1
|
Martin JL, Cadogan M, Brody AA, Mitchell MN, Hernandez DE, Mangold M, Alessi CA, Song Y, Chodosh J. Improving Sleep Using Mentored Behavioral and Environmental Restructuring (SLUMBER). J Am Med Dir Assoc 2024; 25:925-931.e3. [PMID: 38493807 PMCID: PMC11065626 DOI: 10.1016/j.jamda.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To evaluate the impact of a mentoring program to encourage staff-delivered sleep-promoting strategies on sleep, function, depression, and anxiety among skilled nursing facility (SNF) residents. DESIGN Modified stepped-wedge unit-level intervention. SETTING AND PARTICIPANTS Seventy-two residents (mean age 75 ± 15 years; 61.5% female, 41% non-Hispanic white, 35% Black, 20% Hispanic, 3% Asian) of 2 New York City urban SNFs. METHODS Expert mentors provided SNF staff webinars, in-person workshops, and weekly sleep pearls via text messaging. Resident data were collected at baseline, post-intervention (V1), and 3-month follow-up (V2), including wrist actigraphy, resident behavioral observations, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) depression scale, Brief Anxiety and Depression Scale (BADS), Brief Cognitive Assessment Tool (BCAT), and select Minimum Data Set 3.0 (MDS 3.0) measures. Linear mixed models were fit for continuous outcomes and mixed-effects logistic models for binary outcomes. Outcomes were modeled as a function of time. Planned contrasts compared baseline to V1 and V2. RESULTS There was significant improvement in PSQI scores from baseline to V1 (P = .009), and from baseline to V2 (P = .008). Other significant changes between baseline and V1 included decreased depression (PHQ-9) (P = .028), increased daytime observed out of bed (P ≤ .001), and increased daytime observed being awake (P < .001). At V2 (vs baseline) being observed out of bed decreased (P < .001). Daytime sleeping by actigraphy increased from baseline to V1 (P = .004), but not V2. MDS 3.0 activities of daily living and pain showed improvements by the second quarter following implementation of SLUMBER (P's ≤ .034). There were no significant changes in BADS or BCAT between baseline and V1 or V2. CONCLUSIONS AND IMPLICATIONS SNF residents had improvements in sleep quality and depression with intervention, but improvements were not sustained at 3-month follow-up. The COVID-19 pandemic led to premature study termination, so full impacts remain unknown.
Collapse
Affiliation(s)
- Jennifer L Martin
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mary Cadogan
- School of Nursing, University of California, Los Angeles, CA, USA
| | - Abraham A Brody
- Rory Meyers College of Nursing, New York University, New York City, NY, USA; Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael N Mitchell
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Diana E Hernandez
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA
| | - Michael Mangold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Beth Israel), New York City, NY, USA
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; School of Nursing, University of California, Los Angeles, CA, USA
| | - Yeonsu Song
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA; School of Nursing, University of California, Los Angeles, CA, USA
| | - Joshua Chodosh
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York City, NY, USA.
| |
Collapse
|
2
|
Páez A, Frimpong E, Mograss M, Dang-Vu TT. The effectiveness of exercise interventions targeting sleep in older adults with cognitive impairment or Alzheimer's disease and related dementias (AD/ADRD): A systematic review and meta-analysis. J Sleep Res 2024:e14189. [PMID: 38462491 DOI: 10.1111/jsr.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/30/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
Sleep loss is associated with reduced health and quality of life, and increased risk of Alzheimer's disease and related dementias. Up to 66% of persons with Alzheimer's disease and related dementias experience poor sleep, which can predict or accelerate the progression of cognitive decline. Exercise is a widely accessible intervention for poor sleep that can protect against functional and cognitive decline. No previous systematic reviews have investigated the effectiveness of exercise for sleep in older adults with mild cognitive impairment or Alzheimer's disease and related dementias. We systematically reviewed controlled interventional studies of exercise targeting subjectively or objectively (polysomnography/actigraphy) assessed sleep in persons with mild cognitive impairment or Alzheimer's disease and related dementias. We conducted searches in PubMed, Embase, Scopus and Cochrane-Library (n = 6745). Nineteen randomised and one non-randomised controlled interventional trials were included, representing the experiences of 3278 persons with mild cognitive impairment or Alzheimer's disease and related dementias. Ten had low-risk, nine moderate-risk, and one high-risk of bias. Six studies with subjective and eight with objective sleep outcomes were meta-analysed (random-effects model). We found moderate- to high-quality evidence for the beneficial effects of exercise on self-reported and objectively-measured sleep outcomes in persons with mild cognitive impairment or Alzheimer's disease and related dementias. However, no studies examined key potential moderators of these effects, such as sex, napping or medication use. Our results have important implications for clinical practice. Sleep may be one of the most important modifiable risk factors for a range of health conditions, including cognitive decline and the progression of Alzheimer's disease and related dementias. Given our findings, clinicians may consider adding exercise as an effective intervention or adjuvant strategy for improving sleep in older persons with mild cognitive impairment or Alzheimer's disease and related dementias.
