SLEEP DISTURBANCES IN THE DEMENTED ELDERLY - TREATMENT IN AMBULATORY CARE

We report the results of a representative survey in Lower Saxony, Germ any, that focused on the treatment of sleep disturbances in the modera tely demented elderly. Two written sample case histories (vignettes) d escribed either a vascular demented patient suffering from nocturnal w andering or an Alzheimer's-type demented patient without apparent psyc hotic or behavioral (sleep) disorder. These were randomly assigned and presented to 145 family physicians and 14 neuropsychiatrists working in private practice by a trained investigator, who then conducted a st andardized interview with the physicians. The study was representative of physicians (response rate: 83.2%). In response to the question con cerning how they would treat the patient's sleep disturbances, about 2 0% of the physicians (with respect to both versions) answered that the y would not choose drugs. More than 40% considered neuroleptics to be the drugs of choice. Benzodiazepines, antidepressants and other substa nces were seldom considered. No significant difference was noted in th e response to the two different case histories. The results allow for the conclusion that non-drug treatments, which (at least initially) sh ould be the treatment of choice, are mainly disregarded by the majorit y of the ambulatory care physicians. The reason for this seems to be a lack of education in sleep medicine and also in geriatric medicine.