Mediation of the association between multi-morbidity and sleep problems by pain and depressive symptoms among older adults: Evidence from the Longitudinal Aging Study in India, wave- 1

BACKGROUND: There could be several possible mechanisms on how chronic conditions relate to sleep problems in older persons; for instance, pain and sleep have a strong link and depressive symptoms are similarly associated with sleep problems. The present study explored whether pain and depressive symptoms are mediators in the relationship between multi-morbidity and sleep problems among older adults. METHODS: Study utilized data from the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults age 60 years and above. Multivariable logistic regression along with mediation analysis using Karlson–Holm–Breen (KHB) method was conducted. RESULTS: A proportion of 14.8% of the participants suffered from sleep problems, whereas, 22.5% and 8.7% of older adults had multi-morbidity and had depressive symptoms, respectively. Also, around 10.3% of older adults reported pain and received no medication for the relief of pain, whereas 29.3% of older adults reported pain and received some type of medication for the relief of pain. Older adults with multi-morbidity had higher odds of suffering from sleep problems [adjusted odds ratio (aOR):1.26, confidence interval (CI):1.10–1.45] than those who had no multi-morbidity. Older adults who reported pain but received no medication for the relief of pain [aOR: 1.90, CI: 1.64–2.22] or reported pain and received medication for the relief of pain [aOR: 1.82, CI:1.62–2.04] and those who had depressive symptoms [aOR: 2.21, CI:1.89–2.57%] had higher odds of suffering from sleep problems compared to those who did not report pain and had no depressive symptoms, respectively. Around 11.2% of the association of multi-morbidity with sleep problems was mediated by pain and 4.3% of such association was mediated by depressive symptoms. CONCLUSION: Pain and depressive symptoms were found to mediate the association between multi-morbidity and sleep problems; therefore, reducing pain and depressive symptoms may be considered to improve sleep in older multi-morbid patients.