http://pubs.jamanetwork.com/ en-us Mon, 13 May 2013 00:00:00 GMT Tue, 14 May 2013 18:45:39 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1657760 Mon, 13 May 2013 00:00:00 GMT Berry SD, Lee Y, Cai S, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>It is important to understand the relationship between sleep medication use and injurious falls in nursing home residents.<div class="boxTitle">Objective</div>To conduct a case-crossover study to estimate the association between nonbenzodiazepine hypnotic drug use (zolpidem tartrate, eszopiclone, or zaleplon) and the risk for hip fracture among a nationwide sample of long-stay nursing home residents, overall and stratified by individual and facility-level characteristics.<div class="boxTitle">Design and Setting</div>Case-crossover study performed in an academic research setting.<div class="boxTitle">Participants</div>The study participants included 15 528 long-stay US nursing home residents 50 years or older with a hip fracture documented in Medicare Part A and Part D fee-for-service claims between July 1, 2007, and December 31, 2008.<div class="boxTitle">Main Outcome Measures</div>Odds ratios (ORs) of hip fracture were estimated using conditional logistic regression models by comparing the exposure to nonbenzodiazepine hypnotic drugs during the 0 to 29 days before the hip fracture (hazard period) with the exposure during the 60 to 89 and 120 to 149 days before the hip fracture (control periods). Analyses were stratified by individual and facility-level characteristics.<div class="boxTitle">Results</div>Among the study participants, 1715 (11.0%) were dispensed a nonbenzodiazepine hypnotic drug before the hip fracture, with 927 exposure-discordant pairs included in the analyses. The mean (SD) age of participants was 81.0 (9.7) years, and 77.6% were female. The risk for hip fracture was elevated among users of a nonbenzodiazepine hypnotic drug (OR, 1.66; 95% CI, 1.45-1.90). The association between nonbenzodiazepine hypnotic drug use and hip fracture was somes greater in new users (OR, 2.20; 95% CI, 1.76-2.74) and in residents with mild vs moderate to severe impairment in cognition (OR, 1.86 vs 1.43; P = .06), with moderate vs total or severe functional impairment (OR, 1.71 vs 1.16; P = .11), with limited vs full assistance required with transfers (OR, 2.02 vs 1.43; P = .02), or in a facility with fewer Medicaid beds (OR, 1.90 vs 1.46; P = .05).<div class="boxTitle">Conclusions and Relevance</div>The risk for hip fracture is elevated among nursing home residents using a nonbenzodiazepine hypnotic drug. New users and residents having mild to moderate cognitive impairment or requiring limited assistance with transfers may be most vulnerable to the use of these drugs. Caution should be exercised when prescribing sleep medications to nursing home residents.</span> 173 9 754 761 10.1001/jamainternmed.2013.3795 http://pubs.jamanetwork.com/article.aspx?articleID=1657760 http://pubs.jamanetwork.com/article.aspx?articleID=1657762 Mon, 13 May 2013 00:00:00 GMT Widera E. <span class="paragraphSection">Sleep in nursing homes is both cherished yet fleeting. Most nursing home residents complain about the quality of their sleep, which is notable for multiple nighttime awakenings, frequent daytime naps, and a high percentage of time spent awake in bed. This fragmented nature of sleep can be attributed to multiple causes, including a high prevalence of primary sleep disorders (eg, central sleep apnea) and a care environment that pays little attention to sleep quality and structure.</span> 173 9 761 762 10.1001/jamainternmed.2013.3801 http://pubs.jamanetwork.com/article.aspx?articleID=1657762