Disorders In Later Life Research Articles

Impact of Retirement on Mental Health

Impact of Retirement on Mental Health

Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life.

Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.

Schema therapy for personality disorders in older adults: a multiple-baseline study

ABSTRACTObjective: No studies have been conducted yet into the effectiveness of treatment of personality disorders in later life. This study is a first test of the effectiveness of schema therapy for personality disorders in older adults.Method: Multiple-baseline design with eight cluster C personality disorder patients, with a mean age of 69. After a baseline phase with random length, schema therapy was given during the first year, followed by follow-up sessions during six months. Participants weekly rated the credibility of dysfunctional core beliefs. Symptomatic distress, early maladaptive schemas, quality of life and target complaints were assessed every six months and personality disorder diagnosis was assessed before baseline and after follow-up. Data were analyzed with mixed regression analyses.Results: Results revealed significant linear trends during treatment phases, but not during baseline and follow-up. The scores during follow-up remained stable and were significantly lower compared to baseline, with high effect sizes. Seven participants remitted from their personality disorder diagnosis.Conclusion: Schema therapy appears an effective treatment for cluster C personality disorders in older adults. This finding is highly innovative as this is the first study exploring the effectiveness of psychotherapy, in this case schema therapy, for personality disorders in older adults.

The psycho-geriatric patient in the Emergency Room (ER) of the Maggiore della Carità Hospital in Novara

IntroductionDue to population aging, the health system will face increasing challenges in the next years. Concerning mental disorders, they are major public health issues in late life, with mood and anxiety disorders being some of the most common mental disorder among the elderly. For this reason, increasing attention has to be paid to the evaluation of the elderly in psychiatry emergency settings.ObjectivesTo evaluate the socio-demographic and clinical features of over 65 patients referred to psychiatric consultations in the ER of “Maggiore della Carità” Hospital in Novara, in a 7 years period.AimsThe analysis of the characteristics of the study sample could be potentially useful in resource planning in order to better serve this important segment of the general population.MethodsDeterminants of ER visits for over 65 patients referred to psychiatric evaluation were studied retrospectively from 2008 to 2015.ResultsElderly patients made up 14,7% (n = 458) of all psychiatric evaluation in the ER (n = 3124). About two thirds (65,9%) were females and one third were males (34,1%). The mean age of patients recruited was 75.11 years. The majority of subjects (68.6%) presented without a diagnosis of Axis I according to DSM-IV. The other most frequent diagnosis was “cognitive disorders” (11.4%) and “mood disorders” (10.9%).ConclusionsThe large proportion of patients without a diagnosis of Axis I, could be related to the misunderstanding of the psychosocial aspects of aging. Preliminary results highlight the importance of research on this topic, considering population aging and the impact of mental disorders in late-life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Diagnoses Among Older Recipients of Publicly Funded Mental Health Services.

To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety-net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county. Secondary analysis of county human services claims data and claims from an insured population in the same county. Inpatient and outpatient clinics in Allegheny County, PA. Adults aged 65 and older in the county who received treatment for a psychiatric diagnosis in 2012 (county base services, n = 1,457; Medicaid, n = 641; Health plan insurance, n = 5,595). Psychiatric diagnoses were classified using the International Classification of Diseases, 9th revision (ICD-9). Episodic mood disorders and schizophrenia were more common among county-funded and Medicaid recipients (50-54% vs 34%). Neurotic conditions were more common among older adults with health plan insurance (18% vs 8%). Nearly a quarter of older adults receiving county base services were classified as having "ill-defined and unknown causes of morbidity and mortality," compared <1% among insured and 6% among Medicaid recipients. The prevalence of psychiatric conditions among older adults varies by insurance coverage, suggesting a role for social and economic factors associated with safety net coverage as well as system-level differences in delivery of mental health services. Comparing the prevalence of psychiatric diagnoses across insurance types offers insight on social determinants of risk for mental disorders in late life.

