Avidan Alon Y, Fries Brant E, James Mary L, Szafara Kristina L, Wright Glenn T, Chervin Ronald D
Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
J Am Geriatr Soc. 2005 Jun;53(6):955-62. doi: 10.1111/j.1532-5415.2005.53304.x.
To examine the relationship between insomnia, hypnotic use, falls, and hip fractures in older people.
Secondary analysis of a large, longitudinal, assessment database.
Four hundred thirty-seven nursing homes in Michigan.
Residents aged 65 and older in 2001 with a baseline Minimum Data Set assessment and a follow-up 150 to 210 days later.
Logistic regression modeled any follow-up report of fall or hip fracture. Predictors were baseline reports of insomnia (previous month) and use of hypnotics (previous week). Potential confounds taken into account included standard measures of functional status, cognitive status, intensity of resource utilization, proximity to death, illness burden, number of medications, emergency room visits, nursing home new admission, age, and sex.
In 34,163 nursing home residents (76% women, mean age+/-standard deviation 84+/-8), hypnotic use did not predict falls (adjusted odds ratio (AOR)=1.13, 95% confidence interval (CI)=0.98, 1.30). In contrast, insomnia did predict future falls (AOR=1.52, 95% CI=1.38, 1.66). Untreated insomnia (AOR=1.55, 95% CI=1.41, 1.71) and hypnotic-treated (unresponsive) insomnia (AOR=1.32, 95% CI=1.02, 1.70) predicted more falls than did the absence of insomnia. After adjustment for confounding variables, insomnia and hypnotic use were not associated with subsequent hip fracture.
In elderly nursing home residents, insomnia, but not hypnotic use, is associated with a greater risk of subsequent falls. Future studies will need to confirm these findings and determine whether appropriate hypnotic use can protect against future falls.
研究老年人失眠、使用催眠药物、跌倒和髋部骨折之间的关系。
对一个大型纵向评估数据库进行二次分析。
密歇根州的437家疗养院。
2001年年龄在65岁及以上的居民，进行了基线最低数据集评估，并在150至210天后进行了随访。
逻辑回归模型用于分析跌倒或髋部骨折的任何随访报告。预测因素为失眠（前一个月）和使用催眠药物（前一周）的基线报告。考虑的潜在混杂因素包括功能状态、认知状态、资源利用强度、接近死亡程度、疾病负担、药物数量、急诊室就诊次数、疗养院新入院情况、年龄和性别等标准测量指标。
在34163名疗养院居民中（76%为女性，平均年龄±标准差84±8岁），使用催眠药物并不能预测跌倒（调整后的优势比（AOR）=1.13，95%置信区间（CI）=0.98，1.30）。相比之下，失眠确实能预测未来的跌倒（AOR=1.52，95%CI=1.38，1.66）。未经治疗的失眠（AOR=1.55，95%CI=1.41，1.71）和使用催眠药物治疗（无反应）的失眠（AOR=1.32，95%CI=1.02，1.70）比没有失眠的情况预测了更多的跌倒。在对混杂变量进行调整后，失眠和使用催眠药物与随后的髋部骨折无关。
在老年疗养院居民中，失眠而非使用催眠药物与随后跌倒的风险增加有关。未来的研究需要证实这些发现，并确定适当使用催眠药物是否可以预防未来的跌倒。
