40Winks: Enhancing Sleep Quality for Nursing Home Residents With Dementia
Study Details
Study Description
Brief Summary
This study will improve clinical outcomes for an important, growing, and vulnerable population-nursing home (NH) residents with Alzheimer's disease or related dementias (ADRDs)-by implementing an evidence-based intervention (LOCK) to improve these residents' sleep. It will also significantly increase our understanding of how to implement and sustain nursing home interventions.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
In community (non-VA) NHs [one from each of 3 NH corporations, still to be recruited], our multi-disciplinary team proposes to (1) refine the LOCK sleep program to focus on sleep for residents with ADRD during this pilot (R61) phase, (2) which will prepare the team for the next phase of this NIH-funded grant (the R33 phase) to test the impact and sustainability of this intervention for NH residents with ADRD in an incomplete stepped-wedge randomized controlled trial.
THIS CURRENT PILOT STUDY R61 PHASE (1 YEAR; N = 3 NHS; 1 NH PER CORPORATION) HAS THE
FOLLOWING SPECIFIC AIMS:
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Refine the LOCK sleep program train-the-trainer protocol by implementing and pilot-testing in three NHs.
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Test and refine the research methods to: effectively identify eligible NHs and residents; obtain consent; collect primary data from residents and staff (sleep time via actigraph); explore staff impressions of additional sleep measurement devices (Fitbits); transfer primary and secondary data to our data center; and merge all data.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: LOCK sleep intervention Nursing home staff receive the LOCK sleep intervention training and thus provide to nursing home residents with dementia the LOCK sleep intervention |
Behavioral: LOCK sleep intervention
Nursing home staff are trained to use a collaborative problem-solving approach to sleep quality improvement using front-line huddling
|
Outcome Measures
Primary Outcome Measures
- Sleep (actigraph measurement) [6 week sleep intervention period]
Total sleep time (total minutes asleep each nighttime period - 10pm to 6am)
Secondary Outcome Measures
- Psychotropic medication use (change from baseline - decrease, increase, same) [6 week sleep intervention period]
As recorded in the Minimum Data Set's Medications received subscale, Antipsychotic medication question, and Psychotropic Drug Care Area Trigger Code. The Medications received subscale asks if the resident has received any antipsychotic, antianxiety or antidepressant medication in the past seven days or since admission/reentry if less than seven days. The Antipsychotic medication, similar to in the previous subscale, asks whether the resident received antipsychotic medications since admission/entry or reentry or the prior OBRA assessment, whichever is more recent. Finally, the Psychotropic Drug Trigger Code asks whether the Psychotropic Drug Use Care Area was triggered. These are MDS items N0410A-C, N0450A, and V0200A17A, respectively. These data will be consolidated into a trichotomous indicator of change from baseline (decrease, increase, same).
- Pain treatment received (change from baseline - decrease, increase, same) [6 week sleep intervention period]
Based on the Pain Management items as recorded in the Minimum Data Set. The Pain Management sub scale asks, using yes or no questions, if the resident has been on a scheduled pain medication regimen, received PRN pain medication or was offered and declined, and, has received non-medication intervention for pain in the past five days. These data will be consolidated into a trichotomous indicator of change from baseline (decrease, increase, same).
- Pain - Resident Report (change from baseline - decrease, increase, same) [6 week sleep intervention period]
Based on the Pain Assessment items as recorded in the Minimum Data Set. The Pain Assessment sub scale asks if the resident has had pain or hurting (yes, no), the frequency of pain or hurting (almost constantly, frequently, occasionally, rarely), if the resident had difficulty sleeping because of pain or hurting (yes, no), if the residents day-to-day activities were limited because of pain or hurting (yes, no) over the past five days. The Pain Intensity sub scale asks the residents numeric pain rating value (0-10 scale) and intensity of worst pain experienced (mild, moderate, severe, very severe or horrible) in the past five days. These data will be consolidated into a trichotomous indicator of change from baseline (decrease, increase, same).
- Pain - Staff Report (change from baseline - decrease, increase, same) [6 week sleep intervention period]
As recorded in the Minimum Data Set, the Staff Assessment sub scale asks staff members, all yes, no responses, if the resident had non-verbal sounds, verbal complaints, facial expressions, protective body movements or postures, or no signs that may be an indicator of possible pain in the last five days. These data will be consolidated into a trichotomous indicator of change from baseline (decrease, increase, same).
- Activities of daily living decline (change from baseline - decrease, increase, same) [6 week sleep intervention period]
Has activities of daily living functional ability declined from baseline. Based on Minimum Data Set items assessing decline in activities of daily living (MDS; G0110A-J & G0120A-B; QM N028.01), these data will be consolidated into a trichotomous indicator of change from baseline (decrease, increase, same)
Eligibility Criteria
Criteria
Inclusion Criteria:
- Nursing home residents aged >=50 years with an Alzheimer disease or related dementia (ADRD) diagnosis, identified by nursing home staff participating in frontline LOCK sleep huddles as having sleep problems
Exclusion Criteria:
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residents with a high risk of OSA who are not being treated for OSA because actigraph measurements are inaccurate in that population.
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residents who have a persistent bilateral resting tremor or paralysis in both arms (a subset of persons with Parkinson's disease and related significant tremor-causing diagnoses), due to actigraph measurement inaccuracies
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | The University of Alabama | Tuscaloosa | Alabama | United States | 35487-0348 |
Sponsors and Collaborators
- University of Alabama, Tuscaloosa
- University of Massachusetts, Lowell
- The University of Texas Health Science Center, Houston
- University of Texas at Austin
- Brown University
Investigators
- Principal Investigator: Lynn Snow, PhD, The University of Alabama
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 1R61AG065619-01