No CrossRef data available.
Article contents
Intervention for sleep problems in nursing home residents with dementia: a cluster-randomized study
Published online by Cambridge University Press: 08 January 2024
Abstract
Objective:
To reduce sleep problems in people living with dementia using a multi-component intervention.
Design:
Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks.
Setting:
Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants).
Participants:
Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH.
Intervention:
The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two “sleep nurses,” (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care.
Measurements:
Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI).
Results:
Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of −24.5% (95% CI, −46.3% – −2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087–0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks.
Conclusions:
The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.
Keywords
- Type
- Original Research Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press on behalf of International Psychogeriatric Association
References
Abraham, J., Kupfer, R., Behncke, A., Berger-Höger, B., Icks, A., Haastert, B., Meyer, G., Köpke, S., Möhler, R. (2019). Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): a pragmatic cluster randomized controlled trial. Internationl Journal of Nursing Studies, 96, 27–34.CrossRefGoogle ScholarPubMed
Blytt, K. M., Bjorvatn, B., Husebo, B., & Flo, E. (2017). Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy. BMC Geriatrics, 17(1), 253.CrossRefGoogle ScholarPubMed
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1988). The pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.CrossRefGoogle Scholar
Cipriani, G., Lucetti, C., Danti, S., & Nuti, A. (2015). Sleep disturbances and dementia. Psychogeriatrics, 15(1), 65–74.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. (1991). Instruction Manual for the Cohen-Mansfield Agitation Inventory (CMAI) Rockville. https://oregonbhi.org/wp-content/uploads/2020/01/CMAI_Manual.pdf
Google Scholar
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2013). Developing and evaluating complex interventions: the new medical research council guidance. International Journal of Nursing Studies, 50(5), 587–592.CrossRefGoogle ScholarPubMed
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., Petticrew, M. (2008). Developing and evaluating complex interventions: the new medical research council guidance. BMJ, 337, a1655.CrossRefGoogle ScholarPubMed
Dichter, M. N., Berg, A., Hylla, J., Eggers, D., Wilfling, D., Möhler, R., Haastert, B., Meyer, G., Halek, M., Köpke, S. (2021). Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial. Bmc Geriatrics, 21(1), 40.CrossRefGoogle ScholarPubMed
Dichter, M. N., Ettema, T. P., Schwab, C. G. G., Meyer, G., Bartholomeyczik, S., & Halek, M. (2016). Benutzerhandbuch für die deutschsprachige QUALIDEM Version 2.0. Witten.Google Scholar
Dichter, M. N., Hylla, J., Berg, A., Wilfling, D. (2020). Entwicklung einer Theory of Change als Grundlage Einer Intervention zur Reduktion von Schlafproblemen bei Menschen mit Demenz in der stationären Altenpflege. [Development of a Theory of Change as Basis for a Intervention Aiming the Reduction of Sleep Problems of People With Dementia in Nursing Homes] (pp. 21). Jahrestagung des EbM Netzwerks 2020 Universität Basel.Google Scholar
Dichter, M. N., Quasdorf, T., Schwab, C. G.. C.;nter G., Trutschel, D., Haastert, B., Riesner, C., Bartholomeyczik, S., Halek, M. (2015). Dementia care mapping: effects on residents’ quality of life and challenging behavior in german nursing homes. A quasi-experimental trial. International Psychogeriatrics, 27(11), 1875–1892.CrossRefGoogle ScholarPubMed
Donner, A., & Klar, N. (2000). Design and Analysis of Cluster Randomization Trials in Health Research. Arnold.Google Scholar
Dörner, J., Hüsken, J. M., Schmüdderich, K., Dinand, C., Dichter, M. N., & Halek, M. (2023). Perspectives on sleep of people living with dementia in nursing homes: a qualitative interview study. Bmc Geriatrics, 23(1), 331.CrossRefGoogle ScholarPubMed
