Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
German Center for Neurodegenerative Diseases (DZNE), Witten, Germany.
Int Psychogeriatr. 2021 Mar;33(3):245-273. doi: 10.1017/S1041610220000733. Epub 2020 Jun 5.
Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents.
This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies' methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria.
A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories "daytime activities," "nighttime activities," "staff training," and "light exposure." The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories.
The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.
痴呆症指南建议使用非药物干预措施来治疗老年人的睡眠障碍。基于现有综述，多组分干预措施最有可能有效地改善睡眠。然而，缺乏对多组分干预措施的详细描述。本系统综述旨在确定、描述和总结多组分非药物干预措施，以减少或避免养老院居民的睡眠障碍。
本综述遵循系统证据综合的既定方法框架。2018 年 12 月，使用 PubMed、CINAHL、Scopus 和 Cochrane 图书馆数据库进行了计算机检索。两名独立的审查员评估所有检索结果，以确定合格的研究，并根据随机对照试验的 Cochrane 偏倚风险方法和对照试验的 CASP 评估检查表评估研究的方法学质量。纳入了评估任何设计的多组分干预措施的研究，不包括病例研究。应用 TIDieR 和 CReDECI 2 标准分析纳入干预方案的组成部分。
通过数据库检索共确定了 2056 项研究；有十项出版物涉及九项干预措施符合纳入标准并纳入本综述。确定的干预措施可归纳为“日间活动”、“夜间活动”、“员工培训”和“光照暴露”等类别。这些方法在程序、材料、实施方式、干预提供者和干预时间方面具有相似性和差异性。没有一项研究描述了干预措施之间的任何预期相互作用，也没有考虑干预模型中的背景特征以及影响干预实施的内部和外部促进因素或障碍。我们发现了提到的类别中与睡眠相关的结果的积极或混合积极影响。
对纳入干预措施的分析表明，虽然结果难以解释，因为干预措施描述不充分，而且开发和评估复杂干预措施的挑战也没有得到充分认识，但这些干预措施具有一定的前景。
