Forensic Nursing Chronicles

Not only is insomnia an issue for the healthy older adult, it can be even worse for the older adult with dementia as they frequently get their sleep/wake cycles confused. Families often call or present at the office requesting sleeping aids. These sleeping aids for healthy elders pose their own risks, but for a dementia patient these risks are increased. Sleep aids often cause confusion, which can lead to increased wander. With increased wandering, there is an increased potential for falls, especially if there are stairs in the home. The likelihood of a patient actually leaving the safety of the home is increased, with the very real possibility of becoming lost. Another issue associated with increased nighttime confusion is often frantic phone calls, most often to adult children/siblings, which can disrupt other households. These phone calls also are known to go to emergency response personnel requiring them to respond to the home for a non-emergency situation. For all these reasons, the use of sedative/hypnotics as sleep aids in the elderly, especially those with dementia, should usually be avoided at all costs. Other pharmacologic interventions, which have been found to be useful with fewer side effects, are trazadone or melatonin. These medications usually work, but the patient can develop a tolerance, requiring higher doses. These medications are not addictive, but higher doses increase side effects. Non- pharmacologic interventions include herbal teas or gentle massage, much as you would do to an infant’s back. The overall goal, of course is return the patient to the appropriate sleep/wake cycle. No one intervention is always effective, and several mat need to be tried. The use of sedative/hypnotics should always be used as an absolute last resort and only for very short periods of time.

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