Brief Report
The Effect of Age in the Association between Frailty and Poor Sleep Quality: A Population-Based Study in Community-Dwellers (The Atahualpa Project)

https://doi.org/10.1016/j.jamda.2015.12.009Get rights and content

Abstract

Purpose

To assess the effect of age in the association between poor sleep quality and frailty status.

Design and Setting

Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador.

Methods

Out of 351 Atahualpa residents aged ≥60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association.

Results

Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11–0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores.

Conclusions

This study shows the strong effect of age in the association between poor sleep quality and frailty status.

Section snippets

Methods

Atahualpa is a rural village located in coastal Ecuador where previous epidemiologic studies have been performed. More than 95% of the population belongs to the Native/Mestizo ethnic group, and their living characteristics are fairly homogeneous, as detailed elsewhere.10 All Atahualpa residents ≥60 years of age were identified during a door-to-door survey and were invited to participate in this study. Those who signed the informed consent and were mentally able to complete the questionnaires by

Results

Information on PSQI and EFS scores were available in 311 (89%) out of 351 eligible individuals. Mean age of participants was 71 ± 8 years (median, 69 years), 177 (57%) were women, 255 (82%) had primary school education only, 233 (75%) had poor cardiovascular health status, 151 (49%) had severe edentulism, and 38 (12%) had symptoms of depression. Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers (≥6 points). Mean score in the EFS was 5 ± 3 points, with 46%

Discussion

This study shows a significant relationship between poor sleep quality and high EFS scores and, more importantly, the strong effect of age on this association. The clusters that drive this statistical significance include the number of robust individuals ≤70 years of age who are good sleepers (27% of the population) and, to a lesser extent, the number of individuals with high EFS scores aged ≥80 years of age who are poor sleepers. In addition, the clusters of younger individuals who are poor

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This study was partially supported by Universidad Espiritu Santo–Ecuador, and by Drs. Martin and Dorothy Spatz Foundation (Sebastopol, CA).

The authors declare no conflicts of interest.

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