Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2018

Open Access 01-12-2018 | Research article

Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study

Authors: Samuel Kwaku Essien, Cindy Xin Feng, Wenjie Sun, Marwa Farag, Longhai Li, Yongqing Gao

Published in: BMC Geriatrics | Issue 1/2018

Login to get access

Abstract

Background

Falls pose major health problems to the middle-aged and older adults and may potentially lead to various levels of injuries. Sleep duration and disturbances have been shown to be associated with falls in literature; however, studies of the joint and distinct effects of those sleep problems are still sparse. To fill this gap, we aimed to determine the association between sleep duration, sleep disturbances and falls among middle-aged and older adults in China controlling for psychosocial, lifestyle, socio-demographical factors and comorbidity.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) based on multi-stage sampling designs, with respondents aged 50 and older. Associations were evaluated by using multiple logistic regression adjusting for confounders and complex survey design. To further determine if the association of sleep duration/disturbance and falls depends on age groups, the study data were divided into two samples (age 50–64 vs. age 65+) and comparison was made between the two age groups.

Results

Of the 12,759 respondents, 2172 (17%) had falls within the last 2 years. Our findings indicated that the participants who had nighttime sleep duration ≤5 were more likely to report falls than those who had nighttime sleep duration ≥6 h; whereas no association between nighttime sleep duration > 8 h and falls. Participants having sleep disturbances 1–2 days, or 3–4 days, and 5–7 days per week were also more likely to report falls than those who had no sleep disturbance. The nap sleep duration was not significantly associated with falls. Although the combined sample found both sleep duration and sleep disturbance to be strongly associated with falls after adjusting for various confounders, sleep disturbance was not significantly related to falls among participants aged 65 + .

