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Caring for the Elderly in an Inpatient Setting: Managing Insomnia and Polypharmacy

From the University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, North Carolina (JK, TST, HP); Wake Area Health Education Center, Raleigh, North Carolina (TST); Department of Pharmacy, UNC Hospitals, Chapel Hill, North Carolina (HP).

Correspondence: Toyin S. Tofade, University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC 27514; e-mail: ttofade{at}wakemed.org.

Caring for the elderly in an inpatient setting can be difficult because of the lack of literature to provide clinical guidelines addressing issues in this population. Insomnia and polypharmacy are common concerns. This article addresses these concerns by highlighting key points from the available literature. Insomnia may be a problem in the elderly because of their increased sensitivity to changes in environment among other factors. First, obtain a sleep history and a comprehensive medical and medication history to identify the cause. Next, treat the underlying cause with nonpharmacological interventions to restore restful and qualitative sleep. When nonpharmacological interventions are not successful, pharmacological means are indicated. Remember to start low, go slow, and treat for a short duration of time (less than 4 weeks) to avoid withdrawal or rebound insomnia. First-line agents are trazodone, triazolam, temazepam, and lorazepam followed by zaleplon and zolpidem. As people age, it is common for them to have multiple chronic comorbidities, which may result in polypharmacy and an increased risk of adverse events. Clinical practitioners should identify and prevent potential complications of polypharmacy. This should prevent further hospitalizations, decrease health care costs, and ultimately improve the quality of care in the elderly.

Key Words: elderly • insomnia • inappropriate medications • polypharmacy

This version was published on October 1, 2009

Journal of Pharmacy Practice, Vol. 22, No. 5, 494-506 (2009)
DOI: 10.1177/0897190008330199


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