International Psychogeriatrics · Jun 1, 2026

Physical health and sleep quality as mediators of the stress-cognitive function pathway in community-dwelling older adults

By Simi TA, Jagasia K, Phillips JP et al.

BACKGROUND: Stress is a risk factor for impaired cognitive function, but the mechanisms linking stress and cognitive function in older adults remain unclear. This study examined whether physical health and sleep quality mediate the relationship between stress and cognitive function in community-dwelling older adults. METHODS: Data were analyzed from 600 community-dwelling older adults aged 60 and above. Ordinary least squares regression models tested associations between stress, physical health, sleep quality, and cognitive function, while adjusting for age, gender, race, and education. Bootstrapped mediation analyses were conducted to estimate indirect effects of physical health and sleep quality on the stress-cognitive function relationship. RESULTS: Higher perceived stress was significantly associated with lower cognitive function in the adjusted model (B = -0.113, p = 0.013). Physical health showed a significant indirect effect (B indirect = -0.0443, 95% CI [-0.0775, -0.0147]), with higher stress associated with poorer physical health, which in turn predicted lower cognition. Sleep quality also showed a significant indirect effect in an inconsistent direction (B indirect = 0.0265, 95% CI [0.0029, 0.0542]), with opposing paths whereby higher stress was associated with more reported sleep problems, while greater sleep problems predicted improved cognition. CONCLUSIONS: Stress may affect cognition in older adults partly through sleep quality and physical health, suggesting modifiable pathways for promoting cognitive resilience and healthy aging.

doi.org/10.1016/j.inpsyc.2026.100225 Open access PubMed 42315452 Populations