Tonight's Sleep Predicts Tomorrow's Fatigue: A Daily Diary Study of Long-Term Care Employees With Nonwork Caregiving Roles

Amant O, Ward-Griffin C, Anderson S. Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing me down"

The COVID-19 pandemic has considerably strained health care providers and family caregivers. Double-duty caregivers give unpaid care at home and are employed as care providers. This sequential mixed-method study, a survey followed by qualitative interviews, aimed to comprehensively understand the experiences of these Canadian double-duty caregivers amidst the pandemic and the transition to the endemic phase. The multi-section survey included standardized assessments such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with demographic, employment-related, and care work questions. Data analysis employed descriptive and linear regression modeling statistics, and content analysis of the qualitative data. Out of the 415 respondents, the majority were female (92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 years. 68.9% reported mental health decline over the past year, while 60.7% noted physical health deteriorated. 75.9% of participants self-rated their anxiety as moderate to high. The final regression model explained 36.8% of the variance in participants' anxiety levels. Factors contributing to lower anxiety included more personal supports, awareness of limits, younger age, and fewer weekly employment hours. Increased anxiety was linked to poorer self-rated health, and both perceptions and consequences of blurred boundaries. The eighteen interviewees highlighted the stress of managing additional work and home care during the pandemic. They highlighted the difficulty navigating systems and coordinating care. Double-duty caregivers form a significant portion of the healthcare workforce. Despite the spotlight on care and caregiving during the COVID-19 pandemic, the vital contributions and well-being of double-duty caregivers and family caregivers have remained unnoticed. Prioritizing their welfare is crucial for health systems as they make up the largest care workforce, particularly evident during the ongoing healthcare workforce shortage.

Association between prior-night sleep and next-day fatigue in older adults: a daily diary study

BACKGROUND

Fatigue is known as an element of frailty. Sleep problems (e.g., short sleep duration and low sleep quality) can increase fatigue, but the day-to-day relationship between sleep and fatigue has not been studied well in older adults. Using a daily diary method, this study examined the within- and between-person associations between sleep and fatigue in older adults.

METHODS

The study recruited 56 Japanese community dwellers (age: 82-86 years; female: 37.5%). Participants responded to a daily diary questionnaire at the end of each day. Over seven days, time in bed and satisfaction were measured after waking up, whereas fatigue was assessed before going to bed. We included person-level covariates (demographic factors, and physical and mental health) and day-level covariates (time in study, and positive and negative emotions). Multilevel models were estimated to examine within- and between-person associations.

RESULTS

At the within-person level, on days following short and long time in bed and days following low levels of sleep satisfaction, individuals felt higher levels of fatigue compared with usual days. At the between-person level, no statistically significant differences in fatigue were observed between individuals with long and short time in bed.

CONCLUSIONS

The findings suggest that prior-day sleep is associated with next-day fatigue in older adults. Long and short sleep duration and low sleep quality can lead to fatigue. Considering that sleep is a modifiable health behavior, appropriate management of sleep behavior may reduce fatigue.

Tiredness Takes Its Toll: An Integrative Review on Sleep and Occupational Outcomes for Long-Term Care Workers

Poor sleep quality and duration among health care professionals have negative impacts on worker safety, work readiness, and well-being. However, the consequences of impaired sleep among long-term care (LTC) workers remain understudied. The current integrative review sought to explore associations between sleep and occupational outcomes in LTC workers. Multiple database searches yielded 1,543 articles; nine articles met inclusion criteria. Results synthesized from included articles revealed sleep-associated occupational outcomes across three themes, Burnout/Fatigue, Mental and Physical Health, and Well-Being, which may affect performance measures and predict injuries/errors. Exploring outcomes of poor sleep quality and duration among LTC workers has highlighted the needs of this population and may inform future intervention development. LTC organizations should consider implementing strategies to better support the sleep quality of their workforce. In addition, further research is needed to explore how impaired sleep contributes to negative worker outcomes and patient care quality. [Journal of Gerontological Nursing, 49(1), 27-33.].

The relationship between repetitive negative thinking, sleep disturbance, and subjective fatigue in women with Generalized Anxiety Disorder

Objectives

Fatigue is a prominent symptom of Generalized Anxiety Disorder (GAD). However, the pathways contributing to elevated fatigue in GAD are poorly understood. Sleep disturbance, also prominent in GAD, only partially explains elevated fatigue in GAD. Repetitive negative thinking (RNT) is a cognitive feature of both GAD and sleep disturbance, and RNT has recently also been associated with elevated fatigue. Therefore, this study assessed whether elevated fatigue in GAD is accounted for by a combination of sleep quality and RNT.

Design

Between‐group, correlational design in 64 primarily university‐educated women with and without a GAD diagnosis.

