Sleep in care homes (original) (raw)
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Effectiveness of strategies to manage sleep in residents of aged care facilities
JBI Reports 2(4) :115-83., 2004
Background The promotion of sleep in older adults is a significant issue in high-level residential aged care facilities, with as many as 67% of residents experiencing disruptions to their sleep patterns. Not only do health concerns such as cognitive impairment, pain and incontinence impact upon this population's sleep quality and quantity, but environmental factors including noise, light and night-time nursing care also affect sleep of those residing in institutions. In order to address the issue of sleep disruption, assessment and diagnosis of sleep problems and implementation of interventions that are effective in promoting sleep are essential.Objectives The objective of this review was to determine the most effective tools for the assessment and diagnosis of sleep in older adults in high-level aged care. The review also sought to determine the most effective strategies for the promotion of sleep in this population. Outcome measures for this review were: indicators of improved sleep quality and quantity, including an improvement in daytime functioning and improved night-time sleep; reduction in use of hypnotics and sedatives; and increased satisfaction with sleep.Search strategy A literature search was performed using the following databases for the years 1993–2003: AgeLine, APAIS Health, CINAHL, Cochrane Library, Current Contents, Dissertation Abstracts International, Embase, Medline, Proquest, PsycInfo, Science Citations Index. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language.Selection criteria The review was limited to papers addressing sleep diagnosis, assessment and/or management in adults aged 65 or over who were residing in high-level aged care. The review included randomised controlled trials (RCTs) and, due to the limited number of RCTs available, non-RCTs, cohort and case control studies and qualitative research were also considered for inclusion. Research was included if it addressed the assessment, diagnosis or management of sleep using outcome measure of improved night-time sleep or daytime function, improvements in resident satisfaction with sleep or reduction in medication use associated with sleep. The types of interventions considered by this review were alternative therapies including massage, aromatherapy and medicinal herbs; behavioural or cognitive interventions; biochemical interventions; environmental interventions; pharmacological interventions and related nocturnal interventions such as continence care. Instruments and strategies to diagnose and assess the sleep of older high-level care residents, including objective and subjective assessment tools, were considered by this review.Data collection and analysis All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Papers were grouped according to the type of intervention or type of assessment tool used and findings were presented in a narrative summary.Findings Wrist actigraphy was found to be the most accurate objective sleep assessment tool for use in the population of interest, and issues surrounding its use are presented. Although no subjective sleep assessment tools were identified in this review, the evidence suggested that subjective reports of sleep quality are an important consideration in sleep assessment. Evidence suggested that behavioural observations may be an effective assessment strategy when conducted on a frequent basis. The review found no evidence on the effectiveness of any assessment tools for the diagnosis of specific sleep problems in older adults. The use of multidisciplinary strategies including reduction of environmental noise, reduction of night-time nursing care that disrupts sleep and daytime activity is likely to be the most effective strategy for the promotion of sleep in older high-level care residents. The use of sedating medications did not appear to have a substantial effect in promoting sleep, and health practitioners in high-level aged care should consider their use cautiously.
Journal of Clinical Nursing 15(10):1267-75, 2006
Aims and objectives. The objectives of this systematic review were to determine the most effective tools for the assessment and diagnosis of sleep problems, as well as identify the most effective strategies for the promotion of sleep within this population.Background. Experiencing reduced sleep quality is often associated with normal ageing, however this may be exacerbated for residents of aged care facilities. External factors such as noise, light and night-time nursing may impact negatively upon sleeping patterns.Methods. Eleven electronic databases and the reference lists and bibliographies of included studies were searched. Papers were grouped according to type of intervention or assessment tool and presented in a narrative summary.Conclusions. The review identified many interventions to promote sleep. Multidisciplinary strategies such as combining a reduction in environmental noise, reduction of night-time nursing care and promotion of daytime activity, are likely to be most effective for promoting sleep in the population of interest. The use of sedating medications is cautioned, as their long-term efficacy in promoting sleep is questionable. Wrist actigraphy was found to be the most accurate objective sleep assessment tool.Relevance to clinical practice. Lack of sleep, disturbed sleep and the overuse of medications especially sedations reduce the quality of life for older people. Effective, safe sleep interventions should be promoted and practised by nurses.
