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McPhillips MV, Dickson VV, Cacchione PZ, Li J, Gooneratne N, Riegel B. Nursing Home Eligible, Community-Dwelling Older Adults' Perceptions and Beliefs About Sleep: A Mixed-Methods Study. Clin Nurs Res 2019; 29:177-188. [PMID: 31104492 DOI: 10.1177/1054773819849348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances are highly prevalent in older adults; little is known about sleep in those who remain living in the community despite qualifying for nursing home placement. We conducted a concurrent, nested, mixed-methods study to describe sleep characteristics and sleep disturbances in this population. Our final sample (n = 40) was Black (100%), female (85%) older adults with a mean (±SD) age of 72 ± 9.5 years. Of these, 35 had objectively measured short or long sleep duration, and 30 had subjectively reported poor sleep quality. Our evidence suggests that sleep disturbances are common in this group, and these older adults had adjusted their expectations and adapted to their sleep disturbances. Given that at-risk older adults may not perceive their sleep disturbances as problematic, clinicians must proactively assess sleep and educate about the importance of sleep. These results reveal modifiable factors with potential to improve health outcomes in this vulnerable population.
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Affiliation(s)
| | | | | | - Junxin Li
- Johns Hopkins University, Baltimore, MD, USA
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Taylor SS, Hughes JM, Coffman CJ, Jeffreys AS, Ulmer CS, Oddone EZ, Bosworth HB, Yancy WS, Allen KD. Prevalence of and characteristics associated with insomnia and obstructive sleep apnea among veterans with knee and hip osteoarthritis. BMC Musculoskelet Disord 2018; 19:79. [PMID: 29523117 PMCID: PMC5845198 DOI: 10.1186/s12891-018-1993-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/26/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans with OA. Secondary objectives were to assess proportions of individuals with insomnia and OSA symptoms who may have been undiagnosed and to examine Veterans' characteristics associated with insomnia and OSA symptoms. METHODS Veterans (n = 300) enrolled in a clinical trial completed the Insomnia Severity Index (ISI) and the Berlin Questionnaire (BQ) at baseline; proportions of participants with symptoms consistent with insomnia and OSA were calculated, using standard cut-offs for ISI and BQ. For Veterans with insomnia and OSA symptoms, electronic medical records were searched to identify whether there was a diagnosis code for these conditions. Multivariable linear (ISI) and logistic (BQ) regression models examined associations of the following characteristics with symptoms of insomnia and OSA: age, gender, race, self-reported general health, body mass index (BMI), diagnosis of post-traumatic stress disorder (PTSD), pain severity, depressive symptoms, number of joints with arthritis symptoms and opioid use. RESULTS Symptoms consistent with insomnia and OSA were found in 53 and 66% of this sample, respectively. Among participants screening positive for insomnia and OSA, diagnosis codes for these disorders were present in the electronic medical record for 22 and 51%, respectively. Characteristics associated with insomnia were lower age (β (SE) = - 0.09 (0.04), 95% confidence interval [CI] = - 0.16, - 0.02), having a PTSD diagnosis (β (SE) = 1.68 (0.73), CI = 0.25, 3.11), greater pain severity (β (SE) = 0.36 (0.09), CI = 0.17, 0.55), and greater depressive symptoms (β (SE) = 0.84 (0.07), CI = 0.70, 0.98). Characteristics associated with OSA were higher BMI (odds ratio [OR] = 1.13, CI = 1.06, 1.21), greater depressive symptoms (OR = 1.12, CI = 1.05, 1.20), and opioid use (OR = 0.51, CI = 0.26, 0.99). CONCLUSIONS Insomnia and OSA symptoms were very common in Veterans with OA, and a substantial proportion of individuals with symptoms may have been undiagnosed. Characteristics associated with insomnia and OSA symptoms were consistent with prior studies. TRIAL REGISTRATION NCT01130740 .
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Affiliation(s)
- Shannon Stark Taylor
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605 USA
| | - Jaime M. Hughes
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Cynthia J. Coffman
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Amy S. Jeffreys
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
| | - Christi S. Ulmer
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Eugene Z. Oddone
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Hayden B. Bosworth
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - William S. Yancy
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- Duke University School of Medicine, Durham, NC USA
| | - Kelli D. Allen
- Durham VA Health Care System, VA Medical Center (152), 508 Fulton Street, Durham, NC 27705 USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Hughes JM, Song Y, Fung CH, Dzierzewski JM, Mitchell MN, Jouldjian S, Josephson KR, Alessi CA, Martin JL. Measuring Sleep in Vulnerable Older Adults: A Comparison of Subjective and Objective Sleep Measures. Clin Gerontol 2018; 41:145-157. [PMID: 29283797 PMCID: PMC5809246 DOI: 10.1080/07317115.2017.1408734] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program. METHODS 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures. RESULTS Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE. CONCLUSIONS Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems. CLINICAL IMPLICATIONS Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.
