Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-30T01:15:28.865Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of change over time in subjective daytime sleepiness among older adult recipients of long-term services and supports

Published online by Cambridge University Press:  11 June 2020

Darina V. Petrovsky Open the ORCID record for Darina V. Petrovsky [Opens in a new window] ,
Karen B. Hirschman ,
Miranda Varrasse McPhillips ,
Justine S. Sefcik ,
Alexandra L. Hanlon ,
Liming Huang ,
Glenna S. Brewster ,
Nancy A. Hodgson  and
Mary D. Naylor
Darina V. Petrovsky*
Affiliation:
Family and Community Health Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Karen B. Hirschman
Affiliation:
Family and Community Health Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Miranda Varrasse McPhillips
Affiliation:
Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Justine S. Sefcik
Affiliation:
Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
Alexandra L. Hanlon
Affiliation:
Department of Statistics, Virginia Tech, Roanoke, VA, USA
Liming Huang
Affiliation:
Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Glenna S. Brewster
Affiliation:
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
Nancy A. Hodgson
Affiliation:
Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
Mary D. Naylor
Affiliation:
Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
*
Correspondence should be addressed to: Darina V. Petrovsky, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA19104, USA. Phone: +1 215 898 9746. Email: dmolkina@nursing.upenn.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.

Design and Setting:

Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months.

Participants:

470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60–98; 71% women).

Measurements:

Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support).

Results:

Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = −0.006, 95% CI: −0.013 to −0.0001, p = 0.045) and higher number of depressive symptoms (effect size = −0.002, 95% CI: −0.004 to −0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time.

Conclusions:

Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.

