How Changes in Living Arrangements Are Associated With Changes in Sleep Quality and Duration Among Chinese Older Adults: Results From a Longitudinal Study (2008–2018)
Restricted accessResearch articleFirst published online 2026
How Changes in Living Arrangements Are Associated With Changes in Sleep Quality and Duration Among Chinese Older Adults: Results From a Longitudinal Study (2008–2018)
This study examined how transitions in living arrangements are associated with changes in sleep quality and sleep duration among Chinese older adults.
Major findings
Using four waves of the Chinese Longitudinal Healthy Longevity Survey data (2008–2018), we examined how living arrangement transitions affect sleep among 10,473 observations from older adults (65+). Cox models showed that older adults who remained living with household members (hazard ratio [HR] = 0.66, 95% CI: 0.53–0.81; p < .001) or transitioned to living alone (HR = 0.71, 95% CI: 0.57–0.89; p = .003) had significantly lower risks of experiencing a decline in sleep quality compared to those who transitioned to institutional care. Although similar patterns were observed for sleep duration, these associations were not statistically significant.
Conclusions
Older adults transitioning to institutional care may warrant additional monitoring and supportive care regarding sleep health during residential transitions.
CaiD.ZengY.ChenM.ZhongY.QuanY.YeM.HuangX. (2025). Association between sleep duration and disability in activities of daily living among Chinese older adults: A nationwide observational study. Frontiers in Public Health, 13, 1580101. https://doi.org/10.3389/FPUBH.2025.1580101/BIBTEX
ChuY.AuneD.YuC.WuY.FerrariG.RezendeL. F. M.WangY. (2023). Temporal trends in sleep pattern among Chinese adults between 2010 and 2018: Findings from five consecutive nationally representative surveys. Public Health, 225, 360–368. https://doi.org/10.1016/J.PUHE.2023.10.004
4.
DongX.WangY.ChenY.WangX.ZhuJ.WangN.JiangQ.FuC. (2018). Poor sleep quality and influencing factors among rural adults in deqing, China. Sleep and Breathing, 22(4), 1213–1220. https://doi.org/10.1007/S11325-018-1685-8/TABLES/5
EdwardsB. A.O’DriscollD. M.AliA.JordanA. S.TrinderJ.MalhotraA. (2010). Aging and sleep: Physiology and pathophysiology. Seminars in Respiratory and Critical Care Medicine, 31(5), 618–633. https://doi.org/10.1055/S-0030-1265902/ID/24/BIB
EserI.KhorshidL.ÇinarS. (2007). Sleep quality of older adults in nursing homes in Turkey: Enhancing the quality of sleep improves quality of life. Journal of Gerontological Nursing, 33(10), 42–49. https://doi.org/10.3928/00989134-20071001-07
9.
FengZ.FalkinghamJ.LiuX.VlachantoniA. (2017). Changes in living arrangements and mortality among older people in China. SSM - Population Health, 3, 9–19. https://doi.org/10.1016/J.SSMPH.2016.11.009
10.
GadieA.ShaftoM.LengY.KievitR. A.Cam-CAN. (2017). How are age-related differences in sleep quality associated with health outcomes? An epidemiological investigation in a UK cohort of 2406 adults. BMJ Open, 7(7), e014920. https://doi.org/10.1136/BMJOPEN-2016-014920
11.
GentiliA.WeinerD. K.KuchibhatlaM.EdingerJ. D. (1997). Factors that disturb sleep in nursing home residents. Aging Clinical and Experimental Research, 9(3), 207–213. https://doi.org/10.1007/BF03340151/METRICS
12.
GnädingerM.HerzigL.CeschiA.ConenD.StaehelinA.ZollerM.PuhanM. A. (2018). Chronic conditions and multimorbidity in a primary care population: A study in the Swiss sentinel surveillance network (sentinella). International Journal of Public Health, 63(9), 1017–1026. https://doi.org/10.1007/S00038-018-1114-6/FIGURES/4
13.
GriffinS. C.WilliamsA. B.RavytsS. G.MladenS. N.RybarczykB. D. (2022). The relationship between living arrangements and sleep quality in older adults: Gender differences. International Journal of Environmental Research and Public Health, 19(7), 3893. https://doi.org/10.3390/IJERPH19073893
14.
GuD.SautterJ.PipkinR.ZengY. (2010). Sociodemographic and health correlates of sleep quality and duration among very old Chinese. Sleep, 33(5), 601–610. https://doi.org/10.1093/SLEEP/33.5.601
15.
