Health In Aging Blog


Cognitive Behavior Therapy Conducted by Telephone May Ease Arthritis-Related Insomnia

Journal of the American Geriatrics Society Research Summary

A new study revealed that a talk therapy practice conducted by telephone could help older adults who have arthritis-related insomnia sleep better. The study was published in the Journal of the American Geriatrics Society.

Why does this matter?

Insomnia is a difficulty in falling or staying asleep. It affects more than 14 million Americans aged 65 and older. It may lead to daytime problems such as tiredness or fatigue, poor concentration, and daytime sleepiness.

Osteoarthritis (OA) is the most common form of arthritis. It can cause or worsen sleep problems. Older adults may develop arthritis after years of wear and tear on their joints, often due to normal physical activity or past injuries. About half of Americans over the age of 65 have been told they have arthritis by their healthcare provider.

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can be a fast-acting, long-lasting treatment for insomnia in older adults. In fact, studies suggest that CBT is one of the most effective therapies for insomnia. During CBT sessions, you learn to develop new sleep habits and to identify and change any unhelpful sleep habits.

What the Researchers Learned from this Study

The researchers’ interest in this study was inspired by earlier studies that showed strong evidence that  cognitive behavioral therapy is an effective treatment for insomnia. A growing body of evidence suggests that CBT is an especially successful treatment for insomnia that is related to arthritis discomfort.

However, CBT treatment typically requires weekly visits to a therapist’s office, often over several months. For older adults who have insomnia and arthritis, attending therapy sessions in person can be difficult or even impossible.

In this new study, researchers showed that having brief CBT sessions over the telephone was effective for improving arthritis-related insomnia and fatigue over 12 months. They said that the results of their trial showed that telephone CBT reduced the clinical and financial burdens of in-person, arthritis-related CBT insomnia treatment.

Research has shown that telephone CBT can also successfully treat smoking cessation and depression. These results have prompted some health insurance providers to cover CBT phone treatment for certain conditions.

How the Researchers Conducted this Study

The researchers recruited 325 adults aged 60 and over who had moderate to severe insomnia and arthritis pain. The participants were randomly selected to receive one of two treatments. One group received six CBT telephone sessions each week for eight weeks. These participants received coaching on sleep restriction, sleep hygiene, and learned how to restructure their sleep behavior. Participants also got homework assignments to perform.

Participants in the second treatment group received information about sleep and arthritis but did not receive any CBT sleep coaching. Both groups kept sleep diaries.

The researchers collected information on how the participants rated their general health and quality of life according to standard questionnaires. The participants ranked their insomnia status as well as their arthritis pain, stiffness, and ability to function.

After the sessions ended, the researchers said that the people in the CBT group showed improvements in sleeplessness and pain compared to those in the education-only group. They estimated that the cost for the CBT sessions was about $200 per person.

Study Limitations

According to the researchers, no studies exist to show whether CBT for arthritis-related insomnia is a cost-effective treatment. Experts say that there is a strong need for further study in this area. The researchers suggest that further study will help insurers and health care providers decide upon the best treatment decisions and evaluate the cost-effectiveness of CBT telephone treatment for arthritis-related insomnia.

What this Study Means for You

The researchers concluded that phone-delivered CBT significantly improved sleeplessness and pain without increasing total healthcare costs. The researchers said that their findings should encourage healthcare practitioners to consider telephone CBT treatment of insomnia for older adults who also have arthritis.

This summary is from “Cost-Effectiveness of Telephone Cognitive Behavioral Therapy for Osteoarthritis-Related Insomnia.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Kai Yeung, PharmD, PhD; Weiwei Zhu, MS; Susan M. McCurry, PhD; Michael Von Korff, ScD; Robert Wellman, MS; Charles M. Morin, PhD; and Michael V. Vitiello, PhD.

What’s the Best Way to Prevent Falls in Older Adults?

Journal of the American Geriatrics Society Research Summary

An international team of experts compared practices that research has shown to help older adults prevent falls. Their new study, published in the Journal of the American Geriatrics Society, suggests that:

  • Exercise is the most effective method for decreasing the rate of falls in adults aged 65 and older who live independently. It is especially effective in adults aged 75 and older.
  • Exercise and a basic falls risk assessment by your healthcare provider can reduce your risk of breaking bones in a fall. In a falls assessment, your healthcare provider asks you about whether you’ve fallen, the details of the fall, and whether your home environment contributed to the fall. They also evaluate how well you walk and move around, along with your balance and other walking-related issues.

These strategies can also help prevent falls:

  • Using assistive technology and devices. These can include canes, walkers, and devices that can call for help at the touch of a button.
  • Making homes safer by:
    • removing clutter, throw rugs, and other falling hazards
    • improving lighting
    • installing grab bars
    • making other home improvements.