Keywords

daytime sleepinessquality of lifeolder adultssleepdepression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 7: Issue Theme: Sleep and Sleep Disorders in Older Adults , July 2020 , pp. 849 - 861
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alessi, C. A. and Schnelle, J. F. (2000). Approach to sleep disorders in the nursing home setting. Sleep Medicine Reviews, 4, 45–56. doi: 10.1053/smrv.1999.0066CrossRefGoogle ScholarPubMed
American Academy of Sleep Medicine. (2014). International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine.Google Scholar
Baldwin, C. M.et al. (2010). Sleep disturbances, quality of life, and ethnicity: the sleep heart health study. Journal of Clinical Sleep Medicine, 6, 176–183.10.5664/jcsm.27768CrossRefGoogle ScholarPubMed
Benloucif, S.et al. (2004). Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults. Sleep, 27, 1542–1551. doi: 10.1093/sleep/27.8.1542CrossRefGoogle ScholarPubMed
Brewster, G. S.et al. (2019). Association of health related quality of life domains with daytime sleepiness among elderly recipients of long-term services and supports. Geriatric Nursing, doi: 10.1016/j.gerinurse.2019.01.006CrossRefGoogle ScholarPubMed
Brod, M., Stewart, A. L., Sands, L. and Walton, P. (1999). Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL). Gerontologist, 39, 25–36. doi: 10.1093/geront/39.1.25CrossRefGoogle Scholar
Burke, W. J., Roccaforte, W. H. and Wengel, S. P. (1991). The short form of the geriatric depression scale: a comparison with the 30-item form. Journal of Geriatric Psychiatry and Neurology, 4, 173–178.Google ScholarPubMed
Carvalho, D. Z.et al. (2018). Association of excessive daytime sleepiness with longitudinal beta-amyloid accumulation in elderly persons without dementia. JAMA Neurology, 75, 672–680. doi: 10.1001/jamaneurol.2018.0049CrossRefGoogle ScholarPubMed
Creavin, S. T.et al. (2016). Mini-mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. The Cochrane Database of Systematic Reviews, CD011145. doi: 10.1002/14651858.CD011145.pub2Google ScholarPubMed
Empana, J. P.et al. (2009). Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke, 40, 1219–1224. doi: 10.1161/strokeaha.108.530824CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Furihata, R.et al. (2017). An aggregate measure of sleep health is associated with prevalent and incident clinically significant depression symptoms among community-dwelling older women. Sleep, 40. doi: 10.1093/sleep/zsw075CrossRefGoogle ScholarPubMed
Garms-Homolova, V., Flick, U. and Rohnsch, G. (2010). Sleep disorders and activities in long term care facilities – a vicious cycle? Journal of Health Psychology, 15, 744–754. doi: 10.1177/1359105310368185CrossRefGoogle ScholarPubMed
Gehrman, P., Marler, M., Martin, J. L., Shochat, T., Corey-Bloom, J. and Ancoli-Israel, S. (2004). The timing of activity rhythms in patients with dementia is related to survival. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59, 1050–1055. doi: 10.1093/gerona/59.10.M1050CrossRefGoogle Scholar
Hayley, A. C., Williams, L. J., Kennedy, G. A., Berk, M., Brennan, S. L. and Pasco, J. A. (2015). Excessive daytime sleepiness and metabolic syndrome: a cross-sectional study. Metabolism: Clinical and Experimental, 64, 244–252. doi: 10.1016/j.metabol.2014.09.011CrossRefGoogle ScholarPubMed
Heidrich, S. M. and D’Amico, D. (1993). Physical and mental health relationships in the very old. Journal of Community Health Nursing, 10, 11–21. doi: 10.1207/s15327655jchn1001_2CrossRefGoogle ScholarPubMed
Hirshkowitz, M.et al. (2015). National sleep foundation’s updated sleep duration recommendations: final report. Sleep Health, 1, 233–243. doi: 10.1016/j.sleh.2015.10.004CrossRefGoogle ScholarPubMed
Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14, 540–545. doi: 10.1093/sleep/14.6.540CrossRefGoogle ScholarPubMed
Johnson, J. K.et al. (2018). A community choir intervention to promote well-being among diverse older adults: results from the community of voices trial. The Journals of Gerontology: Series B, gby132–gby132. doi: 10.1093/geronb/gby132Google Scholar
Katz, S. and Akpom, C. A. (1976). Index of ADL. Medical Care, 14(5), 116–118. doi: 10.1097/00005650-197605001-00018CrossRefGoogle ScholarPubMed
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffe, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 185, 914–919. doi: 10.1001/jama.1963.03060120024016CrossRefGoogle ScholarPubMed
Koehler, M.et al. (2005). Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatrics, 5, 1. doi: 10.1186/1471-2318-5-1CrossRefGoogle ScholarPubMed
Lai, H. C., Hsu, N. W., Chou, P. and Chen, H. C. (2019). The associations between various sleep-wake disturbances and depression in community-dwelling older adults- the Yilan study, Taiwan. Aging and Mental Health, 1–8. doi:10.1080/13607863.2019.1582006Google ScholarPubMed
