Insomnia in Older Adults

Sex Differences in the Role of Sleep on Cognition in Older Adults

Study Objectives

The study aimed to investigate sex differences in the relationship between sleep quality (self-report and objective) and cognitive function across three domains (executive function, verbal memory, and attention) in older adults.

Methods

We analyzed cross-sectional data from 207 participants with normal cognition or mild cognitive impairment (89 males and 118 females) aged over 60. The relationship between sleep quality and cognitive performance was estimated using generalized additive models. Objective sleep was measured with the GT9X Link Actigraph, and self-reported sleep was measured with the Pittsburgh Sleep Quality Index.

Results

We found that females exhibited stable performance of executive function with up to about 400 minutes of total sleep time, with significant declines in performance (p = 0.02) when total sleep time was longer. Additionally, a longer total sleep time contributed to lower verbal memory in a slightly non-linear manner (p = 0.03). Higher self-reported sleep complaints were associated with poorer executive function in females with normal cognition (p = 0.02). In males, a positive linear relationship emerged between sleep efficiency and executive function (p = 0.04), while self-reported sleep was not associated with cognitive performance in males with normal cognition.

Conclusions

Our findings suggest that the relationships between sleep quality and cognition differ between older males and females, with executive function being the most influenced by objective and self-reported sleep. Interventions targeting sleep quality to mitigate cognitive decline in older adults may need to be tailored according to sex, with distinct approaches for males and females.

Prognostic impact of insomnia in patients receiving trans-catheter aortic valve replacement

BACKGROUND

The presence of insomnia exhibits a profound association with diverse cardiovascular pathologies. However, its prognostic implications in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis remain ambiguous.

METHODS

This retrospective study enrolled patients who underwent TAVR for severe aortic stenosis at a prominent academic center from 2015 to 2022. The impact of insomnia, operationally defined as the prescription of soporific agents, on the two-year composite primary outcome comprising all-cause mortality and hospital readmissions was scrutinized.

RESULTS

A cohort of 345 patients (median age 85 years, 99 males) was encompassed in the analysis. All subjects underwent successful TAVR and subsequent discharge. The presence of insomnia (N = 91) emerged as an independent predictor of the two-year composite endpoint, with an adjusted hazard ratio of 1.66 (95 % confidence interval 1.08-2.57, p = 0.022), significantly delineating the two-year cumulative incidence of the primary endpoint (40 % versus 30 %, p = 0.035).

CONCLUSION

Approximately one-fourth of TAVR candidates manifested symptoms of insomnia, a condition autonomously correlated with heightened mortality and morbidity following the TAVR procedure. The optimal strategy for addressing insomnia in TAVR candidates constitutes a paramount consideration for future interventions.

Factors associated with reduced sleep among spouses and caregivers of older adults with varying levels of cognitive decline

BACKGROUND

Caregivers of persons with cognitive decline (PWCD) are at increased risk of poor sleep quantity and quality. It is unclear whether this is due to factors in the caregiver versus in the PWCD.

METHODS

This secondary data analysis using Aging, Demographics, and Memory Study data from the Health Retirement Study examined factors contributing to reduced sleep/rest among spouses and caregivers of older adults with varying levels of cognitive decline (cognitively normal (CN), cognitive impairment but not dementia (CIND), or dementia).

RESULTS

In our preliminary analysis, among N = 218 spouses (not necessarily caregivers) (mean age (SD) = 73.77 (7.30); 70.64% female) of older adults with varying levels of cognitive decline, regression revealed that frequency of sleep complaints was lowest among spouses with CN partners, second highest with CIND partners, and highest with dementia-partners, X2  = 26.810, P = 0.002.

PRIMARY AIM

among n = 136 caregivers of PWCD (mean age (SD) = 59.27 (13.97); 74.26% female; 22.79% spouses), we analyzed whether caregiver reduced sleep/rest was predicted by PWCD factors (i.e., frequent nighttime waking, dementia severity) and/or caregiver factors (i.e., depression symptoms, caregiver role overload). Regression revealed that caregiver depression symptoms (d = 0.62) and role overload (d = 0.88), but not PWCD factors, were associated with reduced caregiver sleep/rest after adjusting for demographic factors, caregiving frequency, and shared-dwelling status (overall model: X2  = 31.876, P = 0.002). Exploratory analyses revealed that a caregiver was 7.901 times more likely (95% CI: 0.99-63.15) to endorse experiencing reduced sleep/rest if back-up care was not available (P = 0.023).

CONCLUSION

Findings highlight that the frequency of reported sleep problems among spouses increases in a stepwise fashion when partners have dementia versus CIND versus CN. The results also emphasise that caregiver mental health and burden are strongly associated with caregiver sleep disturbances and thus may be targets of intervention for caregiver sleep problems.

The relationship between social support and sleep quality in older adults: A review of the evidence

OBJECTIVES

Sleep quality is crucial for the health and well-being of older adults, and social support has been consistently shown to be related to sleep quality. However, there is a need for research to understand the mechanisms through which these two factors are linked. The purpose of this review is to synthesize scientific literature on the relationship between social support and sleep quality in older adults.

METHODS

Using an integrative review method, this review was conducted for a period from January 2012 to November 2022 using a combination of keywords related to social support and sleep quality in older adults.

RESULTS

A total of 21 studies that met the inclusion criteria were included. Social support was found to have a positive relationship with subjective and objective sleep quality. It may act as both a mediator between insomnia and hopelessness and a moderator buffering the influence of rumination and negative emotions on sleep quality.

CONCLUSION

This review provides evidence for the positive relationship between social support and sleep quality in older adults. Based on the findings of this review, healthcare professionals should prioritize incorporating assessments of social support and implementing interventions aimed at enhancing social support in older adults to improve their sleep quality.

The Night and Day Challenge of Sleep Disorders and Insomnia: A Narrative Review

This is a narrative review of sleep disorders, especially chronic insomnia, as a primary diagnosis or as a comorbid diagnosis associated with different psychiatric and organic diseases. The epidemiological evidence is reviewed, the diagnostic criteria most frequently used in clinical practice are examined, and a series of therapeutic recommendations for the correct treatment of this pathology is presented. Sleep disorders are very prevalent in the general population (one-third experiences difficulty with sleep initiation/maintenance at least once a week, and about 6-15% meet the criteria for insomnia disorders), but remain relatively poorly understood and frequently overlooked by healthcare professionals. Prevalence estimates of insomnia disorder vary between 5% and 20%. Sleep disorders co-exist with psychiatric and medical conditions with an interactive and bidirectional relationship. About 70-80% of psychiatric patients show some sleep disturbance and there is a correlation between the severity of the sleep disturbance and the severity of the psychopathology. Untreated sleep disorders increase the risk of cardiovascular events, cognitive impairment, motor vehicle accidents, obesity, diabetes, and efficiency and safety at work, leading to increased all-cause healthcare utilization and being a strong predictor of sick leave or disability pension and poor quality of life. Sleep disorders can cause drowsiness or excessive daytime sleepiness, which can lead to functional impairment in 15% of the general adult population. Sleep quality should be a routine target in the evaluation of patients with psychiatric and non-psychiatric diseases to ensure sleep health based on early diagnosis and adequate therapeutic approaches.

Sleep Profiles of Caregivers for Persons Living with Dementia: A Qualitative Study

Sleep disturbance is prevalent among caregivers of people living with dementia. However, gaps exist about caregivers' sleep patterns before and during their caregiving trajectory. This exploratory secondary analysis using a qualitative descriptive approach aimed to (1) identify and describe current caregivers' patterns of change in sleep before and during caregiving, and (2) understand caregivers' perceptions of their current sleep compared to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers taking part in a larger randomized controlled trial. Participants were female (n = 11), white (n = 13) and on average 63 years of age. Interview questions focused on caregivers' sleep patterns. The interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Three distinct caregiver-sleep profiles emerged from the qualitative data: changed and dissatisfied, changed and satisfied, and unchanged and dissatisfied. Caregivers whose sleep was categorized as changed reported a difference when comparing their current sleep pattern to their pre-caregiving sleep pattern. This was usually a change from good to poor sleep. Caregivers whose sleep was unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being satisfied or dissatisfied with their current sleep pattern, defined in terms of distress and impairment. These three subtypes highlight the heterogeneity of caregivers' sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance, many who may be ready to engage in behaviors to improve their sleep. Knowing caregivers' sleep profiles will enable health care providers and researchers to determine caregivers' needs and readiness for interventions then work collaboratively with them to improve their sleep problems.

