title: Insomnia in long-term care facilities: a comparison of seven European countries and Israel: the Services and Health for Elderly in Long TERm care study.
abstract: OBJECTIVE
  To assess insomnia and its correlates as part of the Services and Health for Elderly in Long TERm care (SHELTER) study, funded by the 7th Framework Programme of the European Union.
  
  
  METHODS
  Cross-cultural investigation.
  
  
  METHODS
  Long-term care facilities (LTCFs) in eight European countries (Czech Republic, France, Finland, Germany, England, the Netherlands, Italy) and one non-European country (Israel).
  
  
  METHODS
  Elderly residents (N = 4,156) of 57 LTCFs.
  
  
  METHODS
  Information on insomnia, age, sex, activities of daily living (ADLs), cognitive status, depression, major stressful life events, physical activity, fatigue, pain, and sleep medication use was extracted from the International Resident Assessment Instrument (interRAI)LTCF instrument. Rates of insomnia and its correlates were analyzed. Multivariate logistic regression was used to assess factors associated with insomnia, controlling for demographic variables.
  
  
  RESULTS
  The prevalence of insomnia was 24% (range 13-30%), with significant differences between countries (P < .001). More insomnia complaints were reported in older than younger residents (P < .001). Higher rates of insomnia were associated with hypnosedatives and depression in all countries (P < .001) and with stressful life events, fatigue, and pain in most countries (P < .001). No associations were found between insomnia and ADLs, physical activity, or cognitive status. Age, depression, stressful life events, fatigue, pain and hypnosedatives were independent significant predictors of insomnia, controlling for all other variables and for country.
  
  
  CONCLUSIONS
  Hypnosedatives and depression were strong predictors of insomnia beyond cultural differences. Overall, psychosocial variables were more strongly related to insomnia than functional and mental capacities.
authors.affiliation: Center for Standards in Health and Disability, University of Haifa, Mt. Carmel, Haifa, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gindin
authors.forename: Tamar
authors.initials: T
authors.lastname: Shochat
authors.forename: Angela
authors.initials: A
authors.lastname: Chetrit
authors.forename: Shulamit
authors.initials: S
authors.lastname: Epstein
authors.forename: Yehoshua
authors.initials: Y
authors.lastname: Ben Israel
authors.forename: Sarah
authors.initials: S
authors.lastname: Levi
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Ian
authors.initials: I
authors.lastname: Carpenter
authors.forename: Harriet
authors.initials: H
authors.lastname: Finne-Soveri
authors.forename: Hein
authors.initials: H
authors.lastname: van Hout
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Henrard
authors.forename: Thorsten
authors.initials: T
authors.lastname: Nikolaus
authors.forename: Eva
authors.initials: E
authors.lastname: Topinkova
authors.forename: Daniela
authors.initials: D
authors.lastname: Fialová
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D009730:Nursing Assessment / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000209:etiology
keywords: Insomnia; InterRAI; elderly; hypnosedatives; long-term care facility