The Rhythm of the Unit Is the Pace of Life: A Study of Everyday Activities and Sleep in Swedish Residential Care
Affiliation(s)
1 Department of Health and Caring Sciences, Linnæus University, Kalmar, Sweden. 2 Department of Health Sciences, Lund University, Lund, Sweden. 3 Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden. 4 Department of Care Science, Malmö University, Malmö, Sweden. 5 Blekinge Centre of Competence, Karlskrona, Sweden.
1 Department of Health and Caring Sciences, Linnæus University, Kalmar, Sweden. 2 Department of Health Sciences, Lund University, Lund, Sweden. 3 Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden. 4 Department of Care Science, Malmö University, Malmö, Sweden. 5 Blekinge Centre of Competence, Karlskrona, Sweden.
ABSTRACT
Social and physical activities can improve sleep in older people. However, living in a residential care facility has been associated with a limited potential for activities and increased inactivity, reflected in poor sleep among residents. In turn, poor sleep can impair physical and mental functions. This paper explores sleep habits and everyday activities at three residential care facilities and investigates the link between sleep habits and everyday activities from the perspective of the residents. Data were collected through observations of daily life and interviews with residents. The results showed that fixed times during the day reduced daytime sleep and motivated them to go to the day room, thus enabling social interaction. More impaired residents spent more time in the day room napping or being less active. The residents stated that going outdoors was a desired activity, thought to improve sleep. However, the activity did not occur to the extent the residents wished for. Maintaining mobility and influence over daily activities together with regularity seemed to improve sleep. Awareness among staff of the need for stimulating and enriching activities, as well as access to bright light is requisite. Specific consideration should be given to residents who have difficulties communicating their wishes and/or impaired mobility.
Social and physical activities can improve sleep in older people. However, living in a residential care facility has been associated with a limited potential for activities and increased inactivity, reflected in poor sleep among residents. In turn, poor sleep can impair physical and mental functions. This paper explores sleep habits and everyday activities at three residential care facilities and investigates the link between sleep habits and everyday activities from the perspective of the residents. Data were collected through observations of daily life and interviews with residents. The results showed that fixed times during the day reduced daytime sleep and motivated them to go to the day room, thus enabling social interaction. More impaired residents spent more time in the day room napping or being less active. The residents stated that going outdoors was a desired activity, thought to improve sleep. However, the activity did not occur to the extent the residents wished for. Maintaining mobility and influence over daily activities together with regularity seemed to improve sleep. Awareness among staff of the need for stimulating and enriching activities, as well as access to bright light is requisite. Specific consideration should be given to residents who have difficulties communicating their wishes and/or impaired mobility.
Cite this paper
Hellström, A. , Condelius, A. , Willman, A. , Fagerström, C. (2015) The Rhythm of the Unit Is the Pace of Life: A Study of Everyday Activities and Sleep in Swedish Residential Care. Open Journal of Nursing, 5, 697-706. doi: 10.4236/ojn.2015.58073.
Hellström, A. , Condelius, A. , Willman, A. , Fagerström, C. (2015) The Rhythm of the Unit Is the Pace of Life: A Study of Everyday Activities and Sleep in Swedish Residential Care. Open Journal of Nursing, 5, 697-706. doi: 10.4236/ojn.2015.58073.
References
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http://dx.doi.org/10.1111/j.1532-5415.2010.02815.x [2] Ancoli-Israel, S. and Shochat, T. (2010) Insomnia in Older Adults. In: Kryger, M.H., Roth, T. and Dement, W.C., Eds., Priciples and Practice of Sleep Medicine, Saunders Elsevier, Philadelphia, 1544-1550. [3] Herrmann, W.J. and Flick, U. (2011) Nursing Home Residents’ Self-Perceived Resources for Good Sleep. Scandinavian Journal of Primary Health Care, 29, 247-251.
http://dx.doi.org/10.3109/02813432.2011.628243 [4] Lee, Y. And Kim, S. (2008) Effects of Indoor Gardening on Sleep, Agitation, and Cognition in Dementia Patients—A Pilot Study. International Journal of Geriatric Psychiatry, 23, 485-489.
http://dx.doi.org/10.1002/gps.1920 [5] Richards, K.C., et al. (2011) Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial. Journal of American Geriatrics Society, 59, 214-223.
