Insomnia treatment preferences of older adults and people living with dementia: A qualitative study

Background Insomnia is common in people living with dementia and older adults. While clinical guidelines recommend non-pharmacological treatment as first-line therapy, insomnia is often managed with benzodiazepine receptor agonists (BZRAs), which carry a significant risk of medication-related harm. Objective To explore what influences decisions to engage with pharmacological and non-pharmacological insomnia treatments among older adults, people living with dementia and their carers. Methods Semi-structured interviews were conducted with three participant groups (people living with dementia, their carers, and older adults). The interviews were conducted and transcribed in Zoom. Participants identified and prioritized factors that influence their treatment decisions. Thematic analysis was conducted in NVivo to generate themes that described how participants’ beliefs and experiences influenced their preferences. Results From 19 interviews with 20 participants (Median age range = 65–74 years, 37% female), 14 factors were identified. Risk of side effects (n = 10) and effectiveness (n = 7) were most commonly prioritized and frequently reported across all participant groups. Medication side effects on cognition and daytime sedation were frequent concerns. Underpinning these factors were five main themes determined from thematic analysis, including: beliefs about sleep and insomnia, treatment expectations and experiences, external influences, treatment characteristics, and barriers to treatment. Conclusions Decisions about insomnia treatments are influenced not only by expected and/or experienced treatment effectiveness, but also by perceived risks and health beliefs. Integrating these perspectives into clinical decision-making may help reduce medication-related harm and promote safer, acceptable alternatives.