Pharmacologic Treatment of Disturbed Sleep in the Elderly
Harvard Medical School, Boston, MA, USA. carlHarvard Review of Psychiatry (Impact Factor: 1.73). 09/2008; 16(5):271-8. DOI: 10.1080/10673220802432442
Disturbed sleep is common in the elderly, who, as a group, take a disproportionately large number of hypnotic medications. Benzodiazepine hypnotics, as well as the newer benzodiazepine receptor agonists, are the primary treatments for these late-life sleep disorders and are effective and safe when used within recommended prescribing guidelines. The elderly also receive other psychiatric medications to induce sleep, although these are off-label uses not well supported by research literature. There is also no literature support for the use of over-the-counter sleep preparations, although both melatonin and a melatonin receptor agonist appear to be moderately effective and safe. Prescribing guidelines for the elderly continue to emphasize short-term, low-dose use, with short-half-life medications. Hypnotic drugs should be used in conjunction with nonmedication treatments, including appropriate sleep hygiene practice, and treatment of other medical or psychiatric causes of disturbed sleep.
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ABSTRACT: The most common complaints of older adults concern their difficulty initiating or maintaining sleep, which results in insufficient sleep and an increased risk of falls, difficulty with concentration and memory, and overall decreased quality of life. Difficulties sleeping are not, however, an inevitable part of aging. Rather, the sleep complaints are often comorbid with medical and psychiatric illness, associated with the medications used to treat those illnesses, or the result of circadian rhythm changes or other sleep disorders. Health care professionals specializing in geriatrics need to learn to recognize the different causes of sleep disturbances in this population and to initiate appropriate treatment. Nonpharmacological treatment techniques are discussed; pharmacological treatments are discussed in a companion article.
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ABSTRACT: Gender and age are assumed to affect spatial performance. However, systematic attention to gender differences across life-span remains sparse. This paper provides an overview on behavioural changes in human reorientation as effect of gender and age. A total of 340 healthy participants, balanced by gender, were divided into three groups (166 children, 72 young adults, 102 aged adults) and engaged in a virtual version of the Reorientation Paradigm. The task consisted of a learning phase, in which participants acquired spatial information about the position of a target, and of a testing phase, in which participants searched for the hidden target. Performances of the three groups have been compared in: (a) an environment with layout information only, (b) an environment with both layout and featural information, and (c) an environment with featural information only. Accuracy in testing phase (i.e. number of correct searches) and navigation style (i.e. measured as time spent and path lengths, in both learning and testing phase) were evaluated. Results showed an age related effect in all the measures provided. On average, children and aged adults spent more time and cover longer distance with respect to young adults, in both learning and testing phase. In addition, the ability to evaluate spatial information is not completely achieved in children and tends to decrease in aged adults. The interaction between gender and age showed that gender related differences are absent in childhood, but became considerable in adulthood and remain stable in old age. These results are in line with an explanation of gender-related differences in spatial cognition founded on the interaction between biological and environmental/cultural factors.
Article: Sleep Disturbances in Dementia[Show abstract] [Hide abstract]
ABSTRACT: Approximately one quarter of adults with dementia experience sleep disturbances. The purpose of this article is to (a) describe and define sleep disturbances in individuals with dementia, (b) describe techniques to assess for sleep disturbances in individuals with dementia, and (c) provide nursing interventions to improve sleep in this patient population. Typical presentations of sleep disturbances in individuals with dementia are described, along with medications that may interfere with sleep. Suggestions for nursing measures that can be implemented to enhance sleep are also presented. Nurses have numerous nonpharmacological options to assist with the regulation of sleep-wake rhythms in individuals with dementia.
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