http://dx.doi.org/10.1111/j.1532-5415.2010.03246.x [6] Cooke, J.R. and Ancoli-Israel, S. (2006) Sleep and Its Disorders in Older Adults. Psychiatric Clinics of North America, 29, 1077-1093; Abstract x-xi.
http://dx.doi.org/10.1016/j.psc.2006.08.003 [7] Zisberg, A., et al. (2007) A Concept Analysis of Routine: Relevance to Nursing. Journal of Advanced Nursing, 57, 442-453.
http://dx.doi.org/10.1111/j.1365-2648.2007.04103.x [8] Song, Y., et al. (2009) Rest-Activity Patterns in Institutionalized Korean Older Adults with Dementia: A Pilot Study. Journal of Gerontological Nursing, 35, 20-28; Quiz 30-31.
http://dx.doi.org/10.3928/00989134-20091109-99 [9] Bliwise, D.L. (2010) Sleep in Independently Living and Institutionalized Elderly. In: Kryger, M.H., Roth, T. and Dement, W.C., Eds., Principles and Practice of Sleep Medicine, Saunders Elsevier, Philadelphia, 1551-1561. [10] The National Board of Health and Welfare (2010) Vad tycker de äldre om äldreomsorgen?—En rikstäckande undersökning av äldres uppfattning om kvaliteten i hemtjänst och äldreboenden 2010 [What Is the Elderlys’ Opinion on Elderly Care?—A National Survey of Elderly Persons’ Perceptions of Quality in Home-Help Service and Residential Care Facilities 2010]. [11] Alessi, C.A. and Schnelle, J.F. (2000) Approach to Sleep Disorders in the Nursing Home Setting. Sleep Medicine Reviews, 4, 45-56.
http://dx.doi.org/10.1053/smrv.1999.0066 [12] Ancoli-Israel, S., Ayalon, L. and Salzman, C. (2008) Sleep in the Elderly: Normal Variations and Common Sleep Disorders. Harvard Review of Psychiatry, 16, 279-286.
http://dx.doi.org/10.1080/10673220802432210 [13] Neikrug, A.B. and Ancoli-Israel, S. (2010) Sleep Disturbances in Nursing Homes. Journal of Nutrition, Health & Aging, 14, 207-211.
http://dx.doi.org/10.1007/s12603-010-0051-8 [14] Bliwise, D.L. (1993) Sleep in Normal Ageing and Dementia. Sleep, 16, 40-81. [15] Fagerström, C. and Hellström, A. (2011) Sleep Complaints and Their Association with Comorbidity and Health-Related Quality of Life in an Older Population in Sweden. Aging and Mental Health, 15, 204-213.
http://dx.doi.org/10.1080/13607863.2010.513039 [16] Monjan, A.A. (2010) Perspective on Sleep and Aging. Frontiers in Neurology, 1, 1-9.
http://dx.doi.org/10.3389/fneur.2010.00124 [17] Rama, A.N., Cho, S.C. and Kushida, C.A. (2006) Normal Human Sleep. In: Lee-Chiong, T., Ed., Sleep: A Comprehensive Handbook, John Wiley & Sons, Hoboken, 3-11. [18] Chen, K.M., et al. (2009) Sleep Quality, Depression State, and Health Status of Older Adults after Silver Yoga Exercises: Cluster Randomized Trial. International Journal of Nursing Studies, 46, 154-163.
http://dx.doi.org/10.1016/j.ijnurstu.2008.09.005 [19] Irwin, M.R., Olmstead, R. and Motivala, S.J. (2008) Improving Sleep Quality in Older Adults with Moderate Sleep Complaints: A Randomized Controlled Trial of Tai Chi Chih. Sleep, 31, 1001-1008. [20] Li, F., et al. (2004) Tai Chi and Self-Rated Quality of Sleep and Daytime Sleepiness in Older Adults: A Randomized Controlled Trial. Journal of American Geriatrics Society, 52, 892-900.
http://dx.doi.org/10.1111/j.1532-5415.2004.52255.x [21] Berg, B. (2009) Qualitative Research Methods. 7th Edition, Allyn & Bacon, Boston. [22] Bolster, D. and Manias, E. (2010) Person-Centred Interactions between Nurses and Patients during Medication Activities in an Acute Hospital Setting: Qualitative Observation and Interview Study. International Journal of Nursing Studies, 47, 154-165.
http://dx.doi.org/10.1016/j.ijnurstu.2009.05.021 [23] Burnard, P., et al. (2008) Analysing and Representing Qualitative Data. British Dental Journal, 204, 429-432.
