Age Group Differences in the Association Between Sleep Status and Frailty Among Community-Dwelling Older Adults: The SONIC Study

Associations between sleep duration and quality and physical frailty in community-dwelling older adults: a cross-sectional study

The effects of sleep duration and quality on physical frailty may differ. We examined the association between sleep duration/quality and frailty phenotype according to frailty components. This cross-sectional study analyzed 848 community-dwelling Japanese adults aged 65-75 years (mean age 70.8 yrs, 50.1% women) without long-term care needs. We classified the participants by their sleep duration: short-, middle-, and long-sleep groups. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and divided into PSQI ≤ 5, 6-8, and ≥ 9 groups. Physical frailty was operationalized with the Fried phenotype. A logistic regression model was used to compute the odds ratios (ORs) and 95% confidence interval (CIs) for frailty status outcomes. The prevalence of frailty was 4.7%. The ORs for the presence of frailty in the long-sleep group was 8.50 (95%CI: 2.82-25.62) compared to the middle-sleep group, and the PSQI ≥ 9 group was 2.81 (95%CI: 1.08-7.33) compared to the PSQI ≤ 5 group. Short sleep and poor sleep quality were associated with exhaustion; long sleep was associated with low physical activity. The duration and quality of sleep may thus have different effects on frailty components. The possible causal relationship between sleep duration/quality and frailty merits further investigation.

Multidimensional insights about healthy aging from the cohort study for community-dwelling older adults: The SONIC study

The Septuagenarian, Octogenarian, Nonagenarian Investigation with Centenarian (SONIC) study was established considering population trends and targeting the oldest-old population. This study is unique in its narrow age range, consisting of individuals aged in their 70s, 80s and 90s, and is carried out as a longitudinal cohort study with follow ups every 3 years in urban and rural areas of eastern and western Japan. The aims of the SONIC study are primarily to clarify aging-related changes in multiple domains of human functioning, explore the dynamics of interactions among these domains and identify factors influencing healthy longevity, including psychological well-being. Investigations spanning medical, dental, nutritional, psychological and sociological fields were carried out by specialists, yielding important results. Findings from the SONIC study in Japan, a super-aged society, will provide valuable information for addressing the global aging trend. This review introduces the results from the SONIC study, and explains factors contributing to healthy longevity and happy aging. Geriatr Gerontol Int 2025; 25: 346-355.

Sleep disorders and the association with frailty among community-dwelling older adults in Northwest China: a cross-sectional study

OBJECTIVES

To investigate the status of sleep disorders and their association with comprehensive frailty in the community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

Six community healthcare centres in Xi'an City, Northwest China.

PARTICIPANTS

A total of 2647 community-dwelling older adults completed the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes included frailty and sleep disorders, measured with the Comprehensive Frailty Assessment Instrument and Pittsburgh Sleep Quality Index (PSQI), respectively. The secondary outcomes were potential factors associated with frailty.

RESULTS

The participants averaged 5.23±2.94 in the total score of the PSQI, with a poor sleep quality prevalence of 19.9%. Individuals with poor sleep quality are more likely to have mild and high frailty, with an OR of 1.64 and 2.81, respectively. Both shortened (<5 hours) and prolonged (>8 hours) sleep duration are associated with higher level of frailty. Poor overall sleep, poor subjective sleep quality, extended sleep latency, sleep disturbances, use of sleeping medication and daytime dysfunction were associated with higher level of frailty (with a correlational coefficient of 0.237, 0.201, 0.223, 0.197, 0.087 and 0.378, respectively).

CONCLUSION

Sleep disorders are common problems among community-dwelling older adults, the severity of which rises with the increase in frailty level. Poor overall sleep quality, poor subjective sleep quality, extended sleep latency, sleep disturbances, daytime dysfunction and abnormal sleep duration are associated with frailty.

Sleep quality and duration and frailty in older adults: a systematic review

Introduction

Sleep problems and frailty are associated with adverse health outcomes in older adults, including mortality, and constitute a major public health challenge.

Objective

This study investigated the association between sleep quality and duration and frailty in older adults, with emphasis on methods of evaluation.

Methods

This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). The Embase, Medline (Pubmed) and Cochrane libraries were searched, with no time restrictions for publications.

Results and discussion

Of the 17 studies included in this review, all published between 2009 and 2024, 13 were cross-sectional and only four were longitudinal. The Pittsburgh Sleep Quality Index and the Fried phenotype were widely used as methods to assess, respectively, sleep and frailty. Studies evaluating insomnia and frailty by the Fried phenotype all found an independent association. Poor sleep quality was independently associated with pre-frailty and frailty. Sleep onset insomnia, but not sleep maintenance insomnia, was associated with frailty. Short (5 h) and long (9 h) sleep duration were also associated with frailty. Poor sleep quality was associated with pre-frailty and frailty in older adults. The results show a wide diversity of methods for assessing both exposure (sleep quality) and outcome (frailty) and point to a need for further - especially longitudinal - research on the relationship between sleep and frailty.

The prevalence and risk factors of sleep disturbances in community-dwelling older adults: a systematic review and meta-analysis

PURPOSE

Sleep disturbance is one of the most prevalent health issues among community-dwelling older adults. This systematic review aims to assess the prevalence of sleep disturbances among these adults living in the community and identify associated risk factors.

