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Aryankhesal A, Blake J, Wong G, Megson M, Briscoe S, Allan L, Broomfield NM, Eastwood Z, Greene L, Hilton A, Killett A, Lazar AS, Litherland R, Livingston G, Maidment I, Reeve J, Rook G, Scott S, Um J, van Horik J, Fox C. Sleep disturbance in people living with dementia or mild cognitive impairment: a realist review of general practice. Br J Gen Pract 2024; 74:BJGP.2023.0171. [PMID: 38499365 PMCID: PMC10962510 DOI: 10.3399/bjgp.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/23/2023] [Indexed: 03/20/2024] Open
Abstract
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.
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Affiliation(s)
- Aidin Aryankhesal
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Jessica Blake
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Molly Megson
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | | | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich
| | - Zenahrai Eastwood
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Andrea Hilton
- School of Paramedical PeriOperative and Advanced Practice, Faculty of Health Sciences, University of Hull, Hull
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | - Alpar S Lazar
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich
| | | | - Gill Livingston
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull
| | | | - Sion Scott
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester
| | - Jinpil Um
- University of Exeter Medical School, Exeter
| | | | - Chris Fox
- University of Exeter Medical School, Exeter
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Morgan TL, Faught E, Ross-White A, Fortier MS, Duggan M, Jain R, Lane KN, Lorbergs A, Maclaren K, McFadden T, Tomasone JR. Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review. BMC PRIMARY CARE 2023; 24:140. [PMID: 37420229 PMCID: PMC10326959 DOI: 10.1186/s12875-023-02091-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries. METHODS An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied. CONCLUSIONS Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.
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Affiliation(s)
- Tamara L Morgan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada.
| | - Emma Faught
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | | | - Mary Duggan
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
| | - Rahul Jain
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirstin N Lane
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | | | - Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Canadian Medical Association, Ottawa, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada
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Watt JA, Bronskill SE, Lin M, Youngson E, Ho J, Hemmelgarn B, Straus SE, Gruneir A. Comparative Risk of Harm Associated with Zopiclone or Trazodone Use in Nursing Home Residents: a Retrospective Cohort Study in Alberta, Canada. Can Geriatr J 2023; 26:9-22. [PMID: 36865408 PMCID: PMC9953503 DOI: 10.5770/cgj.26.622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background There is growing evidence of harm associated with trazodone and nonbenzodiazepine sedative hypnotics (e.g., zopiclone); however, their comparative risk of harm is unknown. Methods We conducted a retrospective cohort study with linked health administrative data, which enrolled older (≥66 years old) nursing home residents living in Alberta, Canada, between December 1, 2009, and December 31, 2018; the last follow-up date was June 30, 2019. We compared the rate of injurious falls and major osteoporotic fractures (primary outcome) and all-cause mortality (secondary outcome) within 180 days of first prescription of zopiclone or trazodone with cause-specific hazard models and inverse probability of treatment weights to control for confounding; primary analysis was intention-to-treat and secondary analysis was per-protocol (i.e., residents censored if dispensed the other exposure drug). Results Our cohort included 1,403 residents newly dispensed trazodone and 1,599 residents newly dispensed zopiclone. At cohort entry, the mean resident age was 85.7 (standard deviation [SD] 7.4), 61.6% were female, and 81.2% had dementia. New zopiclone use was associated with similar rates of injurious falls and major osteoporotic fractures (intention-to-treat-weighted hazard ratio 1.15, 95% confidence interval [CI] 0.90-1.48; per-protocol-weighted hazard ratio 0.85, 95% CI 0.60-1.21) and all-cause mortality (intention-to-treat-weighted hazard ratio 0.96, 95% CI 0.79-1.16; per-protocol-weighted hazard ratio 0.90, 95% CI 0.66-1.23) compared to trazodone. Conclusions Zopiclone was associated with a similar rate of injurious falls, major osteoporotic fractures, and all-cause mortality compared to trazodone-suggesting one medication should not be used in lieu of the other. Appropriate prescribing initiatives should also target zopiclone and trazodone.
