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Abstract
OBJECTIVES This study aims to comprehensively review and update the literature concerning the correlates of sleep disturbance among caregivers of persons living with Alzheimer's disease and related dementias to identify gaps in the literature and antecedent targets for interventions. METHODS We searched PubMed, CINAHL, PsycINFO, and Embase using terms related to "sleep," "caregiver," and "dementia." RESULTS Thirty-six articles were included in this review. Based on the antecedents within the 3P model of insomnia, predisposing factors associated with caregiver sleep included caregiver demographics, and physiological factors like genotype and biomarkers. Precipitating factors related to caregiver sleep included caregiving status and responsibilities, and person living with dementia factors. CONCLUSIONS Sleep disturbance is a significant issue for caregivers of persons living with dementia. However, this review has identified multiple precipitating factors that are modifiable targets for interventions to improve or enhance caregiver sleep. CLINICAL IMPLICATIONS Numerous predisposing and precipitating factors contribute to caregivers of persons living with dementia being susceptible to sleep disturbance. Healthcare providers should ask patients about their caregiving status during annual visits. Healthcare providers should also evaluate caregivers' sleep patterns, and the predisposing and precipitating factors of sleep disturbance, with a focus on the modifiable factors, to enable timely intervention.
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Affiliation(s)
- Glenna S. Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dingyue Wang
- School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Li M, McPhillips MV, Szanton SL, Wenzel J, Li J. Electronic Wearable Device Use for Physical Activity in Older Adults: A Qualitative Study. Work Aging Retire 2024; 10:25-37. [PMID: 38196825 PMCID: PMC10772964 DOI: 10.1093/workar/waac023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Innovative solutions to help older adults increase physical activity are critically important. In this qualitative study, we explored older adults' acceptance, capability, and experiences of using three different types of electronic wearable devices over a period of 4-24 weeks for self-monitoring and promoting physical activity. We conducted 23 semistructured interviews with older adults who participated in three physical activity intervention studies. Two researchers analyzed the data using NVivo version 12, applying a directed content analysis that was partially guided by the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2). Six themes emerged: (1) device learning, (2) hedonic motivation, (3) habit and adherence, (4) facilitating conditions, (5) effort expectancy, and (6) performance expectancy. Although most older adults (95.8%) from this study were first-time users, they reflected positive experiences and generally enjoyed using electronic wearable devices. Participants reported issues related to electronic wearable device functionalities that can be improved to better enhance user experience and motivate increased physical activity. Future research should explore the role of electronic wearable devices in older adults' physical activity with an emphasis on behavioral change over time.
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Affiliation(s)
- Mengchi Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sarah L Szanton
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Junxin Li
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Gaugler JE, Baier RR, Baker ZG, Boltz M, Fortinsky RH, Gustavson AM, Hodgson NA, Jutkowitz E, McPhillips MV, Parker LJ, Sefcik JS, Gitlin LN. Using Hybrid Effectiveness Studies to Facilitate Implementation in Community-Based Settings: Three Case Studies in Dementia Care Research. J Am Med Dir Assoc 2024; 25:27-33. [PMID: 37643720 PMCID: PMC10840611 DOI: 10.1016/j.jamda.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
The pipeline from discovery to testing and then implementing evidence-based innovations in real-world contexts may take 2 decades or more to achieve. Implementation science innovations, such as hybrid studies that combine effectiveness and implementation research questions, may help to bridge the chasm between intervention testing and implementation in dementia care. This paper describes hybrid effectiveness studies and presents 3 examples of dementia care interventions conducted in various community-based settings. Studies that focus on outcomes and implementation processes simultaneously may result in a truncated and more efficient implementation pipeline, thereby providing older persons, their families, health care providers, and communities with the best evidence to improve quality of life and care more rapidly. We offer post-acute and long-term care researchers considerations related to study design, sampling, data collection, and analysis that they can apply to their own dementia and other chronic disease care investigations.
