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26-05-2013 | Sleep medicine | Article

Insomnia may increase health service use in older adults


Free abstract

medwireNews: Insomnia symptoms in middle-aged and older adults are associated with increased use of healthcare services, find researchers, who say that treatment of such symptoms could greatly reduce costly health service use among these individuals.

Compared with individuals with no insomnia symptoms, those reporting one symptom were a significant 1.28 times more likely to use any health service, and those reporting two or more symptoms were 1.72 times more likely, after adjusting for age, gender, race, and education.

The researchers, led by Adam Spira (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA), note that if the relationship between insomnia and health service use was causal - something they were unable to conclude from their findings - preventing insomnia in this population could mean a 6% to 14% decrease in health service use.

"Under this scenario, treating insomnia might decrease the patient load in many health care settings and lead to significant health care cost savings," they report in the Journal of Gerontology: Medical Sciences.

A total of 14,355 adults aged 55 years and older participated in the Health and Retirement study and responded to questions such as whether they had trouble falling asleep, waking during the night, and waking early and not able to fall asleep again. Of these, 8441 (59%) reported no insomnia symptoms, 3392 (24%) reported one symptom, and 2522 (18%) at least two symptoms.

Patients with one insomnia symptom had a significantly greater risk for hospitalization and home healthcare service use than those with no symptoms, at respective odds ratios of 1.28 and 1.29, after adjusting for age, gender, race, and education.

Those reporting at least two insomnia symptoms also had a significantly greater risk for nursing home use than those reporting no symptoms, at an odds ratio of 1.45, as well as 1.71 for hospitalization and 1.64 for home healthcare use.

After further adjustment for the variables heart attack, stroke, hypertension, diabetes, cancer, osteoarthritis, and depression, only the associations between insomnia and hospitalization remained significant.

This finding suggests that "insomnia may simply be a marker of poor health status," note the researchers. "However, it is also possible that insomnia exacerbates the severity of underlying health conditions resulting in increased service utilization."

They believe that "the assessment and recognition of insomnia by clinicians might help identify individuals at greater risk of hospitalization and other costly services."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter