© 1997 Oxford University Press
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Longitudinal trends in late-life insomnia: implications for prescribing
Centre for Ageing and Rehabilitation Studies, University of Sheffield Northern General Hospital, Sheffield S5 7AU, UK
1Department of Health Care of the Elderly, University of Nottingham Medical School, Queen's Medical Centre Nottingham NG7 2UH, UK
Address correspondence to: K. Morgan. Fax: (+;44) 114 271 5771
OBJECTIVE:: to assess trends in insomnia and hypnotic drug use in a representative sample of elderly general practice patients.
DESIGN:: longitudinal study with three interview waves—1985, 1989 and 1993.
SETTING:: urban and suburban Nottingham.
PARTICIPANTS:: 1042 patients originally aged 65 and over randomly sampled from general practitioner lists.
MAIN OUTCOME MEASURES:: point prevalence estimates, status (case/non-case/died) at 4-year follow-up, episode incidence and survival functions.
RESULTS:: at baseline (1985) 221 respondents met the survey criteria for insomnia. Of these, 36.1% continued to report severely disrupted sleep in 1989. Within this period 84 new cases of insomnia were identified (an incidence rate of 3.1% per person-year at risk). Controlling for age and sex, insomnia was unrelated to survival among prevalent cases, but significantly related to survival among incident cases (odds ratio =1.7; 95% confidence interval = 1.1–2.5). Of 166 respondents using prescription hypnotics in 1985, 31.7% continued to report usage in 1989. Similarly, out of 41 new hypnotic drug users identified in 1989, 29.3% continued to report usage in 1993.
CONCLUSIONS:: important clinical differences in the natural history of insomnia are evident when incident and prevalent cases are compared. Nevertheless, outcomes at 4-year follow-up suggest that, for the majority of surviving cases identified in a prevalence screen and for a substantial minority of incident cases, late-life insomnia shows a level of chronicify incompatible with hypnotic drug therapy as currendy recommended.
Keywords: ageing, epidermiology, hypnotics, incidence, insomnia
Received September 26, 1996;
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