Association of back pain with all-cause and cause-specific mortality among older men: a cohort study.

OBJECTIVE: We evaluated whether more severe back pain phenotypes-persistent, frequent or disabling back pain-are associated with higher mortality among older men. METHODS: In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from six U.S. sites. The primary back pain measure used baseline and year five back pain questionnaire data to characterize participants as having: no back pain; non-persistent back pain; infrequent persistent back pain; or frequent persistent back pain. Secondary measures of back pain from year five questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific mortality. RESULTS: After the year five exam, during up to 18 years of follow-up (mean follow-up=10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95%CI=1.11-1.45). No association was evident after further adjusting for health-related factors such as self-reported general health and comorbid chronic health conditions (fully-adjusted HR = 1.00; 95%CI=0.86-1.15). Results were similar for cardiovascular mortality and other mortality, but we observed no association of back pain with cancer mortality. Secondary back pain measures including back-related disability were associated with increased mortality risk that remained statistically significant in fully-adjusted models. CONCLUSION: While frequent persistent back pain was not independently associated with mortality in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality. Future investigations should evaluate whether improvements in disabling back pain effect general health and well-being or mortality.

Too little or too much: nonlinear relationship between sleep duration and daily affective well-being in depressed adults.

BACKGROUND: In addition to having higher negative affect and lower positive affect overall, depressed individuals exhibit heightened affective reactivity to external stimuli than non-depressed individuals. Sleep may contribute to day-to-day fluctuations in depressed individuals, given that sleep disturbance is a common symptom of depression. Yet, little is known about changes in daily affect as a function of nightly sleep duration in depressed adults and non-depressed adults. The current study examined whether and how naturally-occurring sleep duration is associated with negative and positive affect, and how these associations differ between depressed vs. non-depressed adults. METHODS: Data were drawn from the second wave of the National Study of Daily Experiences (NSDE), a daily diary project of the Midlife in the United States (MIDUS) study. The sample of 2,012 adults (Mage=56.5; 57% female; 84% white) completed eight-day diary interviews via telephone on their daily experiences including nightly sleep duration and negative and positive affect. They also completed assessments of the Composite International Diagnostic Interview-Short form, and depressed status was determined based on DSM-III. Multilevel regression models with linear, quadratic, and cubic terms of sleep duration examined the nonlinear relationship between nightly sleep duration and daily affect. Interaction terms with depression status were added to examine differences between depressed and non-depressed adults. RESULTS: Depressed adults exhibited significant and greater fluctuations in daily affect as a function of nightly sleep duration than non-depressed adults. Specifically, the degree of decrease in positive affect and increase in negative affect was greater when depressed adults slept 2 or more hours less or longer than their usual sleep hours. Non-depressed adults exhibited relatively stable daily affect regardless of their nightly sleep hours. CONCLUSIONS: Sleep duration is nonlinearly associated with affect in daily lives of depressed adults, highlighting that both having too little sleep and excessive sleep are associated with adverse daily affective well-being. Implementing sleep interventions to promote an appropriate sleep duration may help improve daily affect among depressed adults.

Ten-Year Stability of an Insomnia Sleeper Phenotype and Its Association With Chronic Conditions.

OBJECTIVE: To identify distinct sleep health phenotypes in adults, examine transitions in sleep health phenotypes over time, and subsequently relate these to the risk of chronic conditions. METHODS: A national sample of adults from the Midlife in the United States study ( N = 3683) provided longitudinal data with two time points (T1: 2004-2006, T2: 2013-2017). Participants self-reported on sleep health (regularity, satisfaction, alertness, efficiency, duration) and the number and type of chronic conditions. Covariates included age, sex, race, education, education, partnered status, number of children, work status, smoking, alcohol, and physical activity. RESULTS: Latent transition analysis identified four sleep health phenotypes across both time points: good sleepers, insomnia sleepers, weekend catch-up sleepers, and nappers. Between T1 and T2, the majority (77%) maintained their phenotype, with the nappers and insomnia sleepers being the most stable. In fully adjusted models with good sleepers at both time points as the reference, being an insomnia sleeper at either time point was related to having an increased number of total chronic conditions by 28%-81% at T2, adjusting for T1 conditions. Insomnia sleepers at both time points were at 72%-188% higher risk for cardiovascular disease, diabetes, depression, and frailty. Being a napper at any time point related to increased risks for diabetes, cancer, and frailty. Being a weekend catch-up sleeper was not associated with chronic conditions. Those with lower education and unemployed were more likely to be insomnia sleepers; older adults and retirees were more likely to be nappers. CONCLUSION: Findings indicate a heightened risk of chronic conditions involved in suboptimal sleep health phenotypes, mainly insomnia sleepers.