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Affiliation(s)
- Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, MN, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Rosa R Baier
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; Center for Long-Term Care Quality & Innovation and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Zachary G Baker
- School of Public Health, University of Minnesota, Minneapolis, MN, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Marie Boltz
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
| | - Richard H Fortinsky
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Administration Healthcare System, Minneapolis, MN, USA; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Nancy A Hodgson
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; Biobehavioral Health Sciences Department, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric Jutkowitz
- Center for Long-Term Care Quality & Innovation and Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Miranda V McPhillips
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren J Parker
- National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA; National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory Implementation Core, Providence, RI, USA
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Hodgson NA, McPhillips MV, Petrovsky DV, Perez A, Talwar S, Gooneratne N, Riegel B, Aryal S, Gitlin LN. Timed Activity to Minimize Sleep Disturbance in People With Cognitive Impairment. Innov Aging 2023; 8:igad132. [PMID: 38235487 PMCID: PMC10790812 DOI: 10.1093/geroni/igad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 01/19/2024] Open
Abstract
Background and Objectives Sleep disturbances occur in >60% of persons living with cognitive impairment, affecting their quality of life (QOL). Regulating the sleep-wake cycle through engaging cognitive, physical, and sensory-based activities delivered at strategic times may reduce sleep disturbances and be a feasible nonpharmacological treatment for sleep problems. The objective of this trial was to test the efficacy of a timed-activity intervention in improving QOL and sleep disturbances in persons living with cognitive impairment. Research Design and Method Randomized 2-group parallel design involving 209 dyads of community-residing persons living with cognitive impairment and care partners. Dyads were randomly assigned (1:1) to 1-hr home activity sessions administered weekly in the morning, afternoon, or evening over 4 weeks (the Healthy Patterns Sleep Program), or to an attention-control condition consisting of sleep hygiene training plus education on home safety and health promotion. QOL, objective and subjective sleep quality, and neuropsychiatric symptoms were assessed at baseline and 4 weeks later. Results QOL was significantly improved in the intervention group compared to control (p = .0491). There were no significant effects on objective or subjective sleep or neuropsychiatric symptoms. In a subgroup analysis, subjective sleep as measured by the PROMIS (Patient Reported Outcomes Measurement Information System) Sleep-Related Impairment survey was significantly improved in the intervention group compared to the control group for individuals with symptoms of depression (p = .015) or poor observed sleep at baseline (p = .005). Discussion and Implications The Healthy Patterns Intervention may benefit QOL for persons living with cognitive impairment and those with poor subjective sleep. A longer dose may be necessary to elicit improvement in actigraphically measured sleep-wake activity. Clinical Trial Registration Number NCT0368218 5.
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Affiliation(s)
- Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sonia Talwar
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nalaka Gooneratne
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Hwang Y, McPhillips MV, Huang L, Perez GA, Hodgson NA. Better caregiver mastery is associated with less anxiety in individuals with cognitive impairment. BMC Nurs 2023; 22:307. [PMID: 37674161 PMCID: PMC10483800 DOI: 10.1186/s12912-023-01471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND When caregivers have a high level of caregiver mastery, their care recipients with cognitive impairment have less behavioral health problems. However, the relationship between caregiver mastery and anxiety among care recipients over time is unknown. Therefore, this study was conducted to examine that better caregiver mastery is associated with less anxiety in individuals with cognitive impairment over time. METHODS A secondary data analysis was conducted using the Healthy Patterns Clinical Trial (NCT03682185) dataset and guided by Factors Associated with Behavioral and Psychological Symptoms of Dementia conceptual framework. This study included 154 dyads of individuals with cognitive impairment and their caregivers. Multiple linear regression analyses were performed on changes in anxiety. Model 1 included variables at the level of neurodegeneration (i.e., cognitive impairment and age). Model 2 added patient factors (i.e., sleep problems and depression) with the Model 1. Finally, Model 3 included caregiver factor (i.e., caregiver mastery) with the Model 2 to examine how changes in caregiver mastery influence changes in anxiety of care recipients. RESULTS Model 3 was statistically significant; after controlling for variables at the level of neurodegeneration associated with cognitive impairment and patient factors, improvement of caregiver mastery over time (β =-0.230, p = 0.015) was related to decreased anxiety over time (R2 = 0.1099). CONCLUSIONS Caregivers with high caregiver mastery may have better knowledge on how to care for their loved ones and how to manage their neuropsychiatric symptoms. Therefore, improving the level of caregiver mastery by providing psychoeducational programs and resources that family caregivers need will help reduce the frequency of anxiety in individuals with cognitive impairment.
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Affiliation(s)
- Yeji Hwang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | | | - Liming Huang
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - G Adriana Perez
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Watach AJ, McPhillips MV, Saconi B, Lang-Gallagher R, Lyons MM, Renz SM, Rosen IM, Sawyer AM. Exploring Nurse Practitioner Students' Perceptions of a Sleep e-Learning Program. Nurs Educ Perspect 2023; 44:229-236. [PMID: 37417857 PMCID: PMC10348450 DOI: 10.1097/01.nep.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
AIM The aim of this study was to explore nurse practitioner (NP) students' perceptions of a sleep e-learning program. BACKGROUND Sleep assessment is uncommon as nursing curricula lack sleep education. By preparing NPs to conduct sleep assessment and screening and understand basic sleep diagnostics, sleep health is more likely to be part of the differential diagnosis. METHOD The study is a qualitative descriptive study utilizing two focus groups. A directed content analysis, guided by the Kirkpatrick model, was used for analysis. RESULTS Twenty-four students participated in focus groups. Two overarching themes emerged: perceptions of course design and content. Asynchronous, case-based scenarios and quizzes were favorable. Students spoke of content relevance to themselves and patients and intentions to adopt sleep assessment practices. CONCLUSION NP students embraced sleep education and declared intention to apply learned skills in practice. This study highlights the feasibility of increasing curricular exposure to sleep education and ensuring NPs have skills to recognize implications of poor and disordered sleep in patients.
