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Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults
OBJECTIVE: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666546/ https://www.ncbi.nlm.nih.gov/pubmed/23723696 http://dx.doi.org/10.2147/CIA.S44926 |
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author | Chong, Mei Sian Tan, Keng Teng Tay, Laura Wong, Yoke Moi Ancoli-Israel, Sonia |
author_facet | Chong, Mei Sian Tan, Keng Teng Tay, Laura Wong, Yoke Moi Ancoli-Israel, Sonia |
author_sort | Chong, Mei Sian |
collection | PubMed |
description | OBJECTIVE: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients. METHOD: A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini–Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed. RESULTS: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype. CONCLUSION: This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies. |
format | Online Article Text |
id | pubmed-3666546 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-36665462013-05-30 Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults Chong, Mei Sian Tan, Keng Teng Tay, Laura Wong, Yoke Moi Ancoli-Israel, Sonia Clin Interv Aging Original Research OBJECTIVE: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000–3000 lux; 6–10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients. METHOD: A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini–Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient’s GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed. RESULTS: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep–wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype. CONCLUSION: This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies. Dove Medical Press 2013 2013-05-22 /pmc/articles/PMC3666546/ /pubmed/23723696 http://dx.doi.org/10.2147/CIA.S44926 Text en © 2013 Chong et al, publisher and licensee Dove Medical Press Ltd This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. |
spellingShingle | Original Research Chong, Mei Sian Tan, Keng Teng Tay, Laura Wong, Yoke Moi Ancoli-Israel, Sonia Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title | Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title_full | Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title_fullStr | Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title_full_unstemmed | Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title_short | Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
title_sort | bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666546/ https://www.ncbi.nlm.nih.gov/pubmed/23723696 http://dx.doi.org/10.2147/CIA.S44926 |
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