Catherine S. Cole

Sleep disruption in older adults. Harmful and by no means inevitable, it should be assessed for and treated.

Insomnia is not a normal part of aging, but nighttime sleep in older adults is often disrupted, leading to excessive daytime sleepiness and other physical, psychological, and cognitive changes that affect overall health. Even so, clinicians often pay little attention to sleep in this population. The sleep of older adults tends to be less deep than that of younger people, and coexisting conditions and treatment effects can more easily disrupt sleep. This article reviews the current literature on sleep disruption in older adults and suggests ways that nurses can apply the information in intervening to improve sleep in their older patients.

Sleep across chemotherapy treatment: a growing concern for women older than 50 with breast cancer.

PURPOSE/OBJECTIVES To conduct a metasynthesis of human sleep studies that included women aged 50 years and older with breast cancer across chemotherapy treatment. DATA SOURCES English publications were searched with the terms sleep and breast cancer via Ovid, PubMed, and EBSCO-host databases. Human studies that used sleep-specific instruments published from January 1974-May 2009 were included. Intervention studies also were included if they provided baseline sleep data. Studies that used quality-of-life or symptom instruments or in which patients were prescreened for insomnia were not included. DATA SYNTHESIS 382 publications were found; 17 met inclusion criteria, and 3 additional studies were located from the literature on fatigue. Two articles reported on the same study, so a total of 19 studies were included in the review. In women with nonmetastatic breast cancer, subjective and objective sleep quality appear to be poor and nocturnal awakenings frequent across chemotherapy treatment. Daytime sleepiness increases in the active phase of chemotherapy, and insomnia symptoms are common before and following chemotherapy treatment. In women with recurrent or metastatic breast cancer, difficulty falling asleep, nocturnal awakenings, difficulty awakening, and daytime sleepiness are problematic at different points in chemotherapy treatment. CONCLUSIONS Sleep for women, including those older than 50 years, appears to be impaired across chemotherapy treatment, although replication of findings is very limited. IMPLICATIONS FOR NURSING Future research should investigate sleep in specific age and minority groups, include daytime sleep and sleepiness, and use standard sleep nomenclature and objective measures.

Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer.

PURPOSE/OBJECTIVES To examine subjective sleep quality in women aged 50 and older as predicted by cancer status, age, number of comorbidities, and symptoms of depressed mood; and to describe objective sleep characteristics, insomnia symptom severity, and daytime sleepiness. DESIGN Descriptive. SETTING Urban university and private oncology clinics in the southern United States. SAMPLE 32 women with and 35 without nonmetastatic breast cancer, aged 50-90 years (X=64.9, SD=4.67). METHODS Two telephone interviews, the Pittsburgh Sleep Quality Index, Profile of Mood States, three days of home actigraphy, Insomnia Severity Index, Epworth Sleepiness Scale, and medical records review. MAIN RESEARCH VARIABLES Subjective quality of sleep; secondary objectives were sleep characteristics, insomnia symptoms, and daytime sleepiness. FINDINGS Poor subjective sleep quality was predicted by depressed mood (p<0.00005). All mean objective sleep characteristics were similar for the breast cancer and comparison groups. Nocturnal awakenings were excessive (9.2 versus 7.3). Mean sleep onset latency was longer for the breast cancer group than for the comparison group (34.8 versus 15.6 minutes). Mean insomnia severity scores for the breast cancer group indicated subthreshold insomnia symptoms, and no clinically significant insomnia for the comparison group (8.9 versus 6.4). Mean daytime sleepiness scores were normal for both groups (7 versus 6). CONCLUSIONS Subjective sleep quality was predicted by depressed mood only. Sleep in the breast cancer group was characterized by poor sleep quality, frequent nocturnal awakenings, and insomnia symptoms. IMPLICATIONS FOR NURSING Screening and monitoring in women aged 50 and older with breast cancer may help promote early sleep intervention; however, additional collaborative research regarding the underlying causes of sleep disruption is needed.

SLEEP AND COGNITION IN PEOPLE WITH ALZHEIMER'S DISEASE

It is important that we identify factors that could lead to interventions to slow cognitive decline in people with Alzheimers disease. One potentially modifiable factor in Alzheimers disease is disturbed sleep. The effect of disturbed sleep on cognition is of profound importance in people with Alzheimers disease because disturbed sleep may worsen memory complaints. Therefore, the purpose of this article is to provide an updated review of literature that describes the impact of disturbed sleep on cognition in healthy populations and discuss the implications that this relationship has for people with Alzheimers disease and their formal and informal caregivers.

