Objective This study aims to systematically evaluate the effects of music-based interventions on sleep quality in older adults and to further explore its impact on depression, anxiety, and cognitive function. Methods A comprehensive literature search was conducted in CNKI, Wanfang Data, VIP Database, China Biology Medicine disc (CBM), PubMed, Web of Science, the Cochrane Library, and Embase from database inception to November 2025. Randomized controlled trials (RCTs) investigating music therapy in older adults were included. Meta-analysis was performed using RevMan 5.4 and Stata 18.0 software. The primary outcome was sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI), while secondary outcomes included the Geriatric Depression Scale (GDS), Self-Rating Anxiety Scale (SAS), and Mini-Mental State Examination (MMSE). Fixed- or random-effects models were applied according to heterogeneity, and subgroup analyses were conducted. Results A total of 14 studies published in Chinese and English were finally included, involving 1,730 participants, with 863 in the intervention groups and 867 in the control groups. Meta-analysis showed that music-based interventions significantly improved sleep quality in older adults (PSQI: MD = −3.37, 95% CI: −4.24 to −2.50, P 0.00001). Compared with control groups, music-based interventions significantly reduced depressive (GDS: MD = −3.94, 95% CI: −4.90 to −2.97, P 0.00001) and anxiety symptoms (SAS: MD = −9.28, 95% CI: −18.21 to −0.35, P = 0.04), and improved cognitive function (MMSE: MD = 2.86, 95% CI: 1.40 to 4.13, P = 0.0001). The subgroup analyses indicated that interventions lasting 4–8 weeks, with session durations of 30–45 min and a frequency of seven sessions per week, were associated with greater improvements in sleep quality. Conclusions Music-based interventions significantly improve sleep quality in older adults and has beneficial effects on depressive and anxiety symptoms as well as cognitive function. As a safe, non-invasive, and non-pharmacological intervention, music interventions may serve as an effective adjunct in the management of sleep and mental health in older adults. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251270027.
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