How Social and Medical Factors Influence Sleep Quality in Older Adults: A Systematic Review of Cross-Sectional Studies

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Abstract
Background: Sleep quality is essential for overall health and well-being, particularly in older adults who are at increased risk of sleep disturbances such as insomnia and sleep apnea. Poor sleep is associated with physical, cognitive, and emotional decline in aging populations; however, existing reviews often examine medical, social, or environmental determinants in isolation, leaving limited understanding of how these factors jointly influence sleep quality in older adults.Purpose: This systematic review aims to synthesize cross-sectional evidence on the physiological, psychological, medical, social, and environmental factors influencing sleep quality in older adults.Methods: A computer-based search was conducted in PubMed, ScienceDirect, and BioMed Central (BMC) using the terms (“sleep quality” OR “sleep disturbances”) AND (“older adults” OR “elderly”) AND (“factors” OR “determinants”) AND (“cross-sectional”). Articles published between January 2020 and April 2025 were included. The review followed PRISMA 2020 guidelines and used the Joanna Briggs Institute (JBI) checklist to appraise study quality.Results: Twenty cross-sectional studies were included. Sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), varied widely (6%–79%). Thematic synthesis identified five key domains: physiological decline (n = 5), psychological factors (n = 6), medical comorbidities (n = 5), social-environmental conditions (n = 3), and lifestyle factors (n = 1). Common factors associated with poor sleep included female gender, frailty, depression, anxiety, multimorbidity, and low social support. Considerable heterogeneity was noted in study populations and assessment tools.Conclusion: Associations observed in cross-sectional studies indicate that several interacting factors are related to sleep quality in older adults; however, causality cannot be inferred. Longitudinal research is needed to clarify these relationships and inform integrated care approaches.

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