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Sleep in care homes

Published online by Cambridge University Press:  03 August 2010

Adam L Gordon*
Affiliation:
Division of Rehabilitation and Ageing, University of Nottingham, UK
John RF Gladman
Affiliation:
Division of Rehabilitation and Ageing, University of Nottingham, UK
*
Address for correspondence: Adam Gordon, Room B98, Division of Rehabilitation and Ageing, Medical School, Queens Medical Centre, Nottingham NG7 2UH. Email: [email protected]

Summary

Sleep problems in older adults are common and disturbance in sleep is associated with increased mortality. These problems are more pronounced in the care home population because of institutional factors and a high prevalence of frailty and co-morbidity. This article reviews the randomized controlled trials undertaken to address sleep problems in care homes. These suggest that stand-alone therapies – oral melatonin and light therapy – have no effect on sleep but that combination treatments – physical exercise plus sleep hygiene, physical exercise plus sleep hygiene plus light and melatonin plus light – may have positive effects. These effects are more marked for daytime arousal than nocturnal sleep. Practical considerations for care homes are how to maximize light exposure, incorporate exercise into daily routines and minimize night-time disruption for residents. Trials undertaken so far are compromised by small sample size and inappropriate randomization strategies and further research is therefore required.

Type
Intermediate care and rehabilitation
Copyright
Copyright © Cambridge University Press 2010

