Skip to main content
SpringerLink
Log in

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

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Inouye SK, Brown CJ, Tinetti ME. Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med. 2009;360(23):2390–3.

    Article  CAS  PubMed  Google Scholar 

  2. Van Nieuwenhuizen RC, van Dijk N, van Breda FG, et al. Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL Triage Instrument. Am J Emerg Med. 2010;28(9):994–1001.

    Article  PubMed  Google Scholar 

  3. Fabre JM, Ellis R, Kosma M, et al. Falls risk factors and a compendium of falls risk screening instruments. J Geriatr Phys Ther. 2010;33(4):184–97.

    PubMed  Google Scholar 

  4. Woolcott JC, Richardson KJ, Wiens MO, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.

    Article  PubMed  Google Scholar 

  5. Bloch F, Thibaud M, Dugué B, et al. Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J Aging Health. 2011;23(2):329–46.

    Article  PubMed  Google Scholar 

  6. Ray WA. Psychotropic drugs and injuries among the elderly: a review. J Clin Psychopharmacol. 1992;12(6):386–96.

    CAS  PubMed  Google Scholar 

  7. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clin Orthop Relat Res. 1990;252:163–6.

    PubMed  Google Scholar 

  8. Ford GA, Hoffman BB, Blaschke TF. Effect of temazepam on blood pressure regulation in healthy elderly subjects. Br J Clin Pharmacol. 1990;29(1):61–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Allain H, Bentue-Ferrer D, Polard E, et al. Postural instability and consequent falls and hip fractures associated with use of hypnotics in the elderly: a comparative review. Drugs Aging. 2005;22(9):749–65.

    Article  PubMed  Google Scholar 

  10. Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep. 1995;18(6):425–32.

    CAS  PubMed  Google Scholar 

  11. Foley D, Ancoli-Israel S, Britz P, et al. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502.

    Article  PubMed  Google Scholar 

  12. Janssens JP, Pautex S, Hilleret H, et al. Sleep disordered breathing in the elderly. Aging (Milano). 2000;12(6):417–29.

    CAS  PubMed  Google Scholar 

  13. Grunstein R. Insomnia. Diagnosis and management. Aust Fam Physician. 2002;31(11):995–1000.

    PubMed  Google Scholar 

  14. Avidan AY, Fries BE, James ML, et al. Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in Michigan nursing homes. J Am Geriatr Soc. 2005;53(6):955–62.

    Article  PubMed  Google Scholar 

  15. Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc. 2000;48(10):1234–40.

    Article  CAS  PubMed  Google Scholar 

  16. Helbig AK, Döring A, Heier M, et al. Association between sleep disturbances and falls among the elderly: Results from the German Cooperative Health Research in the Region of Augsburg-Age Study. Sleep Med. 2013;14(12):1356–63.

    Article  PubMed  Google Scholar 

  17. Teo JS, Briffa NK, Devine A, et al. Do sleep problems or urinary incontinence predict falls in elderly women? Aust J Physiother. 2006;52(1):19–24.

    Article  PubMed  Google Scholar 

  18. Mesas AE, Lopez-Garcia E, Rodriguez-Artalejo F. Self-reported sleep duration and falls in older adults. J Sleep Res. 2011;20(1 Pt 1):21–7.

    Article  PubMed  Google Scholar 

  19. Kuo HK, Yang CCH, Yu YH, et al. Gender-specific association between self-reported sleep duration and falls in high-functioning older adults. J Gerontol A Biol Sci Med Sci. 2010;65A(2):190–6.

    Article  Google Scholar 

  20. Jonker C, Geerlings MI, Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry. 2000;15(11):983–91.

    Article  CAS  PubMed  Google Scholar 

  21. Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  PubMed  Google Scholar 

  22. Cole JC, Dubois D, Kosinski M. Use of patient-reported sleep measures in clinical trials of pain treatment: a literature review and synthesis of current sleep measures and a conceptual model of sleep disturbance in pain. Clin Ther. 2007;29(Suppl):2580–8.

    Article  PubMed  Google Scholar 

  23. Russell MA, Hill KD, Blackberry I, et al. The reliability and predictive accuracy of the falls risk for older people in the community assessment (FROP-Com) tool. Age Ageing. 2008;37(6):634–9.

    Article  PubMed  Google Scholar 

  24. World Health Organization. WHO global report on falls prevention in older age. Available at: www.who.int/ageing/publications/Falls_prevention7March.pdf. Accessed 14 Sept 2014.

  25. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31.

  26. Gooneratne NS, Tavaria A, Patel N, et al. Perceived effectiveness of diverse sleep treatments in older adults. J Am Geriatr Soc. 2011;59(2):297–303.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.

    Article  CAS  PubMed  Google Scholar 

  28. Tinetti M, Baker D, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge the participants in this study.

Authors’ contributions

Dr. Min was involved in the study design, IRB submission, subject recruitment, data collection, data analysis and interpretation, and manuscript writing; Dr. Kirkwood was involved in approving the study methodology, and manuscript review; Dr. Mays was involved in approving the study analysis plan and manuscript review; and Dr. Slattum was involved in approving the design and implementation of the study, IRB submission, data analysis plan, and manuscript preparation.

Author information

Authors and Affiliations

  1. Department of Pharmacotherapy and Outcomes Sciences, School of Pharmacy, Virginia Commonwealth University, 410 N 12th Street, PO Box 980533, Richmond, VA, 23298-0533, USA

    Yaena Min, Cynthia K. Kirkwood & Patricia W. Slattum

  2. Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, 1015 Floyd Avenue, PO Box 843083, Richmond, VA, 23284-3083, USA

    Darcy P. Mays

Authors
  1. Yaena Min
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia K. Kirkwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darcy P. Mays
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patricia W. Slattum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yaena Min.

Ethics declarations

Conflict of interest

Yaena Min, Cynthia K. Kirkwood, Darcy P. Mays, and Patricia W. Slattum declare that they have no conflicts of interest.

Funding

None.

Ethical approval and informed consent

This study was reviewed and approved by the Virginia Commonwealth University IRB. Written informed consent was obtained from all study participants prior to enrollment in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Min, Y., Kirkwood, C.K., Mays, D.P. et al. 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. Drugs Aging 33, 151–158 (2016). https://doi.org/10.1007/s40266-015-0339-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-015-0339-9

Keywords

Search

Navigation