Advisor(s)
S Justin Thomas
Committee Member(s)
Christopher Henrich
Victor Del Bene
School
College of Arts and Sciences
Document Type
Thesis
Department (new version)
Psychology
Date of Award
6-4-2025
Abstract
Older adults are more likely to have symptoms of insomnia than other age ranges. Ensuring an appropriate clinical response to insomnia in older adults is vital to their health and well-being. This paper addresses the assessment and treatment of insomnia symptoms in older adults in two separate studies analyzing data from the AMBulatoRy blOod preSsure In older Adults (AMBROSIA) study, which recruited older adults (≥65 years old) who had hypertension and were living in Southern California. The first study aimed to investigate the ability of the insomnia severity index (ISI), a standard self-report measure used to assess insomnia symptoms, to accurately assess sleep patterns reflective of insomnia seen on actigraphy data in a sample of 180 older adults. Results of this study found older adults tended to underreport insomnia symptom severity on the ISI, and variation in ISI response based on sleep efficiency (SE) was moderated by cognitive impairment such that older adults who were cognitively impaired showed no difference on ISI score depending on SE, while older adults who were not cognitively impaired reported more insomnia symptoms when SE was low. These results indicate that older adults are not responding consistently to the ISI in relation to their actual sleep. The use of objective sleep measures (specifically using actigraphy) in assessment may give a more accurate picture of insomnia symptom severity in older adults. The second study aimed to investigate differences in insomnia severity, cognitive impairment, and fall risk among types of hypnotic use (none, over-the-counter, prescription, or both). Analyses used data from a sample of 250 older adults. Results of this study found no association between hypnotic use type and cognitive impairment, higher insomnia severity in over-the-counter and both hypnotic use groups, and increased risk of falling in older adults taking both over-the-counter and prescription hypnotics. These results indicate over-the-counter hypnotics may not be effective in the treatment of insomnia symptoms for older adults. Additionally, with potential risks, clinicians should advise against combining them with prescription hypnotics. Finally, these findings suggest that over-the-counter medications should be included in research investigating polypharmacy.
ProQuest ID
Recommended Citation
Ward, Katherine C., "Balancing The Clinical Response To Sleep Disturbance In Adults 65 And Older" (2025). All ETDs from UAB. 7332.
https://digitalcommons.library.uab.edu/etd-collection/7332
