Sleep disturbances are a major impediment to quality of life in all dementia care settings, as they contribute to cognitive and emotional distress. Sleep disturbances can be particularly difficult in assisted living communities and other supportive residential settings where they contribute greatly to a high-transfer rate into skilled nursing care. A group of researchers at the University of Washington tested a sleep education program (SEP) for staff and residents of several adult family homes (AFHs) in the state of Washington to assess whether such interventions are a feasible and effective tool for dementia care.
AFHs in Washington house two to six adults, who usually have some form of cognitive impairment but do not require skilled nursing care. The researchers enrolled 37 AFHs, and 47 of their residents, for their study, which compared the SEP with standard treatment of sleep disturbance. Residents were randomly assigned to either the SEP or the control group. The SEP consisted of four sessions that provided nonpharmacological strategies for improving sleep and in which staff and trainers developed and began implementing an individualized sleep plan for each resident.
The SEP appeared feasible in the study, with about three quarters of the staff participants completing all four sessions, and showing improvements in understanding of sleep disturbances. All SEP group staff participants were able to target for treatment a specific sleep disturbance on the part of a resident, and all showed improved ability to identify causes and consequences of sleep disturbance.
Immediately after the four sessions, there were no significant differences in sleep patterns between the SEP and control groups. However, at a six month follow-up, residents who had participated in the SEP spent a significantly greater portion of their nighttime hours asleep. Further, SEP participants maintained the same amount of daytime inactivity during the six months, while residents from the control group experienced a significant increase in their daytime inactivity. This study suggests that behavioral sleep interventions may be a useful way to improve quality of life in supportive residential settings.
McCurry SM, LaFazia DM, Pike KC, et al (2012). Development and evaluation of a sleep education program for older adults with dementia living in adult family homes. Am J Geriatr Psychiatry, e-pub ahead of print.