A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings

Abstract

BackgroundDisturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents.MethodsThe Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered.ResultsOf the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure.ConclusionsNon-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0794-3) contains supplementary material, which is available to authorized users.

A nurse practitioner led protocol to address polypharmacy in long-term care

“…They should be the initial focus for delirium 41 and behavioral and psychological symptoms with diagnosis of dementia. 42 In addition, these measures have been found to aid in decreasing falls, 43 improving psychosocial health and well-being, 44 potentially enhancing sleep, 45 and reducing pain and prn medications. 46 …”

Sleep Management within Skilled Nursing Facilities: A Practice Survey

“…This study found deficiencies in evidence-informed practice among practitioners who are addressing sleep. This includes extensive use of bed positioning, although not supported in literature (Capezuti et al, 2018) and the lack of use of evidence- Note: Percentages were rounded to the nearest whole number. Since the responses allowed multiple selections, totals can be more than 100%.…”

Acupressure to improve sleep quality of older people in residential aged care: a randomised controlled trial protocol

“…Sleep disturbance in older people is often treated with medications, which have potential adverse effects: drowsiness, poor concentration, loss of memory, and drug dependence [15,16]. These adverse effects contribute to risks of falls, accidents, and cognitive impairment with long-term use of sleep medications [13,17]. To avoid the adverse effects of sleep medications, a nonpharmacological treatment approach has been recommended to manage sleep disturbances in older people [17,18].…”

“…These adverse effects contribute to risks of falls, accidents, and cognitive impairment with long-term use of sleep medications [13,17]. To avoid the adverse effects of sleep medications, a nonpharmacological treatment approach has been recommended to manage sleep disturbances in older people [17,18]. Use of complementary and alternative medicine (CAM) may be beneficial for sleep improvement in older people.…”