Multidimensional Sleep Health Problems Across Middle and Older Adulthood Predict Early Mortality.

BACKGROUND: Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality. METHODS: Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (MIDUS-2; M2) and in 2013-2014 (MIDUS-3; M3). We calculated a composite score of sleep health problems across 5 dimensions: Regularity, Satisfaction, Alertness, Efficiency, and Duration (higher = more problems). Two separate models for baseline sleep health (n = 5 140; median follow-up time = 15.3 years) and change in sleep health (n = 2 991; median follow-up time = 6.4 years) to mortality were conducted. Cox regression models controlled for sociodemographics and key health risk factors (body mass index, smoking, depressive symptoms, diabetes, and hypertension). RESULTS: On average, 88% of the sample reported having one or more sleep health problems at M2. Each additional sleep health problem at M2 was associated with 12% greater risk of all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.04-1.21), but not heart disease-related mortality (HR = 1.14, 95% CI = 0.99-1.31). An increase in sleep health problems from M2 to M3 was associated with 27% greater risk of all-cause mortality (HR = 1.27, 95% CI = 1.005-1.59), and 153% greater risk of heart disease mortality (HR = 2.53, 95% CI = 1.37-4.68). CONCLUSIONS: More sleep health problems may increase the risk of early mortality. Sleep health in middle and older adulthood is a vital sign that can be assessed at medical checkups to identify those at greater risk.

Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults.

INTRODUCTION: A greater fear of falling predicts disability, falls, and mortality among older adults. Although poor sleep has been identified as a relevant risk factor for fear of falling among older adults, evidence is primarily shown in cross-sectional studies using isolated sleep characteristics. Less is known about whether prior fall experiences change the sleep health-fear of falling link among older adults. We investigated the longitudinal relationship between sleep health and the incidence of fear of falling among community-dwelling older adults and how the association differed between those with or without prior fall experiences. METHODS: Data were from individuals who completed the sleep module in the National Health and Aging Trends Study (2013-2014; n = 686). Fear of falling was assessed with a single item. Multidimensional sleep health was measured with self-reported sleep items based on the SATED model (ie, sleep satisfaction, daytime alertness, timing, efficiency, and duration). Covariates included sociodemographics, assistive device usage, health, risky behavior, and sleep medications. Multiple logistic regression was used to analyze the data. RESULTS: Poor sleep health was associated with the onset of fear of falling at 1-year follow-up (odds ratios=1.20, 95% confidence interval=1.02-1.41). Moreover, poor sleep health increased the odds of having fear of falling among individuals without prior falls experiences and elevated the already heightened risks of developing fear of falling among those who fell at baseline. CONCLUSIONS: Given that fear of falling and experiencing a fall each increase the risk of the other occurring in the future, improving sleep health may prevent older adults from stepping into the vicious cycle of fear of falling and falls.

Sleep Disorders and Cognitive Aging Among Cognitively Impaired Versus Unimpaired Older Adults.

