DISCUSSION
visual impairment, insomnia, hypertensive, ill, health-beneficial behaviors
DISEASE, EVENTS, EVENT
The prevalence of worse sleep conditions was higher in female older adults. This
finding may be related to the fact that women accumulate more tasks, such as raising
children and grandchildren, which results in overload and dysfunctional thoughts,
which culminate in changes in sleep architectureIn the present study, most older adults reported living with grandchildren, sons and
daughters-in-law. A similar result found 39% of negative sleep perception in female
older adults in this same family arrangementThe results of this experimental study revealed an improvement in sleep quality in
both groups (G1 and G2) after the interventions so that nursing guidelines and the
use of the booklet were similarly effective in increasing sleep efficiency. This
parameter is directly related to the number of hours slept and length of stay in
bed, which also depend on the latency time and night awakenings, which consolidate
its fragmentation and directly impact sleep architecture and organization.The reduction in time to fall asleep converges with sleep hygiene guidelines anchored
in the principles of the theoretical model of belief in health, in which older
adults were encouraged to perceive the benefits of sleeping well and thus realize
them. Successful results of nursing guidelines were observed in the states of Mato
Grosso and São Paulo, also for older adultsSleep poor quality in people with dysfunctional beliefs requires an approach based on
this theoretical model, which seeks to explain and predict the acceptance of
recommendations on health care that prioritize the theme of sleep. Therefore, the
HBM theory considers the stimuli, the uniqueness of the contexts, the knowledge of
the population and anticipates that nurses should add strategies to their practices
to provide adequate information, refute myths and misconceptions.In the context of sleep fragmentation due to nocturnal awakenings, it is noteworthy
that hypertensive patients increase cortisol and antidiuretic hormone
secretionThe HBM has been considered to explain and predict acceptance of health care
recommendations. After the intervention, there was a reduction in the parameter of
waking up in the middle of the night, as older adults took the position of ingesting
less liquids close to bedtime as well as adjusting the time of diuretics. When
verifying the effectiveness of this orientation and its possible impact on a sleep
quality parameter, the belief in action effectiveness and the perception of its
positive consequences stand out.Self-rated sleep changed from a statistical point of view after both interventions.
Such event, when contextualized in the light of the HBM, elucidates that the
susceptibility to poor sleep was, in this study, reinforced by the belief that there
is a condition/risk of falling ill and, consequently, under the belief of action
effectiveness to reduce such risk. Similar to this situation, it shows the fact that
the educational interventions carried out were dedicated to making older adults
realize how serious it is not to sleep well and its consequences.Self-rated sleep represents the way individuals see their state and understands their
condition for illness, being considered a risk marker. In this study, some older
adults self-perceived the risk of falling ill and compliance with sleep hygiene
guidelines. This behavior was observed in studies carried out in Minas Gerais and
Iran on the same subjectThe preponderance of older adults who improved their perception of sleep self-rating
after the experiment supports the idea that, when working on behavioral issues of
the health belief model, it is possible to obtain good results from the perspective
that older adults can sharpen their subjective perception of the personal risk of
contracting a disease if they do not sleep and play a role in their self-care, made
possible by the transfer of knowledge about the theme.The results related to sleep efficiency converge to support significant changes: the
reduction of minutes to sleep and, consequently, the reduction of trouble sleeping,
which occurred significantly in both groups after different interventions. It is
noteworthy that reducing the number of minutes to sleep is important, as insomnia
can configure emotional destabilization in older adults, associated with
anticipatory sleep anxietyWhen it comes to older adults, poor sleep quality can result from erroneous habits
and requires correction of maladaptive attitudes and beliefs that sleeping is luxury
or laziness. These myths associated with the false belief that sleeping poorly in
old age is predictable, reinforces to older adults that there is no effective
treatment other than pharmacological.Contrary to drug treatment, international studies have revealed that stimulus
control, sleep restriction, sleep hygiene, cognitive therapy and relaxation
techniques associated with health education are the first-line strategies,
recommended for insomnia treatment in older adults due to lower risk of adverse
effects and better quality of lifeBoth interventions also modified parameters of sleep quality. Greater effects of the
educational intervention mediated by the booklet may not have been obtained due to
the influence of the low level of education that older adults had, as low education
is a factor that contributes to worse health outcomesA higher educational level is associated with health-beneficial behaviors and good
results in understanding health information, which prevent predictive events of
sleep problems. This fact may be related to a less sensitive improvement in sleep
quality parameters of the group submitted to the intervention with an educational
booklet, taking into account that older adults could feel discouraged from seeing
the material due to the embarrassment of not knowing how to read, since the
expressive majority attended little formal school and the material, despite being
well illustrated, had text.Verbal guidelines, without using printed material, proved to be sufficient to modify
the reality found. It is pointed out that these, when they are part of the
professional routine of empowered nurses, generate positive results by favoring
significant learning by older adults, strengthening the user-professional
relationship, promoting changes in life habits, exercising autonomy for healthy
practices and reinforcing self-efficacy for changing behavior and overcoming
perceived barriers, according to HBM.It should be noted that health professionals should be encouraged to use the booklet,
as well as to offer verbal guidance on sleep hygiene, as there was a change in
important parameters of sleep quality, based on the two interventions used with the
groups. Verbal guidelines present their importance and their need for use,
especially for the public that will not be reached with a booklet, such as due to
visual impairment.One of the limitations of the study is the fact that it was carried out from older
adults’ exposure to the intervention that occurred in a single moment (without
repetitions). Finally, the assessment of the effect of the interventions took place
in older adults in the community, Unified Health System (