Mental health in the peri-hospital period of older patients: the roles of physical symptoms burden and sleep quality

Background: Anxiety and depressive mood are common among older adults at the peri-hospital period, impacting independence and well-being. Hospital factors such as physical symptoms burden (PSB) and sleep quality (SQ), may impact mood trajectories. This study aims to explore changes in anxiety and depressive mood from admission to discharge and one-month post-discharge, assessing the role of SQ, PSB and sedative-hypnotic medications (SHM) burden across timepoints. Methods: This is a prospective study of older patients (65+) hospitalized in acute medical units. Interviews were conducted at admission, discharge and one-month post-discharge. A two-stage modelling approach was applied, separating in-hospital and peri-hospital trajectories of anxiety and depressive mood. Mixed-models analyses examined contributions of SQ and PSB, controlling for SHM burden, demographic and baseline characteristics. Results: Of 683 (male: 54.9%; age 77.31 ± 6.67), 643 completed discharge interviews and 545 completed one-month post-discharge interviews. Anxiety and depressive mood worsened over time. Poor SQ, greater PSB (B_anx = .39, P < .001; B_dep = .25, P = < .001), and higher SHM burden (B_anx = .55, P < .01) significantly predicted worse mental outcomes throughout hospitalization and post-discharge. SQ effects varied by timepoints: poor SQ was associated with heightened anxiety post-discharge (F_(2,878) = 7.52, P < .001) and worsened depressive mood during hospitalization (F_(2,874) = 7.99, P < .001). Higher SHM burden correlated with depressive mood at discharge (F_(2,874) = 4.80, P < .01). Conclusion: Findings highlight the need to address anxiety and depressive mood in hospitalized older adults through improved sleep, symptoms relief, and cautious SHM use. Further research should explore long-term interventions to support mental health during and after hospitalization.