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Update in Geriatrics
- William J. Hall, MD; and
- Rosanne M. Leipzig, MD, PhD
- From University of Rochester School of Medicine, Rochester, New York; and Mount Sinai School of Medicine, New York, New York.
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
This, the “millennial” edition of Update in Geriatrics, is based on a review of studies culled from about 30 peer-reviewed English-language journals—those most likely to be found in the libraries of community hospitals. All the studies were published in 1999 or early in 2000, and for the most part they are evidence-based trials rather than reviews or anecdotal reports. The guiding principle was that the information from these studies should be of immediate clinical use, not necessarily to geriatricians but to internists in a primary care practice, almost all of whom regularly encounter older, sometimes frail patients in the office setting, in the hospital, or when visiting a nursing home.
Insomnia
Between 12% and 25% of elderly persons in good general health have chronic insomnia. Normal aging is characterized by lighter sleep, less rapid-eye-movement sleep, and more arousals. Conditions such as sleep apnea and myoclonic jerks also become more prevalent. Older persons poorly tolerate drug treatment of disordered sleep. The use of sedative–hypnotics, for instance, can lead to falling, driving accidents, and impaired memory.
Cognitive–Behavioral Approach Provided More Enduring Relief of Chronic Late-Life Insomnia Than Use of a Benzodiazepine
Morin and colleagues' randomized study, undertaken at an academic medical center, is the first placebo-controlled clinical trial comparing behavioral and pharmacologic treatments, separately and combined, for late-life insomnia. The 78 participants, 50 women and 28 men (average age, 65 years), had had chronic primary insomnia of either the sleep-onset or maintenance variety for 6 months or longer and had experienced fatigue, impaired function, or disordered mood as a result. The participants were highly educated, were not depressed, and did not have the sleep apnea syndrome (apnea–hypopnea index > 15). The participants were treated as outpatients for 8 weeks and followed up after 3, 12, and 24 …
