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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3025 — Daytime Sleeping is Associated with Receiving Less Therapy Among Older Rehabilitation Patients

Author List:
Martin JL (VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center - Sepulveda, and University of California, Los Angeles)
Webber AP (University of California, Los Angeles)
Alam T (University of California, Los Angeles)
Josephson KR (VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center - Sepulveda)
Harker JO (VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center - Sepulveda)
Alessi CA (VA Greater Los Angeles Healthcare System Geriatric Research, Education and Clinical Center - Sepulveda, and University of California, Los Angeles)

Objectives:
Cognitive impairment, depression, and health status impact participation in and outcomes of rehabilitation among older people. In addition, we have evidence that daytime sleeping (but not nighttime sleep disruption) attenuates functional improvement during rehabilitation. The current study tested the hypothesis that more daytime sleeping is related to less actual participation in therapy (i.e., minutes of therapy per day) among older people undergoing rehabilitation after an acute hospital stay.

Methods:
We enrolled 245 patients over age 65 at one VA (n=87) and one community (n=158) post-acute rehabilitation site. Daytime percent sleeping (i.e., percent time asleep, 8am-8pm) was estimated by wrist actigraphy for one week. Other measures included: Mini-Mental State Examination (MMSE), 15-item Geriatric Depression Scale (GDS-15), and Cumulative Illness Rating Scale-Geriatrics (CIRS-G; a comorbidity measure). Processes of rehabilitation were abstracted from medical records using a standardized protocol, and minutes of physical and occupational therapy received each day during which therapy was available (i.e., excluding holidays and weekends) was computed. Multiple linear regression was used to determine whether MMSE, CIRS, GDS, and percent daytime sleeping predicted minutes of therapy received per day.

Results:
Mean age of participants (38% women) was 80 years; mean MMSE was 23.5. On average, participants received 78 minutes of therapy per day, and slept 16% of the day (2 hours total, characterized by frequent, brief sleep episodes; not a consolidated nap). In bivariate analyses, more minutes of therapy per day was related to better CIRS-G (r=-.31, p<.001), better MMSE (r=.14, p=.03), and lower percent daytime sleeping (r=-.18, p=.01). In a regression analysis (F=5.57, p<.001), more daytime sleeping was associated with fewer minutes of therapy per day (t= -3.38, p<.001). Findings were identical when VA and community sites were examined separately.

Implications:
Daytime sleeping during rehabilitation is associated with reduced participation in therapy activities among older people (measured by minutes of therapy received per day), even when other potential predictors are taken into account.

Impacts:
Daytime sleeping is an important, potentially modifiable predictor of less participation in rehabilitation among older veterans and non-veterans. Research is needed to target recommendations for reducing daytime sleeping among older patients in VA and community rehabilitation facilities.


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