A Multicomponent Nonpharmacological Intervention Improves Activity Rhythms Among Nursing Home Residents With Disrupted Sleep/Wake Patterns
Abstract
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 (alpha). 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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The health education control intervention was designed to have no effect on sleep (i.e., a placebo).
“the control intervention was developed to have no effect on sleep (i.e., a placebo) (26).”
From Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints (2008) · cites this paper as [26]
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“However, exercise has helped reduce fragmentation of the rest-activity rhythm (33) as well as mood disturbances in this population (34).”
BackgroundZhang, M., Wang, Q., Pu, L., Tang, H., Chen, M., Wang, X., Li, Z., Zhao, D., & Xiong, Z. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.10.008 · Cited by 22 · see citing works
- Authors
- Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R., & Alessi, C. A.
- Affiliations
- University of California, Los Angeles (US)
- University of California San Diego (US)
- VA Sepulveda Ambulatory Care Center (US)
- Corresponding author
- Martin, J. L.
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-01-01
- Volume
- 62
- Issue
- 1
- Pages
- 67-72
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2112200483
- Cited by
- 97
- References
- 50
- Citations by year
- 2025: 6 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 8 · 2013: 8 · 2012: 9
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29ag013885-05)
- National Institute on Aging (AG-10415, P60AG010415, R29 AG13885)
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- nursing home residents, circadian rhythm disruption, sleep-wake patterns, non-pharmacological treatment, bright light exposure, bedtime routines, physical activity, rest-activity rhythm, actigraphy, mesor
- MeSH terms
- Aged, 80 and over, Circadian Rhythm, Exercise Therapy, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Male, Motor Activity, Nursing Homes, Rest, Retrospective Studies, Sleep, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome
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