Hostname: page-component-55f67697df-4ks9w Total loading time: 0 Render date: 2025-05-10T09:17:59.854Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects on sleep from group activity with a robotic seal for nursing home residents with dementia: a cluster randomized controlled trial

Published online by Cambridge University Press:  28 September 2020

Nina Jøranson Open the ORCID record for Nina Jøranson [Opens in a new window] ,
Christine Olsen ,
Giovanna Calogiuri ,
Camilla Ihlebæk  and
Ingeborg Pedersen
Nina Jøranson*
Affiliation:
VID Specialized University, Faculty of Health Studies, Campus Diakonhjemmet, P.O. Box 184 Vinderen, N-0319Oslo, Norway
Christine Olsen
Affiliation:
Norwegian Center of Anthrozoology, Ås, Norway
Giovanna Calogiuri
Affiliation:
Inland Norway University of Applied Sciences, Faculty of Social and Health Sciences, Department of Public Health and Sport Sciences, Elverum, Norway
Camilla Ihlebæk
Affiliation:
Norwegian University of Life Sciences, LANDSAM, Department of Public Health Science, Ås, Norway Østfold University College, Faculty of Health and Social Studies, Fredrikstad, Norway
Ingeborg Pedersen
Affiliation:
Norwegian University of Life Sciences, LANDSAM, Department of Public Health Science, Ås, Norway
*
Correspondence should be addressed to: Nina Jøranson, VID Specialized University, Faculty of Health Studies, Campus Diakonhjemmet, P.O. Box 184 Vinderen, N-0319Oslo, Norway. Phone: +47 22 45 18 36. Email: [email protected]
Get access

Abstract

Objectives:

Sleep disturbances are common in people with dementia and increase with the severity of the disease. Sleep disturbances are complex and caused by several factors and are difficult to treat. There is a need for more robust and systematic studies dealing with sleep disturbances in older people with dementia. The aim of this study was to investigate effects from robot-assisted (Paro) group activity on sleep patterns in nursing home (NH) residents with dementia.

Design:

A cluster randomized controlled trial.

Setting:

Special care units in 10 NH in Norway.

Participants:

A total of 60 participants over 65 years with dementia were recruited. Thirty participants were recruited to the intervention group and 30 participants to the control group.

Intervention:

Participants participated in group activity with Paro for 30 minutes twice a week over 12 weeks or in control group (treatment as usual).

Measurements:

Sleep–wake patterns were assessed objectively by 7 days of wrist actigraphy before and after the intervention. Data were collected between March 2013 and September 2014. Data were analyzed using mixed models.

Results:

Positive effects on change in sleep were found in the intervention group as compared with the control group. The intervention group increased percentage of sleep efficiency, increased the amount of total sleep time and reduced number of nocturnal awakenings. In addition, a significant effect was found in reduced awakenings after sleep onset.

Conclusions:

Social stimulation through engaging group activity could contribute to improved sleep in people with dementia in NH. Increased sleep efficiency and total sleep time, in addition to fewer night awakenings, affect central indicators of good sleep quality across the life span. Improved sleep quality will also affect quality of life and comorbidities in vulnerable groups. We believe group activity with Paro to be an accessible and feasible non-pharmacological treatment for those who enjoy Paro.