Therapeutic dilemma's: antipsychotics use for neuropsychiatric symptoms of dementia, delirium and insomnia and risk of falling in older adults, a clinical review

PURPOSE

Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacokinetic and pharmacodynamic mechanisms associated with antipsychotic use and falls. Finally, we aim to provide information to clinicians for weighing the benefits and harms of (de)prescribing.

METHODS

A literature search was executed in CINAHL, PubMed and Scopus in March 2022 to identify studies focusing on fall-related adverse effects of the antipsychotic use in older adults. We focused on the antipsychotic use for neuropsychiatric symptoms of dementia, insomnia, and delirium.

RESULTS

Antipsychotics increase the risk of falls through anticholinergic, orthostatic and extrapyramidal effects, sedation, and adverse effects on cardio- and cerebrovascular system. Practical resources and algorithms are available that guide and assist clinicians in deprescribing antipsychotics without current indication.

CONCLUSIONS

Deprescribing of antipsychotics should be considered and encouraged in older people at risk of falling, especially when prescribed for neuropsychiatric symptoms of dementia, delirium or insomnia. If antipsychotics are still needed, we recommend that the benefits and harms of antipsychotic use should be reassessed within two to four weeks of prescription. If the use of antipsychotic causes more harm than benefit, the deprescribing process should be started.

[Relationship between body composition and the risk of non-communicable chronic diseases in active older women from Chillán (Chile).]

OBJECTIVE

In Chile, the elderly represent 18% of the population. In women, the aging process impacts body composition, in addition to the coexistence of other pathologies such as chronic noncommunicable diseases (NCDs). The aim of the study was to relate body composition to the presence of chronic noncommunicable diseases in active older women in the city of Chillán.

METHODS

The sample consisted of 284 women belonging to senior centers in Chillán. Body composition was determined by bioimpedanciometry. Sociodemographic information, prevalent pathologies, geriatric syndromes and physical activity were determined by means of a validated questionnaire. Data were analyzed with descriptive and inferential statistics in STATA 15.0 software with an α<0.05.

RESULTS

Of the sample, 63% were under seventy-five years of age, 77.5% had less than twelve years of schooling, the predominant socioeconomic level was low, and the poor perception of health was mainly referred to as well as the use of regular medication. Arterial hypertension (AHT) and hypercholesterolemia were prevalent with 70.4% and 48.2% respectively. Body mass index (BMI) was 29.7±4.8 and 71.8% had excess malnutrition. The group older than seventy-five years presented more body fat (BMF) and extracellular water (ECW). AHT was related to higher BMI, TGM, MBC (Mean Arm Circumference), PC (Calf Circumference) and ECW (p<0.05), while Diabetes mellitus was related to BMI and MBC.

CONCLUSIONS

Hypertension is the most frequent pathology and is related to higher BMI, MGT, CMB, CP and ECW, followed by DM2 which is related to BMI and CMB.

Substance Use Disorders in the Geriatric Population: a Review and Synthesis of the Literature of a Growing Problem in a Growing Population

Purpose of review

Substance use disorders are becoming increasingly prevalent in the geriatric population, necessitating an updated understanding of the existing literature. This review aims to describe the epidemiology, special considerations, and management of substance use disorders in older adults.

Recent findings

PubMed, Ovid MEDLINE, and PsychINFO databases were searched from their inception through June 2022 using the following keywords: "substance use disorder," "substance abuse," "abuse," "illicit substances," "illicit drugs," "addiction," "geriatric," "elderly," "older adults," "alcohol," "marijuana," "cannabis," "cocaine," "heroin," "opioid," and "benzodiazepine." Our findings suggest an increasing trend in substance use in older adults despite medical and psychiatric consequences when using such substances. The majority of older patients admitted to substance abuse treatment programs were not referred by healthcare providers, suggesting room for improvement in the screening and discussion of substance use disorders. Our review also suggests that there should be careful consideration of COVID-19 and racial disparities when screening, diagnosing, and treating substance use disorders in the older population.

