Northeast Ohio Medical University, Rootstown, OH, USA.
The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Am Med Dir Assoc. 2022 Jun;23(6):1031-1037. doi: 10.1016/j.jamda.2021.10.005. Epub 2021 Nov 8.
Aging is associated with sleep problems, which are common among assisted living (AL) residents. More than 40% of residents have insomnia, and almost 70% have a sleep disturbance of some kind. Melatonin to treat sleep disorders has become common among older adults, but its use in AL is unknown, which is concerning because melatonin may have side effects and interfere with other medications. The purpose of this study was to determine the prevalence and correlates of melatonin prescribing in AL, to inform whether changes in care may be indicated.
Cross-sectional chart abstracts and interviews.
Data were collected in 250 randomly selected AL communities among 5777 residents across 7 states in the United States and weighted to an estimated 4043 communities and 152,719 residents.
Charts of residents were abstracted, and AL administrators and health care supervisors were interviewed to obtain information related to case-mix, staffing, and attitudes regarding psychoactive medications. Weighted analyses primarily examined the association of melatonin prescribing with community- and resident-level characteristics.
Melatonin was prescribed in 82% of communities, more commonly in those that had a registered nurse or licensed practical nurse on site (+7%, P = .027), and whose health care supervisor was more favorable toward nonpharmacologic practices (+18%, P = .010). On average, 9% of residents were prescribed melatonin, with prescriptions being more common among those diagnosed with dementia (+24%, P = .004); a psychiatric disorder, especially an anxiety disorder (+43%, P = .007); having behavioral expressions; and taking other psychotropics. Coprescribing was common, especially with antidepressants (OR 2.64, 95% CI 1.99, 3.48; P < .001).
This study is the first to examine melatonin prescribing in AL, and finds it to be common. Such use may be appropriate if it is as a more suitable replacement for hypnotics. The fact that use varies by organizational characteristics suggests practices may be modifiable. Research examining benefits and side effects of melatonin, overall and in relation to other medications, is indicated to promote better care for AL residents.
衰老与睡眠问题有关，这些问题在辅助生活（AL）居民中很常见。超过 40%的居民患有失眠症，几乎 70%的居民存在某种睡眠障碍。褪黑素治疗睡眠障碍在老年人中已很常见，但在 AL 中的使用情况尚不清楚，这令人担忧，因为褪黑素可能有副作用，并干扰其他药物。本研究旨在确定 AL 中褪黑素开处方的患病率和相关因素，以确定是否需要改变护理方式。
横断面图表摘要和访谈。
数据采集于美国 7 个州的 5777 名居民中的 250 个随机选择的 AL 社区，数据经过加权处理，估计覆盖了 4043 个社区和 152719 名居民。
对居民的病历进行摘要，并对 AL 管理人员和医疗保健主管进行访谈，以获取与病例组合、人员配备以及对精神药物的态度相关的信息。加权分析主要研究了褪黑素开处方与社区和居民水平特征的关联。
82%的社区开了褪黑素处方，在有注册护士或执业护士的社区中更为常见（增加 7%，P=0.027），而对非药物治疗更为支持的医疗保健主管所在社区（增加 18%，P=0.010）开的处方也更多。平均而言，有 9%的居民开了褪黑素处方，在被诊断为痴呆症的患者中更为常见（增加 24%，P=0.004）；患有精神障碍，尤其是焦虑症（增加 43%，P=0.007）；有行为表现；以及服用其他精神药物。联合用药很常见，尤其是与抗抑郁药（OR 2.64，95%CI 1.99，3.48；P<0.001）。
这是第一项关于 AL 中褪黑素开处方的研究，结果发现其使用非常普遍。如果褪黑素可以作为更合适的催眠药物替代品，那么这种使用可能是合理的。使用情况因组织特征而异，这表明实践可能是可以改变的。为了促进更好地护理 AL 居民，需要进行研究来检查褪黑素的益处和副作用，以及它与其他药物的关系。
