Sleep Problems In Older Adults Research Articles

Association between sleep problems and self-perception of health among community-dwelling older adults: Data from the 2019 national health survey

BackgroundSleep problems in the older adults are often linked to their self-perceived health status, significantly affecting their overall well-being. Investigating this relationship is essential to understand how sleep impacts health perception in older adults and to develop targeted strategies to improve their quality of life and health outcomes. The objective was to verifying the association between sleep problems and negative self-perception of health in community-dwelling older adults. MethodsCross-sectional study, with data from 43,554 older adults participants of the National Health Survey (PNS-2019). The exposure variable was self-report of sleep problems in the last 15 days (difficulty in falling asleep, waking up frequently at night, or sleeping more than usual) and the study endpoints were self-perception of health (positive/negative). Associations were checked using multivariable logistic regression. ResultsOlder adults with sleep problems were 1.92 (95 %CI 1.77; 2.08) more likely to have a negative self-perception of health when compared to older adults without sleep problems. ConclusionsThese findings reinforce the need for programs aimed at reducing sleep problems in older adults, since these are associated with negative self-perceptions of health. A better understanding of these associations may help health care professionals to better control sleep disturbances as well as their outcomes.

Bridging Gaps in Sleep Health and Dementia: Linking Sleep Disorders and Neurocognitive Health

There is growing evidence of a bidirectional relationship between sleep disturbances and disorders and cognitive function in normal and pathological aging. Not only do sleep disturbances and disorders predict and contribute to a decline in neurocognitive function, but neurodegenerative disorders impair sleep. Furthermore, sleep and rhythm disturbances may be some of the earliest symptoms of neurodegenerative disorders such as MCI, AD, and Parkinson's disease. However, the potential effects of improving sleep on mitigating decline in cognitive function are still unknown. While some of the classes of pharmaceutical agents may improve subjective sleep, they have variable effects on sleep oscillations and cognition. The effects of other approaches, such as cognitive behavioral therapy and neuromodulation, on neurodegenerative processes are not yet fully understood.The goal of this session and panel is to educate participants about changes in sleep patterns and sleep oscillations that occur in aging and neurodegenerative disorders, mechanisms for associations between poor sleep and sleep disorders and cognitive decline and contribution to dementia, and the potential benefits of identifying and treating sleep disorders in older adults who may be at risk of developing dementia. In addition, the discussion will highlight the lack of standardized care pathways for diagnosing and treating sleep problems in older adults.

Association between sleep problems and functional disability in community-dwelling older adults

BackgroundSleep problems are frequently observed in older adults. They can lead to changes in the individual’s physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.MethodsThis was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.ResultsOlder adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.ConclusionsOlder adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Comparative efficacy of non-pharmacological interventions on sleep quality in old adults: A systematic review and network meta-analysis.

To compare the effectiveness of non-pharmacological interventions in enhancing sleep quality in older people. Sleep problems in older adults have become increasingly prominent. Sleep problems not only affect the health and quality of life of older people, but also the range of chronic diseases caused by sleep problems also impose a huge burden on social services and health care. Non-pharmacological interventions are an effective alternative to pharmacological therapies, but it is unclear which non-pharmacological therapies are most effective in enhancing sleep quality in older adults. A systematic review and network meta-analysis based on PRISMA-NMA. A total of seven databases were searched from the establishment of the database to March 2023. After literature screening and data extraction, the Cochrane Bias assessment tool 2.0 version of randomised controlled trials (RCTs) was used to evaluate literature quality. A network meta-analysis was performed to evaluate the relative efficacy of the non-pharmacological interventions on sleep quality. A total of 71 RCTs involving nine non-pharmacological interventions were included. The results of the network meta-analysis showed that the joint intervention may be the most effective non-pharmacological intervention to enhance sleep quality in older adults. This study confirms that non-pharmacological interventions can improve sleep quality in older adults. The use of non-pharmacological interventions can be promoted by healthcare professionals in the future to improve the quality of sleep and thus the physical and mental health of older people. This evidence suggests that joint interventions may be most effective. Therefore, in the future, a combination of non-pharmacological interventions could be used to maximise their effectiveness in improving sleep quality in older people and promoting healthy aging. No patient or public contribution is not applicable to this study.

Description of care pathways for benzodiazepine and sedative hypnotic discontinuation in older adults: protocol of a multicentre qualitative study

Introduction: Benzodiazepines and sedative hypnotics (BSHs) may represent a threat to patient safety, especially among older adults. The project BE-SAFE (Implementing a patient-centred and evidence-based intervention to reduce BEnzodiazepine and sedative-hypnotic use to improve patient SAFEty and quality of care) is a 5-year research project funded through the Horizon Europe Research Programme (Grant agreement n° 101057123). Its goal is to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSHs used for sleep problems in older adults. Within the project, a patient-centred and evidence-based intervention will be developed to reduce the use of BSHs for sleep problems in older adults. This intervention will be tested in a cluster randomized controlled trial in different hospitals of six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland). Understanding current care pathways and healthcare systems in relation to BSH discontinuation should help tailor the BE-SAFE intervention to target contexts. This understanding should also shed light on the conditions for patient involvement in shared-decision making and interprofessional and interorganisational collaboration. These elements are expected to be key to the success of the intervention.
 
 Objective: To describe care pathways, including interprofessional and interorganisational collaborations, and healthcare systems in relation to BSH discontinuation in the six countries participating in the BE-SAFE trial, from the perspective of healthcare professionals and patients.
 Methods: A qualitative study will be conducted in the hospitals where the trial will take place and in other healthcare settings that are part of the care pathway, such as primary care. This study will follow four phases: 1) exploring healthcare systems, 2) mapping a typical care pathway for BSH discontinuation, including stakeholder analysis with patients, healthcare professionals and managers, 3) characterising healthcare systems in relation to BSH discontinuation, and 4) validation of results with stakeholders. Participants will be healthcare professionals, especially those involved in BSH discontinuation, managers and patients over 65 years of age either taking BSHs for sleep problems or who have undergone BSH discontinuation in the last three months. Data will be collected through self-administered questionnaires, semi-structured interviews and focus groups. The “6 W” multidimensional model of care trajectories (1) and the “Context and Capabilities for Integrating Care” framework (2) will be used to guide data collection and analyses.
 Expected results: We will obtain an in-depth description of care pathways and healthcare systems in relation to BSH discontinuation in each of the six countries participating in the BE-SAFE trial. These results will help to inform intervention development through the creation of logic models and to fit the BE-SAFE intervention to target contexts. By May 2023, we will have an initial version of the description of care pathways in each country.
 1.Vanasse A, Courteau M, Ethier JF. The ‘6W’ multidimensional model of care trajectories for patients with chronic ambulatory care sensitive conditions and hospital readmissions. Public Health. 2018 Apr 1;157:53–61.
 2.Evans JM, Grudniewicz A, Baker GR, Wodchis WP. Organizational context and capabilities for integrating care: A framework for improvement. Int J Integr Care. 2016 Jun 24;16(3):1–14.
 

Social distancing and trouble sleeping during COVID-19 pandemic among older adults in Europe: Mediating and moderating effects.

We examined the association between social distancing and trouble sleeping during the COVID-19 outbreak in adults 65+, and underlying potential mechanisms. We used data from the extensive Survey of Health, Aging, and Retirement in Europe (SHARE). Logistic regression analysis tested the direct and indirect associations between social distancing and trouble sleeping during the pandemic, the mediation effect of depression, and the moderating-mediation effects of perceived economic status and employment status. Social distancing was associated with a higher probability of sleeping problems, partially mediated by depression and moderated by employment status and perceived economic status. Depression had a greater effect on trouble sleeping among those unemployed and those who perceived their economic status as difficult or partially difficult. COVID-19 policy of lockdowns and physical distancing has negative consequences on sleeping and the development of depressive symptoms among older adults. Clinicians should be aware of sleep problems in older adults during the pandemic and after, and try to reduce depressive symptoms. Policymakers should determine future policies and regulations that encourage employment among older adults and improve their economic resilience during pandemics.

Fulfillment of Sleep Needs in Elderly Insomnia in South Sibolga District, Sibolga City

Background: Insomnia is one of the most common sleep problems in older adults (elderly). Insomnia in the elderly is caused by several factors, namely health status factors, drug use, environmental conditions, psychological stress, diet/nutrition. Purpose: overcoming insomnia in the elderly by combining two theories, namely Comfort and Environmental. Methods: The type of research used in this study is qualitative with a phenomenological approach. the number of participants who participated in this study were fifteen people. Collecting data using Focus Group Discuss (FGD), Observation, and in-depth interviews, the results of data collection in this study using analysis techniques Triangulation method (Focus Group Discuss, in-depth interviews, and observation). Results: This study produced five main themes, namely: 1) physical, 2) psychology, 3) religion, 4) social, 5) environment. Conclusion: In achieving the quality and quantity of sleep for the elderly who experience insomnia, it is expected that the elderly can fulfill their comfort and cleanliness in their surrounding environment.

Risk Factors of Sleep Disturbance in Older Adults With Dementia: An Actigraphy-Based Validation Study

Sleep disturbance is a common and significant symptom experienced by older adults with dementia. Early detection and timely treatment of sleep disturbance are critical to prevent adverse consequences including decreased quality of life for persons with dementia and increased caregiver burden. While direct observations and sleep diaries are often unreliable, actigraphy is a cost-effective method in measuring sleep problems in older adults with dementia and provides reliable and rich sleep data. Therefore, this study aimed to examine sleep disturbance objectively measured by actigraphy and its risk factors in community-dwelling older adults with dementia in Korea. This is a prospective study consisting of a two-wave dataset. The model was fitted using Wave 1 data (n=151) and then validated using Wave 2 data (n=59). Independent variables were demographics, cognitive and physical function, depressive symptoms, physical activity level, and neuropsychiatric symptoms measured by Neuropsychiatric Inventory(NPI), and clinical factors including dementia type, sedative use, and comorbidities. Sleep disturbance was defined as less than six nighttime sleep hours and sleep efficacy less than 75%. Using the Youden’s Index, the sample was dichotomized into sleep disturbance group (n=83) and sound sleep group (n=68). The results of the generalized linear mixed model showed that the risk factors for sleep disturbance included vascular dementia, age, step count, and having three neuropsychiatric symptoms (i.e., delusions, depression, and disinhibition). Individuals with dementia at risk for sleep disturbance should be identified to prioritize early prevention strategies and individualized interventions. Particularly, management of delusion, depression, disinhibition is critical in preventing disturbed sleep.

Impact of Subjective and Objective Sleep Quality on Peptic Ulcer Rebleeding in Older Adults.

This study aimed to examine the association of subjective and objective sleep quality with subsequent peptic ulcer rebleeding among older patients. Of 1196 older patients with peptic ulcer bleeding (PUB) recruited from 12 grade A hospitals in the People's Republic of China, 1106 achieved full recovery from PUB, and they were followed up for up to 30 days. Using multiple measures at 1-week intervals, patients who presented PUB symptoms were invited to have an esophagogastroduodenoscopy examination. Subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Objective sleep quality domains were measured using an accelerometer, including sleep onset latency, sleep efficiency, total sleep time, and the number of awakenings. This study documented a 30-day cumulative ulcer rebleeding rate of 15.3%. Multivariate analyses showed that longer sleep onset latency (hazard ratio [HR] = 2.136 [1.336-2.558]) and more nighttime awakenings (HR = 1.698 [1.169-2.666]) increased the risk of ulcer rebleeding. However, a longer total sleep time (HR = 0.768 [0.698-0.887]) and better sleep efficiency (HR = 0.795 [0.682-0.975]) protected against ulcer rebleeding. Older patients who perceived poorer sleep quality were also more likely to experience ulcer rebleeding (HR = 2.295 [1.352-3.925]). The present results highlight the importance of proper treatment and prevention of sleep problems in older adults after successful PUB treatment. Our results, if replicable in future studies with more rigorous design and representative samples, might shed light on the etiology of ulcer rebleeding and suggest new pathways for preventing this disease.

Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults.

Passive body heating in controlled settings could shorten sleep onset latency (SOL). The hypothesized mechanism is vasodilation-induced heat loss before bedtime. However, this evidence is based on small sample-sized studies in specific populations. Thus, we analyzed the association of hot-water bathing and its before-bedtime timing with SOL and heat loss in a large study population of older adults. We conducted a longitudinal analysis using repeated measurements of hot-water bathing and sleep among 1,094 older adults (mean age, 72.0 years). SOL was recorded using actigraphy and self-reported sleep estimates and was categorized into conditions (intervals of 1-60, 61-120, 121-180, and > 181 minutes between hot bath and bedtime) and compared with the control condition of no bathing. The heat-loss indicator, distal-proximal skin temperature gradient, was examined in the same categorization. Mixed-effects linear regression models suggested that the bathing conditions of 61-120 minutes and 121-180 minutes showed significantly shorter log-transformed actigraphic SOL by 0.23 log-minutes (95% confidence interval (CI), 0.03-0.42) and 0.32 log-minutes (95% CI, 0.09-0.56), shorter self-reported SOL by 0.16 log-minutes (95% CI, 0.02-0.30) and 0.18 log-minutes (95% CI, 0.01-0.35), and higher distal-proximal skin temperature gradient for 30 minutes before bedtime by 0.49°C (95% CI, 0.22-0.75) and 0.51°C (95% CI, 0.20-0.83), respectively, independent of potential confounders. Hot-water bathing before bedtime is significantly associated with shorter SOL and higher distal-proximal skin temperature gradient among the large-scale older population. This finding could enhance the generalizability of hot-water bathing habits for ameliorating sleep initiation difficulty.