Falls: A Serious Health Problem for Older Adults

Falling, or accidentally and unexpectedly landing on the ground, usually happens in familiar environments while you are doing your normal, daily activities. You may fall when something pushes you, you trip, you lose consciousness (from a seizure, stroke, or other health problem), or you are experiencing the symptoms of a new illness.

Falls have serious consequences. One out of five falls does causes a serious injury, such as a broken bone or a head injury.[1] In older adults, they are the number one cause of hospital admissions for injuries. The older you are, the more likely falls are to threaten your ability to live at home and increase your risk of an early death.

Falls are very common among older adults, especially those who have multiple chronic conditions. An older person falls every second of the day, and one out of three older adults living at home falls every year.

Why the Researchers Studied Fall Prevention Strategies

Falls are such a big problem for older adults that many researchers have studied ways of preventing them. In order to get the big picture of what works best to prevent falls, the researchers of this study did what is called a systematic review and meta-analysis. This means that the researchers looked at the results of multiple studies all at once.

Most of the studies they looked at evaluated programs that used more than one strategy at the same time to prevent falls. Researchers say this study is the first to look at how effective the individual falls prevention strategies are when they are examined separately, instead of together. Understanding and comparing the effects of each strategy can make it easier for healthcare professionals to offer older adults personalized help.

Earlier studies have also failed to include people over the age of 75 and older adults with multiple chronic conditions. Because people in these groups have an especially high risk of falling, it is important to learn more about which falls prevention methods are most effective for them.

What the Researchers Learned

The researchers examined 192 studies that included nearly 100,000 older adults who live independently. Of those studies, 128 included adults between the ages of 75 and 84 years old.  Eleven of the studies included people 85 or older. The studies compared the effects of 63 fall prevention strategies—some individual strategies and some combinations of strategies—to the effects of the care the participants usually received.

Researchers found that that exercise is the most effective individual strategy for decreasing the rate of falls and number of falls in adults aged 65 and older who live independently. It seems to be especially effective in adults aged 75 and older. Strategies that work in combination include exercise, falls risk assessments, the use of assistive devices, and making changes to your home that make it safer.

Study findings also suggest that older adults who exercise and have had falls risk assessments may be less likely to break bones if they fall.

Study Limitations

Over half the studies that the researchers looked at used methods that may have caused biased results.

What This Study Means for You

If you do only one thing to prevent falls and fall-related broken bones, make it exercise.

This summary is from “Interventions for preventing falls and fall-related fractures in community-dwelling older adults: a systematic review and network meta-analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Lauren Dautzenberg, MD, MSc; Shanthi Beglinger, MD, MBiolSci; Sofia Tsokanid, MSc; Stella Zevgitid, PhD; Renee CMA Raijmanna, MD, MSc; Nicolas Rodondib, MD, PhD; Rob JPM Scholtene, MD, PhD; Anne WS Rutjesc, PhD; Marcello Di Nisiog, MD, PhD; Marielle Emmelot-Vonka, MD, PhD; Andrea C Tricco, PhD; Sharon E Straush, MD, MSc; Sonia Thomash, MSc; Lisa Bretagneb, MD, MSc; Wilma Knola, MD, PhD; Dimitris Mavridis, PhD; and Huiberdina L Koeka, MD, PhD.

[1] https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Heart Transplants: Age is No Barrier to Successful Surgery

Journal of the American Geriatrics Society Research Summary

A new study published in the Journal of the American Geriatrics Society suggests that survival rates after heart transplant surgery are similar in adults ages 18 to 69 and adults ages 70 and older.

Researchers examined a large U.S. database of patients who were listed as candidates for surgery to replace their failing hearts with healthier donor hearts. The researchers found that:

  • Only 1 in 50 people who are considered for heart transplant surgery and 1 in 50 people who receive a heart transplant are ages 70 or older.
  • For older adults in the study, the likelihood of surviving one or five years after a heart transplant was about the same as for younger adults.
  • Having a stroke after heart transplant surgery was more common in older adults, but the risk in both age groups was low.
  • Older patients were more likely to receive hearts from higher-risk donors, who are older and more likely to have diabetes and high blood pressure.
  • Advanced age alone should not prevent people from being considered as candidates for heart transplants.

Why We May Need Heart Transplants as We Age Continue reading

Does Listening to Calming Music at Bedtime Actually Help You Sleep?

Journal of the American Geriatrics Society Research Summary

A new study published in the Journal of the American Geriatrics Society has found that listening to music can help older adults sleep better.

