title: Patterns and predictors of sleep quality before, during, and after hospitalization in older adults.
abstract: OBJECTIVE
  The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep.
  
  
  METHODS
  This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission.
  
  
  RESULTS
  Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged.
  
  
  CONCLUSIONS
  Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Dzierzewski
authors.affiliation: VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mitchell
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.|School of Medicine, Pontificia Universidad Catolica de Chile.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Rodriguez
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Constance H
authors.initials: CH
authors.lastname: Fung
authors.affiliation: VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Stella
authors.initials: S
authors.lastname: Jouldjian
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Alessi
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; Los Angeles, CA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: aging; clinical cutoffs; hospitalization; latent class analysis; sleep