Summary

This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine.

Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic

Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao-Scott χ² tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era.

Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States

OBJECTIVE

To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.

DATA SOURCES

The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.

STUDY DESIGN

This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.

DATA COLLECTION/EXTRACTION METHODS

We extracted longitudinal data from 2002 through 2018 waves of the HRS.

PRINCIPAL FINDINGS

Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.

CONCLUSIONS

The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

Effectiveness of cognitive behaviour therapy (CBT) to improve the sleep quality of the elderly in hospital

Background Quality of sleep is very important for everyone both healthy and sick, Efforts to provide sleeping pills have also not been effective because of the elderly do not want to report or treat sleep problems experienced so that the quality of sleep becomes poor. One of the therapies that can be done to improve the quality of sleep in the elderly, using Cognitive Behaviour Theraphy (CBT) therapy. Method research design is quasi experimental design pre and post test design with Control group and interventions in the form of CBT therapy to elderly clients. The study was conducted using two groups, the intervention group was given CBT therapeutic interventions and the control group was only given general care. The study subjects got CBT therapy for 2 days (dose 2 X 1 day @ 20-30 minutes). Measurement of sleep quality was carried out 2 times for 4 days in the study subjects using the Indonesian version of the ISI instrument.

Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: a population-based cohort study

To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and nonrestorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15 511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15 511 cohort respondents (mean [±SD] age at baseline, 63.7 [±10.2] years; 56.0% females), 5878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR = 1.11; 95% CI: 1.03-1.20), two (HR = 1.12; 95% CI: 1.01-1.23), three (HR = 1.15; 95% CI: 1.05-1.27), or four (HR = 1.32; 95% CI: 1.12-1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR = 1.12; 95% CI: 1.02-1.22), early-morning awakening (HR = 1.09; 95% CI: 1.01-1.18), and nonrestorative sleep (HR = 1.17; 95% CI: 1.09-1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.

Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars

PURPOSE OF REVIEW

We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars.

RECENT FINDINGS

Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.

Insomnia symptoms and incident heart failure: a population-based cohort study

AIMS

Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF.

METHODS AND RESULTS

Data were obtained from the Health and Retirement Study in the US for a population-representative sample of 12,761 middle-aged and older adults (age ≥ 50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discrete-time survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. At baseline, 38.4% of the respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 1,730 respondents developed incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08-1.38), two (HR=1.45; 95% CI: 1.21-1.72), three (HR=1.66; 95% CI: 1.37-2.02), or four (HR=1.80; 95% CI: 1.25-2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents that had trouble initiating sleep (HR=1.17; 95%CI: 1.01-1.36), maintaining sleep (HR=1.14; 95% CI: 1.01-1.28), early-morning awakening (HR=1.20; 95% CI: 1.02-1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06-1.46) had a higher hazard of incident HF than asymptomatic respondents.

CONCLUSION

Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence.

Gender differences in the association of insomnia symptoms and coronary artery calcification in the multi-ethnic study of atherosclerosis

STUDY OBJECTIVES

To quantify the gender-specific associations between insomnia symptoms and subclinical atherosclerosis, measured by coronary artery calcium (CAC) scores, which has strong predictive value for incident cardiovascular disease.

METHODS

We analyzed data from 1,429 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants completed standardized questionnaires and underwent polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as: self-reported trouble falling, staying or returning to sleep, early-morning awakenings, or hypnotic use, for ≥5 nights/week. MESA assessed CAC using computed tomography. We employed multivariable linear regression to model the probability of CAC >0 overall and to model the linear continuous effect among those with nonzero CAC.