Conclusions

Our study suggested that there is an independent association between falls and short sleep duration and disturbed sleep among middle-aged and older adults in China. Findings underscore the need for evidence-based prevention and interventions targeting sleep duration and disturbance among this study population.
Literature
1.
Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J. Prevention of falls and consequent injuries in elderly people. Lancet. 2005;366(9500):1885–93.CrossRefPubMed
2.
3.
Ravindran RM, Kutty VR. Risk factors for fall-related injuries leading to hospitalization among community-dwelling older persons: a hospital-based case-control study in Thiruvananthapuram, Kerala, India. Asia Pac. J. Public Health. 2016;28(1_suppl):70S–6S.CrossRefPubMed
4.
Stevens JA, Mack KA, Paulozzi LJ, Ballesteros MF. Self-reported falls and fall-related injuries among persons aged≥ 65 years–United States, 2006. J Saf Res. 2008;39(3):345–9.CrossRef
5.
6.
Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M. Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW falls prevention baseline survey. N. S. W. Public Health Bull. 2011;22(4):43–8.CrossRefPubMed
7.
Siqueira FV, Facchini LA, DSd S, Piccini RX, Tomasi E, Thumé E, Silva SM, Dilélio A. Prevalence of falls in elderly in Brazil: a countrywide analysis. Cadernos de Saúde Pública. 2011;27(9):1819–26.CrossRefPubMed
8.
9.
Zhao Y, Strauss J, Yang G, Giles J, Hu P, Hu Y, Lei X, Park A, Smith JP, Wang Y. China health and retirement longitudinal study–2011–2012 national baseline users’ guide. Beijing: National School of Development, Peking University; 2013.
10.
Kwan MMS, Close JC, Wong AKW, Lord SR. Falls incidence, risk factors, and consequences in Chinese older people: a systematic review. J Am Geriatr Soc. 2011;59(3):536–43.CrossRefPubMed
11.
World Health Organization. WHO global report on falls prevention in older age. 2007. In: Geneva (Switzerland); 2007.
12.
13.
14.
Hua F, Yoshida S, Junling G, Hui P: Falls prevention in older age in western Pacific Asia region. WHO Background Paper to the Global Report on Falls among Older Persons 2007.
15.
Slattum P, Ansello EF. Medications as a risk factor in falls by older adults with and without intellectual disabilities. Age in Action. 2013;28(1):1.
16.
Leblanc M-F, Desjardins S, Desgagné A. The relationship between sleep habits, anxiety and depression in the elderly. Nature and science of sleep. 2015;7:33.PubMedPubMedCentral
17.
Foley DJ, Monjan AA, Brown SL, Simonsick EM. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep: Journal of Sleep Research Sleep Med. 1995;
18.
Ailshire JA, Crimmins EM. Psychosocial factors associated with longevity in the United States: age differences between the old and oldest-old in the health and retirement study. Journal of aging research. 2011;2011
19.
Faulkner KA, Cauley JA, Studenski SA, Landsittel DP, Cummings SR, Ensrud KE, Donaldson M, Nevitt M. Group SoOFR: Lifestyle predicts falls independent of physical risk factors. Osteoporos Int. 2009;20(12):2025–34.CrossRefPubMedPubMedCentral
20.
Liu H, Byles JE, Xu X, Zhang M, Wu X, Hall JJ. Association between nighttime sleep and successful aging among older Chinese people. Sleep Med. 2016;22:18–24.CrossRefPubMed
21.
Lu L, Wang S-B, Rao W-W, Ungvari GS, Ng CH, Chiu HF, Zhang J, Kou C, Jia F-J, Xiang Y-T. Sleep duration and patterns in Chinese older adults: a comprehensive meta-analysis. Int J Biol Sci. 2017;13(6):682–9.CrossRefPubMedPubMedCentral
22.
Stone KL, Ancoli-Israel S, Blackwell T, Ensrud KE, Cauley JA, Redline S, Hillier TA, Schneider J, Claman D, Cummings SR. Actigraphy-measured sleep characteristics and risk of falls in older women. Arch Intern Med. 2008;168(16):1768–75.CrossRefPubMed
23.
Mesas AE, LÓPEZ-GARCÍA E, RODRÍGUEZ-ARTALEJO F. Self-reported sleep duration and falls in older adults. J Sleep Res. 2011;20(1pt1):21–7.CrossRefPubMed
24.
Kuo H-K, Yang CC, Yu Y-H, Tsai K-T, Chen C-Y. Gender-specific association between self-reported sleep duration and falls in high-functioning older adults. J Gerontol Ser A Biol Med Sci. 2010;65(2):190–6.CrossRef
25.
Kim SY, Kim S-G, Sim S, Park B, Choi HG. Excessive sleep and lack of sleep are associated with slips and falls in the adult Korean population: a population-based cross-sectional study. Medicine. 2016;95(4):e2397.CrossRefPubMedPubMedCentral
26.
Helbig AK, Döring A, Heier M, Emeny RT, Zimmermann A-K, Autenrieth CS, Ladwig K-H, Grill E, Meisinger C. Association between sleep disturbances and falls among the elderly: results from the German cooperative Health Research in the region of Augsburg-age study. Sleep Med. 2013;14(12):1356–63.CrossRefPubMed
27.
ÅKERSTEDT T, Hume K, Minors D, Waterhouse J. The meaning of good sleep: a longitudinal study of polysomnography and subjective sleep quality. J Sleep Res. 1994;3(3):152–8.CrossRefPubMed
28.
Latimer Hill E, Cumming RG, Lewis R, Carrington S, Le Couteur DG. Sleep disturbances and falls in older people. J Gerontol A Biol Sci Med Sci. 2007;62(1):62–6.CrossRefPubMed
