title: Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample.
abstract: BACKGROUND
  Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults.
  
  
  METHODS
  This study assessed 367 women aged 60-93 years (median 72, interquartile range 65-79) and 451 men aged 60-92 years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of  ≥ 10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models.
  
  
  RESULTS
  Among women, 50 (13.6%) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR = 2.54, 95% CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p < .001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR = 2.63, 95% CI 1.31-5.30). Among men, 72 (16.0%) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p = 0.06), however, age explained this relationship (age adjusted OR = 2.20, 95% CI 1.03-1.10).
  
  
  CONCLUSIONS
  For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls.
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. achayley@deakin.edu.au.|Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia. achayley@deakin.edu.au.
authors.forename: Amie C
authors.initials: AC
authors.lastname: Hayley
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. lanaw@barwonhealth.org.au.
authors.forename: Lana J
authors.initials: LJ
authors.lastname: Williams
authors.affiliation: School of Psychology, Counselling & Psychotherapy, Cairnmillar Institute, 993 Burke Road, Camberwell, Australia. gerard.kennedy@cairnmillar.org.au.|Institute for Breathing and Sleep, Bowen Centre, Austin Health, PO Box 5555, Heidelberg, Melbourne, Australia. gerard.kennedy@cairnmillar.org.au.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Kennedy
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. khollo@barwonhealth.org.au.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Holloway
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. mikeb@barwonhealth.org.au.|Department of Psychiatry, The University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, Australia. mikeb@barwonhealth.org.au.|Orygen, the National Centre of Excellence for Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia. mikeb@barwonhealth.org.au.|Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, Melbourne, Australia. mikeb@barwonhealth.org.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. sharob@barwonhealth.org.au.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia. sharob@barwonhealth.org.au.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Brennan-Olsen
authors.affiliation: IMPACT SRC, School of Medicine, Deakin University, Barwon Health, PO Box 281, Geelong, Australia. juliep@barwonhealth.org.au.|NorthWest Academic Centre, Department of Medicine, The University of Melbourne, CHRE Building, Level 3 East, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Australia. juliep@barwonhealth.org.au.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry / Q000379:methods; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000379:methods; D012307:Risk Factors; D057566:Self Report; D013223:Statistics as Topic