scholarly journals 261 Sleep and Frailty: Examining the Effects of Frailty on Sleep Disturbance in Hospitalised Older Adults

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Helen Mannion ◽  
Rónán O'Caoimh
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Cognitive Status ◽  
University Hospital ◽  
Charlson Comorbidity Index Score ◽  
Night Time ◽  
Clinical Frailty Scale ◽  
Prolonged Length ◽  
Frail Patients

Abstract Background Sleep disturbance is common in hospital, potentially resulting in poor clinical outcomes. Frailty is similarly prevalent and associated with multiple adverse events. Despite this, little is known about the interaction between frailty and sleep among older hospital inpatients. Methods Consecutive, non-critically ill patients aged ≥70, admitted medically through a large university hospital emergency department (ED) during the preceding 24 hours, were evaluated with measures assessing overnight sleep quality (Richards Campbell Sleep Questionnaire/RCSQ), baseline sleep (Pittsburgh Sleep Quality Index/PSQI) and insomnia (Insomnia Severity Index/ISI). Additional variables included medications, frailty (PRISMA-7 scores ≥3 and Clinical Frailty Scale/CFS scores ≥5), functional and cognitive status, and night-time noise levels. Patients were reassessed 48 hours later. Results Over four weeks, 152 patients, mean age 80 (±6.8) years were included; 61% were male (n=92). In all, 43% were frail (mean CFS score 4.23±1.6), median PRISMA-7 score 4±4; a further 24% were pre-frail. The median Charlson Comorbidity Index score was 6±2. The majority, 72% (110/152), reported impaired baseline sleep quality (PSQI ≥5) and 13% (20/152) had clinical insomnia (ISI ≥15). The median time spent in ED was 23±13 hours, median duration asleep was only one hour (range 0-8). After adjusting for possible confounders, frailty status was significantly associated with lower PSQI (p<0.001) but not ISI (p=0.07) and RCSQ (p=0.07) scores. Frail patients were twice as likely to report poor baseline sleep OR 2, (95% CI:1.3-3.2). Baseline and overnight sleep disturbance were not associated with prolonged length of stay (LOS) or 30-day readmission rates. Conclusion The prevalence of sleep disturbance and clinical insomnia among older adults admitted through ED is high and overnight sleep quality low, although these did not impact on LOS or 30-day re-admission rates. Frail patients reported significantly poorer baseline sleep but did not have higher rates of insomnia or experience worse overnight sleep.

scholarly journals Sleep Disturbance in Older Patients in the Emergency Department: Prevalence, Predictors and Associated Outcomes

2019 ◽  
Vol 16 (19) ◽  
pp. 3577 ◽  
Author(s):  
Helen Mannion ◽  
D. William Molloy ◽  
Rónán O’Caoimh
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Cognitive Status ◽  
University Hospital ◽  
Night Time ◽  
Admission Rates ◽  
Significant Difference ◽  
One Year ◽  
Impaired Sleep

Impaired sleep is common in hospital. Despite this, little is known about sleep disturbance among older adults attending Emergency Departments (ED), particularly overnight-boarders, those admitted but housed overnight while awaiting a bed. Consecutive, medically-stable patients aged ≥70, admitted through a university hospital ED were evaluated for overnight sleep quality (Richards Campbell Sleep Questionnaire/RCSQ) and baseline sleep (Pittsburgh Sleep Quality Index/PSQI). Additional variables included frailty, functional and cognitive status, trolley location, time in ED and night-time noise levels. Over four-weeks, 152 patients, mean age 80 (± 6.8) years were included; 61% were male. Most (68%) were ED boarders (n = 104) and 43% were frail. The majority (72%) reported impaired sleep quality at baseline (PSQI ≥ 5) and 13% (20/152) had clinical insomnia. The median time spent in ED for boarders was 23 h (Interquartile ± 13). After adjusting for confounders, median RCSQ scores were significantly poorer for ED boarders compared with non-boarders: 22 (± 45) versus 71 (± 34), respectively, (p = 0.003). There was no significant difference in one-year mortality (p = 0.08) length of stay (LOS) (p = 0.84), 30-day (p = 0.73) or 90-day (p = 0.64) readmission rates between boarders and non-boarders. Sleep disturbance is highly prevalent among older adults admitted through ED. ED boarders experienced significantly poorer sleep, without this impacting upon mortality, LOS or re-admission rates.

scholarly journals Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients With COVID-19: A Retrospective Observational Study.

