Research Summaries

In Assisted Living Facilities, Many Older Adults Have Sleep Problems, Which Appear to Contribute to Depression, Lower Quality of Life and Poorer Function

A growing number of older adults who have difficulty living independently, but don't need all the services nursing homes provide, are moving to assisted living facilities (ALFs). Residents of ALFs are usually better able to function and more independent than nursing home residents. But research suggests that ALF residents are at a very vulnerable point in their lives, and run a high risk of loss of function that could ultimately lead to their moving to nursing homes.

Sleep problems, among other things, can contribute to physical and mental health problems and loss of function, studies have found.

New Research in the Journal of the American Geriatrics Society
To learn more about sleep problems among ALF residents - including how common these problems are, and how they affect residents' physical and mental health and ability function, researchers recently studied more than 120 adults living in ALFs over the course of six months. All of the adults were 65 or older.

At the beginning of the study, and three and six months later, the researchers asked the residents how well they slept, how long it took them to fall sleep, how long they slept and related questions. They asked the residents whether they had symptoms of sleep disorders, such as "restless leg syndrome" - an urge to move your legs while resting; or "sleep apnea" - a disorder that causes you to stop breathing and awaken, briefly but repeatedly, during sleep. The researchers also asked the residents whether their sleep was affected by noise, light or other people in the ALF, and whether they took any medications to help them sleep.

In addition, the researchers monitored and evaluated the residents at the start of the study and three and six months later, to check whether they actually had sleep disorders, and to see how long and well they actually slept. The researchers also checked whether the residents were depressed, whether they had any physical or cognitive (thinking) problems, and how well they could carry out activities of daily living (ADLs) such as dressing, bathing, and getting in and out of bed without help. The researchers evaluated each resident's quality of life as well.

Roughly 65% of the residents reported getting poor sleep, and monitoring confirmed that many residents didn't sleep well, the researchers report. Residents who had poor sleep at the start of the study were more likely to have worse symptoms of depression, poorer quality of life, and more difficulty with activities of daily living later in the study, the researchers found. While a third of the residents in the study said they took medications to help them sleep, these medications didn't seem to improve sleep, or lower risks of depression or difficulty with daily activities, the researchers report.

"Taken together, these findings suggest that ... poor sleep may be a predictor of subsequent decline in functional status and increase in depression," the researchers report in the Journal of the American Geriatrics Society.

"Since functional status decline and depression are factors that can lead to nursing home placement and/or falls, improving sleep quality may serve to delay these negative outcomes," they add, noting that more research focused on sleep in later life, and how to improve it, is needed.

The summary above is from the full report titled, "Sleep Quality Among Residents of Assisted Living Facilities: Impact on Quality of life, Functional Status and Depression." It is in the May 2010 issue of the Journal of the American Geriatrics Society (Volume 58, Issue 5). The report is authored by Jennifer L. Martin, PhD, Lavinia Fiorentino, PhD, Stella Jouldjian, MSW, MPH, Karen R. Josephson, MPH, and Cathy A. Alessi, MD.