Purpose This study aimed to explore the role of sleep quality as a mediator in the activities of daily living (ADLs) and depression. Patients and Methods Participants (N=645; age≥60) were included in six nursing homes in Weifang, Shandong Province, using convenience sampling. Participants completed questionnaires to assess sleep quality, ADLs, and depression. Depression condition was assessed by the Patient Health Questionnaire (PHQ-9), ADLs was assessed by the Barthel Index (BI), and sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Mediation analysis was carried out by SPSS PROCESS. Results ADLs ( r =0.449, P <0.01) and sleep quality ( r =0.450, P <0.01) were found to be positively associated with depression among the elderly. Sleep quality plays a significant mediating role in the influence of ADLs on depression in the elderly in nursing homes (Bootstrap 95% CI [0.076, 0.139]), The pathway from ADLs to sleep quality to depression yielded a medium effect size of 20.23%. Conclusion ADLs help to explain how sleep quality partly mediates depression among the elderly in nursing homes. It is therefore recommended that timely detection and efficient interventions should focus on promoting physical function and improving sleep quality among the elderly in nursing homes.

The coronavirus disease 2019 (COVID-19) pandemic has placed a heavy burden on global healthcare. Depressive symptoms and physical function impairment are 2 common health problems among the elderly, but the association between depressive symptoms and physical function in nursing homes have not been extensively investigated during the COVID-19 pandemic. The purpose of this study was to investigate the current status of depressive symptoms and physical function and analyze the prevalence and related factors of depression among elderly people in nursing homes during the COVID-19 pandemic in China. A cross-sectional study was conducted. 381 elderly people were included in 4 nursing homes who were 60 to 100 years old with more than 3 months’ residential in Weifang City, Shandong Province using convenience cluster sampling. The Patient Health Questionnaire (PHQ-9) was performed to evaluate geriatric depression, the Barthel Index (BI) was administered to assess the activities of daily living, and a self-designed demographic data questionnaire was used to collect the demographic data. Multiple logistic regression analysis was conducted. 103 (27.0%) old residents reported depression according to PHQ-9. 279 (73.2%) old residents reported impaired self-care ability according to BI. The mean score of PHQ-9 and BI in the elderly was 3.56 ± 3.76 and 5.76 ± 7.05. The total PHQ-9 score of the elderly in nursing homes was positively correlated with the total activities of daily living score (R = 0.503, P < .01). Regression analysis showed that gender, self-care ability, more chronic diseases and medicines, especially Alzheimer’s disease and cataract were risk factors for depression among elderly people in nursing homes (P < .05). Our study showed 27.0% depression rate among old residents in nursing homes in China in the context of the COVID-19 pandemic. Depression is relatively prevalent among the elderly in China, and we should pay attention to those with poor self-care ability and more chronic diseases and medicines.