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Affiliation(s)
- Jaime M Hughes
- a Center for Health Services Research in Primary Care , Durham VA Medical Center , Durham , North Carolina , USA
| | - Yeonsu Song
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Constance H Fung
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Joseph M Dzierzewski
- d Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Michael N Mitchell
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Stella Jouldjian
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Karen R Josephson
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Cathy A Alessi
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
| | - Jennifer L Martin
- b Geriatric Research, Education, and Clinical Center , VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c David Geffen School of Medicine , University of California at Los Angeles , Los Angeles , California , USA
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Hughes JM, Ulmer CS, Gierisch JM, Nicole Hastings S, Howard MO. Insomnia in United States military veterans: An integrated theoretical model. Clin Psychol Rev 2018; 59:118-125. [PMID: 29180102 PMCID: PMC5930488 DOI: 10.1016/j.cpr.2017.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
Marked by difficulty falling or staying asleep and/or poor sleep leading to daytime dysfunction, insomnia contributes to functional impairment, poor health, and increased healthcare utilization when left untreated. As many as two-thirds of Iraq and Afghanistan military veterans complain of insomnia. Older veterans of prior conflicts report insomnia occurring since initial service, suggesting a chronic nature to insomnia in this population. Despite insomnia's high prevalence and severe consequences, there is no theoretical model to explain either the onset or chronicity of insomnia in this growing patient population. Existing theories view insomnia as an acute, unidirectional phenomenon and do little to elucidate long-term consequences of such problems. Existing theories also fail to address mechanisms by which acute insomnia becomes chronic. This paper presents an original, integrated theoretical model that draws upon constructs from several prominent behavioral medicine theories to reconceptualize insomnia as a chronic, cyclical problem that is both a consequence and predictor of stress. Additional research examining the relationships between stress, sleep, resilience, and outcomes of interest could inform clinical and research practices. Addressing sleep problems early could potentially enhance adaptive capacity, thereby reducing the risk for subsequent negative outcomes.
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Affiliation(s)
- Jaime M Hughes
- Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States.
| | - Christi S Ulmer
- Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Jennifer M Gierisch
- Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - S Nicole Hastings
- Health Services Research & Development, Durham VA Health Care System, Durham, NC, United States; Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, United States; Department of Medicine and Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States
| | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Abstract
PURPOSE OF REVIEW The number of informal caregivers providing assistance to adults is increasing commensurate with our aging society. Sleep disturbances are prevalent in caregivers and associated with negative physical, medical, and functional outcomes. Here, we describe the predisposing, precipitating, and perpetuating factors contributing to the development of sleep problems in caregivers, and discuss three understudied caregiving populations that have clinical importance and unique circumstances influencing sleep quality and health. RECENT FINDINGS There is clear evidence supporting the interaction between sleep loss, caregiving stress, and vulnerability to chronic disease. Telehealth and telemedicine sleep interventions for caregivers combined with assistive technologies targeting care-receivers have potential to be more individualized, affordable, and widely accessible than traditional in-person insomnia treatment approaches. Limited data exist describing the etiology and treatment of sleep problems in caregivers of veterans, medical patients newly discharged from the hospital, and developmentally disabled adults. SUMMARY There is a growing literature describing the general determinants of sleep disturbances in caregivers, the health consequences of these disturbances, and intervention strategies for treating them. Identifying effective sleep treatments suited to more specialized caregiving situations and increasing intervention access will help caregivers continue to provide quality care while protecting their own health and well-being.
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Song Y, Dzierzewski JM, Fung CH, Rodriguez JC, Jouldjian S, Mitchell MN, Josephson KR, Alessi CA, Martin JL. Association Between Sleep and Physical Function in Older Veterans in an Adult Day Healthcare Program. J Am Geriatr Soc 2015. [PMID: 26200520 DOI: 10.1111/jgs.13527] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine whether sleep disturbance is associated with poor physical function in older veterans in an adult day healthcare (ADHC) program. DESIGN Cross-sectional. SETTING One ADHC program in a Veterans Affairs Ambulatory Care Center. PARTICIPANTS Older veterans (N = 50) enrolled in a randomized controlled trial of a sleep intervention program who had complete baseline data. MEASUREMENTS Information on participant characteristics (e.g., age, depression, relationship to caregiver, pain, comorbidity) was collected using appropriate questionnaires. Physical function was measured using activity of daily living (ADL) and instrumental ADL (IADL) total scores from the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Sleep was assessed subjectively (Pittsburgh Sleep Quality Index, Insomnia Severity Index) and objectively (wrist actigraphy). RESULTS Participants required substantial assistance with ADLs and IADLs. A regression model showed that participant characteristics (marital status, use of sleep medication, comorbidity, posttraumatic stress disorder) and living arrangement (living with a spouse or others) were significantly associated with poor physical function. Poorer objective sleep (total sleep time, total numbers of awakenings, total wake time) was significantly associated with poor physical function, accounting for a significant proportion of the variance other than participant characteristics. CONCLUSION Objective measures of nighttime sleep disturbance were associated with poor physical function in older veterans in an ADHC program. Further research is needed to determine whether interventions to improve sleep will delay functional decline in this vulnerable population.
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Affiliation(s)
- Yeonsu Song
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Joseph M Dzierzewski
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Juan C Rodriguez
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Medicine, Pontificia Universidad Catolica, Santiago, Chile
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Karen R Josephson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Cathy A Alessi
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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