Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article

Strukturierte Fallbesprechung bei Schlafproblemen von Pflegeheimbewohner_innen mit kognitiven Einschränkungen

Published Online:January 18, 2024https://doi.org/10.1024/1012-5302/a000972

Abstract

Zusammenfassung:Hintergrund: Pflegeheimbewohner_innen mit kognitiven Einschränkungen leiden häufig unter Schlafproblemen. Medikamentöse Maßnahmen werden hierbei nicht als Therapie der ersten Wahl empfohlen. Generell steht zwar ein breites Spektrum an nicht-pharmakologischen Interventionen zur Verfügung, derzeit kann jedoch keine eindeutig geeignete Intervention benannt werden. Fragestellung/Ziel: Der Fallbericht stellt das Vorgehen einer strukturierten Analyse dar, um die Auswahl nicht-pharmakologischer Maßnahmen zur Schlafförderung zu unterstützen. Methoden: Entlang einer entwickelten Fallbearbeitungsmaske erfolgte eine strukturierte Fallbesprechung zur Erstellung eines individuellen Maßnahmenplans. Ergebnisse: Ausgehend von der Situationsbeschreibung und der Ursachensuche wurden verschiedene Maßnahmen aus sechs Kernbereichen geplant: „passende Aktivierungen am Tag anbieten“, „Gestaltung von Zu-Bett-Geh-Routinen“, „Überprüfung der Schlafumgebung“, „Beobachtung möglicher körperlicher und psychischer Ursachen“, „Reflexion nächtlicher Pflegeroutinen“ sowie „Anwendung von Schlafmedikation nur im Ausnahmefall“. Schlussfolgerungen: Für eine erfolgreiche Bearbeitung von Schlafproblemen bei Pflegeheimbewohner_innen mit kognitiven Einschränkungen ist es wesentlich, dass die konkreten schlafbezogenen Symptome sowie Ursachen systematisch und berufsübergreifend eingeschätzt werden, um mit passenden Maßnahmen auf eine Verbesserung hinarbeiten zu können. Um adäquate Lösungen zu finden, sollte dabei evidenzbasiertes Fachwissen einbezogen werden.


Structured case conference for sleep disturbances in nursing home residents with cognitive impairment

Abstract:Background: Nursing home residents living with cognitive impairment often suffer from sleep disturbances. Pharmacological interventions are not recommended to be the first-choice therapy. In general, a wide variance of non-pharmacological interventions is available, but no clearly suitable intervention can currently be specified. Aim: The case report presents the procedure of a structured analysis to support the selection of non-pharmacological interventions to promote sleep. Methods: A structured case conference was held using a developed case management template to draw up an individual intervention plan. Results: Based on the description of the situation and the determination of causes, different interventions from six main topics were planned: “offering appropriate activations during daytime”, “creating bedtime routines”, “checking the sleep environment”, “observation of potential physical and psychological causes”, “reflection on night care routines”, and “use of drug therapies only in exceptional cases”. Conclusions: For a successful management of sleep disturbances in nursing home residents living with cognitive impairment, it is essential that the specific sleep-related symptoms and causes are assessed systematically and interprofessionally to be able to work towards an improvement with appropriate measures. In order to obtain adequate solutions, evidence-based expertise should be taken into consideration.

Literatur

  • Alessi, C. A. , Martin, J. L. , Webber, A. P. , Cynthia Kim, E. , Harker, J. O. , & Josephson, K. R. (2005). Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. Journal of the American Geriatrics Society , 53 (5), 803–810. https://doi.org/10.1111/j.1532-5415.2005.53251.x First citation in articleCrossref Medline, Google Scholar

  • Alessi, C. A. , Yoon, E. J. , Schnelle, J. F. , Al-Samarrai, N. R. , & Cruise, P. A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatrics Society , 47 (7), 784–791. https://doi.org/10.1111/j.1532-5415.1999.tb03833.x First citation in articleCrossref Medline, Google Scholar

  • Buysse, D. J. , Reynolds, C. F. 3rd , Monk, T. H. , Berman, S. R. , & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research , 28 (2), 193–213. https://doi.org/10.1016/0165-1781(89)90047-4 First citation in articleCrossref Medline, Google Scholar

  • Capezuti, E. , Sagha Zadeh, R. , Pain, K. , Basara, A. , Jiang, N. Z. , & Krieger, A. C. (2018). A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings. BMC Geriatrics , 18 (1), 143. https://doi.org/10.1186/s12877-018-0794-3 First citation in articleCrossref Medline, Google Scholar

  • Casagrande, M. , Forte, G. , Favieri, F. , & Corbo, I. (2022). Sleep quality and aging: a systematic review on healthy older people, mild cognitive impairment and Alzheimer’s disease. International Journal of Environmental Research and Public Health , 19 (14), 8457. https://doi.org/10.3390/ijerph19148457 First citation in articleCrossref Medline, Google Scholar

  • Cohen-Mansfield, J. (1991). Instruction Manual for the Cohen-Mansfield Agitation Inventory (CMAI) . The Research Institute of the Hebrew Home of Greater Washington. First citation in articleGoogle Scholar

  • Dichter, M. N. , Berg, A. , Hylla, J. , Eggers, D. , Wilfling, D. , Möhler, R. , Haastert, B. , Meyer, G. , Halek, M. , & Köpke, S. (2021). Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-Sleep): study protocol for a cluster-randomized exploratory trial. BMC Geriatrics , 21 (1), 40. https://doi.org/10.1186/s12877-020-01997-8 First citation in articleCrossref Medline, Google Scholar

  • Ettema, T. P. , Droes, R. M. , de Lange, J. , Mellenbergh, G. J. , & Ribbe, M. W. (2007). QUALIDEM: development and evaluation of a dementia specific quality of life instrument. Scalability, reliability and internal structure. International Journal of Geriatric Psychiatry , 22 (6), 549–556. https://doi.org/10.1002/gps.1713 First citation in articleCrossref Medline, Google Scholar

  • Frohnhofen, H. , Bibl, M. , Nickel, B. , & Popp, R. (2010). Der Essener Fragebogen Alter und Schläfrigkeit (EFAS) – ein neues Assessmentinstrument zur Messung von Tagschläfrigkeit bei alten Menschen. European Journal of Geriatrics , 12 (2), 84–90. First citation in articleGoogle Scholar

  • Gagnier, J. J. , Riley, D. , Altman, D. G. , Moher, D. , Sox, H. , Kienle, G. , & Group, C. (2013). The CARE guidelines: consensus-based clinical case reporting guideline development. Deutsches Ärzteblatt International , 110 (37), 603–608. https://doi.org/10.3238/arztebl.2013.0603 First citation in articleCrossref Medline, Google Scholar

  • Glass, J. , Lanctot, K. L. , Herrmann, N. , Sproule, B. A. , & Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ , 331 (7526), 1169. https://doi.org/10.1136/bmj.38623.768588.47 First citation in articleCrossref Medline, Google Scholar

  • Holle, D. , Krüger, C. , Halek, M. , Sirsch, E. , & Bartholomeyczik, S. (2015). Experiences of nursing staff using dementia-specific case conferences in nursing homes. American Journal of Alzheimer’s Disease and Other Dementias , 30 (3), 228–237. https://doi.org/10.1177/1533317514552320 First citation in articleCrossref Medline, Google Scholar

  • Holle, D. , Müller-Widmer, R. , Reuther, S. , Rosier-Segschneider, U. , Graf, R. , Roes, M. , & Halek, M. (2019). Process evaluation of the context, reach and recruitment of participants and delivery of dementia-specific case conferences (WELCOME-IdA) in nursing homes (FallDem): a mixed-methods study. Trials , 20 (1), 45. https://doi.org/10.1186/s13063-018-3147-9 First citation in articleCrossref Medline, Google Scholar

  • Hylla, J. , Kitzmann, N. , Berg, A. , Wilfling, D. , Möhler, R. , Meyer, G. , Halek, M. , Köpke, S. , & Dichter, M.N. (2021). Schlaf und Schlafprobleme bei Menschen mit Demenz in der stationären Altenpflege: Informationsbroschüre zum Projekt „MoNoPol-Sleep“ . https://www.monopol-sleep.de First citation in articleGoogle Scholar

  • Köhler, L. , Weyerer, S. , & Schäufele, M. (2007). Proxy screening tools improve the recognition of dementia in old-age homes: results of a validation study. Age and Ageing , 36 (5), 549–554. https://doi.org/10.1093/ageing/afm108 First citation in articleCrossref Medline, Google Scholar

  • Lohse, M. J. , & Müller-Oerlinghausen, B. (2018). Hypnotika und Sedativa. In U. Schwabe D. Paffrath W. D. Ludwig J. Klauber (Hrsg.), Arzneiverordnungs-Report 2018 (S. 553–562). Springer. First citation in articleCrossref, Google Scholar

  • McCleery, J. , & Sharpley, A. L. (2020). Pharmacotherapies for sleep disturbances in dementia. Cochrane Database of Systematic Reviews , 11 (11), CD009178. https://doi.org/10.1002/14651858.CD009178.pub4 First citation in articleCrossref Medline, Google Scholar

  • Ouslander, J. G. , Connell, B. R. , Bliwise, D. L. , Endeshaw, Y. , Griffiths, P. , & Schnelle, J. F. (2006). A nonpharmacological intervention to improve sleep in nursing home patients: results of a controlled clinical trial. Journal of the American Geriatrics Society , 54 (1), 38–47. https://doi.org/10.1111/j.1532-5415.2005.00562.x First citation in articleCrossref Medline, Google Scholar

  • Phillips, J. L. , West, P. A. , Davidson, P. M. , & Agar, M. (2013). Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: evidence from an integrative review? International Journal of Nursing Studies , 50 (8), 1122–1135. https://doi.org/10.1016/j.ijnurstu.2012.11.001 First citation in articleCrossref Medline, Google Scholar

  • Reuther, S. , Dichter, M. N. , Buscher, I. , Vollmar, H. C. , Holle, D. , Bartholomeyczik, S. , & Halek, M. (2012). Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review. International Psychogeriatrics , 24 (12), 1891–1903. https://doi.org/10.1017/S1041610212001342 First citation in articleCrossref Medline, Google Scholar

  • Richards, K. C. , Lambert, C. , Beck, C. K. , Bliwise, D. L. , Evans, W. J. , Kalra, G. K. , Kleban, M. H. , Lorenz, R. , Rose, K. , Gooneratne, N. S. , & Sullivan, D. H. (2011). Strength training, walking, and social activity improve sleep in nursing home and assisted living residents: randomized controlled trial. Journal of the American Geriatrics Society , 59 (2), 214–223. https://doi.org/10.1111/j.1532-5415.2010.03246.x First citation in articleCrossref Medline, Google Scholar

  • Richter, K. , Kellner, S. , Miloseva, L. , & Frohnhofen, H. (2020). Therapie der Insomnie im höheren Lebensalter. Zeitschrift für Gerontologie und Geriatrie , 53 (2), 105–111. https://doi.org/10.1007/s00391-019-01684-3 First citation in articleCrossref Medline, Google Scholar

  • Schnelle, J. F. , Alessi, C. A. , Al-Samarrai, N. R. , Fricker, R. D. Jr. , & Ouslander, J. G. (1999). The nursing home at night: effects of an intervention on noise, light, and sleep. Journal of the American Geriatrics Society , 47 (4), 430–438. https://doi.org/10.1111/j.1532-5415.1999.tb07235.x First citation in articleCrossref Medline, Google Scholar

  • Shang, B. , Yin, H. , Jia, Y. , Zhao, J. , Meng, X. , Chen, L. , & Liu, P. (2019). Nonpharmacological interventions to improve sleep in nursing home residents: a systematic review. Geriatric Nursing (New York, N.Y.) , 40 (4), 405–416. https://doi.org/10.1016/j.gerinurse.2019.01.001 First citation in articleCrossref Medline, Google Scholar

  • Teupen, S. , Holle, D. , & Roes, M. (2021). Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial. Implementation Science Communications , 2 (1), 90. https://doi.org/10.1186/s43058-021-00191-0 First citation in articleCrossref Medline, Google Scholar

  • Tractenberg, R. E. , Singer, C. M. , Cummings, J. L. , & Thal, L. J. (2003). The Sleep Disorders Inventory: an instrument for studies of sleep disturbance in persons with Alzheimer’s disease. Journal of Sleep Research , 12 (4), 331–337. https://doi.org/10.1046/j.0962-1105.2003.00374.x First citation in articleCrossref Medline, Google Scholar

  • Webster, L. , Costafreda Gonzalez, S. , Stringer, A. , Lineham, A. , Budgett, J. , Kyle, S. , Barber, J. , & Livingston, G. (2020). Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep , 43 (4). https://doi.org/10.1093/sleep/zsz251 First citation in articleCrossref Medline, Google Scholar

  • Webster, L. , Powell, K. , Costafreda, S. G. , & Livingston, G. (2020). The impact of sleep disturbances on care home residents with dementia: the SIESTA qualitative study. International Psychogeriatrics , 32 (7), 839–847. https://doi.org/10.1017/S1041610220000642 First citation in articleCrossref Medline, Google Scholar

  • Wilfling, D. , Calo, S. , Dichter, M. N. , Meyer, G. , Möhler, R. , & Köpke, S. (2023). Non-pharmacological interventions for sleep disturbances in people with dementia. Cochrane Database of Systematic Reviews , 1 (1), CD011881. https://doi.org/10.1002/14651858.CD011881.pub2 First citation in articleCrossref Medline, Google Scholar

  • Wilfling, D. , Dichter, M. N. , Trutschel, D. , & Köpke, S. (2019). Prevalence of sleep disturbances in German nursing home residents with dementia: a multicenter cross-sectional study. Journal of Alzheimer’s Disease , 69 (1), 227–236. https://doi.org/10.3233/JAD-180784 First citation in articleCrossref Medline, Google Scholar

  • Wilfling, D. , Dichter, M. N. , Trutschel, D. , & Köpke, S. (2020). Nurses’ burden caused by sleep disturbances of nursing home residents with dementia: multicenter cross-sectional study. BMC Nursing , 19 , 83. https://doi.org/10.1186/s12912-020-00478-y First citation in articleCrossref Medline, Google Scholar

  • Wilfling, D. , Hylla, J. , Berg, A. , Meyer, G. , Köpke, S. , Halek, M. , Möhler, R. , & Dichter, M. N. (2021). Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review. International Psychogeriatrics , 33 (3), 245–273. https://doi.org/10.1017/S1041610220000733 First citation in articleCrossref Medline, Google Scholar