Keywords

dementia caresleepParo-activitynon-pharmacological interventionRCTnursing home
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 10: Issue Theme: Non-cognitive Concerns in People with Dementia , October 2021 , pp. 1045 - 1056
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ancoli-Israel, S., Clopton, P., Klauber, M. R., Fell, R. and Mason, W. (1997). Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep, 20, 24–27.CrossRefGoogle ScholarPubMed
Bates-Jensen, B. M. et al. (2004). The Minimum Data Set bedfast quality indicator: differences among nursing homes. Nursing Research, 53, 260–272. doi: 10.1097/00006199-200407000-00009.CrossRefGoogle ScholarPubMed
Blytt, K. M., Bjorvatn, B., Husebo, B. and Flo, E. (2017). Clinically significant discrepancies between sleep problems assessed by standard clinical tools and actigraphy. BMC Geriatrics, 17, 253. doi: 10.1186/s12877-017-0653-7.CrossRefGoogle ScholarPubMed
Brown, C. A., Berry, R., Tan, M. C., Khoshia, A., Turlapati, L. and Swedlove, F. (2013). A critique of the evidence base for non-pharmacological sleep interventions for persons with dementia. Dementia, 12, 210–237. doi: 10.1177/1471301211426909.CrossRefGoogle ScholarPubMed
Calogiuri, G., Weydahl, A. and Carandente, F. (2013). Methodological issues for studying the rest–activity cycle and sleep disturbances: a chronobiological approach using actigraphy data. Biological Research for Nursing, 15, 5–12. doi: 10.1177/1099800411416224.CrossRefGoogle ScholarPubMed
Capezuti, E., Sagha Zadeh, R., Pain, K., Basara, A., Jiang, N. Z. and Krieger, A. C. (2018). A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings. BMC Geriatrics, 18, 143. doi: 10.1186/s12877-018-0794-3.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Marx, M. S., Dakheel-Ali, M., Regier, N. G. and Thein, K. (2010). Can persons with dementia be engaged with stimuli? American Journal of Geriatric Psychiatry, 18, 351–362. doi: 10.1097/Jgp.0b013e3181c531fd.CrossRefGoogle ScholarPubMed
Cole, C. S. and Richards, K. C. (2005). Sleep and cognition in people with Alzheimer’s disease. Issues in Mental Health Nursing, 26, 687–698. doi: 10.1080/01612840591008258.CrossRefGoogle ScholarPubMed
Conley, S. et al. (2019). Agreement between actigraphic and polysomnographic measures of sleep in adults with and without chronic conditions: a systematic review and meta-analysis. Sleep Medicine Reviews, 46, 151–160. doi: 10.1016/j.smrv.2019.05.001.CrossRefGoogle ScholarPubMed
David, R. et al. (2012). Decreased daytime motor activity associated with apathy in Alzheimer disease: an actigraphic study. American Journal of Geriatric Psychiatry, 20, 806–814. doi: 10.1097/Jgp.0b013e31823038af.CrossRefGoogle Scholar
Dijk, D.-J. and Lockley, S. W. (2002). Invited review: integration of human sleep-wake regulation and circadian rhythmicity. Journal of Applied Physiology, 92, 852–862. doi: 10.1152/japplphysiol.00924.2001.CrossRefGoogle Scholar
Dzierzewski, J. M., Dautovich, N. and Ravyts, S. (2018). Sleep and cognition in older adults. Sleep Medicine Clinics, 13, 93–106. doi: 10.1016/j.jsmc.2017.09.009.CrossRefGoogle ScholarPubMed
Eggermont, L. H. P., Blankevoort, C. G. and Scherder, E. J. A. (2010). Walking and night-time restlessness in mild-to-moderate dementia: a randomized controlled trial. Age and Ageing, 39, 746–749. doi: 10.1093/ageing/afq115.CrossRefGoogle ScholarPubMed
Engedal, K. and Haugen, P. K. (2018). Environmental treatment. In: Engedal, K. and Haugen, P. K. (Eds.), Dementia—Diseases, Diagnostics and Treatment. Tønsberg: Forlaget aldring og helse - akademisk.Google Scholar
Fetveit, A. and Bjorvatn, B. (2002). Sleep disturbances among nursing home residents. International Journal of Geriatric Psychiatry, 17, 604–609. doi: 10.1002/gps.639.CrossRefGoogle ScholarPubMed
Finkel, S. I., Lyons, J. S. and Anderson, R. L. (1993). A brief agitation rating scale (BARS) for nursing home elderly. Journal of the American Geriatrics Society, 41, 50–52. doi: 10.1111/j.1532-5415.1993.tb05948.x.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and Mchugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Forbes, D., Blake, C. M., Thiessen, E. J., Peacock, S. and Hawranik, P. (2014). Light therapy for improving cognition, activities of daily living, sleep, challenging behaviour, and psychiatric disturbances in dementia. Cochrane Database of Systematic Reviews, 2, CD003946. doi: 10.1002/14651858.CD003946.pub4.Google Scholar
