Sleep in hospitalized elders: a pilot study.

Geriatr Nurs. 2010 Jul-Aug;31(4):263-71

Authors: Missildine K, Bergstrom N, Meininger J, Richards K, Foreman MD

Hospitalized elders frequently experience disturbed sleep related to environmental factors. To determine relationships between sleep and environmental noise and light, a descriptive exploratory study was conducted with 48 hospitalized older adults. Participants aged 70 years or older were monitored for sleep via wrist actigraphy, and noise and light levels were measured the first night of hospitalization. Sleep time was brief (mean, 3.75 hours) and fragmented (mean, 13 awakenings per night). The sleep environment was noisy with a median sound level of 49.65 dB(A). There was an average of 3 periods of elevated light levels (mean, 64 lux) lasting an average of 1.75 hours each night. No significant correlation was found among sleep and age, light, and sound. Recommendations include light and sound reduction measures and dedicated “do not disturb” times to allow for a full 90-minute sleep cycle.

PMID: 20682404 [PubMed - indexed for MEDLINE]

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The initial examination of the efficacy of low-dose promethazine for the treatment of nausea and vomiting in the hospitalized elderly.

Geriatr Nurs. 2010 Mar 4;31(2):115-22

Authors: McClintock GH, LaReau RM, Watcharotone K, DeMaagd G

The purpose of this study was to assess efficacy and safety of 3 doses (6.25 mg, 12.5 mg, 25 mg) of intravenous (IV) promethazine in treatment of established nausea and vomiting (N/V) in hospitalized elderly patients. Study participants aged > or =65 years received at least 1 dose of IV promethazine for treatment of N/V. Outcomes were degree of efficacy and safety. Efficacy was measured by time to relief and whether relief occurred. Safety was measured by the incidence of adverse drug reactions (ADRs). The results showed no difference in the time to relief and proportion of patients who felt relief between the 6.25-mg and 12.5-mg groups. The median frequency of ADRs in the 6.25-mg group, based on total administrations, was significantly less than the 12.5-mg group (P = .048). This study suggests a starting dose of 6.25 mg IV promethazine is as effective as higher doses and has fewer ADRs.

PMID: 20381712 [PubMed - indexed for MEDLINE]

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Evaluating the relationship between inattention and impulsivity-related falls in hospitalized older adults.

Geriatr Nurs. 2010 Jan-Feb;31(1):8-16

Authors: Harrison BE, Ferrari M, Campbell C, Maddens M, Whall AL

Impulsivity in older adults is poorly understood and there is limited literature on the relationship between impulsivity and falls. This retrospective study evaluated the relationship between of inattention and impulsivity related falls (IRF) in hospitalized older adults. The sample (N = 192) included patients 65 years and older with a documented in-patient fall in 2007. “Impaired judgment” was identified as the critical attribute of IRF. The Confusion Assessment Method item for inattention was extracted as the variable for inattention. Twenty-eight percent (28%) of falls were classified as IRF. A significant relationship was found between inattention on the shift prior to a fall and the fall being an IRF (Chi-square = 45.5, df = 1, p = .00, Phi = .54, p = .00). Early identification of older adults with impaired attention has potential to reduce IRF when nursing uses this assessment to implement additional safety interventions for hospitalized older adults.

PMID: 20159349 [PubMed - indexed for MEDLINE]

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Central nervous system medication changes and falls in nursing home residents.

Geriatr Nurs. 2009 Sep-Oct;30(5):334-40

Authors: Sorock GS, Quigley PA, Rutledge MK, Taylor J, Luo X, Foulis P, Wang MC, Varadhan R, Bellantoni M, Baker SP

We investigated the role of changes in 6 mutually exclusive medication categories on the risk of falling in nursing home residents. The 6 categories were: gastrointestinal, hypoglycemics, antibiotics, central nervous system (CNS) acting, cardiovascular disease agents, and analgesics. A change was defined as a new start, a dose change, an as-needed dose, or a discontinuation. Incident reports were used to determine the fall date and time. Medication records were abstracted to identify the date of changes before the date of each fall. The 158 residents who fell had 419 recorded falls during 2002 and 2003; they were on average 80.5 years old (SD 8.1; range 65-103), and 67% were men. Within 1-3 days of a change in any CNS medication (antipsychotic, sedative, antidepressant, or antiseizure), the fall risk (odds ratio) increased 3.4-fold (95% confidence interval 1.2-9.5) using 7-9 days prior as comparable control days. No changes in other medication categories had a significant effect on fall risk. These data suggest that the risk of falls among nursing home residents is significantly elevated within 3 days of a CNS medication change.

PMID: 19818269 [PubMed - indexed for MEDLINE]

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