BACKGROUND AND OBJECTIVES: Sleep disorders often predict or co-occur with cognitive decline. Yet, little is known about how the relationship unfolds among older adults at risk for cognitive decline. To examine the associations of sleep disorders with cognitive decline in older adults with unimpaired cognition or impaired cognition (mild cognitive impairment and dementia). RESEARCH DESIGN AND METHODS: A total of 5,822 participants (Mage = 70) of the National Alzheimer's Coordinating Center database with unimpaired or impaired cognition were followed for 3 subsequent waves. Four types of clinician-diagnosed sleep disorders were reported: sleep apnea, hyposomnia/insomnia, REM sleep behavior disorder, or "other." Cognition over time was measured by the Montreal Cognitive Assessment (MoCA) or an estimate of general cognitive ability (GCA) derived from scores based on 12 neuropsychological tests. Growth curve models were estimated adjusting for covariates. RESULTS: In participants with impaired cognition, baseline sleep apnea was related to better baseline MoCA performance (b = 0.65, 95% confidence interval [95% CI] = [0.07, 1.23]) and less decline in GCA over time (b = 0.06, 95% CI = [0.001, 0.12]). Baseline insomnia was related to better baseline MoCA (b = 1.54, 95% CI = [0.88, 2.21]) and less decline in MoCA over time (b = 0.56, 95% CI = [0.20, 0.92]). Furthermore, having more sleep disorders (across the 4 types) at baseline predicted better baseline MoCA and GCA, and less decline in MoCA and GCA over time. These results were only found in those with impaired cognition and generally consistent when using self-reported symptoms of sleep apnea or insomnia. DISCUSSION AND IMPLICATIONS: Participants with sleep disorder diagnoses may have better access to healthcare, which may help maintain cognition through improved sleep.

Employee Cardiometabolic Risk Following a Cluster-Randomized Workplace Intervention From the Work, Family and Health Network, 2009-2013.

Objectives. To examine whether workplace interventions to increase workplace flexibility and supervisor support and decrease work-family conflict can reduce cardiometabolic risk. Methods. We randomly assigned employees from information technology (n = 555) and long-term care (n = 973) industries in the United States to the Work, Family and Health Network intervention or usual practice (we collected the data 2009-2013). We calculated a validated cardiometabolic risk score (CRS) based on resting blood pressure, HbA1c (glycated hemoglobin), HDL (high-density lipoprotein) and total cholesterol, height and weight (body mass index), and tobacco consumption. We compared changes in baseline CRS to 12-month follow-up. Results. There was no significant main effect on CRS associated with the intervention in either industry. However, significant interaction effects revealed that the intervention improved CRS at the 12-month follow-up among intervention participants in both industries with a higher baseline CRS. Age also moderated intervention effects: older employees had significantly larger reductions in CRS at 12 months than did younger employees. Conclusions. The intervention benefited employee health by reducing CRS equivalent to 5 to 10 years of age-related changes for those with a higher baseline CRS and for older employees. Trial Registration. ClinicalTrials.gov Identifier: NCT02050204. (Am J Public Health. 2023;113(12):1322-1331. https://doi.org/10.2105/AJPH.2023.307413).

Factors Associated With Working Caregivers' Well-Being: Comparisons Between Black and White Working Caregivers in the United States.

This study investigated stressors and strains, resources, and well-being among Black working caregivers (BWC) and White working caregivers (WWC) who participated in the Midlife in the United States study (Black: n = 49, White: n = 250). Comparisons were made between BWC and WWC for primary caregiving stressors, secondary strains, resources, and well-being, and hierarchical regression models tested associations among these factors. BWC reported less negative work-to-family spillover, more perceived control and religious/spiritual coping, and higher positive affect than WWC, complementing existing evidence of greater resilience among BWC. Secondary strains stemming from the workplace had stronger associations with well-being than primary caregiving stressors, confirming that the workplace deserves greater attention in stress research and interventions for working caregivers. Finally, perceived control, optimism, and family support were important resources for well-being for both BWC and WWC, substantiating their valuable role in interventions for working caregivers.

Switching it up: Activity diversity and cognitive functioning in later life.

Participating in a broad and balanced range of daily activities (i.e., activity diversity) has been associated with better cognitive functioning in later life. One possible explanation for this finding is that high levels of activity diversity are merely a proxy for being more physically active, a factor robustly linked to cognitive health. The present study examined whether activity diversity has a unique association with cognitive functioning beyond physical movement. Community-dwelling older adults (N = 252, Mage = 73.55 years, SD = 6.39) completed a cognitive battery and then responded to ecological momentary assessments of their participation in 10 common activity types (e.g., reading, chores, social visits) every 3 hr for 5-6 days. They also wore accelerometers to track daily physical movement. Multiple regression models revealed that greater diversity in daily activities was related to higher cognitive functioning even after adjusting for physical movement and other covariates such as education level. This study further clarifies the unique relationship of activity diversity, beyond physical movement, with cognition. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social activity diversity as a lifestyle factor to alleviate loneliness and chronic pain.

