Evidence in Relation to Daytime Sleepiness in Aged Care Residents - Coursework Example

Evidence in Relation to Daytime Sleepiness in Aged Care Residents Introduction Nighttime sleep disruption is common in aged care residents and results to excessive daytime sleepiness. Causes of excessive daytime sleepiness consist of changes in chronobiology due to ageing, lifestyle habits, sleep disorders and other medical and psychological disorders, circadian rhythm abnormalities, medications, environmental factors, in addition to changed social patterns (Blake, Kerr & Gururajan, 2010). The focus of this paper is to find evidence and research on daytime sleepiness in aged care residents. Asking Clinical Question In older adults (P), does using non-pharmacologic strategies (I) as compared to pharmacologic strategies (C) to manage excessive daytime sleepiness, more effective in improved night sleep quantity (O)? P (population): Older adults I (intervention): Non-pharmacologic strategies C (comparison): Pharmacologic strategies O (outcome): Improved night sleep quantity The PICO question is type of foreground question and specifically a therapy question. This is because the question involves treatment (non-pharmacologic strategies/pharmacologic in treatment of daytime excessive sleepiness) in order to achieve some outcome (Improved night sleep quantity) (Dowson et al, 2010).   Process of Locating and Retrieving Evidence Locating and retrieving the best evidence depends on framing a focused clinical question that is searchable. Therefore, the PICO format of the clinical question frames an effective literature search. A literature search will be carried out to locate the best available evidence for the clinical question. USQ online databases will be used in retrieving the evidence. However, searching other databases such as: Pubmed; Cochrane Database of Systematic Reviews; and British Medical Journal (BMJ will be done to ensure all possibilities have been explored. The best available evidence will be retrieved using key words and terms from the clinical question. Accordingly, the key words and terms will be directly related to the clinical question and they will include: daytime sleepiness, older adults, medical conditions, psychological disorders, medications, non- pharmacologic strategies, drug prescriptions, nighttime sleep disruption and improved night sleep quantity. Numerous studies consisting of titles and abstracts of possible relevant studies will be identified through the search process and then the irrelevant ones will be excluded. The inclusion/exclusion criteria that will be applied to the identified titles and abstracts will encompass: English only, relevancy to the topic, suitability of the study results, recent studies (last 5 years), and reliability of the studies. Any study that does not meet any of the inclusion/exclusion criteria will not be done away with. Additionally, any study that does not relate to the clinical question in any way will be excluded. Retrieval of the full texts of the titles and abstracts that meet the inclusion/exclusion criteria will then follow (Shayna & Salimah, 2013). The retrieved studies will be examined further to ensure they all meet inclusion/exclusion criteria or relevancy. Further exclusion will be done to all studies with inadequate statistics, invalidated research methods or unclear results. The remaining studies will then be accepted to be used as evidence. The evidence will be used to establish what is already known regarding the research topic and indentify research gaps on the topic (Shayna & Salimah, 2013). A Summary of the Evidence ­­Authors and year of publication Hierarchy of Evidence – Type of Evidence & Ranking The Research Question / or Problem being addressed Ai m of the Study Description of participants/subjects involved in the study Type of Research Method Edwin Tan et al (2014) Cross-sectional study (Level 2) Pain and sleep disturbances in people in Australian residential aged care facilities To investigate the prevalence of daytime sedation in individuals within Australian residential aged care facilities 300 permanent residents in Australian aged care facilities in South Australia. The study participants included people with and without dementia. Inclusion criteria was people aged 65 years and above Experimental Blake, Jacqueline; Kerr, Don & Gururajan, Raj (2010) Design science approach (Level 5) Diagnosis of sleep problems To present the progress for the development of a patient data gathering system and decision support system ____ Program evaluation Boulos MI & Murray BJ (2010) Systematic review (Level 1) Neurological conditions with daytime sleepiness To find out important features in the diagnosis of daytime sleepiness and treatment approaches ____ Searches on Electronic Databases Deschenes Cynthia & McCurry Susan (2009) Systematic review (Level 1) Sleep disturbances in people with dementia To find out the current available treatments for people with sleep disturbances ____ Hand-searches of Published Literature Searches of Electronic Databases Dowson Leslie et al (2010) Systematic review (Level 1) Sleep disorders amongst older people in residential care To identify evidence‑based strategies to improve sleep in residential aged care facilities ____ Electronic database search Review of 34 papers Irwin Michael; Olmstead Richard & Motivala Saros (2010) Randomised controlled trial (RCT) (Level 2) Sleep complaints in older people s To establish the efficacy of a novel behavioral intervention in improving sleep quality in older people with sleep problems 112 healthy older adults, aged between 59 to 86 years Experimental Martin Jennifer & Ancoli- Israel Sonia (2009) Systematic review (Level 1) Sleep disturbances in long-term care To investigate about the causes of night sleep disturbances and treatments ­ ____ Hand-searches of Published Literature Searches of Electronic Databases McCurry Susan et al (2009) Systematic review (Level 1) Insomnia in older adults To identify treatment and management strategies of sleep problems in older adults Only studies that