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Affiliation(s)
- Alexa J Watach
- About the Authors Alexa J. Watach, PhD, RN, is an instructor, Division of Sleep Medicine, and lecturer, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania. Miranda V. McPhillips, PhD, RN, is a lecturer, School of Nursing, University of Pennsylvania. Bruno Saconi, PhD, RN, is a lecturer, University of Pennsylvania School of Nursing, and staff scientist, Geisinger. Rebecca Lang-Gallagher, MSEd, is research project manager, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine. M. Melanie Lyons, PhD, MSN, ACNP, is an assistant clinical professor and nurse practitioner, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University College of Medicine, Columbus, Ohio. Susan M. Renz, PhD, DNP, RN, is a practice associate professor, University of Pennsylvania School of Nursing. Ilene M. Rosen, MD, MSCE, is an associate professor of medicine, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine. Amy M. Sawyer, PhD, RN, is an associate professor of sleep and health behavior, University of Pennsylvania School of Nursing, and clinician scientist and educator, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. This work was supported by National Institutes of Health (R25HL120874, Rosen; K23NR018487, McPhillips) and the Agency for Healthcare Research and Quality (AHRQ; K12HS026372, Watach). The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government. The authors acknowledge the following for their contributions to the conduct of this research: Kathleen O. DeMutis, DNP, ANP-BC; Hanne S. Harbison, MHSPH, MSN, WHNP-BC; Joe Schatz, DNP, CRNP, PMHNB-BC, CARN-AP; and June A. Treston, DNP, CRNP. For more information, contact Dr. Watach at /
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Starr LT, Washington K, McPhillips MV, Pitzer K, Demiris G, Oliver DP. Insomnia Symptoms Among Hospice Family Caregivers: Prevalence and Association with Caregiver Mental and Physical Health, Quality of Life, and Caregiver Burden. Am J Hosp Palliat Care 2023; 40:517-528. [PMID: 35620797 PMCID: PMC9699902 DOI: 10.1177/10499091221105882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Poor sleep exacerbates mental health problems and reduces quality-of-life (QOL) but prevalence of insomnia symptoms among hospice family caregivers and associations of poor sleep with caregiver health and QOL outcomes are not known. OBJECTIVE To describe prevalence of insomnia symptoms among hospice family caregivers and compare anxiety, depression, self-rated health, QOL, and caregiver burden between hospice family caregivers with and without insomnia symptoms. METHODS Descriptive sub-study using data collected during baseline interviews of hospice family caregivers involved in a randomized clinical trial in Midwestern United States (xxxxxxxx). Caregivers were dichotomized based on Insomnia Severity Index (ISI) scores (8+ indicated insomnia symptoms). RESULTS Among 57 hospice family caregivers, the mean ISI score was 8.2; nearly half (49.1%) experienced insomnia symptoms. Compared to caregivers without insomnia symptoms, caregivers with insomnia symptoms reported 2.4 times greater mean anxiety scores (4.7 vs 11.4); 3.5 times greater mean depression scores (3.1 vs 10.7); 2.1 times greater caregiver burden scores (5.6 vs 11.8); and 1.3 times lower self-rated health (3.5 vs 2.8); 1.3 times lower total QOL scores (29.3 vs 22.6); including differences in emotional QOL (7.9 vs 2.2), social QOL (7.2 vs 3.0), and physical QOL (7.4 vs 5.3). CONCLUSIONS Hospice family caregivers experience high prevalence of insomnia symptoms; caregivers with insomnia symptoms report worse anxiety, depression, caregiver burden, QOL, self-rated health. Clinicians must screen hospice caregivers for poor sleep and mental health and offer supportive interventions that improve their sleep and health. Policy makers must expand hospice benefits to better support family caregivers.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Philadelphia, PA, USA
| | - Karla Washington
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Miranda V. McPhillips
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Philadelphia, PA, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - George Demiris
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
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McPhillips MV, Li J, Petrovsky DV, Gooneratne NS, Aryal S, Hodgson NA. A randomized controlled trial to test a behavioral sleep intervention to improve insomnia symptoms in older adults with mild cognitive impairment: Multicomponent Behavioral Sleep Intervention (MBSI) protocol. Contemp Clin Trials 2023; 127:107137. [PMID: 36858255 PMCID: PMC10068807 DOI: 10.1016/j.cct.2023.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Insomnia symptoms in older adults with mild cognitive impairment represent a significant public health burden in terms of impaired quality of life, risks from untreated insomnia, and adverse effects from pharmaceutical insomnia treatment. To address current limitations in the most effective non-pharmacological treatments for insomnia in older adults with mild cognitive impairment, we are conducting a randomized pilot study to test a brief (4- week), tablet-based, personalized, multicomponent behavioral sleep intervention (MBSI) for insomnia, compared to a sleep education control, in a sample of older adults with mild cognitive impairment. METHODS Participants will be randomized in a 1:1 ratio to intervention or control group. Both groups will complete three virtual study data collection visits: baseline, 4-week post-intervention, and 12-week post-intervention follow-up. Key components of the 4-week intervention include sleep hygiene education, stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (4-week) and sustained efficacy (12-week) of MBSI compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which the intervention affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. RESULTS (N/A). DISCUSSION The findings of the proposed project will inform future, larger scale clinical trials and may provide a novel and innovative way for older adults with mild cognitive impairment to achieve better sleep and health-related quality of life outcomes.
