Sleep disturbance and sedative/hypnotic use by elderly in nursing homes.

Abstract

The overuse of medications has been referred to as the most common "error of commission" in nursing homes and evidence suggests that pscychotropic medications are overused and inappropriately prescribed for nursing home patients. The purpose of the present studies was to document the actual prescription and administration practices of sedative/hypnotics for the elderly residing in nursing homes and also to assess the difference in self-reported sleep complaints as well as behavioral and cognitive impairment between those residents receiving sedative/hypnotics and those not receiving sedative/hypnotics. Doctors' and nurses' progress notes were reviewed for two weeks prior to the initial administration of a sedative/hypnotic. Results showed that there was only one resident for whom a formal diagnosis of sleep disorder was documented. In addition, there were 81 charted references to sleep on 42 of the 56 residents during the two weeks prior to initial prescription of a sedative/hypnotic. In the four weeks following initial administration of a sedative/hypnotic, there were 167 references to sleep on 40 residents. These findings suggest minimal documented evidence to support the prescription of sedative/hypnotic medications. Prescription use was also examined in light of the initiation of new guidelines regarding psychotropic medications instituted by the Health Care Financing Administration (HCFA) on October 1, 1990. The number of residents receiving prescriptions of these medications decreased in the 6 months following October 1 but those who received medication were given it with increased frequency. In a second study, residents on sedative/hypnotic were compared to those not on sedative/hypnotics with reference to sleep complaints as well as behavioral and cognitive impairment. Findings showed that there were no differences between groups. Sleep disorders may not be the primary justification for the prescription of sedative/hypnotic medications. These findings are consistent with previous assertions that sedative/hypnotic medications are used as "chemical restraints" in this fragile population. This may be a particular danger if the nursing home staff is not knowledgeable regarding the diagnosis and treatment of sleep disorders.