As patients cope with the burden of often multiple chronic conditions, they present their physicians with common complaints that may have a disproportionate impact on their quality of life. These complaints may have multiple causes, and management needs to take into account the multifactorial nature of the cause. Sometimes treating underlying causes can relieve symptoms, but often the symptoms must be managed independently. We have included in this chapter several of the most common complaints that may have dire consequences if left untreated, and outlined an approach to diagnosis and management.

INSOMNIA

As many as 50% of older adults suffer from insomnia. Patients may complain of difficulty falling asleep, frequent nocturnal or early morning awakening, or not feeling rested after sleep. Insomnia may have severe consequences: Studies have shown increased risk of cognitive impairment, poor self-perceived health, falls, and depression. Prevalence is higher in women, especially women who are divorced or widowed, as well as nursing home residents, demented individuals, and elders with psychiatric illness. Insomnia is usually chronic: Most of those affected will still have insomnia in 2 years. On the other hand, there is evidence that healthy elders have little or no increase in prevalence over the general population.

Sleep architecture changes with age. Stages 3 and 4, or deep sleep, almost disappear, replaced by lighter Stage 1. Circadian rhythm is shifted earlier, so that older adults may fall asleep early in the evening and awaken at 3 or 4 am.