Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in michigan nursing homes
Insomnia and hypnotic use, recorded in the minimum data set, as predictors of falls and hip fractures in michigan nursing homes
复制标题
DOI：
10.1111/j.1532-5415.2005.53304.x
复制
发表时间：
2005-06-01
影响因子：
6.3
通讯作者：
Chervin, RD
中科院分区：
文献类型：
--
作者：
Avidan, AY;Fries, BE;Chervin, RD
目的：研究老年人失眠、催眠药使用、福尔斯和髋部骨折之间的关系。设计：对一个大型、纵向、评估数据库的二级分析。设置：密歇根州437家疗养院。参与者：2001年65岁及以上的居民，基线最小数据集评估和150 - 210天后的随访。测量：逻辑回归模型的任何后续报告跌倒或髋部骨折。预测因素是失眠的基线报告（前一个月）和催眠药的使用（前一周）。考虑的潜在混淆因素包括功能状态、认知状态、资源利用强度、死亡接近度、疾病负担、药物治疗次数、急诊室就诊次数、疗养院新入院人数、年龄和性别等标准指标。在34,163名养老院居民中，（76%的女性，平均年龄+/-标准差84 +/- 8），催眠药的使用不能预测福尔斯跌倒（调整的比值比（AOR）=1.13，95%置信区间（CI）=0.98，1.30）。相比之下，失眠确实预测未来的福尔斯（AOR=1.52，95% CI=1.38，1.66）。未经治疗的失眠症（AOR=1.55，95% CI=1.41，1.71）和催眠治疗（无反应）的失眠症（AOR=1.32，95% CI=1.02，1.70）预测比没有失眠症更多的福尔斯。调整混杂变量后，失眠和催眠药的使用与随后的hipfracture.CONCLUSION：在老年疗养院居民，失眠，但不是催眠药的使用，与随后的福尔斯的风险更大。未来的研究将需要证实这些发现，并确定是否适当的催眠使用可以防止未来的福尔斯。
OBJECTIVES: To examine the relationship between insomnia, hypnotic use, falls, and hip fractures in older people.DESIGN: Secondary analysis of a large, longitudinal, assessment database.SETTING: Four hundred thirty-seven nursing homes in Michigan.PARTICIPANTS: Residents aged 65 and older in 2001 with a baseline Minimum Data Set assessment and a follow-up 150 to 210 days later.MEASUREMENTS: 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.RESULTS: 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.CONCLUSION: 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.