29.
Stone KL, Blackwell TL, Ancoli-Israel S, Cauley JA, Redline S, Marshall LM, Ensrud KE. Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of sleep disorders in older men (MrOS sleep) study. J Am Geriatr Soc. 2014;62(2):299–305.CrossRefPubMedPubMedCentral
30.
Wallace CJ, Robins J, Alvord LS, Walker JM. The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise. Am J Crit Care. 1999;8(4):210.PubMed
31.
Aurell J, Elmqvist D. Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care. Br Med J (Clin Res Ed). 1985;290(6474):1029–32.CrossRef
32.
Broughton R, Baron R. Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction. Electroencephalogr Clin Neurophysiol. 1978;45(3):348–60.CrossRefPubMed
33.
Bihari S, McEvoy D, Matheson E, Kim S, Woodman RJ, Bersten AD. Factors affecting sleep quality of patients in intensive care unit. Journal of Clinical Sleep Medicine. 2012;8(3):301–7.PubMedPubMedCentral
34.
Krachman SL, Criner GJ, D'Alonzo GE. Sleep in the intensive care unit. Chest journal. 1995;107(6):1713–20.CrossRef
35.
Kumari M, Green R, Nazroo J. 5. Sleep duration and sleep disturbance. Financial circumstances, health and well-being of the older population in England; 2010. p. 178.
36.
Lei X, Sun X, Strauss J, Zhang P, Zhao Y. Depressive symptoms and SES among the mid-aged and elderly in China: evidence from the China health and retirement longitudinal study national baseline. Soc Sci Med. 2014;120:224–32.CrossRefPubMedPubMedCentral
37.
Lei X, Smith JP, Sun X, Zhao Y: Gender differences in cognition in China and reasons for change over time: evidence from CHARLS. 2013.
38.
Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2012:dys203.
39.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.CrossRefPubMed
40.
41.
Spira AP, Beaudreau SA, Stone KL, Kezirian EJ, Lui L-Y, Redline S, Ancoli-Israel S, Ensrud K, Stewart A. Reliability and validity of the Pittsburgh sleep quality index and the Epworth sleepiness scale in older men. J Gerontol Ser A Biol Med Sci. 2011:glr172.
42.
Hayward LB, Mant A, Eyland EA, Hewitt H, Pond CD, Saunders NA. Neuropsychological functioning and sleep patterns in the elderly. Med J Aust. 1992;157(1):51–2.PubMed
43.
Jørgensen TSH, Hansen AH, Sahlberg M, Gislason GH, Torp-Pedersen C, Andersson C, Holm E. Falls and comorbidity: the pathway to fractures. Scand. J. Public Health. 2014:1403494813516831.
44.
George M, Azhar G, Kilmer G, Miller S, Bynum L, Balamurugan A. Falls and comorbid conditions among community dwelling Arkansas older adults from a population-based survey. J. Ark. Med. Soc. 2014;111(7):136–9.PubMed
45.
Bruckner J, Herge EA. Assessing the risk of falls in elders with mental retardation and developmental disabilities. Topics in Geriatric Rehabilitation. 2003;19(3):206–11.CrossRef
46.
Li C, Liu T, Sun W, Wu L, Zou Z-Y. Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study. Rheumatology. 2014;54(4):697–706.CrossRefPubMed
47.
Hosmer DW, Lemeshow S, Cook E. Applied logistic regression. 2nd ed. NY: John Wiley & Sons; 2000.CrossRef
48.
Konishi S, Kitagawa G. Information criteria and statistical modeling: Springer Science & Business Media; 2008.
49.
50.
Agnelli, R., Examples of logistic modeling with the SURVEYLOGISTIC procedure.2014.
51.
Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc. 2000;48(10):1234–40.CrossRefPubMed
52.
Stone KL, Ewing SK, Lui LY, Ensrud KE, Ancoli-Israel S, Bauer DC, Cauley JA, Hillier TA, Cummings SR. Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. J Am Geriatr Soc. 2006;54(8):1177–83.CrossRefPubMed
53.
Gu D, Sautter J, Pipkin R, Zeng Y. Sociodemographic and health correlates of sleep quality and duration among very old Chinese. Sleep. 2010;33(5):601–10.CrossRefPubMedPubMedCentral
54.
55.
Smagula SF, Stone KL, Fabio A, Cauley JA. Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Med Rev. 2016;25:21–30.CrossRefPubMed
56.
Vieira ER, Freund-Heritage R, da Costa BR. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. Clin Rehabil. 2011;25(9):788–99.CrossRefPubMed
57.
Lin S-I. Risk of falls in community-dwelling older adults: a review of evidence and Taiwan experiences. education. 2013;23:26.
58.
Picarsic JL, Glynn NW, Taylor CA, Katula JA, Goldman SE, Studenski SA, Newman AB. Self-reported napping and duration and quality of sleep in the lifestyle interventions and independence for elders pilot study. J Am Geriatr Soc. 2008;56(9):1674–80.CrossRefPubMedPubMedCentral
59.
Matsuda R, Kohno T, Fukuoka R, Kondo M, Maekawa Y, Sano M, Fukuda K. The prevalence of sleep disturbance and its strong impact on depression symptom in patients hospitalized with cardiovascular diseases. Circulation. 2015;132(Suppl 3):A14835.
60.
Glozier N, Martiniuk A, Patton G, Ivers R, Li Q, Hickie I, Senserrick T, Woodward M, Norton R, Stevenson M. Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. Sleep. 2010;33(9):1139–45.CrossRefPubMedPubMedCentral
61.
