Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program.
Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program.
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提高老年痴呆症疗养院居民的睡眠质量：一项基于循证的前线拥挤计划的实用随机对照试验。
DOI：
10.1186/s12877-021-02189-8
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发表时间：
2021-04-27
期刊：
影响因子：
4.1
通讯作者：
Hartmann CW
中科院分区：
文献类型：
--
作者：
Snow AL;Loup J;Morgan RO;Richards K;Parmelee PA;Baier RR;McCreedy E;Frank B;Brady C;Fry L;McCullough M;Hartmann CW
睡眠紊乱使老年人面临更高的虚弱、发病甚至死亡风险。然而，疗养院的日常工作经常通过使用噪音、光线或努力减少尿失禁来扰乱居民的睡眠。老年痴呆症和/或相关痴呆的疗养院居民几乎占长期居住疗养院居民的三分之二很可能特别受到睡眠障碍的影响。为了解决这些问题，这项研究方案实施了一项基于证据的干预措施来改善睡眠：一项名为“睡眠障碍”的养老院一线工作人员聚集计划。该计划是来自证据支持优势为基础的学习，系统观察，基于关系的团队合作，和效率。本研究方案概述了NIH第三阶段，真实世界的混合功效-效果实用性试验的睡眠干预。在两个阶段中，在来自3家公司的27家非VA养老院中，该研究将（1）改进睡眠质量管理计划，重点关注痴呆症患者的睡眠，（2）测试睡眠质量管理睡眠干预对养老院痴呆症患者的影响，以及（3）评估干预的可持续性。第一阶段（1年; n = 3家疗养院;每个公司1个）将完善干预和培训培训员方案，并对所有研究方法进行试点测试。第二阶段：4年; n = 24家疗养院;每家公司8家）将使用改进的干预措施进行楔形设计的随机对照临床试验。第二阶段的结果将衡量睡眠干预对睡眠（主要结果）和精神药物使用，疼痛和镇痛药物使用以及日常生活活动下降（次要结果）的影响。调查结果将指出在该计划的实施和可持续性设施间的变化。据我们所知，这是第一项应用痴呆症睡眠干预系统地解决养老院质量改善工作的已知障碍的研究。这项创新的研究未来有可能解决睡眠以外的临床问题（安全，感染控制），并扩展到其他环境（辅助生活，住院精神健康）。该研究强大的团队，对设计挑战的仔细考虑，以及由此产生的严格，务实的方法将确保这种有希望的干预措施对老年痴呆症疗养院居民的成功。NCT 04533815，ClinicalTrials.gov，2020年8月20日。在线版本包含补充材料，可通过10.1186/s12877-021-02189-8获得。
Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. NCT04533815, ClinicalTrials.gov, August 20, 2020. The online version contains supplementary material available at 10.1186/s12877-021-02189-8.
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影响因子：
9.8
作者：
Chung F;Subramanyam R;Liao P;Sasaki E;Shapiro C;Sun Y
通讯作者：
Sun Y
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
0.8
作者：
BEEBE, J
通讯作者：
BEEBE, J
影响因子：
5.7
作者：
Bellows, Nicole M.;Halpin, Helen A.
通讯作者：
Halpin, Helen A.
影响因子：
2.9
作者：
da Silva AA;de Mello RG;Schaan CW;Fuchs FD;Redline S;Fuchs SC
通讯作者：
Fuchs SC