Are Reallocations between Sedentary Behaviour and Physical Activity Associated with Better Sleep in Adults Aged 55+ Years? An Isotemporal Substitution Analysis.

Physical activity has been proposed as an effective alternative treatment option for the increasing occurrence of sleep problems in older adults. Although higher physical activity levels are associated with better sleep, the association between specific physical activity intensities and sedentary behaviour (SB) with sleep remains unclear. This study examines the associations of statistically modelled time reallocations between sedentary time and different physical activity intensities with sleep outcomes using isotemporal substitution analysis. Device-measured physical activity data and both objective and subjective sleep data were collected from 439 adults aged 55+ years. Replacing 30 min of SB with moderate to vigorous intensity physical activity (MVPA) was significantly associated with an increased number of awakenings. Moreover, a reallocation of 30 min between light physical activity (LPA) and MVPA was significantly associated with increased sleep efficiency. Furthermore, reallocating 30 min of SB to LPA showed a significant association with decreased sleep efficiency. There were no significant associations of time reallocations for wake time after sleep onset, length of awakenings, and sleep quality. These results improve our understanding of the interrelationships between different intensities of movement behaviours and several aspects of sleep in older adults.

Use of Cannabis for Sleep: Patterns of Use Among a Sample of Patients in a Geriatrics Clinic

Cannabis may be useful for treatment of sleep problems in older adults. Little is known about use patterns of cannabis for sleep. We conducted a clinic-based anonymous survey in a geriatrics clinic in La Jolla, CA. Among n=568 surveys, 10% reported recent use (within past 6 months). Among recent users, 30% reported using cannabis for sleep, most finding it helpful. Compared to cannabis users for other conditions, cannabis users for sleep were more likely to use THC containing products (62.5% vs. 32.1%), use cannabis on a daily or weekly basis (76.2% vs. 43.2%), use vape pens (29.2% vs. 6.9%), and to obtain cannabis via a delivery service (33.3% vs. 14.0%) (all p’s<0.05). Only 40% reported their doctor knew about their cannabis use. Our findings suggest sleep is a common reason for using cannabis. Future research should assess how use patterns can result in effective treatment for sleep in older adults. Part of a symposium sponsored by the Sleep, Circadian Rhythms and Aging Interest Group.

Contributors to and Consequences of Poor Sleep in Older Adults: Biopsychosocial Perspectives

Sleep is a significant contributor to health and wellbeing across the lifespan, especially in later life. Poor sleep is common among older adults and can be both a risk factor for and consequence of numerous physical and mental health-related outcomes. In this symposium, we will present novel results from four studies that will advance understanding of the biological, psychological, and social factors that may contribute to or result from poor sleep in older adults. Specifically, Study 1 will present findings tying objectively measured sleep to performance on cognitive tasks administered using ecological momentary assessment (EMA) in the day-to-day lives of older adults with or without mild cognitive impairment (MCI). Study 2 will examine associations of personality dimensions and facets with insomnia symptoms in well-functioning older adults. Study 3 will examine psychological pathways linking parent-child relationships to subjective and objective sleep characteristics among older parents. Finally, study 4 will examine use patterns of cannabis for the treatment of sleep problems in older adults, and the ways in which this might differ from patients using cannabis for other reasons (e.g., pain). Together, this symposium will highlight novel links of an array of factors with sleep health in the aging population and their implications for prevention. Sleep, Circadian Rhythms and Aging Interest Group Sponsored Symposium.

