Measuring Sleep in Vulnerable Older Adults: A Comparison of Subjective and Objective Sleep Measures

ABSTRACT

Objectives: This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program.

Methods: 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures.

Results: Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE.

Conclusions: Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems.

Clinical Implications: Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.

KEYWORDS:

• Adult day health care
• discrepancy
• insomnia
• measurement
• objective
• sleep
• subjective

Acknowledgments

This work was completed at the Greater Los Angeles VA Health Care System Geriatric Research, Education and Clinical Center.

Disclosure Statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. The views of this manuscript are those of the authors and do not reflect the views of the funding agencies or the federal government.

Additional information

Funding

VA Rehabilitation Research and Development Service Merit Review Project (1RX000135-01, PI: Martin). Additional support from VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC); Center for Health Services Research in Primary Care, Durham VA Medical Center (Hughes, CIN 13-410); Office of Academic Affiliations, VA Health Services Research & Development (Hughes; TPH 21-000); National Institute on Aging of the National Institutes of Health (Dzierzewski; K23AG049955, Fung K23AG045937, Song K23AG055668), and the Beeson Career Development in Aging Research Award Program (Fung, supported by NIA, AFAR, The John A. Hartford Foundation, and the Atlantic Philanthropies).