title: Too little sleep and too much sleep among older adults: Associations with self-reported sleep medication use, sleep quality and healthcare utilization.
abstract: OBJECTIVE
  The present study examined relationships among older adults' sleep duration (1-5 h and ≥10 h vs 6-9 h), sleep medication use, sleep quality and healthcare use.
  
  
  METHODS
  The 2013 USA National Health Interview Survey provided data on a sample of 7196 community-dwelling individuals aged ≥65 years. Bivariate analyses and multivariate regression analyses were used to examine study questions.
  
  
  RESULTS
  Of the sample, 85% slept 6-9 h on average, 8% slept 1-5 h and 7% slept ≥10 h. One-sixth of optimal sleepers, one-quarter of short sleepers and one-fifth of long sleepers used sleep medications at least once in the preceding week. Medication intake of one to two times, as opposed to non-use, was associated with a greater risk of short than optimal sleep (RRR 1.60, 95% CI 1.03-2.48). Short sleep was positively, but long sleep was negatively associated with trouble falling asleep and staying asleep. Any medication use was positively associated with trouble falling asleep and staying asleep. Short sleep was associated with greater odds of emergency department visits (OR 1.36, 95% CI 1.06-1.77), whereas long sleep was associated with greater odds of an overnight hospital stay (OR 1.48, 95% CI 1.04-2.11) and home care use (OR 2.46, 95% CI 1.37-4.41). Medication intake one to two times was associated with greater odds of emergency department visits (OR 1.48, 95% CI 1.11-1.98).
  
  
  CONCLUSIONS
  Sleep medication use does not appear to promote sleep health. Both short and long sleep durations are associated with a higher likelihood of healthcare use. Clinicians need to examine older adults' sleep health and medication use, and their effects on healthcare use. Geriatr Gerontol Int 2017; 17: 545-553.
authors.affiliation: The University of Texas at Austin, Austin, Texas.
authors.forename: Namkee G
authors.initials: NG
authors.lastname: Choi
authors.affiliation: The University of Texas at Austin, Austin, Texas.
authors.forename: Diana M
authors.initials: DM
authors.lastname: DiNitto
authors.affiliation: The University of Texas at Austin, Austin, Texas.
authors.forename: C Nathan
authors.initials: CN
authors.lastname: Marti
authors.affiliation: Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
authors.forename: Bryan Y
authors.initials: BY
authors.lastname: Choi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D057566:Self Report; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States
keywords: emergency department visit; hospitalization; sleep duration; sleep health; sleep medication