Neck circumference measurement as a screening tool for obesity in children

Background: Childhood obesity is a rising epidemic and a major public health problem with the risk for type 2 diabetes mellitus, hypertension and cardiovascular disorders in later life. Neck circumference (NC), a marker of upper body subcutaneous adipose tissue distribution can predict higher metabolic risk. The aim of the present study was to evaluate the association between neck circumference (NC) and obesity.Methods: This cross-sectional prospective observational study was conducted in Bangalore in the month of October 2016. 172 male and 161 female students, aged 13-17 years were screened. Anthropometric markers of obesity measured included body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and compared with neck circumference (NC) of the same subjects. Pearson’s correlation coefficient was calculated between neck circumference and other obesity indices, and receiver operating characteristic curve analysis was used to determine the best cutoff value of neck circumference in predicting high BMI. Results: Overall, 13.2% boys and 9.9% girls were found overweight/obese. The mean BMI was 25.27±2.09kg/m2 and25.17±2.23kg/m2, mean neck circumference was 33.43±2.3cm and 31.50±1.4 in overweight/obese boys and girl respectively. All of the anthropometric parameters were found to be significantly higher in overweight/obese children than with their normal weight peers and higher in boys compared to girls. The neck circumference in boys was significantly greater than girls and higher in overweight/obese with P&lt;0.001. The best cut-off value of neck circumference by ROC to identify boys with a high BMI was 32cm with sensitivity of (81.82%), specificity (89.06%), and for girls was 30cm with sensitivity of (84.85%), specificity (87.5%). Neck circumference had a strong positive correlation with other anthropometric measures BMI, WC, waist hip ratio in both boys and girls (p &lt;0.001).Conclusions: Neck circumference significantly correlated with other indices of obesity. It can be used with great reliability to screen overweight and obesity in children. NC can be considered as a simple, time saving and inexpensive clinical tool for detection of obesity in large population-based studies in children and adolescents.

The impact of frailty on depressive disorder in later life: Findings from the Netherlands Study of depression in older persons

BackgroundPhysical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown. MethodsA cohort of 378 older persons (≥60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination. ResultsFor each additional frailty component, the odds of non-remission was 1.24 [95% CI=1.01–1.52] (P=040). Linear mixed models showed that only improvement of the motivational (P<001) subscale and the somatic subscale (P=003) of the IDS over time were dependent on the frailty severity. ConclusionsPhysical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.

Consequences of early adverse rearing experience(EARE) on development: insights from non-human primate studies.

Early rearing experiences are important in one's whole life, whereas early adverse rearing experience (EARE) is usually related to various physical and mental disorders in later life. Although there were many studies on human and animals, regarding the effect of EARE on brain development, neuroendocrine systems, as well as the consequential mental disorders and behavioral abnormalities, the underlying mechanisms remain unclear. Due to the close genetic relationship and similarity in social organizations with humans, non-human primate (NHP) studies were performed for over 60 years. Various EARE models were developed to disrupt the early normal interactions between infants and mothers or peers. Those studies provided important insights of EARE induced effects on the physiological and behavioral systems of NHPs across life span, such as social behaviors (including disturbance behavior, social deficiency, sexual behavior, etc), learning and memory ability, brain structural and functional developments (including influences on neurons and glia cells, neuroendocrine systems, e.g., hypothalamic-pituitary-adrenal (HPA) axis, etc). In this review, the effects of EARE and the underlying epigenetic mechanisms were comprehensively summarized and the possibility of rehabilitation was discussed.

Perinatal programming and cardiomyocyte aging

The developmental origins of health and disease hypothesis suggests that the conditions for the development of the organism in the prenatal and early postnatal periods thus affect the expression of genes that program the early onset of cardiovascular and metabolic diseases. Experimental studies demonstrate the major role of epigenetic mechanisms (gene methylation) in this scenario. The review provides data showing that perinatal programming can accelerate aging processes, resulting in early onset of these diseases. It considers the importance of fetal hypoxia as a factor leading to the birth of babies at increased risk for abnormalities of the brain, heart, liver, and kidney, as well as for hypertension and metabolic disorders in later life. The role of oxidative stress and reactive oxygen species in the processes of perinatal programming is discussed.

Bullying Mediates Between Attention-Deficit/Hyperactivity Disorder in Childhood and Psychotic Experiences in Early Adolescence.

Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.

Intrinsic brain abnormalities in young healthy adults with childhood trauma: A resting-state functional magnetic resonance imaging study of regional homogeneity and functional connectivity.

Childhood trauma confers great risk for the development of multiple psychiatric disorders; however, the neural basis for this association is still unknown. The present resting-state functional magnetic resonance imaging study aimed to detect the effects of childhood trauma on brain function in a group of young healthy adults. In total, 24 healthy individuals with childhood trauma and 24 age- and sex-matched adults without childhood trauma were recruited. Each participant underwent resting-state functional magnetic resonance imaging scanning. Intra-regional brain activity was evaluated by regional homogeneity method and compared between groups. Areas with altered regional homogeneity were further selected as seeds in subsequent functional connectivity analysis. Statistical analyses were performed by setting current depression and anxiety as covariates. Adults with childhood trauma showed decreased regional homogeneity in bilateral superior temporal gyrus and insula, and the right inferior parietal lobule, as well as increased regional homogeneity in the right cerebellum and left middle temporal gyrus. Regional homogeneity values in the left middle temporal gyrus, right insula and right cerebellum were correlated with childhood trauma severity. In addition, individuals with childhood trauma also exhibited altered default mode network, cerebellum-default mode network and insula-default mode network connectivity when the left middle temporal gyrus, right cerebellum and right insula were selected as seed area, respectively. The present outcomes suggest that childhood trauma is associated with disturbed intrinsic brain function, especially the default mode network, in adults even without psychiatric diagnoses, which may mediate the relationship between childhood trauma and psychiatric disorders in later life.

Hormonal regulation of postnatal growth from birth to age six months in Small-for-Gestational - Age children

This article is devoted to the investigation hormonal mechanisms of postnatal growth from birth to age six months in small for gestational age children (SGA) with asymmetrical and asymmetrical IUGR. The IGF-1 and GH levels, insulin sensitivity (by homeostasis model assessment (HOMA-IR)) were measured blood at 3 and 6 months of age. The prospective study includes 40 SGA infants (group 1) - 24 - with asymmetrical (1a) and 16 with symmetrical IUGR babies (1b) and 17 appropriate for gestational age (AGA) infants (group 2). Most SGA infants showed rapid, or “catch-up” postnatal growth. Symmetrical IUGR infants with “catch-up” growth had higher IGF-1 and growth GH levels at 3 month of age than asymmetrical IUGR with “catch-up” growth (p &lt; 0,05). From 3 to 6 months of age 77 % of infants with “catch-up” growth showed retardation of growth velocity. At 6 month of age SGA infants with “catch-up” growth had lower IGF-1, GH blood levels and HOMA-IR than at 3 months of age (p &lt; 0,05). Infants without “catch-up” growth had similar hormone levels at 3 and 6 months of age. We suppose, that these changes of “GH - IGF-1” axis and insulin sensitivity at age 3 and 6 months in SGA infants are the mechanisms, which promote the postnatal growth. It can be assumed that the same mechanisms may underlie metabolic disorders in later life.

Fluoxetine Ameliorates Atopic Dermatitis-Like Skin Lesions in BALB/c Mice through Reducing Psychological Stress and Inflammatory Response.

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder, and patients with AD suffer from severe psychological stress, which markedly increases the prevalence rate of depression and anxiety disorders in later life. Fluoxetine, a selective serotonin reuptake inhibitor, has recently been reported to exert anti-inflammatory and immunosuppressive effects. However, it is unclear whether fluoxetine is effective in the treatment of AD through reducing psychological stress and inflammatory reaction. Here, we reported that a BALB/c mouse model of AD was induced by application of 2,4-dinitrochlorobenzene (DNCB) onto hairless dorsal skin. Chronic fluoxetine treatment (10 mg/kg per day, i.p.) significantly attenuated AD-like symptoms, as reflected by a dramatic decrease in scratching bouts, as well as a decrease in anxiety- and depressive-like behaviors. Furthermore, these behavioral changes were accompanied by a significant decrease in epidermal thickness, the number of mast cells in skin tissue, mRNA levels of interleukin-4 (IL-4) and IL-13 in the spleen, as well as serum immunoglobulin E (IgE) in the DNCB-treated mice by treatment with fluoxetine. Taken together, these results indicate that fluoxetine may suppress psychological stress and inflammatory response during AD development, and subsequently ameliorate AD symptoms, suggesting that fluoxetine may be a potential therapeutic agent against AD in clinic.

Environmental enrichment mitigates the impact of ancestral stress on motor skill and corticospinal tract plasticity

BackgroundAn adverse fetal environment in utero has been associated with long-term alterations in brain structure and function, and a higher risk of neurological disorders in later life. A common consequence of early adverse experience is impaired motor system function. A causal relationship for stress-associated impairments and a suitable therapy, however, have not been determined yet. ObjectiveTo investigate the impact of ancestral stress on corticospinal tract (CST) morphology and fine motor performance in rats, and to determine if adverse programming by ancestral stress can be mitigated by environmental enrichment therapy in rats. MethodsThe study examined F3 offspring generated by three lineages; one with prenatal stress only in the F1 generation, one with compounding effects of multigenerational prenatal stress, and a non-stress control lineage. F3 offspring from each lineage were injected with biotinylated dextran amine (BDA) into the motor cortex for anterograde tracing of the CST. ResultsExamination of the CST revealed reduced axonal density in the ancestrally stressed lineages. These anatomical changes were associated with significant impairments in skilled walking, as indicated by reduced foot placement accuracy and disturbed inter-limb coordination. Therapeutic intervention by environmental enrichment reduced the neuromorphological consequences of ancestral stress and restored skilled walking ability. ConclusionsThe data suggest a causal relationship between stress-induced abnormal CST function and loss of fine motor performance. Thus, ancestral stress may be a determinant of motor system development and motor skill. Environmental enrichment may represent an effective intervention for the adverse programming by ancestral stress and trauma.

Risk of dementia and death in community-dwelling older men with bipolar disorder.

Bipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking. To investigate the 13-year risk of dementia and death in older adults with bipolar disorder. Cohort study of 37 768 men aged 65-85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest. Bipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80-2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28-1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system. Bipolar disorder in later life is associated with increased risk of dementia and premature death.

Risk of developing major depression and bipolar disorder among adolescents with atopic diseases: A nationwide longitudinal study in Taiwan

BackgroundsPrevious studies have found an increased prevalence of atopic diseases among patients with major depression and bipolar disorder. But the temporal association between atopic diseases in adolescence and the subsequent risk of developing mood disorders has been rarely investigated. MethodsUsing the Taiwan National Health Insurance Research Databases, 5075 adolescents with atopic diseases (atopic cohort) and 44,729 without (non-atopic cohort) aged between 10 and 17 in 2000 were enrolled into our study and followed to the end of 2010. Subjects who developed major depression or bipolar disorder during the follow-up were identified. ResultsThe atopic cohort had an increased risk of developing major depression (HR: 2.45, 95% CI: 1.93~3.11) and bipolar disorder (HR: 2.51, 95% CI: 1.71~3.67) compared to the non-atopic cohort, with a dose-dependent relationship between having a greater number of atopic comorbidities and a greater likelihood of major depression (1 atopic disease: HR: 1.80, 95% CI: 1.29~2.50; 2 atopic comorbidities: HR: 2.42, 95% CI: 1.93~3.04;≥3 atopic comorbidities: HR: 3.79, 95% CI: 3.05~4.72) and bipolar disorder (HR: 1.40, 95% CI: 0.57~3.44; HR: 2.81, 95% CI: 1.68~4.68; HR: 3.02, 95% CI: 1.69~5.38). DiscussionHaving atopic diseases in adolescence increased the risk of developing major depression and bipolar disorder in later life. Further studies may be required to clarify the underlying mechanism between atopy and mood disorders, and to investigate whether prompt intervention may decrease the risk of subsequent mood disorders.

0383 : Vascular programming of rats exposed in utero to maternal obesity

Obesity in women of childbearing age is of particular concern since there is overwhelming evidence that being born to an obese mother increases the risk for the child of developing metabolic (obesity, insulin resistance) and cardiovascular (vascular dysfunction) disorders in later life. These findings suggest that the nutritional stress associated with maternal obesity has an impact on the longterm health of the offspring and could impact directly the fetal vascular function. However, current studies use animals in which vascular dysfunction and metabolic disorders are present simultaneously. Using a model of rats exposed in utero to maternal obesity, we aimed to determine if maternal obesity was able to directly re-program fetal vascular function or if development of such dysfunction was linked to metabolic abnormalities in offspring. Obese female rats (under hight-fat diet) were crossed with non-obese males. The metabolic status of male offspring from obese mothers (OMO) and mothers controls (CMO) was evaluated immediately after weaning (21j) and 2 months later by tolerance tests to insulin (ITT) and glucose (GTT), and plasmatic lipid profile. Vascular reactivity of the aorta was evaluated by myography (vascular reactivity in response to pharmacological agents). At weaning, GTT, ITT, plasmatic lipid profile as well as vascular reactivity of OMO were similar to those of CMO. At 3 months of age, although metabolic and lipid profiles are not modified, endotheliumdependant vasodilation was altered in OMO compared to CMO (acetylcholine dose-response curve EC 50 : 2,46E-06±5,26E-07 vs 3,60E-07±5,01E-08 for OMO and CMO respectively, p<0,05). In presence of L-NAME, indomethacin (coxinhibitor) improved vasodilation showing that prostaglandins have a more important role in OMO than in CMO. Our results bring out a vascular dysfunction before the development of metabolic disorders and highlight a possible fetal vascular reprogramming in response to maternal obesity. The author hereby declares no conflict of interest

Cardiovascular Susceptibility to Acute Myocardial Ischemic Injury in Male And Female Rat Offspring Born Growth Restricted

