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Cited by 343Balance, Gait, and Falls PreventionSleep and related disordersPharmaceutical Practices and Patient Outcomes

Insomnia and Hypnotic Use, Recorded in the Minimum Data Set, as Predictors of Falls and Hip Fractures in Michigan Nursing Homes

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Avidan, Alon Y., Fries, Brant E., James, Mary L., Szafara, Kristina L., Wright, Glenn T., Chervin, Ronald D.·2005·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2005.53304.x
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Abstract

Objectives: To examine the relationship between insomnia, hypnotic use, falls, and hip fractures in older people. Design: Secondary analysis of a large, longitudinal, assessment database. Setting: Four hundred thirty‐seven nursing homes in Michigan. Participants: Residents aged 65 and older in 2001 with a baseline Minimum Data Set assessment and a follow‐up 150 to 210 days later. Measurements: Logistic regression modeled any follow‐up report of fall or hip fracture. Predictors were baseline reports of insomnia (previous month) and use of hypnotics (previous week). Potential confounds taken into account included standard measures of functional status, cognitive status, intensity of resource utilization, proximity to death, illness burden, number of medications, emergency room visits, nursing home new admission, age, and sex. Results: In 34,163 nursing home residents (76% women, mean age±standard deviation 84±8), hypnotic use did not predict falls (adjusted odds ratio (AOR)=1.13, 95% confidence interval (CI)=0.98, 1.30). In contrast, insomnia did predict future falls (AOR=1.52, 95% CI=1.38, 1.66). Untreated insomnia (AOR=1.55, 95% CI=1.41, 1.71) and hypnotic‐treated (unresponsive) insomnia (AOR=1.32, 95% CI=1.02, 1.70) predicted more falls than did the absence of insomnia. After adjustment for confounding variables, insomnia and hypnotic use were not associated with subsequent hip fracture. Conclusion: In elderly nursing home residents, insomnia, but not hypnotic use, is associated with a greater risk of subsequent falls. Future studies will need to confirm these findings and determine whether appropriate hypnotic use can protect against future falls.

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  • Lower doses of all agents (with the exception of ramelteon) may be required in older adults.

    “However, lower doses of all agents (with the exception of ramelteon) may be required in older adults, and the potential for side-effects and drug-drug interactions should be carefully considered. 60-62”

    From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [62]

    The Explanatory Variables and Potential Confounders section lists hypnotics used in the study, and the Discussion compares some drugs’ potential cognitive effects. Neither section gives dosing recommendations for older adults or mentions a ramelteon exception. Searches for ramelteon, lower doses, and drug interactions found no passage addressing the claim. (LLM, conf=0.75)

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Research works printed but not linked: 36

  1. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in com- munity-living older adults: A 1-year prospective study. Arch Phys Med Rehab 2001;82:1050-1056.
  2. Murphy SL. Deaths: Final data for 1998. Natl Vital Stat Rep 2000;48:1-105.
  3. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 1992;82:1020- 1023.
  4. Koski K, Luukinen H, Laippala P et al. Physiological factors and medications as predictors of injurious falls by elderly people: A prospective population- based study. Age Ageing 1996;25:29-38.
  5. Mustard CA, Mayer T. Case-control study of exposure to medication and the risk of injurious falls requiring hospitalization among nursing home residents. Am J Epidemiol 1997;145:738-745.
  6. Neutel CI, Perry S, Maxwell C. Medication use and risk of falls. Pharmacoepidemiol Drug Safety 2002;11:97-104.
  7. Stenbacka M, Jansson B, Leifman A et al. Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: A longitudinal general population study. Al- cohol 2002;28:9-16.
  8. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly per- sons living in the community. N Engl J Med 1988;319:1701-1707.
  9. Ray WA. Psychotropic drugs and injuries among the elderly: A review. J Clin Psychopharmacol 1992;12:386-396.
  10. Ford GA, Hoffman BB, Blaschke TF. Effect of temazepam on blood pressure regulation in healthy elderly subjects. Br J Clin Pharmacol 1990;29:61-67.
  11. O'Loughlin JL, Robitaille Y, Boivin JF et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 1993;137:342-354.
  12. Pierfitte C, Macouillard G, Thicoipe M et al. Benzodiazepines and hip frac- tures in elderly people. A case-control study. BMJ 2001;322:704-708.
  13. Trewin VF, Lawrence CJ, Veitch GB. An investigation of the association of benzodiazepines and other hypnotics with the incidence of falls in the elderly. J Clin Pharmacy Therap 1992;17:129-133.
  14. Kryger M, Monjan A, Bliwise D et al. Sleep, health, and aging: Bridging the gap between science and clinical practice. Geriatrics 2004;59:24-26.
  15. Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64 to 99 years. J Am Geriatr Soc 2000;48:1234-1240.
  16. Morris J, Nonemaker S, Murphy K et al. A commitment to change. Revision of HCFA's RAI. J Am Geriatr Soc 1997;45:1011-1016.
  17. Hawes C, Morris J, Phillips CD et al. Reliability estimates for the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). Gerontologist 1995;35:172-178.
  18. Morris JN, Hawes C, Fries BE et al. Designing the national resident assessment instrument for nursing homes. Gerontologist 1990;30:293-307.
  19. Sgadari A, Morris J, Fries BE et al. Efforts to establish the reliability of the Resident Assessment Instrument. Age Ageing 1997;27:30.
  20. Hawes C, Morris JN, Phillips CD et al. Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist 1995;35:172-178.
  21. Mor V, Angelelli J, Jones R et al. Inter-rater reliability of nursing home quality indicators in the US. BMC Health Serv Res 2003;3:20.
  22. Morris J, Fries BE, Mehr DR et al. MDS Cognitive Performance Scale. J Ger- ontol 1994;49:M174-M182.
  23. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
  24. Albert M, Cohen C. The Test for Severe Impairment. An instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc 1992;40:449-453.
  25. Fries BE, Hawes C, Morris J et al. Effect of the national Resident Assessment Instrument on selected health conditions and problems. J Am Geriatr Soc 1997;45:994-1001.
  26. Hawes C, Morris J, Phillips CD et al. Development of the nursing home Res- ident Assessment Instrument in the USA. Age Ageing 1997;26:19-25.
  27. Mor V, Intrator O, Fries BE et al. Changes in hospitalization associated with introducing the Resident Assessment Instrument. J Am Geriatr Soc 1997;45:1002-1010.
  28. Phillips CD, Morris J, Hawes C et al. Association of the Resident Assessment Instrument (RAI) with changes in function, cognition, and psychosocial status. J Am Geriatr Soc 1997;45:986-993.
  29. Hawes C, Phillips CD, Mor V et al. MDS data should be used for research. Gerontologist 1992;2:563-564.
  30. Fries BE, Schneider DP, Foley WJ et al. Refining a case-mix measure for nursing homes: Resource utilization groups (RUG-III). Med Care 1994;32:668-685.
  31. Ancoli-Israel S. Insomnia in the elderly. A review for the primary care prac- titioner. Sleep 2000;23(Suppl 1):S23-S30.
  32. Jewett ME, Dijk DJ, Kronauer RE et al. Dose-response relationship between sleep duration and human psychomotor vigilance and subjective alertness. Sleep 1999;22:171-179.
  33. Belenky G, Wesensten NJ, Thorne DR et al. Patterns of performance degra- dation and restoration during sleep restriction and subsequent recovery: A sleep dose-response study. J Sleep Res 2003;12:1-12.
  34. Chau N, Gauchard GC, Siegfried C et al. Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers. Int Arch Occup Environ Health 2003;77:60-66.
  35. Goldberg R, Shah SJ, Halstead J et al. Sleep problems in emergency depart- ment patients with injuries. Acad Emerg Med 1999;6:1134-1140.
  36. Powell NB, Riley RW, Schechtman KB et al. A comparative model: Reaction time performance in sleep-disordered breathing versus alcohol-impaired con- trols. Laryngoscope 1999;109:1648-1654.

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Authors
Avidan, A. Y., Fries, B. E., James, M. L., Szafara, K. L., Wright, G. T., & Chervin, R. D.
Affiliations
University of Michigan (US)
Corresponding author
Avidan, Alon Y.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2005-05-31
Volume
53
Issue
6
Pages
955-962
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2005.53304.x
OpenAlex
W1518386324
Cited by
343
References
1
Citations by year
2026: 6 · 2025: 3 · 2024: 9 · 2023: 7 · 2022: 12 · 2021: 9 · 2020: 14 · 2019: 16 · 2018: 16 · 2017: 20 · 2016: 15 · 2015: 10 · 2014: 11 · 2013: 34 · 2012: 20
FWCI
63.98
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • U.S. Public Health Service (P60 A608808-10)
  • National Institute on Aging (T32 AG-00114, T32AG000114)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
insomnia, hypnotic use, falls, hip fracture, nursing home residents, older adults, fall risk, sleep disorders, Minimum Data Set
MeSH terms
Accidental Falls, Aged, Aged, 80 and over, Cognition Disorders, Cross-Sectional Studies, Dose-Response Relationship, Drug, Drug Utilization, Female, Follow-Up Studies, Hip Fractures, Homes for the Aged, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Michigan, Nursing Homes, Risk Factors, Vision Disorders, Comorbidity, Causality, Risk Assessment

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