THE IMPACT OF SEDATIVE-HYPNOTIC USE ON SLEEP SYMPTOMS IN ELDERLY NURSING-HOME RESIDENTS

Objective: To determine the frequency of sleep-related complaints amon g institutionalized elderly subjects and to assess the relationship be tween perceived sleep quality and the use of sedative-hypnotic agents and other psychoactive medications. Methods: In 12 nursing homes in Ma ssachusetts, we conducted observational, cross-sectional, and longitud inal studies of 145 institutionalized elderly subjects (average age, 8 3.0 years; age range, 65 to 105 years). We recorded the patients' demo graphic characteristics and all medication use (both scheduled and as needed) during a 1-month baseline period. A research assistant who was blinded to diagnoses and medication use performed detailed neuropsych ologic testing and administered a series of standardized questions con cerning difficulty sleeping, early morning awakening, and time spent a wake in bed. Medication use and patient assessments were repeated afte r a 6-month interval. Results: One or more sleep-related complaints we re present at baseline in 94 (65%) of the residents studied. Using log istic regression to adjust for potential confounding, we found no rela tionship in the baseline month between use of sedative-hypnotic agents and the presence or absence of sleep complaints. After 6 months of fo llow-up, 27 (19%) of the residents had decreased their use of sedative -hypnotic agents and 23 (16%) had increased their use. However, there was no relationship between decreased use of sedative-hypnotic agents and worsened sleep (P > 0.20) or between their increased use and impro ved sleep reports (P > 0.10). Improvement in functional status was sig nificantly associated with improved sleep at follow-up (P < 0.005). Co nclusions: Sleep complaints occur in the majority of institutionalized elderly persons. Neither cross-sectional nor longitudinal analyses sh owed a relationship between patterns of sedative-hypnotic use and the presence, absence, or change in sleep complaints.