Exercise and Social Activity Improve Everyday Function in Long-Term Care Residents

OBJECTIVES This study examined the effects of high-intensity resistance strength training and walking (E), individualized social activity (SA), and resistance training and walking combined with social activity (ESA) on everyday function in long-term care (LTC) residents and explored the relationship between change in everyday function and change in sleep. DESIGN The study used data from The Effect of Activities and Exercise on Sleep, a randomized controlled trial. SETTING Residential LTC facilities. PARTICIPANTS A total of 119 participants who had measures of everyday function and sleep at baseline and postintervention. INTERVENTIONS The E group exercised 5 days a week. The SA group was involved in social activities 5 days a week. The ESA group received both E and SA interventions. The usual care (UC) control group participated in usual activities. MEASUREMENTS Everyday function was measured by the Nursing Home Physical Performance Test. Nighttime sleep was measured by attended polysomnography. RESULTS The UC and SA groups showed a decline in everyday function, whereas the E and ESA groups showed improvement. There were statistically significant differences between the groups, with pairwise comparisons showing significant improvements in the ESA group over the SA group (95% confidence interval, -3.94 to -0.97) and the UC group (95% confidence interval, -3.69 to -0.64). No relationship was found between change in everyday function and change in sleep. CONCLUSION Seven weeks of high-intensity resistance strength training and walking, combined with individualized social activities (ESA), improved everyday function among LTC residents, independent of change in sleep.

Sleep disturbance in women before myocardial infarction

OBJECTIVE The study objective was to describe the prevalence and correlates of sleep disturbances among women who retrospectively reported sleep disturbance before their myocardial infarction (MI). MI is frequently unrecognized in women because they may have only vague symptoms, such as sleep disturbance. Describing correlates of sleep disturbance before MI may assist in recognizing women at risk for coronary heart disease. METHODS A secondary analysis was performed of a dataset derived from 15 sites. RESULTS Of 1270 women experiencing initial MI, 632 reported new onset of or worsening sleep disturbance before MI. Prevalence was similar across racial groups. Women reporting prodromal sleep disturbance were more likely to be older, to be heavier, and to report cognitive changes (adjusted odds ratio [OR], 1.47), new or increasing anxiety (adjusted OR, 2.21), and unusual fatigue (adjusted OR, 2.16). CONCLUSION Subjective reports of sleep disturbance preceding MI seem to be prevalent in women of all races and may be an important warning sign for MI in women.

Nursing Home Residents' Sense of Coherence and Functional Status Decline

Functional status decline places an enormous burden on health care services and strategies to identify at risk subgroups are needed. The purpose of this study was to examine the relationship between sense of coherence (SOC) and functional status to determine if SOC can be used to identify at-risk subgroups. In a convenience sample (N = 65) of nursing home residents measures of functional status and SOC were compared at 2 times. The mean functional status score of the weak SOC group (n = 28) at Time 1 was 16.14 and 17.32 at Time 2 indicating functional status decline. The mean functional status score of the strong SOC group (n = 37) at Time 1 was 12.38 and 11.76 at Time 2 indicating improved functional status. Although these changes were not statistically significant the trends suggest that a weak SOC may indicate increased risk for functional status decline.

Relationships among disordered sleep and cognitive and functional status in nursing home residents.

This descriptive study examined relationships among disordered sleep and cognitive and functional status in nursing home residents (N = 90). Baseline data were used from a randomized controlled clinical trial that took place in three nursing homes. The sample included individuals age 55 and older with disordered sleep and cognitive impairment. We measured nighttime sleep with attended polysomnography and cognitive status with the Mini-Mental State Examination and assessed two indicators of functional status: level of assistance required and gait speed. Decreased total sleep time (TST), fewer respiratory awakenings, and higher oxygen saturation (SaO(2)) nadir were associated with better cognitive and functional status. After controlling for the effect of cognitive status, the association between decreased TST and better gait speed remained significant. Although correlation does not establish causation, these findings suggest that interventions to decrease nighttime respiratory awakenings and maintain SaO(2) have the potential to support cognitive and functional status in nursing home residents.

Reflections of a Bean Counter: The Costs of Recruiting

Although information on the costs of participant recruitment for large-scale clinical trials has been published, the information may not be applicable to small feasibility studies. To determine the most effective recruitment strategy for a feasibility study that sought to adapt laboratory measurement of simple reaction times of individuals with Alzheimers disease (AD) to the home, we adapted a metric developed by Chin Feman et al. We recruited individuals with mild to moderate dementia from (a) enrollees in a Memory Research Center, (b) AD support groups, (c) the senior clinic at our university, and (d) senior citizen housing units. We compared costs and enrollment rates associated with various recruitment strategies and found that recruitment through the Memory Research Center was most effective (enrollment rate = 66.7%, salary costs =

Tone-Induced Sleep Fragmentation in Persons with Alzheimer’s Disease: A Feasibility Study

49.47 per participant). These findings have implications for investigators preparing budgets for small feasibility studies involving populations with dementia.Although there is published information regarding the costs of participant recruitment for large-scale clinical trials, these findings may not be applicable for small feasibility studies. To determine the most effective recruitment strategy we adapted a metric developed by Chin Feman et al. (Chin Feman et al., 2008). We compared costs and enrollment rates associated with various recruitment strategies. We recruited persons with mild to moderate dementia for a feasibility study that sought to adapt laboratory measures of daytime function to the home. We recruited from 1) enrollees in a Memory Research Center, 2) Alzheimer’s disease support groups, 3) the Reynolds Senior Health Center Clinic at the University of Arkansas for Medical Sciences, and 4) senior citizens housing. We determined that recruitment through the Memory Research Center was most effective (enrollment rate 67%, salary costs