Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities
Abstract
:1. Introduction
2. Materials and Methods
2.1. Settings and Participants
2.2. Determination of Falls
2.3. Sleep Quality and Medication Use
2.4. Potential Confounders
2.5. Ethical Consideration
2.6. Statistical Analysis
3. Results
3.1. Basic Characteristics of the Participants
3.2. Sleep Quality, Hypnotics Use, and Sleep-Related Behaviors
3.3. Sleep Quality, Hypnotics Use, and Falls
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (%) | Insomnia (n = 120) | Non-Insomnia (n = 485) | p-Value * | Hypnotic User (n = 86) | Non-Hypnotic User (n = 519) | p-Value * |
---|---|---|---|---|---|---|---|
Gender | |||||||
Male | 179 (29.59) | 12.85 | 87.15 | 0.005 | 12.85 | 87.15 | 0.533 |
Female | 426 (70.41) | 22.77 | 77.23 | 14.79 | 85.21 | ||
Age | |||||||
<80 years | 100 (16.53) | 21.00 | 79.00 | 0.091 | 12.00 | 88.00 | 0.564 |
80–89 years | 384 (63.47) | 17.45 | 82.55 | 15.36 | 84.64 | ||
≥90 years | 121 (20.00) | 26.45 | 73.55 | 12.40 | 87.60 | ||
Care level | |||||||
Level 1 | 206 (34.05) | 19.42 | 80.58 | 0.602 | 15.05 | 84.95 | 0.501 |
Level 2 | 287 (47.44) | 18.82 | 81.18 | 14.98 | 85.02 | ||
Level 3 | 112(18.51) | 23.21 | 76.79 | 10.71 | 89.29 | ||
Charlson Comorbidity Index | |||||||
0 | 174 (28.76) | 16.09 | 83.91 | <0.001 | 8.62 | 91.38 | <0.001 |
1–2 | 208 (34.38) | 13.46 | 86.54 | 10.58 | 89.42 | ||
≥2 | 223 (36.86) | 28.70 | 71.30 | 21.97 | 78.03 | ||
Cognitive state | |||||||
Intact | 214 (35.37) | 21.03 | 78.97 | 0.586 | 16.36 | 83.64 | 0.265 |
Decline | 391 (64.63) | 19.18 | 80.82 | 13.04 | 86.96 | ||
Depression | |||||||
No | 399 (65.95) | 13.78 | 86.22 | <0.001 | 13.53 | 86.47 | 0.504 |
Yes | 206 (34.05) | 31.55 | 68.45 | 15.53 | 84.47 | ||
Balance ability | |||||||
Intact | 218 (36.03) | 21.10 | 78.90 | 0.558 | 14.22 | 85.78 | 0.998 |
Decline | 387 (63.97) | 19.12 | 80.88 | 14.21 | 85.79 | ||
Nighttime sleep time | |||||||
<6 h | 125 (20.66) | 48.00 | 52.00 | <0.001 | 19.20 | 80.80 | 0.073 |
≥6 h | 480 (79.34) | 12.50 | 87.50 | 12.92 | 87.08 | ||
Total sleep time | |||||||
<6 h | 66 (10.91) | 63.64 | 36.36 | <0.001 | 21.21 | 78.79 | 0.085 |
≥6 h | 539 (89.09) | 14.47 | 85.53 | 13.36 | 86.64 | ||
Nap in daytime | |||||||
None | 141 (23.31) | 26.24 | 73.76 | 0.048 | 17.73 | 82.27 | 0.013 |
<2 h | 375 (61.98) | 18.93 | 81.07 | 15.20 | 84.80 | ||
≥2 h | 89 (14.71) | 13.48 | 86.52 | 4.49 | 95.51 | ||
Nighttime toilet visits | |||||||
<3 times | 518 (85.62) | 16.99 | 83.01 | <0.001 | 12.55 | 87.45 | 0.004 |
≥3 times | 87 (14.38) | 36.78 | 63.22 | 24.14 | 75.86 |
Sleep and Hypnotics Use | Fallers (n = 132) | Non-Fallers (n = 473) | p-Value * | Injurious Fallers (n = 92) | Non-Injurious Fallers (n = 513) | p-Value * |
---|---|---|---|---|---|---|
Sleep quality * | ||||||
Insomnia | 31.67 | 68.33 | 0.004 | 23.33 | 76.67 | 0.006 |
Non-insomnia | 19.38 | 80.62 | 13.20 | 86.80 | ||
Hypnotics use | ||||||
Yes | 29.07 | 70.93 | 0.079 | 23.26 | 76.74 | 0.025 * |
No | 20.62 | 79.38 | 13.87 | 86.13 | ||
Benzodiazepines use | ||||||
Yes | 34.88 | 65.12 | 0.031 | 34.88 | 65.12 | <0.001 |
No | 20.82 | 79.18 | 13.70 | 86.30 | ||
Non-benzodiazepines use | ||||||
Yes | 23.26 | 76.74 | 0.813 | 15.48 | 84.52 | 0.499 |
No | 21.71 | 78.29 | 11.63 | 88.37 | ||
Sleep quality & hypnotics use | ||||||
No insomnia, no hypnotics use | 18.81 | 81.19 | 0.044 | 12.16 | 87.84 | 0.003 |