HallM.BuysseD. J.NofzingerE. A.ReynoldsC. F.ThompsonW.MazumdarS.MonkT. H. (2008). Financial strain is a significant correlate of sleep continuity disturbances in late-life. Biological Psychology, 77(2), 217–222. https://doi.org/10.1016/J.BIOPSYCHO.2007.10.012
HirshkowitzM.WhitonK.AlbertS. M.AlessiC.BruniO.DonCarlosL.HazenN.HermanJ.KatzE. S.Kheirandish-GozalL.NeubauerD. N.O’DonnellA. E.OhayonM.PeeverJ.RawdingR.SachdevaR. C.SettersB.VitielloM. V.WareJ. C.Adams HillardP. J. (2015). National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010
18.
HolbrookA. M.CrowtherR.LotterA.ChengC.KingD. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ: Canadian Medical Association Journal, 162(2), 225–233.
19.
JiaQ.DuanY.GongR.JiangM.YouD.QuY. (2023). Living arrangements and depression of the older adults– evidence from the Chinese longitudinal healthy longevity survey. BMC Public Health, 23(1), 1–12. https://doi.org/10.1186/S12889-023-16730-4/FIGURES/2
20.
KoffelE.Ancoli-IsraelS.ZeeP.DzierzewskiJ. M. (2023). Sleep health and aging: Recommendations for promoting healthy sleep among older adults: A national sleep foundation report. Sleep Health, 9(6), 821–824. https://doi.org/10.1016/J.SLEH.2023.08.018
LeeY. H.ChiangT.XuC.ShelleyM.KalidindiA.ChangY. C. (2024). Behavioral change in fruit and vegetable consumption and associated cognitive impairment among Chinese older adults. European Geriatric Medicine, 15(6), 1749–1761. https://doi.org/10.1007/S41999-024-01058-Y
23.
LeeY. H.KongD.LeeY. T. H.LinC. H.LiuC. T.ChangY. C. (2022). Functional disabilities and changes in sleep quality and duration among older adults: Results from a longitudinal study in China, 2005–2014. European Geriatric Medicine, 13(4), 967–975. https://doi.org/10.1007/S41999-022-00619-3/METRICS
24.
LeiX.StraussJ.TianM.ZhaoY. (2015). Living arrangements of the elderly in China: Evidence from the CHARLS national baseline. China Economic Journal, 8(3), 191–214. https://doi.org/10.1080/17538963.2015.1102473
LiuH.ShiY.YuM.GuoX.RuanY.QinF.ZhouR.FengJ.HuZ.WuF.JiaQ.YinY.GuoY.WuF. (2025). Individual and joint associations between sleep duration and physical activity with cognitive function: A longitudinal analysis among middle-aged and older adults in China. Alzheimer’s and Dementia, 21(1), e14212. https://doi.org/10.1002/ALZ.14212;PAGEGROUP:STRING:PUBLICATION
27.
LuL.WangS. B.RaoW. W.UngvariG. S.NgC. H.ChiuH. F. K.ZhangJ.KouC.JiaF. J.XiangY. T. (2017). Sleep duration and patterns in Chinese older adults: A comprehensive meta-analysis. International Journal of Biological Sciences, 13(6), 682. https://doi.org/10.7150/IJBS.19695
28.
MaX. Q.JiangC. Q.XuL.ZhangW. S.ZhuF.JinY. L.ThomasG. N.LamT. H. (2020). Sleep quality and cognitive impairment in older Chinese: Guangzhou biobank cohort study. Age and Ageing, 49(1), 119–124. https://doi.org/10.1093/AGEING/AFZ120
OrhanFÖTuncelD.TaşF.DemirciN.ÖzerA.KaraaslanM. F. (2012). Relationship between sleep quality and depression among elderly nursing home residents in Turkey. Sleep and Breathing, 16(4), 1059–1067. https://doi.org/10.1007/S11325-011-0601-2/TABLES/4
33.
PanX. B.WangH. X.CaoY. J.LiuY. Y. (2023). Secular trends in sleep conditions in Chinese elderly individuals: A national population-based study. Nature and Science of Sleep, 15, 555. https://doi.org/10.2147/NSS.S416084
34.
QianJ.YuX.ZhangQ. (2025). Association of sleep duration and sleep quality with cognitive frailty in Chinese older adults. Frontiers in Public Health, 13, 1596965. https://doi.org/10.3389/FPUBH.2025.1596965/BIBTEX
35.
