In general, we found evidence of the internal consistency reliability and construct validity of the PSQI and ESS in older men. Despite low correlation with the PSQI global score, the PSQI daytime dysfunction and sleep medications components do not appreciably reduce the PSQI total score's reliability or validity in older men.

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Objectives Despite routine use with older adults, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) have not been adequately validated in older samples, particularly those from diverse racial backgrounds. The objective of this study was to determine the reliability and validity of and to provide normative data for these questionnaires in community-dwelling older women. Methods Participants were 306 black and 2,662 white women aged ≥70 from the Study of Osteoporotic Fractures. Participants completed the PSQI and ESS, and provided self-reported assessments of mood, cognition, and functioning, and underwent wrist actigraphy for sleep-wake estimation. Results Good internal consistency in both black and white women was demonstrated for the PSQI and ESS. Two PSQI subscales, however, were found to have inadequate reliability (Medications, Daytime Dysfunction). Both the PSQI and ESS were associated with theoretically similar measures in the expected directions. The PSQI also differentiated participants with no reported sleep disorder from those reporting at least one sleep disturbance, such as insomnia, sleep apnea, and restless legs. The ESS only differentiated women reporting no sleep disorder from those reporting insomnia. Conclusions In general, findings suggest that the PSQI and ESS are internally consistent, valid measures of self-reported sleep conditions problems in older women. Additional research is required to evaluate the impact of removing the Medications and Daytime Dysfunction PSQI subscales on this measure's internal consistency in older women.

We examined the association of anxiety, depressive symptoms, and their co-occurrence on cognitive processes in 102 community-dwelling older adults. Participants completed anxiety and depression questionnaires, and measures of episodic and semantic memory, word fluency, processing speed/shifting attention, and inhibition. Participants with only increased anxiety had poorer processing speed/shifting attention, and inhibition, but depressive symptoms alone were not associated with any cognitive deficits. Although co-existing anxiety and depressive symptoms was associated with deficits in 3 cognitive domains, reductions in inhibition were solely attributed to anxiety. Findings suggest an excess cognitive load on inhibitory ability in normal older adults reporting mild anxiety.

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Objectives The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms. Methods 4,219 participants (65 or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models’ outcome was elevated anxiety (≥12 on 5-item Beck Anxiety Inventory) or depressive symptoms (≥ on 8-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of 7 self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses. Results Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% CI: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of 7 medical conditions, with the exception being stroke, were present in the majority of triads. Conclusion Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. Since anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity.

The aim of this study was to determine whether distress and burden were associated with objective measures of sleep disturbance in dementia caregivers. Using wrist actigraphy, sleep was measured in 60 female, Caucasian dementia family caregivers (mean age, 64.8 years). Caregivers completed questionnaires about demographics, health, depression, duration of caregiving and care recipient nighttime behavior. Care recipients completed a mental status exam. We investigated whether these measures were associated with actigraphic sleep parameters. Greater depressive symptoms among caregivers were associated with poorer sleep efficiency. Older caregiver age and poorer self-rated health were associated with longer time in bed. Sleep disturbance, which is common among dementia caregivers, might be an important index of caregiver distress (ie, depression) but might not be associated with burden (based on the care recipient's general cognitive impairment or nighttime awakenings.).

Objectives Few studies have examined the association between anxiety symptoms and objectively measured sleep quality in older adults. We determined this association in a large cohort of very old community-dwelling women. Design Cross-sectional. Setting Participants’ homes, sites of the Study of Osteoporotic Fractures. Participants 3,040 women (mean age = 83.6 years) enrolled in a prospective study of aging. Measurements Participants completed the Goldberg Anxiety Scale (ANX), the 15-item Geriatric Depression Scale (GDS), and ≥3 nights of actigraphy--a means of measuring sleep by recording movement using a device called an actigraph. Elevated anxiety symptoms were defined as ANX ≥6. Elevated depressive symptoms were defined as GDS ≥6. Results Participants’ mean ANX score was 1.4 (SD = 2.2); 9.2% (n = 280) had ANX ≥6. Elevated anxiety symptoms were associated with greater odds of poor sleep efficiency (odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.34, 2.23) and time awake after sleep onset (OR = 1.64, 95% CI 1.27, 2.11). Associations remained after adjustment for GDS ≥6, anti-anxiety medications, and other potential confounders (sleep efficiency OR = 1.50, 95% CI 1.15, 1.97; time awake after sleep onset OR = 1.33, 95% CI 1.01, 1.75). Anxiety symptoms were not associated with other sleep parameters. Conclusion Anxiety symptoms are associated with poor objectively measured sleep efficiency and elevated sleep fragmentation in very old women. These associations are independent of elevated depressive symptoms, medical co-morbidities, and use of anti-anxiety medications. Elevated anxiety is a robust predictor of lower sleep quality in this population.