2021 ◽  
Author(s):  
Christopher N Osuafor ◽  
Catriona Davidson ◽  
Alistair J Mackett ◽  
Marie Goujon ◽  
Lelane Van Der Poel ◽  
...  
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Clinical Features ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Clinical Frailty Scale ◽  
Frail Patients

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19, and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio [HR], 95% Confidence Interval). Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to non-frail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs 20.8%, p&lt;0.001) and were more likely to die (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24). Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission and diagnosis should prompt early advanced care planning.

scholarly journals Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

2020 ◽  
Author(s):  
Christopher N Osuafor ◽  
Catriona Davidson ◽  
Alistair J Mackett ◽  
Marie Goujon ◽  
Lelane Van Der Poel ◽  
...  
Keyword(s):  
Older Adults ◽  
Observational Study ◽  
Clinical Features ◽  
University Hospital ◽  
Retrospective Observational Study ◽  
Clinical Frailty Scale ◽  
Atypical Symptoms ◽  
Risk Of Death ◽  
Frail Patients ◽  
Older Inpatients

Abstract Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.

Sleep disturbances in adults with frailty and sarcopenia

2020 ◽  
Vol 21 (2) ◽  
pp. 89-107
Author(s):  
Reona Chiba ◽  
Yuki Ohashi ◽  
Akiko Ozaki
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Sleep Quality ◽  
Sleep Disturbances ◽  
Short Sleep Duration ◽  
Night Time ◽  
Content Type ◽  
Age Related ◽  
Increased Risk ◽  
The Relationship

Purpose Several epidemiological studies have reported an age-related increase in the prevalence of sleep disturbances. This study aims to investigate the relationship between sleep and sarcopenia/frailty in older adults and clarify issues that remain to be addressed in future studies. Design/methodology/approach PubMed was searched for relevant studies with the following keywords in the title: “sleep” and “sarcopenia” or “sleep” and “frailty.” A total of 15 studies published in English between 1998 and 2018 were reviewed. Findings Among the four studies that examined the relationship between sarcopenia and sleep, two reported that long or short sleep duration increased the risk of sarcopenia and this association was more pronounced in women than men. Among the seven studies examining the relationship between frailty and sleep, four reported that higher Pittsburgh Sleep Quality Index (PSQI) scores were associated with an increased risk of frailty. Practical implications Most previous studies have focused on interventions targeting a single area such as muscle strength or exercise habits, in older adults at risk for frailty. The results suggest that interventions targeting improved sleep may positively impact the maintenance of muscle strength. Originality/value The literature review revealed that too much or too little sleep increases the risk of sarcopenia in older adults. Further, sleep deprivation, greater night-time wakefulness and reduced sleep quality increase the risk of frailty. Interestingly, the risk of mortality is increased in individuals with daytime functional disorders such as excessive drowsiness or napping habits.

An Assessment of Sleep Disturbance in Patients before and after Carpal Tunnel Release

2019 ◽  
Vol 24 (02) ◽  
pp. 144-146 ◽  
Author(s):  
John Erickson ◽  
Daniel Polatsch ◽  
Steven Beldner ◽  
Eitan Melamed
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbance ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Continuous Variables ◽  
Night Time ◽  
Before And After ◽  
Tunnel Syndrome ◽  
English Speaking

