Pa. Cruise et al., THE NIGHTTIME ENVIRONMENT AND INCONTINENCE CARE PRACTICES IN NURSING-HOMES, Journal of the American Geriatrics Society, 46(2), 1998, pp. 181-186
OBJECTIVES: To determine the variability in noise, light, and incontin
ence care practices between nursing homes (NHs) and the association be
tween these factors and residents' nighttime sleep. DESIGN: Prospectiv
e descriptive study of a sample of incontinent NH residents.SETTING: T
en nursing homes. SUBJECTS: Two hundred twenty-five incontinent NH res
idents. MAIN OUTCOME MEASURES: Measurements of residents' sleep by wri
st actigraphs, bed mobility by pressure sensitive Kynar strips, and en
vironmental noise and light changes were recorded by bedside monitors
in consecutive 2-minute intervals for two 10-hour nighttime data colle
ction periods (7 PM to 5 AM). RESULTS: Forty-two percent of waking epi
sodes lasting 4 minutes or longer were associated with noise, light, o
r incontinence care events. Twenty-two percent of waking episodes of 4
minutes or longer were associated with noise alone, 10% with light or
light + noise, and 10% with incontinence care routines. Seventy-six p
ercent of all incontinence care practices resulted in awakenings. Ther
e was variability between the 10 NHs, with the percentage of waking ep
isodes associated with environmental events (noise, light, or incontin
ence care events) ranging from 23.6 to 66.0%. CONCLUSION: Noise and in
cidents of incontinence care practices were associated with a substant
ial amount of sleep disruption in residents in all 10 nursing homes, e
ven though there was variability between homes. Interventions minimizi
ng such environmental events are needed to promote better sleep in inc
ontinent NH residents.