Friedmann, E., Galik, E., Thomas, S. A., Hall, P. S., Chung, S. Y. and Mccune, S. (2015). Evaluation of a pet-assisted living intervention for improving functional status in assisted living residents with mild to moderate cognitive impairment: a pilot study. American Journal of Alzheimer’s Disease & Other Dementias, 30, 276–289. doi: 10.1177/1533317514545477.CrossRefGoogle ScholarPubMed
Gulia, K. K. and Kumar, V. M. (2018). Sleep disorders in the elderly: a growing challenge. Psychogeriatrics, 18, 155–165. doi: 10.1111/psyg.12319.CrossRefGoogle ScholarPubMed
Hirshkowitz, M. et al. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 1, 40–43. doi: 10.1016/j.sleh.2014.12.010.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical-scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572. doi: 10.1192/bjp.140.6.566.CrossRefGoogle ScholarPubMed
Jøranson, N., Pedersen, I., Rokstad, A. M. M., Aamodt, G., Olsen, C. and Ihlebæk, C. (2016a). Group activity with Paro in nursing homes: systematic investigation of behaviors in participants. International Psychogeriatrics, 28, 1345–1354. doi: 10.1017/S1041610216000120.CrossRefGoogle ScholarPubMed
Jøranson, N., Pedersen, I., Rokstad, A. M. M. and Ihlebæk, C. (2015). Effects on symptoms of agitation and depression in persons with dementia participating in robot-assisted activity: a cluster-randomized controlled trial. Journal of the American Medical Directors Association, 16, 867–873. doi: 10.1016/j.jamda.2015.05.002.CrossRefGoogle ScholarPubMed
Jøranson, N., Pedersen, I., Rokstad, A. M. M. and Ihlebæk, C. (2016b). Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial. Journal of Advanced Nursing, 72, 3020-3033. doi: 10.1111/jan.13076 CrossRefGoogle ScholarPubMed
Kuck, J., Pantke, M. and Flick, U. (2014). Effects of social activation and physical mobilization on sleep in nursing home residents. Geriatric Nursing, 35, 455–461. doi: 10.1016/j.gerinurse.2014.08.009.CrossRefGoogle ScholarPubMed
Livingston, G. et al. (2017). Dementia prevention, intervention, and care. Lancet, 390, 2673–2734. doi: 10.1016/S0140-6736(17)31363-6.CrossRefGoogle ScholarPubMed
Malhotra, R. K. (2018). Neurodegenerative disorders and sleep. Sleep Medicine Clinics, 13, 63–70. doi: 10.1016/j.jsmc.2017.09.006.CrossRefGoogle ScholarPubMed
Mander, B. A., Winer, J. R. and Walker, M. P. (2017). Sleep and human aging. Neuron, 94, 19–36. doi: 10.1016/j.neuron.2017.02.004.CrossRefGoogle ScholarPubMed
Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R. and Alessi, C. A. (2007). A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. The Journals of Gerontology: Series A, 62, 67–72. doi: 10.1093/gerona/62.1.67.CrossRefGoogle ScholarPubMed
McCleery, J., Cohen, D. A. and Sharpley, A. L. (2016). Pharmacotherapies for sleep disturbances in dementia. Cochrane Database of Systematic Reviews, 11, CD009178. doi: 10.1002/14651858.CD009178.pub3.Google ScholarPubMed
Moyle, W. et al. (2018). Effect of a robotic seal on the motor activity and sleep patterns of older people with dementia, as measured by wearable technology: a cluster-randomised controlled trial. Maturitas, 110, 10–17. doi: 10.1016/j.maturitas.2018.01.007.CrossRefGoogle ScholarPubMed
Neikrug, A. B. and Ancoli-Israel, S. (2010). Sleep disorders in the older adult—a mini-review. Gerontology, 56, 181–189. doi: 10.1159/000236900.CrossRefGoogle ScholarPubMed
Nygaard, H. A. and Ruths, S. (2003). Missing the diagnosis: senile dementia in patients admitted to nursing homes. Scandinavian Journal of Primary Health Care, 21, 148–152. doi: 10.1080/02813430310001798.CrossRefGoogle ScholarPubMed
Ohayon, M. et al. (2017). National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health, 3, 6–19. doi: 10.1016/j.sleh.2016.11.006.CrossRefGoogle ScholarPubMed
Peter-Derex, L., Yammine, P., Bastuji, H. and Croisile, B. (2015). Sleep and Alzheimer’s disease. Sleep Medicine Reviews, 19, 29–38. doi: 10.1016/j.smrv.2014.03.007.CrossRefGoogle ScholarPubMed
Petrovsky, D. V., Mcphillips, M. V., Li, J., Brody, A., Caffeé, L. and Hodgson, N. A. (2018). Sleep disruption and quality of life in persons with dementia: a state-of-the-art review. Geriatric Nursing, 39, 640–645. doi: 10.1016/j.gerinurse.2018.04.014.CrossRefGoogle ScholarPubMed
