Insomnia symptoms in elderly persons - assessment, associated factors and non-pharmacological nursing interventions

Abstract: The aim of this thesis was to test a tool for assessing insomnia symptoms in elderly persons and to investigate late-life insomnia in terms of associated factors and evidence of non-pharmacological interventions in healthcare settings. Data were collected by means of a systematic literature search (Study I), questionnaires (Studies II-III), interviews and observations (Study IV). The results from Study I are based on nine studies and six non-pharmacological interventions were found. Evidence for the interventions was limited. However, massage, acupunctural stimulation and listening to music/natural sounds or watching an instrumental music video showed a moderate to large effect on several sleep outcomes. In Study II, the measurement properties of the Minimal Insomnia Symptom scale (MISS) were tested on 497 elderly pesons. Corrected item-total correlations were 0.64-0.70, floor/ceiling effects were 6.6/0.6% and reliability 0.81. Using a cut-off score of ≥7 points, sensitivity and specificity were 93/84%. MISS was found to be feasible as a screening tool for insomnia in the elderly. An investigation of associations between leisure activities and sleep disturbances (Study III) showed that gardening, strolling in the country, home maintenance, repairing cars/machines and playing chess/cards were associated with fewer sleep disturbances in elderly persons. Adjusting for age, gender, general health, functional ability and mood, only playing chess/cards remained statistically significant. After interactions between gender and leisure activities were added to the model, only home maintenance was statistically significant. The ability to pursue home maintenance seemed to be particularly important for women. Investigating sleep and everyday activities at residential care facilities (RCFs) revealed that the punctual scheduling of meals and coffee times helped to maintain a regular rhythm and limit daytime sleep (Study IV). Several residents perceived their sleep to be longer and more regular since moving in. Less mobile residents would spend most of the day in the day room, with less activity and without the possibility of withdrawing. Slumbering in the day room was common. Residents who were mobile spent more time in the privacy of their apartments, pursuing activities on their own. In conclusion, evidence for non-pharmacological sleep interventions is limited. Socio-intellectual activities, such as playing chess/cards or doing home maintenance, were associated with fewer sleep disturbances. Less dependent pesons benefitted from the structured day at the RCF, they performed solitary activities to a large extent and they felt their sleep had improved. MISS was found to be a reliable tool for initial screening of insomnia in the elderly, and could be useful in clinical practice.