S1 01 LaFazia

Treating Sleep Disturbances in Adult Family Homes : 

Treating Sleep Disturbances in Adult Family Homes David LaFazia, M.S.W. Susan McCurry, Ph.D. University of Washington School of Nursing Department of Psychosocial & Community Health Northwest Research Group on Aging Alzheimer’s Disease Research Center

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Adult Family Homes Board and care facilities with 2-6 residents not related to the owner or operator. Provide room and board, 24-hour supervision, and assistance with personal care tasks. Over 2000 in the State of Washington.

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University of Washington 2003 AFH Survey 101 homes in King, Pierce, and Snohomish Counties 11% of homes contacted not providing care to persons with dementia 68% with dementia residents report one or more residents have some form of sleep disturbance These disturbances disrupt the sleep of both residents and caregiving staff Sleep disturbances also negatively impact quality of life for resident him/herself

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Surveyed AFH Sleep Problems 83% - Getting up during the night (excluding 1-2 brief bathroom trips) 72% - Incontinence 71% - Waking earlier than the usual time 66% - Waking caregiver(s) 62% - Talking, yelling, or calling out 60% - Wandering, pacing, or other inappropriate activity 60% - Waking and dressing to start the day 54% - Sleeping too much during the day 57% - Trouble falling asleep 45% - Waking other residents 43% - Nightmares or hallucinations 29% - Eating or drinking at night 17% - Sleep apnea, SDB, restless legs, thrashing in bed

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Treating Sleep Disturbances in Dementia Residents of Adult Family Homes Funded by: University of Washington (RIFP McCurryS 04 WI) Alzheimer’s Association (IIRG-05-13293) SM McCurry, L Teri, D LaFazia, D Bliwise (consultant)

Subjects: 

Subjects N = 48 (20 enrolled to date) Probable or possible Alzheimer’s disease (no Parkinson’s disease) Two or more sleep problems, occurring 3+ times/week No diagnosed primary sleep disorder (sleep apnea, restless legs syndrome, REM behavior disorder, periodic leg movement syndrome)

Study Design: 

Study Design Randomized controlled clinical trial Two conditions: Sleep Education Program Usual Care Control Both conditions 4 weeks duration. Assessments at baseline, post treatment, 6 month follow up. Interviewers blind to treatment conditions.

Descriptive Data : 

Descriptive Data

Protocol: Improving Sleep in AFH Residents: 

Protocol: Improving Sleep in AFH Residents

Changing the ABC’s of Behavior: 

Changing the ABC’s of Behavior “A”: Look for the antecedent Did anyone or anything trigger the event? “B”: Define and observe the problem Who does it happen around? What is the current behavior? Where does it happen most? How often does it occur? “C”: Identify the consequence What happened after the behavior? How did others react?

Considerations in Treating Sleep Problems in AFHs: 

Considerations in Treating Sleep Problems in AFHs Resident considerations: Sleep/wake scheduling, physical status, dietary factors, family involvement Facility considerations: Staff scheduling, competing demands, physical environment, “buy-in” to behavioral model

Resident Considerations: 

Resident Considerations Bed/rising routines Daytime inactivity Incontinence and pain Depression Medical morbidity & frailty Dietary habits Family involvement

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Incontinence Treatment Guide

Case Example: 1: 

Case Example: 1 Sleep-related Problem Behaviors Wakes up at night and wanders in her room Is up during the night and sleeping during the day Spends entire days awake or sleeping Sleep Education Plan Put a lower wattage light bulb in room. Walk with resident and then re-direct back to bed. Offer warm milk or other snack. Limit napping to ½ hour for each nap. No naps after dinner. Target bed and rising times.

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Case 1 – Actigraphy Data

Facility Considerations: 

Facility Considerations Resident : staff ratios Rotating shift schedules Duration of intervention/session length Facility routines (meal, bed/rising times) Light and noise

Case Example: 2: 

Case Example: 2 Sleep-related Problem Behaviors Trouble falling asleep at night Difficulty waking up in the morning Sleep Education Plan Establish regular rising time. Exercise daily outside. Establish regular bed time. Encourage resident to read by window for light exposure. Decrease/eliminate evening naps. Use Pleasant Events to keep resident awake in the evening.

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Case 2 – Actigraphy Data

Treatment Adherence: 

Treatment Adherence 92% of homes completed 4 treatment sessions. On a scale of 1 – 5: Caregivers were very interested in the treatment (4.3). Willing to implement recommendations (4.1). Understood and utilized behavioral concepts (4.1). The AFH home was conducive to the intervention (4.7). Caregivers engaged in and enjoyed the sessions.

A-B-Cs: Simple but Tricky: 

A-B-Cs: Simple but Tricky Creative brainstorming is not easy Behaviors can be influenced by more than one thing at a time The message being communicated is more important than the actual behavior Observation is critical and challenging The caregiver is the expert

Thank You!: 

Thank You! University of Washington School of Nursing (RIFP McCurryS 04 WI) Alzheimer’s Association (IIRG-05-13293) Washington State Residential Care Council of Adult Family Homes (WSRCC-AFH) Adult Family Home Association of Washington (AFHAW) UW Northwest Research Group on Aging