Worldwide Prevalence of Poor Sleep Quality in Older Adults: A Systematic Review and Meta-Analysis
Abstract
Objective: The objective of this meta-analysis was to establish the prevalence of poor sleep quality among individuals aged over 60 years old, utilizing the Pittsburgh Sleep Quality Index (PSQI).
Method: To identify appropriate records, a thorough search of PubMed, Scopus, and Web of Knowledge databases was conducted until May 22, 2024. The quality of the included studies was assessed using the Hoy tool. To calculate the pooled prevalence with a 95% confidence interval, the random effects model was utilized. Additionally, subgroup analyses were carried out to investigate the potential sources of heterogeneity.
Results: This study examined 52 cross-sectional studies encompassing 24,217 individuals aged 60 and older. The quality of the studies was assessed, with 4 rated as moderate and 48 as good. China reported the lowest prevalence of poor sleep quality at 14%, while Malaysia recorded the highest at 96%. The overall pooled prevalence was found to be 50% (95% CI: 45-55%), exhibiting significant heterogeneity across the studies (I² = 99.60%, Pheterogeneity < 0.001). Subgroup analysis indicated that geographic location significantly influenced this heterogeneity (p < 0.001), with Africa showing a lower prevalence of poor sleep quality at 27% (95% CI: 23%-32%) compared to other regions. However, no significant differences were observed in the impact of other factors, such as gender, level of development, sample size, survey time, PSQI cut-off, and response rate on the overall heterogeneity of the analyzed data.
Conclusion: This study reveals that approximately half of older adults experience poor sleep quality. However, this prevalence varies across different locations, underscoring the necessity for targeted interventions that consider regional factors influencing sleep health.
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8. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-6.
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27. Zitser J, Allen IE, Falgàs N, Le MM, Neylan TC, Kramer JH, et al. Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults. PLoS One. 2022;17(6):e0270095.
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2. Nelson KL, Davis JE, Corbett CF. Sleep quality: An evolutionary concept analysis. Nurs Forum. 2022;57(1):144-51.
3. Cotroneo A, Gareri P, Lacava R, Cabodi S. Use of zolpidem in over 75-year-old patients with sleep disorders and comorbidities. Arch Gerontol Geriatr Suppl. 2004(9):93-6.
4. Stone KL, Xiao Q. Impact of Poor Sleep on Physical and Mental Health in Older Women. Sleep Med Clin. 2018;13(3):457-65.
5. Tel H. Sleep quality and quality of life among the elderly people. Neurol Psychiatry Brain Res. 2013;19(1):48-52.
6. Corbo I, Forte G, Favieri F, Casagrande M. Poor Sleep Quality in Aging: The Association with Mental Health. Int J Environ Res Public Health. 2023;20(3):1661.
7. Stone KL, Xiao Q. Impact of Poor Sleep on Physical and Mental Health in Older Women. Sleep Med Clin. 2018;13(3):457-65.
8. Huyett P, Bhattacharyya N. Incremental health care utilization and expenditures for sleep disorders in the United States. J Clin Sleep Med. 2021;17(10):1981-6.
9. Streatfeild J, Smith J, Mansfield D, Pezzullo L, Hillman D. The social and economic cost of sleep disorders. Sleep. 2021;44(11): zsab132.
10. "World Health organization" [Available from: https://www.who.int/news/item/30-09-2015-who-number-of-people-over-60-years-set-to-double-by-2050-major-societal-changes-required.
11. Lu L, Wang SB, Rao W, Zhang Q, Ungvari GS, Ng CH, et al. The Prevalence of Sleep Disturbances and Sleep Quality in Older Chinese Adults: A Comprehensive Meta-Analysis. Behav Sleep Med. 2019;17(6):683-97.
12. Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, et al. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med. 2024;119:118-34.
13. Jalali R, Mohammadi M, Vaisi-Raygani A, Salari N. The prevalence of sleep disorders among Iranian older adults: A systematic review and meta-analysis. Curr Psychol. 2021:1-8.
