SLEEP AND FRAILTY: EXAMINING THE EFFECTS OF FRAILTY ON SLEEP DISTURBANCE IN HOSPITALISED OLDER ADULTS

Abstract Ref: 
0261

Helen Mannion1, Rónán O’Caoimh1,2,3
1National University of Ireland, Galway, Galway, Ireland
2Mercy University Hospital, Cork, Ireland
3University College Cork, Cork, Ireland

Background: Sleep disturbance is common in hospital, potentially resulting in poor clinical
outcomes. Frailty is similarly prevalent and associated with multiple adverse events. Despite
this, little is known about the interaction between frailty and sleep among older hospital
inpatients.
Methods: Consecutive, non-critically ill patients aged ≥70, admitted medically through
a large university hospital emergency department (ED) during the preceding 24 hours,
were evaluated with measures assessing overnight sleep quality (Richards Campbell
Sleep Questionnaire/RCSQ), baseline sleep (Pittsburgh Sleep Quality Index/PSQI) and
insomnia (Insomnia Severity Index/ISI). Additional variables included medications, frailty
(PRISMA-7 scores ≥3 and Clinical Frailty Scale/CFS scores ≥5), functional and cognitive
status, and night-time noise levels. Patients were reassessed 48 hours later.
Results: Over four weeks, 152 patients, mean age 80 (±6.8) years were included; 61%
were male (n=92). In all, 43% were frail (mean CFS score 4.23±1.6), median PRISMA-7
score 4±4; a further 24% were pre-frail. The median Charlson Comorbidity Index score
was 6±2. The majority, 72% (110/152), reported impaired baseline sleep quality (PSQI
≥5) and 13% (20/152) had clinical insomnia (ISI ≥15). The median time spent in ED was
23±13 hours, median duration asleep was only one hour (range 0-8). After adjusting for
possible confounders, frailty status was significantly associated with lower PSQI (p<0.001)
but not ISI (p=0.07) and RCSQ (p=0.07) scores. Frail patients were twice as likely
to report poor baseline sleep OR 2, (95% CI:1.3-3.2). Baseline and overnight sleep
disturbance were not associated with prolonged length of stay (LOS) or 30-day readmission
rates.
Conclusion: The prevalence of sleep disturbance and clinical insomnia among older adults
admitted through ED is high and overnight sleep quality low, although these did not
impact on LOS or 30-day re-admission rates. Frail patients reported significantly poorer
baseline sleep but did not have higher rates of insomnia or experience worse overnight
sleep.