Date of Award

2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Barbara J. Riegel

Abstract

ABSTRACT

UNDERSTANDING SLEEP AND SLEEP DISTURBANCES IN NURSING-HOME ELGIBLE COMMUNITY DWELLING OLDER ADULTS: A MIXED METHODS STUDY

Miranda S. Varrasse

Barbara J. Riegel

It is estimated that one-half to two-thirds of older adults have at least one sleep related complaint and older adults with chronic conditions and functional limitations are even more likely to suffer from sleep disturbances. Sleep disturbances can lead to poor overall health, a decrease in physical and cognitive function, and an increase in health care service utilization and cost. Yet, sleep complaints are often underreported and underdiagnosed. Nursing-home eligible older adults who remain living in the community are at an increased risk of nursing home placement, due to their high level of care needs, comorbidities and functional status. Sleep disturbances may increase the risk of decline but relatively little is known about sleep disturbances in this high risk group. The overall purpose of this concurrent nested mixed methods study [QUAL+quan] was to describe sleep characteristics in 40 nursing-home eligible, community dwelling older adults. Qualitative data were weighted more heavily and obtained via semi-structured interviews. Quantitative data consisted of three self-report sleep surveys and one week of actigraphy and sleep diary. Data were collected concurrently and analyzed sequentially.

Our final sample of 40 older adults was comprised of Black (100%), primarily female (85%) older adults with a mean age of 72.37 � 9.54. The two major findings were: 1) the majority of the sample had objectively poor sleep quality and napped frequently during the day, regardless of self-perceptions of sleep quality, and 2) these older adults had adjusted their health expectations and adapted to their sleep disturbances. We also identified modifiable targets for intervention development and testing. To our knowledge this is the first mixed methods study of sleep in nursing-home eligible, community dwelling, at-risk older adults. These results begin to equip us to intervene on modifiable factors that have the potential to improve health outcomes in this vulnerable population.

Available for download on Thursday, July 23, 2020

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