Changes and predictors of sleep quality with a 2-year follow-up in older adults according to living arrangements

•Sleep quality was improved among empty nesters living as a couple during follow-up.•Compared with nonempty nesters, empty nesters living alone had worse sleep quality.•The main predictors of sleep quality in nonempty nesters were physical factors.•Depression was a predictor of sleep quality in the empty-nester group and its subgroups. This study aimed to explore changes and predictors of sleep quality with a 2-year follow-up in Chinese elderly individuals and to further present them according to living arrangements. A total of 3005 individuals were effectively surveyed at baseline and at the 2-year follow-up. Generalized estimating equation (GEE) was performed to explore associations between sleep quality and predictor variables. The rate of poor sleep quality was 32.6% at baseline and 27.4% at follow-up. According to living arrangements, sleep quality improved among empty nesters living as a couple (P < 0.001). After adjusting for sex, age, and other influencing factors, empty nesters living alone had poorer sleep quality (OR = 1.399, 95% CI = 1.022-1.917) than nonempty nesters. Sex, age, education, self-reported health, depression, and social support were predictors of poor sleep quality for all participants. In the subgroup analyses, self-reported physical health and body mass index (BMI) were predictors of sleep quality in the nonempty-nester group, but depression was not a predictor. Depression was a predictor of sleep quality in the empty-nester group. Sleep quality was improved in this 2-year follow-up survey. However, sleep quality problems in the elderly cannot be ignored, especially empty nesters living alone. Therefore, according to living arrangements, different intervention methods should be selected to prevent and control poor sleep quality.