Lee, Y. T., Tsai, C. F., Ouyang, W. C., Yang, A. C., Yang, C. H. and Hwang, J. P. (2013). Daytime sleepiness: a risk factor for poor social engagement among the elderly. Psychogeriatrics, 13, 213–220. doi: 10.1111/psyg.12020CrossRefGoogle ScholarPubMed
Li, J., Chang, Y.-P. and Porock, D. (2015). Factors associated with daytime sleep in nursing home residents. Research on Aging, 37, 103–117. doi: 10.1177/0164027514537081CrossRefGoogle ScholarPubMed
Maglione, J. E.et al. (2012). Depressive symptoms and subjective and objective sleep in community-dwelling older women. Journal of the American Geriatrics Society, 60, 635–643. doi: 10.1111/j.1532-5415.2012.03908.xCrossRefGoogle ScholarPubMed
Martin, J. L., Webber, A. P., Alam, T., Harker, J. O., Josephson, K. R. and Alessi, C. A. (2006). Daytime sleeping, sleep disturbance, and circadian rhythms in the nursing home. The American Journal of Geriatric Psychiatry, 14, 121–129. doi: 10.1097/01.JGP.0000192483.35555.a3CrossRefGoogle ScholarPubMed
Martins da Silva, R., Afonso, P., Fonseca, M. and Teodoro, T. (2019). Comparing sleep quality in institutionalized and non-institutionalized elderly individuals. Aging and Mental Health, 1–7. doi: 10.1080/13607863.2019.1619168CrossRefGoogle ScholarPubMed
Merlino, G.et al. (2010). Daytime sleepiness is associated with dementia and cognitive decline in older Italian adults: a population-based study. Sleep Medicine, 11, 372–377. doi: 10.1016/j.sleep.2009.07.018CrossRefGoogle ScholarPubMed
Mittelman, M. S. and Papayannopoulou, P. M. (2018). The unforgettables: a chorus for people with dementia with their family members and friends. International Psychogeriatrics, 30, 779–789. doi: 10.1017/S1041610217001867CrossRefGoogle ScholarPubMed
Nakakubo, S.et al. (2018). Sleep condition and cognitive decline in Japanese community-dwelling older people: data from a 4-year longitudinal study. Journal of Sleep Research, e12803. doi: 10.1111/jsr.12803CrossRefGoogle ScholarPubMed
National Center for Health Statistics. (2019). Long-term care providers and services users in the United States, 2015–2016. Vital and Health Statistics, Washington, DC, USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.Google Scholar
Naylor, E.et al. (2000). Daily social and physical activity increases slow-wave sleep and daytime neuropsychological performance in the elderly. Sleep, 23, 1–9. doi: 10.1093/sleep/23.1.1fCrossRefGoogle ScholarPubMed
Naylor, M. D., et al. (2016). Factors associated with changes in perceived quality of life among elderly recipients of long-term services and supports. Journal of the American Medical Directors Association, 17, 44–52. doi: 10.1016/j.jamda.2015.07.019CrossRefGoogle ScholarPubMed
Neikrug, A. B. and Ancoli-Israel, S. (2010). Sleep disturbances in nursing homes. The Journal of Nutrition, Health and Aging, 14, 207–211. doi: 10.1007/s12603-010-0051-8CrossRefGoogle ScholarPubMed
Pak, V. M., Onen, S. H., Gooneratne, N. S., Falissard, B. and Onen, F. (2017). Observation and interview-based diurnal sleepiness inventory for measurement of sleepiness in older adults. Nature and Science of Sleep, 9, 241–247. doi: 10.2147/NSS.S134112CrossRefGoogle ScholarPubMed
Petrovsky, D., Cacchione, P. Z. and George, M. (2015). Review of the effect of music interventions on symptoms of anxiety and depression in older adults with mild dementia. International Psychogeriatrics, 1–10. doi: 10.1017/S1041610215000393Google ScholarPubMed
Petrovsky, D., McPhillips, M. V., Li, J., Brody, A., Caffeé, L. and Hodgson, N. A. (2018). Sleep disruption and quality of life in persons with dementia: a state-of-the-art review. Geriatric Nursing, 39, 640–645.CrossRefGoogle ScholarPubMed
Petrovsky, D. V., Sefcik, J. S. and Cacchione, P. Z. (2020). A qualitative exploration of choral singing in community-dwelling older adults. Western Journal of Nursing Research, 42, 340–347. doi: 10.1177/0193945919861380CrossRefGoogle ScholarPubMed
Rao, V.et al. (2008). Insomnia and daytime sleepiness in people with dementia residing in assisted living: findings from the Maryland assisted living study. International Journal of Geriatric Psychiatry, 23, 199–206. doi: 10.1002/gps.1863CrossRefGoogle ScholarPubMed
Rao, V.et al. (2005). Sleep disturbances in the elderly residing in assisted living: findings from the Maryland assisted living study. International Journal of Geriatric Psychiatry, 20, 956–966. doi: 10.1002/gps.1380CrossRefGoogle ScholarPubMed
Resnick, B. and Nahm, E. S. (2001). Reliability and validity testing of the revised 12-item short-form health survey in older adults. Journal of Nursing Measurement, 151–161. doi: 10.1891/1061-3749.9.2.151CrossRefGoogle Scholar
Reuben, D. B., Valle, L. A., Hays, R. D. and Siu, A. L. (1995). Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures. Journal of the American Geriatrics Society, 43, 17–23.CrossRefGoogle ScholarPubMed
