Background: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people.

Objectives: To determine the extent to which a range of physiological, psychological and health-related factors predict night-time sleep quality of older people living in self-care and assisted-care, and whether poor sleep quality is a risk factor for falls.

Methods: 572 people, 81 men and 491 women (mean age 79.7 years, SD 6.4), recruited from self-care retirement villages and assisted-care hostels participated in the cross-sectional study with a subgroup of 169 followed up for falls for 1 year. The main outcome measures were sleep quality and prospective falls.

Results: Approximately half of the sample rated their sleep quality as poor or fair. Many measures of health, medication use and mood were significantly associated with ratings of poor night-time sleep quality. Multiple regression analyses revealed poor circulation, use of psychotropic and diuretic medications, negative affect, pain, not having a friend in the village, lower fitness levels and daytime napping were significant and independent predictors of night-time sleep quality in both residential care groups. Napping daily was reported by 28% of the self-care group and 37% of the assisted-care group. Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures.

Conclusions: Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.