Gender Differences in Self-Perceptions About Aging and Sleep Among Elderly Chinese Residents in Taiwan

Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Stressful life events and subjectively rated sleep quality among older adults in China: the roles of positive and negative attitudes towards ageing

Sleep is an integral part of individuals' health and wellbeing. Despite evidence showing that social stressors are important contributors to older adults' sleep problems, how the accumulative stressful life events (SLEs) and ageing attitudes independently and jointly affect sleep quality among older adults in developing countries remains unclear. This study examined the effects of SLEs on subjectively rated sleep quality among older adults in China, and explored the potential mediating and moderating roles of positive and negative ageing attitudes on the above association. Using data from the 2014 China Longitudinal Ageing Social Survey, we had complete data for 7,780 older adults aged 60 and older. We employed logistic regression models and the Karlson–Holm–Breen decomposition method. Our findings indicated that SLEs significantly increased the risk of poor sleep quality, especially for those who had experienced two or more SLEs during the past year. Positive ageing attitudes were associated with lower odds of poor sleep quality, whereas negative ageing attitudes were related to higher odds of poor sleep quality. Moreover, the mediation analyses suggested that SLEs were associated with poor sleep quality via negative ageing attitudes. The moderating effects further documented that higher levels of positive ageing attitudes can significantly attenuate the deleterious impact of SLEs on sleep quality. The findings highlight the significance of SLEs for older adults' sleep quality and shed light on the importance of ageing attitudes to improve older adults' sleep in China as well as other low- and middle-income countries, where the social safety nets are still underdeveloped.

Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults

IMPORTANCE

Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.

OBJECTIVES

To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.

EXPOSURE

Aging satisfaction.

MAIN OUTCOMES AND MEASURES

A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.

RESULTS

During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.

CONCLUSIONS AND RELEVANCE

This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.

Cannabis Affects Cerebellar Volume and Sleep Differently in Men and Women

Background: There are known sex differences in behavioral and clinical outcomes associated with drugs of abuse, including cannabis. However, little is known about how chronic cannabis use and sex interact to affect brain structure, particularly in regions with high cannabinoid receptor expression, such as the cerebellum, amygdala, and hippocampus. Based on behavioral data suggesting that females may be particularly vulnerable to the effects of chronic cannabis use, we hypothesized lower volumes in these regions in female cannabis users. We also hypothesized poorer sleep quality among female cannabis users, given recent findings highlighting the importance of sleep for many outcomes related to cannabis use disorder. Methods: Using data from the Human Connectome Project, we examined 170 chronic cannabis users (>100 lifetime uses and/or a lifetime diagnosis of cannabis dependence) and 170 controls that we attempted to match on age, sex, BMI, race, tobacco use, and alcohol use. We performed group-by-sex ANOVAs, testing for an interaction in subcortical volumes, and in self-reported sleep quality (Pittsburgh Sleep Questionnaire Inventory). Results: After controlling for total intracranial volume and past/current tobacco usage, we found that cannabis users relative to controls had smaller cerebellum volume and poorer sleep quality, and these effects were driven by the female cannabis users (i.e., a group-by-sex interaction). Among cannabis users, there was an age of first use-by-sex interaction in sleep quality, such that females with earlier age of first cannabis use tended to have more self-reported sleep issues, whereas this trend was not present among male cannabis users. The amygdala volume was smaller in cannabis users than in non-users but the group by sex interaction was not significant. Conclusions: These data corroborate prior findings that females may be more sensitive to the neural and behavioral effects of chronic cannabis use than males. Further work is needed to determine if reduced cerebellar and amygdala volumes contribute to sleep impairments in cannabis users.

An exploration of the sleep quality and potential violence among patients with schizophrenia in community

PURPOSE

Sleep quality in patients with schizophrenia is correlated with potential violence. However, few studies have conducted in-depth discussions on community patients with schizophrenia. The purpose of this study was to explore the influences of demographic characteristics, psychiatric symptom severity, and sleep quality in community patients with schizophrenia on the risks of potential violence and its subdimensions (ie, physical aggression, verbal aggression, anger, and hostility).