were randomized controlled group design or within-subject trials published in peer-reviewed journals before 2006 Computerized searches of electronic databases Hand searches of published reviews, meta-analyses, and journals allied to sleep and aging Schwartz Jonathan et al (2009) Systematic review (Level 1) Excessive sleepiness in primary care setting To find out the underlying causes, management and treatment of excessive sleepiness ____ Literature search using PubMed search engine Slater Gemma & Steier Joerg (2012) Systematic review (Level 1) Sleep disorders and Excessive daytime sleepiness To find out factors that put patients at high risk of day time sleepiness and treatment options to the underlying causes ____ Computerized searches of electronic databases for evidence based studies A Synthesis of the Evidence According to Martin & Ancoli-Israel (2009), the prevalence of chronic sleep disturbances and sleep complaints among the elderly is extremely high. This is supported by McCurry et al (2009) who found out that lack of sleep is very common among the aged and is allied to several individual socioeconomic consequences. The elderly usually suffer from chronic insomnia (difficulty in initiating, maintaining or getting restorative sleep) which is typified by difficulty in maintaining sleep rather than difficulty in sleep initiation (McCurry et al, 2009). McCurry et al, 2009) further stipulates that the aged population spends more time awake after initially falling asleep and thus problem in maintaining sleep is a primary symptom among the elderly. These findings were confirmed by Edwin et al (2014) who found that sleep among the elderly in Australian residential aged care facilities was typified by more frequent and prolonged awakening during the night (Edwin et al, 2014). As the evidence indicates, the aged have problems with sleeping during the night and as a result they tend to sleep during day. Sleeping during the day is what is known as excessive daytime sleepiness and is a manifestation of inadequate, poor or disturbed night’s sleep. This is in consistent with Schwartz et al (2009) who found out that the aged often sleep less deeply and wake up a lot of times throughout the night which is the reason they often sleep daytime. As per Slater & Steier (2012), the night sleep disturbances and the resulting excessive daytime sleepiness are due to various to various causes such as: physiologic changes allied to aging or dementing illness in the elderly; sleep disorders like sleep apnea; side effects of medications; medical and psychiatric factors; as well as environmental and behavioral aspects (Slater & Steier, 2012). Medical causes of sleep disturbances include non-prescription medications such as caffeine, prescription drugs such as corticosteroids, β-Blockers, Quinidine among others. Medical conditions such as sleep apnea, alcohol intoxication, pain from any cause or neurological causes such as Parkinson’s disease and Alzheimer or chronic illnesses. Psychological causes of sleep disturbances consist of anxiety, depression, bedtime worries as well as other life stressors. On the other hand, environmental causes include too hot/cold bedrooms, too much noise, daytime nap, and eating, exercising or taking drinks such as coffee during bedtime (Dowson et al, 2010). Studies indicate that sleep disturbances among the aged population are in most cases is due to existing chronic illness, general poor physical health and psychosocial morbidity (Deschenes & McCurry, 2009). For instance, the medical or psychiatric condition and drugs used in treating the condition might disrupt night sleep and hence contribute to excessive daytime sleepiness. Therefore, is important for healthcare providers to assess if excessive daytime sleepiness due to night sleep disturbances is a primary or secondary condition. Boulos & Murray (2010) explain there are pharmacologic and non-pharmacologic strategies used in management and treatment of excessive daytime sleepiness. Non-pharmacologic approaches to daytime sleepiness include sleep hygiene and behavioural strategies such as cognitive-behavioral therapy or supportive therapies. Pharmacologic therapies include medications benzodiazepines for treating the sleeping problems (Boulos & Murray, 2010). However, evidence shows that using pharmacologic therapy in treatment of excessive daytime sleepiness should consider the pharmacokinetic and pharmacodynamic changes in drug metabolism that characteristically come with the aging process (Dowson et al, 2010). Therefore, selection of suitable medication to treat excessive daytime sleepiness in older persons should be done cautiously. Drugs that impair cognitive and psychomotor functions can have significant effects for elderly persons (Schwartz et al, 2009). For instance, evidence shows that using benzodiazepines to treat sleep problems among the elderly has been associated with elevated risk of falling (Slater & Steier, 2012). Similarly, Deschenes & McCurry (2009) found out that use of diazepam to treat sleep problems for the elderly is a risk factor for multiple falls. Accordingly, use of pharmacologic therapy comes with various side effects to older persons. A randomized controlled trial by Irwin, Olmstead & Motivala (2010) employed non-pharmacologic approaches that consisted of behavioural recommendations for sleep improvement in older persons which centered in decreasing day in-bed time, having more social and physical activities as well as changing the environment to make it more favorable to nighttime sleep. The study results showed that the quantity and quality of night sleep improved and there were no side effects. Slater & Steier (2012) also found out that behavioral treatments for sleep problems such as stimulus control, progressive muscle relaxation, sleep hygiene education, as well as multicomponent cognitive-behavioral therapy are effective with older persons. As the evidence indicates, due to the risks and side effects associated with pharmacologic therapies, non-pharmacologic therapies are more recommended as first-line treatment for elderly persons with sleep problems (Martin & Ancoli- Israel, 2009). Evidence based strategies include maintenance of regular sleeping and waking times, limitation of daytime napping and limiting time in bed. Evidence also shows that dietary strategies consist of; having consistent meal times, limiting alcohol, nicotine and caffeine intake as well as visiting toilet prior to sleeping. In addition, sleeping environment is not supposed to be overly hot or cold and excess noise and light should be limited (Deschenes & McCurry, 2009). Critique of a Research Article Aspect Evidence Analysis Citation Schwartz J, Roth T, Hirshkowitz M, Wright J. (2009). Recognition and Management of Excessive Sleepiness in the Primary Care Setting. J Clin Psychiatry. 