For older adults, falling may be linked to taking physician-recommended sleep medications, according to a new study published in the October issue of Sleep. Using data from the Health and Retirement Study for the years 2006 - 2014, a team of researchers found that older adults using physician-recommended sleep medications exhibited a consistently higher fall risk in the future than those not taking sleep medications.
The report, “A Greater Extent of Insomnia Symptoms and Physician-Recommended Sleep Medication Use Predict Fall Risk in Community-Dwelling Older Adults,” analyzed the independent and interactive effects of the extent of insomnia symptoms and sleep medications on fall risk over two-year periods among older adults living in a community setting.
The researchers used a sample of 6,882 observations from 4,669 participants, of whom the average age was 74.5 years.
The researchers also found that experiencing a greater number of insomnia symptoms predicted a higher risk of falling. For participants with no symptoms, the probability of a fall was 28 percent, and for those reporting four symptoms, it was 40 percent. These symptoms included trouble falling asleep, waking up during the night, waking up too early, and not feeling rested.
What was most surprising about the study, according to the authors, was the adverse effects the medications had on older adults. “We thought that physician-prescribed medications could help older adults sleep through the night, so their risk of falling would reduce,” says Tuo-Yu Chen, PhD, visiting assistant professor, Duke-NUS Graduate Medical School and an international faculty affiliate at Pennsylvania State Center for Healthy Aging. “But, it didn’t. Physician-prescribed medications actually imposed additional risk of falling above and beyond the existing insomnia symptoms.”
Medication errors may also play a role, says Chen. “Medication errors can sometimes occur because most older adults take multiple medications concurrently, and they may have frequent transitions between different settings, such as nursing centers and assisted living communities. Physicians should treat insomnia and effectively manage sleep medications to avoid falls.”
Over 30 percent of adults age 65 and over in a community setting fall every year, according to the study. In the U.S., about $23.3 billion is spent on falls among older adults every year.
When treating older adults for insomnia, says Chen, care providers should use cognitive behavioral therapy for insomnia (CBT-I) first, which helps patients change their thoughts and behaviors with ultimate goals to sleep well again. “This is effective for older adults and has fewer side effects for falls,” he says. “Its effect also lasts longer than medications and other treatments.”
“If CBT-I is not successful, short-term use of sleep medications can be recommended,” says Chen. Providers should discuss with the patients regarding the benefits and risks of the sleep medications before prescribing, he says.
Source: Provider magazine
Available at: http://www.providermagazine.com/news/Pages/2017/1017/Falls-More-Likely-Among-Seniors-Taking-Sleep-Medications-Study.aspx