Back to search

OFFPHD-Offentlig sektor-ph.d.

Effekten av lysterapi-rom på sykehjemspasienter med demens - DEM.LIGHT

Awarded: NOK 1.0 mill.

Project Number:

259987

Project Period:

2016 - 2021

Funding received from:

Location:

Partner countries:

Background: Sleep disturbances affect up to 70% of nursing home patients with dementia. The disruptions often include frequent awakenings at night and excessive daytime sleep, and have negative consequences for cognition, mood, behaviour, and quality of life. The symptoms are also challenging for the staff. Sleep problems among nursing home patients are often treated pharmacologically. Research has demonstrated that the medications most frequently used in this population are of unclear effectiveness and have serious adverse side effects in this group. It is therefore of utmost importance to identify non-pharmacological treatment options to improve sleep among these patients. One important contributing factor to sleep disruption is suboptimal light exposure. Light is the most important synchronizing factor to our circadian rhythms, and is therefore essential to sleep-wake regulation. Nursing home patients spend little time outdoors, and meausrements of indoor light levels have shown that indoor light is not sufficient to stabilize the sleep-wake rhythm. Some studies have demonstrated that increased light exposure during the day, or bright light treatment (BLT), can improve sleep, circadian rhythmicity, and mood in this group. The research have, however, some weaknesses. For example, few randomized controlled trials have been completed. In addition, few instruments exist that are specifically developed and validated to measure sleep disturbances among nursing home patients with dementia. Proper sleep evaluation therefore represents a challenge both in research and in clinical practice. The goal of this thesis was to investigate whether BLT may improve sleep in nursing home patients with dementia, and to address methodological challenges in this field of research. Methods: Paper 1 is a systematic review summarizing previous research on the effect of BLT in people with dementia. Paper 2 and 3 are based on data from the DEM.LIGHT trial; a cluster-randomized placebo-controlled trial, where 69 nursing home patients with dementia participated. The intervention comprised ceiling-mounted LED lights installed in the common room of the nursing homes. The installation provided a cycle of light, with high intensity blue-white light from 10:00 to 15:00, and gradually less intense yellow-white light during the morning and afternoon/evening. The control group received standard light throughout the day. Data on sleep, circadian rhythmicity, mood, behaviour, and function were collected at baseline and at week 8, 16, and 24. Paper 2 used baseline data from the DEM.LIGHT trial to validate a sleep scale using an objective measure of sleep (actigraphy) as a reference. Paper 3 evaluated the effect of the intervention on sleep in week 8, 16, and 24. Results: In Paper 1, we found that as a whole, previous research have shown varying results regarding the effect of BLT on sleep and circadian disturbances in people with dementia. The studies varied in terms of intervention strategy, design, participant characteristics, and chosen outcome measures, which may explain the divergent findings. In Paper 2, we found that the sleep scale Sleep Disorder Inventory (SDI) had satisfactory validity, and that a score of five or more on the SDI can be used to identify people with sleep disruption. Importantly, actigraphy have some weaknesses that need to be considered, such as underestimating nocturnal wake time. In Paper 3, we demonstrated that sleep as measured by the SDI improved in the intervention group from baseline to week 16 and week 24, compared to the control group. There was no change in sleep measured by actigraphy. Conclusion: The thesis show promising, but inconclusive results regarding the effect of BLT on sleep in nursing home patients with dementia. More research is needed to identify the optimal light conditions for nursing home patients and which patients may benefit from such treatment. The finding of an effect in week 16 and not in week 8 indicate that the effect of BLT takes time to manifest in this population. The research field have some important methodological challenges, such as accurately measuring sleep in this patient group. The SDI may contribute in this regard, however, the field will greatly benefit from future improvements of sleep measurements.

Artiklane som inngår i avhandlinga er viktige bidrag til forskingslitteraturen og forståinga av effekten av lys på søvn hos personar med demens i sjukeheim. Den siste artikkelen viste ei betring i søvn hos personar med demens i sjukeheim i respons til lysbehandling over 16 og 24 veker. Prosjektet bidrege til å auke kompetanse blant personale i sjukeheim i å fylle ut kliniske spørjeskjema som kan komme avdelinga og bebuarar til gode. Vidare har prosjektet bidrege til å knyte band mellom universitet, kommune og industri og lagt til rette for framtidig samarbeid. Prosjektet har blitt presentert i lokale, nasjonale og internasjonale fora, både vitskapelege og meir praksisnære. På lang sikt kan forskinga som inngår i kandidatens doktorgrad bidra til at viktigheita av lys blir løfta fram som eit viktig omsyn ein må ta i utbygging av sjukeheimar og i den daglege drifta.

Atferdsproblemer og symptomer på psykisk lidelse (Behavioral and psychological symptoms of dementia; BPSD) og søvnproblemer, og 90 % rammes i løpet av demensforløpet. BPSD omfatter symptomer som utagerende atferd, angst, nedstemthet, hallusinasjoner og vrangforestillinger. BPSD viser døgnfluktuasjon, der atferdsforstyrrelser ofte er mer uttalt om ettermiddag og kveld (kalt sundowning). BPSD og søvnproblemer er ofte belastende, ikke bare for den personen som lider av demens, men også for deres omsorgspersoner; både familie og helsepersonell. Omlag 80 % av sykehjemspopulasjonen har symptomer forenlig med demens. Sykehjemspasienter med demens får ofte flere ulike psykofarmaka å lindre søvn og atferdsforstyrrelser, men studier tyder på lite gunstige effekter, og betydelige bivirkninger. Samtidig er det økende støtte for bruk av ikke-farmakologiske tiltak i denne populasjonen. Lys har i flere studier vist å forbedre både døgnrytme, søvn og BPSD, men mer forskning er nødvendig. Hovedmålet til DEM.LIGHT studien er å undersøke effekten av lysterapi-rom på søvn og BPSD (primærmål) hos sykehjemspasienter med demens med en klynge-randomisert kryssbalansert studie. Vi vil rekruttere 60 pasienter fra 6 demensenheter (en enhet = 1 klynge) ved 2-3 sykehjem i Bergen. Døgnrytmen vår synkroniseres av daglys, som er best simulert av lysterapi gitt fra takmonterte LED-kilder. Lyset vil bli installert i fellesrom både i intervensjons- og kontrollenhetene. I intervensjonsbetingelsen administreres følgende lys: a) 07:00-10:00: 500 lux i øyehøyde, 4000 Kelvin(K), b) 10:00-16:00: 1000 lux, 6000 K, c)16:00-20:00: 500 lux, 4000 K, og 20:00-07:00, vil standard lys (100 lux, 3000K) være tilgjengelig. I kontrollgruppen vil standard lys gis 07:00-20:00, tilgjengelig 20:00-07:00. Vi benytter validerte instrumenter og objektive mål (kroppstemperatur og aktigrafer) for effekt-mål av intervensjonen etter 4 måneder.

Publications from Cristin

No publications found

No publications found

No publications found

No publications found

Funding scheme:

OFFPHD-Offentlig sektor-ph.d.