April 13, 2015 by Oscar E Rodriguez, MD from Reassure Analytics
Do but consider what an excellent thing sleep is...that golden chain that ties health and our bodies together. ~Thomas Dekker
The 17th Century English Dramatist Thomas Dekker probably didn’t realize how right he truly was about the importance of sleep; especially for the health and well-being of our elderly loved ones. A recent study published by Dr. Katie Stone and her colleagues in the Journal of the American Geriatrics Society demonstrated that elderly men who failed to get sufficient quality sleep at night were at an increased risk of suffering a potentially debilitating fall during the day.
Our elderly loved ones don’t need more sleep than the 7 to 9 hours typically recommended for their younger adult counterparts, however they often get less quality sleep than they need. Anxiety due to retirement concerns or loss of spouse, arthritic discomfort, sleep apnea, frequent urination at night and/or urinary incontinence, all can contribute to the difficulty in falling asleep; the decreased time spent in deep sleep and the increased number of awakenings, 3 - 4 on average a night, experienced by our elderly loved ones. As many as 50% of older community-dwelling men and women surveyed in the 2003 National Sleep Foundation Sleep in America Survey reported some form of sleep disturbance and The National Institute on Aging’s Established Populations for Epidemiological Studies of the Elderly estimates that 42% community-dwelling seniors suffer from insomnia.
The actual number of older adults suffering from sleep disturbances, however, could be significantly higher. First, the reported numbers in these studies rely on the elderly participants to self-report accurately and honestly on their sleep, an activity during which they are not conscious. Second, it has been traditionally thought, until recently, that decline in sleep need and quality with age was normal. As such, many elderly may not report their sleep issues because they think that it is just part and parcel with getting older. Lastly, some elderly loved ones may not report their ailments because they simply don’t want to be a burden.
The extent of poor quality sleep being experienced by a large proportion of our elderly loved ones is alarming given associated increase risk of falls revealed in Dr. Stone’s study.
One out of three of our elderly loved ones falls each year, less than half of which are reported, and these falls are the leading cause of both fatal and nonfatal injuries. Falls are the most common cause of hip fractures and traumatic brain injury (TBI) among the elderly and about half of the fatalities due to fall are because of TBI.
Participants in Dr Stone’s study who had 5 hours or less of actual measured sleep had twice the risk of suffering recurrent falls during the day while those who slept 5 to 7 hours still had 1.4 times greater risk of experiencing falls compared to those elderly participants who slept 7 to 8 hours. The study also found that even disturbed sleep can increase the risk of recurrent falls in our elderly loved ones. Those elderly participants in the study who experienced restlessness for greater than 30% of their total sleep time (eg. approximately 2 hours of restlessness during 6 hours of sleep) had a 56% greater risk of recurrent falls than those who did not. Unfortunately, these objective sleep symptoms are difficult to catch because they happen at night when no one is watching your elderly loved ones. Moreover, as described above, many older adults may not want to report these symptoms or be able to report on them accurately. Dr Stone’s study also suggests that if your elderly loved complains of excessive sleepiness during the day they may be at a 52% to 73% increased risk of falling.
Sleep in our elderly loved ones is as important as any therapy, activity or medication they take to keep them healthy and safe from potentially debilitating and/or fatal falls.
Oscar Rodriguez, MD is a Co-Founder of Reassure Analytics, where they focus on helping others engage in the care of their loved ones with the use of Care|Mind, an iOS app.He's has over a decade of experience in the healthcare industry, where he has surgically trained at Cedar Sinai in Los Angeles and held various roles at a Fortune 500 healthcare provider. Oscar has a BS in Biology from Duke University, MD from New York Medical College and Universidad Autónoma de Guadalajara School of Medicine, and MBA from UCLA.