Developing a night-time care programme for people with dementia with sleep disturbance in care homes

Lead Investigator: Dr Anne Corbett

Institution: King's College London

Grant type: PhD studentship

Duration: 3 years

Amount: £84,575

Scientific Title: Sleep disturbance in people with dementia living in care homes: Development of a night-time care programme

Why did we fund this project? Comments from members of our Research Network:

'I highly value attempts to raise the standard of care and quality of life for people with dementia now.'

'This is a key area for improvement. As a carer I recognise all the symptoms both at home and now in a care home.'

'A well devised and nicely targeted project which should have marked benefits for the patient, his/her carer, care home staff and fellow residents.'

What do we already know?

In 2015 there will be 850,000 people living with dementia in the UK. One third of people with dementia in the UK currently live in care homes. These individuals are often in thelater stages of the condition and experience many symptoms that can be distressing for them and their caregivers, and have a serious impact on the care they receive.

One such symptom is sleep disturbance, in which the person is unable to sleep at night. Over 40 per cent of people with dementia in the community experience sleep disturbance, and it is common on dementia wards in hospitals and care homes.

This symptom has a number of possible underlying causes. In several types of dementia the biological pathways in the brain that regulate sleep are known to be disrupted. Dementia medications such as Memantine also affect peoples' sleep. Furthermore, many people experience behavioural and psychological symptoms of dementia (BPSD) such as agitation and aggression which are frequently worse in the evening. There may also be environmental factors such as light and noise in care homes, which prevent people from sleeping.

People with sleep disturbance are often restless at night, frequently leaving their beds and bedrooms. In some cases people also become agitated and distressed, and may shout, scream and resist their caregivers. The impact of sleep disturbance is considerable; it affects the cognition of people with dementia, and increases their risk of mortality and BPSD, which can lead to prescriptions of harmful antipsychotic medications. They are more likely to sleep during the day, meaning their nutrition suffers as a result of missed meals and drinks.

They are also likely to be left out of activities in the care home and opportunities for social interaction, including family visits. Sleep disturbance also has an indirect impact on other residents in care homes as they are woken when people become vocal or distressed at night. Importantly, care staff find it very difficult to provide care for people who are awake at night, particularly since staffing levels are much lower during night-time hours. 

Sleep disturbance in dementia is clearly a very important issue in the care of people living in care homes, yet no studies have recorded the frequency or overall impact of this symptom. As a result it is not possible to provide guidance to care homes on the best way to care for people with disturbed sleep.

What does this project involve?

This PhD studentship aims to understand the prevalence of sleep disturbance in people with dementia living in care homes, and to develop and evaluate a night-time care programme.

This will involve a search of all of the published literature on methods to improve sleep disturbances in people with dementia, the development of a programme to manage these problems within care homes, and a six-week trial to evaluate the effectiveness of this new programme.

How will this benefit people with dementia?

This research has the potential to significantly improve care in an area that currently receives little attention in research or care practice. The studentship will provide valuable information about sleep disturbance in care homes, enabling better guidance for care staff and improved understanding of the issue. 

The key output of the study will be the stepped care programme for use at night-time. If shown to be effective, use of this programme could greatly improve the care people receive during night-time hours, reducing the impact of sleep disturbance for people with dementia, other residents and the care staff. It has the potential to improve people's quality of life and important symptoms such as behaviour, as well as enabling them to make the most of opportunities to engage in activities and social interaction, which are essential elements in high quality care.