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Affiliation(s)
| | - Junxin Li
- School of Nursing, John Hopkins University, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, USA
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Petrovsky DV, Bradt J, McPhillips MV, Sefcik JS, Gitlin LN, Hodgson NA. Tailored Music Listening in Persons With Dementia: A Feasibility Randomized Clinical Trial. Am J Alzheimers Dis Other Demen 2023; 38:15333175231186728. [PMID: 37470678 PMCID: PMC10489003 DOI: 10.1177/15333175231186728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Introduction: This study examined the feasibility, acceptability, and preliminary efficacy of tailored music listening intervention on sleep disturbances in older adults with dementia and their caregivers. Methods: We randomly assigned 33 older adults with dementia (mean age 71.7 [SD: 7.1], 72.7% female, 81.8% African American/Black) and their caregivers (mean age 58.4 [SD: 16.7], 72.7% female, 84.8% African American/Black) to a wait-list control or intervention group (NCT04157244). Results: The music intervention was feasible as evidenced by high study measure completion and retention rates (>90%). Recruitment was stopped prematurely due to the COVID-19 pandemic. We found mixed acceptability results from the survey and qualitative interviews with the participants. Both groups improved on objective sleep outcomes of sleep latency and wake sleep after onset. We found a small effect size for sleep duration post-intervention. Discussion: The findings provide preliminary evidence for the feasibility of a tailored music intervention and identified ways to improve its acceptability.
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Affiliation(s)
| | - Joke Bradt
- Drexel University, Philadelphia, PA, USA
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Starr LT, Washington KT, McPhillips MV, Pitzer K, Demiris G, Oliver DP. "It was terrible, I didn't sleep for two years": A mixed methods exploration of sleep and its effects among family caregivers of in-home hospice patients at end-of-life. Palliat Med 2022; 36:1504-1521. [PMID: 36151698 PMCID: PMC10168118 DOI: 10.1177/02692163221122956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to overnight caregiving demands; exacerbation of high rates of anxiety, depression, and distress; and inadequate support, millions of family caregivers of patients receiving in-home hospice are at risk of poor sleep and negative health effects. AIM To describe sleep experiences of family caregivers of in-home hospice patients and perceptions of these experiences on caregivers' wellbeing in the context of caregiver health and live-in status. DESIGN Developed using the Symptom Management Model, this mixed methods study featured a concurrent nested design prioritizing qualitative reflexive thematic analysis. SETTING/PARTICIPANTS About 47 family caregivers of in-home hospice patients from two randomized clinical trials (NCT03712410, NCT02929108) were interviewed (United States, 2021). Anxiety (GAD-7), depression (PHQ-9), quality-of-life (QOL) (CQLI-R), and self-rated health and energy were reported prior to interviews. RESULTS Qualitative analysis revealed three themes: compromised sleep quality, factors influencing sleep, effects of sleep. 72.5% of hospice family caregivers described "fair" or "poor" sleep quality, with "interrupted" sleep and frequent night-waking due to "on-call" "vigilance" and anxiety. Negative effects included exhaustion, mental and physical health decline, and reduced caregiver function. Live-in caregivers reported higher mean depression scores (8.4 vs 4.3, p = 0.08), higher mean anxiety scores (7.7 vs 3.3, p = 0.06), and lower mean QOL scores (24.8 vs 33.6, p < 0.001) than live-out caregivers. Anxiety, depression, and QOL worsened as self-reported caregiver sleep quality decreased. Few caregivers had adequate support. CONCLUSION End-of-life family caregivers experience disrupted sleep with negative effects and inadequate support. Clinicians must assess sleep, offer sleep interventions, and provide more supports to hospice family caregivers.
