Pain and Social Isolation as Mediators of the Longitudinal Association Between Sleep Problems and Frailty in U.S. Older Adults

J Appl Gerontol. 2026 Apr 27:7334648261444531. doi: 10.1177/07334648261444531. Online ahead of print.

ABSTRACT

Background Sleep problems are common in older adults and associated with higher frailty risk.ObjectiveTo examine whether pain and social isolation explain the longitudinal association between sleep problems and frailty.

Methods Data were from 925 adults aged 65+ in the 2013-2014 National Aging and Health Trends Study. Sleep problems were self-reported, and frailty was assessed using Fried's phenotype. Mediators included pain, activity-limiting pain, number of pain locations, and social isolation. Multivariable logistic regression and Karlson-Holm-Breen method were used.

Results Baseline pain and social isolation partially mediated the association between sleep problems and frailty at one-year follow-up, with pain accounting for 13.29%, activity-limiting pain 10.24%, pain locations 19.84%, and social isolation 12.77%, and pain and social isolation combined over 24% of the association.

Conclusions Pain and social isolation explain part of the association between sleep problems and frailty, informing efforts to reduce sleep-related frailty risk over time.

PMID:42037609 | DOI:10.1177/07334648261444531