14. Lu L, Wang SB, Rao W, Zhang Q, Ungvari GS, Ng CH, et al. The Prevalence of Sleep Disturbances and Sleep Quality in Older Chinese Adults: A Comprehensive Meta-Analysis. Behav Sleep Med. 2019;17(6):683-97.
15. Fabbri M, Beracci A, Martoni M, Meneo D, Tonetti L, Natale V. Measuring Subjective Sleep Quality: A Review. Int J Environ Res Public Health. 2021;18(3):1082.
16. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
17. de la Vega R, Tomé-Pires C, Solé E, Racine M, Castarlenas E, Jensen MP, et al. The Pittsburgh Sleep Quality Index: Validity and factor structure in young people. Psychol Assess. 2015;27(4):e22-7.
18. Manzar MD, BaHammam AS, Hameed UA, Spence DW, Pandi-Perumal SR, Moscovitch A, et al. Dimensionality of the Pittsburgh Sleep Quality Index: a systematic review. Health Qual Life Outcomes. 2018;16(1):89.
19. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000;283(15):2008-12.
20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336-41.
21. Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. 2018;121(Pt 1):1027-31.
22. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. Journal of clinical epidemiology. 2012;65(9):934-9.
23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-60.
24. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193-206.
25. da Silva RV, Soares NM, Pereira GM, da Silva Júnior EG, do Carmo Eulálio M. Sleep quality features and their association with mood symptoms and cognitive factors in a non-clinical sample of older Brazilian adults. Psychogeriatrics. 2020;20(5):673-80.
26. Wu CY, Su TP, Fang CL, Yeh Chang M. Sleep quality among community-dwelling elderly people and its demographic, mental, and physical correlates. J Chin Med Assoc. 2012;75(2):75-80.
27. Zitser J, Allen IE, Falgàs N, Le MM, Neylan TC, Kramer JH, et al. Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults. PLoS One. 2022;17(6):e0270095.
28. Li N, Xu G, Chen G, Zheng X. Sleep quality among Chinese elderly people: A population-based study. Arch Gerontol Geriatr. 2020;87:103968.
29. Lu L, Wang SB, Rao W, Zhang Q, Ungvari GS, Ng CH, et al. The Prevalence of Sleep Disturbances and Sleep Quality in Older Chinese Adults: A Comprehensive Meta-Analysis. Behav Sleep Med. 2019;17(6):683-97.
30. Simonelli G, Marshall NS, Grillakis A, Miller CB, Hoyos CM, Glozier N. Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration. Sleep Health. 2018;4(3):239-50.
31. Chueh KH, Yang MS, Chen CS, Chiou SM. Poor sleep quality and alcohol use problems among elderly Taiwanese aboriginal women. Int Psychogeriatr. 2009;21(3):593-9.
32. Araújo CL, Ceolim MF. [Sleep quality of elders living in long-term care institutions]. Rev Esc Enferm USP. 2010;44(3):619-26.
33. Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Ensrud KE, Stefanick ML, et al. Association of sleep characteristics and cognition in older community-dwelling men: the MrOS sleep study. Sleep. 2011;34(10):1347-56.
34. Yang CY, Chiou AF. Predictors of sleep quality in community-dwelling older adults in Northern Taiwan. J Nurs Res. 2012;20(4):249-60.
35. Park JH, Yoo MS, Bae SH. Prevalence and predictors of poor sleep quality in Korean older adults. Int J Nurs Pract. 2013;19(2):116-23.
36. Orhan FO, Tuncel D, Taş F, Demirci N, Ozer A, Karaaslan MF. Relationship between sleep quality and depression among elderly nursing home residents in Turkey. Sleep Breath. 2012;16(4):1059-67.
37. Luo J, Zhu G, Zhao Q, Guo Q, Meng H, Hong Z, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: results from the Shanghai aging study. PLoS One. 2013;8(11):e81261.
38. Jirong Y, Changquan H, Hongmei W, Bi-Rong D. Association of sleep quality and dementia among long-lived Chinese older adults. Age (Dordr). 2013;35(4):1423-32.