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Affiliation(s)
- Lauren T Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Karla T Washington
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Miranda V McPhillips
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, USA
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McPhillips MV, Li J, Petrovsky DV, Brewster GS, Ward EJ, Hodgson N, Gooneratne NS. Assisted Relaxation Therapy for Insomnia in Older Adults With Mild Cognitive Impairment: A Pilot Study. Int J Aging Hum Dev 2022; 97:65-80. [PMID: 36259123 PMCID: PMC10110766 DOI: 10.1177/00914150221132163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Insomnia symptoms are prevalent in older adults with mild cognitive impairment (MCI) and can pose treatment challenges. We tested the feasibility, acceptability, and preliminary efficacy of assisted relaxation therapy (ART) to improve insomnia symptoms in community-dwelling older adults with MCI. In this pilot RCT, 25 participants were assigned to intervention or control groups for 2 weeks. The final sample (n = 20) consisted of all Black, primarily female (70%) older adults (mean age 69.10; SD = 7.45) with mean Montreal Cognitive Assessment scores of 21.10 (SD = 2.49). Recruitment was timely; attrition was low (80%). Participants were able to use ART (average use 7.00; SD = 5.07 days). Participants in the ART group improved on Insomnia Severity Index (ISI) (- 7.10; 95% CI [-11.63, -2.55]; p = .004) compared to baseline. There were clinically meaningful mean change scores on ISI for the intervention group compared to the control (- 7.10 vs. - 4.33). Results provide justification for testing ART in a fully powered clinical trial.
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Affiliation(s)
- Miranda V McPhillips
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA.,Center for Sleep and Circadian Neurobiology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Junxin Li
- School of Nursing, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Darina V Petrovsky
- Institute for Health, Health Care Policy, and Aging Research, School of Nursing, 242612Rutgers University, New Brunswick, NJ, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, 1371Emory University, Atlanta, GA, USA
| | - E John Ward
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Hodgson
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nalaka S Gooneratne
- Center for Sleep and Circadian Neurobiology, 6572University of Pennsylvania, Philadelphia, PA, USA.,Division of Geriatric Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
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12
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Sawyer AM, Saconi B, Lyons MM, Lang-Gallagher R, Renz SM, Watach AJ, McPhillips MV, Rosen IM. Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students. J Clin Sleep Med 2022; 18:2367-2376. [PMID: 35702026 PMCID: PMC9516573 DOI: 10.5664/jcsm.10112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Primary care nurse practitioners (NPs) receive little sleep education in graduate programs but are often first-line providers for patients presenting with sleep-related symptoms. A pre-/postevaluation study was conducted using asynchronous, case-based sleep education modules in a cohort of primary care NP students enrolled in a single academic institution's nursing master's degree program. METHODS Six virtual, case-based modules addressed adult sleep health and disorders, prioritized based on prevalence and primary care presentation. Kirkpatrick Training Evaluation Model guided outcome selection. Descriptive and paired comparative analyses were conducted. RESULTS Participants were first-year NP students (n = 149; 88% female; 82% ≤ 35 years of age) in an adult primary care program that included psychiatric/mental health track. Participants reacted positively to course delivery methods and content. Insomnia was endorsed by 87% as most relevant to practice with healthy sleep (88%) and obstructive sleep apnea (50%) also frequently endorsed as practice relevant. Posttest knowledge scores significantly improved for all modules (P < .001). Self-rated confidence for future practice application was high. CONCLUSIONS This novel asynchronous, virtual curriculum met Kirkpatrick levels 1 and 2 (positive reaction and knowledge transfer) in NP students who predicted an impact on their practice (Kirkpatrick level 3). Studies are needed to assess the benefits of increasing primary care NP knowledge in sleep medicine on quality of care and access to care (Kirkpatrick level 4). Future use of this novel sleep curriculum in other professional curricula, new-to-sleep clinical researchers, and practicing primary care providers may further potentiate care quality and sleep care access. CITATION Sawyer AM, Saconi B, Lyons MM, et al. Case-based, asynchronous sleep education outcomes among primary care nurse practitioner students. J Clin Sleep Med. 2022;18(10):2367-2376.
