Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-18T12:28:27.390Z Has data issue: false hasContentIssue false
  • English
  • Français

Sleep and agitation in nursing home residents with and without dementia

Published online by Cambridge University Press:  01 October 2015

Donnamay T. Brown ,
Juanita L. Westbury  and
Benjamin Schüz
Donnamay T. Brown*
Affiliation:
Division of Psychology, School of Medicine, University of Tasmania, Hobart, Australia Wicking Dementia Research and Education Centre, School of Medicine, University of Tasmania, Hobart, Australia
Juanita L. Westbury
Affiliation:
Wicking Dementia Research and Education Centre, School of Medicine, University of Tasmania, Hobart, Australia
Benjamin Schüz
Affiliation:
Division of Psychology, School of Medicine, University of Tasmania, Hobart, Australia
*
Correspondence should be addressed to: Donnamay Brown, Wicking Dementia Research and Education Centre, School of Medicine, Private Bag 143, University of Tasmania, Hobart TAS 7001, Australia. Phone: +61 3 6226 4883; Fax: +61 3 6226 4862. Email: [email protected].
Get access

Abstract

Background:

The prevalence of dementia in Australian nursing homes is high. A large proportion of residents express themselves through agitated behaviors, with substantial interpersonal and day-to-day variance. One factor that may increase agitation is poor sleep. The current study aimed to determine if sleep influences symptoms of agitation in nursing home residents, and whether this effect differed by dementia status. As benzodiazepines are used widely as hypnotic medication, their impact was also considered.

Methods:

Actigraph devices worn on residents’ non-dominant wrists for three days were used to obtain objective measures of sleep. Symptoms of agitation were assessed using staff responses to two standardized questionnaires – the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory – nursing home version (NPI-NH). Presence of dementia and benzodiazepine use were obtained from resident medical charts.

Results:

Forty-nine residents (mean age: 85.57 years) from four nursing homes in Tasmania were included in the study. Results indicated that residents were in bed for an average of 11.04 h and slept for 10.14 h per day. Significant relationships between sleep and verbal as well as non-aggressive agitation were found. No relationships between sleep and aggressive agitation were detected. A significant moderation effect of dementia was found, in which residents without dementia expressed verbal agitation when obtaining less sleep, but not residents with dementia. Benzodiazepine use did not result in significantly more sleep.

Conclusions:

These results suggest that sleep could play an important role in explaining agitation, but more research is needed to explore the relationship between sleep and benzodiazepines in nursing home residents.

Keywords

aged carenursing homessleepagitationdementia
Type
2015 IPA Junior Research Awards – Third Prize Winner
Information
International Psychogeriatrics , Volume 27 , Issue 12 , December 2015 , pp. 1945 - 1955
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