No insomnia, hypnotics use | 24.49 | 75.51 | 22.45 | 77.55 | ||
Insomnia, no hypnotics use | 30.12 | 69.88 | 22.89 | 77.11 | ||
Insomnia, benzodiazepines use | 36.84 | 63.16 | 36.84 | 63.16 | ||
Insomnia, non-benzodiazepines use | 33.33 | 66.67 | 11.11 | 88.89 | ||
Nighttime sleep durance | ||||||
<6 h | 24.24 | 75.76 | 0.507 | 17.60 | 82.40 | 0.403 |
≥6 h | 21.52 | 78.48 | 14.58 | 85.42 | ||
Total sleep durance | ||||||
<6 h | 24.00 | 76.00 | 0.613 | 19.70 | 80.30 | 0.282 |
≥6 h | 21.25 | 78.75 | 14.66 | 85.34 | ||
Nap in daytime | ||||||
None | 24.31 | 75.69 | 0.043 | 19.44 | 80.56 | 0.021 |
<2 h | 18.37 | 81.63 | 11.66 | 88.34 | ||
≥2 h | 28.81 | 71.19 | 20.34 | 79.66 | ||
Nighttime toilet visits | ||||||
<3 times | 21.04 | 78.96 | 0.260 | 14.67 | 85.33 | 0.371 |
≥3 times | 26.44 | 73.56 | 18.39 | 81.61 |
Model | Predictive Factor | Falls | Injurious Falls | ||||
---|---|---|---|---|---|---|---|
RR * | 95% CI | p-Value | RR * | 95% CI | p-Value | ||
Model1 | age | 0.994 | (0.967–1.022) | 0.687 | 1.009 | (0.976–1.043) | 0.613 |
Insomnia | 1.934 | (1.238–3.021) | 0.004 | 1.994 | (1.211–3.282) | 0.007 | |
Model2 | age | 0.995 | (0.967–1.023) | 0.710 | 1.008 | (0.975–1.043) | 0.627 |
Benzodiazepines | 2.047 | (1.058–3.960) | 0.033 | 3.355 | (1.713–6.570) | 0.0004 | |
Model3 | age | 0.994 | (0.966–1.022) | 0.662 | 1.008 | (0.974–1.042) | 0.652 |
Insomnia | 1.815 | (1.152–2.860) | 0.010 | 1.749 | (1.046–2.923) | 0.033 | |
Benzodiazepines use | 1.755 | (0.892–3.451) | 0.103 | 2.919 | (1.467–5.808) | 0.002 | |
Model4 | Insomnia | 1.787 | (1.106–2.887) | 0.018 | 1.683 | (0.977–2.899) | 0.061 |
Benzodiazepines use | 1.891 | (0.947–3.776) | 0.071 | 3.128 | (1.541–6.350) | 0.002 | |
age | 0.993 | (0.964–1.023) | 0.662 | 1.009 | (0.974–1.046) | 0.609 | |
female | 0.868 | (0.560-1.347) | 0.529 | 1.039 | (0.618–1.746) | 0.885 | |
Care Level 1 | Ref | Ref | Ref | Ref | Ref | Ref | |
Care level 2 | 0.710 | (0.457–1.103) | 0.194 | 1.030 | (0.612–1.733) | 0.801 | |
Care Level 3 | 0.869 | (0.490–1.541) | 0.908 | 1.197 | (0.615–2.332) | 0.584 | |
Charlson comorbidity score | 1.023 | (0.884–1.185) | 0.760 | 0.926 | (0.776–1.105) | 0.394 | |
Depression | 1.014 | (0.294–3.503) | 0.982 | 1.818 | (0.504–6.551) | 0.361 | |
Nighttime toilet visits ≥3 times | 1.135 | (0.658–1.955) | 0.650 | 1.106 | (0.592–2.067) | 0.752 | |
Don’t take nap | 1.250 | (0.782–2.000) | 0.971 | 1.572 | (0.928–2.663) | 0.491 | |
Take nap less than <2 h | Ref | Ref | Ref | Ref | Ref | Ref | |
Take nap ≥2 h | 1.535 | (0.884–2.667) | 0.254 | 1.695 | (0.893–3.215) | 0.342 |
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Jiang, Y.; Xia, Q.; Wang, J.; Zhou, P.; Jiang, S.; Diwan, V.K.; Xu, B. Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities. Int. J. Environ. Res. Public Health 2019, 16, 4623. https://doi.org/10.3390/ijerph16234623
Jiang Y, Xia Q, Wang J, Zhou P, Jiang S, Diwan VK, Xu B. Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities. International Journal of Environmental Research and Public Health. 2019; 16(23):4623. https://doi.org/10.3390/ijerph16234623
Chicago/Turabian StyleJiang, Yu, Qinghua Xia, Jie Wang, Peng Zhou, Shuo Jiang, Vinod K. Diwan, and Biao Xu. 2019. "Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities" International Journal of Environmental Research and Public Health 16, no. 23: 4623. https://doi.org/10.3390/ijerph16234623