Objectively Measured Sleep Quality and Nursing Home Placement in Older Women

Authors

  • Adam P. Spira PhD,

    Corresponding author
    • Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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  • Kenneth Covinsky MD, MPH,

    1. Division of Geriatrics, Department of Medicine, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • George W. Rebok PhD,

    1. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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  • Katie L. Stone PhD,

    1. California Pacific Medical Center Research Institute, San Francisco, California
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  • Susan Redline MD, MPH,

    1. Division of Sleep Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Kristine Yaffe MD

    1. Departments of Psychiatry, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
    2. Neurology, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
    3. Epidemiology and Biostatistics, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
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Address correspondence to Adam P. Spira, 624 N. Broadway, Hampton House, Rm. 794, Baltimore, MD 21205. E-mail: aspira@jhsph.edu

Abstract

Objectives

To determine the association between objectively measured sleep and subsequent placement in a nursing home or a personal care home.

Design

Prospective cohort.

Setting

Participants' homes and sites of the Study of Osteoporotic Fractures.

Participants

One thousand six hundred sixty-four community-dwelling women with a mean age of 83 ± 4.

Measurements

At baseline, participants completed an average of 4 nights of wrist actigraphy; they provided data on place of residence at baseline and at follow-up, 5 years later.

Results

At baseline, participants had a mean total sleep time of 408 ± 72 minutes, mean wake after sleep onset of 71 ± 43 minutes, and mean sleep efficiency of 79 ± 11%. At follow-up, 71 (4%) were residing in a nursing home, and 127 (8%) were in a personal care home. Women with the most wake after sleep onset (by quartile) had more than twice the odds as those with the least of placement in a nursing home (adjusted odds ratio (AOR) = 2.94, 95% confidence interval (CI) = 1.34–6.44) or a personal care home (AOR = 2.33, 95% CI = 1.26–4.30). Similarly, women with the lowest sleep efficiency had more than three times the odds as those with the highest of nursing home placement (AOR = 3.25, 95% CI = 1.35, 7.82) and more than twice the odds of placement in a personal care home (AOR = 2.38, 95% CI = 1.33, 4.24). There was no association between sleep duration and placement.

Conclusion

In very old community-dwelling women, greater wake after sleep onset and lower sleep efficiency are risk factors for placement in a nursing home or personal care home. Sleep duration alone does not appear to increase the risk of placement in these long-term care settings.

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