Introduction
One of the problems in old age is the decrease in the quality and quantity of sleep, which can affect the body and mind, quality of life, and daily activities of older adults and is closely related to mental health problems, including anxiety and anxiety. It can also cause a decline in executive function and memory, an increase in the risk of falls, and a disruption in strategic planning ability. Another problem in old age is the occurrence of psychological disorders. It is the second cause of losing disability-adjusted life years after traffic accidents. One of the non-pharmacological methods for the treatment of various sleep disorders in older adults and is used due to its simplicity and high effectiveness is cognitive behavioral therapy (CBT). This method increases and improves the sleep environment, reduces negative actions and thoughts that can disturb the quality of sleep, and creates a regular sleep schedule. Keeping this in mind, this study aims to determine the effectiveness of a CBT-based educational program on sleep quality and general health of older men living in nursing homes.

Methods
This is a double-blind controlled clinical trial with a pre-test/post-test/one-month follow-up design. The study population consists of all older men aged >65 years living in a nursing home in Kermanshah, Iran (n=85), of whom 68 were selected based on the inclusion criteria and were randomly divided into two groups of intervention (n=34) and control (n=34). The intervention group received a CBT-based educational program for 8 weeks at eight sessions of 45 minutes (one session per week). During this period, the control group did not receive any special treatment except daily routine care and verbal communication. At the end of the intervention, educational content was provided to them in a single session. The data were collected before, immediately after, and one month after the intervention using the Pittsburgh sleep quality index (PSQI) and Goldberg’s general health questionnaire (GHQ-28), where higher scores indicate higher sleep disturbances and distress. Finally, the data were analyzed using descriptive (mean, frequency, percentage, and standard deviation) and inferential (Kolmogorov-Smirnov, paired t-test, independent t-test, and repeated measures ANOVA) statistics in SPSS software, version 16.

Results
The mean age of the participants was 71.55±5.24 years. Most of the participants were married with primary school education and no children, and their previous job status was retired employees. Using the chi-square test, no significant difference in any demographic variables was found between the two groups (P>0.05). Tables 1, 2 and 3 show the mean scores of PSQI and GHQ-28 for the intervention and control groups in the three stages of pre-test, post-test, and follow-up.








The results showed a significant difference in the mean scores of PSQI and GHQ-28 and their domains between the two groups. Their scores decreased significantly in the posttest and follow-up phases compared to the pretest phase in the intervention group, which shows the positive and significant effect of the educational program.

Conclusions 
The CBT-based educational program can improve the sleep quality and general health of older men living in nursing homes.

Ethical Considerations
Compliance with ethical guidelines
This research was approved by the Ethics Committee of Ilam University of Medical Sciences (Code: IR.MEDILAM.REC.1402.213) and was registered by the Iranian Registry of Clinical Trials (ID: IRCT20230808059089N1). All participants declared their written informed consent. They were assured of the confidentiality of their information and were free to leave the study at any time.

Funding
This article was extracted from a master’s thesis in geriatric nursing at Ilam University of Medical Sciences. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
Conceptualization: Hamid Taghinejad and Masoumeh Otaghi; methodology: Hamid Taghinejad, Masoumeh Otaghi, and Mohammad Hossein Sahami Gilan; Investigation and original draft preparation: Hamid Taghinejad and Afsaneh Raiesifar; Resources: Kourosh Sayeh Miri; Review and editing: Masoumeh Otaghi and Afsaneh Raiesifar; Visualization, supervision, and funding acquisition: Mohammad Hossein Sahami Gilan.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Welfare Organization and the nursing homes in Kermanshah, and all seniors who participated in this research for their cooperation.


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