A Randomized Trial of a Combined Physical Activity and Environmental Intervention in Nursing Home Residents: Do Sleep and Agitation Improve?
Abstract
OBJECTIVES: The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents. DESIGN: A randomized trial. SETTING: One community nursing home in the Los Angeles, California area. PARTICIPANTS: Twenty‐nine incontinent residents (mean age 88.3 years, 90% female). INTERVENTION: Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep‐disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). MEASUREMENTS: Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed day time behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. RESULTS: Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow‐up compared with 67.0% at baseline to 66.3% at follow‐up in controls (MANOVA, group by time, F = 4.42, P =. 045, df = 27). At follow‐up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P =. 029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow‐up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. CONCLUSIONS: This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.
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TRIs of a physical nature, designed to meet the specific needs of individuals, can improve physical functioning and decrease agitated behaviors.
“Research indicates that TRIs of a physical nature, that are designed to meet the specific needs of individuals, can improve physical functioning, 23,27,28 and decrease agitated behaviors. 29-32”
From Therapeutic recreation interventions for need-driven dementia-compromised (2002) · cites this paper as [30]
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- Authors
- Alessi, C. A., Yoon, E. J., Schnelle, J. F., Al‐Samarrai, N. R., & Cruise, P. A.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Alessi, Cathy A.
- ORCID
- Alessi, Cathy A.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 1999-07
- Volume
- 47
- Issue
- 7
- Pages
- 784-791
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2016109384
- Cited by
- 227
- References
- 31
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 8 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 8 · 2018: 5 · 2017: 5 · 2016: 11 · 2015: 8 · 2014: 5 · 2013: 12 · 2012: 11
- FWCI
- 19.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01ag013013-04)
- National Institute on Aging (R01 AG13013)
- National Institute of Nursing Research (R01-NR027595-06)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- nursing home residents, physical activity, sleep, agitation, incontinence, noise reduction, nursing care practices, actigraphy, physical function, older adults
- MeSH terms
- Aged, Aged, 80 and over, Exercise Therapy, Female, Follow-Up Studies, Health Facility Environment, Humans, Male, Night Care, Noise, Nursing Homes, Psychomotor Agitation, Sleep Wake Disorders, Urinary Incontinence, Los Angeles, Multivariate Analysis, Polysomnography
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