|
BACKGROUND/RATIONALE:
Over the past several years, rehabilitation of older people after an acute illness is increasingly provided in postacute settings, such as nursing homes (NHs) and intermediate care settings. These post-acute settings provide rehabilitation for older people who are recovering from a variety of acute events that can lead to physical and functional decline, such as stroke, fracture, acute medical illness, and surgery. The primary goal is restoration of physical functioning to facilitate return to a previous living location and the resumption of former activities. Previously identified predictors of poor functional recovery from rehabilitation in older people include cognitive impairment, depression, lack of social support, and pre- and post-event dependency in basic activities of daily living (ADLs). From a prospective cohort study (VA HSR&D IIR-O1-053-1, PI: Alessi) to investigate sleep disturbance among older people undergoing post-acute rehabilitation, we have found a high prevalence of sleep disturbance and potentially modifiable environmental factors that may contribute to sleep disruption. We also found that excessive daytime sleeping is associated with less functional recovery between admission and discharge, and at outpatient follow-up.
OBJECTIVE(S):
Based on this new evidence, the purpose of the current proposal is to perform a randomized controlled trial to test whether a multicomponent, nonpharmacological intervention improves abnormal sleep/wake patterns, functional recovery and quality of life in older people (N=214) undergoing post-acute rehabilitation.
This proposal represents new and original work that is based on extensive preliminary studies, as well as a strong theoretical framework. The main objective of this research is to determine if the intervention improves abnormal sleep/wake patterns, functional recovery and quality of life in older adults. The long-term objective is to identify ways to improve care for older people undergoing post-acute rehabilitation (which can be incorporated into usual care) in order to improve their well-being, function and quality of life.
METHODS:
The intervention will combine: 1) structured sleep assessment, 2) environmental interventions (efforts to increase bright light exposure, decrease daytime in-bed time, and provide a structured bedtime routine) implemented in the post-acute rehabilitation setting, and 3) elements of cognitive-behavioral strategies (combining aspects of stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) performed during the post-acute rehabilitation stay. This project will be conducted in a VA post-acute rehabilitation site. Older patients ( > or = 60 years) years who were previously community-dwelling, will be screened on admission to the post-acute rehabilitation setting for evidence of sleep disturbance by subjective (i.e., questionnaire) and objective (i.e., wrist actigraphy) measures. Eligible participants (N=214) will be randomized within each study site to receive the intervention, or a low-intensity sleep and general health education program as the control condition. Data collected at baseline will include medical data and demographics, as well as subjective and objective measures of sleep, structured assessments of functional status, and medical comorbidity. Follow-up assessments will be performed at discharge from the facility, and 3 months and 6 months from enrollment into the study. The main outcome measures will include sleep/wake patterns (sleep questionnaires and wrist actigraphy), functional status, and self-reported quality of life. Data will be analyzed for all randomized participants in an intention to treat analysis.
FINDINGS/RESULTS:
Over the first 18-month period, a total of 158 participants were enrolled (56% of eligible admissions to the rehabilitation ward). The mean age of enrolled participants is 72.5 years and 98% are male. Among these participants, 101 (65% have been randomized to the treatment or control groups).
IMPACT:
We hypothesize that compared to control participants, intervention participants will have improvements in abnormal sleep/wake patterns in the post-acute rehabilitation setting. We also hypothesize that the intervention will lead to improvements in sleep, greater functional recovery and improved quality of life.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Rehabilitation, Quality of Care
Keywords:
Patient outcomes, Quality of life, Sleep disorders
MeSH Terms:
none
|