Collapse
Affiliation(s)
- Arsenio Páez
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Nuffield Department for Primary Care Health Sciences, University of Oxford, Oxford, UK
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| | - Emmanuel Frimpong
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Melodee Mograss
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Laboratory, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| |
Collapse
|
3
|
Klatt T, Bauer I, Behrendt D, Berg A. [Structured case conference for sleep disturbances in nursing home residents with cognitive impairment]. Pflege 2024. [PMID: 38234247 DOI: 10.1024/1012-5302/a000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Structured case conference for sleep disturbances in nursing home residents with cognitive impairment Abstract: Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: "offering appropriate activations during daytime", "creating bedtime routines", "checking the sleep environment", "observation of potential physical and psychological causes", "reflection on night care routines", and "use of drug therapies only in exceptional cases". Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.
Collapse
Affiliation(s)
- Thomas Klatt
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Ivonne Bauer
- Altenpflegeheim "Am Georgengarten" des Städtischen Klinikums Dessau, Deutschland
| | - Daniel Behrendt
- Städtisches Klinikum Dessau, Akademisches Lehrkrankenhaus mit Hochschulklinik der Medizinischen Hochschule Brandenburg Theodor Fontane (MHB), Deutschland
| | - Almuth Berg
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Deutschland
| |
Collapse
|
4
|
Dichter MN, Dörner J, Wilfling D, Berg A, Klatt T, Möhler R, Haastert B, Meyer G, Halek M, Köpke S. Intervention for sleep problems in nursing home residents with dementia: a cluster-randomized study. Int Psychogeriatr 2024:1-14. [PMID: 38186227 DOI: 10.1017/s1041610223004489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To reduce sleep problems in people living with dementia using a multi-component intervention. DESIGN Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks. SETTING Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants). PARTICIPANTS Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH. INTERVENTION The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two "sleep nurses," (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care. MEASUREMENTS Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI). RESULTS Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of -24.5% (95% CI, -46.3% - -2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087-0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks. CONCLUSIONS The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.
Collapse
Affiliation(s)
- Martin Nikolaus Dichter
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonas Dörner
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Lübeck, Germany
| | - Almuth Berg
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Thomas Klatt
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
5
|
Kim D, Choi YR, Lee YN, Chang SO. How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study. Nurs Health Sci 2024. [PMID: 38163765 DOI: 10.1111/nhs.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.
