title: The Effect of Sleep Medication Use and Poor Sleep Quality on Risk of Falls in Community-Dwelling Older Adults in the US: A Prospective Cohort Study.
abstract: BACKGROUND
  Sleep complaints and the consumption of medications for sleep are common in older adults. Falls are also a significant concern for older adults and sedative use has been identified as a risk factor for falls. Sleep quality is a potential confounder in studies evaluating the relationship between sleep medication use and falls. However, very few studies have assessed the combined impact of sleep medication use and sleep quality on the risk of falls.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the association between sleep medication use, poor sleep quality, and falls in community-dwelling older adults.
  
  
  METHODS
  This was a multicenter, 6-month prospective cohort study conducted in senior housings settings in central Virginia, USA. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and a medication review was conducted. Data regarding falls were collected over 6 months by use of a diary. Logistic regression modeling was used to examine the effects of poor sleep quality, sleep medication use, and both, on the risk of falls.
  
  
  RESULTS
  Among 113 independently living older adults (mean age ± standard deviation 81.1 ± 8.6), 46.9 % fell at least once during a 6-month period; 62.8 % (n = 71) had poor sleep quality, and 44.2 % (n = 50) used medications or treatments to aid sleep. Compared with participants reporting good sleep quality and no sleep medication use, those who reported poor sleep quality and sleep medication use had an increased risk of falls after adjusting for covariates (odds ratio 3.23, 95 % confidence interval 1.05-9.91). The group with good sleep quality and sleep medication use, as well as the group with poor sleep quality and no sleep medication use had no significantly greater risk for falls compared with the group with good sleep quality and no sleep medication use.
  
  
  CONCLUSIONS
  A combined effect of sleep quality and sleep medication use on the risk of falls suggests that medication effectiveness may be an important factor to consider in understanding the risk of falls associated with sedative medications.
authors.affiliation: Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA. miny@vcu.edu.
authors.forename: Yaena
authors.initials: Y
authors.lastname: Min
authors.affiliation: Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Kirkwood
authors.affiliation: Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, 1015 Floyd Avenue, PO Box 843083, Richmond, VA, 23284-3083, USA.
authors.forename: Darcy P
authors.initials: DP
authors.lastname: Mays
authors.affiliation: Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA. pwslattu@vcu.edu.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Slattum
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D057187:Independent Living / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives
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