Sleep problems in dementia care are linked more to emotional well-being than fear of falling

by Mary Cunningham, George Mason University

edited by Stephanie Baum, reviewed by Andrew Zinin

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While fear of falling has long been linked to poor sleep among older adults, new research from George Mason University suggests that emotional well-being may be an even stronger predictor of sleep quality for people with dementia and the spouses who care for them. In what is believed to be the first study of its kind, dementia researcher Kyeung Mi Oh examined how fear of falling and sleep quality interact within dementia caregiving couples, in which one partner has probable or possible dementia and the other serves as caregiver. The work is published in the Journal of Applied Gerontology.

Falls are a common concern among older adults and can lead to reduced mobility, more frequent hospital visits and limits on daily activities. Many individuals also develop a persistent fear of falling, causing them to avoid activities even when they are physically able. In dementia care, that fear can further increase caregiver burden and affect sleep for both partners.

Though the study found that fear of falling was associated with poorer sleep for both partners, emotional well-being ultimately was more strongly linked to sleep outcomes.

The importance of emotional well-being

"These findings suggest that improving emotional well-being may be more important for sleep health in dementia care dyads than addressing physical health factors alone," said Oh, professor of nursing in George Mason University's College of Public Health.

For care recipients, positive emotion was associated with better sleep, while psychological distress, like depression and anxiety, was associated with worse sleep among caregivers.

The results highlight the importance of assessing both physical and emotional factors in dementia care.

"Routine assessment of fear of falling, fall history and psychological distress in both members of dementia care couples could help identify those at risk for poor sleep," said Oh. "Clinically, interventions that promote emotional well-being and reduce psychological distress may improve sleep for both care recipients and caregivers, highlighting the need for a family-centered approach to dementia care."

Fear of falling was associated with poor sleep. However, after factoring in demographic, lifestyle and health-related factors, positive emotion predicted lower insomnia severity in care recipients, while psychological distress predicted higher insomnia severity in caregivers.Both fear of falling and recent falls were linked to worse insomnia for people with dementia and their caregivers.

More information

Kyeung Mi Oh et al, Fear of Falling and Sleep Disturbances in Spousal Care Dyads Affected by Dementia, Journal of Applied Gerontology (2026). DOI: 10.1177/07334648261420474

Key medical concepts

Emotional Well-beingDementiafear of falling

Clinical categories

Sleep & RecoverySleep medicinePsychiatryNeurologyPsychology & Mental healthGeriatric palliative careHealthy aging Provided by George Mason University Who's behind this story?

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