A randomized trial of a combined physical activity and environmental intervention in nursing home residents: Do sleep and agitation improve?
A randomized trial of a combined physical activity and environmental intervention in nursing home residents: Do sleep and agitation improve?
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DOI：
10.1111/j.1532-5415.1999.tb03833.x
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发表时间：
1999-07-01
影响因子：
6.3
通讯作者：
Cruise, PA
中科院分区：
文献类型：
--
作者：
Alessi, CA;Yoon, EJ;Cruise, PA
目的：本研究的目的是测试将增加白天体力活动与改善夜间环境相结合的干预措施是否可以改善疗养院居民的睡眠并减少躁动。设计：一项随机试验。地点：加利福尼亚州洛杉矶地区的一个社区疗养院。参与者：29 名失禁居民（平均年龄 88.3 岁，90% 为女性）。干预：受试者被随机分配接受 (1) 一项结合增加日间体力活动和改善夜间环境的干预措施。白天体力活动（持续 14 周）加上夜间计划（持续 5 个晚上）以减少噪音和干扰睡眠的护理实践（干预组），或 (2) 单独夜间计划（对照组）。 测量：日间体力活动监测器和结构化身体功能评估；夜间手腕活动监测器以估计夜间睡眠；结果：身体功能测量没有显着变化（重复测量的多元方差分析，按时间效应分组）。干预受试者夜间睡眠百分比（夜间床上监测的睡眠时间与时间的关系）的腕部活动记录估计值从基线时的 51.7% 增加到随访时的 62.5%，而对照组则从基线时的 67.0% 增加到随访时的 66.3%（多元方差分析，按时间分组，F = 4.42，P = .045，df = 27）。随访时，与基线相比，干预对象白天卧床观察的百分比平均下降 32%，而对照组基本没有变化（多元方差分析，按时间分组，F = 5.31，P = .029，df = 27）。与基线相比，15 名干预受试者中的 7 名在随访时观察到的躁动有所减少，而 14 名对照组中只有 1 名观察到的躁动有所减少。结论：这项研究提供了初步证据，表明将增加体力活动与改善夜间疗养院环境相结合的干预措施可以改善疗养院居民的睡眠并减少躁动。
OBJECTIVES: The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents.DESIGN: A randomized trial.SETTING: One community nursing home in the Los Angeles, California area.PARTICIPANTS: Twenty-nine incontinent residents (mean age 88.3 years, 90% female).INTERVENTION: Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group).MEASUREMENTS: Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation.RESULTS: Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls (MANOVA, group by time, F = 4.42, P = .045, df = 27). At follow-up, intervention-subject averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P = .029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation.CONCLUSIONS: This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.