“Multiple insomnia complaints are common among older adults, and our findings suggest that investigating a single insomnia symptom may underestimate the impact of multiple co-existing insomnia symptoms on fall risk,” wrote Orfeu Buxton, Ph.D., and colleagues at the Pennsylvania State University Center for Healthy Aging.
Buxton and colleagues analyzed data from the 2006 through 2014 versions of the Health and Retirement Study (HRS), an ongoing national study that interviews older adults every two years on a variety of health and lifestyle topics. The HRS includes sleep-related questions such as whether the participants have trouble “falling asleep,” “waking up during the night,” “waking up too early and not being able to fall asleep again,” and “not feeling rested during the day.” The researchers compiled answers from participants aged 65 and older to create a composite insomnia score of 0-4 for each respondent. As part of the HRS interview, participants were also asked whether they had fallen since the previous assessment (last two years).
They found that a higher insomnia score correlated with a future risk of falling. Specifically, older adults were 5% more likely to report a fall for each insomnia symptom they had. In addition, adults who used physician-recommended sleep medications were approximately 34% more likely to report a fall at the survey two years later compared with adults who did not use sleep medications. Interestingly, nonphysician-recommended sleep medications showed no association with falls at follow up.
“It is … important for clinicians to screen older adults for the presence of insomnia and make a referral to a specialist in sleep disorders if needed,” Buxton and colleagues wrote. “CBT-I [cognitive-behavioral therapy for insomnia] has been found to be effective in treating insomnia among older adults and in sustaining the effects longer compared with sleep medications or other treatments … with potentially fewer side effects for falls.”
For related information, see the Psychiatric News article “Online CBT for Insomnia Offers Long-Term Benefit.”