Measuring the sleep of older people: Tool development and use in the evaluation of therapeutic massage

Abstract

This paper examines the measurement of sleep in nursing care settings, within the context of a pilot study which aimed to assess the effect of therapeutic back massage by nurses on the quality and pattern of sleep in older people in nursing homes and a community hospital. Sleep is an important factor in effective recovery and rehabilitation from illness and for the quality of life of older people in care settings. Issues are raised concerning the measurement of the sleep of older people for the purposes of evaluation research. New instruments are introduced, some building on existing tools. The value of self-reported and observed sleep data are discussed. Issues of the feasibility and rigour of these instruments are examined and recommendations are made for their further refinement and use.

Effectiveness of strategies to manage sleep in residents of aged care facilities

“…Although commonly used to assess resident sleep, numerous researchers have questioned the validity of behavioural observation. As described in many cohort trials, the sleep of older nursing home residents, particularly those with dementia, is punctuated by regular interruptions and it is questionable whether 1–2 hourly observations by nursing staff are sensitive to episodic night wakening 1,14,15,17,20,21,28 …”

“…Ersser et al . described a pair of sleep assessment tools, designed for use in a sleep intervention trial, and outlined their experiences utilising the tools 28 . The Sleep Patterns Assessment Tool (SPAT) was designed to collect objective sleep data through hourly behavioural observations of residents by nursing staff, documented on a daily sleep record sheet.…”

“…The SPAT required documentation of settling time, sleep onset time, final waking time and time of getting up, as well as timing and duration of both daytime naps and night‐time awakenings. Daytime drowsiness was rated by nursing staff once daily on a 5‐point scale 28 . SPAT assessment was conducted concurrent to using a subjective sleep assessment tool (outlined later in this review).…”

“…SPAT assessment was conducted concurrent to using a subjective sleep assessment tool (outlined later in this review). The development of both tools was informed by a literature review and the tools were administered for a 7‐day baseline‐recording period to 32 older nursing home residents with no cognitive impairment recruited for a sleep intervention study 28 . Formal validation of these sleep assessment tools was not conducted.…”

“…Ersser et al . found that the SPAT tool was poorly completed by nursing staff 28 . Fifty‐five per cent of data required to calculate total sleep time, 68% of data required to calculate sleep efficiency and 79% of daytime sleep data was not completed.…”