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Self Treatment of Insomnia in the Elderly

Self Treatment of Insomnia in the Elderly

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Self Treatment of Insomnia in the Elderly

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  1. Self Treatment of Insomnia in the Elderly Ashdin Tavaria M.D., Nalaka S. Gooneratne M.D., Clara Kwan M.D., Nirav Patel M.D., Lavanya Madhusudan, Kathy C. Richards, Ph.D. May 18, 2010

  2. Acknowledgement • Supported by: • The Hartford Foundation • Penn Center of Excellence • National Institute of Health

  3. Introduction Sleep disorders are common in the elderly, with up to 57% of older adults complaining of difficulties with their sleep1

  4. Prevalence of Insomnia by Age -Ohayon, J Psychiat Res 1997

  5. Introduction • Sleep disorders can be associated with an increased risk of • Driving accidents 2-4 • Cardiovascular mortality 5 • Falls6 • Depression7 • Cognitive deficits 8

  6. Insomnia-associated Mortality • Nursing home study of 272 patients • 2 year follow-up • Adjusted for ADLs, age, gender • Manabe et al., Gerontology 2000

  7. Insomnia-associated Cognitive Impairment: Results • EPESE dataset, 3 year follow-up, n=6,444 • Adjusted for demographic and health factors Cricco et al., JAGS 2001

  8. Introduction • Despite the significant prevalence of sleep disorders, many older adults do not seek evaluation or treatment of their sleep problems • Instead engage in a number of self-treatment activities 9, 10

  9. Study Methods • Purpose of this study was to explore • Different types of self-treatment strategies • Determine their perceived efficacy

  10. Study Methods • Cross-sectional survey study consisting of a mailed questionnaire • Adults over the age of 65 recruited from the greater Philadelphia area • Penn Partners in Healthy Living Program Data Base which is an elder outreach program affiliated with the University of Pennsylvania Health System

  11. Results • A total of 242 study questionnaires were completed • Average of 4.8 treatments used per study participant (SD 2.9, range 0-13) • Correlation between the number of treatments attempted and the PSQI sleep quality score (r=0.37, p<0.0001) • Suggested that study participants who had worse sleep quality had attempted more sleep treatments.

  12. Results Bar graph showing the number of treatments used by subjects

  13. Results

  14. Results

  15. Efficacy of Different Types of Self-treatment Strategies

  16. Efficacy of Different Types of Self-treatment Strategies

  17. Results • Prescription sleeping pills were felt to be the most effective treatment option (2.5) • Ear plugs (1.0) were felt to be the least effective • Prescription medications had a perceived efficacy that was significantly larger than the other methods (p-value = 0.0024)

  18. Results • In our study, most commonly used interventions were watching TV or listening to the radio, or reading • Pain medications were the most commonly used form of medication highlighting the impact of pain as a contributing factor to insomnia in the elderly • Of particular concern, nearly half of all subjects who used alcohol or over-the-counter sleeping aids had not told this to their health care provider

  19. Results • Women are more likely to engage in broad range of activities to improve their sleep when compared to men • Caucasians tended to rely on pharmacotherapy while African Americans tended to use social tools

  20. Discussion • Wide array of treatment options used by elders for the management of their insomnia • High usage rates of several treatments highlights the importance of inquiring about the broad range of treatment choices made by older adults as they seek to address their sleep complaints

  21. Discussion • Some elderly patients are trying up to 13 different treatments

  22. Discussion • Response rate may be affected by participants may have become discouraged by the end and chosen not to fill out additional questionnaire • Patients may have underreported negatively viewed activities or treatments such as alcohol, smoking, or even medications

  23. Discussion • Self treatment can be dangerous • Patients are unaware of the interplay between aging and physiology, chronic diseases and drugs • Polypharmacy can result in adverse drug-drug interactions which can lead to confusion, falls, and incontinence • Over-the-counter sleep aids

  24. Discussion • As Healthcare providers we must be asking our patients about their sleep patterns • If they are having disturbances we must ask what if any self-treatment activities they are engaging in

  25. References