Ettema, T. P., Dröes, R. M., de Lange, J., Mellenbergh, G. J., & Ribbe, M. W. (2007). QUALIDEM: development and evaluation of a dementia specific quality of life instrument. Scalability, reliability and internal structure. Int J Geriatr Psychiatry, 22(6), 549–556.CrossRefGoogle ScholarPubMed
Frohnhofen, H., Bibl, M., Nickel, B., & Popp, R. (2010). Der essener fragebogen alter und schläfrigkeit (EFAS) – ein neues assessmentinstrument zur Messung von Tagesschläfrigkeit bei alten menschen. [The Essen questionnaire on age and sleepiness – a new assessment tool to measure daytime sleepiness in elderly people]. European Journal of Geriatrics, 12, 84–90.Google Scholar
Fung, C. H., Vitiello, M. V., Alessi, C. A., Kuchel, G. A., Committee, A. N. S. C. P., & Faculty (2016). Report and research agenda of the American geriatrics society and national institute on aging bedside-to-bench conference on sleep, circadian rhythms, and aging: new avenues for improving brain health, physical health, and functioning. J Am Geriatr Soc, 64, e238–e247.CrossRefGoogle Scholar
Hjetland, G. J., Kolberg, E. Pallesen, S. Thun, E. Nordhus, I. H., Bjorvatn, B. Flo-Groeneboom, E. (2021). Ambient bright light treatment improved proxy-rated sleep but not sleep measured by actigraphy in nursing home patients with dementia: a placebo-controlled randomised trial. Bmc Geriatrics, 21, 312.CrossRefGoogle Scholar
Hjetland, G. J., Nordhus, I. H., Pallesen, Såle, Cummings, J., Tractenberg, R. E., Thun, E., Kolberg, E., Flo, E. (2020). An actigraphy-based validation study of the sleep disorder inventory in the nursing home. Front Psychiatry, 11, 173.CrossRefGoogle ScholarPubMed
Hülser, K. (2001). Diagnostic in the framework of quality development [Diagnostik im Rahmen der Qualitätssicherung]. Ruhr-Universität Bochum.Google Scholar
Janus, S. I., van Manen, J. G., I.J., M. J., & Zuidema, S. U. (2016). Psychotropic drug prescriptions in Western European nursing homes. International Psychogeriatrics, 28(11), 1775–1790.CrossRefGoogle ScholarPubMed
Kim, H. J., Lee, Y., & Sohng, K. Y. (2016). The effects of footbath on sleep among the older adults in nursing home: a quasi-experimental study. Complementary Therapies in Medicine, 26, 40–46.CrossRefGoogle ScholarPubMed
Köhler, L., Weyerer, S., Schäufele, M. (2007). Proxy screening tools improve the recognition of dementia in old-age homes: results of a validation study. Age and Ageing, 36(5), 549–554.CrossRefGoogle ScholarPubMed
Li, J., & Gooneratne, N. S. (2019). Sleep and Health in Older Adults (pp. 31–43). Elsevier.Google Scholar
Li, J., Grandner, M. A., Chang, Y. P., Jungquist, C., & Porock, D. (2017). Person-centered dementia care and sleep in assisted living residents with dementia: a pilot study. Behavioral Sleep Medicine, 15(2), 97–113.CrossRefGoogle ScholarPubMed
McCleery, J., & Sharpley, A. L. (2020). Pharmacotherapies for sleep disturbances in Alzheimer’s disease. Cochrane Database of Systematic Reviews, (11), CD009178. https://doi.org/10.1002/14651858.CD009178.pub4
Google Scholar
National Institute for Health and Care Excellence (2018). Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers. https://www.nice.org.uk/guidance/ng97/resources/dementia-assessment-management-and-support-for-people-living-with-dementia-and-their-carers-pdf-1837760199109
Google Scholar
Neikrug, A. B., & Ancoli-Israel, S. (2010). Sleep disturbances in nursing homes. Journal of Nutrition Health & Aging, 14(3), 207–211.CrossRefGoogle ScholarPubMed
Petrovsky, D. V., Bradt, J., McPhillips, M. V., Sefcik, J. S., Gitlin, L. N., & Hodgson, N. A. (2023). Tailored music listening in persons with dementia: a feasibility randomized clinical trial. American Journal of Alzheimer’s Disease & Other Dementias®, 38, 15333175231186728.CrossRefGoogle ScholarPubMed
Ramar, K., Malhotra, R. K., Carden, K. A., Martin, J. L., Abbasi-Feinberg, F., Aurora, R. N., Kapur, V. K., Olson, E. J., Rosen, C. L., Rowley, J. A., Shelgikar, A. V., Trotti, L. M. (2021). Sleep is essential to health: an American academy of sleep medicine position statement. Journal of Clinical Sleep Medicine, 17(10), 2115–2119.CrossRefGoogle ScholarPubMed
Reuther, S., Dichter, M. N., Bartholomeyczik, S., Nordheim, J., & Halek, M. (2016). Construct validity and internal consistency of the neuropsychiatric inventory - nursing home (NPI-NH) in German nursing homes. International Psychogeriatrics, 28(6), 1017–1027.CrossRefGoogle ScholarPubMed
