Physical Activity and Insomnia Symptoms Over 10 Years in a U.S. National Sample of Late-Middle-Age and Older Adults: Age Matters

Use of mHealth Technologies to Increase Sleep Quality among Older Adults: A Scoping Review

Sleep disorders increase with age and are known risk factors for several mental and physical diseases. They also significantly contribute to a lower quality of life. Nonpharmaceutical approaches, such as cognitive behavioral therapy for insomnia, sleep hygiene advice, relaxation exercises, and physical activity programs, can be delivered directly to patients via mHealth technologies, thereby increasing the accessibility of such interventions and reducing health care-related costs. This scoping review aims to evaluate the effectiveness of mHealth interventions for improving sleep quality among older adults. Published studies in the last 10 years (2013-2023) were identified by searching electronic medical databases (PubMed, PsycINFO, CINAHL, and Scopus) in July 2023 and were independently reviewed by two different authors. The analysis of the data was performed in 2023. The research retrieved 693 records; after duplicates were removed, 524 articles were screened based on their title and abstract, and 28 of them were assessed in full text. A total of 23 studies were excluded because they did not meet the inclusion criteria in terms of population age (60 years or over) or type of intervention (mHealth-based) or because they addressed secondary insomnia. A total of five studies were included in this review, and all of them reported improvements in subjective sleep quality after the application of the mHealth interventions. Two studies also conducted objective assessments of sleep outcomes using actigraphy, reporting improvements only in some of the variables considered. Despite the limited number of available studies, these results are promising and encourage further research.

Impact of COVID-19 lockdown on physical activity, insomnia, and loneliness among Spanish women and men

During COVID-19 pandemic, quality of living was impacted by social isolation, loneliness, and altered sleep habits. The aims of this study were (1) to examine the relationship between physical activity (PA) levels with insomnia and loneliness among adults during Spain's first COVID-19 wave of lockdown and its impact on women and (2) to examine the digital technologic resources used to support both PA and other recreational activities in women. A cross-sectional design was used. An anonymous 15-min online survey was conducted in Spain to adults (≥ 18 years old) during the first COVID-19 lockdown, a 40-day period. A snowball distribution method was employed using personal email and social networks (Facebook, Whatsapp, Linkedin, Twitter). Variables studied included: socio-demographic items, insomnia, loneliness, PA, and digital technologic resources. A total of 996 adults (females = 663, 66.6%) completed the survey. Higher education levels were associated with greater PA levels (p-value < 0.001). Women presented with higher insomnia risk than men with low PA levels (OR = 1.9, CI = 1.25; 2.95). Living with family members or other individuals was related to lower insomnia risk. A strong correlation between medium-high PA levels was found with greater digital technology resources (DTS) than individuals with low PA levels. Females used significantly more DTS than males (p-value < 0.001). No significant associations between DTS were found with age or academic education level. PA levels, sex, and loneliness were related to insomnia risk. A strong correlation between PA and DTS use was observed. Participants with medium-high PA levels and females use them more than those with low PA levels and males. We recommend promoting the PA through digital technologies for women. This recommendation would also improve sleep disorders in women who present higher insomnia risks than men.

Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States

OBJECTIVE

To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.

DATA SOURCES

The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.

STUDY DESIGN

This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.

DATA COLLECTION/EXTRACTION METHODS

We extracted longitudinal data from 2002 through 2018 waves of the HRS.

PRINCIPAL FINDINGS

Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.

CONCLUSIONS

The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

An mHealth-Facilitated Personalized Intervention for Physical Activity and Sleep in Community-Dwelling Older Adults

This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including self-monitoring, motivational messages, activity reminders, and phone coaching, were used to facilitate PA participation. PA and sleep were measured using actigraphy and questionnaires at baseline and 8-, 16-, and 24-week visits. Participants in the intervention group had lower objective PA levels at 24 weeks than at 8 and 16 weeks, although levels of PA remained higher than at baseline. Compared with the control group, the intervention increased PA at 8, 16, and 24 weeks; improved subjective sleep quality at 16 and 24 weeks; and increased actigraphy-measured sleep duration and sleep efficiency at 24 weeks. mHealth PA interventions may benefit PA and sleep in older adults. Strategies for maintaining long-term PA behavioral changes are needed.

Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.

The Evolutionarily Mismatched Impact of Urbanization on Insomnia Symptoms: a Short Review of the Recent Literature

PURPOSE OF REVIEW

For the most part of human existence, individuals have been living a rural lifestyle in a rural setting. However, such sleep-conducive conditions have largely been transformed dramatically by urbanization within a relatively short span of time in recent history, and the resulting evolved mechanisms-environment mismatch is theorized to bring about an increased risk for insomnia symptoms. This brief review of the recent literature is designed to evaluate the veracity of this proposition.

RECENT FINDINGS

The majority of recent findings have suggested that most proposed evolutionarily mismatched urban factors are indeed related to the presence of insomnia symptoms. However, there is a general paucity of longitudinal evidence (and for some other factors, a lack of enough evidence of any kind). Although there is a preponderance of recent findings indicating a link between evolutionarily mismatched urban phenomena and insomnia symptoms, more longitudinal data are needed before any causative conclusion can be drawn.

Effects of Physical Exercise on Autophagy and Apoptosis in Aged Brain: Human and Animal Studies

The aging process is characterized by a series of molecular and cellular changes over the years that could culminate in the deterioration of physiological parameters important to keeping an organism alive and healthy. Physical exercise, defined as planned, structured and repetitive physical activity, has been an important force to alter physiology and brain development during the process of human beings' evolution. Among several aspects of aging, the aim of this review is to discuss the balance between two vital cellular processes such as autophagy and apoptosis, based on the fact that physical exercise as a non-pharmacological strategy seems to rescue the imbalance between autophagy and apoptosis during aging. Therefore, the effects of different types or modalities of physical exercise in humans and animals, and the benefits of each of them on aging, will be discussed as a possible preventive strategy against neuronal death.