Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress.

Peipei Fu,Qingyue Meng,Chengchao Zhou

doi:10.3390/ijerph17145240

Abstract

Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19–1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.

Highlights

Frailty in older adults is one complicated condition accompanied with aging and characterized with progressive decline in physiological reserves and resistance to stressors, which are related to increased morbidity and mortality [1,2]
This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association
In this cross-sectional study, after adjustment for a variety of confounders, we have identified that both sleep quality and psychological distress were significantly associated with frailty status

Summary

Introduction

Frailty in older adults is one complicated condition accompanied with aging and characterized with progressive decline in physiological reserves and resistance to stressors, which are related to increased morbidity and mortality [1,2]. Numerous evidences have linked frailty to negative health, such as disability, hospitalization, higher mortality rates, and threaten quality of life of older adults [3,4]. Previous studies indicate that chronic diseases are positively associated with the onset of frailty [5,6,7]. A study in Singapore demonstrate that frailty prevalence in older adults with diabetes is twice of that in general population [8]. Frail individuals with chronic disease are demonstrated to have higher risk of mortality [9]. Frailty among the individuals with chronic disease requires

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