Collapse
Affiliation(s)
- Dayeong Kim
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Young-Rim Choi
- Research professor, College of Nursing, Korea University, Seoul, Republic of Korea
| | - Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Dörner J, Hüsken JM, Schmüdderich K, Dinand C, Dichter MN, Halek M. Perspectives on sleep of people living with dementia in nursing homes: a qualitative interview study. BMC Geriatr 2023; 23:331. [PMID: 37237308 DOI: 10.1186/s12877-023-04052-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Disturbed sleep among people living with dementia in nursing homes is widespread and is associated with diseases and all-cause mortality. This study examined the sleep of people living with dementia from their perspectives in nursing homes and that of the nurses who care for people living with dementia. METHODS A qualitative cross-sectional study was conducted. A total of 15 people living with dementia and 15 nurses in 11 German nursing homes were enrolled in this study. Data was collected between February and August 2021 through semistructured interviews, which were audio recorded and transcribed. Thematic analyses were performed by three independent researchers. Thematic mind maps and controversial findings were discussed with the Research Working Group of People with Dementia of the German Alzheimer Association. RESULTS Thematic analysis identified five overarching themes from the nursing home participants regarding sleep patterns: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences of people living with dementia on sleep, (4) environmental factors on sleep, and (5) sleep strategies of people living with dementia. Analysis also identified five overarching themes from the nurses participants: (1) characteristics of good sleep, (2) characteristics of bad sleep, (3) personal influences on sleep, (4) environmental factors on sleep, and (5) interventions for sleep promotion. CONCLUSIONS The thematic analyses demonstrated that the perspectives of people living with dementia and nurses indicate the need to give more consideration to psychosocial factors and individual aspects of sleep in clinical practice. The results could also be helpful for the development of targeted assessment instruments and complex non-pharmacological interventions to promote sleep.
Collapse
Affiliation(s)
- Jonas Dörner
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer st. 12, 58453, Witten, Germany.
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany.
| | - Johann-Moritz Hüsken
- German Institute of Applied Nursing Research, Hülchrather st. 15, 50670, Cologne, Germany
| | - Kathrin Schmüdderich
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer st. 12, 58453, Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
| | - Claudia Dinand
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Medical Faculty and University Hospital of Cologne, University of Cologne, Gleueler st. 176-178, 50935, Cologne, Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Alfred- Herrhausen-st. 45, 58455, Witten, Germany
| |
Collapse
|
7
|
Wilfling D, Berg A, Dörner J, Bartmann N, Klatt T, Meyer G, Halek M, Möhler R, Köpke S, Dichter MN. Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey. BMC Geriatr 2023; 23:206. [PMID: 37003974 PMCID: PMC10066004 DOI: 10.1186/s12877-023-03928-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/24/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Sleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses' knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management. METHODS A multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers. RESULTS Finally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident' health. Although, the assessment of sleep was seen as nurses' responsibility, only 40 nurses (14.7%) stated that residents' sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training. CONCLUSIONS Our results indicate that nurses working at night can play an important role in residents' sleep promotion. The findings indicate nurses' educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents' sleep based on adequate evidence-based non-pharmacological interventions.
Collapse
Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
| | - Almuth Berg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Jonas Dörner
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Natascha Bartmann
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Thomas Klatt
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle- Wittenberg, Halle (Saale), Germany
| | - Margareta Halek
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin N Dichter
- German Center of Neurodegenerative Diseases (DZNE), Witten, Germany
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| |
Collapse
|
8
|
Midorikawa H, Ekoyama S, Tachikawa H, Ota M, Tamura M, Takahashi T, Sekine A, Ide M, Matsuzaki A, Nemoto M, Nemoto K, Arai T. Association between behavioural and psychological symptoms of dementia and residence status in patients with Alzheimer's disease. Psychogeriatrics 2023; 23:45-51. [PMID: 36289565 DOI: 10.1111/psyg.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Examining the relationship between the behavioural and psychological symptoms of dementia (BPSD) and residence status is crucial to improving BPSD and reducing the burden on caregivers. However, studies on how BPSD differ between individuals living at home and those in institutional settings are lacking. We conducted a questionnaire survey among healthcare providers (HCPs) involved in dementia care and nursing to clarify the characteristics of BPSD by residence status in patients with Alzheimer's disease (AD) living at home or in facilities. METHODS We sent questionnaires to HCPs and asked them to answer questions on up to five cases that needed treatment for BPSD and who received long-term care insurance services from 1 April 2016 to 31 March 2017. Responses were received for 371 cases, of which 130 diagnosed with AD were analyzed. The patients were divided into two groups: patients with AD living at home (home care group) and patients with AD living in facilities (facility care group). A Chi-square test was used to identify differences between the two groups. A binomial logistic regression analysis was also conducted to clarify the association between residence status and BPSD. RESULTS Of the 130 patients, 72 lived at home (home care group) and 58 resided in facilities (facility care group). None of the background factors was significantly different between the two groups. The Chi-square test indicated that sleep disturbance was significantly more common in the facility care group (60.3% in the facility care group vs. 33.3% in the home care group, P = 0.003), while the logistic regression analysis indicated that sleep disturbance was significantly associated with residence status (odds ratio: 2.529, P = 0.038). CONCLUSIONS Sleep disturbances were more frequently observed among patients with AD living in institutions than among those living in their homes.
