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OBJECTIVES:(1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING:Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS:Community-dwelling women aged ≥80 years. MEASUREMENTS:Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS:Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R2 = 0.06). CONCLUSIONS:Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.

ObjectivesTo test a new cognitive behavioral therapy for insomnia (CBT-I) program designed for use by nonclinicians.DesignRandomized controlled trial.SettingDepartment of Veterans Affairs healthcare system.ParticipantsCommunity-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159).InterventionNonclinician "sleep coaches" delivered a five-session manual-based CBT-I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education.MeasurementsPrimary outcomes, including self-reported (7-day sleep diary) sleep onset latency (SOL-D), wake after sleep onset (WASO-D), total wake time (TWT-D), and sleep efficiency (SE-D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7-day wrist actigraphy, SE-A) were measured at baseline, at the posttreatment assessment, and at 6- and 12-month follow-up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and quality of life (Medical Outcomes Study 12-item Short-form Survey version 2 (SF-12v2)).ResultsIntervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6-month assessments, and the baseline and 12-month assessments in SOL-D (-23.4, -15.8, and -17.3 minutes, respectively), TWT-D (-68.4, -37.0, and -30.9 minutes, respectively), SE-D (10.5%, 6.7%, and 5.4%, respectively), PSQI (-3.4, -2.4, and -2.1 in total score, respectively), and ISI (-4.5, -3.9, and -2.8 in total score, respectively) (all P < .05). There were no significant differences in SE-A, PHQ-9, or SF-12v2.ConclusionManual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.

ObjectivesTo investigate the association between pain and functional independence in older adults during and after admission to rehabilitation after an acute illness or injury.DesignProspective, observational cohort study.SettingOne community and one Veterans Affairs rehabilitation center.ParticipantsIndividuals aged 65 and older admitted for rehabilitation after an acute illness or injury (postacute rehabilitation) (N = 245; mean age 80.6, 72% male)).MeasurementsPain was assessed using the Geriatric Pain Measure (GPM, score 0-100). Functional independence was measured using the motor component of the Functional Independence Measure (mFIM, score 13-91). Both scores were obtained at admission; discharge; and 3-, 6-, and 9-month follow-up. In bivariate analyses, discharge GPM and persistent pain (lasting >3 months) were evaluated as predictors of mFIM score at 9 months. Applying a multilevel modeling (MLM) approach, individual deviations in GPM scores were used to predict variations in mFIM.ResultsAt admission, 210 participants (87.9%) reported pain (16.3% mild (GPM70)); 21.3% reported persistent pain after discharge. The bivariate analyses did not find statistically significant associations between discharge GPM or persistent pain and mFIM score at 9 months, but in the MLM analysis, deviations in GPM were significant predictors of deviations in mFIM score, suggesting that, when individuals experienced above-average levels of pain (GPM > their personal mean GPM), they also experienced worse functional independence (mFIM < their personal mean mFIM).ConclusionTwenty-one percent of older adults undergoing postacute rehabilitation reported persistent pain after discharge from rehabilitation. The bivariate analysis did not find association between pain and functional independence, but MLM analysis showed that, when participants experienced more pain than their average, they had less functional independence.

OBJECTIVES: To examine whether sleep disturbance is associated with poor physical function in older veterans in an adult day healthcare (ADHC) program. DESIGN: Cross-sectional. SETTING: One ADHC program in a Veterans Affairs Ambulatory Care Center. PARTICIPANTS: Older veterans (N = 50) enrolled in a randomized controlled trial of a sleep intervention program who had complete baseline data. MEASUREMENTS: Information on participant characteristics (e.g., age, depression, relationship to caregiver, pain, comorbidity) was collected using appropriate questionnaires. Physical function was measured using activity of daily living (ADL) and instrumental ADL (IADL) total scores from the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Sleep was assessed subjectively (Pittsburgh Sleep Quality Index, Insomnia Severity Index) and objectively (wrist actigraphy). RESULTS: Participants required substantial assistance with ADLs and IADLs. A regression model showed that participant characteristics (marital status, use of sleep medication, comorbidity, posttraumatic stress disorder) and living arrangement (living with a spouse or others) were significantly associated with poor physical function. Poorer objective sleep (total sleep time, total numbers of awakenings, total wake time) was significantly associated with poor physical function, accounting for a significant proportion of the variance other than participant characteristics. CONCLUSION: Objective measures of nighttime sleep disturbance were associated with poor physical function in older veterans in an ADHC program. Further research is needed to determine whether interventions to improve sleep will delay functional decline in this vulnerable population.

Background: Cognitive behavioral therapy for insomnia (CBT‐I) is the gold‐standard treatment for insomnia disorder in adults. Compared to young adults, older adults have increased risk for the development of conditions associated with chronic pain, which may impact the efficacy of CBT‐I in improving insomnia symptoms in older adults. This study evaluated the effect of participant‐rated pain on sleep‐related outcomes of a supervised, non‐clinician administered CBT‐I program in older adult patients with chronic insomnia disorder. Methods: Secondary analysis was conducted using data from a randomized controlled trial among 106 community‐dwelling older adult veterans (N = 106; mean age 72.1 years, 96% male, 78.3% White, 6.6% Hispanic, 5.7% African American) with chronic (≥3 months) insomnia disorder. Participants engaged in five sessions of manual‐based CBT‐I in individual or group format within one Department of Veterans Affairs healthcare system, provided by non‐clinician "sleep coaches" who had weekly telephone supervision by behavioral sleep medicine specialists. Insomnia symptoms (Insomnia Severity Index), perceived sleep quality (Pittsburgh Sleep Quality Index), fatigue (Flinder's Fatigue Scale), daytime sleepiness (Epworth Sleepiness Scale), and perceived pain severity (items from the Geriatric Pain Measure) were assessed at 4 time points: baseline, one‐week posttreatment, 6‐month follow‐up, and 12‐month follow‐up. Mixed effects models with time invariant and time varying predictors were employed for analyses. Results: CBT‐I improved insomnia symptoms, perceived sleep quality, fatigue, and daytime sleepiness among older veterans with chronic insomnia. Participant‐reported pain was associated with greater improvements in insomnia symptoms following CBT‐I. Pain did not affect improvements in other sleep‐related outcomes (−0.38 ≤ b ≤ 0.07, p > 0.05). Between‐subjects differences in pain, but not within‐subject changes in pain over time, appeared to play a central role in insomnia symptom improvement at posttreatment, with individuals with higher‐than‐average pain showing greater insomnia symptom improvement (ISI score reduction; −0.32 ≤ b ≤ −0.28, p ≤ 0.005). Conclusions: Pain did not meaningfully hinder the effects of CBT‐I on sleep outcomes. Among older veterans with chronic insomnia disorder, individuals with higher pain exhibited slightly greater improvement in insomnia than those with lower levels of pain. These findings suggest that experiencing pain does not impair treatment response and should not preclude older adults with insomnia from being offered CBT‐I. [ABSTRACT FROM AUTHOR]