Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-30T15:10:48.789Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study

Published online by Cambridge University Press:  21 May 2020

Lucy Webster ,
Kingsley Powell ,
Sergi G. Costafreda Open the ORCID record for Sergi G. Costafreda [Opens in a new window]  and
Gill Livingston Open the ORCID record for Gill Livingston [Opens in a new window]
Lucy Webster*
Affiliation:
Division of Psychiatry, UCL, London, UK
Kingsley Powell
Affiliation:
Division of Psychiatry, UCL, London, UK
Sergi G. Costafreda
Affiliation:
Division of Psychiatry, UCL, London, UK Camden and Islington NHS Foundation Trust, London, UK
Gill Livingston
Affiliation:
Division of Psychiatry, UCL, London, UK Camden and Islington NHS Foundation Trust, London, UK
*
Correspondence should be addressed to: Lucy Webster, UCL Division of Psychiatry, 6th Floor Maple House, 149 Tottenham Court Road, LondonW1T 7NF, UK. Phone: (+44) 203 1087 184. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Nearly 40% of care home residents who are living with dementia also have symptoms of disturbed sleep. However, the impact of these disturbances is relatively unknown and is needed to indicate whether interventions are warranted; therefore, we aimed to investigate the impact.

Design:

One-to-one semi-structured interviews.

Settings:

Four UK care homes.

Participants:

We interviewed 18 nurses and care assistants about residents with sleep disturbances.

Measurements:

We used a topic guide to explore staff experience of sleep disturbance in residents with dementia. The interviews were audio recorded and transcribed and then analyzed thematically by two researchers independently.

Results:

Staff described that sleep disturbances in most, but not all, residents impacted negatively on the resident, other residents, staff, and relatives. Residents became more irritable or agitated if they had slept badly. They slept in the daytime after a bad night, which then increased their chances of being awake the following night. For some, being sleepy in the day led to falls, missing medication, drinks, and meals. Staff perceived hypnotics as having low efficacy, but increasing the risk of falls and drowsiness. Other residents were disturbed by noise, and staff described stress when several residents had sleep disturbance. Some of the strategies reported by staff to deal with sleep disturbances such as feeding or providing caffeinated tea at night might be counterproductive.

Conclusions:

Sleep disturbances in care home residents living with dementia negatively affect their physical and psychological well-being. These disturbances also disturb other residents and increase stress in staff.

Keywords

cognitive impairmentcare homesnighttimequalitative research
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 7: Issue Theme: Sleep and Sleep Disorders in Older Adults , July 2020 , pp. 839 - 847
Copyright
© International Psychogeriatric Association 2020

