Insomnia in Long-Term Care Facilities: A Comparison of Seven European Countries and Israel: The Services and Health for Elderly in Long TERm care Study

Objectives To assess insomnia and its correlates as part of the Services and Health for Elderly in Long TERm care (SHELTER) study, funded by the 7th Framework Programme of the European Union. Design Cross-cultural investigation. Setting Long-term care facilities (LTCFs) in eight European countries (Czech Republic, France, Finland, Germany, England, the Netherlands, Italy) and one non-European country (Israel). Participants Elderly residents (N = 4,156) of 57 LTCFs. Measurements Information on insomnia, age, sex, activities of daily living (ADLs), cognitive status, depression, major stressful life events, physical activity, fatigue, pain, and sleep medication use was extracted from the International Resident Assessment Instrument (interRAI)LTCF instrument. Rates of insomnia and its correlates were analyzed. Multivariate logistic regression was used to assess factors associated with insomnia, controlling for demographic variables. Results The prevalence of insomnia was 24% (range 13-30%), with significant differences between countries (P <.001). More insomnia complaints were reported in older than younger residents (P <.001). Higher rates of insomnia were associated with hypnosedatives and depression in all countries (P <.001) and with stressful life events, fatigue, and pain in most countries (P <.001). No associations were found between insomnia and ADLs, physical activity, or cognitive status. Age, depression, stressful life events, fatigue, pain and hypnosedatives were independent significant predictors of insomnia, controlling for all other variables and for country. Conclusion Hypnosedatives and depression were strong predictors of insomnia beyond cultural differences. Overall, psychosocial variables were more strongly related to insomnia than functional and mental capacities.