RenQ.TreimanD. J. (2015). Living arrangements of the elderly in China and consequences for their emotional well-being. Chinese Sociological Review, 47(3), 255–286. https://doi.org/10.1080/21620555.2015.1032162
36.
SongY.LiuH.GuK.LiuY. (2024). U-shaped association between sleep duration and frailty in Chinese older adults: A cross-sectional study. Frontiers in Public Health, 12, 1464734. https://doi.org/10.3389/FPUBH.2024.1464734/BIBTEX
TaoZ.FengY.LiuJ.TaoL. (2023). Trends and disparities in sleep quality and duration in older adults in China from 2008 to 2018: A national observational study. Frontiers in Public Health, 11, 998699. https://doi.org/10.3389/FPUBH.2023.998699/BIBTEX
VermuntJ. K.MagidsonJ. (2007). Latent class analysis with sampling weights. Sociological Methods & Research, 36(1), 87–111. https://doi.org/10.1177/0049124107301965
41.
WangP.SongL.WangK.HanX.CongL.WangY.ZhangL.YanZ.TangS.DuY. (2020). Prevalence and associated factors of poor sleep quality among Chinese older adults living in a rural area: A population-based study. Aging Clinical and Experimental Research, 32(1), 125–131. https://doi.org/10.1007/S40520-019-01171-0/TABLES/3
42.
WangS.WuY.UngvariG. S.NgC. H.ForesterB. P.GatchelJ. R.ChiuH. F. K.KouC.FuY.QiY.YuY.LiB.XiangY. T. (2017). Sleep duration and its association with demographics, lifestyle factors, poor mental health and chronic diseases in older Chinese adults. Psychiatry Research, 257, 212–218. https://doi.org/10.1016/J.PSYCHRES.2017.07.036
43.
WangY.LiJ.FuP.JingZ.ZhouC. (2021). Social engagement and sleep quality among older adults in rural China: Is there a sex difference?Journal of the American Medical Directors Association, 22(10), 2140–2146. https://doi.org/10.1016/j.jamda.2020.11.014
XuC. (2025). Can changes in social isolation and loneliness affect changes in cognitive-functional impairment among Chinese older adults? A 10-year longitudinal study (2008-2018). Research on Aging, 1640275261427305. https://doi.org/10.1177/01640275261427305
46.
XuC.ChangY. C.LeeY. H.ShelleyM.LiK.GuoW. (2026). How changes in functional disability are associated with living arrangements for Chinese older adults: Results from a longitudinal study (2008–2018). Australasian Journal on Ageing, 45(2), e70169. https://doi.org/10.1111/AJAG.70169;WGROUP:STRING:PUBLICATION
47.
YangH.XuL.QinW.HuF.LiL.ChenC.TangW. (2023). Gender differences in the modifying effect of living arrangements on the association of sleep quality with cognitive function among community-dwelling older adults: A cross-sectional study. Frontiers in Public Health, 11, 1142362. https://doi.org/10.3389/FPUBH.2023.1142362/BIBTEX
48.
YueZ.ZhangY.ChengX.ZhangJ.ChangC.-C.YueZ.ZhangY.ChengX.ZhangJ. (2022). Sleep quality among the elderly in 21st century shandong province, China: A ten-year comparative study. International Journal of Environmental Research and Public Health, 19(21), 14296. https://doi.org/10.3390/IJERPH192114296
ZhangL.YangL. (2024). Exploration of home care models for disabled older adults in China: Challenges and choices. Chinese Journal of Population Resources and Environment, 22(4), 526–530. https://doi.org/10.1016/j.cjpre.2024.11.015
51.
ZhangL.ZhangL. (2015). Living arrangements and subjective well-being among the Chinese elderly. Open Journal of Social Sciences, 3(3), 150–161. https://doi.org/10.4236/JSS.2015.33024
52.
ZhaoL. (2023). China’s aging population: A review of living arrangement, intergenerational support, and wellbeing. Health Care Science, 2(5), 317. https://doi.org/10.1002/HCS2.64
ZhuX.HuZ.NieY.ZhuT.KamingaA. C.YuY.XuH. (2020). The prevalence of poor sleep quality and associated risk factors among Chinese elderly adults in nursing homes: A cross-sectional study. PLOS ONE, 15(5), e0232834. https://doi.org/10.1371/JOURNAL.PONE.0232834
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