Bedtime Music for Sleep Problems in older Adults with Dementia: a feasibility Study

Sleep problems are highly prevalent in elderly persons with dementia. Poor sleep constitute a major problem as it causes distress and may aggravate the dementia symptoms. Music has been proposed as a potential sleep aid, and in this study, we assessed the feasibility and effect of bedtime music listening for improving sleep problems in older adults with dementia. We used a within-subject design including 40 participants. Participants and caregivers evaluated the feasibility and effect after the intervention period, and we measured sleep with wrist actigraphy 14 days at baseline and during the 14 days intervention period. In the intervention period participants listened to music for 30 minutes every night at bedtime. We developed five playlists with slow, soothing music of different genres, and participants could choose the genre they liked the best. We found that the music intervention was well-liked and sleep improvement was observed in around half the participants. Wrist actigraphy showed no significant changes in the objective sleep pattern. Music listening at bedtime could provide a safe, comfortable and low-cost intervention for sleep problems among elderly persons with dementia, the intervention is feasible, but more research is needed to determine the effect on sleep outcomes.

COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators

ObjectivesOlder adults may experience loneliness due to social distancing and isolation during the Coronavirus disease 2019 (COVID-19) pandemic. Loneliness may further catalyze numerous poor health outcomes including impaired sleep. This study aimed to assess COVID-19 related worries and resilience as potential moderators of the loneliness-sleep problems link. MethodIn the midst of the lock-down period of COVID-19, we collected data using a web-based public platform from 243 Israeli older adults (mean age = 69.76, SD = 6.69, age range = 60–92). Participants completed measures of COVID-19 related loneliness, sleep problems, COVID-related worries, and resilience. ResultsCOVID-19 related loneliness was related to more sleep problems. The loneliness-sleep association was especially strong among those with more COVID-19 related worries or among those with lower resilience. ConclusionThe relationship between COVID-19 related loneliness and sleep problems is not uniform across older adults. The subjective sleep quality of those with more COVID-19 related worries or less resilience (i.e., feeling less being able to adapt to the challenging circumstances) is more susceptible to feeling lonely. Considering these variables may facilitate detection of and intervention for older adults vulnerable to aversive results in the context of COVID-19.

Tai Chi exercise for sleep problems in older adults: A protocol of systematic review and meta-analysis.

Sleep plays a crucial role in the general health of the human body. However, sleep problems become increasingly severe with age, and its incidence is on the rise. Notably, Tai Chi exercise may be an efficacious means to ameliorate sleep problems among older adults. This is especially since Tai Chi has been widely used to manage sleep problems in China for many years, but there is limited evidence regarding its effectiveness. We will conduct this study aiming to investigate the efficacy of Tai Chi as a complementary and alternative therapy for sleep problems in older adults. We will systematically search Scopus, Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database from their inceptions to August 2019. Only randomized controlled trials of Tai Chi for sleep problems among older adults will be considered for inclusion and the Pittsburgh sleep quality index will be the primary outcome measurement. Moreover, study selection, data extraction, and the evaluation of the methodological quality of trials will each be independently completed by at least 2 researchers. We will employ the software Stata version 12.0 to implement the statistical analysis. The current systematic review and meta-analysis will provide synthesized results of the effectiveness and safety of Tai Chi exercise for sleep problems among older adults. This systematic review and meta-analysis will provide high-quality evidence on the effectiveness and safety of Tai Chi exercise for sleep problems in older adults. PEROSPERO CRD42019129782.

Relationships between sleep quality, depressive symptoms and MCI diagnosis: A path analysis

BackgroundThis study examined the complex relationships between sleep quality, depressive symptoms, and cognitive decline in older adults. We hypothesised that older age, lower education and greater medical comorbidities would each be associated with increased mild cognitive impairment (MCI) diagnosis risk through indirect effects via poorer sleep quality, and greater depressive symptomology. Methods540 adults 44 years and over were recruited at the Brain and Mind Centre, Sydney, Australia. Participants underwent comprehensive psychiatric, neuropsychological, and medical assessment. Subjective sleep quality, current depressive symptomatology, and current medical burden were assessed. ResultsThere were significant indirect effects of each of age, comorbidities and education, that operated via both sleep and depression. Younger age, greater comorbidities and fewer years’ education each predicted greater chance of MCI diagnosis via poorer sleep and in turn higher depressive symptomatology. Additionally, there was a significant direct effect of older age on MCI. LimitationsThe current study is cross-sectional and cannot determine whether poorer sleep quality and greater depressive symptomatology precede or arise as a result of the onset of cognitive decline in later-life. A longitudinal design may allow further explication of these relationships. ConclusionsBoth sleep and depression are linked with cognitive decline in older adults, with sleep disturbance appearing to predict depressive symptoms. These findings have implications for the management of MCI. Both greater depression symptomatology and sleep disturbance were shown to predict the risk of MCI diagnosis, with this effect strongest in those that are younger. Improved early detection and treatment of sleep problems in older adults may help prevent depressive symptom manifestation or exacerbation, in turn potentially reducing the risk of subsequent cognitive decline.

