Sleep Care

Sleeping Pills Raise Hip Fracture Risk In the Elderly

Insomnia, the condition of severely prolonged sleep onset, a failure of initiating sleep at all, or having frequent disruptions to one’s sleep throughout the night is much

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more common in the elderly population. As an individual grows older they become more inclined to experiencing many different psychological, physical, and even social changes that can really affect sleep and the quality of sleep. Even the overall sleep pattern changes as a person ages, making each sleep cycle throughout a nights rest shorter and more fragmented. Depression, a major side effect of insomnia, also has the ability to contribute to insomnia and is too often left untreated in the older populations.

iStock_000014371972SmallTo date the most common treatment for insomnia with the elderly has been a class of drugs known as nonbenzodiazepine hypnotic drugs. Some of the most popular nonbenzodiazepine hypnotic drugs are Sonata, Ambien, Ambien CR, and Lunesta and were created to combat the high dependence rate of those using benzodiazepine drugs and also the next day sedation experienced from the different benzodiazepines. These drugs operate by binding to a receptor in the brain and thus inducing sleep. Generally these drugs are taken around 30 minutes before bed and the dosage prescribed differs from case to case but when being used by the older population is often a lower dose. A nonbenzodiazepine hypnotic drug, like any other medication, does have side effects to be aware of. Some of these include dizziness, loss of balance, drowsiness, and impaired coordination. Pair these potential side effects with an elderly person who has limited mobility and or a case of dementia and the mixture could have serious consequences; which a recent study has revealed.

Research conducted by experts at the Harvard Medical School and led by Sarah D. Berry, M.D., M.P.H. showed that out of 15,500 long stay nursing home residents, almost 1,700 were given a nonbenzodiazepine hypnotic drug to help encourage sleep prior to the patient experiencing a hip fracture. Every subject in the study was over the age of 50 and the average age of the residents participating was 81 years old. These results showed that the risk of hip fracture from a serious fall in the subjects is approximately two-thirds higher while taking nonbenzodiazepine hypnotic sleep medications; and the risk was actually higher than that in the elderly patients who are new users of the sleep aides. The authors of the study are quoted as saying, “It is important to understand the relationship between sleep medication use and injurious falls in nursing homes.” And, “The risk of hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs.”

It is important all parties involved in assisted living are aware of these dangers and side effects. The staff, families, and patients must be properly educated on how correct doses, side effects, and what to do in case of an emergency while using these sleep drugs. Dr. Berry also stressed the importance of physicians being aware of the dangers by stating, “Caution should be exercised when prescribing sleep medications to nursing home residents.” A nursing home can also create a better sleep culture for residents by limiting things like daytime naps, keeping residents engaged mentally and physically throughout the day, and improved social activities can all help limit the need and use of these sleep aides.

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