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Affiliation(s)
- Jennifer A. Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, ON,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON,ICES, Toronto, ON,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Susan E. Bronskill
- ICES, Toronto, ON,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Meng Lin
- Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, AB
| | - Erik Youngson
- Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, AB
| | - Joanne Ho
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Kitchener, ON,Schlegel Research Institute for Aging, University of Waterloo, Waterloo, ON
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, AB
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto, Toronto, ON,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, AB
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Enam N, Grampurohit N, Farber RS. Sleep Management within Skilled Nursing Facilities: A Practice Survey. Occup Ther Health Care 2023; 37:1-17. [PMID: 33228469 DOI: 10.1080/07380577.2020.1846234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A cross-sectional descriptive survey of 105 occupational therapy practitioners examined the practice patterns in sleep management within skilled nursing facilities. All participants viewed sleep as essential to address in their settings, since clients frequently reported inadequate sleep, daytime sleepiness, difficulty staying asleep, and situational interruption. Majority of the practitioners reported not screening, assessing, treating, or documenting sleep issues and lack the use of standardized assessments and evidence-based interventions for sleep. Results suggest that practitioners need more training, education, and advocacy skills to promote the role of occupational therapy in addressing sleep management in skilled nursing facilities.
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Affiliation(s)
- Nabila Enam
- Occupational Therapy, University of the Sciences, Philadelphia, PA, USA
| | - Namrata Grampurohit
- Occupational Therapy, Thomas Jefferson University - Center City Campus, Philadelphia, PA, USA
| | - Ruth S Farber
- Rehabilitation Sciences/Occupational Therapy, Temple University, Philadelphia, PA, USA
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Isolated REM sleep behaviour disorder: current diagnostic procedures and emerging new technologies. J Neurol 2022; 269:4684-4695. [PMID: 35748910 PMCID: PMC9363360 DOI: 10.1007/s00415-022-11213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022]
Abstract
Isolated REM sleep behaviour disorder (iRBD) is characterised by dream enactment behaviours, such as kicking and punching while asleep, and vivid/violent dreams. It is now acknowledged as a prodromal phase of neurodegenerative disease-approximately 80% of people with iRBD will develop dementia with Lewy Bodies, Parkinson's disease or another degenerative brain disease within 10 years. It is important that neurologists and other clinicians understand how to make an early accurate diagnosis of iRBD so that affected people can have the opportunity to take part in clinical trials. However, making a diagnosis can be clinically challenging due to a variety of reasons, including delayed referral, symptom overlap with other disorders, and uncertainty about how to confirm a diagnosis. Several methods of assessment are available, such as clinical interview, screening questionnaires and video polysomnography or 'sleep study'. This review aims to support clinical neurologists in assessing people who present with symptoms suggestive of iRBD. We describe the usefulness and limitations of each diagnostic method currently available in clinical practice, and present recent research on the utility of new wearable technologies to assist with iRBD diagnosis, which may offer a more practical assessment method for clinicians. This review highlights the importance of thorough clinical investigation when patients present with suspected iRBD and emphasises the need for easier access to diagnostic procedures for accurate and early diagnosis.
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Capezuti E, Zadeh RS, Brigham MA, Dias BA, Kim BC, Lengetti E, Erikson B, Swezey N, Krieger AC. Development and palliative care staff reactions to a sleep regulation educational intervention. BMC Palliat Care 2022; 21:12. [PMID: 35062933 PMCID: PMC8780339 DOI: 10.1186/s12904-022-00902-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background In palliative care, sleep and circadian rhythm problems are common symptoms. Nonpharmacological interventions are available; however, health care providers are not aware of these or lack the knowledge to effectively implement in practice. This study reports the content and design development of the PRIME™ (Program for Improving & Managing Environments for Sleep) sleep online educational intervention as well as the evaluation of the intervention by practicing nurses with a focus on perceived acceptability and satisfaction. Methods Development of the education employed a multi-step process that assesses the current state of the science in this area (literature reviews), the needs of regional target recipients (hospice/palliative care staff), expert recommendations and views of a national pool of hospice/palliative workers. A cross-sectional, descriptive study with key staff informants evaluated the acceptability and usability of the modules using both scale-response items to rate the content and design of the modules and overall satisfaction and five open-response questions to suggest changes to the educational intervention. Results Among 31 palliative care professionals, most rated the content and design favorably. A total of 20 participants provided suggestions to improve the educational intervention. Their comments were categorized into six themes: Integration into Practice; Content, Exercises and Material Provided by Modules; User Interface and Design; and Adapt and Expand Modules for Public, Family and Caregivers. Conclusions The data suggest that the PRIME™ educational intervention can be an effective tool to train direct-care palliative care professionals on interventions for use in their daily practice. We also demonstrated that the educational intervention is feasible to deliver online and that the online modules appealed to respondents, suggesting that future delivery of the educational intervention can use the same or similar modes of presentation.
