Ingrid Eyers

AN ACTIGRAPHIC STUDY COMPARING COMMUNITY DWELLING POOR SLEEPERS WITH NON-DEMENTED CARE HOME RESIDENTS

Sleep disturbances are a common problem among institutionalized older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms, and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This article compares actigraphic data collected for 14 days from 122 non-demented institutional care residents (across ten care facilities) with 52 community dwelling poor sleepers >65 yrs of age. Four dependent variables were analyzed: (i) “interdaily stability” (IS); (ii) “intradaily variability” (IV); (iii) relative amplitude (RA) of the activity rhythm; and (iv) mean 24 h activity level. Data were analyzed using a fixed-effect, single-level model (using MLwiN). This model enables comparisons between community and institutional care groups to be made while conditioning out possible “individual” effects of “age,” “sex,” “level of dependency,” “level of incontinence care,” and “number of regular daily/prescribed medications.” After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there was little difference between community dwelling older adults and institutional care residents in IS score, suggesting that the stability of day-to-day patterns (such as bed get-up, lunch times, etc.) is similar within these two resident groups. However, institutional care residents experienced more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older peoples rest/wake patterns; although, longitudinal studies are required to fully understand any causal relationships. (Author correspondence: r.meadows@surrey.ac.uk)

Care assistants overlooked?: A cross‐national study of care home staff in England and Germany

Within the context of residential care settings in England and Germany little consideration is given to the role of care assistants. Policies that determine the staffing levels in both countries have resulted in care assistants making a considerable contribution towards the ‘hands‐on’ care of dependent, older people. However, the policies overlook the need to encourage and support care assistants in developing the skills required to provide effective, efficient care to dependent, older people. This paper presents the findings of a small‐scale qualitative study conducted in residential care settings situated in the south east of England and north Germany. The study establishes the connection between the nature of ‘emotional labour’ and the need to provide suitable training to care assistants, thus influencing the quality of care provided to dependent, older people. At present training in both countries is focused on qualified staff. Overlooking care assistants and their contribution towards care could be detrimental to the quality of care provided to older people in both England and Germany.

Professionalising the care of older people: Transforming the workforce

Key to successfully addressing the ongoing transitions being experienced in the care home sector is a transformation of the workforce. This is required in order to respond appropriately to the increasing dependency of older people moving into care homes. This article considers the policy framework surrounding the provision of care services in England and reviews the relevant research into the workforce and the changes needed if the sector is to meet the needs of vulnerable older people living in care homes. Building on present policy and practice, consideration is given to how this change could be achieved.

“Sleeping Like a log.. .”? Technology supporting the implementation of person-centered care at night

Sleep is widely acknowledged to be vital to our well-being, yet its importance is often overlooked or taken for granted. However, it has been identified that older people living in long-term care facilities in the United Kingdom, Germany, and the United States experience poor sleep. However, the evidence-based development of technology has the potential to support the provision of person-centered care enabling residents to “sleep like a log” and experience restorative sleep, thus improving their ability to actively participate in everyday life. This chapter provides an insight into research that underpins the need for technology to support the provision of person-centered nighttime care. The issue of acceptance is related to research findings and four technological devices developed enabling older people to “sleep like a log” and supporting care staff are presented and discussed.