Introduction
Among different age groups, the number of older adults has had the fastest growth rate in the world [1]. Along with the increase in the aged population, their health problems become more important because physical and mental health in old age is at greater risk than in other stages of life [2, 3]. Among the problems of old age, sleep disorders have affected more than 50% of the elderly [4]. Sleep disorders are associated with an increased risk of heart diseases, metabolic diseases, obesity, depression, and anxiety [5], while adequate sleep improves emotional health, productivity, brain function, and overall physical and metabolic health [6]. Identifying and treating sleep problems can lead to reduced complications of diseases and health costs, increased quality of life, improved daily performance, and improved safety of patients and their families [7, 8, 9]. In this study, we aim to examine the effect of the guided imagery technique on the quality of sleep and general health of the elderly with sleep problems in Ardabil, Iran.

Methods
This is an interventional study with a pre-test/post-test design. The study population consists of older people with sleep problems referred to Javid Mohseni Health Center in Ardabil City in 2021. Based on a similar study [10], a confidence interval of 95%, a test power of 80%, and taking into account the possible sample drop, the sample size was determined 35 for each group. In this regard, 70 older people were selected based on the entry and exit criteria using a convenience sampling method. Then, the samples were randomly assigned to two intervention (n=35) and control (n=35) groups using the random number table. The data collection tools were a demographic form, the abbreviated mental test (AMT), the Pittsburgh sleep quality index (PSQI), and Goldberg’s 28-item general health questionnaire (GHQ-28). After obtaining informed consent, both groups completed the mentioned questionnaires.
The intervention was the guided imagery therapy that was provided to the participants in the intervention group in the form of audio files recorded on a compact disc, and they were asked to listen to it at home for 10 minutes at a certain time before going to bed for four weeks, once a day, and implement its contents. The content of the program was compiled based on reliable sources and under the supervision of experts in psychology, music therapy, and geriatrics. The intervention group received guided imagery therapy along with their routine treatments. The control group continued to receive routine treatments with no intervention. After the end of the fourth week, the PSQI and GHQ-28 questionnaires were completed by the participants. The obtained results were analyzed in SPSS software, version 22 using independent t-test, paired t-test, chi-square test, Mann-Whitney U test, Levene’s test, and Kolmogorov Smirnov test. The significance level was set at 0.05.

Results
Among the participants, four from the intervention group and two from the control group left the study. The mean age of the participants was 69.3±7.34 years; 37(57.8%) were female, and 51(79.7%) were married. Most of the participants (28.1%) had sleep disorders for less than three years, and the least of them (21.9%) had sleep disorders for 5-10 years. There was no statistically significant difference between the two study groups in terms of demographic characteristics (P≥0.05). The results of the Mann-Whitney U test and independent t-test showed that before the intervention, the two groups were not significantly different in terms of general health and its domains (P≥0.05). After the intervention, the difference between the groups was statistically significant in all domains, except for social dysfunction and severe depression (P≤0.05). Also, the results showed that the two groups were not significantly different in terms of sleep quality and its domains before the intervention (P≥0.05). After the intervention, there was a significant difference between the two groups in all sleep quality domains (P≤0.01). There was no significant difference in the mean scores of PSQI and GHQ-28 before and after the intervention in the control group (P≥0.05). In the intervention group, the difference in all domains of PSQI was significant before and after the intervention (P≤0.05). Regarding the GHQ-28, the difference was significant in the domains of somatic symptoms, anxiety/insomnia, severe depression, and the total score.

Conclusion
Guided imagery therapy, along with common treatments, can significantly improve the quality of sleep and general health of community-dwelling older people. It is recommended that this method be used as a non-pharmacological and non-invasive, safe, easy, and cost-effective intervention, along with medication treatments by nurses and other members of the health team for the elderly and, thereby, modulate the amount of sleeping pill use. It seems the guided imagery technique, by activating the temporal part of the cerebral cortex, reduces the stress response, increases the sense of relaxation, and subsequently improves the quality of sleep and health of the elderly [11] and is effective in preventing the prescription of additional drugs.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Code: IR.USWR.REC.1400.239).

Funding
This article was extracted from the master’s thesis of Mahdieh Heidarian, approved by Department of Nursing, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, and was supported by the University of Social Welfare and Rehabilitation Sciences.

Authors' contributions
Study design: Mahdieh Heidarian, Farahnaz Mohammadi and Shamaneh Mohammadi; Investigation: Mahdieh Heidarian, Farahnaz Mohammadi and Nazila Vosoghi; Data analysis: Mehdi Noroozi; The original draft preparation: Mahdieh Heidarian and Farahnaz Mohammadi; Review & editing: Shamaneh Mohammadi and Nasim Sadeghi Mahalli.

Conflicts of interest
The authors declared no conflict of interest

Acknowledgements
The authors thank and appreciate the cooperation and support of University of Social Welfare and Rehabilitation Science and Ardabil University of Medical Science, as well as elderly who participated in this study.

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