Background: Night time numbness is a key characteristic of CTS and relief of night time symptoms is one of the outcomes most important to patients. This study tested the null hypothesis that there is no difference between sleep quality and night symptoms before and after carpal tunnel release (CTR). Methods: Forty-four, English-speaking adult patients requesting open CTR for electrodiagnostically confirmed carpal tunnel syndrome completed questionnaires before and after surgery. Average age was 59, 24 patients were men and 20 were women. Patient with a primary or secondary sleep disorder were excluded. Before surgery, patients completed the Pittsburg Sleep Quality index (PSQI). At an average of 3 months after surgery, participants completed PSQI questionnaires. Onset of sleep quality improvement was specifically addressed. Differences between preoperative and postoperative sleep quality were evaluated using the paired t-test. Spearman correlations were used to assess the relationship between continuous variables. Results: Of the 44 patients, 32 (72%) were classified as poor sleepers (PSQI > 5.5) prior to surgery. At 3 months follow up, there was a significant improvement PSQI global scores (7.8 ± 5.1 vs 4 ± 3.5, p < 0.001) as well as subdivisions. Daytime dysfunction (0.2 ± 0.4, p < 0.001) and medication use (1.0 ± 1.2 vs 0.9 ± 1.2, p < 0.045) secondary to sleep disturbance and was improved as well. In all patients, onset of improvement was within 24 hours of surgery. Conclusions: CTR is associated with improvement in sleep quality at 3 months follow-up. CTR improves daytime dysfunction related to the sleep disturbance. The onset of sleep improvement is 24 hours after surgery in most cases.

scholarly journals Sleep disturbances and frailty status in older adults in Vietnam

2021 ◽  
Vol 141 (5) ◽  
pp. 69-74
Author(s):  
Nguyen Trung Anh ◽  
Nguyen Thi Ngoc Anh ◽  
Dang Thi Xuan ◽  
Nguyen Xuan Thanh
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Early Morning ◽  
Cross Sectional Study ◽  
Poor Sleep ◽  
Cross Sectional ◽  
Frailty Status ◽  
Geriatric Hospital

This cross-sectional study aimed to describe sleep disturbance and its association with frailty syndrome among 903 older adults at the National Geriatric Hospital in Vietnam. Frailty was diagnosed according to the Fried criteria. Sleep disturbances was assessed based on the Pittsburgh Sleep Quality Index (PSQI). Of 903 patients, the mean age was 71.8 (SD = 8.5), and 537 (59.5%) were female. Most (96.7%) of the patients diagnosed with frailty had poor sleep; 95.3% had to get up at midnight or early morning; 93.3% could not sleep within 30 minutes; 86% had sleep efficiency less than 85%; 53.3% coughed at night; 50.7% had nightmares; and 27.3% and 22.7% of patients felt hot and cold, respectively. The majority (80.0%) of patients must get up to use the bathroom. In conclusion, most older adult diagnosed with frailty experienced at least one form of of sleep disturbance. Medical staffs should attend to the patient’s sleep quality, especially in patients with frailty.

513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
M Thomas ◽  
M Baltatzis ◽  
A Price ◽  
L Pearce ◽  
J Fox ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Cholangitis ◽  
Pancreatic Disease ◽  
Biliary Disease ◽  
Clinical Frailty Scale ◽  
Care Level ◽  
Frail Patients ◽  
Common Diagnosis ◽  
Endoscopic Cholangiopancreatography ◽  
Observational Cohort

Abstract Introduction The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay. Methods Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission. Results We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%). Conclusion Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.

scholarly journals Association of Qi-stagnation and Subjective Sleep Characteristics with Mild Cognitive Impairment Among Non-depressed Elderly in Community: A Cross-Sectional Study

2021 ◽  
Author(s):  
Zhizhen Liu ◽  
Jingsong Wu ◽  
Youze He ◽  
Jingnan Tu ◽  
Lei Cao ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Sleep Latency ◽  
Subjective Sleep Quality ◽  
Subjective Sleep ◽  
Qi Stagnation

