Poor sleep plagues most older adults in Turkish primary care, study finds

Nearly three out of four adults aged 65 and over attending a primary care clinic in Türkiye were classified as poor sleepers, according to a cross-sectional study published in BMC Primary Care. Of 388 older adults registered with a family medicine unit, 73.5%—285 participants—scored at or above the threshold for poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI), a validated questionnaire widely used to assess sleep over the previous month. The participants had a mean age of 71.6 years, with a standard deviation of 5.0 years, and women recorded significantly higher PSQI scores than men.

Poor sleep quality was significantly associated with a broad range of chronic conditions, including hypertension, cardiovascular disease, respiratory disease, thyroid disease, psychiatric disorders and gastrointestinal disorders, all at p < .05. When the researchers adjusted for multiple factors simultaneously, three variables emerged as independently associated with poor sleep quality: psychiatric disorders carried an odds ratio of 4.54 (95% confidence interval 1.05–19.64), gastrointestinal disorders an odds ratio of 3.76 (95% CI 1.82–7.79), and polypharmacy—defined as the use of five or more medications—an odds ratio of 2.48 (95% CI 1.45–4.23). Participants taking five or more medications also had significantly higher PSQI scores than those taking fewer drugs (p < .001).

Perhaps the most striking finding concerns the gap between how older adults believe they sleep and what a validated instrument says about them. Among the 285 participants classified as poor sleepers, 17.2%—49 people—rated their own sleep as good or very good. The authors describe this mismatch between global subjective sleep perception and PSQI-defined sleep quality as a substantial sleep-perception discordance, suggesting that simple self-report questions in routine consultations may miss a meaningful share of older patients whose sleep is objectively disturbed by standardized criteria.

The findings sit within a wider clinical context outlined in the paper’s background: poor sleep quality is described as a common but frequently overlooked problem among older adults, associated with impaired quality of life, increased morbidity and higher healthcare utilization. In primary care settings, where multimorbidity and polypharmacy cluster together, the combined association of these factors with sleep disturbances had remained insufficiently characterized, which the authors cite as the motivation for the study.

As a cross-sectional study of patients registered with a single primary care family medicine unit in Türkiye, the work captures associations at one point in time and cannot establish causal directions—whether psychiatric or gastrointestinal disorders and multiple medications disturb sleep, or whether poor sleep contributes to greater morbidity and prescribing, or both. The wide confidence interval around the psychiatric disorder estimate, spanning from 1.05 to 19.64, also reflects uncertainty in that particular association. The authors note that the article is being shared early as a peer-reviewed, accepted version that remains subject to further edits before the final Version of Record.

Nevertheless, the practical implication the authors draw is straightforward: because poor sleep quality was present in nearly three-quarters of this primary care population and was independently linked to psychiatric disorders, gastrointestinal disorders and polypharmacy, integrating structured sleep assessment and medication review into geriatric primary care may improve the identification and management of sleep-related problems in older adults. For clinicians, the discordance finding adds a further caution—asking older patients whether they sleep well may not be enough to uncover the scale of the problem measured by validated instruments.

Subject of Research: Sleep quality, polypharmacy and chronic disease in older adults attending primary care in Türkiye

Article Title: Poor sleep quality in older adults in primary care in Türkiye: the role of polypharmacy, comorbidities, and sleep-perception discordance

Article References: Seçkin, F. E., Özen, M., & Onan, A. (2026). Poor sleep quality in older adults in primary care in Türkiye: the role of polypharmacy, comorbidities, and sleep-perception discordance. BMC Primary Care. https://doi.org/10.1186/s12875-026-03633-7

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03633-7

Keywords: sleep quality, older adults, primary care, polypharmacy, PSQI, multimorbidity, psychiatric disorders, gastrointestinal disorders, Türkiye, sleep-perception discordance, cross-sectional study, geriatric care