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Affiliation(s)
- Amy M. Sawyer
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Division of Sleep Medicine, Philadelphia, Pennsylvania
| | - Bruno Saconi
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - M. Melanie Lyons
- The Ohio State University, Division of Pulmonary, Critical Care and Sleep Medicine, Columbus, Ohio
| | - Rebecca Lang-Gallagher
- University of Pennsylvania Perelman School of Medicine, Division of Sleep Medicine, Philadelphia, Pennsylvania
| | - Susan M. Renz
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Alexa J. Watach
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Division of Sleep Medicine, Philadelphia, Pennsylvania
| | - Miranda V. McPhillips
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Ilene M. Rosen
- University of Pennsylvania Perelman School of Medicine, Division of Sleep Medicine, Philadelphia, Pennsylvania
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13
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Hwang Y, McPhillips MV, Talwar S, Perez GA, Hodgson NA. The Relationship Between Light Exposure before Bedtime and Daytime Sleepiness Among People Living With Cognitive Impairment. J Appl Gerontol 2022; 41:1686-1694. [PMID: 35341367 DOI: 10.1177/07334648221083658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
While sleep disturbances are common in people living with cognitive impairment, little is known about the influence of evening light exposure on their sleep. The purpose of this study was to examine the relationship between evening light exposure in natural living environment and daytime sleepiness in community residing people living with cognitive impairment. A secondary data analysis was conducted using the baseline data of the Healthy Patterns Clinical Trial. Actiwatch Spectrum Plus was used to collect information on the average white light intensity of 4 hours before sleep for three consecutive days. Multivariate regression analyses were used. Among 173 participants, the average light intensity during evening was 80.25 ± 123.04 lux. After controlling for covariates, greater intensity of light exposure during evening was related to excessive daytime sleepiness (β = 0.211, p = .004). The results of our study suggest exposure to light during evening may disturb sleep and subsequently influence daytime sleepiness the following day.
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Affiliation(s)
- Yeji Hwang
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonia Talwar
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - G Adriana Perez
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
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14
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Sun J, McPhillips MV, Chen KC, Zang Y, Li J, Oehlke J, Brewster GS, Gooneratne NS. Primary care provider evaluation and management of insomnia. J Clin Sleep Med 2021; 17:1083-1091. [PMID: 33576737 DOI: 10.5664/jcsm.9154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the type and extent of information collected from patients with insomnia during their first office encounter for insomnia and the prescribing therapies of primary care providers during this initial encounter. METHODS This study was a retrospective chart review of randomly selected patients who had a primary care provider office visit at any clinic affiliated with a university medical system between March 1, 2013, and March 1, 2016. Demographic and clinical information was abstracted for analysis. RESULTS Our sample (n = 200) was primarily female (63.5%), White (69%), middle-aged (ages 44.6 ± 15.1 years) adults. Most (68.5%) encounter notes did not have significant information related to insomnia risk factors and symptoms (< 50% of the notes). When examining comorbidities, we found that younger patients (<45 years old) were more likely to have anxiety linked to insomnia (P = .025), whereas older patients (≥45) were less likely to have any identified comorbidities associated with insomnia (P = .009). Only 5.0% of patients with insomnia were referred for cognitive-behavioral therapy for insomnia, whereas 51.5% of patients were prescribed sleep medications. The younger cohort was statistically more likely to receive sleep hygiene or cognitive-behavioral therapy for insomnia as a treatment option in comparison to the older cohort (P = .01 and P = .04, respectively). CONCLUSIONS Progress notes from primary care providers tend to have a paucity of information on insomnia symptoms and related comorbidities. Medications are often prescribed as the first-line treatment for insomnia. Cognitive-behavioral therapy for insomnia remains underutilized despite robust evidence suggesting that cognitive-behavioral therapy for insomnia is a safe and effective treatment for insomnia.
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Affiliation(s)
- Joy Sun
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Miranda V McPhillips
- Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ker-Cheng Chen
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yinyin Zang
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, Maryland
| | - Jessica Oehlke
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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McPhillips MV, Petrovsky DV, Brewster GS, Li J, Gooneratne NS, Hodgson NA, Sefcik JS. Recruiting Persons with Dementia and Caregivers in a Clinical Trial: Dyads Perceptions. West J Nurs Res 2021; 44:557-566. [PMID: 33870784 DOI: 10.1177/01939459211008563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recruitment for dementia research is challenging and costly. Using Ajzen's Theory of Planned Behavior we explored attitudes, perceived norms, and perceived behavioral control of persons living with dementia (PLWD) and their caregivers who participated in one clinical trial to better understand factors that influence dyads' decisions to enroll. We conducted semi-structured telephone interviews with 12 PLWD and 9 caregivers and utilized directed content analysis. Categories connected with positive attitudes about study enrollment were personal desires of wanting to learn and in-person meetings with knowledgeable staff. Additionally, participants said the money always helps in terms of the financial incentive. Participants reported enrolling to support another person (perceived norm). Study requirements were thought to be easy (perceived behavioral control). Participants highlighted the importance of flexible scheduling and study tasks being completed at their home. Findings can inform future recruitment efforts and should be investigated as effective recruitment methods in other clinical trials.
