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Melatonin Prescribing in Assisted Living.

Punita Peketi1, Sheryl Zimmerman2, Stephanie Palmertree3

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Melatonin prescribing is common in assisted living (AL) facilities, with 9% of residents receiving prescriptions. Prescribing patterns vary by community characteristics, suggesting potential for improved care practices for sleep disturbances in AL.

Keywords:
Assisted livingmedicationprescribing

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Area of Science:

  • Gerontology and Geriatric Medicine
  • Sleep Medicine
  • Pharmacology in Long-Term Care

Background:

  • Sleep problems, including insomnia, are highly prevalent among residents in assisted living (AL) facilities.
  • Melatonin use for sleep disorders is common in older adults, but its prescribing patterns and implications in AL settings are largely unknown.
  • Concerns exist regarding potential side effects and drug interactions of melatonin in this vulnerable population.

Purpose of the Study:

  • To determine the prevalence of melatonin prescribing among residents in assisted living communities.
  • To identify community- and resident-level factors associated with melatonin use in AL.
  • To inform potential modifications in care practices for managing sleep disturbances in AL residents.

Main Methods:

  • A cross-sectional study involving chart abstractions and interviews with administrators and health care supervisors in 250 randomly selected AL communities across the US.
  • Data were collected from 5,777 residents and weighted to represent over 150,000 residents in approximately 4,000 communities.
  • Weighted analyses examined associations between melatonin prescribing and community characteristics (e.g., staffing) and resident factors (e.g., diagnoses, other medications).

Main Results:

  • Melatonin was prescribed in 82% of AL communities, with higher rates in facilities with on-site nursing staff and favorable attitudes toward non-pharmacologic practices.
  • Approximately 9% of AL residents were prescribed melatonin, with increased likelihood in residents with dementia, psychiatric disorders (especially anxiety), behavioral expressions, or those taking other psychotropic medications.
  • Co-prescription of melatonin with antidepressants was common (OR 2.64).

Conclusions:

  • Melatonin prescribing is a common practice in assisted living facilities, highlighting a significant area for clinical attention.
  • Prescribing practices vary based on organizational factors, indicating that care approaches may be modifiable.
  • Further research is needed to evaluate the benefits, risks, and interactions of melatonin in AL residents to optimize sleep disorder management.