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Haq IU, Hameed MA, Thomas MM, Syed KS, Othman AMM, Ahmed S, Alabbas AA, Ahmad M. Knowledge of Sleep Disorders Among Physicians at a Tertiary Care Hospital in Qatar: Cross-sectional Study. Interact J Med Res 2021; 10:e25606. [PMID: 33978594 PMCID: PMC8156111 DOI: 10.2196/25606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background Sleep disorders constitute a major health problem because of their relatively high and rising prevalence. Several studies worldwide have analyzed health care providers’ knowledge of sleep disorders. Objective In this study, we aimed to assess the knowledge of sleep disorders among physicians in Qatar. Methods A total of 250 physicians were surveyed regarding their knowledge of sleep medicine by using the validated 30-item Assessment of Sleep Knowledge in Medical Education (ASKME) Survey. The participants included residents, fellows, and consultants in medicine and allied subspecialties. A high score was defined as ≥60% of correctly answered questions, implying the respondent has adequate knowledge of sleep disorders. Results Responses were received from 158 of the 250 physicians, with a response rate of 63.2%. This included responses from 34 residents, 74 clinical fellows, and 50 consultants. The overall mean score was 15.53 (SD 4.42), with the highest possible score of 30. Only 57 of 158 (36.1%) respondents were able to answer ≥60% of the questions correctly. No statistically significant difference was found in the scores of participants with regard to their ranks (ie, residents, fellows, or consultants) or years of medical training. Conclusions This study demonstrates that health care providers in Qatar have decreased awareness and knowledge about sleep medicine, which may reflect reduced emphasis on sleep disorders during medical school and training. Increasing awareness regarding sleep medicine among nonspecialist physicians will allow early detection and treatment of sleep disorders, thereby reducing the morbidity associated with these disorders.
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Affiliation(s)
| | - Mansoor Ali Hameed
- Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Merlin Marry Thomas
- Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | | | | | | | | | - Mushtaq Ahmad
- Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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Caudwell L, Himani H, Khaw A, Taylor R, White J, Rhodes S, Skinner M. Attitudes and perceptions of health professionals towards sleep health: a systematic review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Lachlan Caudwell
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Himani Himani
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Alice Khaw
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ruby Taylor
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jessica White
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Sarah Rhodes
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Margot Skinner
- Center for Health Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Assessment and treatment of pediatric behavioral sleep disorders in Canada. Sleep Med 2018; 56:29-37. [PMID: 30555028 DOI: 10.1016/j.sleep.2018.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES/BACKGROUND This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children. METHODS Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences. RESULTS It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country. CONCLUSIONS Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system.
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Abstract
Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living independently. Poor sleep increases the risk of LTC placement, and sleep disturbance is extremely common among LTC residents. The identification and management of sleep disturbance in LTC residents is a vital, but perhaps underappreciated, aspect of offering high-quality care for this already compromised population. This review describes the nature and consequences of sleep disturbances in LTC, clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.
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Affiliation(s)
- Lichuan Ye
- Bouvé College of Health Sciences School of Nursing, Northeastern University, Boston, MA 02115, USA
| | - Kathy C Richards
- The University of Texas at Austin, School of Nursing, 1710 Red River, Austin, TX 78701, USA.
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12
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Hayman SL, Tieman JJ. Discovering the dementia evidence base: Tools to support knowledge to action in dementia care (innovative practice). DEMENTIA 2016; 15:1279-88. [DOI: 10.1177/1471301215587819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia requires expert care and decision making, based on sound evidence. Reliable evidence is difficult for busy dementia care professionals to find quickly. This study developed an experimentally tested search filter as an innovative tool to retrieve literature on dementia. It has a known retrieval performance and can be provided as an open access web link directly to current literature. The Dementia Search Filter was developed using validated methodology. An Expert Advisory Group of dementia care practitioners and researchers ratified a representative set of relevant studies and undertook post hoc relevance assessment, to ensure the usefulness of the search filter. The Dementia Search Filter is published on two websites and combined with expert searches to link to evidence on dementia, at end of life in aged care settings and more generally. Evidence accessed by the Dementia Search Filter will help overcome barriers to finding current relevant research in the field, for practitioners, researchers and decision makers.
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Affiliation(s)
- Sarah L Hayman
- CareSearch Palliative Care Knowledge Network, Flinders University, South Australia, Australia
| | - Jennifer J Tieman
- CareSearch Palliative Care Knowledge Network, Flinders University, South Australia, Australia
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