Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program

BMC Geriatrics

Patricia A. Parmelee¹  A. Lynn Snow²  Julia Loup²  Barbara Frank³  Cathie Brady³  Ellen McCreedy⁴  Rosa R. Baier⁴  Liam Fry⁵  Robert O. Morgan⁶  Megan McCullough⁷  Christine W. Hartmann⁷  Kathy Richards⁸ 

[1] Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, 35487, Tuscaloosa, AL, USA;Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, 35487, Tuscaloosa, AL, USA;Tuscaloosa Veterans Affairs Medical Center, 35404, Tuscaloosa, AL, USA;B&F Consulting, 02885, Warren, RI, USA;Brown University School of Public Health, 02912, Providence, RI, USA;Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, 78712, Austin, TX, USA;Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA;Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 01854, Lowell, MA, USA;Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 01730, Bedford, MA, USA;School of Nursing, The University of Texas at Austin, 78701-1412, Austin, TX, USA;

关键词: Sleep;    Alzheimer’s disease;    Dementia;    Quality improvement;    Quality indicators;    Health care;    Program development;    Front line staff;    Nursing homes;    Long term care;    Mental health;   

DOI  :  10.1186/s12877-021-02189-8

来源: Springer

【 摘 要 】

BackgroundDisturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.MethodsThis study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.DiscussionThis is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.Trial registrationNCT04533815, ClinicalTrials.gov, August 20, 2020. 

【 授权许可】

CC BY