11(5): 197–204. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781030/ Was the purpose and/ research question stated clearly? No. The purpose of the research is not clearly stated. This purpose of the study is extremely general and does not clearly identify the aim of the study. Additionally, the study lacks a research question. Was relevant background literature reviewed? Yes. The article reviews enormous literature and a lot of previous studies as well. Specifically, the article reviewed literature and a number of studies from PubMed. Additionally, the article sufficiently discusses the literature on what is known about the study topic and therefore adequately provides the background of the study topic. Was a theoretical perspective identified? No. The article does not identify any theoretical perspective. Many studies have been reviewed on the study topic and thus a lot is known about this topic. With enourmous information available on the topic, the article should have had a theoretical perspective to base the study. The process of purposeful selection was described? A literature search was done using PubMed search engine. English-language search terms and keywords related to the study topic were used to locate articles and this means that only studies and articles that were relevant to the article’s topic were included. Further information was identified using bibliography reviews of relevant articles. Sampling was done until redundancy in data was reached? Yes. All the relevant data to the study was retrieved from the PubMed database. Only studies that were not relevant to the study were excluded. Data collection strategies appropriate? No. The article does not clearly describe data collection strategies and only briefly discusses data collection aspect in the abstract. Process of analysing the data was described adequately? No. Just like data collection, the article does not describe how the data was analysed. No data presentation was done and obviously the article ignored an important element of any study. Ethical considerations There are no ethical considerations in the article. The article does not show if any permit was sought from the relevant prior to conducting the study. The study involved accessing clinical data from secondary sources and hence it would have been appropriate for the study to state ethical considerations such as marinating confidentiality. Conclusions were appropriate given the study findings? Yes. Conclusions were appropriate since they are supported by previous study findings. The article concludes that excessive daytime sleep among the aged can be successfully treated by treating and managing the root cause problem rather than treating the symptoms. These conclusions have been validated by many previous studies. The findings contributed to future practice? Yes. The findings have been validated by other previous studies and therefore the findings can be used in future practice. Conclusion According to the evidence, nighttime sleep disruption among the elderly and it is what causes excessive daytime sleepiness. Causes of sleep problems in the elderly are many and they include environmental factors, medication, medical reasons among others. Excessive daytime sleepiness can be managed through pharmacologic and non-pharmacologic strategies. The reviewed evidence shows that non-pharmacologic are more preferable because pharmacologic approaches come with some side effects that are harmful to the elderly persons. References Andrew T, Bell J, Vitry A et al. (2014). Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol. BMJ Open. 5(6): DOI:10.1136/bmjopen-2014-005757. Blake, Jacqueline and Kerr, Don and Gururajan, Raj (2010) Development of knowledge management support for the sleep disorder diagnosis process. In: ACIS 2010: 21st Australasian Conference on Information Systems: Information Systems: Defining and Establishing a High Impact Discipline, 1-3 Dec 2010, Brisbane, Australia. Boulos M & Murray B. (2010). Current evaluation and management of excessive daytime sleepiness. Can J Neurol Sci. 37(2):167-76. Deschenes C & McCurry S. (2009). Current Treatments for Sleep Disturbances in Individuals with Dementia. Curr Psychiatry Rep. 11(1): 20–26. Dowson L, Moore K, Ledgerwood K & Dow B. (2010). Sleep in residential aged care: A review of the literature. Australian Journal Of Advanced Nursing. 29(4): 11-19. Irwin M, Olmstead R & Motivala S. (2010). Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi. The American Geriatrics Society. 55:511–551. Martin J & Ancoli- Israel S. (2009). Sleep Disturbances in Long-Term Care. Clin Geriatr Med. 24(1): 39–vi. DOI:  10.1016/j.cger.2007.08.001. McCurry S, Gibbons L, Logsdon R, Vitiello M & Teri L. (2009). Insomnia In Caregivers Of Persons With Dementia: Who Is At Risk And What Can Be Done About It?Sleep Med Clin. 4(4): 519–526. Schwartz J, Roth T, Hirshkowitz M, Wright J. (2009). Recognition and Management of Excessive Sleepiness in the Primary Care Setting. J Clin Psychiatry. 11(5): 197–204. Shayna B & Salimah S. (2013). Retrieving Clinical Evidence: A Comparison of PubMed and Google Scholar for Quick Clinical Searches. JMR Publications. 15(8). Slater G & Steier J. (2012). Excessive daytime sleepiness in sleep disorders. J Thorac Dis. 4(6): 608–616. DOI:  10.3978/j.issn.2072-1439.2012.10.07. Read More