Predictors of persistent sleep problems among older disaster survivors: a natural experiment from the 2011 Great East Japan earthquake and tsunami.

To examine prospectively the associations of disaster experiences and social support with sleep problems in older adults. Data came from a natural experiment caused by the 2011 Great East Japan earthquake and tsunami. Participants in an ongoing prospective cohort (3547 Japanese individuals aged 65 years or older) were inadvertently exposed to the disaster due to their residential location (Iwanuma city) after the 2010 baseline survey. We conducted a follow-up survey in 2013 to inquire about disaster-related experiences and short sleep duration, sleep insufficiency, poor sleep quality, insomnia symptoms, and sleep medication use. Poisson regression models adjusted for baseline socio-demographic and lifestyle covariates. Financial hardship predicted increased risks of short sleep duration (relative risk [RR] = 1.40; 95% confidence interval [CI] [1.03, 1.90]), sleep insufficiency (RR = 1.29; 95% CI [1.01, 1.66]), poor sleep quality (RR = 1.47; 95% CI [1.26, 1.70]), and insomnia symptoms (RR = 1.13; 95% CI [1.01, 1.28]). Home destruction predicted sleep medication use while health care disruption predicted poor sleep quality. Loss of close relatives or friends did not predict any sustained sleep problems. Additionally, having instrumental support reduced risks of all sleep problems while having emotional support reduced risk of poor sleep quality. Approximately 2.5 years after the disaster, older survivors' sleep problems were more durably linked to material aspects of disaster damage than to loss of loved ones. Findings could inform targeted recovery efforts for groups with greatest need to promote older survivors' sleep health and overall well-being.

Neighborhood Disorder and Sleep Problems in Older Adults: Subjective Social Power as Mediator and Moderator.

Contextual contributors to sleep problems are important to examine among older adults because sleep problems are associated with a number of adverse outcomes in late life. We examine whether disordered neighborhoods are a key contextual determinant of sleep problems in late life, as well as how subjective social power-a sense of personal control and subjective social status-mediates and moderates this association. Central to this contribution is the use of econometric techniques that holistically control for time-stable factors that may bias estimated associations. Three waves (2006, 2010, 2014) of the psychosocial subsample of the Health and Retirement Study (N = 7,130) are analyzed with random-effects models that adjust for repeated observations, as well as fixed-effects models that additionally control for all time-stable confounders. Neighborhood disorder is associated with greater sleep problems in random-effects models, but this association is substantially weakened in a fixed-effects model. Personal control mediates this association, but does not moderate it. Subjective social status does not mediate the association, but does moderate it. Although neighborhood disorder is associated with sleep problems in older adults, this association is likely to be overestimated in analyses that do not compressively control for time-stable confounders. Rather than acting as dual mediators and moderators, perceived control and subjective social status play distinct roles in this association, with seniors at lower levels of subjective social status especially at risk for sleep problems due to neighborhood disorder.

Objective assessment of sleep and sleep problems in older adults with intellectual disabilities

Little is known about sleep in older adults with intellectual disability (ID). Aim of this study was to investigate sleep and its associated factors, and to estimate the prevalence of sleep problems in this population. This study was part of the healthy aging and intellectual disabilities study. Sleep was assessed using the Actiwatch, a watch-like device that measures sleep and wakefulness based on movement activity. Participants (n=551) wore the Actiwatch at least seven days and nights continuously. Variables of interest were time in bed (TIB), sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency and get-up time latency. Multivariate analyses were used to investigate factors associated with these sleep parameters. Provisional definitions were drafted to estimate the prevalence of sleep problems. Mean TIB was 630 min. Longer TIB was independently associated with higher age, more severe level of ID, living at a central facility, wheelchair dependence, female gender and depressive symptoms (adjusted R(2)=.358, F-change=8.302, p<.001). The prevalence of sleep problems was 23.9% settling problem, 63.1% night waking problem, 20.9% short sleep time, 9.3% early waking problem. 72% of the participants had at least one problem, 12.3% had three or more sleep problems. Older adults with ID lie in bed very long, and the prevalence of sleep problems is high. Further research should focus on causality of the relationships found in this study, and effects of sleep problems on health and well-being in this population.