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

Aasmul, I., Husebo, B. S. and Flo, E. (2016). Staff distress improves by treating pain in nursing home patients with dementia: results from a cluster-randomized controlled trial. Journal of Pain and Symptom Management, 52, 795–805. 10.1016/j.jpainsymman.2016.07.004.CrossRefGoogle ScholarPubMed
Beerens, H. C.etal. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Medical Directors Association, 15, 54–61. 10.1016/j.jamda.2013.09.010.CrossRefGoogle ScholarPubMed
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. 10.1191/1478088706qp063oa.10.1191/1478088706qp063oaCrossRefGoogle Scholar
Clark, I. and Landolt, H. P. (2017). Coffee, caffeine, and sleep: a systematic review of epidemiological studies and randomized controlled trials. Sleep Medicine Reviews, 31, 70–78. 10.1016/j.smrv.2016.01.006.CrossRefGoogle ScholarPubMed
Competition and Markets Authority (2017). Care Home Market Study Update Paper. Available at: https://www.gov.uk/cma-cases/care-homes-market-study; last accessed 7 February 2020.Google Scholar
De Pooter-Stijnman, L. M. M., Vrijkotte, S. and Smalbrugge, M. (2018). Effect of caffeine on sleep and behaviour in nursing home residents with dementia. European Geriatric Medicine, 9, 829–835. 10.1007/s41999-018-0115-6.CrossRefGoogle ScholarPubMed
Ellmers, T., Arber, S., Luff, R., Eyers, I. and Young, E. (2013). Factors affecting residents’ sleep in care homes. Nursing Older People, 25, 29–32. 10.7748/nop2013.10.25.8.29.e466.10.7748/nop2013.10.25.8.29.e466CrossRefGoogle ScholarPubMed
Fusch, P. I. and Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20, 1408–1416.Google Scholar
Gao, C., Chapagain, N. Y. and Scullin, M. K. (2019). Sleep duration and sleep quality in caregivers of patients with dementia: a systematic review and meta-analysis. JAMA Network Open, 2, e199891. 10.1001/jamanetworkopen.2019.9891.CrossRefGoogle ScholarPubMed
Gaugler, J. E.et al. (2010). The effects of incident and persistent behavioral problems on change in caregiver burden and nursing home admission of persons with dementia. Med Care, 48, 875–883. 10.1097/MLR.0b013e3181ec557b.CrossRefGoogle ScholarPubMed
Gibson, R. H., Gander, P. H. and Jones, L. M. (2014). Understanding the sleep problems of people with dementia and their family caregivers. Dementia-International Journal of Social Research and Practice, 13, 350–365. 10.1177/1471301212473884.Google ScholarPubMed
Hodgson, N., Gitlin, L. N. and Huang, J. (2014). The influence of sleep disruption and pain perception on indicators of quality of life in individuals living with dementia at home. Geriatric Nursing, 35, 394–398. 10.1016/j.gerinurse.2014.08.005.10.1016/j.gerinurse.2014.08.005CrossRefGoogle ScholarPubMed
Hope, T., Keene, J., Gedling, K., Fairburn, C. G. and Jacoby, R. (1998). Predictors of institutionalization for people with dementia living at home with a carer. International Journal of Geriatric Psychiatry, 13, 682–690. 10.1002/(Sici)1099-1166(1998100)13:10<682:Aid-Gps847>3.0.Co;2-Y.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Kerr, D., Wilkinson, H. and Cunningham, C. (2008). Supporting Older People in Care Homes at Night. New York: Joseph Rowntree Foundation.Google Scholar
Kinnunen, K., Vikhanova, A. and Livingston, G. (2017). The management of sleep disorders in dementia: an update. Current Opinion in Psychiatry, 30, 491–497. 10.1097/YCO.0000000000000370.10.1097/YCO.0000000000000370CrossRefGoogle ScholarPubMed
Kinnunen, K.et al. (2018). A manual-based intervention for carers of people with dementia and sleep disturbances: an acceptability and feasibility RCT. Health Technology Assessment, 22(71). 10.3310/hta22710.10.3310/hta22710CrossRefGoogle ScholarPubMed
Kromhout, M. A., Jongerling, J. and Achterberg, W. P. (2014). Relation between caffeine and behavioral symptoms in elderly patients with dementia: an observational study. Journal of Nutrition Health and Aging, 18, 407–410. 10.1007/s12603-013-0417-9.10.1007/s12603-013-0417-9CrossRefGoogle ScholarPubMed
Law, K., Patterson, T. G. and Muers, J. (2019). Experiences of healthcare assistants working with clients with dementia in residential care homes. Dementia (London), 18, 644–659. 10.1177/1471301216688396.10.1177/1471301216688396CrossRefGoogle ScholarPubMed
Livingston, G.etal. (2017). Prevalence of and associations with agitation in residents with dementia living in care homes: MARQUE cross-sectional study. BJPsych Open, 3, 171–178.10.1192/bjpo.bp.117.005181.CrossRefGoogle ScholarPubMed
Masot, O., Lavedan, A., Nuin, C., Escobar-Bravo, M. A., Miranda, J. and Botigue, T. (2018). Risk factors associated with dehydration in older people living in nursing homes: Scoping review (vol 82, pg 90, 2018). International Journal of Nursing Studies, 83, 103–103. 10.1016/j.ijnurstu.2018.04.014.CrossRefGoogle Scholar
