Effects of volitional lifestyle on sleep-life habits in the aged

Perceived versus objective sleep quality in long-stay hospitalised older adults-a mixed methods study

BACKGROUND

Hospital inpatients experience substantial sleep problems that have been linked with worse health outcomes, poor quality of life and the post-hospital syndrome. However, little is known about assessing sleep issues in older hospitalised patients.

OBJECTIVE

To conduct an in-depth investigation on hospitalised older adults' sleep challenges and methods of sleep assessment.

DESIGN

Cross-sectional observational study.

SETTING

Public hospital inpatient unit.

SUBJECTS

Long-stay hospitalised older adults.

METHODS

Data were collected using validated sleep questionnaires, actigraphy devices and qualitative interviews. Quantitative data were analysed with descriptive statistics, multiple logistic regression and Cohen's Kappa. Qualitative data were analysed with qualitative content analysis; findings compared to the quantitative assessments.

RESULTS

We collected data on 33 older long-stay hospital inpatients, who were mean (SD) 80.2(7.4) years old, 57.6% female and were hospitalised following stroke, medical illness and orthopaedic fracture. Mean (SD) total sleep time and actigraphic sleep efficiency were 480.6(73.6) minutes and 81.5(11.2)%, respectively. About, 57.6% were poor sleepers (Pittsburgh Sleep Quality Index [PSQI]) and 30.8% had indicators of clinical depression/low quality of life (WHO-5 well-being index). Three main themes were identified: "sleep assessment"; "factors that affect sleep"; "expectations of sleep". Bad sleepers were more likely to feel a lack of control over their sleep, while good sleepers spoke about the ability to adjust and accept their circumstances.

CONCLUSIONS

We found high levels of sleep problems and identified substantial discrepancies between the validated sleep questionnaire and qualitative response data. Our findings indicate that standard assessment tools, such as PSQI, may not be suitable to assess sleep in hospitalised older adults and call for further investigations to build more appropriate methods. Further exploring psychological factors and expectations could potentially lead to novel interventions to improve sleep in this setting.

Perceived control and sleep in hospitalized older adults: a sound hypothesis?

BACKGROUND/OBJECTIVES

To examine the associations between perceived control over sleep, noise levels, sleep duration, and noise complaints in a cohort of hospitalized adults.

DESIGN

Prospective cohort study.

SETTING

General medicine ward in an academic medical center.

PARTICIPANTS

One hundred eighteen hospitalized patients age 50 years and over (mean age, 65 years; 57% female; 67% African American).

MEASUREMENTS

Sleep duration was measured via wrist actigraphy, and noise levels in patient rooms were measured via sound monitors. Validated questionnaires were used to assess sleep characteristics at baseline and sleep quality for each night. Perceived control over sleep was measured at baseline using the Sleep Self-Efficacy (SSE) scale (range 9-45).

RESULTS

The mean SSE score was 32.1 (standard deviation, 9.4), and the median score was 34 (interquartile range, 24-41). Average sleep duration for patients in the hospital was 333 minutes (5.5 hours). Forty-two percent of patients complained of noise disrupting their sleep. Linear regression clustered by subject showed that above median SSE was associated with longer sleep duration (+55 minutes 95% confidence interval [CI]: 14, 97; P = 0.010). This association remained significant after controlling for objective noise levels and patient demographics (+50 minutes 95% CI: 11, 90; P = 0.014). In logistic regression controlling for noise level and patient demographics, those patients with high SSE were 51% less likely to complain of noise disruptions (odds ratio: 0.49; 95% CI: 0.25, 0.96; P = 0.039).

CONCLUSION

Higher perceived control over sleep is associated with longer sleep duration, better sleep quality, and fewer reports of noise disruptions. In addition to noise control, interventions to boost perceived control may improve in-hospital sleep.

Volitional lifestyle in healthy elderly: its relevance to rest-activity cycle, nocturnal sleep, and daytime napping

Sleep-related problems are prevalent among the aged. The present study examined the influence of a mentally active or "volitional" lifestyle on the rest-activity cycle, nocturnal sleep, and daytime napping in the healthy elderly. 14 aged individuals with a high Volitional lifestyle (M = 74.1 yr. old) and 14 with a Low Volitional lifestyle (M = 73.0 yr. old) were screened by questionnaires including the Philadelphia Geriatric Center Morale scale and the Self-confidence scale. Their activity levels were monitored by a wrist actigraph system for 14 consecutive days. They were also asked to record daily sleep logs. The total times of nocturnal sleep and daytime napping did not differ between the groups. However, the acrophases of circadian (tau = 24 hr.) and circasemidian (tau = 12 hr.) activity cycles were more advanced in the Low Volitional group. In addition, the High Volitional group took a daytime nap with a better timing than did the Low Volitional group: the former started a nap during the phase in which their activity level was going down, whereas the latter when their activity level was going up. These results suggest that high volitional lifestyle may be related to better rest-activity cycle in the healthy elderly.

Effects of volitional lifestyle on rest-activity cycle in the aged

The present study investigated the relationship among volitional lifestyle, activity and sleep in the aged. We selected 28 subjects over 65 years of age to survey volition to lifestyle. High-volitional group (14 Ss, mean age: 74.1 years, seven males and seven females) and low-volitional group (14 Ss, mean age: 73.0 years, seven males and seven females) were identified by the scale of self-confidence and the Philadelphia Geriatric Center morale scale. Wrist activities were monitored by Actigraph for 10 or 14 consecutive days. The subjects recorded sleep logs by themselves for those days. It was found that high volitional aged individuals had a relatively well structured sleep in comparison with low volitional aged individuals, and that most of them took a clock dependent habitual nap around 14.00 h. On the other hand, low volitional aged individuals had a relatively poor structured sleep, and took a nap time-dependently after 8 h from the morning rising time. These results suggest that high volitional aged individuals build a short nap into their well organized sleep-life habits.