We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%; delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.
KeywordsPatients in Home CareElderlyDeliriumSleep
Bond, S.M. (2009) Delirium at Home: Strategies for Home Health Clinicians. Home Healthcare Nurse, 27, 24-34. https://doi.org/10.1097/01.NHH.0000343782.11723.ea
Committee for the Development of Japanese Guidelines for the Management of Pain, Agitation, and Delirium in Intensive Care Unit, Japanese Society of Intensive Care Medicine (2014) Japanese Guidelines for the Management of Pain, Agitation, and Delirium in Intensive Care Unit (J-PAD). Journal of the Japanese Society of Intensive Care Medicine, 21, 539-579. https://doi.org/10.3918/jsicm.21.539
Boettger, S., Friedlander, M., Breitbart, W. and Passik, S. (2011) Aripiprazole and Haloperidol in the Treatment of Delirium. Australian & New Zealand Journal of Psychiatry, 45, 477-482. https://doi.org/10.3109/00048674.2011.543411
Inouye, S.K., Bogardus Jr, S.T., Charpentier, P.A., Leo-Summers, L., Acampora, D., et al. (1999) A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients. The New England Journal of Medicine, 340, 669-676. https://doi.org/10.1056/NEJM199903043400901
Burton, J.K., Craig, L., Yong, S.Q., Siddiqi, N., Teale, E.A., et al. (2021) Non-Pharmacological Interventions for Preventing Delirium in HospitalisedNon-ICU Patients. Cochrane Database of Systematic Reviews, 11, CD013307. https://doi.org/10.1002/14651858.CD013307.pub3
Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
Soldatos, C.R., Dikeos, D.G. and Paparrigopoulos, T.J. (2000) Athens Insomnia Scale: Validation of an Instrument Based on ICD-10 Criteria. Journal of Psychosomatic Research, 48, 555-560. https://doi.org/10.1016/S0022-3999(00)00095-7
Soldatos, C.R., Dikeos, D.G. and Paparrigopoulos, T.J. (2003) The Diagnostic Validity of the Athens Insomnia Scale. Journal of Psychosomatic Research, 55, 263-267. https://doi.org/10.1016/S0022-3999(02)00604-9
Okajima, I., Nakajima, S., Kobayashi, M. and Inoue, Y. (2013) Development and Validation of the Japanese Version of the Athens Insomnia Scale. Psychiatry and Clinical Neurosciences, 67, 420-425. https://doi.org/10.1111/pcn.12073
Chiu, H.Y., Chang, L.Y., Hsieh, Y.J. and Tsai, P.S. (2016) A Meta-Analysis of Diagnostic Accuracy of Three Screening Tools for Insomnia. Journal of Psychosomatic Research, 87, 85-92. https://doi.org/10.1016/j.jpsychores.2016.06.010
Marcantonio, E.R., Ngo, L.H., O’Connor, M., Jones, R.N., Crane, P.K., et al. (2014) 3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-Defined Delirium: A Cross-Sectional Diagnostic Test Study. Annals of Internal Medicine, 161, 554-561. https://doi.org/10.7326/M14-0865
Kogure, T., Shirakawa, S., Shimokawa, M. and Hosokawa, Y. (2011) Automatic Sleep/Wake Scoring from Body Motion in Bed: Validation of a Newly Developed Sensor Placed under a Mattress. Journal of Physiological Anthropology, 30, 103-109. https://doi.org/10.2114/jpa2.30.103
Sandberg, O., Gustafson, Y., Brannstrom, B. and Bucht, G. (1998) Prevalence of Dementia, Delirium and Psychiatric Symptoms in Various Care Settings for the Elderly. Scandinavian Journal of Social Medicine, 26, 56-62. https://doi.org/10.1177/14034948980260011201
Sabbe, K., van der Mast, R., Dilles, T. and Van Rompaey, B. (2021) The Prevalence of Delirium in Belgian Nursing Homes: A Cross-Sectional Evaluation. BMC Geriatrics, 21, Article No. 634. https://doi.org/10.1186/s12877-021-02517-y
Cheung, E.N.M., Benjamin, S., Heckman, G., Man-Wai Ho, J., Lee, L., et al. (2018) Clinical Characteristics Associated with the Onset of Delirium among Long-Term Nursing Home Residents. BMC Geriatrics, 18, Article No. 39. https://doi.org/10.1186/s12877-018-0733-3
Meagher, D., O’Regan, N., Ryan, D., Connolly, W., Boland, E., et al. (2015) Frequency of Delirium and Subsyndromal Delirium in an Adult Acute Hospital Population. British Journal of Psychiatry, 205, 478-485. https://doi.org/10.1192/bjp.bp.113.139865
Farasat, S., Dorsch, J.J., Pearce, A.K., Moore, A.A., Martin, J.L., et al. (2020) Sleep and Delirium in Older Adults. Current Sleep Medicine Reports, 6, 136-148. https://doi.org/10.1007/s40675-020-00174-y
Kukreja, D., Günther, U. and Popp, J. (2015) Delirium in the Elderly: Current Problems with Increasing Geriatric Age. Indian Journal of Medical Research, 142, 655-662. https://doi.org/10.4103/0971-5916.174546
Sharma, A., Malhotra, S., Grover, S. and Jindal, S.K. (2012) Incidence, Prevalence, Risk Factor and Outcome of Delirium in Intensive Care Unit: A Study from India. General Hospital Psychiatry, 34, 639-646. https://doi.org/10.1016/j.genhosppsych.2012.06.009
Folstein, M.F., Bassett, S.S., Romanoski, A.J. and Nestadt, G. (1991) The Epidemiology of Delirium in the Community: The Eastern Baltimore Mental Health Survey. International Psychogeriatrics, 3, 169-176. https://doi.org/10.1017/S1041610291000637
Otsuka, S., Kamakura, Y., Yoneda, M., Fukada, J., Kanada, H. and Shinoda, M. (2006) Relations among Symptoms and Sleep, Urinary Prostaglandin E2 Pattern in Patients after Esophagectomy. Japan Journal of Nursing Science, 26, 11-18. https://doi.org/10.5630/jans.26.4_11
Mineko, S. (2005) A Study of Fact-Finding and Risk Factors of Delirium among Stroke Patients of Elderly. Journal of Japan Academy of Gerontological Nursing, 10, 95-104.
Jaiswal, S.J., Kang, D.Y., Wineinger, N.E. and Owens, R.L. (2021) Objectively Measured Sleep Fragmentation Is Associated with Incident Delirium in Older Hospitalized Patients: Analysis of Data Collected from an Randomized Controlled Trial. Journal of Sleep Research, 30, e13205. https://doi.org/10.1111/jsr.13205