Elevated noise levels in hospital wards correlate with impaired sleep quality, worsened emotional state, heightened physiological stress, and prolonged recovery in older patients with proximal humerus fractures, highlighting the importance of noise-reduction interventions in orthopedic wards.
Key Findings
Results
Older patients exposed to high ward noise levels (>55 dB) had significantly worse sleep quality at discharge compared to those in low noise environments.
Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI); higher scores indicate worse sleep.
HNE group PSQI score at discharge: 9.24 ± 2.15 vs. LNE group: 6.87 ± 1.93 (P < 0.001).
Groups were stratified by average ward noise: HNE (>55 dB, n=78) vs. LNE (≤55 dB, n=78).
Participants were older patients aged ≥65 years admitted with proximal humerus fractures between January 2022 and December 2024.
Results
High noise exposure was associated with significantly greater anxiety and depression scores at discharge.
Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS).
Salivary cortisol levels, a marker of physiological stress, were significantly elevated in the high noise exposure group at discharge.
HNE group salivary cortisol: 0.67 ± 0.14 µg/dL vs. LNE group: 0.45 ± 0.11 µg/dL (P < 0.001).
The difference represents approximately a 49% higher cortisol level in the HNE group compared to the LNE group.
Salivary cortisol was used as the measure of physiological stress response.
Results
Patients in the high noise exposure group reported significantly higher pain intensity at discharge.
Pain was assessed using the Visual Analog Scale (VAS).
HNE group VAS score: 6.78 ± 1.45 vs. LNE group: 4.92 ± 1.32 (P < 0.001).
The difference in VAS scores was approximately 1.86 points on the pain scale.
Results
Functional outcomes were significantly worse in the high noise exposure group compared to the low noise exposure group.
Functional outcomes were measured using the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH); higher scores indicate greater disability.
HNE group DASH score: 58.92 ± 12.34 vs. LNE group: 48.76 ± 11.28 (P < 0.001).
The difference in DASH scores was approximately 10 points.
Results
Patients exposed to high ward noise levels had significantly longer hospital stays than those in low noise environments.
HNE group mean length of stay: 8.45 ± 2.67 days vs. LNE group: 6.83 ± 2.14 days (P < 0.001).
The difference represents approximately 1.62 additional days in hospital for the HNE group.
Length of hospital stay was one of the additional outcome measures assessed in this retrospective study.
Methods
The study enrolled 156 older patients with proximal humerus fractures stratified into two equal groups based on average ward noise exposure.
Total sample: 156 patients aged ≥65 years admitted between January 2022 and December 2024.
This was a retrospective study design with data collected at baseline and discharge.
The 55 dB threshold was used as the stratification cutpoint for noise exposure groups.
What This Means
This research suggests that the level of noise in a hospital ward significantly affects how well elderly patients with shoulder fractures sleep, feel emotionally, and recover physically. The study compared 156 patients aged 65 and older who were in noisier wards (averaging more than 55 decibels) versus quieter wards (55 decibels or below). At the time of hospital discharge, patients in the noisier wards had notably worse sleep quality, higher levels of anxiety and depression, and elevated stress hormones (cortisol) compared to those in quieter wards.
Beyond mental and emotional wellbeing, the research also found that higher noise exposure was linked to more pain, worse arm and shoulder function, and longer hospital stays — about 1.6 additional days on average. These patterns suggest that hospital noise may not just be uncomfortable but may actively interfere with healing and recovery processes in vulnerable older patients.
This research suggests that managing ward noise levels could be an important, relatively low-cost strategy for improving patient outcomes in orthopedic settings. Simple noise-reduction measures — such as quieter equipment, staff communication policies, and soundproofing — may help older patients sleep better, feel less anxious or depressed, experience less pain, and potentially leave the hospital sooner. The findings point to ward noise as an often-overlooked environmental factor in patient care quality.
Pan Q, Wei W, Tang C. (2026). Effects of Ward Noise on Sleep Quality and Emotional State in Older Patients with Proximal Humerus Fractures: A Retrospective Study.. Noise & health. https://doi.org/10.4103/nah.nah_126_25