Poor sleep quality is significantly associated with a greater risk of falls among adults aged 50 or older, with depressive symptoms mediating approximately 28% of this association.
Poorer sleep quality was independently associated with greater odds of falls in a cross-sectional analysis of UK adults aged 50 and older.
Poorer sleep quality was prospectively associated with new-onset falls over a 4-year follow-up period.
Restricted cubic spline analyses revealed a dose-response relationship between worsening sleep quality and increasing fall risk.
Machine learning approaches identified depressive symptoms as a key variable associated with falls across different study designs.
Depressive symptoms partially mediated the association between sleep quality and both falls and new-onset falls.
This research suggests that older adults (aged 50 and above) in the UK who have poorer sleep quality face a meaningfully higher risk of falling, both at a single point in time and over a four-year follow-up period. The study analyzed data from thousands of participants in the English Longitudinal Study of Ageing, finding that each unit of worsening sleep quality was associated with a 7% higher odds of falls in the cross-sectional analysis and a 4% higher odds of new-onset falls in the prospective analysis. The relationship followed a dose-response pattern, meaning that as sleep quality got worse, the risk of falls continued to increase. The study also investigated why poor sleep might lead to falls, using both machine learning tools and mediation analysis. Depressive symptoms emerged as a particularly important factor, accounting for roughly 28% of the link between poor sleep and falls. This means that part of the reason poor sleepers fall more often may be because poor sleep contributes to depression, and depression in turn raises fall risk — though the majority of the sleep-fall association appears to operate through other mechanisms not fully explained in this study. This research suggests that addressing both sleep problems and depressive symptoms in older adults could be a useful strategy for reducing fall risk in this population. Falls are a major public health issue for aging populations, often leading to serious injury and loss of independence, so identifying modifiable risk factors like sleep quality and depression is practically important for healthcare and public health planning.
Li Y, Rong Y, Jiang K, Lu B, Liang X, Li J, et al.. (2026). Sleep Quality and Falls Risk in the ELSA Study: A Cross-Sectional and Prospective Cohort Study.. Brain and behavior. https://doi.org/10.1002/brb3.71719