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Efficacy of cognitive behavioral therapy for insomnia in geriatric primary care patients

Insomnia is common in older adults and associated with increased mortality and morbidity including depression, anxiety, cognitive decline, and increased risk for falls. Prevalence rates range from 12% to 41%, and are greatest in those with medical problems. Most medications for insomnia are listed in theAmericanGeriatrics Society BeersCriteria as potentially inappropriate for use in older adults due to increased adverse events including falls, fractures, and motor vehicle accidents. Cognitive behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological treatment for insomnia, and is recommended as the first-line treatment by the American College of Physicians and other professional organizations, noting concern about long-term use of hypnotics. CBT-I has been found to be effective in the treatment of insomnia in older adults but most study participants are between 65 and 74 years. It is not knownwhether CBT-I would be acceptable and effective in the “old” (aged 75–84) and the “oldest old” (85 years and older) who often have more medical and psychosocial concerns than those in their 60s and early 70s.