OBJECTIVE: This study examined whether social activity diversity, a novel concept indicating an active social lifestyle, is associated with lower subsequent loneliness, and decreased loneliness is further associated with less chronic pain over time. METHODS: 2528 adults from the Midlife in the United States Study (Mage = 54 yrs) provided data at baseline (2004-2009) and 9 years later. Social activity diversity was operationalized by Shannon's entropy that captures the variety and evenness of engagement across 13 social activities (0-1). Participants reported feelings of loneliness (1-5), presence of any chronic pain (yes/no), the degree of chronic pain-related interference (0-10), and the number of chronic pain locations. Indirect associations of social activity diversity with chronic pain through loneliness were evaluated, adjusting for sociodemographics, living alone, and chronic conditions. RESULTS: Higher social activity diversity at baseline (B = -0.21, 95%CI = [-0.41, -0.02]) and an increase in social activity diversity over time (B = -0.24, 95%CI = [-0.42, -0.06]) were associated with lower loneliness 9 years later. An increase in loneliness was associated with 24% higher risk of any chronic pain (95%CI = [1.11, 1.38]), greater chronic pain-related interference (B = 0.36, 95%CI = [0.14, 0.58]), and 17% increase in the number of chronic pain locations (95%CI = [1.10, 1.25]) at the follow-up, after controlling for corresponding chronic pain at baseline and covariates. Social activity diversity was not directly was associated with chronic pain, but there were indirect associations through its association with loneliness. CONCLUSION: Diversity in social life may be associated with decreased loneliness, which in turn, may be associated with less chronic pain, two of the prevalent concerns in adulthood.

Working and working out: Decision-making inputs connect daily work demands to physical exercise.

Work demands can undermine engagement in physical exercise, posing a threat to employee health and well-being. Integrating resource theories and a novel decision-making theory called the decision triangle, we propose that this effect may emerge because work stress changes the energetic and emotional processes people engage in when making decisions about exercise after work. Using diary-style data across two workweeks (N = 83 workers, 783 days), we used multilevel latent profile analysis to extract common decision input profiles, or daily configurations of energy and affect as key decision-making resources. Consistent with the decision triangle, three profiles emerged: visceral inputs (low energy/high negative affect), automatic inputs (low energy/low negative affect), and logical inputs (high energy/low negative affect). Daily job demands were highest among the visceral profile. In turn, the daily visceral profile related to the lowest likelihood of and intensity of physical exercise after work, especially relative to the daily logical profile. Whether or not those in the daily automatic profile exercised depended on their health orientation, or trait-level value of maintaining personal health. Our results support decision-making as a promising mechanism explaining the link between work demands and healthy leisure choices. Organizational interventions can target work stress, health orientation, or logical decision-making to promote frequent and vigorous employee physical exercise. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Adults Older Than Age 55 Engage in Less Diverse Activities Than Those 18 Years Ago.

OBJECTIVES: Life-span perspectives have long acknowledged that individual functioning is shaped by historical and sociocultural contexts. Secular increases favoring recent cohorts are widely documented. However, little is known about secular trends in day-to-day activities and whether historical changes have occurred in younger and older adults alike. METHODS: We compared data from 2 independent cohort samples of the daily diary portion of the Midlife in the United States Study obtained 18 years apart (1995/1996 cohort: n = 1,499 vs 2013/2014 cohort: n = 782) and identified case-matched cohorts (n = 757 per cohort) based on age, gender, education, and race. An activity diversity score was calculated based on 7 common daily activities, using Shannon's entropy method. We additionally examined the roles of age and other sociodemographic and health characteristics in cohort differences in activity diversity. RESULTS: Results revealed that the 2013/2014 cohort experienced lower daily activity diversity than the 1995/1996 cohort. Age was positively associated with activity diversity in the 1995/1996 cohort, whereas age was negatively associated with activity diversity in the 2013/2014 cohort. These associations were significant for those who were older than age 55. Cohorts also differed in the types of most dominant activities and average time spent on those activities. DISCUSSION: Findings show changes in the lifestyles and daily activities of U.S. adults across 2 decades. Contrasting to the common belief that today's adults may be healthier and more active, they seem engaging in less diverse daily activities, which can be a risk for future health outcomes.

Sleep quality moderates the association between family bereavement and heart rate variability.