Richards, K. C., Beck, C., O’Sullivan, P. S. and Shue, V. M. (2005). Effect of individualized social activity on sleep in nursing home residents with dementia. Journal of the American Geriatrics Society, 53, 1510–1517. doi: 10.1111/j.1532-5415.2005.53460.xCrossRefGoogle ScholarPubMed
Richards, K. C.et al. (2011). Strength training, walking, and social activity improve sleep in nursing home and assisted living residents: randomized controlled trial. Journal of the American Geriatrics Society, 59, 214–223. doi: 10.1111/j.1532-5415.2010.03246.xCrossRefGoogle ScholarPubMed
Schenk, L., Meyer, R., Behr, A., Kuhlmey, A. and Holzhausen, M. (2013). Quality of life in nursing homes: results of a qualitative resident survey. Quality of Life Research, 22, 2929–2938.10.1007/s11136-013-0400-2CrossRefGoogle ScholarPubMed
Sheikh, J. and Yesavage, J. (1986). Brink, TL. Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. Clinical Gerontology: A Guide to Assessment and Intervention. New York: Haworth Press.Google Scholar
Sherbourne, C. D. and Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705–714. doi: 10.1007/s11136-013-0400-2CrossRefGoogle ScholarPubMed
Smit, D., de Lange, J., Willemse, B., Twisk, J. and Pot, A. M. (2016). Activity involvement and quality of life of people at different stages of dementia in long term care facilities. Aging and Mental Health, 20, 100–109. doi: 10.1080/13607863.2015.1049116CrossRefGoogle ScholarPubMed
Spira, A. P.et al. (2012). Reliability and validity of the Pittsburgh sleep quality index and the Epworth sleepiness scale in older men. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 67, 433–439. doi: 10.1093/gerona/glr172CrossRefGoogle ScholarPubMed
Tsapanou, A., et al. (2016). Daytime somnolence as an early sign of cognitive decline in a community-based study of older people. International Journal of Geriatric Psychiatry, 31, 247–255. doi: 10.1002/gps.4318CrossRefGoogle Scholar
van der Spuy, I., et al. (2017). Determinants of excessive daytime sleepiness in two first nation communities. BMC Pulmonary Medicine, 17, 192. doi: 10.1186/s12890-017-0536-xCrossRefGoogle ScholarPubMed
Varrasse, M., Li, J. and Gooneratne, N. (2015). Exercise and sleep in community-dwelling older adults. Current Sleep Medicine Reports, 1, 232–240. doi: 10.1007/s40675-015-0028-6CrossRefGoogle ScholarPubMed
Vashum, K. P., et al. (2015). Prevalence of and associations with excessive daytime sleepiness in an Australian older population. Asia-Pacific Journal of Public Health, 27s, NP2275–NP2284. doi: 10.1177/1010539513497783CrossRefGoogle Scholar
Voyer, P., Verreault, R., Mengue, P. N. and Morin, C. M. (2006). Prevalence of insomnia and its associated factors in elderly long-term care residents. Archives of Gerontology and Geriatrics, 42, 1–20. doi: 10.1016/j.archger.2005.06.008CrossRefGoogle ScholarPubMed
Ware, J. E., Kosinski, M. and Keller, S. D. (1996). A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefGoogle ScholarPubMed
Wilson, I. B. and Cleary, P. D. (1995). Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes. JAMA, 273, 59–65.CrossRefGoogle ScholarPubMed
Wysocki, A., Butler, M., Kane, R. L., Kane, R. A., Shippee, T. and Sainfort, F. (2015). Long-term services and supports for older adults: a review of home and community-based services versus institutional care. Journal of Aging and Social Policy, 27, 255–279. doi: 10.1080/08959420.2015.1024545Google ScholarPubMed
Yaffe, K., Falvey, C. M. and Hoang, T. (2014). Connections between sleep and cognition in older adults. The Lancet Neurology, 13, 1017–1028. doi: 10.1016/s1474-4422(14)70172-3CrossRefGoogle ScholarPubMed
Yesavage, J. A.et al. (1982). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 37–49.CrossRefGoogle ScholarPubMed
Yohannes, A. M., Dodd, M., Morris, J. and Webb, K. (2011). Reliability and validity of a single item measure of quality of life scale for adult patients with cystic fibrosis. Health and Quality of Life Outcomes, 9, 105. doi: 10.1186/1477-7525-9-105CrossRefGoogle ScholarPubMed
Young, T. B. (2004). Epidemiology of daytime sleepiness: definitions, symptomatology, and prevalence. The Journal of Clinical Psychiatry, 65, 12–16.Google ScholarPubMed
Zimmerman, M.et al. (2006). Developing brief scales for use in clinical practice: the reliability and validity of single-item self-report measures of depression symptom severity, psychosocial impairment due to depression, and quality of life. Journal of Clinical Psychiatry, 67, 1536–1541. doi: 10.4088/jcp.v67n1007CrossRefGoogle Scholar
Zubritsky, C., Hirschman, K. B., Bowles, K. H., Naylor, M. D., Abbott, K. M. and Foust, J. B. (2013). Health-related quality of life: expanding a conceptual framework to include older adults who receive long-term services and supports. Gerontologist, 53, 205–210. doi: 10.1093/geront/gns093CrossRefGoogle ScholarPubMed