Risk of Sleep Problems in Middle-Aged and Older Adults Experiencing Bodily Pains: Serial Multiple Mediation Estimates of Emotional Distress and Activity Limitations.

OBJECTIVES: Pain is increasingly becoming common among middle-aged and older adults. While research on the association between pain characteristics and sleep problems (SP) is limited in low- and middle-income countries, the underlying mechanisms of the association are poorly understood. This study examines the association of bodily pain intensity and pain interference with SP and investigates the mediating role of activity limitation and emotional distress in this association. METHODS: We analyzed population-based data, including 1,201 individuals aged ≥50 (mean [SD] age 66.14 [11.85] years) from the 2016-2018 AgeHeaPsyWel-HeaSeeB study in Ghana. Multiple OLS regressions and serial multiple mediation modeling using bootstrapping analyses examined direct and indirect effects from pain to SP through activity limitation and emotional distress. RESULTS: Regressions demonstrated that pain intensity and interference were significantly associated with higher levels of activity limitation, emotional distress, and SP (range: ß = 0.049-0.658). Bootstrapping analysis showed that activity limitation and emotional distress serially mediated the relationship between pain intensity and SP (total effect: ß = 0.264, Bootstrap 95% confidence interval [CI] = 0.165-0.362; direct effect: (ß = 0.107, Bootstrap 95% CI = 0.005-0.210; total indirect effect: ß = 0.156, Bootstrap 95% CI = 0.005-0.210) accounting for ∼59%. Activity limitation and emotional distress mediated pain interference and SP association (total effect: ß = 0.404, Bootstrap 95% CI = 0.318-0.490; direct effect: ß = 0.292, Bootstrap 95% CI = 0.201-0.384; and total indirect effect: ß = 0.112, Bootstrap 95% CI = 0.069-0.156) yielding ∼28%. CONCLUSION: Our data suggest that activity limitation and emotional distress may convey stress-related risks of pain on SP. Future research should evaluate if activity limitation and emotional distress could be effective targets to reduce the effect of pain on sleep in later-life.

Diabetes mellitus and functional limitations among older adults: Evidence from a large, representative Ghanaian aging study.

OBJECTIVES: Literature linking diabetes mellitus (DM) to functional status is limited in low- and middle-income countries. Importantly, factors influencing this association are even less understood. This study aims to examine the association of DM with functional limitations (FL) in older adults and to identify potential factors influencing this association. METHODS: In a cross-sectional analysis, we examined the association between DM and basic and instrumental activities of daily living-related FL in 1201 adults aged ≥50 years from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study. DM was defined as a self-report of physician diagnosis. The associations were assessed using hierarchical regression estimates and bootstrapping technique via the Hayes PROCESS macro program. RESULTS: The prevalence of DM and FL was 10.1% and 36.1%, respectively, with OR = 2.50 (95%CI = 1.59-3.92) after accounting for sociodemographic factors, smoking, alcohol use, self-rated health, loneliness, and sleep quality. After full adjustment, polytomous regressions showed that the association of DM with FL increased with the number of FL (i.e., OR = 1.60 for 1-2, OR = 1.88 for 3-5, and OR = 2.0o for >5 FL compared with no FL). However, this association was attenuated after controlling for physical activity (OR = 2.06, 95%CI = 1.28-3.31), hypertension (OR = 1.87, 95%CI = 1.14-2.99), stroke (OR = 1.82, 95%CI = 1.20-2.93), and pain facets (OR = 1.80, 95%CI = 1.04-3.02). PA thus mediated 40.39% of the DM-FL association. CONCLUSIONS: In this representative study, older adults with DM showed higher odds for FL, and this association was partially explained by physical activity and health variables. Investing in a holistic management approach might be helpful for public health planning efforts to address DM-induced FL in old age.

Food insecurity and sleep quality among older adults: Findings from a population-based study in Ghana.

OBJECTIVE: Sleep architecture in older age is an important public health concern. However, little is known about the effect of food insecurity on sleep quality among older people. We provide the first representative study of the association between food insecurity and poor sleep quality (PSQ) in older adults in the sub-Saharan African context. METHODS: Data were drawn from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study in Ghana. Past 30-day food insecurity was assessed with two items on the frequency of hunger and breakfast-skipping due to lack of food and resources. Participants reported night- and day-time sleep problems and sleep duration. Multiple OLS regressions were used to evaluate the hypothesized associations. RESULTS: Data on 1201 adults aged ≥ 50 years (mean = 63 [SD = 12]; women = 63%) were analyzed. In the full OLS adjusted model, moderate (ß = .144; p < .001) and severe (ß = .184; p < .001) levels of food insecurity were positively and significantly associated with PSQ. Also, older adults reporting moderate (ß = -.153; p < .001) and severe (ß = -.128; p < .001) food insecurity hadfewer sleep hours than those who were food-secure. Women and those aged ≥ 65 were at higher risks of PSQ in the context food insecurity. CONCLUSIONS: Addressing food insecurity may be an effective policy and public health intervention for improving sleep quality and overall well-being in older age.