Managing sleep disturbances in adult family homes: recruitment and implementation of a behavioral treatment program

Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice

BACKGROUND

Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group.

AIM

To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment.

DESIGN AND SETTING

A realist review of existing literature conducted in 2022.

METHOD

Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined.

RESULTS

In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep.

CONCLUSION

In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.

Development and evaluation of a sleep education program for older adults with dementia living in adult family homes

OBJECTIVES

To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared with usual care control in a pilot randomized controlled trial.

PARTICIPANTS

Thirty-seven AFH staff-caregivers and 47 residents with comorbid dementia and sleep disturbances.

INTERVENTION

SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans.

MEASUREMENTS

Treatment fidelity to the SEP was assessed following the National Institutes of Health (NIH) Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month posttreatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected.

RESULTS

Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors and improved actigraphically measured sleep percent and total sleep time over the 6-month follow-up period compared with the control condition.

CONCLUSION

Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes and merit further investigation as a promising intervention for use with AFH residents with dementia.