title: A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial.
abstract: OBJECTIVE
  To improve nighttime sleep in nursing home patients.
  
  
  METHODS
  Controlled clinical trial.
  
  
  METHODS
  Eight community nursing homes enrolled two at a time.
  
  
  METHODS
  Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate-intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate-intervention group and 83 in the delayed-intervention phase).
  
  
  METHODS
  Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention.
  
  
  METHODS
  Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations.
  
  
  RESULTS
  There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate-intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography.
  
  
  CONCLUSIONS
  This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA. jouslan@emory.edu
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouslander
authors.forename: Bettye Rose
authors.initials: BR
authors.lastname: Connell
authors.forename: Donald L
authors.initials: DL
authors.lastname: Bliwise
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Endeshaw
authors.forename: Patricia
authors.initials: P
authors.lastname: Griffiths
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D015444:Exercise; D005260:Female; D006801:Humans; D008029:Lighting; D008297:Male; D008875:Middle Aged; D009551:Night Care / Q000379:methods*; D009622:Noise / Q000517:prevention & control*; D009735:Nursing Homes; D012890:Sleep / Q000502:physiology*; D017211:Treatment Failure