Linking race and well-being within a biopsychosocial framework: variation in subjective sleep quality in two racially diverse older adult samples

Differential life experiences associated with race may critically affect the balance between physical and psychological well-being. This study investigated an age-related and disease-related symptom, restless sleep, among older African American and white members of two sociodemographically matched cohorts, community-dwelling older adults and older adults with chronic renal failure undergoing maintenance dialysis therapy. Sleep behaviors reflect age-dependent and disease-dependent homeostatic and circadian state regulation but are also socioculturally patterned. As hypothesized, restless sleep was significantly more characteristic of the older adults in the chronic disease cohort. With non-renal health conditions, depressed mood, perceived health, medication use, and sociodemographic variables controlled, however, African Americans were significantly less likely than whites in the chronic disease cohort to report restless sleep. African American and white patients differed in their expression of public and private religiousness, which in turn were associated, respectively, with depressed mood and restless sleep complaint. In addition, we suggest that differences for African American and white patients in the environmental exposure of chronic dialysis therapy, including African Americans' greater social integration within the dialysis treatment setting, contributed to their being less at risk than their white peers for subjective perception of sleep decay, a marker of overall well-being.