Two separate bodies of literature point to the link between family bereavement and cardiovascular health and between sleep quality and cardiovascular outcomes. However, less is known about the joint influence of family bereavement and sleep quality on cardiovascular functioning. The aims of this study were to examine the relationships between experiencing the death of a family member and heart rate variability (HRV) and to further explore whether these associations differ by sleep quality. Using data from the Midlife in the United States (MIDUS) Biomarker Project, the sample for this study included respondents who experienced the death of an immediate family member - father, mother, spouse, sibling, or child - within a year before the Biomarker project and those who did not experience any deaths (N = 962). We used two measures of HRV and sleep quality was measured using the Pittsburgh Sleep Quality Index. Results showed that experiencing the death of a family member was associated with worse HRV only among those with poor sleep quality and not for those with good sleep quality. These results suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of a family member. Interventions to improve sleep quality could be effective in enhancing cardiovascular health of bereaved individuals.

Goldilocks at work: Just the right amount of job demands may be needed for your sleep health.

OBJECTIVES: It has been reported that job demands affect sleep, but how different levels of job demands affect sleep remains unclear. We examined whether curvilinear relationships exist between job demands and multiple sleep health outcomes. DESIGN: Cross-sectional analyses with linear and quadratic effects, using self-administered survey data. SETTING: A national sample of US adults. PARTICIPANTS: Workers from Midlife in the United States Study (MIDUS2; n = 2927). MEASUREMENTS: The Job Content Questionnaire assessed overall and 5 specific aspects of job demands (intensity, role conflict, work overload, time pressure, and interruptions). Habitual sleep health patterns across 5 dimensions (regularity, satisfaction/quality, daytime alertness, efficiency, and duration) were assessed. Age, sex, race/ethnicity, marital/partnered status, education, job tenure, work hours, body mass index, smoking status, and study sample were covariates. RESULTS: There were significant linear and quadratic relationships between job demands and sleep outcomes. Specifically, the linear effects indicated that participants with higher job demands had worse sleep health, such as shorter duration, greater irregularity, greater inefficiency, and more sleep dissatisfaction. The quadratic effects, however, indicated that sleep regularity and efficiency outcomes were the best when participants' job demands were moderate rather than too low or too high. These effects were found for overall job demands as well as for specific aspects of job demands. Stratified analyses further revealed that these curvilinear associations were mainly driven by participants with low job control. CONCLUSIONS: Moderate levels of job demands, especially if combined with adequate job control, are related to optimal sleep health.

Who Has Active Lifestyles? Sociodemographic and Personality Correlates of Activity Diversity in Two Samples of Adults.

OBJECTIVES: Activity diversity-an index of active lifestyles that captures variety (number) and evenness (consistency) in activity engagement-is known to support health in adulthood. However, less is known who has higher or lower activity diversity, information that helps identify individuals who may be at greater risk for poor health. This article examined sociodemographic characteristics and Big Five personality traits that may be associated with activity diversity. METHODS: We used 2 independent project samples (nsample1 = 2,699; nsample2 = 301). Sample 1 included U.S. national adults in a wide age range (25-84). Sample 2 included U.S. community-dwelling older adults (age = 65-89). Each study asked about different types of activity engagement using surveys. The activity diversity index was calculated in each sample, using Shannon's entropy method. RESULTS: In Sample 1, older adults, women, non-Hispanic White individuals, married/partnered individuals, and those with higher education and fewer functional limitations had higher activity diversity. Additionally, higher conscientiousness, higher extraversion, and lower neuroticism were each associated with higher activity diversity after controlling for sociodemographic factors. Extraversion and neuroticism remained significant in the younger group (age < 65) of Sample 1, but only extraversion was a significant factor associated with activity diversity in the older group (age ≥ 65). The results in the older group were generally replicated in Sample 2, such that higher extraversion in older adults was consistently associated with higher activity diversity independent of the strong correlates of sex, education, and functional limitations. DISCUSSION: Findings were discussed in terms of age-specific associations between sociodemographic and personality characteristics and activity diversity.

Daily association of stressors with perceived cognitive performance: Moderating role of age.