http://dx.doi.org/10.1038/sj.bdj.2008.292 [24] Downe-Wamboldt, B. (1992) Content Analysis: Method, Applications, and Issues. Health Care for Women International, 13, 313-321.
http://dx.doi.org/10.1080/07399339209516006 [25] Burnard, P. (1991) A Method of Analysing Interview Transcripts in Qualitative Research. Nurse Education Today, 11, 461-466.
http://dx.doi.org/10.1016/0260-6917(91)90009-Y [26] Alftberg, Å. (2012) Vad är det att åldras? [What Is It to Grow Old?]. In: Alftberg, Å., Ed., Humanistiska Fakulteten, Faculty of Humanities, Lund University, Lund, 176. [27] Eyers, I., et al. (2012) Rhetoric and Reality of Daily Life in English Care Homes: The Role of Organized Activities. International Journal of Ageing and Later Life, 7, 53-78.
http://dx.doi.org/10.3384/ijal.1652-8670.11132 [28] Andersson, I., Pettersson, E. and Sidenvall, B. (2007) Daily Life after Moving into a Care Home—Experiences from Older People, Relatives and Contact Persons. Journal of Clinical Nursing, 16, 1712-1718.
http://dx.doi.org/10.1111/j.1365-2702.2007.01703.x [29] Rosenthal, L. (2006) Physiologic Processes during Sleep. In: Lee-Chiong, T., Ed., Sleep: A comprehensive handbook, John Wiley & Sons, Hoboken, 19-25. [30] Martin, J.L. and Alessi, C.A. (2006) Sleep in Institutionalized Older Adults. In: Lee-Chiong, T., Ed., Sleep: A Comprehensive Handbook, John Wiley and Sons Inc., Hoboken, 615-621. [31] Sloane, P.D., et al. (2007) High-Intensity Environmental Light in Dementia: Effect on Sleep and Activity. Journal of American Geriatrics Society, 55, 1524-1533.
http://dx.doi.org/10.1111/j.1532-5415.2007.01358.x [32] Chaperon, C.M., Farr, L.A. and LoChiano, E. (2007) Sleep Disturbance of Residents in a Continuing Care Retirement Community. Journal of Gerontological Nursing, 33, 21-28. [33] Hauge, S. and Heggen, K. (2008) The Nursing Home as a Home: A Field Study of Residents’ Daily Life in the Comon Living Rooms. Journal of Clinical Nursing, 17, 460-467. [34] Casey, D. and Murphy, K. (2009) Issues in Using Methodological Triangulation in Research. Nurse Researcher, 16, 40-55.
http://dx.doi.org/10.7748/nr2009.07.16.4.40.c7160 [35] Tobin, G.A. and Begley, C.M. (2004) Methodological Rigour within a Qualitative Framework. Journal of Advanced Nursing, 48, 388-396.
http://dx.doi.org/10.1111/j.1365-2648.2004.03207.x [36] Moon, M.D., et al. (2013) Evaluating Qualitative Research Studies for Use in the Clinical Setting. Journal of Emergency Nursing, 39, 508-510.
http://dx.doi.org/10.1016/j.jen.2013.06.009 [37] Graneheim, U.H. and Lundman, B. (2004) Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001 [38] O’Connell, S.E., Griffiths, P.L. and Clemes, S.A. (2014) Seasonal Variation in Physical Activity, Sedentary Behaviour and Sleep in a Sample of UK Adults. Annals of Human Biology, 41, 1-8.
http://dx.doi.org/10.3109/03014460.2013.827737
[1] Martin, J.L., et al. (2010) Sleep Quality in Residents of Assisted Living Facilities: Effect on Quality of Life, Functional Status, and Depression. Journal of American Geriatrics Society, 58, 829-836.
http://dx.doi.org/10.1111/j.1532-5415.2010.02815.x [2] Ancoli-Israel, S. and Shochat, T. (2010) Insomnia in Older Adults. In: Kryger, M.H., Roth, T. and Dement, W.C., Eds., Priciples and Practice of Sleep Medicine, Saunders Elsevier, Philadelphia, 1544-1550. [3] Herrmann, W.J. and Flick, U. (2011) Nursing Home Residents’ Self-Perceived Resources for Good Sleep. Scandinavian Journal of Primary Health Care, 29, 247-251.
http://dx.doi.org/10.3109/02813432.2011.628243 [4] Lee, Y. And Kim, S. (2008) Effects of Indoor Gardening on Sleep, Agitation, and Cognition in Dementia Patients—A Pilot Study. International Journal of Geriatric Psychiatry, 23, 485-489.
http://dx.doi.org/10.1002/gps.1920 [5] Richards, K.C., et al. (2011) Strength Training, Walking, and Social Activity Improve Sleep in Nursing Home and Assisted Living Residents: Randomized Controlled Trial. Journal of American Geriatrics Society, 59, 214-223.
http://dx.doi.org/10.1111/j.1532-5415.2010.03246.x [6] Cooke, J.R. and Ancoli-Israel, S. (2006) Sleep and Its Disorders in Older Adults. Psychiatric Clinics of North America, 29, 1077-1093; Abstract x-xi.
http://dx.doi.org/10.1016/j.psc.2006.08.003 [7] Zisberg, A., et al. (2007) A Concept Analysis of Routine: Relevance to Nursing. Journal of Advanced Nursing, 57, 442-453.
http://dx.doi.org/10.1111/j.1365-2648.2007.04103.x [8] Song, Y., et al. (2009) Rest-Activity Patterns in Institutionalized Korean Older Adults with Dementia: A Pilot Study. Journal of Gerontological Nursing, 35, 20-28; Quiz 30-31.
http://dx.doi.org/10.3928/00989134-20091109-99 [9] Bliwise, D.L. (2010) Sleep in Independently Living and Institutionalized Elderly. In: Kryger, M.H., Roth, T. and Dement, W.C., Eds., Principles and Practice of Sleep Medicine, Saunders Elsevier, Philadelphia, 1551-1561. [10] The National Board of Health and Welfare (2010) Vad tycker de äldre om äldreomsorgen?—En rikstäckande undersökning av äldres uppfattning om kvaliteten i hemtjänst och äldreboenden 2010 [What Is the Elderlys’ Opinion on Elderly Care?—A National Survey of Elderly Persons’ Perceptions of Quality in Home-Help Service and Residential Care Facilities 2010]. [11] Alessi, C.A. and Schnelle, J.F. (2000) Approach to Sleep Disorders in the Nursing Home Setting. Sleep Medicine Reviews, 4, 45-56.
http://dx.doi.org/10.1053/smrv.1999.0066 [12] Ancoli-Israel, S., Ayalon, L. and Salzman, C. (2008) Sleep in the Elderly: Normal Variations and Common Sleep Disorders. Harvard Review of Psychiatry, 16, 279-286.
http://dx.doi.org/10.1080/10673220802432210 [13] Neikrug, A.B. and Ancoli-Israel, S. (2010) Sleep Disturbances in Nursing Homes. Journal of Nutrition, Health & Aging, 14, 207-211.
http://dx.doi.org/10.1007/s12603-010-0051-8 [14] Bliwise, D.L. (1993) Sleep in Normal Ageing and Dementia. Sleep, 16, 40-81. [15] Fagerström, C. and Hellström, A. (2011) Sleep Complaints and Their Association with Comorbidity and Health-Related Quality of Life in an Older Population in Sweden. Aging and Mental Health, 15, 204-213.
http://dx.doi.org/10.1080/13607863.2010.513039 [16] Monjan, A.A. (2010) Perspective on Sleep and Aging. Frontiers in Neurology, 1, 1-9.
http://dx.doi.org/10.3389/fneur.2010.00124 [17] Rama, A.N., Cho, S.C. and Kushida, C.A. (2006) Normal Human Sleep. In: Lee-Chiong, T., Ed., Sleep: A Comprehensive Handbook, John Wiley & Sons, Hoboken, 3-11. [18] Chen, K.M., et al. (2009) Sleep Quality, Depression State, and Health Status of Older Adults after Silver Yoga Exercises: Cluster Randomized Trial. International Journal of Nursing Studies, 46, 154-163.
http://dx.doi.org/10.1016/j.ijnurstu.2008.09.005 [19] Irwin, M.R., Olmstead, R. and Motivala, S.J. (2008) Improving Sleep Quality in Older Adults with Moderate Sleep Complaints: A Randomized Controlled Trial of Tai Chi Chih. Sleep, 31, 1001-1008. [20] Li, F., et al. (2004) Tai Chi and Self-Rated Quality of Sleep and Daytime Sleepiness in Older Adults: A Randomized Controlled Trial. Journal of American Geriatrics Society, 52, 892-900.
http://dx.doi.org/10.1111/j.1532-5415.2004.52255.x [21] Berg, B. (2009) Qualitative Research Methods. 7th Edition, Allyn & Bacon, Boston. [22] Bolster, D. and Manias, E. (2010) Person-Centred Interactions between Nurses and Patients during Medication Activities in an Acute Hospital Setting: Qualitative Observation and Interview Study. International Journal of Nursing Studies, 47, 154-165.
http://dx.doi.org/10.1016/j.ijnurstu.2009.05.021 [23] Burnard, P., et al. (2008) Analysing and Representing Qualitative Data. British Dental Journal, 204, 429-432.
http://dx.doi.org/10.1038/sj.bdj.2008.292 [24] Downe-Wamboldt, B. (1992) Content Analysis: Method, Applications, and Issues. Health Care for Women International, 13, 313-321.
http://dx.doi.org/10.1080/07399339209516006 [25] Burnard, P. (1991) A Method of Analysing Interview Transcripts in Qualitative Research. Nurse Education Today, 11, 461-466.
http://dx.doi.org/10.1016/0260-6917(91)90009-Y [26] Alftberg, Å. (2012) Vad är det att åldras? [What Is It to Grow Old?]. In: Alftberg, Å., Ed., Humanistiska Fakulteten, Faculty of Humanities, Lund University, Lund, 176. [27] Eyers, I., et al. (2012) Rhetoric and Reality of Daily Life in English Care Homes: The Role of Organized Activities. International Journal of Ageing and Later Life, 7, 53-78.
http://dx.doi.org/10.3384/ijal.1652-8670.11132 [28] Andersson, I., Pettersson, E. and Sidenvall, B. (2007) Daily Life after Moving into a Care Home—Experiences from Older People, Relatives and Contact Persons. Journal of Clinical Nursing, 16, 1712-1718.
http://dx.doi.org/10.1111/j.1365-2702.2007.01703.x [29] Rosenthal, L. (2006) Physiologic Processes during Sleep. In: Lee-Chiong, T., Ed., Sleep: A comprehensive handbook, John Wiley & Sons, Hoboken, 19-25. [30] Martin, J.L. and Alessi, C.A. (2006) Sleep in Institutionalized Older Adults. In: Lee-Chiong, T., Ed., Sleep: A Comprehensive Handbook, John Wiley and Sons Inc., Hoboken, 615-621. [31] Sloane, P.D., et al. (2007) High-Intensity Environmental Light in Dementia: Effect on Sleep and Activity. Journal of American Geriatrics Society, 55, 1524-1533.
http://dx.doi.org/10.1111/j.1532-5415.2007.01358.x [32] Chaperon, C.M., Farr, L.A. and LoChiano, E. (2007) Sleep Disturbance of Residents in a Continuing Care Retirement Community. Journal of Gerontological Nursing, 33, 21-28. [33] Hauge, S. and Heggen, K. (2008) The Nursing Home as a Home: A Field Study of Residents’ Daily Life in the Comon Living Rooms. Journal of Clinical Nursing, 17, 460-467. [34] Casey, D. and Murphy, K. (2009) Issues in Using Methodological Triangulation in Research. Nurse Researcher, 16, 40-55.
http://dx.doi.org/10.7748/nr2009.07.16.4.40.c7160 [35] Tobin, G.A. and Begley, C.M. (2004) Methodological Rigour within a Qualitative Framework. Journal of Advanced Nursing, 48, 388-396.
http://dx.doi.org/10.1111/j.1365-2648.2004.03207.x [36] Moon, M.D., et al. (2013) Evaluating Qualitative Research Studies for Use in the Clinical Setting. Journal of Emergency Nursing, 39, 508-510.
http://dx.doi.org/10.1016/j.jen.2013.06.009 [37] Graneheim, U.H. and Lundman, B. (2004) Qualitative Content Analysis in Nursing Research: Concepts, Procedures and Measures to Achieve Trustworthiness. Nurse Education Today, 24, 105-112.
http://dx.doi.org/10.1016/j.nedt.2003.10.001 [38] O’Connell, S.E., Griffiths, P.L. and Clemes, S.A. (2014) Seasonal Variation in Physical Activity, Sedentary Behaviour and Sleep in a Sample of UK Adults. Annals of Human Biology, 41, 1-8.
http://dx.doi.org/10.3109/03014460.2013.827737