Keeping nighttime fright away

Every care community administrator knows that nighttime can be a frightening time for some seniors. When the sun goes down, physical and psychological issues that often plague residents can pose a challenge to even the most astute care staff. And the problems could be widespread. In a 2005 Gallup poll of 1,000 adults over the age of 50, only about one-third of those surveyed reported get-ting a good night’s sleep all seven days of the week—even though respondents ranked good sleep as more important even than interpersonal relationships.

Sonia Ancoli-Israel, PhD, professor of psychiatry at the University of California at San Diego and director of the Sleep Disorders Clinic at the Veterans Affairs San Diego Healthcare System, notes that it’s not necessarily the aging process that disturbs sleep, but rather those changes that accompany getting older. “In addition to medical illnesses and medications common in older adults, there can be psychiatric problems and changes in circadian rhythms,” she says.

Ancoli-Israel conducted a study five years ago that exposed patients with dementia living in nursing homes to either morning or evening bright light in an effort to adjust the body’s circadian rhythms. Both techniques improved nighttime sleep. While conducting the studies, Ancoli-Israel observed firsthand how fragmented sleep can be for those individuals who are in a nursing home setting, a situation that may leave these older adults in “a constant state of dozing” during the day. That’s what makes environment an impor-tant determinant of sleep patterns, she says.

“An assisted living facility environment shouldn’t be much different from living at home,” Ancoli-Israel says. “The difficulty comes when seniors move into a community living situation where they have a roommate who’s on a different schedule and who might be a reader at night, or even someone who paces or screams at night.”

Ancoli-Israel encourages care commun-ity administrators to match residents’ sleep patterns and agitation levels as much as possible. “That’s not always an easy thing to do, but certainly something to consider,” she says, adding that nursing homes can be particularly noisy places at night. “I like to encourage care community staff to use quiet voices at night, avoid moving noisy carts down hallways, and keep light levels low. Make the room as dark as possible and, if residents are sleeping, avoid turning on overhead lights and instead use such tools as a pin light.”

When sleep is not an option, despite environmental changes, there are also creative ways to help residents make it through the night. For example, Jenny Graham, executive director of Juniper Village at Louisville, a 52-unit Alzheimer’s and dementia community near Boulder, Colorado, suggests keeping residents active during the day, without a lot of rest periods. When that isn’t sufficient, staff has planned nighttime activities such as playing cards and trivia games, or they’ve given residents who can’t sleep volunteer tasks to keep them occupied while awake.

“Our job here is to create relationships, get to know our residents, and read their life stories,” Graham says. “Some come into our community looking for their families, fearful of their surroundings, and suspicious of new caregivers, and it can take them from a few days to a month to adjust to their new home. For others, issues occur sporadically and their problems go in cycles. Still others may get up to go to the bathroom then have trouble going back to bed. If residents are awake, we like to play Parcheesi and trivia games, and work large-sized puzzles. Some residents like to fold towels and linens and wash counters, it depends on the resident.”

Graham notes, “We have a resident who is very high-functioning, but has breathing problems that make it difficult for her to sleep through the night. When she is awake, she appreciates the companionship she receives from the staff, including playing games and drinking hot chocolate.”

Sometimes the assistance of professional nighttime caregivers can be called upon. Graham recalls, “One family moved their mother here from their home where she was surrounded by children and grandchildren. Initially, she was very lonely and didn’t want to go to sleep. So the family hired a professional caregiver to sit with her, stroke her hair, and wait for her to fall asleep.”

Such caregivers can be called upon to help seniors who return to a care community from a hospitalization or surgery, rehabilitation, or a skilled care unit. Dean Price, franchise owner of the Home Instead Senior Care office serving Colorado in Boulder and Broomfield counties, says one of the best forms of reassurance is human contact. As a direct caregiver, he employs screened, bonded, and insured caregivers who often supplement the work of staff by providing such nonmedical assistance as companionship.

Price experienced a situation several years ago that has helped him empathize with his senior clients: “Two years ago I fell off a ladder and was left alone for brief periods both in the emergency room and after surgery. I made decisions on my state of health based on whether I was alone or someone was with me, and I think that’s the way it is with seniors, as well. The reassurance of waking up and having someone there to tell you that it’s OK is just a huge help.”

Price says his professional goal is to keep seniors independent for as long as possible, regardless of their setting: “Residents often ask, ‘Can you hand me that book, fix my nightgown, and give me a glass of water?’ Those are tasks we can assist with, particularly at night.”

Case in point: At Juniper Village at Louisville, residents are organized into four communities of 13 each. One staffer is assigned to each 13-resident group at night, as compared with two to two-and-a-half staffers during the day. Graham notes that residents can quickly call staff at night, but when someone is having more problems than is typical of an aging senior, her staff recommends additional assistance. Caregiving companies are hired by families, but often reviewed by Juniper Village and carefully screened before being allowed to work at the care community. The caregivers are also monitored while they are in the community. Outside caregivers are required to follow facility rules. Companies whose caregivers are asked to keep a client log in the room are also an asset, says Graham. The log charts all of the activities that occur with the client during a given shift. “The log is intended to serve as communication among the outside caregivers who are serving the resident, but it’s helpful to our staff and the families, too,” she says.

Graham concludes, “Our staff is responsible for the care of the resident day or night. But outside nighttime caregivers are a great help for residents who need to get out of bed, who must be reminded to go back to bed, and who just want to talk during the night.”

Georgene Lahm is a writer based in Omaha, Nebraska. With more than 750 independently owned and operated offices in the United States, Canada, Japan, Portugal, Australia, Ireland, New Zealand, United Kingdom, Taiwan, and Spain, Home Instead Senior Care is the world’s largest provider of nonmedical home care services to the elderly.

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