Abstract Objective: Depression and sleep disturbance is commonly reported in patients with mild cognitive impairment (MCI). However, it remains unclear whether Qi-stagnation is still a risk factor for MCI before the older adults suffer from depression. The purpose of this study was to examine the association between Qi-stagnation and subjective sleep quality with MCI among non-depressed elderly in the Chinese community.Methods: A simple random sampling method was used to abstract research subjects from 34 community elderly day care centers in Fuzhou city based on their electronic health records from March 2019 to December 2020. Intensive face-to-face interviews were conducted using tools such as Montreal cognitive function assessment, AD8 dementia screening questionnaire, Pittsburgh Sleep Quality Index, and TCM constitution assessment scale, among others to analyze the proportion of older adults with MCI who suffer from sleep disturbance and Qi-stagnation in the community. Multi-factor logistical regression was employed to analyze the association among subjective sleep quality, TCM constitution, and MCI.Results: A total of 1,268 subjects were investigated and 1,071 cases were included in this study, among which 314 cases were of MCI patients, with a morbidity of 29.3%. The proportion of individuals having Qi-deficiency (12.4%) and Qi-stagnation (11.1%) was higher in MCI patients than in the controls with normal cognitive function (P<0.05). After adjusting for age, gender, and years of education, the probability of the old with Qi-deficiency and Qi-stagnation suffering from MCI was 1.559 times [95% confidence interval (CI): 1.009–2.407] and 1.706 times (95% CI: 1.078–2.700) higher than that of the older adults without Qi-deficiency and Qi-stagnation, respectively. In the Pittsburgh sleep quality index (PSQI) scale, individuals with MCI had poorer subjective sleep quality (Z=-3.404, P=0.001), longer sleep latency (Z=-3.398, P=0.001), shorter sleep duration (Z=-2.237, P=0.025), and aggravated daytime dysfunction (Z=-3.723, P<0.001) compared with those without MCI. The intergroup differences showed no statistical significance in the three dimensions including habitual sleep efficiency, sleep disturbance, and hypnotics between groups. The results of multi-factor logistical regression showed that sleep latency [odds ratio (OR)=1.168, 95% CI: 1.016–1.342], daytime dysfunction (OR=1.261, 95% CI: 1.087–1.463), and Qi-stagnation (OR=1.449, 95% CI: 1.022–2.055) were the risk factors for MCI; the OR for older adults with sleep disturbance and Qi-stagnation suffering from MCI was 2.581 (95% CI 1.706–3.907).Conclusion: MCI patients have a higher incidence of sleep disorders and Qi-stagnation, and may show specific changes in their daytime and nighttime sleep characteristics, with the specific manifestations such as difficulty in falling asleep, easily waking up at night/ early morning, and daytime dysfunction, among others.

scholarly journals Night-time Noise Levels and Patients’ Sleep Experiences in a Medical Assessment Unit in Northern England

2020 ◽  
Vol 14 (1) ◽  
pp. 80-91
Author(s):  
Felicity Astin ◽  
John Stephenson ◽  
Jonathan Wakefield ◽  
Ben Evans ◽  
Priyanka Rob ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbance ◽  
Sound Level ◽  
Care Quality ◽  
International Studies ◽  
Noise Levels ◽  
Medical Assessment ◽  
Night Time ◽  
Sleep Quantity ◽  
Assessment Unit

Background: Hospital in-patients need sleep so that restorative process and healing can take place. However, over one third of in-patients experience sleep disturbance, often caused by noise. This can compromise patients’ perceptions of care quality and cause physical and psychological ill health. Aims: To assess 1) in-patients sleep quality, quantity, reported sources of sleep disturbance and their suggestions for improvement 2) objectively measure decibel levels recorded at night. Methods: This descriptive study conducted in a Medical Assessment Unit used multi-methods; a semi-structured ‘sleep experience’ questionnaire administered to a purposive sample of in-patients; recording of night-time noise levels, on 52 consecutive nights, using two calibrated Casella sound level meters. Results: Patient ratings of ‘in-hospital’ sleep quantity (3.25; 2.72 SD) and quality (2.91; 2.56 SD) was poorer compared to ‘home’ sleep quantity (5.07; 2.81 SD) and quality (5.52; 2.79 SD). The difference in sleep quality (p<0.001) and quantity (p<0.001) ratings whilst in hospital, compared to at home, was statistically significant. Care processes, noise from other patients and the built environment were common sources of sleep disturbance. Participants’ suggestions for improvement were similar to interventions identified in current research. The constant noise level ranged from 38-57 decibels (equivalent to an office environment), whilst peak levels reached a maximum of 116 decibels, (equivalent to banging a car door one metre away). Conclusion: The self-rated patient sleep experience was significantly poorer in hospital, compared to home. Noise at night contributed to sleep disturbance. Decibel levels were equivalent to those reported in other international studies. Data informed the development of a ‘Sleep Smart’ toolkit designed to improve the in-patient sleep experience.

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