Objectively measured sleep quality and nursing home placement in older women.
OBJECTIVE
To determine the association between objectively measured sleep and subsequent placement in a nursing home or a personal care home.


METHODS
Prospective cohort.


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


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


METHODS
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.


CONCLUSIONS
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.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. aspira@jhsph.edu
Adam P
AP
Spira
Kenneth
K
Covinsky
George W
GW
Rebok
Katie L
KL
Stone
Susan
S
Redline
Kristine
K
Yaffe
D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D018670:Monitoring, Ambulatory / Q000295:instrumentation; D009735:Nursing Homes; D011446:Prospective Studies; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D014481:United States