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Observed daytime sleepiness in in-hospital geriatric patients and risk of falls

Beobachtete Tagesschläfrigkeit bei geriatrischen Patienten im Krankenhaus und Sturzrisiko

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Abstract

Background

Daytime sleepiness and falls are frequent in geriatric in-hospital patients; however, the relationship between both events is not clear. To test the hypothesis that observed daytime sleepiness is associated with falls in geriatric in-hospital patients data collected from medical records of patients who were admitted to an acute geriatric department were retrospectively analyzed.

Methods

The data from the medical records of patients who were admitted to the geriatric department of the Alfried-Krupp-Hospital in Essen, Germany in the period from January 2018 to March 2020 were retrospectively analyzed. Personal data, data concerning the geriatric assessment, observed daytime sleepiness, and falls were recorded.

Results

From a total of 1485 patients who were consecutively admitted to hospital, the data of 1317 (87%) patients could be included for further analysis. During the hospital stay 146 (11%) patients fell at least once, 35 (3%) patients had more than 1 fall and 64 falls (44%) occurred while patients were standing (bipedal fall). Daytime sleepiness was observed in 73% of the patients with bipedal falls and in 65% patients with nonbipedal falls (p < 0.01). Falls correlated significantly with the history of a recent fall, the length of hospital stay, the Barthel index (BI) on admission, the mini mental state examination (MMSE), dementia and observed daytime sleepiness. No correlation was found between falls and age, multimorbidity, and the number of drugs used. Drugs related to falls were medications to treat Parkinson’s disease, antidepressants and neuroleptics. In a multiple logistic regression analysis in-hospital falls were significantly and independently associated with a history of falls, length of in-hospital stay, dementia, and observed daytime sleepiness.

Conclusion

Observed daytime sleepiness is associated with in-hospital falls in geriatric patients. Prospective interventional studies are needed to confirm this relationship, and to quantify the impact of sleepiness on the risk of falling. Additionally, the impact of treatment for observed daytime sleepiness on the risk of falling should be assessed. The assessment of sleepiness should become a routine task in geriatrics.

Zusammenfassung

Hintergrund

Tagesschläfrigkeit und Stürze sind bei geriatrischen Krankenhauspatienten häufig, die Beziehung zwischen beiden Ergebnissen ist jedoch weniger klar. Um die Hypothese zu testen, dass beobachtete Tagesschläfrigkeit bei geriatrischen Krankenhauspatienten mit Sturzereignissen assoziiert ist, wurden Daten von in einer akutgeriatrischen Abteilung behandelten Patienten retrospektiv analysiert.

Methoden

Daten aus Akten von zwischen Januar 2018 und März 2020 in der Abteilung für Geriatrie des Alfried-Krupp-Krankenhauses in Essen, Deutschland, behandelten Patienten wurden retrospektiv analysiert. Erfasst wurden dazu personenbezogene Daten sowie Angaben zum geriatrischen Assessment, zur beobachteten Tagesmüdigkeit und zu Sturzereignissen.

Ergebnisse

Von insgesamt 1485 konsekutiv aufgenommenen Patienten im ausgewählten Zeitraum konnten Daten von 1317 (87 %) Patienten für die weitere Analyse eingeschlossen werden. Während des Krankenhausaufenthaltes stürzten 146 (11 %) Patienten mindestens einmal, 35 (3 %) stürzten wiederholt, und 64 Stürze (44 %) traten bipedal auf (aus dem Stand). Tagesschläfrigkeit wurde bei 73 % der Patienten mit bipedalen und bei 65 % mit nichtbipedalen Stürzen beobachtet (p < 0,01). Stürze korrelierten signifikant mit einer positiven Sturzanamnese, der Dauer des Krankenhausaufenthalts, dem Barthel-Index bei Aufnahme, dem MMSE („mini mental state examination“), Demenz und beobachteter Tagesschläfrigkeit. Keine Korrelation fand sich zwischen Stürzen und Alter, Multimorbidität und Anzahl der verordneten Medikamente. Im Kontext mit Stürzen standen Medikamente zur Behandlung der Parkinson-Erkrankung, Antidepressiva und Neuroleptika. In einer multiplen logistischen Regressionsanalyse waren Stürze im Krankenhaus signifikant und unabhängig assoziiert mit einer Vorgeschichte von Stürzen, der Dauer des Krankenhausaufenthalts, Demenz und beobachteter Schläfrigkeit tagsüber.

Schlussfolgerung

Beobachtete Tagesmüdigkeit ist bei geriatrischen Patienten mit Stürzen im Krankenhaus verbunden. Zur Bestätigung dieses Zusammenhangs und zur Quantifizierung der Auswirkungen von Schläfrigkeit auf das Sturzrisiko sind prospektive Interventionsstudien erforderlich. Außerdem sollte der Einfluss einer Behandlung der beobachteten Schläfrigkeit auf das Sturzrisiko untersucht werden. Die Beurteilung von Tagesmüdigkeit sollte in der Geriatrie Teil des routinemäßig durchgeführten Assessments werden.

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Authors and Affiliations

  1. Rellinghauser Str. 173, 45128, Essen, Germany

    Jeanina Schlitzer

  2. Alfried-Krupp-Krankenhaus Essen, Alfried Krupp Str. 20, 45131, Essen, Germany

    Michaela Friedhoff & Barbara Nickel

  3. Klinik für Orthopädie und Unfallchirurgie, Heinrich Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Helmut Frohnhofen

  4. Fakultät für Gesundheit, Department Humanmedizin, Universität Witten-Herdecke, Alfred-Herrhausen-Str. 50, 58455, Witten, Germany

    Helmut Frohnhofen

Authors
  1. Jeanina Schlitzer
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  2. Michaela Friedhoff
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  3. Barbara Nickel
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  4. Helmut Frohnhofen
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Corresponding author

Correspondence to Helmut Frohnhofen.

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Conflict of interest

J. Schlitzer, M. Friedhoff and B. Nickel declare that they have no competing interests. H. Frohnhofen: advisory fees from Amgen, Heel, Idorsia; lecture fees from Bayer, Pfizer, Amgen, Heel, Idorsia, ResMed, BMS, Medice, Gruenenthal.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Schlitzer, J., Friedhoff, M., Nickel, B. et al. Observed daytime sleepiness in in-hospital geriatric patients and risk of falls. Z Gerontol Geriat 56, 545–550 (2023). https://doi.org/10.1007/s00391-023-02191-2

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  • DOI: https://doi.org/10.1007/s00391-023-02191-2

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