Sleep Quality and Falls in Older People Living in Self- and Assisted-Care Villages

Abstract

Background: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functioning and therefore may increase the incidence of falls in older people. Objectives: To determine the extent to which a range of physiological, psychological and health-related factors predict night-time sleep quality of older people living in self-care and assisted-care, and whether poor sleep quality is a risk factor for falls. Methods: 572 people, 81 men and 491 women (mean age 79.7 years, SD 6.4), recruited from self-care retirement villages and assisted-care hostels participated in the cross-sectional study with a subgroup of 169 followed up for falls for 1 year. The main outcome measures were sleep quality and prospective falls. Results: Approximately half of the sample rated their sleep quality as poor or fair. Many measures of health, medication use and mood were significantly associated with ratings of poor night-time sleep quality. Multiple regression analyses revealed poor circulation, use of psychotropic and diuretic medications, negative affect, pain, not having a friend in the village, lower fitness levels and daytime napping were significant and independent predictors of night-time sleep quality in both residential care groups. Napping daily was reported by 28% of the self-care group and 37% of the assisted-care group. Residents across both care levels who napped >30 min during the day, or reported <6 h sleep at night, were three times more likely to suffer multiple falls in the follow-up year when adjusting for health, medication and activity measures. Conclusions: Sleep disturbances were common and associated with a variety of psychological, physiological, health and lifestyle factors. Long daytime naps and short night-time sleep periods were associated with an increased risk of falls.

Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study

“…Hayley et al 22 discussed that sleepiness is commonly associated with anxiety in older women, suggesting that one must be careful when evaluating the mental state of patients who present daytime sleepiness. Evidences have associated EDS with the use of medications that act in the Central Nervous System influencing in regulation of neurotransmitters responsible for modulation of sleep and wakefulness 12,30 , In this study was not observed any relation between polypharmacy and EDS, maybe due the fact that we did not ask about the use of psychotropic, for example, just for the number of medications in use.…”

“…In addition, it is also related to poor health status 10 , low physical activity levels, disability in daily activities 10 and an increased number of depression symptoms 11 . Among older people, napping for long periods during the day is related to an increased risk of falling 12 . Some methods used for objective assessment of excessive sleepiness are polysomnography and multiple sleep latency.…”

Associação entre sintomas de insônia, cochilo diurno e quedas em idosos da comunidade

“…Independentemente do estado de depressão, mulheres que cochilavam de dia apresentaram risco de sofrer duas ou mais quedas no seguimento quando comparadas as que não relataram cochilar 18 . No estudo envolvendo 572 idosos da comunidade, foi observado que os participantes que relataram cochilar mais do que 30 minutos por dia tinham três vezes mais chances de cair, controlados os demais fatores de risco de quedas 21 .…”

“…Problemas relacionados ao sono e a frequência e duração de cochilo diurno estão entre os fatores de risco de quedas em idosos da comunidade menos estudados 11,12,17,18,19,20,21,22 , em comparação com outros tais como histórico de quedas, diminuição do equilíbrio e da força muscular, alteração na marcha, consumo de psicotrópicos, depressão e limitação funcional em atividades de vida diária 6,7,9,10,13,14,23 . A prevalência no relato de um ou mais sintomas de insônia em idosos da comunidade é de 50% e não há aumento significativo com a idade 24,25,26 .…”

Quantitative Mobility Assessment for Fall Risk Prediction in Dementia: A Systematic Review

“…Beyond extrinsic risk factors for falls, such as footwear, medication use, and environmental hazards [3][4][5], individuals with dementia are at increased risk of falls related to intrinsic changes in sensory, neuromuscular, and cognitive functions. Walking is a task that requires cognitive input, particularly in the domains of attention and executive functioning [6][7][8][9].…”