ActiGraph LLC (2013). ActiSleep+ Monitor. Available at: http://www.actigraphcorp.com/products/actisleep-monitor/; last accessed May 13, 2013.Google Scholar
ActiGraph LLC (2014). ActiLife (Version 6). Pensacola, FL: Actigraph LLC.Google Scholar
Ancoli-Israel, S. (2009). Sleep and its disorders in aging populations. Sleep Medicine, 10, S7–S11.Google Scholar
Ancoli-Israel, S., Clopton, P., Klauber, M. R., Fell, R. and Mason, W. (1997). Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep, 20, 24–27.Google Scholar
Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W. and Pollak, C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. Sleep, 26, 342–392.Google Scholar
Ancoli-Israel, S., Parker, L., Sinaee, R., Fell, R. L. and Kripke, D. F. (1989). Sleep fragmentation in patients from a nursing home. Journal of Gerontology, 44, M18–M21.Google Scholar
Australian Institute for Health and Welfare (AIHW) (2012). Table A2.1 Permanent and respite residents, by sex and age group. Residential Aged Care in Australia 2010–11: A Statistical Overview. Aged Care Statistics Series no. 36. Canberra: AIHW. Available at: http://www.aihw.gov.au/publication-detail/?id=10737422821&tab=3; last accessed May 14, 2015.Google Scholar
Australian Institute for Health and Welfare (AIHW) (2014a). Residential Aged Care and Aged Care Packages in the Community 2012–2013. Canberra: AIHW. Available at: http://www.aihw.gov.au/aged-care/residential-and-community-2012-13/services-and-places/; last accessed May 14, 2015.Google Scholar
Australian Institute for Health and Welfare (AIHW) (2014b). Dementia in residential aged care. Residential Aged Care and Aged Care Packages in the Community 2011–12. Canberra: AIHW. Available at: http://www.aihw.gov.au/aged-care/residential-and-community-2011-12/dementia/; last accessed May 14, 2015.Google Scholar
Australian Institute of Health and Welfare (AIHW) (2014c). Aged Care Funding Instrument; Quality Statement. Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/547478n; last accessed May 14, 2015.Google Scholar
Bjørke-Bertheussen, J., Ehrt, U., Rongve, A., Ballard, C. and Årsland, D. (2012). Neuropsychiatric symptoms in mild dementia with lewy bodies and Alzheimer's Disease. Dementia and Geriatric Cognitive Disorders, 34, S1–S6.Google Scholar
Bourgeois, J., Elseviers, M. M., Van Bortel, L., Petrovic, M. and Vander Stichele, R. H. (2013). Sleep quality of benzodiazepine users in nursing homes: a comparative study with nonusers. Sleep Medicine, 14, 614–621.CrossRefGoogle ScholarPubMed
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E. B. (2012). Behavioral and psychological symptoms of dementia. Frontiers in Neurology, 3, Article 73, 1–21.Google Scholar
Chang, C. B. and Chan, D. C. (2010). Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs and Aging, 27, 947–957.Google Scholar
Cohen-Mansfield, J. and Marx, M. S. (1990). The relationship between sleep disturbances and agitation in a nursing home. Journal of Aging and Health, 2, 42–57.Google Scholar
Cohen-Mansfield, J., Marx, M. S. and Rosenthal, A. S. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44, M77–M84.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S. and Werner, P. (1992). Agitation in elderly persons: an integrative report of findings in a nursing home. International Psychogeriatrics, 4, S221–S240.Google Scholar
Cole, R. J., Kripke, D. F., Gruen, W., Mullaney, D. J. and Gillin, J. C. (1992). Automatic sleep/wake identification from wrist activity. Sleep, 15, 461–469.Google Scholar
Conn, D. K. and Madan, R. (2012). Use of sleep promoting medications in nursing home residents: risks versus benefits. Drugs and Aging, 23, 271–287.CrossRefGoogle Scholar
Cooke, J. R. and Ancoli-Israel, S. (2011). Normal and abnormal sleep in the elderly. Handbook of Clinical Neurology, 98, 653–665.Google Scholar
Department of Health and Ageing (DHA) (2013). Aged Care Funding Instrument (ACFI) – User Guide. Canberra: DHA. Available at: https://www.dss.gov.au/sites/default/files/documents/10_2014/acfi_user_guide_1_july_2013.pdf.Google Scholar
Ersser, S., Wiles, A., Taylor, H., Wade, S., Walsh, R. and Bentlet, T. (1999). The sleep of older people in hospitals and nursing homes. Journal of Clinical Nursing, 8, 360–368.Google Scholar
Fauth, E. B. and Gibbons, A. (2014). Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. International Journal of Geriatric Psychiatry, 29, 263–271.Google Scholar
Fetveit, A, and Bjorvatn, B. (2002). Sleep disturbances among nursing home residents. International Journal of Geriatric Psychiatry, 17, 604–609 Google Scholar
