Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

Mei Sian Chong,1 Keng Teng Tan,2 Laura Tay,1 Yoke Moi Wong,1 Sonia Ancoli-Israel3,41Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; 2Department of Pharmacy, Tan Tock Seng Hospital, Singapore; 3Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA;...

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Autores principales:	Chong MS, Tan KT, Tay L, Wong YM, Ancoli-Israel S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Sleep delirium function elderly Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/c04dc0d729694cba92b4ff923a330480
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spelling	oai:doaj.org-article:c04dc0d729694cba92b4ff923a3304802021-12-02T01:19:50ZBright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults1178-1998https://doaj.org/article/c04dc0d729694cba92b4ff923a3304802013-05-01T00:00:00Zhttps://www.dovepress.com/bright-light-therapy-as-part-of-a-multicomponent-management-program-im-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Mei Sian Chong,1 Keng Teng Tan,2 Laura Tay,1 Yoke Moi Wong,1 Sonia Ancoli-Israel3,41Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; 2Department of Pharmacy, Tan Tock Seng Hospital, Singapore; 3Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA; 4VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USAObjective: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.Method: A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini–Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.Results: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.Conclusion: This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.Keywords: sleep, delirium, function, elderlyChong MSTan KTTay LWong YMAncoli-Israel SDove Medical PressarticleSleepdeliriumfunctionelderlyGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 565-572 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sleep delirium function elderly Geriatrics RC952-954.6
spellingShingle	Sleep delirium function elderly Geriatrics RC952-954.6 Chong MS Tan KT Tay L Wong YM Ancoli-Israel S Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
description	Mei Sian Chong,1 Keng Teng Tan,2 Laura Tay,1 Yoke Moi Wong,1 Sonia Ancoli-Israel3,41Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; 2Department of Pharmacy, Tan Tock Seng Hospital, Singapore; 3Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA; 4VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USAObjective: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.Method: A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini–Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.Results: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.Conclusion: This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.Keywords: sleep, delirium, function, elderly
format	article
author	Chong MS Tan KT Tay L Wong YM Ancoli-Israel S
author_facet	Chong MS Tan KT Tay L Wong YM Ancoli-Israel S
author_sort	Chong MS
title	Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
title_short	Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
title_full	Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
title_fullStr	Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
title_full_unstemmed	Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
title_sort	bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/c04dc0d729694cba92b4ff923a330480
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Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

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