Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

Abstract

ObjectiveDelirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.MethodA total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini–Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.ResultsThe mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.ConclusionThis study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.

The Effect of Systematic Light Exposure on Sleep in a Mixed Group of Fatigued Cancer Survivors

“…11 Indeed, sLE using bright light has been shown to improve sleep quality in noncancer populations 12 and has improved correlates of sleep disturbance in cancer patients, including circadian activity rhythms 13 and fatigue, both during chemotherapy 14 and, in our current sample, after primary cancer treatment for fatigue.…”

Recent Insights on Prevalence and Corelations of Hypoactive Delirium

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Blue-Enriched Lighting for Older People Living in Care Homes: Effect on Activity, Actigraphic Sleep, Mood and Alertness

“…Increased light levels have been shown to increase total sleep time [17] and to improve both alertness and mood at night and during the day [18; 19]. Nonvisual effects of light on behaviour and physiology are dependent on its timing, duration, intensity and wavelength [15; 20-22], with short wavelength blue light (420 -460 nm) having the greatest effect [22][23][24][25].…”