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Affiliation(s)
| | | | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, MD, USA
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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16
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Saconi B, Polomano RC, Compton PC, McPhillips MV, Kuna ST, Sawyer AM. The influence of sleep disturbances and sleep disorders on pain outcomes among veterans: A systematic scoping review. Sleep Med Rev 2020; 56:101411. [PMID: 33348172 DOI: 10.1016/j.smrv.2020.101411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Chronic nonmalignant pain, sleep disturbances and sleep disorders are highly prevalent conditions among U.S. military veterans. Evidence summaries highlight the influence of sleep on pain outcomes in the general adult population but not for the military veteran population. This is a significant gap as U.S. military veterans are an exceedingly high-risk population for both chronic pain and sleep disturbances and/or disorders. We aimed to review the influence of sleep disturbances and sleep disorders on pain outcomes among veterans with chronic nonmalignant pain. A systematic scoping review was conducted using PubMed/Medline, EMBASE, Scopus, CINAHL, and PsycINFO. Twenty-six out of 1450 studies from initial search were included in this review resulting in a combined sample size of N = 923,434 participants. Sleep disturbances and sleep disorders were associated with worse pain outcomes among veterans with chronic pain. Treatment-induced sleep improvements ameliorated pain outcomes in veterans with sleep disorders and sleep disturbances. Research is indicated to address an overlooked pain treatment opportunity - that of sleep disturbance and sleep disorder management.
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Affiliation(s)
- Bruno Saconi
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care, USA.
| | - Peggy C Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Miranda V McPhillips
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| | - Samuel T Kuna
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
| | - Amy M Sawyer
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA.
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17
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McPhillips MV, Li J, Hodgson NA, Cacchione PZ, Dickson VV, Gooneratne NS, Riegel B. Daytime sleepiness and napping in nursing-home eligible community dwelling older adults: A mixed methods study. Gerontol Geriatr Med 2020; 6:2333721420970730. [PMID: 35059470 PMCID: PMC8764400 DOI: 10.1177/2333721420970730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/18/2023] Open
Abstract
Objectives To describe perceptions and beliefs about daytime sleepiness and napping along with subjective and objective daytime sleep characteristics in nursing-home eligible community dwelling older adults. Methods A mixed methods study; we conducted semi-structured interviews and measured sleep variables via Actigraphy, sleep diary, and Epworth Sleepiness Scale (ESS). Napping was defined as >10 minutes; anything less was considered dozing. Results Final sample (n = 40) was primarily female (85%), Black (100%), with a mean age of 72 ± 9.5 years. Few (25%) reported daytime sleepiness (ESS >10). However, average duration of napping per day was 33.1 ± 11.5 minutes with a nap frequency of 2.5 ± 1.5 naps. Conclusion Our sample napped frequently throughout the day, yet the majority reported no daytime sleepiness. These older adults did not always recognize napping or how much they napped.
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Affiliation(s)
| | - Junxin Li
- Johns Hopkins University, Baltimore, MD, USA
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18
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Gawrysiak MJ, Baime M, King TS, Watach AJ, McPhillips MV, Kolanowski A, Schutte-Rodin S, Sawyer AM. Intervention Design and Trial Protocol: Mindfulness-based Exposure for PAP-associated Claustrophobia. West J Nurs Res 2020; 43:261-272. [PMID: 32443950 DOI: 10.1177/0193945920924608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive airway pressure (PAP) associated claustrophobia is common among obstructive sleep apnea patients and plays a prominent role in low adherence and treatment failure. As there are no evidence-based interventions for PAP-associated claustrophobia, the objective of the present research is to pilot test Mindfulness-based Exposure for PAP-associated Claustrophobia, in sleep apnea adults that present with treatment non-adherence and claustrophobia. This approach combines Mindfulness-based Stress Reduction with exposure-based treatment components to target this treatment-associated claustrophobia. The present article outlines the mindfulness exposure intervention design and methods and reports the pilot trial study protocol. Trial findings are intended to: (a) develop a preliminary effect size of the intervention on PAP-associated claustrophobia; (b) explore differences in treatment adherence by group (intervention vs control); and (c) establish feasibility for expanded protocol implementation, delivery, and participant acceptability of the intervention to support subsequent design of a fully powered randomized controlled trial.
