title: Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults.
abstract: OBJECTIVE
  Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000-3000 lux; 6-10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.
  
  
  METHODS
  A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini-Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient's GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.
  
  
  RESULTS
  The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep-wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.
  
  
  CONCLUSIONS
  This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. Mei_Sian_Chong@ttsh.com.sg
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
authors.forename: Keng Teng
authors.initials: KT
authors.lastname: Tan
authors.forename: Laura
authors.initials: L
authors.lastname: Tay
authors.forename: Yoke Moi
authors.initials: YM
authors.lastname: Wong
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
mesh_terms: D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D003693:Delirium / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D009483:Neuropsychological Tests; D010789:Phototherapy / Q000379:methods*; D012893:Sleep Wake Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
keywords: delirium; elderly; function; sleep