The relationships between sleep disturbance and falls: A systematic review.

The purpose of this systematic review was to examine critically the literature that addresses the association between sleep disturbance and falls. Electronic databases OVID MEDLINE, PubMed, and CINAHL were searched using MeSH terms "sleep" and "accidental falls." Search limits included adults, humans, and English. The articles selected for the final sample were assessed for methodological quality. Eleven key attributes of sleep disturbance were extracted. The search yielded 177 articles from OVID MEDLINE, 124 from PubMed, and 46 from CINAHL. The final sample included 42 papers. The mean methodological quality score was 7.5 (range 2-10). Those who self-report >11 h or ≤5 h of nocturnal sleep duration may have a greater fall risk, but variations in cutoff points, study designs, and data collection methods contribute to difficulty in comparing study results. Subjective sleep fragmentation is associated with falls. The few studies on obstructive sleep apnea and insomnia demonstrate evidence of an increased risk for falls. It remains unclear whether daytime sleepiness, self-reported sleep quality, snoring, or napping are associated with falls, since some but not all studies demonstrate an association and the study quality did not differ.

The challenges of enrolling older adults into intervention studies.

Adults aged 65 years or older have been routinely and systematically excluded from research. With the number of older adults at a record high and growing faster than any other age group, there must be an increased priority on meeting the enrollment challenges so intervention studies are relevant to this population. The challenge centers around the complexity and heterogeneity of older adults, leaving a gap between older adults who participate in studies and those who exist in the real world. Barriers to enrollment stem from both the researcher and participant side. Eight barriers from the research perspective and six from the participant perspective are identified and discussed. Solutions to these barriers can be approached from a three-tier framework. The lowest tier is direct solutions to problems, the middle involves support from funders and journals, and the top tier considers a comprehensive view of sampling and design decisions.