Department of Sociology, Faculty of Arts and Human Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
Chronobiol Int. 2010 Jun;27(4):842-54. doi: 10.3109/07420521003797732.
Sleep disturbances are a common problem among institutionalized older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms, and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This article compares actigraphic data collected for 14 days from 122 non-demented institutional care residents (across ten care facilities) with 52 community dwelling poor sleepers >65 yrs of age. Four dependent variables were analyzed: (i) "interdaily stability" (IS); (ii) "intradaily variability" (IV); (iii) relative amplitude (RA) of the activity rhythm; and (iv) mean 24 h activity level. Data were analyzed using a fixed-effect, single-level model (using MLwiN). This model enables comparisons between community and institutional care groups to be made while conditioning out possible "individual" effects of "age," "sex," "level of dependency," "level of incontinence care," and "number of regular daily/prescribed medications." After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there was little difference between community dwelling older adults and institutional care residents in IS score, suggesting that the stability of day-to-day patterns (such as bed get-up, lunch times, etc.) is similar within these two resident groups. However, institutional care residents experienced more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older people's rest/wake patterns; although, longitudinal studies are required to fully understand any causal relationships.
睡眠障碍是机构化老年人中常见的问题。研究表明，该人群的睡眠潜伏期延长，碎片化增加，睡眠起始后觉醒，昼夜节律紊乱，夜间白天颠倒。然而，研究尚未考察这种情况在多大程度上是由于影响睡眠的个体因素（如年龄）造成的，或者是由于机构环境造成的。本文比较了从 10 家护理机构的 122 名非痴呆机构护理居民（共 14 天）收集的活动记录仪数据，与 52 名年龄在 65 岁以上、睡眠质量差的社区居住者。分析了四个依赖变量：（i）“日间稳定性”（IS）；（ii）“日内可变性”（IV）；（iii）活动节律的相对幅度（RA）；（iv）24 小时平均活动水平。使用 MLwiN 采用固定效应、单水平模型分析数据。该模型可在排除“年龄”、“性别”、“依赖程度”、“失禁护理水平”和“日常/规定药物数量”等“个体”因素的个体影响的同时，对社区和机构护理组进行比较。在控制了一系列个体水平因素的影响，并控制了各组之间不等方差（异方差）后，社区居住的老年人和机构护理居民的 IS 评分几乎没有差异，这表明这两组居民的日常模式稳定性（如起床时间、午餐时间等）相似。然而，机构护理居民的休息/觉醒模式更加碎片化（IV 评分显著较高，平均活动值显著较低）。我们的研究结果强烈表明，机构护理环境本身与老年人的休息/觉醒模式存在负面关联；然而，需要进行纵向研究才能全面了解任何因果关系。