BackgroundIschemic heart disease causes the greatest mortality in the world today. Epidemiological and animal studies have shown that populations who suffer intrauterine growth restriction (IUGR), one of the most common consequences of complicated pregnancies, are more susceptible to develop cardiovascular disorders in later life. We tested the hypothesis that adult male and female IUGR rat offspring are more susceptible to develop cardiac dysfunction following acute myocardial ischemic injury.MethodsMale and female control or IUGR rat offspring (created by exposing pregnant dams to hypoxia, 11.0±0.5% O2, for the last third of pregnancy) were randomly assigned to undergo sham or myocardial infarction (MI) surgery (by ligation of the left anterior descending coronary artery) at the age of 12 weeks. Thus the experimental groups consisted of: Control‐sham, Control‐MI, IUGR‐sham, and IUGR‐MI. One week after MI surgery, echocardiography was performed to assess cardiac morphometry, systolic function and diastolic function.ResultsFemale, but not male, IUGR offspring had lower body weight compared to controls at 12 weeks of age post 1 week of MI. Anterior left ventricular (LV) wall thickness was decreased whereas LV internal diameter during diastole was significantly increased in both control‐MI and IUGR‐MI groups independent of sex or IUGR; indicating wall thinning and LV dilatation due to MI. Ejection fraction, fractional shortening and fractional area change were significantly decreased in both control‐MI and IUGR‐MI groups in male and female offspring. The Tei index was significantly increased in both control‐MI and IUGR‐MI male groups. Interestingly, E/E’ ratio, an index of ventricular filling pressure, was significantly increased in only male IUGR‐MI group compared to IUGR‐Sham (IUGR‐Sham vs IUGR‐MI: 19.84 ± 2.13 vs 35.21 ± 3.66, P&lt;0.05) and control‐MI (Control‐MI vs IUGR‐MI: 22.37 ± 1.73 vs 35.21 ± 3.66, P&lt;0.01).ConclusionIschemic heart disease such as MI was shown to alter LV wall morphometry leading to LV dilatation in both sexes. MI impaired systolic function independent of being born growth‐restricted or sex. However, male IUGR offspring were more susceptible to develop diastolic dysfunction following acute MI. These studies indicate a susceptibility of the male IUGR population to develop diastolic heart failure due to acute myocardial ischemia.Support or Funding InformationThis work is funded by grants from the Canadian Institutes of Health Research (CIHR); and the Women and Children's Health Research Institute (WCHRI) through the generous contributions of the Stollery Children's Hospital Foundation (SCHF) and the Royal Alexandra Hospital Foundation (RAHF). A shah is supported by fellowships from the Heart and Stroke Foundation of Canada.

Myasthenia Gravis in the Elderly: Differential Diagnosis and Management

Late-life disorders presenting with weakness often have a delay in diagnosis leading to decreased quality of life and impairment of mobility. Myasthenia gravis is an immune disorder affecting the neuromuscular junction resulting in varying levels of weakness in the orbital, bulbar, and limb muscles. The evaluation of weakness in the elderly should be geared toward treatable and reversible causes such as myasthenia gravis. The major treatment options include symptomatic, immunosuppressive, and immunomodulating therapies.

Management of late-life insomnia

IntroductionInsomnia is the most frequent sleep disorder in late life. Forty-two percent of elderly people in the United States often complain about difficulties to get or maintain sleep, or awakening too early. Insomnia is frequent in old people greatly due to frequency of concomitant medical illnesses and polypharmacy, rather than because of age.ObjectivesThe objective of our research was to revise the current state of knowledge about management of insomnia in people above 65 years of age.MethodologyFor that, a bibliographical search through PubMed.gov has been made. From the obtained results, the 14 which best suited for our goals were selected, 10 of them dealing with people above 65 years and the rest with people above 75 or 80 years of age.ResultsBased on the literature reviewed, the current options of management of late-life insomnia are based on behavioral or pharmacological therapy. The combination of behavioral therapies shows results and is currently considered as an option, especially given the possibility of medicine interaction and the secondary effects hypnotic and sedative medicines might produce. There is a paucity of long-term safety and efficacy data for the use of non-benzodiazepine sedative-hypnotics. There are no criteria for the use of antidepressant sedatives in elderly people without diagnosed depression, although they are still used in practice.ConclusionPossibility of using behavioral therapy as first option. In case of polymedicated or multi-pathological patients, pay special attention when starting a pharmacological treatment, choose the most suitable one and supervise it closely.Disclosure of interestThe authors have not supplied their declaration of competing interest.