Science and Knowledge Transfer -

The SomnIA Project: Understanding Quality of Sleep among Older

People living in the Community and in Care Homes

Sara Arber and Rebekah LuffCentre for Research on Ageing and Gender (CRAG)

University of Surrey

NDA Programme Meeting, Hilton London Euston Hotel20th October 2010

www.somnia.surrey.ac.uk

Sleep in later life is an important topic because: Among older people, untreated chronic sleep disturbance degrades

quality of later life, inhibits recovery following illness (Ersser et al, 1999) and rehabilitation (Stepanski et al, 2003), and is an independent risk factor for falls and depression (Leger 1994; Livingston et al. 1993).

Lack of knowledge about sleep and ageing The specific aetiology of late-life sleep problems remains unclear

(Montgomery and Dennis 2004).

Concerns about current treatment practices for poor sleep To reduce hypnotic drug prescribing which increases confusion and

falls among older people Effective non-pharmacological approaches to sleep management need

to be explored and evaluated in the community and in care homes.

To understand the meanings and determinants of poor quality sleep among older people in the community and in residential settings - by assessing the relative contributions of social, psychological and environmental factors, medication use and health status, and identifying potential solutions

To develop a cost-effective approach to non-pharmacological self-management of insomnia among older people with chronic disease - by evaluating the impact of an evidence-based, Expert Patient 'supported' self-management programme.

To develop and promote effective non-pharmacological treatment options for sleep problems, and evaluate their acceptability to users, e.g. ‘enriched’ blue light and novel sensors.

To develop web-based user-friendly information and advice for older people with sleep problems. Created module on ‘Sleep Problems in Later Life’ for www.healthtalkonline.org

A multi-disciplinary project, aiming to link approaches from different disciplines in order to better understand older people’s sleep problems and develop cost-effective ways to reduce sleep problems.

Focus on ‘normal’ sleep disruption and sleep problems rather than specific sleep disorders.

Sociology (Prof Sara Arber, Surrey) (PI)

Psychology (Prof Kevin Morgan, Loughborough)

Neuroendocrinology (Prof Debra Skene, Surrey)

Engineering (Prof Roger Orpwood, Bath)

Nursing (Dr Ingrid Eyers, Surrey)

Medicine (Prof David Armstrong, King’s College London)

4 year project, began 1 December 2006

Philips Lighting (Dr Luc Schlangen) Expertise in the design of luminaries/fixtures for ‘blue light’ trials in the

community and care homes

North Nottinghamshire Health Community (Dr Maureen Tomeny) Supporting the training of 12 NHS primary care practitioners and 20 ‘expert

patients’ to evaluate ‘supported’ sleep self-management

The Relatives & Residents Association (Dr Gillian Dalley) Facilitating access and links with older service users, which is informing all

aspects of the research and product development

Age UK (formerly Help the Aged/Age Concern) (Prof James Goodwin) Helping to facilitate links with service users, and dissemination of findings,

including publishing self-help material to improve sleep of older people in the community and care homes

Healthtalkonline (Sue Ziebland/University of Oxford) Formerly DIPEx - producing a website module on ‘Sleep problems in Later

Life’for their award-winning website (www.healthtalkonline.org) on patient experiences of illness

WP3: Understanding the social and environmental factors influencing quality of sleep in care homes - Ingrid Eyers, Rebekah Luff, Emma Cope, Theresa Ellmers - Surrey

WP7: Development and evaluation of sensor-based devices to improve sleep of older people in care homes and the community – Roger Orpwood, Bruce Carey-Smith, Nina Evans – Bath

- inter-connections between WPs

1)How much time do care home residents spend in bed and how does this relate to likely time spent sleeping?

2)How does resident dependence level relate to bed times and getting up times?

3)How do staff shift changes and related staffing levels influence bed times and getting up times?

4)How can resident choice be understood within the context of their dependency and the care home routine?

10 care homes in SE England 145 residents with valid data

◦ Male = 40, Female = 105◦ Age range 65-102 (median 85-89)

Data collection for 14 consecutive days:◦ Actiwatches◦ Daily diaries: covering daytime activities and

night◦ Socio-demographic information◦ Medication/ health◦ Dependency◦ Environment

Every day for 14 days‣Last night:

‣Time went to bed

‣Time went to sleep

‣Time woke up

‣Time got up

‣Sleep disturbances‣Number of times woke up during the

previous night

‣Why woke up

‣Evaluation of their sleep quality the previous night

Average time spent in bed in hours1716151413121110987

Freq

uenc

y

24

22

20

18

16

14

12

10

8

6

4

2

0

Mean time spent in bed = 10hrs 50mins

N= 125

Number of hours in bed 'awake'9876543210

Fre

quen

cy

25

20

15

10

5

0

Mean time spent in bed ‘awake’ = 2hrs 25mins

Average bedtime24.0023.0022.0021.0020.0019.0018.00

Fre

quency

8

7

6

5

4

3

2

1

0

Average bedtime24.0023.0022.0021.0020.0019.0018.00

Assisted by staffGot self ready for bed

Staff shift change

N=24 N=36

Average getting up time12.0011.0010.009.008.007.006.00

Fre

quency

8

7

6

5

4

3

2

1

0

Average getting up time12.0011.0010.009.008.007.006.00

Assisted by staffGot self ready for bed

Staff shift changeN=24 N=36

Collate results and summarise areas of

need

Findings from SomnIA care home observational studies and previously published work

Interview care home staff and residents

SomnIA Workshop 1Identify technology

concepts

Prioritise concepts

Early prototypes

Circulate concepts to SomnIA team

Interviews with care home staff

Interviews with care home staff and residents

SomnIA Workshop 2

User evaluation

Stage 1 Ethical approval

Technology development

Stage 2 Ethical approval

En

vir

on

men

tal

Psy

choso

cial

External disturbances

Anxiety over provision of care

Comfort and accessibility of the environment

Factors contributing to poor sleep

Supporting staff to provide timely and appropriate care

Reassuring residents that care is available

Enabling residents to reliably access appropriate care when it is needed

Minimising external sources of noise

Providing appropriate ambient light levels

Minimising disturbance associated with physical checks

Improving ability to engage in soporific night-time activities

Enabling residents to satisfy their physical needs

Noise activated call system

Remote monitoring

Accessible call button

Encouraging reluctant callers

Bedside item storage

Personal radio or music player

Versatile lighting

Night-time communication

Design ideas

What we know – comments from survey and demonstrations◦ Needs to provide a audio from a variety of

sources (TV, radio, mp3)◦ Needs to be wipe-clean◦ Different pillow options important◦ Controls need to be simple to use

What we need to find out◦ Does it lead to reduce noise levels?◦ Does it lead to increased restfulness?◦ Are in-pillow controls suitable?

What we know – comments from survey and demonstrations◦ Needs to be wipe-clean◦ Needs to be soft and comfortable◦ Needs to be compact, light and portable◦ Primarily operated by staff

What we need to find out◦ Is sufficient amplification achievable without

feedback?◦ Does its use lead to reduced disturbance?

Academic Conferences – 65 Oral and 37 poster presentations (including 13 invited)

Practitioner/User Conferences – 13 Oral and 8 Poster presentations (including 10 invited)

Publications – long time lag for publications, outputs to date vary with timing of different WPs◦ 8 peer-reviewed articles ◦ 2 practitioner articles ◦ 2 book chapters◦ 4 articles under submission

Media – 3 TV; 4 radio; 22 newspaper/online blog - ??Concerns about possible ‘bad publicity, e.g. re: care home findings

Briefing Papers – 2 pages of A4, colour ◦ 9 produced - one general, and one on each WP◦ Distributed widely, e.g. At Day conferences◦ On website, etc.

Website – Information about WPs, SomnIA Conferences, Findings etc.

British Science Festival Symposium on ‘Sleep after 60’, Sept 2009 – generated media interest

Launch of ‘Sleep Problems in Later Life’ module on healthtalkonline website – Nov 2009, London

2 Day Workshops for care home industry (July 2009, Guildford & July 2010, Bristol) – each attended by 80-90 care home managers

Conference with National Care Homes Research & Development Forum (Dec 2009, Surrey)

Day Conference – ‘Help yourself to sleep’ for health service practitioners – (Nov 2010, Loughborough)

‘Sleep, Well-being and Active Ageing: New Evidence for Policy and Practice’ – 28th October 2010, Church House Conference Centre, Westminster.

Mixture of key speakers from Ageing (e.g. Mike Nolan), Sleep (e.g. Colin Espie), Assistive Technology (Peter Lansley), Voluntary Sector (e.g. James Goodwin), plus SomnIA speakers

Key Findings Booklet - will be distributed Press Releases – publicity. BUT some WPs still

in early stages of analysis PLUS may not want to release ‘findings’ until they are published....

This research is supported by the:

New Dynamics of Ageing initiative, a multidisciplinary research programme supported by AHRC, BBSRC, EPSRC, ESRC and MRC. (Grant number RES-339-25-0009).

Thank YouThank You

S.Arber@surrey.ac.ukRebekah.Luff@surrey.ac.uk

www.somnia.surrey.ac.uk

Thanks to all our SomnIA colleagues