Longitudinal relationships between persistent moderate-to-severe pain and poor multidimensional sleep health with frailty among community-dwelling older adults

• Acute and persistent moderate-to-severe pain increased the risk of future frailty. • Poor multidimensional sleep health increased the risk of future frailty. • Poor sleep health and persistent moderate-to-severe pain together affect the risks of frailty. Evidence supports that persistent pain, poor multidimensional sleep health, and frailty might be related among community-dwelling older adults. However, the associations of persistent pain and poor multidimensional sleep health with frailty are not yet fully understood, and it remains unclear whether better sleep could alleviate the impact of persistent pain on frailty. We investigated whether baseline persistent moderate-to-severe pain and poor multidimensional sleep health predicted frailty at 4-year follow-up among community-dwelling older adults and whether the relationship between persistent moderate-to-severe pain and frailty differed by multidimensional sleep health status. Data were from the Taiwan Longitudinal Study on Aging (N=2,490; 2011-2015). A frailty index based on the deficit accumulation model was built. Pain included four categories (no pain [reference], some pain, acute moderate-to-severe pain, and persistent moderate-to-severe pain). Multidimensional sleep health was assessed using the SATED model. Covariates included sociodemographic characteristics, health status, and health behaviors. The results showed that acute and persistent moderate-to-severe pain and poor multidimensional sleep health increased the risks of frailty at 4-year follow-up. A significant interaction effect was observed between persistent moderate-to-severe pain and poor multidimensional sleep health. Specifically, frailty risks exhibited a dose-response relationship with poor sleep health. Compared to no pain, poor multidimensional sleep health elevated already heightened risks of frailty by persistent moderate-to-severe pain. Our findings revealed that acute and persistent moderate-to-sever pain and poor multidimensional sleep health were important factors for future frailty. Improving multidimensional sleep health among community-dwelling older adults with persistent moderate-to-sever pain may help mitigate the risks of frailty.