Researchers from the National Cheng Kung University Hospital in Taiwan combined the results of past studies to understand the effect that listening to music can have on the quality of older adults’ sleep. Their work suggests that:

  • Older adults (ages 60 and up) living at home sleep better when they listen to music for 30 minutes to one hour at bedtime.
  • Calm music improves older adults’ sleep quality better than rhythmic music does.
  • Older adults should listen to music for more than four weeks to see the most benefit from listening to music.

Why Older Adults Have Trouble Getting a Good Night’s Sleep

As we age, our sleep cycles change and make a good night’s sleep harder to achieve. What does it really mean to get a good night’s sleep? If you wake up rested and ready to start your day, you probably slept deeply the night before. But if you’re tired during the day, need coffee to keep you going, or wake up several times during the night, you may not be getting the deep sleep you need. [1] According to the National Institute on Aging, older adults need seven to nine hours of sleep each night.[2]

But studies have shown that 40 to 70 percent of older adults have sleep problems and over 40 percent have insomnia, meaning they wake up often during the night or too early in the morning.  Sleep problems can make you feel irritable and depressed, can cause memory problems, and can even lead to falls or accidents.

How the Researchers Studied the Effect of Music on Older Adults’ Quality of Sleep

For their study, the researchers searched for past studies that tested the effect of listening to music on older adults with sleep problems who live at home. They looked at five studies with 288 participants. Half of these people listened to music; the other half got the usual or no treatment for their sleep problems. People who were treated with music listened to either calming or rhythmic music for 30 minutes to one hour, over a period ranging from two days to three months.  (Calming music has slow tempo of 60 to 80 beats per minute and a smooth melody, while rhythmic music is faster and louder.) All participants answered questions about how well they thought they were sleeping. Each participant ended up with a score between 0 and 21 for the quality of their sleep.

 The researchers looked at the difference in average scores for:

  • people who listened to music compared to people who did not listen to music;
  • people who listened to calm music compared to people who listened to rhythmic music;
  • and people who listened to music for less than four weeks compared to people who listened to music for more than four weeks.

What the Researchers Learned

Listening to calming music at bedtime improved sleep quality in older adults, and calming music was much better at improving sleep quality than rhythmic music. The researchers said that calming music may improve sleep by slowing your heart rate and breathing, and lowering your blood pressure.[3] This, in turn helps lower your levels of stress and anxiety.

Researchers also learned that listening to music for longer than four weeks is better at improving sleep quality than listening to music for a shorter length of time.

 Limits of the Study

  • Researchers only looked at studies published in English and Chinese, meaning they may have missed studies in other languages on the effect of listening to music on sleep in older adults.
  • Results may not apply to older adults with Alzheimer’s disease or Parkinson’s disease.
  • In the studies researchers used, people who listened to music received more attention from researchers than did people who got standard or no treatment for their sleep problems. This means that sleep improvements in the music therapy group could be due to that extra attention.
  • Since the different studies used different kinds of music, researchers could not single out which type of calming music improved sleep the most.
  • All of the people in the study had similar kinds of sleep problems. This means listening to music may not help people with other kinds of sleep problems.

What this Study Means for You

If you’re having trouble sleeping, listening to music can be a safe, effective, and easy way to help you fall and stay asleep. It may also reduce your need for medication to help you sleep.

This summary is from “Effect of music therapy on improving sleep quality in older adults: A systematic review and meta-analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Chia-Te Chen, NP, MS; Yen-Chin Chen, RN, PhD; Heng-Hsin Tung RN, FNP, PhD; Ching-Ju, Fang, MLIS; Jiun-Ling Wang, MD; Nai-Ying Ko RN, PhD; and Ying-Ju Chang, RN, PhD.

[1] https://www.sleepfoundation.org/how-sleep-works/what-makes-good-night-sleep

[2] https://www.nia.nih.gov/health/good-nights-sleep

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011183/

 

 

 

Physical Activity Reduces Your Risk for Falls

Journal of the American Geriatrics Society Research Summary

Experiencing a fall is one of the most common accidents older adults face: Each year, one-third of people over the age of 65 will fall. Half of these falls cause injuries, including serious ones such as hip fractures and others that require hospitalization.

Researchers have shown that higher levels of physical activity can reduce your risk for a fall. Although you might think that being inactive, or sedentary, is safer for you than being active, it actually contributes to falling.

Common sedentary behaviors include sitting while watching television, using a computer, or riding in a car. To reduce sedentary time, you can use a standing desk, and try devices that remind you when it’s time to get up and move around a bit.

Older adults who are mostly sedentary are likely to suffer poor physical function and other signs of ill health, but we don’t have much research about how sedentary time contributes to your risk for falls. In theory, being sedentary could lead to weakness or loss of stability in your legs and hips, could harm the interaction of your nerves and muscles, or lessen your strength and balance — all of which can lead to falls. Continue reading