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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...

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Autores principales: Chong, Mei Sian, Tan, Keng Teng, Tay, Laura, Wong, Yoke Moi, Ancoli-Israel, Sonia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2013
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.
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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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