Poor sleep quality in older adults in primary care in Türkiye: the role of polypharmacy, comorbidities, and sleep-perception discordance

Poor sleep quality is a common but frequently overlooked health problem among older adults and is associated with impaired quality of life, increased morbidity, and higher healthcare utilization. In primary care, multimorbidity and polypharmacy may be closely linked to sleep disturbances, yet their combined association remains insufficiently characterized. This study aimed to evaluate sleep quality among adults aged 65 and over and to examine its associations with chronic diseases and medication use in a primary care setting. This cross-sectional study included 388 adults aged 65 years and older registered with a primary care family medicine unit in Türkiye. Data were collected through face-to-face interviews using an 11-item socio-demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI). Information on chronic diseases and medication use was verified using national electronic health records. Statistical analyses included Mann-Whitney U, Kruskal-Wallis H, post hoc Bonferroni tests, and Firth penalized logistic regression. The mean age of participants was 71.6 ± 5.0 years, and 73.5% ( n = 285) were classified as having poor sleep quality (PSQI ≥ 5). Women had significantly higher PSQI scores than men. Poor sleep quality was significantly associated with hypertension, cardiovascular disease, respiratory disease, thyroid disease, psychiatric disorders, and gastrointestinal disorders (all p < .05). Participants using five or more medications had significantly higher PSQI scores than those using fewer medications ( p < .001). Multivariable analysis identified psychiatric disorders (OR 4.54, 95% CI 1.05–19.64), gastrointestinal disorders (OR 3.76, 95% CI 1.82–7.79), and polypharmacy (OR 2.48, 95% CI 1.45–4.23) as independently associated with poor sleep quality. Among participants with poor sleep quality, 17.2% ( n = 49) rated their sleep as good or very good, indicating a discrepancy between subjective sleep perception and validated sleep assessment. Poor sleep quality was present in nearly three-quarters of older adults in this primary care population and is independently associated with psychiatric disorders, gastrointestinal disorders, and polypharmacy. The substantial discrepancy between global subjective sleep perception and PSQI-defined sleep quality indicates an important sleep-perception discordance among older adults. Integrating structured sleep assessment and medication review into geriatric primary care may improve the identification and management of sleep-related problems in older adults.