function which affects the psychosocial aspects related
to the personality state in the elderly. The decline
associated with aging is shown in short-term memory,
working memory and long-term memory (Agronin &
Maletta, 2011).
The purpose of this research is to see is there a
significant relationship between sleep quality with
cognitive function in the elderly at BPSLUT Senja Cerah
Manado. In this study, researchers took the nursing
theory proposed by Virginia Handerson. Handerson
views humans as individuals who need help to achieve
health, freedom or peaceful death, as well as help to gain
independence. The theory he put forward consists of 14
basic needs, but researchers only take one of the basic
needs, namely regarding sleep and rest. The sleep cycle
in the elderly was classified according to the amount of
time the elderly spent awake to sleep, as well as the total
sleep quality. Increasing age can affect the quality of
sleep and the quantity of rest. The inability to start
sleeping is a problem that is often complained of by the
elderly.
Initial data collection was carried out on September 11
2019, at the Social Service Center for Displaced Aged
Senja Cerah Manado, there were 56 elderly, as well as
45 elderly who live in nursing homes. One of the
orphanage managers said that there were elderly people
who felt problems and disturbances during sleep, some
were taking sleeping pills, and their memory function
was disturbed. In connection with the previous problem
statement, the researcher is interested in conducting a
study entitled "The Relationship between Sleep Quality
and Cognitive Function".
Methods
The research method used is the descriptive correlation
with a cross-sectional approach, namely research
conducted by collecting data on the independent variable
and the dependent variable simultaneously at a certain
time (Masturoh & Anggita, 2018). The variables to be
studied were classified into two, namely the independent
variable (sleep quality) and the dependent variable
(cognitive function). The sampling method used by
researchers in the research to be carried out was
purposive sampling, the number of samples in this study
was 56 elderly. In this method, the elderly do not have
the same opportunity to be sampled because researchers
will take samples based on inclusion and exclusion
criteria. The inclusion criteria in this study were all
elderly BPSLUT Senja Cerah who were present and
participated in the research and information information.
The exclusion criteria in this study were the elderly
BPSLUT Senja Cerah who could not attend the study,
and the elderly who refused to participate in this study.
The instrument in this study was to use a questionnaire
to determine sleep quality which was adopted from the
Pittsburgh Sleep Quality Index (PSQI) questionnaire by
Buysee (1989) but researchers collected sleep quality
data for the elderly using the Indonesian version
developed by Sukmawati (2019), where the PSQI
questionnaire consists of 19 questions which have 4
 Author Guideliness – Nutrix Journal 3

Results
open-ended questions, and 15 questions with answers on
an ordinal scale. Questions 5a - 5i have a scale: never, This section discusses the analysis of the data that had
once a week, twice a week, and ≥ 3 times a week, been processed using the SPSS application to provide
meanwhile questions 6 - 9 have an ordinal scale with information from the results of the study that had been
response types vary. All 19 items this question measures done on the elderly at Panti Werdha BPSLUT Senja
7 components: ie (1) Subjectively calculated sleep Cerah Manado.
quality based on question no 6; (2) sleep latency which is
calculated based on the sum of the scores questions 2 Table 1. Distribution of Sleep Quality
and 5a; (3) sleep duration measured based on question
no 4; (4) long effective sleep in the measured bed Frequency Percent
questions nos. 1,3, and 4; (5) sleep disturbances as (F) (%)
measured based on questions 5b - 5j; (6) measured use of
sleeping pills based on question no 7; and (7) distraction Poor 1 1.8
the concentration in daylight is measured by questions 8
Good 11 19.6
and 9. Overall components The PSQI questionnaire has a
score ranging from 0-21. Minimum score = 0 (good), Total 56 100.0
maximum score = 21 (bad). With total interpretation, if
the value is ≤5 = good sleep quality and if the value> 5 =
poor sleep quality. Table 1 shows that the good sleep quality experienced by
the elderly at BPSLUT Manado is 11 (19.6%), and those
While the second questionnaire to measure cognitive who experience poor sleep quality are 1 (1.8%). This
function in the elderly is the Mini-Mental State data shows that most of the elderly at BPSLUT Senja
Examination (MMSE) which was adopted from Folstein Cerah Manado have good sleep quality.
