title: A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns.
abstract: BACKGROUND
  Sleep and circadian rhythms are disrupted among many nursing home (NH) residents. We examined the impact of a multicomponent nonpharmacological intervention on 24-hour rest/activity rhythms among long-stay NH residents.
  
  
  METHODS
  The study was a randomized controlled trial in which, following a 3-day baseline, participants received 5 days of either usual care (control condition) or the active intervention. The intervention combined increased exposure to outdoor bright light, efforts to keep residents out of bed during the day, structured physical activity, institution of a bedtime routine, and efforts to reduce nighttime noise and light in residents' rooms. For 100 residents with baseline and follow-up wrist actigraphy data (mean age = 87 years; 76% women), rest/activity rhythms were modeled to determine the rhythm acrophase (peak time), nadir (trough time), midline estimating statistic of rhythm (MESOR) (midpoint), amplitude (height of peak), slope, and the rest period/active period ratio (alpha).
  
  
  RESULTS
  The intervention led to an increase in the duration of the "active" portion of the rhythm, which was primarily accounted for by a shift in the rest/activity rhythm rise to an earlier time. Findings persisted when analyses were adjusted for age, cognitive functioning, medical comorbidities, and behavioral disturbances.
  
  
  CONCLUSIONS
  These findings suggest that the intervention may effectively improve the robustness of rest/activity rhythms in NH residents. Further research is needed to examine the impact of similar interventions on other measures of circadian rhythms (e.g., body temperature, melatonin) among NH residents.
authors.affiliation: Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles, USA. jennifer.martin@va.gov
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martin
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Marler
authors.forename: Judith O
authors.initials: JO
authors.lastname: Harker
authors.forename: Karen R
authors.initials: KR
authors.lastname: Josephson
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Alessi
mesh_terms: D000369:Aged, 80 and over; D002940:Circadian Rhythm / Q000502:physiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D009735:Nursing Homes; D012146:Rest / Q000502:physiology; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome