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A Multicomponent Nonpharmacological Intervention Improves Activity Rhythms Among Nursing Home Residents With Disrupted Sleep/Wake Patterns

¹ Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles.
² VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Sepulveda, California.
³ Department of Psychiatry, University of California San Diego.

Address correspondence to Jennifer L. Martin, PhD, VA Sepulveda, GRECC (11E), 16111 Plummer Street, North Hills, CA 91343. E-mail: jennifer.martin{at}va.gov

Background. Sleep and circadian rhythms are disrupted among many nursing home (NH) residents. We examined the impact of a multicomponent nonpharmacological intervention on 24-hour rest/activity rhythms among long-stay NH residents.

Methods. The study was a randomized controlled trial in which, following a 3-day baseline, participants received 5 days of either usual care (control condition) or the active intervention. The intervention combined increased exposure to outdoor bright light, efforts to keep residents out of bed during the day, structured physical activity, institution of a bedtime routine, and efforts to reduce nighttime noise and light in residents' rooms. For 100 residents with baseline and follow-up wrist actigraphy data (mean age = 87 years; 76% women), rest/activity rhythms were modeled to determine the rhythm acrophase (peak time), nadir (trough time), midline estimating statistic of rhythm (MESOR) (midpoint), amplitude (height of peak), slope, and the rest period/active period ratio ().

Results. The intervention led to an increase in the duration of the "active" portion of the rhythm, which was primarily accounted for by a shift in the rest/activity rhythm rise to an earlier time. Findings persisted when analyses were adjusted for age, cognitive functioning, medical comorbidities, and behavioral disturbances.

Conclusions. These findings suggest that the intervention may effectively improve the robustness of rest/activity rhythms in NH residents. Further research is needed to examine the impact of similar interventions on other measures of circadian rhythms (e.g., body temperature, melatonin) among NH residents.

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