Functional status in the elderly with insomnia.
BACKGROUND: Insomnia causes psychological distress in the elderly. Besides primary insomnia (PI), illness, medications and psychosocial factors contribute to development of sleep disorders. Although elderly insomniacs usually complain of poorer daytime functioning, it is unknown whether the disorder affects capacity to carry out activities. OBJECTIVE: To assess the relationship in the elderly between PI, level of physical functioning, depression and anxiety symptoms, state of psychological well-being and consumption of psychopharmaceuticals. DESIGN: Cross-sectional, observational study. SETTING: Populational. SUBJECTS: About 424 non-institutionalized elderly patients. METHODS: Subjects were interviewed at public Health Centres or at home. They were considered to have PI if DSM-IV criteria were met. The remaining variables measured were: depression and anxiety symptoms (The Goldberg's Depression and Anxiety Scale), cognitive state (Short Portable Mental Status Questionnaire), physical functioning (The Katz Index and the Instrumental Activities of Daily Living Scale), life satisfaction (The Philadelphia Geriatric Center Morale Scale), health problems, consumption of pharmaceuticals and sociodemographic variables. RESULTS: About 34.2% of the elderly admitted to having problems with sleep, but only 20.3% (CI: 95%: 16.5-24.1) fulfilled the criteria for PI. The existence of an anxiety disorder, a score below the 50th percentile on The Philadelphia Geriatric Center Morale Scale (lower life satisfaction) and consumption of psychopharmaceuticals were variables associated with insomnia. Amongst the most common illnesses reported, only diabetes appeared with significantly higher frequency in the elderly with insomnia (24.4% vs. 14.7%) (p < 0.05). No statistically significant association was found between insomnia and level of dependence in carrying out basic or instrumental activities. CONCLUSIONS: Approximately one fifth of the non-institutionalized elderly meet the criteria for PI. Those affected present a poorer state of psychological and social well-being, although level of autonomy for conducting basic and instrumental activities does not appear to be modified by the disorder. The existence of an anxiety disorder, low life satisfaction and consumption of psychopharmaceuticals constitute variables associated with PI in the population we studied.