Tanaka M, Kusaga M, Ushijima K, Watanabe C. Association between depression and fall risk among elderly community residents. Nihon Ronen Igakkai zasshi Jpn. J. Geriatr. 2011;49(6):760–6.CrossRef
62.
Biderman A, Cwikel J, Fried A, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. J Epidemiol Community Health. 2002;56(8):631–6.CrossRefPubMedPubMedCentral
63.
Qader MAA, Amin RM, Shah SA, Isa ZM, Latif KA, Ghazi HF. Psychological risk factors associated with falls among elderly people in Baghdad city Iraq. Open Am. J. Prev. Med. 2013;3(07):441.CrossRef
64.
Whooley MA, Kip KE, Cauley JA, Ensrud KE, Nevitt MC, Browner WS. Depression, falls, and risk of fracture in older women. Arch Intern Med. 1999;159(5):484–90.CrossRefPubMed
65.
Gellis Z, Kim E, McCraeken S. Master’s advanced curriculum (MAC) project mental health and aging resource review 2014 revision: chapter 2: anxiety disorders in older adults literature review. Council On Social Network Education. 2014;
66.
El Fakiri F. Gender differences in risk factors for single and recurrent falls among the community-dwelling elderly. SAGE Open. 2015;5(3):2158244015602045.
67.
Buchman AS, Boyle PA, Wilson RS, James BD, Leurgans SE, Arnold SE, Bennett DA. Loneliness and the rate of motor decline in old age: the rush memory and aging project, a community-based cohort study. BMC Geriatr. 2010;10(1):1.CrossRef
68.
69.
70.
Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin N Am. 2006;90(5):807–24.CrossRefPubMed
71.
Pearson C, St-Arnaud J, Geran L: Understanding Seniors' risk of falling and their perception of risk: Citeseer; 2014.
72.
Lin C-H, Liao K-C, Pu S-J, Chen Y-C, Liu M-S. Associated factors for falls among the community-dwelling older people assessed by annual geriatric health examinations. PLoS One. 2011;6(4):e18976.CrossRefPubMedPubMedCentral
73.
Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Chatterji S, Leonardi M, Koskinen S, Tobiasz-Adamczyk B, Haro JM. Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study. PLoS One. 2014;9(12):e114742.CrossRefPubMedPubMedCentral
74.
75.
Sibley KM, Voth J, Munce SE, Straus SE, Jaglal SB. Chronic disease and falls in community-dwelling Canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions. BMC Geriatr. 2014;14(1):22.CrossRefPubMedPubMedCentral
76.
James K, Gouldbourne J, Morris C, Eldemire-Shearer D, Mona J: Falls and fall prevention in the elderly: insights from Jamaica. In.: Mona, Department of Community Health and Psychiatry, Mona Ageing and Wellness Centre, University of the West Indies, undated; 2009.
77.
Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, Schreiner PJ, Margolis KL, Cauley JA, Nevitt MC. Older women with diabetes have a higher risk of falls a prospective study. Diabetes Care. 2002;25(10):1749–54.CrossRefPubMed
78.
De Mettelinge TR, Cambier D, Calders P, Van Den Noortgate N, Delbaere K. Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study. PLoS One. 2013;8(6):e67055.CrossRef
79.
Malabu UH, Vangaveti VN, Kennedy RL. Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review. Clinical epidemiology. 2014;6:287.CrossRefPubMedPubMedCentral
80.
Anantharama N, Rumantir G, Jomon B, Ananda-Rajah M, Gilbert A: Understanding Risk Factors Of Elderly Inpatient Falls Using Contextual Model. 2016.
81.
Simpson LA, Miller WC, Eng JJ. Effect of stroke on fall rate, location and predictors: a prospective comparison of older adults with and without stroke. PLoS One. 2011;6(4):e19431.CrossRefPubMedPubMedCentral
82.
Lawlor DA, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. Bmj. 2003;327(7417):712–7.CrossRefPubMedPubMedCentral
83.
Dohoo IR, Martin SW, Stryhn H: Methods in epidemiologic research; 2012.
84.
Yoshida-Intern S. A global report on falls prevention epidemiology of falls. Geneva: WHO; 2007.
85.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMed
Metadata
Title
Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study
Authors
Samuel Kwaku Essien
Cindy Xin Feng
Wenjie Sun
Marwa Farag
Longhai Li
Yongqing Gao
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2018
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-018-0889-x

Other articles of this Issue 1/2018

BMC Geriatrics 1/2018 Go to the issue

Research article

The association between obesity and social exclusion in middle-aged and older adults: findings from a nationally representative study in Germany

Research article

Relationship of muscle function to circulating myostatin, follistatin and GDF11 in older women and men

Research article

Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents

Research article

Informant questionnaire on cognitive decline in the elderly (IQCODE) for assessing the severity of dementia in patients with Alzheimer’s disease

Research article

Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study

Research article

Study on relationship between elderly sarcopenia and inflammatory cytokine IL-6, anti-inflammatory cytokine IL-10
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits