Regular Research ArticlesSleep Disturbance Among Older Adults in Assisted Living Facilities
Section snippets
OBJECTIVE
In this article, we analyze data from a prospective, observational cohort study of older adults residing in Los Angeles-area ALFs. Our first objective was to determine whether objectively and subjectively measured sleep disturbances change over a 6-month period. Since most sleep disturbance is chronic among older adults,6 we hypothesized that compared with baseline, mean objective and subjective measures of sleep disturbance would not be statistically different at 3- and 6-month follow-up.
Our
METHODS
This was a prospective, observational cohort study among older people residing in 18 ALFs in Los Angeles County, California, recruited between April 2006 and March 2008 (see Figure 1). The study methods have been reported in detail previously5 and are summarized here. All but one facility was proprietary, and bed size ranged from 60 to 239. Although communal meal times may have been preset, residents, in general, had control over sleep schedules, including bedtime and wake-up time.
The target
Outcome Variables
Wrist actigraphy was used as an objective measure of sleep quality. Participants wore a wrist actigraph (Octagonal Sleep Watch-L, Ambulatory Monitoring, Inc, Ardsley, NY) on their dominant arm (except in cases of paralysis or other barriers to the use of the dominant arm) for three consecutive days and nights. Research staff visually inspected the raw actigraphy data (1-minute epoch) to identify technical and situational artifacts before scoring sleep. Sleep was scored using Action4 software
Sample Characteristics
The mean age of the sample (n = 121) was 85.3 years (SD: 6.5). A majority of the participants were female (n = 87, 86%) and of non-Hispanic white race/ethnicity (n = 106, 88%). The average number of years of residence in the ALF was 2.6 years (SD: 2.9). Most participants reported low comorbidity index scores (mean: 1.4, SD: 1.6). The mean MMSE score was 26.4 (SD: 3.1). The mean GDS-5 score was 1.1 (SD: 1.2), and 30% of the sample had GDS-5 scores suggestive of depression. Most participants had
CONCLUSIONS
This study of sleep disturbance patterns and predictors of sleep disturbance among residents of ALFs in the Los Angeles area is the first study to characterize the persistence of sleep disturbances in this group of older adults and is one of the few studies to characterize predictors of sleep disturbances in this setting. We found that ALF residents had objectively and subjectively measured sleep disturbances that did not change significantly from baseline to 3- and 6-month follow-up. This
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This study was supported by the VA Advanced Geriatrics Fellowship Program; NIH NIA K23 AG028452, NIMH T32 MH 019925-11; UCLA Academic Senate Council on Research; VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; VA Health Services Research and Development (IIR 04-321-2); and UCLA Cousins Center for Psychoneuroimmunology. Additional financial support was provided by Sepracor Inc., Marlborough, MA. The authors thank the study project coordinators, Terry Vandenberg, MA, and Rebecca Saia, the research staff, the staff at the participating facilities, and the ALF residents.
Conflicts of interest: Additional funding for this project was provided to Dr. Alessi from Sepracor Inc., Marlborough, MA. The authors have no other potential conflicts of interest to disclose. Authors' contributions: Dr. Fung contributed to the analysis and interpretation of data and preparation of the manuscript. Dr. Martin and Ms. Josephson contributed to the study design, analysis and interpretation of data, and preparation of the manuscript. Dr. Mitchell contributed to analysis and interpretation of data and preparation of the manuscript. Dr. Fiorentino and Ms. Jouldjian contributed to the analysis and interpretation of data and preparation of the manuscript. Dr. Chung contributed to the analysis and interpretation of data. Dr. Alessi contributed to the study concept and design, analysis and interpretation of data, and preparation of the manuscript. Sponsor's role: The study sponsors had no input in the design, implementation, analysis, or interpretation of this study.