METHODS

A comprehensive literature search was performed using PubMed, Web of Science, Embase, and the Cochrane Library databases. We screened studies focusing on the prevalence of sleep disturbances in community-dwelling older adults (≥ 60 years). A random-effects model was used to calculate the pooled prevalence of sleep disturbances. Sensitivity and subgroup analyses were conducted to investigate sources of heterogeneity, and funnel plots were used to assess publication bias.

RESULTS

Our systematic review included 41 articles, encompassing a total sample of 71,607 participants from 13 countries. The pooled prevalence of sleep disturbances, measured by PSQI, was found to be 45% (95% CI: 40-50%). Notably, the prevalence of sleep disturbances was significantly higher among individuals aged 70 years and older (48%) compared to those aged 60 years and older (41%). Common risk factors for sleep disturbances included depression, advanced age, females, chronic diseases (hypertension, coronary heart disease, chronic obstructive pulmonary disease) and poor external support (poor social support and poor family relationships).

CONCLUSION

The findings highlight the necessity for comprehensive assessments and management strategies targeting this population with depression, advanced age, females, hypertension, coronary heart disease, chronic obstructive pulmonary disease, and poor external support while also underscoring the significance of healthcare planners and policymakers in enhancing sleep quality for older adults.

The Impact of Social Participation on Frailty among Older Adults: The Mediating Role of Loneliness and Sleep Quality

BACKGROUND

Frailty has become a common health issue among older adults, imposing a burden on both society and individuals. The relationship between social participation and frailty has received widespread attention, but the mechanism remains to be explored. The aim of this study is to explore the impact of social participation on frailty among older adults and to analyze the mediating role of loneliness and sleep quality, providing suggestions to alleviate frailty.

METHODS

Data related to social participation, loneliness, sleep quality, and frailty from 7779 older adults were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2018). The chain mediation model was conducted to explore the relationship between variables, and the Bootstrap method was used to examine the path coefficients.

RESULTS

Social participation negatively affected frailty (β = -0.00391049, 95% CI = [-0.042296, -0.035465]); the indirect effect of social participation on frailty mediated by loneliness was -0.0019505 (95% CI = [-0.002551, -0.001371]); the indirect effect of social participation on frailty mediated by sleep quality was -0.0011104 (95%CI = [-0.001692, -0.000557]); the effect mediated by both loneliness and sleep quality was -0.0004263 (95% CI = [-0.000593, -0.000304]).

CONCLUSIONS

Social participation negatively affected frailty. Loneliness and sleep quality not only mediated independently, but also played a chain mediating role. This suggested that encouraging older adults to engage in more social participation, reducing loneliness, and improving sleep quality are feasible measures to improve frailty.

Risk stratification for frailty, impairment and assessment of sleep disorders in community-dwelling older adults

BACKGROUND

Frailty is associated with an increased susceptibility to functional decline, impairment, hospitalization, and mortality among the older adults. However, the potential reversibility of frailty lies in identifying modifiable factors that could prevent, mitigate, or interrupt its progression. While there is a suggestion that sleep disorders may increase the risk of frailty and impairment, the risk stratification of this relationship remains inconclusive.

OBJECTIVE

Stratify the risk of frailty and impairment and investigate potential connections with sleep quality, excessive daytime sleepiness, and the risk of obstructive sleep apnea in older adults dwelling in the community.

METHODS

This was a quantitative cross-sectional investigation. Frailty risk and impairment were stratified using the Frail Non-disabled Questionnaire (for impairment) and the FRAIL Scale (for Frailty). The assessment of excessive daytime sleepiness, sleep quality, and the risk of obstructive sleep apnea involved the employment of the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and the STOP-BANG questionnaire, respectively.

RESULTS

A total of 109 older adults living in the urban area (86 %, p = 0.010), females (61 %; p = 0.030), median age 68 (64-75) years, with overweight (36 %, p < 0.010) and self-identified as belonging to other racial or ethnic categories (71 %, p < 0.010). According to the impairment assessment, 32 % of participants were classified as disable (p < 0.01). Conversely, as per the frailty evaluation, 33 % were pre-frail and 25 % were identified as frail. Additionally, a substantial proportion experienced poor sleep quality (80 %, p = 0.010), exhibited a moderate risk of obstructive sleep apnea (49 %, p < 0.010), and showed no signs of excessive daytime sleepiness (62 %, p < 0.010). There was a modest correlation between frailty and impairment with poor sleep quality (rho = 0.39; p < 0.001) and the risk of obstructive sleep apnea (rho = 0.26; p = 0.000). However, the was no significant relationship was observed between frailty and impairment and excessive daytime sleepiness (rho = 0.04; p = 0.660). Similarly, a modest correlation was observed between sleep quality (rho = 0.33; p < 0.001), the risk of obstructive sleep apnea (rho = 0.27; p = 0.001), and frailty. Conversely, no correlation was found with excessive daytime sleepiness (rho = 0.05; p = 0.590). Also, the poor sleep quality and the risk of obstructive sleep apnea explain 14 % of the risk of frailty in the population of community-dwelling older adults (r2 = 0.14; p = 0.04).

CONCLUSION

This study reveals a modest risk of frailty and impairment with sleep quality and the risk of obstructive sleep apnea, but not with excessive daytime sleepiness in community-dwelling older adults.