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Effect of Institutional Respite Care on the Sleep of People with Dementia and Their Primary Caregivers
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Dr David Lee
Lee DR, Morgan K, Lindesay JEB
Journal of the American Geriatrics Society
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OBJECTIVES: To evaluate the sleep–wake patterns of community-dwelling patients with dementia and their primary caregivers before, during, and after 2-week periods of institutional respite care. DESIGN: Prospective case series. SETTING: Four community hospital units in East Midlands, United Kingdom. PARTICIPANTS: Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for dementia and caregivers completed baseline assessments; 33 of these dyads completed the full protocol. INTERVENTION: A 2-week period of institutional respite care during which patients were admitted to community hospitals (and received routine care) while caregivers remained at home. MEASUREMENTS: For patients and caregivers, primary sleep outcomes were derived from 6 weeks of continuous wrist actigraphy (2 weeks baseline; 2 weeks respite; 2 weeks follow-up) using the Actiwatch system. For caregivers, actigraphic measures were augmented with assessments of quality of life (using the Medical Outcomes Study 36-item Short Form survey) and quality of sleep (using the Pittsburgh Sleep Quality Index) at baseline and by daily sleep diaries and weekly Epworth Sleepiness Scale ratings throughout the study. RESULTS: At baseline, caregivers and patients showed profiles of clinically significant sleep disturbance. For caregivers, respite periods were associated with significant (P<.05) increases in total sleep time per night, total time in bed per night, and improvements in subjective sleep quality. The benefits of respite were most evident for caregivers who did not share a bedroom with the patient. For patients, respite was associated with significant (P<.05) increases in sleep onset latency, reductions in total sleep time per night, and weakening of the circadian activity rhythm. All measures shifted in the direction of baseline levels at follow-up. CONCLUSION: Dementia caregivers show a profile of sleep disturbance consistent with adjustment insomnia, with sleep disturbances partially reversed during periods of institutional respite care. Nevertheless, for patients, respite care worsens already disturbed sleep patterns. To optimize benefits for caregivers and patients, respite care should target sleep management.
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