A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve?
OBJECTIVE
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.


METHODS
A randomized trial.


METHODS
One community nursing home in the Los Angeles, California area.


METHODS
Twenty-nine incontinent residents (mean age 88.3 years, 90% female).


METHODS
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).


METHODS
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 subjects 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.
University of California, Los Angeles, Multicampus Program in Geriatric Medicine and Gerontology, USA.
C A
CA
Alessi
E J
EJ
Yoon
J F
JF
Schnelle
N R
NR
Al-Samarrai
P A
PA
Cruise
D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006272:Health Facility Environment; D006801:Humans; D015141:Los Angeles; D008297:Male; D015999:Multivariate Analysis; D009551:Night Care / Q000379:methods*; D009622:Noise / Q000517:prevention & control; D009735:Nursing Homes; D017286:Polysomnography; D011595:Psychomotor Agitation / Q000517:prevention & control*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014549:Urinary Incontinence / Q000451:nursing*