2011
Sleep disturbance is a common complaint among elderly people living in nursing home. This phenomenon is usually as a result of a series of related factors including medical, environmental, and behavioral and age related factors. Aims: The purpose of the study is to bring to lime line what needs to be done in promoting health through empowerment strategies among elderly people suffering from sleep disturbance. To research on common sleep assessment tools available to diagnose sleep disturbance in nursing home and also to investigate potential non-pharmacological interventions that can resolve sleep problem among elderly people. The study was guided by Derek Chambers & Susan Thompson (2008) theory of Empowerment to enable the author achieves the objectives. Method: Qualitative method was used in this study and deductive content analysis was employed to analyze selected articles for the study and later the findings were organized under four categories. Results: Results shows two main sleep assessment tools Objective and subjective sleep assessment tools. Objective includes; Pittsburgh sleep quality Index (PSQI), wrist actigraphy, polysomnography. While nonpharmacological intervention approaches yielded great significance to promote sleep in elderly people. They include; sleep restriction, stimulus control, relaxation therapy, scheduled bright light, incontinence management, aromatherapy, bed massage, music, acupressure, Tai Chi program and aerobic exercises.
Sleep disturbances in nursing homes
The journal of nutrition, health & aging, 2010
To review the literature on sleep disturbances in nursing home settings. Although 50% of older adults complain of sleep difficulties, increased reports of sleep disturbances are generally associated with poor health. After controlling for comorbidities that often contribute to poor sleep, studies have shown that primary sleep disturbances in healthy older adults are, in fact, rare. Although common in older adults, sleep complaints are even more prevalent in elders living in nursing homes and the sleep disturbances experienced by institutionalized older adults are more severe. Factors contributing to sleep impairment in nursing home residents include age-related changes in sleep architecture and circadian rhythms, sleep disorders, dementia, depression, other medical illness, polypharmacy, and institutional and environmental factors. It is important that nursing home residents suffering from sleep problems be evaluated and treated. Implementing some environmental and culture changes c...
Effect of Non Pharmacological Intervention on Sleep Quality Improvement of Institutionalized Elders
2016
The prevalence of sleep problem in adulthood increases with age. While not all sleep changes are non pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life. The most common treatment for insomnia is pharmacological. Physical exercise may promote relaxation and raise core body temperature in ways that are beneficial to initiating and maintaining sleep. Objectives were to assess the quality of sleep before and after introduction of non pharmacological intervention, controlled exercises among the elders and also to find out the association between the qualities of sleep with selected demographic variables. A pre-experimental, one group pre test post test design was used. The sample consisting of 30 elders were selected by purposive sampling. Tools used were baseline Primary insomnia screening tool, Pittsburgh Sleep Quality Index (PSQI) for quality of sleep, Richards-Campbell sleep questionnaire for quality of slee...
Physical Activity Improves Sleep Quality in Nursing Homes Elderly
2020
Background: Sleep disorders is one of the most important problem in older adults. Objective of the Study: Physical activity improves sleep quality in nursing homes elderly. Methods: The subjects of this study were 119 elderly people over the age of 65 living in nursing homes in Tehran. The demographic characteristics of the subjects were collected and recorded. Then, body composition, blood pressure and anthropometric indices including weight, body mass index [BMI], height and calf circumferences [CC], waist circumferences [WC] and hip circumferences were measured using a digital scale of OMRON, OMRON M2 blood pressure monitor and meter tape. Physical activity and sleep quality were measured by Physical Activity Scale for the Elderly (PASE) and the Pittsburgh Sleep Quality Index (PSQI) respectively. Results: The results of Pearson correlation showed that there was a significant inverse relationship between ages with sleep quality (p < 0.003) and its subunits (Subjective (p < 0...
Does melatonin improve sleep in older people? A randomised crossover trial
Age and Ageing, 2003
Study objective: to determine whether melatonin will improve quality of sleep in healthy older people with age-related sleep maintenance problems. Design: a double blind randomised placebo controlled crossover trial in healthy older volunteers. Setting: a largely urban population, Auckland, New Zealand. Participants: participants were part of the larger Possible Role of Melatonin in Sleep of Elders study. People 65 years or more of age were recruited through widespread advertising. We screened 414 potential participants by mail using the Pittsburgh Sleep Quality Index, and selected 194 for clinic interview. Exclusions included depression, cognitive impairment, hypnosedative medications, sleep phase abnormalities, medical and/or environmental problems that might impair sleep. Twenty normal and 20 problem sleepers were randomly allocated for this study from a larger sample of 60 normal and 60 problem sleepers. Measurements and results: 24-hour urine 6-sulphatoxymelatonin was measured to estimate melatonin secretion in each participant. Five milligrams of melatonin, or matching placebo were each taken at bedtime for 4 weeks, separated by a 4-week washout period. Sleep quality was measured using sleep diaries, the Leeds Sleep Evaluation Questionnaire, and actigraphy. There was a significant difference between the groups in self-reported sleep quality indicators at entry, but no difference in melatonin secretion. Melatonin did not significantly improve any sleep parameter measured in either group. Conclusion: 5 mg of fast release melatonin taken at bedtime does not improve the quality of sleep in older people with age-related sleep maintenance problems.