Richter, C., Berg, A., Langner, H., Meyer, G., Köpke, S., Balzer, K., Wolschon, E.-M., Silies, K., Sönnichsen, A., Löscher, S., Haastert, B., Icks, A., Wolf, U., Fleischer, S. (2019). Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial. Age and Ageing, 48(3), 419–425.CrossRefGoogle ScholarPubMed
Suzuki, K., Miyamoto, M., & Hirata, K. (2017). Sleep disorders in the elderly: diagnosis and management. J Gen Fam Med, 18(2), 61–71.CrossRefGoogle ScholarPubMed
Tractenberg, R. E., Singer, C. M., Cummings, J. L., & Thal, L. J. (2003). The sleep disorders inventory: an instrument for studies of sleep disturbance in persons with Alzheimer’s disease. Journal European Sleep Research Society, 12(4), 331–337.CrossRefGoogle ScholarPubMed
Uchmanowicz, I., Markiewicz, K., Uchmanowicz, B., Koltuniuk, A., & Rosinczuk, J. (2019). The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clinical Interventions in Aging, 14, 155–165.CrossRefGoogle ScholarPubMed
Van de Water, A. T., Holmes, A., & Hurley, D. A. (2011). Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography--a systematic review. Journal of Sleep Research, 20(1pt2), 183–200.CrossRefGoogle ScholarPubMed
Verbeek, H., Zwakhalen, S. M., van Rossum, E., Ambergen, T., Kempen, G. I., & Hamers, J. P. (2010). Dementia care redesigned: effects of small-scale living facilities on residents, their family caregivers, and staff. Journal of The American Medical Directors Association, 11(9), 662–670.CrossRefGoogle ScholarPubMed
Webster, L., Costafreda Gonzalez, S., Stringer, A., Lineham, A., Budgett, J., Kyle, S., Barber, J., Livingston, G. (2020a). Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep, 43(4), 1–14. https://doi.org/10.1093/sleep/zsz251
CrossRefGoogle Scholar
Webster, L., Powell, K., Costafreda, S. G., & Livingston, G. (2020b). The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study. International Psychogeriatrics, 32(7), 839–847.CrossRefGoogle ScholarPubMed
Wilfling, D., Berg, A., Dörner, J., Bartmann, N., Klatt, T., Meyer, G., Halek, M., Möhler, R., Köpke, S., Dichter, M. N. (2023a). Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey. Bmc Geriatrics, 23(1), 206.CrossRefGoogle ScholarPubMed
Wilfling, D., Calo, S., Dichter, M. N., Meyer, G., Mohler, R., & Kopke, S. (2023b). Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Database Syst Rev, 1(1), CD011881.Google ScholarPubMed
Wilfling, D., Dichter, M. N., Trutschel, D., & Kopke, S. (2019). Prevalence of sleep disturbances in German nursing home residents with dementia: a multicenter cross-sectional study. Journal of Alzheimers Disease, 69(1), 227–236.CrossRefGoogle ScholarPubMed
Wilfling, D., Dichter, M. N., Trutschel, D., & Kopke, S. (2020). Nurses’ burden caused by sleep disturbances of nursing home residents with dementia: multicenter cross-sectional study. BMC Nurs, 19(1), 83.CrossRefGoogle ScholarPubMed
Wilfling, D., Hylla, J., Berg, A., Meyer, G., Köpke, S., Halek, M., Möhler, R., Dichter, M. N. (2021). Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review. International Psychogeriatrics, 33(3), 245–273.CrossRefGoogle ScholarPubMed
Wood, S., Cummings, J. L., Hsu, M.-A., Barclay, T., Wheatley, M. V., Yarema, K. T., Schnelle, J. F. (2000). The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement. Am J Geriatr Psychiatry, 8(1), 75–83.CrossRefGoogle ScholarPubMed
Yesavage, J. A., Friedman, L., Ancoli-Israel, S., Bliwise, D., Singer, C., Vitiello, M. V., Monjan, A. A., Lebowitz, B. (2003). Development of diagnostic criteria for defining sleep disturbance in Alzheimer’s disease. J Geriatr Psychiatry Neurol, 16(3), 131–139.CrossRefGoogle ScholarPubMed
Zhang, H., Li, Y., Zhao, X., Mao, Z., Abdulai, T., Liu, X., Tu, R., Wang, Y., Qian, X., Jiang, J., Tian, Z., Luo, Z., Dong, X., Wang, C., Bie, R. (2019). The association between PSQI score and hypertension in a Chinese rural population: the Henan rural cohort study. Sleep Medicine, 58, 27–34.CrossRefGoogle Scholar
Zuidema, S. U., Buursema, A. L., Gerritsen, M. G. J. M., Oosterwal, K. C., Smits, M. M. M., Koopmans, R. T. C. M., de Jonghe, J. F. M. (2011). Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and reliable change index of the neuropsychiatric inventory and the Cohen-mansfield agitation inventory. Int J Geriatr Psychiatry, 26(2), 127–134.CrossRefGoogle ScholarPubMed
Dichter et al. supplementary material
File
19.7 KB