Date Presented 4/16/2015
Sleep problems threaten occupational engagement in older adults. This pilot study suggests that occupational therapy may enhance sleep by targeting engagement in occupation. This study provides a structure for future researchers analyzing the role of occupational therapy in older adult sleep behaviors.
SIGNIFICANCE: Poor sleep is a public health issue that is associated with high health care utilization and escalating health care costs as well as physical, emotional, psychosocial, and occupational health limitations on the individual. Lifestyle interventions have been shown to improve sleep in adults by modifying daily routines to include valued occupations. Yet, very little evidence has established occupational therapy’s role in supporting sleep as an occupation.
INNOVATION: By drawing from a broader randomized control trial data set that captured sleep behaviors as a secondary outcome, in this pilot study we explored the relationship between an occupation-based lifestyle intervention and sleep behaviors. Thus, this study is innovative because it addresses a significant gap in current occupational therapy evidence by examining sleep among a diverse group of urban older adults.
APPROACH: Our hypothesis was that occupation supports improved sleep. Activity engagement and exercise are associated with improved sleep, yet the role of occupation-based intervention is unclear. Therefore, our aim in this pilot study was to explore the relationship between an occupation-based lifestyle intervention and sleep behaviors in community-dwelling older adults.
METHOD: This study involved a secondary data analysis of existing data originating from the University of California (USC) Well Elderly randomized control trial. A diverse sample of community-living older adults aged 65 yr and older in urban Los Angeles participated in the study. Participants were randomized to an occupational therapy lifestyle redesign (LR) group or a no-treatment control group for 6 mo. After randomization, a subgroup of participants (n = 315) from both the LR group and control group opted into an encapsulated study that collected information about sleep behaviors.
At baseline and again at 6-mo follow-up, individuals were asked to self-report sleeping and napping duration and behaviors in the previous 24-hr time period. Total sleep time was calculated by adding nighttime sleep and daytime napping minutes. Change in sleep duration was calculated by subtracting follow-up sleep measures from baseline measures of sleep, including changes in nighttime sleeping, changes in nap duration, and change in total sleep in 24 hr. Data were analyzed with Stata Version 12.0.
RESULTS: Both groups changed their sleeping behaviors by restricting napping. However, the LR group replaced lost daytime sleep with more consolidated nighttime sleep. Thus, the control group experienced an altogether net loss of total sleep time, whereas the LR group gained time in total sleep. The limitations of these findings are that the sample may not be generalizable to all older adults and that sleep measures were self-reported.
CONCLUSION: This pilot study suggests that an occupation-based intervention may be associated with positive changes in sleep behaviors among older adults. As the population ages and becomes more diverse, there is a need for further research to address the role of occupational therapy in sleep problems among the older adult population.
References
Ozminkowski, R. J., Wang, S., & Walsh, J. K. (2007). The direct and indirect costs of untreated insomnia in adults in the United States. Sleep, 30, 263–273.
Stranges, S., Tigbe, W., Gómez-Olivé, F. X., Thorogood, M., & Kandala, N.-B. (2012). Sleep problems: An emerging global epidemic? Sleep, 35, 1173–1181. http://dx.doi.org/10.5665/sleep.2012
