Sensory Stimulation for Nursing-Home Residents: Systematic Review and Meta-Analysis of Its Effects on Sleep Quality and Rest-Activity Rhythm in Dementia

Abstract

<b><i>Introduction:</i></b> Disrupted sleep-wake cycles might be associated with an exacerbation of behavioural disturbances and accelerate disease progression in dementia. The effect of sensory stimulation for improving sleep quality is unclear. <b><i>Methods:</i></b> A systematic literature search was performed and all studies examining the effects of a sensory stimulation intervention (i.e. bright light, massage, acupuncture, animal-assisted interventions) on rest-activity rhythm (RAR) and/or nocturnal restlessness in nursing-home residents with dementia were included. <b><i>Results:</i></b> Sensory stimulation was shown to improve nocturnal behavioural restlessness as well as sleep duration and continuation, but the effect on the number of awakenings, RAR, and daytime sleep was negligible. Notable was the high heterogeneity between studies regarding treatments and patients’ characteristics and sleep parameters. <b><i>Conclusion:</i></b> Sleep quality and nocturnal restlessness in nursing-home residents with dementia may benefit from sensory stimulation. An environment with sensory stimulation may prevent or improve sleep disturbances in nursing homes, and thereby contribute to a better quality of life for their patients.

Stimuli changes and challenging behavior in nursing homes during the COVID-19 pandemic

“…In general, our findings suggest the importance of paying attention to sensory information processing by individual residents and to different types of stimuli present within NHs. While sensory stimulation is important for NH residents [ 37 – 39 ], its effect on behavior may depend on the type of stimuli (targeted or untargeted at the resident) and characteristics of individual residents (e.g., ability to process sensory input). However, to date, little is known about the relation between sensory information processing and challenging behavior of NH residents.…”

A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions

“…Scholars mainly studied MAs in the NH research in the following areas: medicine (17/41 of reviewed studies) [ 20 , 25 , 26 , 28 , 36 , 38 , 39 , 40 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 57 , 60 ], nursing (7/41) [ 24 , 31 , 32 , 33 , 34 , 35 , 56 ], psychiatry or psychology (6/41) [ 22 , 30 , 44 , 45 , 55 , 61 ], public health (4/41) [ 21 , 27 , 37 , 46 ], and pharmacology (3/41) [ 23 , 42 , 53 ], followed by the areas of rehabilitation (1) [ 41 ], nutrition (1) [ 29 ], dentistry (1) [ 43 ], and nursing and dentistry (1) [ 19 ]. In the reviewed articles, some studies (12/41) examined the physical issues NH residents face, including falls, exercise, or rehabilitation issues.…”

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer’s disease

“…Thus, people with dementia are very sensitive to sensory experiences, and their living environment needs to be managed carefully to make it understandable and comfortable [50]. Since sensory organs can be stimulated even in the advanced dementia stages, sensory stimulation is the only personcentered approach that may be provided for people with severe dementia in nursing homes [51].…”

“…The recent overview of 14 systematic reviews of nonpharmacological interventions reported that cognitive stimulation therapy, music-based therapeutic interventions, and psychological treatments (mainly cognitive behavioral therapy) were the most promising interventions for people with moderate dementia [45]. In individuals with moderate to severe dementia, light therapy, acupuncture, massage, and animal-assisted interventions decreased nighttime restlessness, improved nocturnal sleep duration, and continuation, while light therapy strengthened circadian rhythm [51]. The most common nonpharmacological, sensory-based interventions are presented in Table 1.…”

“…[65] Selection of music with slow-to-moderate tempos [91], individual selection of music related to happy memories [65] Visual art therapy (VAT) Beneficial effects on cognition in participants with cognitive decline, less clear in AD patients, alleviation of depression and anxiety [87] Patients without an art background must learn basic skills, some patients might have difficulties completing tasks, requiring sufficient hand function [82] Optimal choice of type, duration and intensity of the intervention, knowledge of the patient's previous abilities and skills Horticultural therapy (HT) Increase in engagement [30,78], decrease the time spent in inactivity [30], some effects on cognition [78], reduction of pain, improvement in attention, lessening of stress Ingestion of toxic plants by advanced dementia residents, getting wet or become stuck during inclement weather [101] Excluding toxic plants and pesticides from the therapeutic garden, close supervision of participants, use of gardens designed specifically for the safety and benefit of residents with dementia, such as wander gardens [101] Bright light therapy (BLT) No effects on behavioral AD symptoms [12], but beneficial effects on sleep, the only therapy to strengthen the circadian rhythm [51] Individuals in earlier AD stages may be more sensitive to light and become agitated with high amounts of short wavelengths [81] Scheduling administration time according to individual circadian rhythm; using more moderate light, levels, tailored on an individual basis, use with caution in agitated patients [80] Acupuncture therapy (AT) Potential to improve cognition and activities of daily living [69], might be even more effective on some cognitive outcomes than conventional medicines [92] Local skin irritation or injury was the most common, nausea, vomiting, dizziness, tiredness a [93], fainting [64] Proper training in acupuncture, recognizing conditions that increase the risk of complications (such as treatment with anticoagulants or immuno-suppressive agents) [93] AT = acupuncture therapy; AAT = animal-assisted therapy; BLT = bright light therapy; HT = horticultural therapy; MT = music therapy; VAT = visual art therapy; MT = manual massage therapy.…”