in (1975). it can be said to be normal if the score reaches
24 to 30 points, and if the score <24 can be said to have Table 2. Distribution according to cognitive function.
impaired cognitive function. . The score is calculated
based on the actual answer from the patient. The Frequency Percent
researcher must not give a score based on assumptions or Criteria
(F) (%)
the patient's correct answer based on these assumptions.
For example in depressed patients, researchers should
not think that in depression there is a decrease in Normal 7 12.5
concentration so that the patient has difficulty
calculating, then this affects the score given to the Moderate 11 19.6
patient. Each question is asked a maximum of 3 times. If Severe
38 67.9
the patient does not respond after being asked 3 times, dementia
give him zero. If the patient answers incorrectly, give a Total 56 100.0
score of zero and the question does not need to be
repeated. Table 2 shows that 38 elderly (67.9%) with severe
dementia and 11 (19.6%) elderly with moderate
In this study, the data collection process was obtained by dementia, and for normal dementia 7 (12.5%). This data
making observations by interviewing several elderly shows that most of the elderly in BPSLUT Senja Cerah
people. The data procedure in this study is that the Manado have severe memory impairment.
researcher makes a permit application letter to the
Nursing Faculty of Klabat University with the aim of Table 3. Relationship between Sleep Quality and Cognitive
visiting the BPSLUT Senja Cerah Manado nursing Function.
home, obtaining a research approval letter by the Dean
of the Faculty of Nursing, Klabat University, obtaining P-value Interpretation
permission from the nursing department of BPSLUT 0,172
Senja Cerah Manado to conduct research. Furthermore,
asking for the consent of research respondents (elderly) Sleep Quality No sicnificant
by giving informed consent and distributing
questionnaires to respondents who have provided Cognitive Function
informed consent, when the questionnaire is conducted,
the researcher will accompany to explain the existing Based on table 3, it can be seen that the p-value of the
questionnaire. collect the questionnaires that have been relationship between sleep quality and cognitive function
filled in, after that thank all those who are sick. This is 0.172 which indicates more than 0.05. These results
research was conducted by considering the principles of indicate that there is no significant relationship between
research ethics, namely the respondent was willing to sleep quality and cognitive function at BPSLUT Senja
agree to the informed consent form, which previously Cerah Manado.
the researcher had explained the objectives and
procedures to be carried out, the respondent only wrote
the initials and numbers on the paper that had been
distributed to see participation.
Author Guideliness – Nutrix Journal
Discussion
In table 1, it can be seen that the results of the study show
that most of the elderly at BPSLUT Manado have good
sleep quality. Because it is well known that the elderly at
BPSLUT Manado has a good environment and sports
activities are held every Friday morning so that it helps
the elderly to feel comfortable. This is also supported by
research from Nofiyanto (2015) where the study states
that improving the quality of sleep in the elderly is
influenced by a comfortable living environment for the
elderly, appropriate room temperature, and also good
lighting can improve sleep quality for the better.
Research which is also conducted by Hidayat (2012),
shows that most of the elderly are subjective sleep quality
is good enough because the elderly have able to tolerate
sleep changes as the aging process. Tolerance process
what the elderly do has happened gradually, thus making
the elderly perceive sleep quality as good or good enough
and they are not considered that the changes in sleep were
harmful to him. Process each elderly is different, some
are able to tolerate change and others are less able to
tolerate changes with the aging process. The perception
of the elderly about their sleep is poor, this is because the
elderly are lacking able to tolerate sleep changes that
occur in him.
