Annals of Long Term Care

Reviewed, prepared, and submitted by Thomas T. Yoshikawa, MD, Editor-in-Chief, Journal of the American Geriatrics Society

Title:

Sleep Quality in Residents of Assisted Living Facilities: Effect on Quality of Life, Functional Status, and Depression

Authors:

Martin JL, Fiorentino L, Jouldjian S, et al

Summary:

Sleep disturbance is common in older people and is associated with poor health, functional impairment, falls, depression, poor quality of life, and higher mortality whether they live independently or in an institution. This study examined sleep patterns in residents living in an assisted living facility (ALF). A total of 121 ALF residents with a mean age of 85.6 (86% female; 88% non-Hispanic white) had data collected at baseline, 3 months and 6 months. It was found that 65% of ALF residents reported clinically significant sleep disturbance on the Pittsburg Sleep Quality Index, and poor quality sleep was confirmed by objective wrist actigraphy data. Moreover, poor sleep was associated with declining functional status and quality of life and greater depression.

Comments:

Although this study had some limitations (non-representative sampling method and exclusion of those who could not consent), it confirms other studies demonstrating sleep disturbance in older people, regardless of residential setting. More importantly, poor sleep leads to poor function, quality of life, and more depression. Future studies need to be done to determine if interventions that improve sleep patterns reduce these negative outcomes.

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.

Title:

A Longitudinal Analysis of a Total 3-year Healthcare Costs for Older Adults Who Experience a Fall Requiring Medical Care

Authors:

Bohl AA, Fishman PA, Ciol MA, et al

Summary:

Falls are common among older adults and are a growing public health concern. The cost of fall-related hospitalization can range from $17,500 to $69,000 depending on severity of injuries and length of hospital day. However, there are little data on the duration of these costs. In this study longitudinal cohort study, 7,993 non-hospitalized fallers, 976 hospitalized fallers, and 8,956 non-fallers aged 67 years and older were evaluated over a 3-year period. Falls requiring medical attention resulted in higher costs than for non-fallers for up to 12 months after a fall (i.e., beyond the acute injury period), especially for falls requiring hospitalization. Preventive interventions should be aimed at reducing fall-related injuries that require hospitalization because they produce the highest excess costs and have a higher likelihood of 1-year mortality.

Comments:

Falls continue to be a major personal and public health concern for older adults. Medicare no longer will pay for healthcare costs for a fall occurring during hospitalization. Hence, it is imperative that we continue to find cost-effective interventions that reduce falls, fall-related injuries, and the fear of falling.

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.

Title:

Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study

Authors:

Morton MC, Smith KR, Ostbye T, et al

Summary:

Informal (unpaid) caregiving of a spouse with dementia has been associated with depression, physical health problems and higher mortality in the caregiving spouse. More recently, there has been evidence of cognitive dysfunction in caregivers of spouses with dementia. In this study, 2,442 participants (1,221 married couples) aged 65 and older were evaluated. Incident dementia was diagnosed in 255 participants using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria. There was a six times greater risk for incident dementia in a participant whose spouse had dementia compared to participants whose spouse was dementia free. Husbands had higher risks (12 times) than wives (3.7 times). It was unclear if the participants themselves were caregivers to their spouses.

Comments:

It is unclear what the pathogenetic mechanism(s) might be if this association is confirmed by further studies. Moreover, in this study the spouse’s exposure to the person with dementia is not clarified, i.e., whether they actually provided caregiving or level of caregiving activities. Nevertheless, this is an interesting observation and if confirmed by others, research must be done to help protect older persons from suffering the same fate as their spouses with dementia.

The opinions expressed are solely those of the reviewer and do not necessarily reflect those of the American Geriatrics Society or Journal of the American Geriatrics Society.