title: Insomnia and health services utilization in middle-aged and older adults: results from the Health and Retirement Study.
abstract: BACKGROUND
  Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.
  
  
  METHODS
  We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or ≥ 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.
  
  
  RESULTS
  Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.15-1.43, p < .001), use of home health care services (AOR = 1.29, 95% CI = 1.09-1.52, p = .004), and any health service use (AOR = 1.28, 95% CI = 1.15-1.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95% CI = 1.50-1.96, p < .001), use of home health care services (AOR = 1.64, 95% CI = 1.32-2.04, p < .001), nursing home use (AOR = 1.45, 95% CI = 1.10-1.90, p = .009), and any health service use (AOR = 1.72, 95% CI = 1.51-1.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.
  
  
  CONCLUSIONS
  In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, Room 794, 624 North Broadway, Baltimore, MD 21205. aspira@jhsph.edu.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Kaufmann
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Canham
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
authors.forename: Amber M
authors.initials: AM
authors.lastname: Gum
authors.forename: Natalie D
authors.initials: ND
authors.lastname: Dautovich
authors.forename: Robert
authors.initials: R
authors.lastname: Kohn
authors.forename: Adam P
authors.initials: AP
authors.lastname: Spira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D017046:Cost Savings; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data; D006306:Health Surveys; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D016017:Odds Ratio; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Health services; Public health.; Sleep