How can we address poor sleep in nursing homes?
How can we address poor sleep in nursing homes?
复制标题
我们如何解决疗养院睡眠质量差的问题？
DOI：
10.1017/s1041610220003300
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发表时间：
2021
影响因子：
7
通讯作者：
Chodosh,Joshua
中科院分区：
文献类型：
--
作者：
Martin,JenniferL;Chodosh,Joshua
睡眠障碍在疗养院的居民中很常见，影响超过69%的居民（Martin等人，2006; Alessi等人，2005年）。睡眠不佳与许多负面结果相关，包括抑郁症恶化（Chau et al.，2019）、焦虑（约翰逊等人，2006）、疼痛（Finan等人，2013）和增加的福尔斯（Jiang et al.，2019年）。从历史上看，镇静催眠药物通常用于解决疗养院居民的睡眠障碍（斯瓦尔斯塔德和Mount，2002）;然而，这些药物可能对老年患者具有显著的不良影响，包括认知受损、福尔斯风险增加和长期睡眠质量变差，尽管它们具有预期效果（Bourgeois等人，2014）。这些不良反应导致了系统性的努力，以减少老年人使用这些药物（美国老年病学会，2019），并确定其他非药物治疗，以解决养老院和其他长期护理环境中的睡眠不良问题。最初的干预研究主要集中在白天定时的强光照射，以加强昼夜节律和巩固睡眠（Ancoli-Israel等人，2002; Fukuda等人，2001年）。这些单一组成部分的干预措施已显示出一定的前景，但在治疗结束后，这些益处并没有持续下去。由于这些限制和睡眠质量的多因素决定因素，特别是对于养老院的居民，研究人员试图开发和测试同时解决多个因素的多组分治疗。由于居民层面因素和环境因素之间的复杂相互作用，疗养院的居民通常会睡眠不佳。养老院的居民经常患有认知障碍和多种慢性疾病，治疗也会导致睡眠不良（例如导致疼痛或不适的疾病或治疗，如增加排尿的药物）。住院医生经常服用多种药物，其中一些药物可能会导致白天镇静（使住院医生难以警觉）或夜间睡眠碎片（使夜间难以获得充足的睡眠）。在最近的一项定性研究中，韦伯斯特等人发现，护理人员认为药物无法充分解决居民的睡眠中断问题，并且可能会在白天对居民产生负面影响（韦伯斯特等人，除了居民个人面临的许多问题之外，养老院的夜间环境不利于稳固，宁静的睡眠。环境通常是嘈杂的，并且灯经常整夜开着（Janus等人，2020; Schnelle等人，1993年）。此外，在白天，居民经常在床上度过早上的时间，照明水平通常较低，并且没有足够的刺激使居民保持清醒。（Martin等人，2006）这些因素的结合创造了一个白天睡觉和夜间清醒的恶性循环。
Sleep disturbances are common among residents of nursing homes, affecting over 69% of residents (Martin et al., 2006; Alessi et al., 2005). Poor sleep is associated with a host of negative outcomes, including worsening depression (Chau et al., 2019), anxiety (Johnson et al., 2006), pain (Finan et al., 2013), and increased falls (Jiang et al., 2019). Historically, sedative-hypnotic medications have been commonly used to address sleep disturbances in nursing home residents (Svarstad and Mount, 2002); however, these medications can have significant adverse effects for older patients including impaired cognition, increased risk of falls, and worse sleep quality over the long-term despite their intended effect (Bourgeois et al., 2014). These adverse effects have led to systematic efforts to reduce use of these medications in older adults (American Geriatrics Society, 2019) and to identify other non-pharmacological treatments to address poor sleep in nursing homes and other long-term care settings. Initial intervention studies focused mostly on timed bright-light exposure during the daytime, in an effort to strengthen circadian rhythms and consolidate sleep (Ancoli-Israel et al., 2002; Fukuda et al., 2001). These single-component interventions have demonstrated some promise; however, benefits have not been sustained after treatment ends. As a result of these limitations and the multifactorial determinants of sleep quality, especially for residents of nursing homes, investigators have sought to develop and test multi-component treatments that address multiple factors simultaneously. Residents of nursing homes typically suffer from poor sleep due to complex interactions among resident-level factors and environmental factors. Residents in nursing homes often suffer from cognitive impairment and multiple chronic conditions for which treatments also contribute to poor sleep (eg conditions that cause pain or discomfort or treatments such as medications that increase urination). Residents often take multiple medications some of which may cause daytime sedation (making it hard for residents to be alert) or nighttime sleep fragmentation (making it hard to obtain adequate sleep at night). In a recent qualitative study, Webster et al. found that nursing staff do not think medications adequately address sleep disruption in residents and can have negative effects on residents during the daytime hours (Webster et al., 2020).On top of the many issues faced by residents individually, the nursing home nighttime environment is not conducive to solid, restful sleep. The environment is typically noisy, and lights are often left on throughout the night (Janus et al., 2020; Schnelle et al., 1993). Moreover, during the daytime, residents often remain in bed past morning hours, lighting levels are often low, and there is insufficient stimulation for residents to sustain wakefulness.(Martin et al., 2006) This combination of factors creates a vicious cycle of daytime sleeping and nighttime wakefulness.