Methods

Women completed self‐report questionnaires assessing RNT experienced in the past few days, previous night’s sleep quality, and current physical and mental fatigue. Hierarchical linear regressions were conducted to assess whether the relationship between GAD status and fatigue is accounted for by RNT and sleep quality.

Results

Women with GAD reported lower sleep quality, and higher RNT and physical and mental fatigue, compared to women without GAD. Sleep quality partly accounted for group differences in both types of fatigue (β’s > −0.4), whereas RNT fully accounted for group differences in both types of fatigue (β’s > 0.29). The relationship between RNT and both types of fatigue was fully accounted for by sleep quality (β’s > −0.39).

Conclusions

These findings indicate that heightened RNT amongst women with GAD may be associated with elevated physical and mental fatigue via its detrimental effects on sleep quality. Interventions that reduce RNT may help to alleviate fatigue symptoms in women with GAD.

Practitioner points

Women with Generalized Anxiety Disorder (GAD) have elevated fatigue and repetitive negative thinking (RNT), and poorer self‐reported sleep quality, relative to women without GAD.

Whereas sleep quality only partially accounts for elevated fatigue in GAD, RNT fully accounts for elevated fatigue, and the relationship between RNT and fatigue is fully accounted for by sleep quality.

These findings provide novel evidence that women with GAD may have elevated fatigue because of the detrimental effects of RNT on sleep.

These findings suggest that targeting RNT in treatment for GAD may help to reduce fatigue in GAD, by improving sleep quality.

Effect of Employment Status on the Association Among Sleep, Care Burden, and Negative Affect in Family Caregivers

OBJECTIVE

To examine the effect of employment status on sleep, care burden, and negative affect among family caregivers (FCs) at home.

METHODS

An intensive longitudinal design was applied in which 25 FCs underwent in-home assessments for up to 56 days. At baseline, demographic data and employment status were collected. FCs wore a wrist-worn device with an accelerometer to assess objective total sleep time (TST) for consecutive 24-hour periods. FCs answered the Zarit Burden Interview (ZBI) and Positive and Negative Affect Schedule (PANAS) every night before sleep. Linear mixed model analysis was used to examine the effect of objective sleep status on ZBI and PANAS scores the following day.

RESULTS

Mean participant age was 66.3 ± 10.8 years (72.0% female), and mean survey period was 29.1 ± 9.6 days (866 observations). Mean TST of FCs was 5.7 ± 1.4 hours. In total, 32.0% of FCs were employed either full- or part-time. TST of employed FCs was significantly associated with care burden and negative affect (B = -0.4 and -1.3, respectively); however, positive affect was not associated with TST. FCs who were unemployed experienced less care burden and negative affect (rate of change: -7.7 and -8.0, respectively). Additionally, TST of unemployed FCs was associated with negative affect; thus, when they slept 1 hour longer than their mean TST, they experienced less negative affect the following day.

CONCLUSION

A reduction in TST could lead to increased care burden and more severe negative affect the following day, which may be moderated by employment status.

Changes in Fatigue Levels and Sleep Measures of Hospital Nurses During Two 12-Hour Work Shifts

OBJECTIVE

The aims of this study were to explore nurses' fatigue levels and sleep measures during two 12-hour consecutive day shifts and examine the relationships between nurses' fatigue levels within shifts and their previous-night sleep characteristics.

BACKGROUND

Monitoring changes in fatigue and sleep is important to enable effective fatigue management.

METHODS

This was a descriptive, repeated-measures study. Data were collected using surveys and actigraphy 4 times during each consecutive shift (7:00 am-7:30 pm).

RESULTS

General fatigue levels started trending up 4 hours after the start of work; highest levels were reported at 7:30 pm. Fatigue levels accumulated across consecutive shifts. Subjective sleep quality was higher the night before the 2nd shift than the night before the 1st shift. Nurses' poor sleep the night before a shift was related to increased fatigue levels during the next shift.

CONCLUSION

It is important to consider when fatigue management interventions will be most effective and to consider previous-night's sleep when monitoring fatigue.

High prevalence of parent-reported sleep problems in pediatric patients with acute lymphoblastic leukemia after induction therapy

OBJECTIVE

To assess sleep problems (prevalence and predictors) in pediatric patients with acute lymphoblastic leukemia (ALL) after the most intensive phase of therapy (induction).

