A growing number of older adults who have difficulty living independently, but don’t require the full range of services that nursing homes (NHs) provide, are moving to assisted living facilities (ALFs). While residents of ALFs are typically higher functioning and more independent than NH residents, research suggests that ALF residents are at a very vulnerable point in their lives: They run a high risk of loss of function that could ultimately lead to their placement in NHs. Among other factors, sleep disturbance may significantly increase older ALF residents’ risks of loss of function and of NH placement, conclude Jennifer L. Martin, PhD, of the David Geffen School of Medicine at the University of California at Los Angeles, and coauthors, in an important study in the May issue of Journal of the American Geriatrics Society^.1

Investigating the relationship between sleep disturbance and quality of life, depression, and functional status, Dr. Martin and colleagues followed 121 residents of 18 ALFs in the Los Angeles area for six months. The residents were all age 65 years and older and had a mean age of 85.3 years. At baseline, and at 3 and 6 months following enrollment, the researchers collected demographic data and information concerning residents’ physical and cognitive functioning, mental health, quality of life, comorbidities, medications, and subjective and objective measures of sleep. Questionnaires were used to evaluate subjective measures of sleep, and data from three days and nights of wrist actigraphy were used to evaluate objective measures.

Nearly two-thirds, or 65%, of enrollees reported clinically significant sleep disturbances on the Pittsburgh Sleep Quality Index. Wrist actigraphy results confirmed poor sleep quality, Dr. Martin and colleagues report. In regression analysis, worse self-reported sleep disturbance at baseline was associated with worse health-related quality of life and worse depressive symptoms at follow-up. In addition, worse nighttime sleep at baseline, as indicated by actigraphy, was associated with both greater depressive symptoms and poorer ability to carry out activities of daily living at follow-up.

“Sleep disturbance is common among older ALF residents, and poor sleep is associated with declining functional status and quality of life and increased depression over 6-months follow-up,” Dr. Martin and coauthors conclude.

The authors call for established treatments for sleep disturbance to be adapted for use among ALF residents and systematically evaluated. We agree.

Reference
1. Martin JL, Fiorentino L, Jouldjian S, et al. Sleep quality in residents of assisted living facilities: Effect on quality of life, functional status, and depression. J Am Geriatr Soc 2010;58(5):829-836.