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Brown, R. T., Diaz-Ramirez, L. G., Boscardin, W. J., Lee, S. J., Williams, B. A., & Steinman, M. A. (2019). Association of Functional Impairment in Middle Age with Hospitalization, Nursing Home Admission, and Death. JAMA Internal Medicine, 179, 668-675.
https://doi.org/10.1001/jamainternmed.2019.0008

has been cited by the following article:

• TITLE: The Mediating Role of Hypnotic Medication in the Association between Sleep Disturbances and Instrumental Activities of Daily Living in Community-Dwelling Brazilian Older Adults

  AUTHORS: Pedro Olivares-Tirado

  KEYWORDS: Sleep Disturbances, Instrumental Activities of Daily Living, Hypnotics Drugs, Mediation Analysis, Older Adults

  JOURNAL NAME: Open Journal of Social Sciences, Vol.13 No.10, October 23, 2025

  ABSTRACT: Aim: This study aimed to determine whether hypnotic medications mediate the effects of sleep disturbances on Instrumental Activities of Daily Living (IADL) deficits among community-dwelling older adults in Brazil. Methods: This cross-sectional study involved 21,701 individuals aged 60 years or older. IADL performance was assessed using the Lawton Scale, while sleep disturbances and hypnotic medication use were evaluated through standardized questions from the Brazilian National Health Survey. Multivariate logistic regression and mediation analysis using structural equation modelling were conducted, adjusting for relevant confounding factors. Results: The prevalence of IADL deficits among the participants was 15.7%. Of those with IADL deficits, 57% reported sleep disturbances, and 38% of this group were using hypnotic medications. The adjusted multiple regression analysis indicated a significant association between sleep disturbances and IADL deficits. Mediation analysis suggests that approximately 19.0% of the impact of sleep disturbances on IADL deficits is mediated by the use of hypnotic medications. Furthermore, the mediated effect of these medications accounts for 23.2% of the direct effect of sleep disturbances on IADL deficits in older adults. Conclusions: Hypnotic medications were a mediating factor in the relationship between sleep disturbances and IADL deficits. Screening for sleep disturbances and promoting non-pharmacological interventions could help manage sleep issues and prevent IADL deficits in community-dwelling older adults.