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Sleep: A Marker of Physical and Mental Health in the Elderly

From the Departments of Neurology (KJR, PCZ) and Psychiatry (ZM), Northwestern University, Feinberg School of Medicine, Chicago, IL; the Council for Jewish Elderly (SF, KH), Chicago, IL; the Chicago Department of Public Health (JS), Chicago, IL; Older Adults Program (RG), Rush University Medical School, Chicago, IL.

Objective: The objective of this study was to determine the occurrence and recognition of common sleep-related problems and their relationship to health-related quality-of-life measures in the elderly.

Method: A total of 1,503 participants with a mean age of 75.5 (± 6.8, range: 62–100) years from 11 primary care sites serving primarily elderly patients were interviewed. Subjects completed a five-item sleep questionnaire and the SF-12. A Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) score was calculated. A systematic medical chart review was conducted to determine whether sleep problems were identified by the healthcare providers.

Results: A total of 68.9% of patients reported at least one sleep complaint and 40% had two or more. Participants most commonly endorsed (45%) that they had "difficulty falling asleep, staying asleep, or being able to sleep." The number and type of sleep problems endorsed was associated with both physical and mental health quality-of-life status. Excessive daytime sleepiness was the best predictor of poor mental and physical health-related quality of life. Even when all five sleep questions were endorsed, a sleep complaint was only reported in the chart 19.2% of the time.

Conclusions: When elicited, sleep complaints predicted the general physical and mental health-related quality-of-life status in elderly populations with comorbid medical and mental illnesses. Yet, questions regarding sleep are not an integral component of most clinical evaluations. Given the growing evidence of a relationship between sleep and health, identification of sleep disorders could lead to improved management of common age-related chronic illnesses and quality of life of elderly patients.

Key Words: Sleep • aging • mental health • physical health