Haesler, E. J. (2004). Effectiveness of strategies to manage sleep in residents of aged care facilities. JBI Reports, 2, 115–183.CrossRefGoogle ScholarPubMed
Hayes, A. F. (2013). An Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York: Guilford Press.Google Scholar
Hirst, A. and Sloan, R. (2001). Benzodiazepines and related drugs for insomnia in palliative care (Review). Cochrane Database of Systematic Reviews, 4. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003346/pdf.Google Scholar
IBM Corp (2013). IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp.Google Scholar
Khachiyants, N., Trinkle, D., Son, S. J. and Kim, K. Y. (2011). Sundown syndrome in persons with dementia: an update. Psychiatry Investigation, 8, 275–287.CrossRefGoogle ScholarPubMed
Koch, S., Haesler, E., Tiziani, A. and Wilson, J. (2006). Effectiveness of sleep management strategies for residents of aged care facilities: findings of a systematic review. Journal of Clinical Nursing, 15, 1267–1275.Google Scholar
Lacks, P. and Morin, C. M. (1992). Recent advances in the assessment and treatment of insomnia. Journal of Consulting and Clinical Psychology, 60, 586–594.Google Scholar
Lange, R. T., Hopp, G. A. and Kang, N. (2004). Psychometric properties and factor structure of the Neuropsychiatric Inventory nursing home version in an elderly neuropsychiatric population. International Journal of Geriatric Psychiatry, 19, 440–448.Google Scholar
Lowery, D. and Warner, J. (2009). Behavioral and psychological symptoms of dementia (BPSD): the personal and practical costs of dementia. Journal of Integrated Care, 17, 13–19.Google Scholar
Lyketsos, C., Steinberg, M., Tschanz, J., Norton, M., Steffens, D. and Breitner, J. (2000). Mental and behavioral disturbances in dementia: findings from the Cache county study on memory in aging. American Journal of Psychiatry, 157, 708–714.Google Scholar
Martin, J. L. and Hakim, A. D. (2011). Wrist actigraphy. Chest, 139, 1514–1527.Google Scholar
Moe, K. E., Vitiello, M. V., Larsen, L. H. and Prinz, P. N. (1995). Sleep/wake patterns in Alzheimer's disease: relationships with cognition and function. Journal of Sleep Research, 4, 15–20.Google Scholar
Sadeh, A. and Acebo, C. (2002). The role of actigraphy in sleep medicine. Sleep Medicine Reviews, 6, 113–124.Google Scholar
Selbæk, G. and Engedal, K. (2012). Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International Psychogeriatrics, 24, 62–73.Google Scholar
Simpson, K., Culpepper Richards, K., Enderlin, C., O’Sullivan, P. and Koehn, M. (2006). Medications and sleep in nursing home residents with dementia. Journal of the American Psychiatric Nurses Association, 12, 279–285.CrossRefGoogle Scholar
Srikanth, S., Nagaraja, A. and Ratnavalli, E. (2005). Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia. Journal of the Neurological Sciences, 236, 43–48.CrossRefGoogle ScholarPubMed
Werner, P., Cohen-Mansfield, J., Koroknay, V. and Braun, J. (1994). The impact of a restraint-reduction program on nursing home residents. Geriatric Nursing, 15, 142–146.Google Scholar
Westbury, J and Peterson, G. (2013). Rethinking psychotropics in nursing homes. Medical Journal of Australia, 199, 98.CrossRefGoogle ScholarPubMed
Whall, A. L. et al. (2008). Factors associated with aggressive behavior among nursing home residents with dementia. The Gerontologist, 48, 721–731.Google Scholar
Wood, S. et al. (2000). The use of the Neuropsychiatric Inventory in nursing home residents, characterization and measurement. American Journal of Geriatric Psychiatry, 8, 75–83.Google Scholar
Youngstedt, S. D. and Kripke, D. F. (2004). Long sleep and mortality: rationale for sleep restriction. Sleep Medicine Reviews, 8, 159–174.CrossRefGoogle ScholarPubMed
Zaudig, M. (2000). A risk-benefit assessment of risperidone for the treatment of behavioral and psychological symptoms in dementia. Drug Safety, 23, 183–195.CrossRefGoogle Scholar
Zuidema, S. U., de Jonghe, J. F., Verhey, F. R. and Koopmans, R. T. (2009). Predictors of neuropsychiatric symptoms in nursing home patients: influence of gender and dementia severity. International Journal of Geriatric Psychiatry, 24, 1079–1086.CrossRefGoogle ScholarPubMed
Zuidema, S. U. et al. (2011). Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and reliable change index of the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. International Journal of Geriatric Psychiatry, 26, 127–134.Google Scholar