Collapse
Affiliation(s)
- Haruhiko Midorikawa
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Saori Ekoyama
- University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Miho Ota
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Masashi Tamura
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takumi Takahashi
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Aya Sekine
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan
| | - Masayuki Ide
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Asaki Matsuzaki
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Miyuki Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
9
|
Webster L, Costafreda SG, Powell K, Livingston G. How do care home staff use non-pharmacological strategies to manage sleep disturbances in residents with dementia: The SIESTA qualitative study. PLoS One 2022; 17:e0272814. [PMID: 35944055 PMCID: PMC9362920 DOI: 10.1371/journal.pone.0272814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Sleep disturbances affect 38% of care home residents living with dementia. They are often treated with medication, but non-pharmacological interventions may be safer and effective yet more difficult to implement. In the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff) we explored care home staffs’ experience of managing sleep disturbances in their residents living with dementia. Methods We conducted one-to-one semi-structured interviews in four UK care homes, and purposively recruited a maximum variation sample of 18 nurses and care assistants, who were each interviewed once. We used a topic guide and audio-recorded the interviews. Two researchers independently analysed themes from transcribed interviews. Results Staff used a range of techniques that often worked in improving or preventing residents’ sleep disturbance. During the daytime, staff encouraged residents to eat well, and be physically active and stimulated to limit daytime sleep. In the evening, staff settled residents into dark, quiet, comfortable bedrooms often after a snack. When residents woke at night, they gave them caffeinated tea or food, considered possible pain and discomfort, and reassured residents they were safe. If residents remained unsettled, staff would engage them in activities. They used telecare to monitor night-time risk. Staff found minimising daytime napping difficult, described insufficient staffing at night to attend to reorient and guide awake residents and said residents frequently did not know it was night-time. Conclusions Some common techniques, such as caffeinated drinks, may be counterproductive. Future non-pharmacological interventions should consider practical difficulties staff face in managing sleep disturbances, including struggling to limit daytime napping, identifying residents’ night-time needs, day-night disorientation, and insufficient night-time staffing.
Collapse
Affiliation(s)
- Lucy Webster
- Division of Psychiatry, UCL, London, United Kingdom
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Sergi G. Costafreda
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | | | - Gill Livingston
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- * E-mail:
| |
Collapse
|
10
|
Chover-Sierra E, Pérez-Ros P, Julián-Rochina I, Long CO, Cauli O. Knowledge and Attitudes towards Palliative Care: Validation of the Spanish Version of Questionnaire on Palliative Care for Advanced Dementia. Healthcare (Basel) 2022; 10:healthcare10040656. [PMID: 35455834 PMCID: PMC9029205 DOI: 10.3390/healthcare10040656] [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: 01/18/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Palliative care is essential in the care of people with advanced dementia, due to the increasing number of patients requiring care in the final stages of life. Nurses need to acquire specific knowledge and skills to provide quality palliative care. The Questionnaire on Palliative Care for Advanced Dementia (qPAD) is useful for assessing knowledge and attitudes toward palliative care, but its adaptation to the Spanish language and analysis of its effectiveness and usefulness for the Spanish culture is lacking. Objective: To report on the Spanish language adaptation and psychometric analysis of the qPAD. Methods: The Questionnaire on Palliative Care for Advanced Dementia Spanish version (qPAD-SV) was obtained from a process that included translation, back-translation, comparison with other language versions, expert review, and pilot study. Content validity, criterion validity, and reliability of the questionnaire were analyzed. The difficulty and discrimination indices of items composing the knowledge subscale were also calculated. Results: Adequate content validity index obtained after the analysis of qPAD-SV by a heterogeneous group of experts was found (overall CVI = 0.96; 0.95 for the Knowledge subscale and 0.99 for the Attitudes subscale). Significant correlations with the Palliative Care Knowledge test (rho = 0.368, p < 0.001) and Self-Efficacy in Palliative Care Scale (rho = 0.621, p < 0.001) show an adequate criterion validity. Cronbach’s alpha coefficients for the Knowledge subscale (0.60) and the Attitudes subscale (0.91) supported the reliability of the qPAD-SV. The questionnaire had an overall difficulty index of 0.71, with three items that could be considered difficult or very difficult, and eleven items that could be considered very easy. Discussion: Although it shows internal consistency, validity, and difficulty indices similar to those obtained by qPAD versions in other languages, a reformulation of the items with lower content validity or discrimination indices and those that show difficulties in their comprehension is an aspect to be taken into account to improve this tool. Conclusions: The qPAD-SV is a useful instrument in Spanish to measure the knowledge of Spanish nurses in palliative care and is suitable for international comparisons.
