Sleep Disturbances and Frailty in Community Dwelling Older Adults: A CrossSectional Study

Abstract

Background: Frailty and poor sleep quality are common geriatric syndromes associated with adverse health outcomes. Depressive symptoms may represent an important psychosocial pathway linking sleep disturbances to frailty, yet evidence from Lebanon remains limited. Aim: To examine the relationship between sleep quality and frailty among community-dwelling older adults in Lebanon and to assess whether depressive symptoms mediate this association. Methods: A cross-sectional study was conducted among 100 community-dwelling adults aged ≥65 years recruited from community settings in Lebanon (September–November 2025). Frailty was assessed using the Edmonton Frail Scale (EFS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and functional status using the Barthel Index. Linear regression analyses were used to examine unadjusted and adjusted associations with frailty, and mediation was assessed using a regression-based approach with a Sobel test. Results: The median age was 70 years (IQR: 67–78), and 46% of participants were female. The median EFS score was 4.5 (IQR: 2–7). The mean PSQI score was 6.07 (SD = 3.1), with 52% classified as having poor sleep quality (PSQI > 5). In unadjusted analyses, poorer sleep quality (B = 0.402, p < .001) and higher depressive symptoms (B = 0.382, p < .001) were associated with higher frailty scores. In the fully adjusted model, frailty remained independently associated with older age (B = 0.082, p = 0.008), depressive symptoms (B = 0.159, p = 0.008), number of medications (B = 0.316, p < .001), and hospital admissions (B = −1.691, p < .001), while sleep quality was no longer independently associated (B = 0.028, p = 0.761) with frailty. Mediation analysis indicated a significant indirect effect of sleep quality on frailty through depressive symptoms (Sobel z = 5.26, p < .001), consistent with partial mediation. Discussion: Frailty in Lebanese community dwelling older adults was associated with older age, polypharmacy, hospital admissions, and depression. Sleep quality was not independently associated after full adjustment but may contribute indirectly to frailty through depressive symptoms and related functional and health system factors. These findings support integrated screening approaches in community and clinical settings, emphasizing depression screening and medication review to support frailty prevention. Funding: No external funding was received for this study.