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

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.

Association between Physical Frailty and Sleep Quality among Saudi Older Adults: A Community-Based, Cross-Sectional Study

“…Shih et al, have reported a significant association between poor sleep quality, and prefrailty and frailty status in the Taiwanese elderly population (OR = 1.95) [ 30 ]. Our results were also consistent with a study conducted in China in which they found that older adults with poor sleep quality were twice as likely to be categorized as frail [ 31 ]. Moreover, our results were also similar to those in Ecuador, where researchers have found that higher scores in the PSQI were significantly associated frailty status in community-dwelling older adults [ 32 ].…”

Prevalence and associated factors of frailty among community dwelling older adults in Northwest China: a cross-sectional study

“…56 Due to various contributors, for example, medication taking, older adults are highly vulnerable to disturbed sleep, increased the risk of the overall frailty and its domains. 55…”

The effect of incontinence on sleep quality in the elderly

“…It has been determined that elderly individuals generally experience problems such as falling asleep, waking up frequently at night, sleeping too much during the day, insomnia, and waking up early 12,13 . It has been reported that 20%‐50% of adult individuals and 57% of home‐dwelling elderly people in Western countries suffer from sleep problems and this rate is higher in elderly people living in nursing homes 10‐15 …”

“…12,13 It has been reported that 20%-50% of adult individuals and 57% of home-dwelling elderly people in Western countries suffer from sleep problems and this rate is higher in elderly people living in nursing homes. [10][11][12][13][14][15] The prevalence of urinary incontinence increases with ageing and it is another important geriatric condition that causes problems during sleep by increasing the frequency of urination at night. The fact that urinary incontinence is a social problem that is generally not mentioned by the elderly leads to under-diagnosis and urinary…”