Collapse
Affiliation(s)
- Elena Chover-Sierra
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Nursing Care and Education Research Group (GRIECE), University of Valencia, 46010 Valencia, Spain
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Pilar Pérez-Ros
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Iván Julián-Rochina
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Carol O. Long
- “Palliative Care Essentials” Research Institute, Fredericksburg, VA 22407, USA;
| | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain; (E.C.-S.); (P.P.-R.); (I.J.-R.)
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Correspondence:
| |
Collapse
|
11
|
Does Public Reporting of Staffing Ratios and Nursing Home Compare Ratings Matter? J Am Med Dir Assoc 2021; 22:2373-2377. [PMID: 33861979 DOI: 10.1016/j.jamda.2021.03.011] [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: 12/11/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Public reporting is a policy to improve quality and increase data transparency. The objective was to examine the association between publicly available staffing ratios and the Five-Star Quality Ratings from Nursing Home Compare over time. DESIGN Panel data analysis. SETTING AND PARTICIPANTS About 146 nursing homes with complete quarterly data in New Jersey between January 1, 2012, and December 31, 2019. METHODS Using data from the State of New Jersey Department of Health and Nursing Home Compare, staff-to-resident ratios were trended for registered nurses, licensed practical nurses, and certified nursing assistants by shift and over time. Panel data analysis was used to test the association between the ratios and the ratings. RESULTS Compared to 2012, staffing ratios improved slightly for licensed practical nurses but not for registered nurses or certified nursing assistants in 2019 (P < .001). The number of residents assigned doubled at night for all personnel. During the day and evening shifts, registered nurse staffing was significantly associated with the Nursing Home Compare staffing rating (P < .01) but not the overall rating. CONCLUSIONS AND IMPLICATIONS Decreasing the number of residents assigned to a registered nurse in NHs results in an increase in staffing ratings. Mandatory public reporting holds nursing homes accountable for quality outcomes but does not improve staffing ratios. Quality resident care is the cumulative result of multiple measures inclusive of staffing; therefore, administrators should continue to focus on improving quality in NHs, which may improve staffing ratios across shifts.
Collapse
|
12
|
Dichter MN, Berg A, Hylla J, Eggers D, Wilfling D, Möhler R, Haastert B, Meyer G, Halek M, Köpke S. Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial. BMC Geriatr 2021; 21:40. [PMID: 33430785 PMCID: PMC7802225 DOI: 10.1186/s12877-020-01997-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no "gold standard" intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. METHODS This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two "sleep nurses" as change agents per nursing home, (3) a basic education course for nursing staff: "Sleep problems in dementia", (4) an advanced education course for nursing staff: "Tailored problem-solving" (two workshops), (5) workshops: "Development of an institutional sleep-promoting concept" (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and "One Minute Wonder" poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. CONCLUSIONS It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. TRIAL REGISTRATION Current controlled trials: ISRCTN36015309 . Date of registration: 06/11/2020.
Collapse
Affiliation(s)
- Martin N Dichter
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany.
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany.
| | - Almuth Berg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Jonas Hylla
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Daniela Eggers
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Denise Wilfling
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- School of Public health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | | | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Margareta Halek
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| |
Collapse
|