Mccleery, J., Cohen, D. A. and Sharpley, A. L. (2016). Pharmacotherapies for sleep disturbances in dementia. Cochrane Database Systematic Review, 11, CD009178. 10.1002/14651858.CD009178.pub3.Google ScholarPubMed
National Institute of Health Dissemination Centre. (2017). Advancing Care: Research with care homes. Available at: https://www.basw.co.uk/resources/advancing-care-research-care-homes; last accessed 7 February 2020.Google Scholar
Nunez, K. M., Khan, Z., Testad, I., Lawrence, V., Creese, B. and Corbett, A. (2018). Current practice and challenges in night-time care for people with dementia living in care homes: a qualitative study. International Journal of Geriatric Psychiatry, 33, e140–e149. 10.1002/gps.4737.CrossRefGoogle ScholarPubMed
Oddy, W. H. and O’Sullivan, T. A. (2009). Energy drinks for children and adolescents. BMJ, 339, b5268. 10.1136/bmj.b5268.CrossRefGoogle ScholarPubMed
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N. and Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health, 42, 533–544. 10.1007/s10488-013-0528-y.CrossRefGoogle ScholarPubMed
Peng, H. L., Lorenz, R. A. and Chang, Y. P. (2019). Factors associated with sleep in family caregivers of individuals with dementia. Perspectives in Psychiatric Care, 55, 95–102.10.1111/ppc.12307.10.1111/ppc.12307CrossRefGoogle ScholarPubMed
Rapaport, P.et al. (2018). How do care home staff understand, manage and respond to agitation in people with dementia? A qualitative study. BMJ open, 8, e022260. 10.1136/bmjopen-2018-022260.CrossRefGoogle ScholarPubMed
Reynolds, A. C. and Adams, R. J. (2019). Treatment of sleep disturbance in older adults. Journal of Pharmacy Practice and Research, 49, 296–304. 10.1002/jppr.1565.CrossRefGoogle Scholar
Risco, E.et al. (2015). The association between physical dependency and the presence of neuropsychiatric symptoms, with the admission of people with dementia to a long-term care institution: a prospective observational cohort study. International Journal of Nursing Studies, 52, 980–987. 10.1016/j.ijnurstu.2015.02.013.CrossRefGoogle ScholarPubMed
Robertson, S.et al. (2019). Comparing proxy rated quality of life of people living with dementia in care homes. Psychological Medicine, 50, 86–95. 10.1017/S0033291718003987.10.1017/S0033291718003987CrossRefGoogle ScholarPubMed
Rokstad, A. M. M., Engedal, K., Kirkevold, O., Benth, J. S. and Selbaek, G. (2018). The impact of attending day care designed for home-dwelling people with dementia on nursing home admission: a 24-month controlled study. BMC Health Services Research, 18, 864. 10.1186/s12913-018-3686-5.10.1186/s12913-018-3686-5CrossRefGoogle ScholarPubMed
Sawan, M., Jeon, Y. H., Fois, R. A. and Chen, T. F. (2017). Exploring the link between organizational climate and the use of psychotropic medicines in nursing homes: a qualitative study. Research in Social and Administrative Pharmacy, 13, 513–523. 10.1016/j.sapharm.2016.06.012.CrossRefGoogle ScholarPubMed
Skills for Care (2019). The state of the adult social care sector and workforce in England, September 2019. Available at: https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx; last accessed 7 February 2020.Google Scholar
Song, J. A. and Oh, Y. (2015). The association between the burden on formal caregivers and Behavioral and Psychological Symptoms of Dementia (BPSD) in Korean Elderly in nursing homes. Archives of Psychiatric Nursing, 29, 346–354. 10.1016/j.apnu.2015.06.004.CrossRefGoogle ScholarPubMed
Van Duinen-Van Den Ijssel, J. C. L.et al. (2018). Nursing staff distress associated with neuropsychiatric symptoms in young-onset dementia and late-onset dementia. Journal of the American Medical Directors Association, 19, 627–632. 10.1016/j.jamda.2017.10.004.CrossRefGoogle ScholarPubMed
Webster, L.et al. (2019). Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. SLEEP, 43, zsz251. 10.1093/sleep/zsz251.10.1093/sleep/zsz251CrossRefGoogle Scholar
Westerlind, B., Ostgren, C. J., Molstad, S., Midlov, P. and Hagg, S. (2019). Use of non-benzodiazepine hypnotics is associated with falls in nursing home residents: a longitudinal cohort study. Aging Clinical and Experimental Research, 31, 1087–1095. 10.1007/s40520-018-1056-0.CrossRefGoogle ScholarPubMed
Zwijsen, S.etal. (2014). Nurses in distress? An explorative study into the relation between distress and individual neuropsychiatric symptoms of people with dementia in nursing homes. International Journal of Geriatric Psychiatry, 29, 384–391. 10.1002/gps.4014.10.1002/gps.4014CrossRefGoogle ScholarPubMed
Supplementary material: File

Webster et al. supplementary material

Webster et al. supplementary material
Download Webster et al. supplementary material(File)
File 515.3 KB