The impact of sedative-hypnotic use on sleep symptoms in elderly nursing home residents.
OBJECTIVE
To determine the frequency of sleep-related complaints among institutionalized elderly subjects and to assess the relationship between perceived sleep quality and the use of sedative-hypnotic agents and other psychoactive medications.


METHODS
In 12 nursing homes in Massachusetts, we conducted observational, cross-sectional, and longitudinal studies of 145 institutionalized elderly subjects (average age, 83.0 years; age range, 65 to 105 years). We recorded the patients' demographic characteristics and all medication use (both scheduled and as needed) during a 1-month baseline period. A research assistant who was blinded to diagnoses and medication use performed detailed neuropsychologic testing and administered a series of standardized questions concerning difficulty sleeping, early morning awakening, and time spent awake in bed. Medication use and patient assessments were repeated after a 6-month interval.


RESULTS
One or more sleep-related complaints were present at baseline in 94 (65%) of the residents studied. Using logistic regression to adjust for potential confounding, we found no relationship in the baseline month between use of sedative-hypnotic agents and the presence or absence of sleep complaints. After 6 months of follow-up, 27 (19%) of the residents had decreased their use of sedative-hypnotic agents and 23 (16%) had increased their use. However, there was no relationship between decreased use of sedative-hypnotic agents and worsened sleep (p > 0.20) or between their increased use and improved sleep reports (p > 0.10). Improvement in functional status was significantly associated with improved sleep at follow-up (p < 0.005).


CONCLUSIONS
Sleep complaints occur in the majority of institutionalized elderly persons. Neither cross-sectional nor longitudinal analyses showed a relationship between patterns of sedative-hypnotic use and the presence, absence, or change in sleep complaints.
Monane
M
M
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Glynn
R J
RJ
Avorn
J
J
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D009735:Nursing Homes; D016017:Odds Ratio; D012893:Sleep Wake Disorders / Q000517:prevention & control*
D006993:Hypnotics and Sedatives