Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home

Background and objectives: Hospitalized older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. In this paper, we describe the development of a multi-component intervention to promote sleep.

Research design and methods: We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components.

Results: The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with aging, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress, and sleep-related beliefs and behaviors. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalization.

Discussion and implications: Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility.