Older adults who move from their own homes to a retirement community, or to assisted living, and in many cases, again to long-term care or a nursing home, pass through a trajectory of increasing dependence reflected in their living situation. On this trajectory, each stage, or change in living situation, represents a reduction in personal competence and independence, a loss of control of personal routines and environment, and the imposition of greater social and physical restrictions. Disordered sleep or insomnia is frequently a key factor when older adults move down the trajectory of dependence, either as a primary cause or as a symptom of worsening physical or cognitive function, but how and why this happens has not been explored.
The purpose of this interpretative descriptive, mixed methods study was to elicit self-report and open narratives from older adults at different points along the trajectory of dependence about their own sleep behaviors, their knowledge of good sleep hygiene, and their thoughts and beliefs about the relationships between sleep, daily functioning and quality of life in order to understand how insomnia affects this population. This study also includes people with early dementia or mild cognitive impairment to ascertain how insomnia affects their outlook and functioning.
Methods: Sample included 4-6 adults from each living situation (independent, assisted and memory unit), who completed Pittsburgh Sleep Quality Index, Geriatric Anxiety Scale, Older People's Quality of Life Questionnaire, The Bath Assessment of Subjective Quality of Life in Dementia (for memory unit residents) and the Consensus Sleep Diary. One week later they gave hour-long interviews about effects of insomnia and how they cope with it. The study used open-ended qualitative interviews, sleep diaries, and instruments/surveys covering both sleep habits and quality of life, as a form of methodological triangulation to construct the most accurate picture of each participant’s sleep experience and its effects on quality of life.
Results: Data analysis is ongoing. However, participants reported experiencing insomnia symptoms ranging from 6 months to 20+ years in duration. Over half the respondents reported sleeping fewer than 5 hours per night for several nights a week. All respondents reported that insomnia had worsened as they aged, and that their resulting daytime fatigue negatively affected their quality of life, daily function and social relationships. Content analysis of participant narratives revealed death of a spouse, anxiety over health issues, dysfunctional beliefs, multiple medications and pain symptoms were common contributing/perpetuating factors.
Conclusion:
These data are important as they support links between insomnia and impairment in older adults. As the population grows older, the need for age-appropriate sleep therapies will increase. Using the voice of older adults, we have illustrated the far reaching negative effects of poor sleep on daily life and overall quality of life as well as identifying some of the common perpetuating factors for insomnia in this population.