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Table 4 Characteristics of multi-component studies (n = 11)

From: A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings

      Environment CHP SPS CCP
First author, Year) Design, Number of groups, and type Setting (number of facilities), Number of participants, Mean age, % Male, Inclusion/exclusion criteria Description of intervention Effect (positive, mixed, none, or negative), Measurement of sleep, Main finding(s) Light Noise Melatonin Physical activity Individual care Less disruptions Mange Sleep wake
Alessi, 1999 [34] RCT Nursing home (n = 1); N = 29, mean age 88.3, 10% male, with incontinence Daytime physical activity and nighttime program to decrease noise and decrease sleep-disruptive nursing care practices 5 days per week for 14 weeks Positive; Actigraphy; Nighttime sleep increased from 51.7 to 62.5% (p = 0.045)   X   X    X
Alessi, 2005 [65] RCT Nursing home (n = 4): N = 118, mean age 86.8, 45% men Efforts to decrease daytime in-bed time, provide daily sunlight exposure for at least 30 min, increase physical activity, structure bedtime routines, and decrease nighttime noise and light for 5 consecutive days and nights Mixed; Actigraphy; Modest decrease in nighttime awakenings (p = 0.04) but no effect on % of nighttime sleep or number of nighttime awakenings X X   X   X X
Connel, 2007 [39] RCT Nursing home (n = 1), N = 20, mean age 79.7, 95% male, with dementia 1 h of group outdoor structured activity for 10 days (compared with indoor structured activity) Positive; Actigraphy; Maximum sleep duration increased and total sleep minutes significantly increased X    X    
Dowling, 2008 [66] RCT Nursing home (n = 2), N = 50, mean age 86, 14% men, with dementia Melatonin 5 mg & 1 h of morning bright light (≥  2500 lx) for 5 mid-week days per week for 10 weeks None; Actigraphy; No significant impact on sleep X   X     
Gammack, 2009 [72] RCT Nursing homes (n = 1), N = 24, mean age 79.5, 37.5% men, without dementia 60-min outdoor morning (between 7 am-12 pm) light and structured recreational activity for 21 days None; Medical Outcome Study Sleep Scale; No differences in sleep scores between treatment and controls X    X    
Ito, 2001 [70] Quasi-experimental pre-post intervention with comparison (bright light only) Nursing home, N = 28, mean age 78.3, 42.9% men, with Alzheimer’s disease Daily Vitamin B12 (1.5 mg for 2 weeks then 3.0 mg for 2 weeks) and 2-h morning (9 am–11 am) bright light (3000 lx) therapy for 4 weeks None; Actigraphy; No significant improvement in nighttime sleep outcomes X   X     
Martin, 2007 [52] RCT Nursing home (n = 4) N = 118, mean age 87.05, 78% men, with sleep disruption Exposure to outdoor bright light (at least 20,000 lx), efforts to keep residents out of bed during the day, bedtime routine, efforts to decrease nighttime noise and light, and structured physical activity for 10 min to 15 min 3 times per day for 5 days None; Actigraphy; Significant change only in the active phase of the rest/activity rhythms. Not able to significantly reduce nighttime noise and light. X    X    X
Ouslander, 2006 [54] RCT, clustered by facility Nursing home (n = 8), N = 160, mean age 83.2, 25% men Daytime activities, keep residents out of bed, evening bright light, consistent bedtime routine, nighttime care routines to minimize disruption, and strategies to reduce nighttime noise for 17 days None; Actigraphy and polysomnography; No improvement in nighttime sleep X X   X   X X
Riemersma-Van Der Lek, 2008 [27] RCT, clustered by facility with 4 groups (bright light, melatonin, combination, or none) Assisted-living facilities (n = 12), N = 189, mean age 85.8, 10% men, with dementia Whole-day bright light (10,000 lx) and 2.5 mg melatonin for a mean of 15 months Positive; Actigraphy; Combined treatment (light and melatonin) significantly ameliorated nocturnal restlessness, reduced awakenings, and increased sleep efficiency. Melatonin shortened sleep onset latency and increased sleep duration. X   X     
Schnelle, 1998 [44] Quasi-experimental pre-post intervention with comparison Nursing home (n = 4), N = 92, mean age 87.3, 19% men, with incontinence Individualized nighttime incontinence care (every 2 or 4 h and when awake) and minimized sleep disruption for 5 nights Positive; Actigraphy; Significant reduction in awakenings due to light and sound (p < 0.001) X X    X X  
Schnelle, 1999 [45] RCT Nursing home (n = 8), N = 267, mean age 83.95, 82% men, with incontinence Individualized nighttime incontinence care (every 2 or 4 h and when awake) and noise abatement and staff feedback to reduce noise for 5 nights Mixed; Actigraphy; Significant reduction in sleep awakenings with noise and light abatement but not in % sleep or sleep duration. Significant reductions in light events but not noise. X X    X X  
  1. CHP Complementary Health Practices, SPS Social/Physical Stimulation, CCP Clinical Care Practices, RCT Randomized controlled trial