RESULTS

Our sample was a mean age of 68.1 ± 9.1 years, 53.9% female, and 36.2% white, 28.0% black, 24.2% Hispanic, and 11.5% Chinese-American. Insomnia symptoms were present in 49.7% of men and 47.2% of women. In multivariable-adjusted analyses, insomnia symptoms was associated with an 18% higher prevalence of CAC (PR 1.18, 95% CI 1.04, 1.33) among females, but no association was observed among males (PR 1.00, 95% CI 0.91, 1.08). There was no evidence that the association between insomnia symptoms and prevalence of CAC >0 differed by objective sleep duration status (by single-night PSG or multi-night actigraphy) in females or males.

CONCLUSIONS

We found that among women, insomnia symptoms were associated with an 18% higher prevalence of CAC compared to no insomnia. Insomnia symptoms were not associated with CAC prevalence in men. Additionally, there was no evidence that the association between insomnia symptoms and CAC score >0 differed by objective short sleep duration status.

Older Adults' Subjective Cognitive Decline Correlated with Subjective but Not Objective Sleep: A Mediator Role of Depression

This study examined the relationship between older adults' subjective versus objective sleep and subjective cognitive decline (SCD), and explored the role of depression on this association. One hundred and four community-dwelling older adults underwent a week of actigraphic sleep monitoring, and completed a series of neuropsychological screeners. Older adults'SCD score was positively correlated with subjective insomnia, but not with objective sleep parameters. Further mediation modeling revealed that older adults'depression mediated the association between subjective insomnia and SCD. Subjective sleep, rather than objective sleep, may be a more sensitive indicator for older adults' SCD, with depression symptoms appearing to account for most of the variance. These findings extend our perspective on the relationship between sleep disruption and cognitive decline, and highlight the necessity of early targeted interventions on sleep to reduce the risk of cognitive impairment in the elderly with SCD.

Physical, Cognitive and Social Rehabilitation in Relation to Sleep Quality and Cognitive Functions in the Elderly

The aim of the study was to assess cognitive functions and sleep quality after a 3-month holistic intervention including physical, social and cognitive rehabilitation in patients 65+. Twenty-nine people participated in the study. The study was divided into two stages. In the first stage, a self-administered questionnaire consisting of sociodemographic questions was used, and cognitive functions were assessed using the Rey-Osterrieth complex figure test, Addenbrooke's Cognitive Examination III (ACE III) test, Montreal Cognitive Function Assessment Scale (MoCA) and digit repetition test. All patients were also assessed for sleep quality using the Athens Insomnia Scale (AIS). After three months, the patients were assessed for cognitive functions and sleep quality, which was the second stage of the study. Analysis of the results obtained by patients in the study showed a statistically significant improvement in sleep quality and cognitive function. Rehabilitation activities, including physical training, cognitive exercises and occupational therapy, reduce the severity of mild cognitive disorders and reduce insomnia.

Predictors of Depression and Insomnia in Community-Dwelling Elderly People: A Cross-Sectional Evidence of Their Bidirectional Relationship

Objective

The aim of this study was to examine associated factors of depression and insomnia in community-dwelling elderly people in order to identify independent predictors.

Materials and methods

A cross-sectional study was conducted among 250 older people aged 60 years and over living in an urban area. A stratified random sampling method was used for recruiting samples from five Open Care Centers for Elderly People of the Municipality of Larissa, Greece. Data were obtained through a questionnaire that included demographic, socioeconomic, and health-related characteristics, 15-item Geriatric Depression Scale (GDS-15), and Athens Insomnia Scale (AIS). Simple and multiple logistic regression analysis was performed.

Results

The prevalence of depression and insomnia was 28.4% (95% CI: 22.9-33.9) and 39.2% (95% CI: 33.0-45.4), respectively. Our findings showed that the overall GDS-15 score was positively related to the overall AIS score (r = 0.405; p < 0.001). The best-fit regression analysis demonstrated four significant predictors (marital status, monthly income, body weight status, and insomnia) explaining 31.6% of the variance in depression risk. Moreover, community-dwelling elderly Greek people with insomnia symptoms were females, had a lower monthly income, and more likely to suffer from chronic diseases and depression.

Conclusion

These findings point to the importance of recognizing risk factors for both depression and insomnia in attempting to apply preventive interventions in the elderly and optimize their quality of life.