Table 2 shows that adults at BPSLUT Manado experience
severe dementia, which is measured using the Mini-
Mental State Examination (MMSE) questionnaire. The
results obtained from the research. The same results were
obtained from the research of Ningsih et al (2017), which
showed that the elderly experiencing severe dementia
were mostly influenced by the elderly aged 60-74 years.
Older age will experience a decline in cognitive thinking,
decreased power remember (memory), and decreased
intelligence. Memory deterioration that weakens the
elderly can affect cognitive function so they experience
impairment. According to Prabowo (2014), in his
research it was found that dementia usually starts slowly
and gets worse over time, so this situation does not
manifest in the first place, memory errors, the ability of
people, places, and things. Ida's research (2015) states
that the older the age, the higher the dementia rate in the
elderly.
Table 3 shows the results of the analysis of the
relationship between sleep quality and cognitive function
in the elderly at BPSLUT Manado. The results of the
Spearmen Correlation test showed that there was no
significant relationship between sleep quality and
cognitive function in the elderly at BPSLUT Manado.
According to researchers that the quality of sleep in the
elderly is at BPSLUT Manado good because it is
supported by good environmental conditions as well good
gymnastic activities. Held every Friday morning helps the
elderly get a sense of comfort. The resulting cognitive
function is poor because most of it is caused by the age
factor that has entered old age so it is difficult for the
elderly to be able to take every test given through the
Mini-Mental State Examination (MMSE) questionnaire.
This is in accordance with previous research conducted by
Hanifa (2016) at the Margaguna Social Institution, South
Jakarta, there is no relationship between sleep quality and
4
cognitive function. The results of the proportion show that
good sleep quality will result in good cognitive function,
while poor sleep quality results in good cognitive
function. So sleep quality is a major factor affecting
cognitive function. There are other factors such as the
latest education, marital status, gender, as well as a role in
the influence of cognitive function in the elderly. The
results also carried out by Lestari (2017) which states that
there is no significant relationship between sleep quality
and cognitive function where there are several factors that
greatly affect education level, and age itself, which causes
aging the process that occurs can experiencing brain
changes that cause changes in thinking and behavior.
This is inversely proportional to the research conducted
by Pramardika (2014) in the work area of Puskesmas
Bengkuring, Samarinda City East Kalimantan Province
that there is a relationship between sleep quality and
cognitive function in the elderly where the elderly will
experience sleep disturbances which results in the elderly
experiencing cognitive dysfunction.
Conclusions
The main objective of this study was to determine whether
there was a significant relationship between sleep quality
and cognitive function in the elderly with the research
hypothesis (Ha), but after the research was carried out the
result was that there was no significant relationship
between sleep quality and cognitive function in BPSLUT
Senja Cerah. Manado because most of the elderly
experience good quality sleep and severe cognitive
dysfunction.
It is recommended that the BPSLUT Senja Cerah Manado
to pay more attention to aspects that support the
improvement of cognitive function in the elderly so as not
to decline. For example discussing what has been watched
on TV, such as news. Because the news that is watched
will be more useful than entertainment to stimulate brain
activity to think again. For further researchers it is
suggested to be able to review potential sources that cause
memory loss in the elderly and can
make the results of this study as a reference for further
research.
The limitation in this research is the difficulty in
contracting time with the nursing department of BPSLUT
Senja Cerah Manado to conduct research. As well as the
lack of teaching aids in the researchers to determine the
cognitive function of the elderly.
 Author Guideliness – Nutrix Journal
Acknowledgements
The researcher would like to thanks to Ns. Debby D
Pontoh, S.Kep as leader of Nursing at Panti Werdha
BPSLUT Senja Cerah Manado, and Elderly who were
respondents at the time of the study. The researcher would
special thanks to Mrs. Priscillia Saluy, BSN.,MSN., Mrs.
Ellen Padaunan, S.Kep., Ns., M.Kep. Mr. Frendy
Fernando Pitoy, S.Kep., Ns. MSN., research families and
friends for their advice, guidance, support, and patience
during this research project.
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