THE NIGHTTIME ENVIRONMENT AND INCONTINENCE CARE PRACTICES IN NURSING-HOMES

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.