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

Autor: Alon Y. Avidan, Glenn T. Wright, Ronald D. Chervin, Mary L. James, Brant E. Fries, Kristina L. Szafara
Rok vydání: 2005
Předmět:
Zdroj: Journal of the American Geriatrics Society. 53:955-962
ISSN: 1532-5415
0002-8614
DOI: 10.1111/j.1532-5415.2005.53304.x
Popis: OBJECTIVES: To examine the relationship between in-somnia,hypnoticuse,falls,andhipfracturesinolderpeople.DESIGN: Secondary analysis of a large, longitudinal, as-sessment database.SETTING: Four hundred thirty-seven nursing homes inMichigan.PARTICIPANTS: Residents aged 65 and older in 2001withabaselineMinimumDataSetassessmentandafollow-up 150 to 210 days later.MEASUREMENTS: Logistic regression modeled any fol-low-up report of fall or hip fracture. Predictors were base-line reports of insomnia (previous month) and use ofhypnotics (previous week). Potential confounds taken intoaccount included standard measures of functional status,cognitive status, intensity of resource utilization, proximitytodeath,illnessburden,numberofmedications,emergencyroom visits, nursing home new admission, age, and sex.RESULTS: In 34,163 nursing home residents (76% wom-en, mean age standard deviation 84 8), hypnotic usedid not predict falls (adjusted odds ratio (AOR)51.13,95% confidence interval (CI)50.98, 1.30). In contrast, in-somnia did predict future falls (AOR51.52, 95%CI51.38, 1.66). Untreated insomnia (AOR51.55, 95%CI51.41, 1.71) and hypnotic-treated (unresponsive) in-somnia (AOR51.32, 95% CI51.02, 1.70) predictedmore falls than did the absence of insomnia. After adjust-mentforconfoundingvariables,insomniaandhypnoticusewere not associated with subsequent hip fracture.CONCLUSION: Inelderlynursinghomeresidents,insom-nia, but not hypnotic use, is associated with a greater riskof subsequent falls. Future studies will need to confirmthese findings and determine whether appropriate hypnoticuse can protect against future falls. J Am Geriatr Soc53:955–962, 2005.Key words: insomnia; accidental falls; hip fractures;aged; nursing homes; Minimum Data Set; interRAI
Databáze: OpenAIRE
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