39. Lo CM, Lee PH. Prevalence and impacts of poor sleep on quality of life and associated factors of good sleepers in a sample of older Chinese adults. Health Qual Life Outcomes. 2012;10:72.
40. Li J, Yao YS, Dong Q, Dong YH, Liu JJ, Yang LS, et al. Characterization and factors associated with sleep quality among rural elderly in China. Arch Gerontol Geriatr. 2013;56(1):237-43.
41. Daglar G, Pinar SE, Sabanciogullari S, Kav S. Sleep quality in the elderly either living at home or in a nursing home. Australian Journal of Advanced Nursing, The. 2014;31(4):6-13.
42. Kang SH, Yoon IY, Lee SD, Kim T, Lee CS, Han JW, et al. Subjective memory complaints in an elderly population with poor sleep quality. Aging Ment Health. 2017;21(5):532-6.
43. Ichimori A, Tsukasaki K, Koyama E. Illuminance, Subjective Sleep Quality, and Psychosomatic Health in Elderly Individuals Requiring Care: A Survey of Japan's Hokuriku Region in Winter. J Community Health Nurs. 2015;32(2):104-14.
44. Chien MY, Chen HC. Poor sleep quality is independently associated with physical disability in older adults. J Clin Sleep Med. 2015;11(3):225-32.
45. Aunjitsakul W, Pitanupong J, Werachattawan N. Sleep quality among elderly people in songkhla province, thailand: A two-stage cluster sampling study. Journal of the Medical Association of Thailand. 2018;101(1).
46. Fawale MB, Ismaila IA, Mustapha AF, Komolafe MA, Ibigbami O. Correlates of sleep quality and sleep duration in a sample of urban-dwelling elderly Nigerian women. Sleep Health. 2017;3(4):257-62.
47. Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand. Epidemiol Health. 2018;40:e2018018.
48. Siripanich C. Health status and behavior influences to sleep quality among community-dwelling elderly in Chanthaburi Province, Thailand. 2017.
49. Štefan L, Vrgoč G, Rupčić T, Sporiš G, Sekulić D. Sleep Duration and Sleep Quality Are Associated with Physical Activity in Elderly People Living in Nursing Homes. Int J Environ Res Public Health. 2018;15(11):2512.
50. Liu Y, Li T, Zhang R, Guo L, Liu K. Poor sleep quality and late-life depression among the elderly in urban communities in liaoning, China: A moderated mediation analysis. Arch Gerontol Geriatr. 2018;79:158-63.
51. Ha J, Kim J. Factors influencing perceived health status among elderly workers: occupational stress, frailty, sleep quality, and motives for food choices. Clin Interv Aging. 2019;14:1493-501.
52. Kumar S, Wong PS, Hasan SS, Kairuz T. The relationship between sleep quality, inappropriate medication use and frailty among older adults in aged care homes in Malaysia. PLoS One. 2019;14(10):e0224122.
53. Ansari M, Doulatshahi B, Sahaf R. Comparing negative emotional components in older people with normal and poor quality of sleep. Iranian Journal Of Ageing. 2019;14(2):200-11.
54. Honarvar B, Lankarani KB, Azadegan M, Khaksar E, Jafari F, Fard TR. The prevalence and predictors of sleep disturbance in the elderly: A population-based study in Shiraz, Iran. Shiraz E-Medical Journal. 2019;20(11).
55. Del Brutto OH, Mera RM, Peñaherrera E, Costa AF, Peñaherrera R, Castillo PR. On the Association Between Sleep Quality and Arterial Stiffness: A Population Study in Community-Dwelling Older Adults Living in Rural Ecuador (The Atahualpa Project). J Clin Sleep Med. 2019;15(8):1101-6.
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| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Aged Cross-Sectional Studies Epidemiology Prevalence Sleep Disorders | ||
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How to Cite
1.
Kavousi P, Mali E, Seifhashemi N, Souri M, Pakravan L, Khalili F. Worldwide Prevalence of Poor Sleep Quality in Older Adults: A Systematic Review and Meta-Analysis. Iran J Psychiatry. 2025;:1-16.
