Insomnia and Constipation in the Elderly patients - Term Paper Example

Mrs Richards, an 85 – year old woman in the residential care demonstrates dementia, which makes her restless and aggressive at times. The patient suffers from frequent falls, restlessness, insomnia, periodontal disease, dysphagia and constipation. Behavioral and psychological symptoms of dementia present a major challenge in the management of nursing home (NH) residents. At least 80% of patients with dementia will at some point develop symptoms such as aggression, irritability, restlessness, depression, and psychosis. Circadian rhythm disturbances in dementia often influence sleep and activity patterns (Ruth 2004). INSOMNIA The symptom of insomnia is defined as a complaint of difficulty falling asleep, staying asleep, or sleep that is nonrestorative. Epidemiological studies have confirmed a high prevalence of insomnia in older adults. When considering simply the complaint of insomnia, approximately 20 to 40% of older adults report at least one symptom. Studies reveal several consistent risk factors for insomnia. The first risk factor is age. The second risk factor is gender; the rates of insomnia in women are typically 20 to 50 % higher than in men. Third, previous insomnia is a risk factor for current insomnia; thus insomnia tends to be a persistent problem. Fourth, chronic health conditions are associated with insomnia. The number of medications taken is also related to insomnia, although the number may simply be a surrogate measure for the medical conditions they treat. Fifth, prevalence of insomnia is inversely related to socioeconomic status. Perhaps most importantly, several studies have shown that depression is a powerful risk factor for insomnia (Buysse 2004). Transient insomnia can be controlled with short-term use of a hypnotic medication. Management of persistent or chronic insomnia can be separated into primary and secondary interventions (Box). Sleep hygiene aims to establish proper daily habits that promote sleep and minimize daily habits that interfere with sleep (drinking coffee or engaging in stressful activities in the evening). Relaxation training can take various forms (progressive muscle relaxation, guided imagery, hypnosis, meditation, yoga, biofeedback), with the goal being the reduction of psychic and muscular tension causing hyper arousal and interference with sleep onset. Stimulus-control therapy is directed both to reducing arousing stimuli in the bedroom that interfere with falling asleep and reinforcing associations between the bed/bedroom and falling asleep. Box. Management of persistent or chronic insomnia When primary interventions are ineffective or partially effective in controlling insomnia, secondary interventions should be considered (Schenck 2003). For older people living in residential aged care facilities, the risk of sleep disturbances may be exacerbated due to a number of reasons. Environmental elements, such as increased light, noise and disruption to sleep by staff and other residents can substantially impact upon the quality of resident’s sleep. Intervention for the promotion of sleep Studies were identified which looked specifically at interventions for the promotion of sleep through modifying the nursing home environment, reduction in nocturnal nursing care, promoting exercise and daytime activity, light therapy, use of aromatherapy, use of valerian, light therapy, melatonin, pharmacological management or multidisciplinary approaches. Nursing home environment light minimization and noise abatement interventions A number of elements in the nursing home environment can impact negatively on resident’s sleep. One study found that reducing night lighting may assist in maintenance of resident’s circadian rhythms and prompt staff to maintain a quiet night-time environment. The study researchers recommended that protocols be adopted which prescribe headphones for night-time television watching to minimize disturbances to other residents, decreasing noise level of alarms and telephones at night and refraining from musing cleaning equipment at night. Nocturnal continence and pressure area care Individualized care regimes, based on assessment of resident’s bed mobility and risk of skin breakdown, or conducting hourly checks and only providing care when a resident is awake, were both found, in separate studies, to significantly improve resident’s sleep quantity. Nocturnal continence and pressure area care Individualized care regimens, based on assessment of residents bed mobility and risk of skin breakdown, or conducting hourly checks and only providing care when a resident is awake, were both found, in separate studies, to significantly improve resident’s sleep quantity. Daily routine and activities It has been suggested that daytime napping can contribute to night-time sleep disturbances. Therefore, maintaining physical activity during the day may have the may have the effect of decreasing daytime napping, and hopefully promoting better sleep. One uncontrolled quasi-experiment investigated the effect of individualized activity intervention. Programs included activities to meet residents’ specific interests and physical capabilities such as board games, ball games, music and simple crafts. All residents displayed improved nocturnal sleep, with an average increase of 6.7% (54.2% compared to 47.5%) of time spent sleeping at night (p Read More