Stress can elicit both positive and negative impacts on cognition. Less is known about whether and how daily stressors are associated with perceived cognitive performance in healthcare workers. We examined daily associations between stressors and perceived cognitive performance in nurses and whether these associations differed by age or nursing tenure. Using 14-day smartphone-based ecological momentary assessment, 60 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents). Each day, participants subjectively evaluated their mental focus, memory, and processing speed. Multilevel modelling examined the within- and between-person associations of daily stressors with cognitive performance. More stressors were associated with poorer perceived cognitive performance at both within- and between-person levels for both daily stressor frequency and severity. For moderation by age, the within-person stressor severity-cognitive performance relationship was only significant for nurses who were younger, but not for those who were older. Similarly, the within-person associations of daily stressor frequency and severity with cognitive performance were only significant for nurses with a shorter tenure. Findings suggest daily stressors may degrade perceived cognitive performance in nurses and the impact may be stronger for those who are younger or with less experience on the job.

Resource-Building Processes Across Life Domains: Father-Child Interactions as Starting Points for Resource Caravans.

In two studies, we examined preconditions of resource-building processes between family and work. Focusing on positive father-child interactions, we investigated positive mood states as links between the two life domains. Fathers employed in information technology (N 1 = 59) and the retail sector (N 2 = 75) participated in micro-longitudinal studies, both for eight consecutive workdays. Study 1 revealed that fathers with more positive interactions with a child also reported more positive mood states and fathers with more positive mood states perceived more social resources from their supervisor during the week. The indirect effect was small but significant. In Study 2, multilevel structural-equation models did not find indirect effects at the within-person level but did show that positive father-child interactions after work were related to fathers' positive mood states before going to bed and positive mood in the morning predicted perceived social resources from supervisors (but not from coworkers) in the forenoon. There were also positive effects of perceived social resources from supervisors on positive mood states, after work. But these did not translate into an increase in positive father-child interactions, in the evening. Hence, only single elements were supported but not the overall resource caravan. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00523-4.

Multidimensional sleep health is associated with physical frailty in a national sample of Taiwanese community-dwelling older adults: Sex matters.

OBJECTIVES: Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty both across and within sex groups. DESIGN: Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N = 2,015). Frailty was defined using the Fried criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model. Their relationship was estimated using logistic regression analysis adjusting for sociodemographic characteristics (age, sex, education), health status (comorbidity, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and health risk behaviors (drinking, smoking, lack of exercise). RESULTS: Having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic characteristics. This association remained significant among women but not among men after adding health and risk behaviors to the models. Satisfaction and alertness in both sexes and duration among women were significantly associated with frailty adjusting for sociodemographic characteristics. Only alertness among men was significantly related to frailty in the model with all covariates. CONCLUSIONS: Our findings show that having better sleep health across multiple dimensions is related to a lower risk of being frail, with differential risks for women and men.

Effects of music interventions on sleep in people with dementia: A systematic review.

Poor sleep health is a risk factor for and a common symptom of dementia. Music has been shown to improve sleep across a wide range of clinical and community populations. However, it is unclear whether and to what extent music interventions may also help alleviate sleep problems in people with dementia. This systematic review is the first review examining the effects of music on sleep outcomes among people with dementia. In accordance with PRISMA guidelines, we extracted 187 articles from nine databases (Academic Search Premier, Ageline, APA PsycArticles, PsycINFO, CINAHL, Embase, PubMed, Scopus, and Web of Science). Eight studies were eligible for this systematic review (Range sample sizes: 1-59 people with dementia). Results revealed that assessments of sleep in the current literature were limited and mainly focused on sleep duration, subjective sleep quality, or nighttime sleep disturbances. Intervention delivery, music selection, and findings varied. Positive effects of music on sleep outcomes were observed in six out of the eight studies (75%), specifically there were decreases in nighttime sleep disturbances, increases in daytime alertness, and improvements in sleep quality. The remaining two studies found no statistically significant change in sleep outcomes (i.e., daytime sleepiness and quality). Study limitations included small sample sizes and the use of proxy reporters (e.g., caregiver, researcher, blinded clinician) which may reduce the accuracy of the sleep measures. Future research may want to incorporate objectively measured sleep to better understand the role of sleep in dementia care. More research is needed to determine whether music interventions are effective in improving sleep in people with dementia and whether improvements in sleep can slow the progression of dementia.