Richards, K. C., Beck, C., O’sullivan, P. S. and Shue, V. M. (2005). Effect of individualized social activity on sleep in nursing home residents with dementia. Journal of the American Geriatrics Society, 53, 1510–1517. doi: 10.1111/j.1532-5415.2005.53460.x.CrossRefGoogle ScholarPubMed
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 the American Geriatrics Society, 59, 214–223. doi: 10.1111/j.1532-5415.2010.03246.x.CrossRefGoogle ScholarPubMed
Richards, K. C., Sullivan, S. C., Phillips, R. L., Beck, C. K. and Overton-Mccoy, A. L. (2001). The effect of individualized activities on the sleep of nursing home residents who are cognitively impaired: a pilot study. Journal of Gerontological Nursing, 27, 30–37.CrossRefGoogle ScholarPubMed
Sadeh, A. (2011). The role and validity of actigraphy in sleep medicine: an update. Sleep Medicine Reviews, 15, 259–267. doi: 10.1016/j.smrv.2010.10.001.CrossRefGoogle ScholarPubMed
Sadeh, A., Sharkey, M. and Carskadon, M. A. (1994). Activity-based sleep–wake Identification: an empirical test of methodological issues. Sleep, 17, 201–207. doi: 10.1093/sleep/17.3.201.CrossRefGoogle ScholarPubMed
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843–849. doi: 10.1002/gps.1749.CrossRefGoogle ScholarPubMed
Shang, B. et al. (2019). Nonpharmacological interventions to improve sleep in nursing home residents: a systematic review. Geriatric Nursing, 40, 405–416. doi: 10.1016/j.gerinurse.2019.01.001.CrossRefGoogle ScholarPubMed
Shibata, T., Wada, K., Saito, T. and Tanie, K. (2004). Robotic therapy at an elderly institution using a therapeutic robot. Annual Review of CyberTherapy and Telemedicine, 2, 125–136.Google Scholar
Smit, D., De Lange, J., Willemse, B., Twisk, J. and Pot, A. M. (2016). Activity involvement and quality of life of people at different stages of dementia in long term care facilities. Aging & Mental Health, 20, 100–109. doi: 10.1080/13607863.2015.1049116.CrossRefGoogle ScholarPubMed
Smith, M. T. et al. (2018). Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep–wake disorders: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 14, 1209–1230. doi: 10.5664/jcsm.7228.CrossRefGoogle ScholarPubMed
Thodberg, K. et al. (2015). Therapeutic effects of dog visits in nursing homes for the elderly. Psychogeriatrics, 16, 289–297. doi: 10.1111/psyg.12159.CrossRefGoogle ScholarPubMed
Trahan, M. A., Kuo, J., Carlson, M. C. and Gitlin, L. N. (2014). A systematic review of strategies to foster activity engagement in persons with dementia. Health Education & Behavior, 41, 70S-83S. doi: 10.1177/1090198114531782.CrossRefGoogle ScholarPubMed
Van De Water, A. T. M., Holmes, A. and Hurley, D. A. (2011). Objective measurements of sleep for non-laboratory settings as alternatives to polysomnography—a systematic review. Journal of Sleep Research, 20, 183–200. doi: 10.1111/j.1365-2869.2009.00814.x.CrossRefGoogle Scholar
Van Someren, E. J. W. et al. (1996). Circadian rest—activity rhythm disturbances in Alzheimer’s disease. Biological Psychiatry, 40, 259–270. doi: https://doi.org/10.1016/0006-3223(95)00370-3.CrossRefGoogle ScholarPubMed
Vitiello, M. V. and Borson, S. (2001). Sleep disturbances in patients with Alzheimer’s disease. CNS Drugs, 15, 777–796. doi: 10.2165/00023210-200115100-00004.CrossRefGoogle ScholarPubMed
Waite, L. et al. (1999). Informant-based staging of dementia using the clinical dementia rating. Alzheimer Disease & Associated Disorders, 13, 34–37.10.1097/00002093-199903000-00005CrossRefGoogle ScholarPubMed
West, B. T. (2009). Analyzing longitudinal data with the linear mixed models procedure in SPSS. Evaluation & the Health Professions, 32, 207–228. doi: 10.1177/0163278709338554.CrossRefGoogle ScholarPubMed
WHO 2017. Global action plan on the public health response to dementia 2017–2025 [Online]. Available at: https://www.who.int/mental_health/neurology/dementia/action_plan_2017_2025/en/ Google Scholar
Wilfling, D., Dichter, M. N., Trutschel, D. and Kopke, S. (2019). Prevalence of sleep disturbances in German nursing home residents with dementia: a multicenter cross-sectional study. Journal of Alzheimer’s Disease, 69, 227–236. doi: 10.3233/jad-180784.CrossRefGoogle ScholarPubMed
Wilfling, D. et al. (2020). Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review. International psychogeriatrics, 1–29. doi: 10.1017/S1041610220000733.Google ScholarPubMed