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Affiliation(s)
- Michael J Gawrysiak
- Department of Psychology, West Chester University of Pennsylvania, West Chester, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Baime
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tonya S King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Alexa J Watach
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda V McPhillips
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann Kolanowski
- College of Nursing, Penn State University, University Park, PA, USA
| | | | - Amy M Sawyer
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia
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19
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McPhillips MV, Kim J, Petrovsky DV, Li J, Talwar S, Caffeé L, Hodgson N. OBJECTIVE AND SUBJECTIVE SLEEP DURATION AND ACTIVITY LEVEL IN OLDER ADULTS WITH MILD DEMENTIA. Innov Aging 2019. [PMCID: PMC6846679 DOI: 10.1093/geroni/igz038.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Little is known about the relationship between sleep duration and activities of daily living (ADLs) in those with mild dementia. We sought to examine the independent relationship between objective and subjective sleep duration and ADLs in community-dwelling older adults with mild dementia. Analyses were conducted on baseline data from participants enrolled in the Healthy Patterns Clinical Trial (Hodgson; R01NR015226). Measures included 24-hour wrist actigraphy for objective sleep duration, proxy-reported Pittsburgh Sleep Quality Index (sleep duration subscale) for subjective sleep duration and the Barthel Index for performance of ADLs. We used Spearman’s correlation and multivariate linear regression. A total of 30 individuals (56.7% male) aged 74.6 (SD 7.4) with mean Clinical Dementia Rating (CDR) scores of 1 (SD 0.5) were enrolled. Objective sleep duration ranged from 2.7 to 11.5 with mean 6.7 (SD 2.4) hours; subjective sleep duration ranged from 4 to 13.5 with mean 7.9 (SD 2.4) hours. Longer objective and subjective sleep duration were significantly associated with worse ADL scores (r = -0.48, p = 0.03; r = -0.59, p=0.007, respectively) in bivariate analyses. After controlling for age, CDR, and depression, subjective sleep duration was independently associated with ADLs (β = -1.90, p =0.03) and objective sleep duration trended toward significance (β = -1.47, p =0.10). These preliminary results suggest self-reported longer sleep could be indicative of declines in ADLs in older adults with mild dementia. Further prospective studies are necessary to determine the independent association between objectively assessed sleep duration and ADLs in patients with mild dementia.
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Affiliation(s)
| | - Jinyoung Kim
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Junxin Li
- John Hopkins University, Baltimore, Maryland, United States
| | - Sonia Talwar
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Laurel Caffeé
- University of Pennsylvania, Philadelphia, United States
| | - Nancy Hodgson
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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20
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McPhillips MV, Dickson VV, Cacchione PZ, Li J, Gooneratne N, Riegel B. Nursing Home Eligible, Community-Dwelling Older Adults' Perceptions and Beliefs About Sleep: A Mixed-Methods Study. Clin Nurs Res 2019; 29:177-188. [PMID: 31104492 DOI: 10.1177/1054773819849348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances are highly prevalent in older adults; little is known about sleep in those who remain living in the community despite qualifying for nursing home placement. We conducted a concurrent, nested, mixed-methods study to describe sleep characteristics and sleep disturbances in this population. Our final sample (n = 40) was Black (100%), female (85%) older adults with a mean (±SD) age of 72 ± 9.5 years. Of these, 35 had objectively measured short or long sleep duration, and 30 had subjectively reported poor sleep quality. Our evidence suggests that sleep disturbances are common in this group, and these older adults had adjusted their expectations and adapted to their sleep disturbances. Given that at-risk older adults may not perceive their sleep disturbances as problematic, clinicians must proactively assess sleep and educate about the importance of sleep. These results reveal modifiable factors with potential to improve health outcomes in this vulnerable population.
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Affiliation(s)
| | | | | | - Junxin Li
- Johns Hopkins University, Baltimore, MD, USA
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21
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McPhillips MV, Li J, Cacchione PZ, Dickson VV, Gooneratne NS, Riegel BJ. 0721 Daytime Sleepiness and Napping in Nursing-Home Eligible Community Dwelling Older Adults: A Mixed Methods Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J Li
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - B J Riegel
- University of Pennsylvania, Philadelphia, PA
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22
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Fan F, McPhillips MV, Li J. 0720 Daytime Napping and Cognition in Older Adults. Sleep 2018. [DOI: 10.1093/sleep/zsy061.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Fan
- University of Pennsylvania, Philadelphia, PA
| | | | - J Li
- University of Pennsylvania, Philadelphia, PA
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23
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McPhillips MV, Dickson VV, Cacchione PZ, Li J, Gooneratne NS, Riegel BJ. 0719 Understanding Sleep Characteristics in Nursing-Home Eligible Community Dwelling Older Adults: A Mixed Methods Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - J Li
- University of Pennsylvania, Philadelphia, PA
| | | | - B J Riegel
- University of Pennsylvania, Philadelphia, PA
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