![]() However, details on guideline use when treating certain conditions are scant. Clinical experts have published guidelines, such as the American Geriatrics Society (AGS) Beers Criteria, to help inform treatment decisions. In particular, medication-related falls or fractures are recognized as an important consideration for clinicians when initiating new pharmacotherapy in older adult patients. Nonetheless, these results should be interpreted with caution as the use of these medications may be indicative of underlying morbidity with potential for residual confounding.įalls are the leading cause of injury-related deaths among older adults (ie, age ≥ 65 years) and incur a substantial economic burden due to costs associated with subsequent fractures, hospital visits, and long-term care. This analysis suggests that significant risks are associated with common, older generation insomnia medication treatments in the elderly. Trazodone and benzodiazepines were associated with the greatest risk of falls. Individuals receiving insomnia treatment had an increased risk of falls and mortality and higher HCRU and costs compared with matched beneficiaries without sleep disorders. All-cause total adjusted mean costs were higher among insomnia treated patients ($967 vs $454). Compared with controls, beneficiaries receiving insomnia treatment demonstrated higher estimated adjusted mean number of inpatient, outpatient, and emergency department visits and longer length of inpatient stay. Crude all-cause mortality rates were 15-times as high for the insomnia-treated as controls. In adjusted analyses, patients receiving benzodiazepines or trazodone had the greatest risk. Relative to controls, adjusted analyses showed that beneficiaries receiving insomnia medication experienced over twice as many falls (odds ratio = 2.34, 95% CI: 2.31–2.36). The study included 1,699,913 Medicare beneficiaries (59.9% female, mean age 75 years). Generalized linear models controlled for several key covariates, including age, race, sex, geographic region and Charlson Comorbidity Index score. The main outcomes were falls, mortality, healthcare resource utilization (HCRU), and medical costs during the 12 months following the earliest fill date for the insomnia medication of interest. Medicare beneficiaries treated for insomnia receiving zolpidem extended-release, zolpidem immediate-release, trazodone, or benzodiazepines were matched with non-sleep disordered controls. This was a retrospective cohort analysis of deidentified Medicare claims from January 2011 through December 2017. This study evaluated the risk of falls and related consequences among adults ≥ 65 years of age treated with common prescription medications for insomnia compared with non-sleep disordered controls. While some research has found that insomnia heightens falls, health care resource utilization (HCRU) and costs, the impact of insomnia treatments on fall risk, mortality, HCRU and costs in the elderly population, which could be of substantial interest to payers, has not been fully elucidated. Melatonin may be helpful when insomnia is related to shift work and jet lag however, its use remains controversial.Falls are the leading cause of injury-related death among older Americans. Long-term use of long-acting benzodiazepines should, in particular, be avoided. When medication is deemed necessary for relief of insomnia, a low-dose sedating antidepressant or a nonbenzodiazepine anxiolytic may offer advantages over traditional sedative-hypnotics. Periodic limb movements during sleep are very common in the elderly and may merit treatment if the movements cause frequent arousals from sleep. Exposure to bright light at appropriate times can help realign the circadian rhythm in patients whose sleep-wake cycle has shifted to undesirable times. Regardless of the cause of insomnia, most patients benefit from behavioral approaches that focus on good sleep habits. Sleep apnea also should be considered in the differential assessment. In most cases, however, a practical management approach is to first consider depression, medications, or both, as potential causes. In the elderly, insomnia is complex and often difficult to relieve because the physiologic parameters of sleep normally change with age. Insomnia has numerous, often concurrent etiologies, including medical conditions, medications, psychiatric disorders and poor sleep hygiene.
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