title: Sleep quality and falls in older people living in self- and assisted-care villages.
abstract: BACKGROUND
  Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people.
  
  
  OBJECTIVE
  To determine the extent to which a range of physiological, psychological and health-related factors predict night-time sleep quality of older people living in self-care and assisted-care, and whether poor sleep quality is a risk factor for falls.
  
  
  METHODS
  572 people, 81 men and 491 women (mean age 79.7 years, SD 6.4), recruited from self-care retirement villages and assisted-care hostels participated in the cross-sectional study with a subgroup of 169 followed up for falls for 1 year. The main outcome measures were sleep quality and prospective falls.
  
  
  RESULTS
  Approximately half of the sample rated their sleep quality as poor or fair. Many measures of health, medication use and mood were significantly associated with ratings of poor night-time sleep quality. Multiple regression analyses revealed poor circulation, use of psychotropic and diuretic medications, negative affect, pain, not having a friend in the village, lower fitness levels and daytime napping were significant and independent predictors of night-time sleep quality in both residential care groups. Napping daily was reported by 28% of the self-care group and 37% of the assisted-care group. Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures.
  
  
  CONCLUSIONS
  Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.
authors.affiliation: Prince of Wales Medical Research Institute, University of New South Wales, Randwick, N.S.W., Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: St George
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.forename: Philippa
authors.initials: P
authors.lastname: Williams
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D010809:Physical Fitness; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires