Self-reported insomnia symptom, sleep duration and the risk of recurrent falls among older men and women

The existing state of knowledge about sleep health in community-dwelling older persons - a scoping review

OBJECTIVES

It is widely known that sleep disorders are a common problem among older persons. Few reviews have described current knowledge about the holistic concept of sleep health of community-dwelling older people.

AIM

This study aimed to describe the current state of knowledge and identify research gaps concerning sleep health among community-dwelling older persons.

METHOD

We conducted a scoping review. Searches were conducted in three databases (Medline, CINAHL, and PsycINFO) to identify scientific articles including outcomes with all five sleep health dimensions (sleep duration, sleep continuity, timing, wakefulness/daytime sleepiness, and sleep quality) among community-dwelling older persons aged ≥65 years. Eight articles were included from a total of 1826 hits, with sample sizes between 1413 and 6485.

RESULTS

The sleep health outcomes of community-dwelling older adults differed between the sexes. Older persons with at least two or more poor sleep health dimensions might have increased risk for depression, higher healthcare costs and mortality, while self-reported better sleep health might be associated with lower odds of frailty.

CONCLUSION

Future research is needed to confirm the findings by investigating the multidimensional concept of sleep health in a general older population. The identified knowledge gaps are how persons ≥80 years' experience their sleep health, and how sleep medicine is prescribed to treat sleep problems in persons ≥80 years in different care contexts.

Real-world association of self-reported sleep duration and quality with falls among older adults: A representative nationwide study of China

INTRODUCTION

Falls are the leading cause of injury-related morbidity and mortality among older adults (aged ≥65 years) worldwide. However, previous studies examining sleep and falls were confined to community subpopulations, and few studies included both sleep quality and sleep duration when discussing risk factors of falls. This nationwide representative study aimed to examine the links between sleep duration, sleep quality and falls among Chinese community-dwelling older adults.

METHOD

Cross-sectional analyses were conducted with 14,681 older individuals (aged ≥65 years) from 23 Chinese provinces from the Chinese Longitudinal Healthy and Longevity Study (CLHLS) in 2018. Individual variables, including sociodemographic factors, lifestyle, and behavioral factors, were measured using a self-reported questionnaire. Falls were confirmed through face-to-face interviews. Three multivariate logistic regression models were conducted to assess the association between sleep duration and sleep quality with falls.

RESULTS

There were 21.7% (95%CI: 21.0-22.4%) participants who had experienced falls in the past year. After controlling demographic and individual variables, falls in older adults were associated with self-reported sleep quality and self-reported sleep duration. Those who reported poor sleep quality were more likely to fall (OR = 1.149; 95%CI = 1.004,1.316). Participants who reported sleep duration that was too short (<5) (OR = 1.349; 95% CI = 1.191 to 1.528) or too long (>8) (OR = 1.267; 95% CI = 1.151 to 1.394) were both associated with higher fall prevalence.

CONCLUSION

Nearly one-fifth of older adults in this study had experienced falls in the past year. The study found that falls were significantly associated with less sleep duration, longer sleep duration, and overall poor sleep quality among the old Chinese population.

Sleep quality and sleep-disturbing factors of geriatric inpatients

PURPOSE

Insomnia, a common problem in older adults, may be precipitated by multiple factors including medical conditions, social, behavioral, and environmental factors. The aims of our study were to evaluate sleep pattern changes during hospitalization, determine the predictors of sleep quality and sleep disorders in geriatric inpatients.

METHODS

In this prospective observational study, all ≥ 65-year-old patients hospitalized in internal medicine wards were assessed at the time of hospitalization and after 1 week. Insomnia Severity Index and Pittsburgh Sleep Quality Index (PSQI) were used to define insomnia and subjective sleep quality. All patients underwent comprehensive geriatric assessment. Data of factors contributing sleep disturbances during hospitalization were recorded.

RESULTS

Totally 101 patients were recruited. Mean ± SD age was 73.5 ± 5.2 years and 53.5% were female. Frequency of poor sleepers was 58.4% at baseline and 64.7% after 1 week according to PSQI score (p 0.804). Although the total scores and frequency of insomnia did not change in the first week of hospitalization, sleep duration was significantly shortened (6.4 ± 2.6 h vs. 5.9 ± 2.7 h, respectively; p < 0.001). Age, pain, restless legs syndrome, Katz ADL, and Lawton-Brody IADL scores were independent correlates of insomnia during hospitalization.

CONCLUSION

The study showed that insomnia was associated with geriatric syndromes in hospitalized geriatric patients, and hospitalization reduced duration of sleep. Sleep quality and insomnia evaluation should be a fundamental part of assessment in hospitalized older adults. Considering the negative outcomes of insomnia, sleep disrupting factors should be identified and corrected.

Sleep characteristics and self-rated health in older persons

PURPOSE

It remains unclear, how much older persons' sleep problems are due to age-related changes in sleep architecture and pattern, or whether they are a consequence of health problems. This work aimed to examine the association between sleep characteristics and self-rated health, taking into account potential confounders.

METHODS

Data about sleep, including sleep efficiency (ratio of sleep duration to the amount of time spent in bed, considered as good if > 85%), as well as health-rated characteristics were self-reported by community-dwelling persons enrolled in the Lausanne cohort 65+ study (n = 2712, age 66-75 years). Participants' subjective health was categorized as good versus poor. The cross-sectional association between good self-rated health and sleep characteristics was examined in bivariate and multivariate analysis.

RESULTS

The majority of participants (68.4%) rated their health as good. Compared to the participants with poor-rated health, they more often reported a good sleep efficiency (59.5% vs 45.0%, p < 0.001) and less often reported napping (41.6% vs 54.0%, p < 0.001) as well as using sleep medication (12.7% vs 31.8%, p < 0.001). After adjustment for comorbidity, depressive symptoms and cognitive difficulties, a positive association persisted between good sleep efficiency and good self-rated health (adjOR: 1.35, 95% CI 1.10-1.66). Regular napping remained negatively associated to feel healthy (adjOR: 0.65, 95% CI 0.53-0.79).

CONCLUSION

Sleep efficiency is positively associated with subjective health, whereas napping and use of sleep medication are negatively associated to rating own health as good. These associations need to be further investigated in longitudinal analyses to better understand causality.