Associations of Insomnia Symptoms with Subsequent Health Services Use among Community-Dwelling U.S. Older Adults.

STUDY OBJECTIVES Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults. METHODS Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e., sleep onset latency >30 minutes, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits. RESULTS Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with 2 insomnia symptoms had a higher odds of ED visits (Odds Ratio [OR)=1.60, 95% Confidence Interval [CI]=1.24-2.07, p<0.001), hospitalizations (OR=1.29, 95% CI=1.01-1.65, p<0.05), and 30-day readmissions (OR=1.88, 95% CI=1.88-3.29, p<0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (Incidence Rate Ratio (IRR)=1.52, 95% CI=1.23-1.87 p<0.001; IRR=1.21, 95% CI=1.02-1.44 p<0.05, respectively) after adjusting for demographic and health characteristics. CONCLUSIONS Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.