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References

1Foley, DJ, Monjan, AA, Brown, SL, Simonsick, EM, Wallace, RB, Blazer, DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995; 18: 425–32.CrossRefGoogle ScholarPubMed
2Ancoli-Israel, S, Ayalon, L. Diagnosis and treatment of sleep disorders in older adults. Focus 2009; 7: 98105.CrossRefGoogle Scholar
3Katz, DA, McHorney, CA. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med 1998; 158: 1099–107.CrossRefGoogle ScholarPubMed
4Garcia-Borreguero, D, Larrosa, O, Bravo, M. Parkinson's disease and sleep. Sleep Med Rev 2003; 7: 115–29.CrossRefGoogle ScholarPubMed
5Vitiello, MV, Prinz, PN, Williams, DE, Frommlet, MS, Ries, RK. Sleep disturbances in patients with mild-stage Alzheimer's disease. J Gerontol 1990; 45: 131–38.CrossRefGoogle ScholarPubMed
6Quan, SF, Katz, R, Olson, J, Bonekat, W, Enright, PL, Young, T, Newman, A. Factors associated with incidence and persistence of symptoms of disturbed sleep in an elderly cohort: the Cardiovascular Health Study. Am J Med Sci 2005; 329: 163–72.CrossRefGoogle Scholar
7Ohayon, MM, Roth, T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. J Psychosom Res 2002; 53: 547–54.CrossRefGoogle ScholarPubMed
8Ancoli-Israel, S, Kripke, DF, Klauber, MR, Mason, WJ, Fell, R, Kaplan, O. Sleep-disordered breathing in community-dwelling elderly. Sleep 1991; 14: 486–95.CrossRefGoogle ScholarPubMed
9Bliwise, DL. Sleep in normal aging and dementia. Sleep 1993; 16: 4081.CrossRefGoogle ScholarPubMed
10Bowman, C, Whistler, J, Ellerby, M. A national census of care home residents. Age Ageing 2004; 33: 561–66.CrossRefGoogle ScholarPubMed
11MacRae, PG, Schnelle, JF, Simmons, SF, Ouslander, JG. Physical activity levels of ambulatory nursing home residents. J Ageing Phys Activity 1996; 4 (3).Google Scholar
12Shochat, T, Martin, J, Marler, M, Ancoli-Israel, S. Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res 2000; 9: 373–79.CrossRefGoogle ScholarPubMed
13Great Britain Department of Health. Care Standards Act 2000. London: Stationery Office; 2001.Google Scholar
14Ribbe, MW, Ljunggren, G, Steel, K, Topinková, E, Hawes, C, Ikegami, N, Henrard, JC, Jónnson, PV. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing 1997; 26 (suppl 2): 312.CrossRefGoogle Scholar
15Ancoli-Israel, S, Parker, L, Sinaee, R, Fell, RL, Kripke, DF. Sleep fragmentation in patients from a nursing home. J Gerontol 1989; 44: M1821.CrossRefGoogle ScholarPubMed
16Espiritu, RC, Kripke, DF, Ancoli-Israel, S, Mowen, MA, Mason, WJ, Fell, RL, Klauber, MR, Kaplan, OJ. Low illumination experienced by San Diego adults: Association with atypical depressive symptoms. Biol Psychiat 1994; 35: 403–7.CrossRefGoogle Scholar
17Campbell, SS, Kripke, DF, Gillin, JC, Hrubovcak, JC. Exposure to light in healthy elderly subjects and Alzheimer's patients. Physiol Behav 1988; 42: 141–44.CrossRefGoogle ScholarPubMed
18Schnelle, JF, Ouslander, JG, Simmons, SF, Alessi, CA, Gravel, MD. The nighttime environment, incontinence care, and sleep disruption in nursing homes. J Am Geriatr Soc 1993; 41: 910–14.CrossRefGoogle ScholarPubMed
19Cruise, PA, Schnelle, JF, Alessi, CA, Simmons, SF, Ouslander, JG. The nighttime environment and incontinence care practices in nursing homes. J Am Geriatr Soc 1998; 46: 181–86.CrossRefGoogle ScholarPubMed
20Brassington, GS, King, AC, Bliwise, DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64–99 years. J Am Geriatr Soc 2000; 48: 1234–40.CrossRefGoogle Scholar
21Dale, MC, Burns, A, Panter, L, Morris, J. Factors affecting survival of elderly nursing home residents. Int J Geriatr Psychiat 2001; 16: 7076.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
22Manabe, K, Matsui, T, Yamaya, M, Sato-Nakagawa, T, Okamura, N, Arai, H, Sasaki, H. Sleep patterns and mortality among elderly patients in a geriatric hospital. Gerontology 2000; 46: 318–22.CrossRefGoogle Scholar
23Glass, J, Lanctot, KL, Herrmann, N, Sproule, BA, Busto, UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005; 331: 1169.CrossRefGoogle ScholarPubMed
24Bloom, HG, Ahmed, I, Alessi, CA, Ancoli-Israel, S, Buysse, DJ, Kryger, MH, Phillips, BA, Thorpy, MJ, Vitiello, MV, Zee, PC. Evidence-based recommendations for the assessment and management of sleep disorders in older persons. J Am Geriatr Soc 2009; 57: 761–89.CrossRefGoogle ScholarPubMed
25Meuleman, JR, Nelson, R, Clark, RL Jr. Evaluation of temazepam and diphenhydramine as hypnotics in a nursing-home population. Ann Pharmacother 1987; 21: 716–20.Google Scholar