DESIGN AND METHODS

This study adopted a cross-sectional research design. Using convenience sampling, 78 community patients with schizophrenia were recruited from psychiatric outpatient clinics, day wards, and those who received home-care services.

FINDINGS

This study discovered that sleep quality is a crucial factor that influences the risks of potential violence. Analysis on the subdimensions revealed that having a violence history during the preceding month and sleep quality are crucial factors that influence physical aggression. In addition, sleep quality is a crucial factor that influences the occurrence of anger. Age and sleep quality substantially influence hostility. However, this study did not identify any crucial factors that influenced verbal aggression.

PRACTICE IMPLICATIONS

In the future, community nursing professionals should collect data on the patients' age, whether the patients exhibited violence behavior during the preceding month, and their sleep quality to prevent risks of potential violence, physical aggression, anger, or hostility.

Measurement Invariance and Sleep Quality Differences Between Men and Women in the Pittsburgh Sleep Quality Index

STUDY OBJECTIVES

Previous research has reported mixed results in terms of sex differences in sleep quality. We conducted an analysis of measurement invariance of the Pittsburgh Sleep Quality Index (PSQI) between men and women to provide a necessary foundation for examining sleep differences.

METHODS

The sample included 861 adults (mean age = 52.73 years, 47.85% male) from the 2012-2016 wave of the Midlife in the United States (MIDUS) Refresher Biomarker survey. We randomly divided the sample into two half samples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. We conducted EFA with a weighted least squares mean and variance adjusted (WLSMV) estimator and Geomin rotation to explore the underlying structure of the PSQI. We then employed multiple-group CFA with the WLSMV estimator and theta parameterization to examine measurement invariance between males and females.

RESULTS

EFA suggested a two-factor structure of the PSQI, and the two-factor CFA model fit the data well. The finding that the two-factor PSQI model was invariant between males and females on configuration, factor loadings, thresholds for all but one measure, and residual variances for all but one measure provided evidence that the two-factor PSQI model was partially invariant between men and women. Females had higher means on latent factors, suggesting worse self-reports of sleep among women.

CONCLUSIONS

Overall, the measure of the PSQI assesses the same factors in a comparable way among men and women. Women reported worse sleep than men.

Gender differences in latent classes of sleep quality in community-dwelling adults based on the Pittsburgh sleep quality index

This study investigated the latent classes of sleep quality based on the Pittsburgh Sleep Quality index (PSQI) in Chinese adults, and analyzed whether these latent classes differed between men and women. A total of 982 adults (age: 18-59 years) participated in the questionnaire survey, and the PSQI was used to assess sleep quality. Two latent classes of sleep quality were found in men, and the cut-off value of PSQI for predicting the poor sleep quality group was 6. Four latent classes were found in women, which were named 'good sleep', 'daytime dysfunction', 'inadequate sleep', and 'poor sleep', respectively. In women, the optimal cut-off values of the PSQI for predicting the poor and good sleep quality groups were 9 and 6, respectively. Women who were not included in the 'poor sleep' group but had a score not less than 2 in the 'sleep duration' or 'daytime dysfunction' dimensions of PSQI were classified into the 'inadequate sleep' group or the 'daytime dysfunction' group. The findings may benefit the identification of sleep problems and assist in more effective alleviation of these issues.

Efficacy and challenges of a culturally relevant intervention to improve attitudes to aging

OBJECTIVES

Attitudes to aging have been linked with important health outcomes. It is unclear whether interventions to improve attitudes to aging are effective across cultural contexts. This study investigated the efficacy of an intervention among women of either Australian or Chinese backgrounds.

METHODS

Among 96 women who provided baseline measures, 86 attended a single, 90-min group session on either healthy aging or healthy diet. Measures of three domains of attitudes to aging were collected at baseline, then immediately and 8 weeks after the intervention.

RESULTS

The intervention improved attitudes in the psychological growth domain, but not the physical change or psychosocial loss domains. Cultural identification did not moderate intervention efficacy.

DISCUSSION

The findings suggest that brief, culturally inclusive interventions may be partially effective at improving attitudes to aging. Furthermore, research is needed to investigate if the intervention would be more effective when baseline attitudes to aging are less positive.