Sensory stimulation for nursing home residents: Systematic review and meta‐analysis of its effects on sleep quality and rest‐activity rhythm in dementia

Abstract

AbstractBackgroundDespite the evidence that disrupted sleep‐wake cycles are associated with an exacerbation of behavioural disturbances and an acceleration of the disease progression in dementia, the effect of sensory stimulation for improving sleep quality and rest‐activity rhythm is unclear. The aim of the current meta‐analysis is to give an overview of the effectiveness of sensory stimulation interventions on reduction and prevention of sleep disturbances in nursing homes residents with dementia.MethodA systematic literature search and meta‐analysis were performed on December 3, 2019. Twenty‐seven studies examining the effects of a sensory stimulation intervention on rest‐activity rhythm and/or nocturnal restlessness in nursing home residents with dementia were included. Outcomes were measured with Actiwatches and/or standardized observation scales. Extensive subgroup meta‐analyses were performed to adjust for varying characteristics of included studies.ResultUni‐sensory stimulation including tactile and visual stimulation (i.e. light therapy, massage, acupuncture, animal‐assisted interventions) seemed effective for improving sleep quality and strengthen the rest‐activity rhythm (Hedges g=.47, p ≤ .01, Figure 1). More specifically, visual and tactile stimulation with a minimum of 30 minutes/day for two weeks have effectively reduced the duration of nocturnal awakenings (g=‐.29, p≤.05), sleep onset latency (g=‐.25, p≤.05), and nocturnal behaviour disturbances (g=‐.57, p≤.01), and have improved nocturnal sleep duration (g = .38, p ≤ .01), and sleep efficiency (g=.48, p≤.01). The heterogeneity within the majority of outcomes varied between medium and large. The majority of studies were of poor quality (59%, Figure 2). Dementia type and severity, gender, treatment duration and intensity (light levels in lux values) were not related to the effectiveness of sensory stimulation in all outcomes.ConclusionAlthough the methodological quality of the studies was limited, we found indications that sleep quality and nocturnal restlessness in nursing home residents with dementia may benefit from sensory stimulation. Recommended is to use a sensory stimulating environment in nursing homes which may prevent or improve sleep disturbances, and therefore can contribute to higher quality of life of their patients. Future research should conduct RCTs, while using comparable interventions, measuring instruments and procure, so the quality of dementia can be further improved.