Poor Sleep Quality Linked to Reduced Medication Adherence in Older Adults

Nicolò Panattoni, PhD

Credit: SciProfiles

Poor sleep quality is strongly associated with reduced medication adherence in older adults, according to research published in Clocks & Sleep. Factors like sleep disorders, sleep duration, sleep efficiency and daytime dysfunction contribute to non-adherence, while inappropriate medication prescriptions can further disrupt sleep.

Older adults are more likely to be diagnosed with comorbid conditions, leading to the development of polypharmacy—defined as being prescribed five or more medications per day—and, in turn, medication non-adherence, which is common among patients with sleep disorders. Medication non-adherence among seniors occurs due to a variety of factors, including memory issues, cognitive impairments and inattention related to aging.

When a person has compromised sleep quality, they often experience symptoms including fatigue, drowsiness, irritability, depressed mood, reduced mental and functional abilities, and even pain and muscle tremors.

“Sleep is a crucial indicator of overall health and well-being, representing a fundamental aspect of quality of life, especially in older adults,” wrote a team of investigators including Nicolò Panattoni, PhD, research fellow in the Department of Public Health and Infectious Diseases at Sapienza University of Rome, Italy. “Sleep quality affects the daily activities of every individual, influencing physical, cognitive and psychological spheres.”

To determine the relationship between sleep quality and medication adherence among this patient population, investigators conducted a systematic review using databases including PubMed, Cochrane Library, Scopus and CINAHL between January and March 2024.

Nine cross-sectional and longitudinal studies were ultimately selected for the analysis based on eligibility criteria, including three from the United States, two from Europe, two from Asia, one from Australia and one from South America. The sample sizes ranged from 24 to 2712 participants across studies and the average age of patients was more than 60 years.

To assess sleep measurements, teams used a variety of tools such as the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS) and the Insomnia Severity Index. Medication adherence was determined with the help of the Morisky Medication Adherence Scale (MMAS-4), the Medication Adherence Report Scale (MARS-5) and the Medication Event Monitoring System (MEMS), among others.

Patients exhibiting poor sleep quality were more likely to have reduced medication adherence compared with good sleepers. The main factors associated with non-adherence were sleep efficiency, sleep duration, sleep disorders and daytime dysfunctions.

Reduced sleep efficiency was linked to incorrect medication prescriptions. Poor medication adherence was also exhibited in older patients, those with worse clinical conditions and poorer quality of daily functioning, and those who spent longer periods of time in the hospital.

Sleep efficiency was linked to good self-rated health by patients, whereas patients with excessive daytime sleepiness were more likely to have a higher body mass index and greater abdominal obesity.

Limitations included the cross-sectional study design of most of the eligible articles as well as the heterogeneity of the patients and study methods, which could have impacted the generalizability of the results. Additionally, subjective assessment tools were most commonly used in the studies. Investigators believe addressing these issues through comprehensive geriatric assessments and nursing education may improve adherence and overall health outcomes in older populations.

“Promoting education aimed at preserving good sleep quality and exploring the interaction of multiple connected risk factors could have benefits on medication adherence and the quality of life of older patients,” investigators concluded.