METHODS

Patients (≥2 years) treated according to the Dutch ALL-11 protocol were included. Sleep was measured using parent-reports and self-reports (Children's Sleep Habits Questionnaire; CSHQ) and actigraphy. Parental sleep (Medical Outcome Study Sleep Scale) and distress and parenting problems (Distress Thermometer for Parents) were assessed with questionnaires. Z-scores were calculated for total CSHQ scores using age-appropriate scores of healthy Dutch children. The prevalence of sleep problems (defined as a Z-score > 1) in patients with ALL was compared to healthy children (chi-square tests). Actigraphic sleep estimates were collected in healthy Dutch children (n = 86, 2-18 years) for comparison with patients (linear regression). Determinants of parent-reported child sleep (total CSHQ Z-score) were identified with regression models.

RESULTS

Responses were collected for 124 patients (response rate 67%), comprising 123 parent-reports, 34 self-reports, and 69 actigraphy assessments. Parents reported sleep problems in 38.0% of the patients compared to 15.2% in healthy children (P < .001). Patients reported fewer sleep problems themselves: 12.1% compared to 15.8% in healthy children (P = .33). Total time in bed (B (95% CI): 22.89 (9.55-36.22)) and total sleep time (B (95% CI):16.30 (1.40-31.19)), as derived from actigraphy, were significantly longer in patients. More parent-reported child sleep problems were predicted by parenting problems, more parental sleep problems, bedroom sharing, and child's sleep medication use (explained variance: 27.4%).

CONCLUSIONS

Systematic monitoring of child and parental sleep and implementation of effective interventions may be a gateway to improve quality of survival in pediatric ALL.

"It's Been a Hard Day's Night": Sleep Problems in Caregivers for Older Adults

PURPOSE OF REVIEW

This paper critically evaluates literature from the last three years on sleep in caregivers for older adults. Research is evaluated in four main areas: factors related to caregivers having sleep problems, sleep health in various types of caregivers, how caregivers' sleep and health inter-relate, and interventions to improve sleep.

RECENT FINDINGS

A range of both care recipients' and caregivers' characteristics have been associated with caregiver sleep quality measured subjectively and objectively. Care recipient factors associated with caregiver sleep quality include fall risk and sleep quality, while caregiver factors include stress, duration, intensity, provision of medical/nursing care tasks, and even particular serotonin genotypes (e.g. short allele carriers for 5-HTTLPR). While the greatest focus has been on dementia caregivers, recent work suggests groups such as end-of-life caregivers, former caregivers, and caregivers with multiple care roles (e.g. child, older adult, paid care) have sleep disturbances that vary by their unique contexts. Caregiver's sleep, particularly subjective assessments, relates to their mood and physiological well-being; and evidence suggests that sleep may be an important mediator linking care stressors with mental health. Factors such as mindfulness and sense of coherence may protect caregivers from sleep disturbances.

Sobrecarga y apoyos en el cuidador familiar de pacientes con enfermedad crónica

Introducción: En el presente siglo se evidencia un incremento de la enfermedad crónica no trasmisible a nivel mundial, los pacientes presentan patologías con mayor duración y complejidad generando dependencia, requiriendo de un cuidador en el hogar; necesitando contar con diferentes para mejorar la competencia de cuidar. Objetivo: Identificar los medios de apoyo que utiliza el cuidador familiar de paciente con patología crónica no trasmisible y su relación con el nivel de sobrecarga del cuidado. Materiales y Métodos: Estudio de abordaje cuantitativo, transversal y analítico, aplicando los instrumentos de “caracterización diada paciente-cuidador y la Encuesta de Percepción de Sobrecarga del Cuidador de Zarit”. La población correspondió a 62 Diadas. Se calcularon OR en regresión logística. Resultados: El 19.35% (12) de los cuidadores presentaban un nivel de sobrecarga intensa, el 20.97%(13) leve y el 59.68%(37) no tenían sobrecarga. Los cuidadores con sobrecarga intensa refieren 0% de apoyo psicológico y social. Las variables relevantes en el nivel de sobrecarga fueron las horas diarias de cuidado OR = 1.14 (IC 95%: 1.01; 1.33), a mayor nivel de conocimiento del computador disminuye la posibilidad de aumento en el nivel de sobrecarga con OR crudo= 0.14 (IC95%: 0.02; 0.91) y OR ajustado = 0.07 (IC95%: 0.007; 0.68).  Discusión: Es básico continuar indagando en aspectos que permitan disminuir la sobrecarga del cuidador, mantenerlo sano y en condiciones para su rol. Conclusiones: Es necesario fortalecer los diferentes medios de apoyos en el cuidador familiar para disminuir el nivel de sobrecarga relacionada con su tarea. Como citar este artículo: Campos MS, Durán EY, Rivera R, Páez N, Carrillo G. Sobrecarga y apoyos en el cuidador familiar de pacientes con enfermedad crónica. Rev Cuid. 2019; 10(3): e649. http://dx.doi.org/10.15649/cuidarte.v10i3.649