NIGHTTIME SLEEP AND BED MOBILITY AMONG INCONTINENT NURSING-HOME RESIDENTS

Objective: To describe sleep and body movement patterns in incontinent nursing home residents for the purpose of determining if the resident s require nighttime changing and body repositioning on a 2-hour schedu le. Design: Cross-sectional survey. Setting: Four nursing homes. Parti cipants: 118 nursing home residents. Measurements: Over two nights, be dside monitoring equipment recorded wrist activity (as a proxy measure for sleep) and body movements of both the shoulder and hip areas in c onsecutive 2-minute intervals. Specific outcome measures were: (1) Ave rage duration of a sleep episode, peak duration of a sleep episode, an d percent of time in bed asleep. (2) The number of 2-minute intervals in which a large movement (45 degree turn) at the shoulder and hip was noted per hour of recording for each resident. (3) The number of resi dent-initiated, rather than staff-initiated, large movements at the sh oulder and hip that occurred within the same 2-minute intervals. Resul ts: There was large variability in all sleep measures; however, on ave rage, residents slept 66% of the time they were in bed. The distributi on of these measures suggests that sleep was punctuated with frequent mighttime awakenings. Thirty-three percent of the incontinent resident s demonstrated very low levels of resident-initiated movement at the s houlder and hip. Sixty-six percent demonstrated at least one large mov ement at the shoulder and hip per hour during periods of sleep as well as during periods of wake. Conclusion: The majority of incontinent nu rsing home residents self-initiate sufficiently frequent movements at both the shoulder and hip so as not to be in need of frequent repositi oning by nursing staff. Since the sleep of many of these residents is also characterized by frequent awakenings, incontinent nursing home re sidents may benefit from a schedule of nursing care at night that cons iders sleep of equal importance to incontinence care and body repositi oning.