Orfeu M. Buxton
Research published in Sleep suggests that among adults aged 50 and older, the number of insomnia symptoms predicts 2-year fall risk, and that taking physician-recommended sleep medications increases fall risk, regardless of the presence of insomnia symptoms.
“No longitudinal study has investigated the association of insomnia symptoms with falls among community-dwelling older adults,” Tuo-Yu Chen, PhD, of the Centre for Aging Research and Education at the Duke-NUS Medical School, Singapore, and colleagues wrote. “As about 50% of community-dwelling older adults report at least one sleep problem, examining the relationship between sleep problems and falls will guide us toward one potential component of future preventive interventions aiming to decrease falls in later life.”
Researchers used data on fall history, sleep habits and sleep medication use from the biennial Health and Retirement Study between 2006 and 2014 to look at the longitudinal association between falls and multiple coexisting insomnia symptoms in 6,882 adults (mean age, 74.5). Eyesight, walking speed and balance were also reported.
According to the results, 32% of the participants reported falling at least once in the previous 2 years at baseline, and at follow-up, 34% of participants reported at least one fall in the previous 2 years.
Chen and colleagues also found that adults who reported one additional insomnia symptom at baseline were 5% more likely to fall at follow-up. Compared with adults who did not take sleep medications, those who did take sleep medications at baseline were approximately 34% more likely to report a fall at follow-up.
In addition, the percentages of participants who were women and white were higher among those who indicated at least one fall vs. those participants who did not fall. Those who fell were older and had poorer eyesight, walking speed and balance than those who did not fall.
Orfeu M. Buxton, PhD, associate professor of the biobehavioral health department at Pennsylvania State University, told Healio Family Medicine that the findings should give clinicians pause before suggesting sleep medications.
“Primary care physicians already have plenty of reasons to hesitate before prescribing powerful sedative hypnotics,” Buxton said. “PCPs may wish to consider fall and other risks, especially in older patients who may not be able to tolerate these medications, especially for long-term use.”
Buxton, who was also a study co-author, suggested cognitive behavioral therapy instead of medication for insomnia.
“Cognitive behavioral therapy is highly effective, and does not have the side effects of hypnotic sleep medication,” Buxton said. “Establishing relationships with professionals who can offer this care should be a priority since sleep difficulties are so common.” – by Janel Miller
Chen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.