26Monane, M, Glynn, RJ, Avorn, J. The impact of sedative-hypnotic use on sleep symptoms in elderly nursing home residents [ast]. Clin Pharmacol Ther 1996; 59: 8392.CrossRefGoogle ScholarPubMed
27Ray, WA, Thapa, PB, Gideon, P. Benzodiazepines and the risk of falls in nursing home residents. J Am Geriatr Soc 2000; 48: 682–85.CrossRefGoogle ScholarPubMed
28Roth, T, Stubbs, C, Walsh, JK. Ramelteon (TAK-375), a selective MT1/MT2-receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep 2005; 28: 303–7.Google Scholar
29Zeitzer, JM, Daniels, JE, Duffy, JF, Klerman, EB, Shanahan, TL, Dijk, DJ, Czeisler, CA. Do plasma melatonin concentrations decline with age? Am J Med 1999; 107: 432–36.CrossRefGoogle ScholarPubMed
30Magri, F, Sarra, S, Cinchetti, W, Guazzoni, V, Fioravanti, M, Cravello, L, Ferrari, E. Qualitative and quantitative changes of melatonin levels in physiological and pathological aging and in centenarians. J Pineal Res 2004; 36: 256–61.CrossRefGoogle ScholarPubMed
31Skene, DJ, Swaab, DF. Melatonin rhythmicity: effect of age and Alzheimer's disease. Exp Gerontol 2003; 38: 199206.CrossRefGoogle ScholarPubMed
32Wyatt, JK, Dijk, D-J, Ritz-de Cecco, A, Ronda, JM, Czeisler, CA. Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependent. Sleep 2006; 29: 609–18.CrossRefGoogle ScholarPubMed
33Ancoli-Israel, S, Clopton, P, Klauber, MR, Fell, R, Mason, W. Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep 1997; 20: 2427.CrossRefGoogle ScholarPubMed
34Cardinali, DP, Brusco, LI, Liberczuk, C, Furio, AM. The use of melatonin in Alzheimer's disease. Neuro Endocrinol Lett 2002; 23 (suppl 1): 2023.Google ScholarPubMed
35Cohen-Mansfield, J, Garfinkel, D, Lipson, S. Melatonin for treatment of sundowning in elderly persons with dementia – a preliminary study. Arch Gerontol Geriatr 2000; 31: 6576.CrossRefGoogle ScholarPubMed
36Singer, C, Tractenberg, RE, Kaye, J, Schafer, K, Gamst, A, Grundman, M, Thomas, R, Thal, LJ; Alzheimer's Disease Cooperative Study. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep 2003; 26: 893901.CrossRefGoogle ScholarPubMed
37Klerman, EB, Duffy, JF, Dijk, DJ, Czeisler, CA. Circadian phase resetting in older people by ocular bright light exposure. J Investig Med 2001; 49: 3040.CrossRefGoogle ScholarPubMed
38Carrier, J, Monk, TH, Reynolds, CF, Buysse, DJ, Kupfer, DJ. Are age differences in sleep due to phase differences in the output of the circadian timing system? Chronobiol Int 1999; 16: 7991.CrossRefGoogle ScholarPubMed
39Satlin, A, Volicer, L, Stopa, EG, Harper, D. Circadian locomotor activity and core-body temperature rhythms in Alzheimer's disease. Neurobiol Aging 1995; 16: 765–71.CrossRefGoogle ScholarPubMed
40Ancoli-Israel, S, Martin, JL, Kripke, DF, Marler, M, Klauber, MR. Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc 2002; 50: 282–89.CrossRefGoogle ScholarPubMed
41Dowling, GA, Hubbard, EM, Mastick, J, Luxenberg, JS, Burr, RL, Van Someren, EJ. Effect of morning bright light treatment for rest–activity disruption in institutionalized patients with severe Alzheimer's disease. Int Psychogeriatr 2005; 17: 221–36.CrossRefGoogle ScholarPubMed
42Swaab, DF, Fliers, E, Partiman, TS. The suprachiasmatic nucleus of the human brain in relation to sex, age and senile dementia. Brain Res 1985; 342: 3744.CrossRefGoogle ScholarPubMed
43Dowling, GA, Burr, RL, Van Someren, EJ, Hubbard, EM, Luxenberg, JS, Mastick, J, Cooper, BA. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 2008; 56: 239–46.CrossRefGoogle ScholarPubMed
44Driver, HS, Taylor, SR. Exercise and sleep. Sleep Med Rev 2000; 4: 387402.CrossRefGoogle ScholarPubMed
45Schnelle, JF, MacRae, PG, Ouslander, JG, Simmons, SF, Nitta, M. Functional incidental training, mobility performance, and incontinence care with nursing home residents. J Am Geriatr Soc 1995; 43: 1356–62.CrossRefGoogle ScholarPubMed
46Alessi, CA, Schnelle, JF, MacRae, PG, Ouslander, JG, al-Samarrai, N, Simmons, SF, Traub, S. Does physical activity improve sleep in impaired nursing home residents? J Am Geriatr Soc 1995; 43: 1098–102.CrossRefGoogle ScholarPubMed
47Alessi, CA, Martin, JL, Webber, AP et al. Randomized, controlled trial of a non-pharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc 2005; 53: 803–10.CrossRefGoogle Scholar
48Martin, JL, Marler, MR, Harker, JO, Josephson, KR, Alessi, CA. A multicomponent non-pharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. J Gerontol A Biol Sci Med Sci 2007; 62: 6772.CrossRefGoogle Scholar