The effects of insomnia on older adults’ quality of life and daily functioning

Older adults who move from their own homes to a retirement community, or to assisted living, and in many cases, again to long-term care or a nursing home, pass through a trajectory of increasing dependence reflected in their living situation. Disordered sleep or insomnia is frequently a key factor when older adults move down this trajectory of dependence, either as a primary cause or as a symptom of worsening physical or cognitive function, but how and why this happens has not been explored. Insomnia in older adults has been linked to increased incidence of falls, depression and anxiety, suicide attempts, cognitive impairment, institutionalization and overall mortality, but traditional sleep assessment instruments, designed for the general adult population, fail to capture many of the experiences and precipitating factors that are unique to older adults. This qualitative descriptive study elicited self-report and open narratives from 18 older adults at two different points along the trajectory of dependence about their own sleep behaviors, their knowledge of good sleep hygiene, and their thoughts and beliefs about the relationships between sleep, daily functioning and quality of life. The interviews were supplemented with five self-report instruments and a sleep diary. Conventional content analysis of the participants’ narratives revealed the overriding theme of Insomnia Is Exhausting, which exemplifies the physical and emotional strain this chronic condition creates, and four categories: A Bad Night, Self-Management, Stoicism and Consequences. By employing qualitative methods that captured a more holistic and nuanced experience of insomnia, this study demonstrated the negative effects that insomnia has on older adults’ quality of life and daily functioning. This study has implications for nursing education and practice, research and policy.