Do Daytime Activity, Mood at Bedtime and Unit Tumult Predict Nighttime Sleep Quality of Long-Term Care Residents?

Abstract Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia. Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life. Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality. A convenience sample of 53 LTC residents with dementia participated in this correlational study. Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale. Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level). Comorbid illness and level of dementia were control variables. Half of the sample had a sleep efficiency that was less than .85 and were awake for more than 90 minutes at night. Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes. Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency. Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.

Introduction: The Late Life Function and Disability Instrument (LLFDI) is a valid self-report tool that quantifies disability based on activity limitations and participation restrictions in everyday life.Both the original longer tool (LLFDI) and the shorter computer adaptive version (LLFDI-CAT) offer practitioners a method for measuring function independent or in conjunction with performance-based assessment.Objectives: Examine scores of the LLFDI and LLFDI-CAT for measuring disability in older adults who are receiving rehabilitation services in community and institution settings.Method: A secondary data analysis was conducted comparing scores from occupational therapy evaluations with older adults from 3 groups: 1) older adults in primary care using the LLFDI; 2) older adults in primary care using the LLFDI-CAT; older adults in a skilled nursing facility (SNF) using the LLFDI-CAT.Results: Mean scores for Activity Limitation and Participation Restriction were lowest for older adults in a SNF indicating greater disability.A one-way Analysis of variance on ranks showed a main effect for Activity Limitation, χ2 (2) = 22.267, p < 0.001, and Participation Restriction, χ2 (2) = 60.372,p < 0.001.Post-hoc analyses revealed significant differences between groups based on tool (i.e.LLFDI vs. LLFDI-CAT) for Activity Limitations and setting (i.e.primary care vs. SNF) for Participation Restriction.Conclusion: The LLFDI-CAT may be the preferred instrument to measure disability in older adults across treatment settings.Additional research is warranted to understand how personal and environmental factors influence LLFDI-CAT outcomes.Achieving institutional goal of full, person-centered care was encumbered by an outdated structural "hospital model" at one long-term care facility that undertook building renovations, transforming long hallways into "neighborhood" of compact households.Quality of Life Survey and Long-term Care Minimum Data Set generated data at baseline and 1-year follow-up, comparing renovated(RU) and non-renovated unit(NRU) residents (n=36) to evaluate achievement of personcentered care.RU residents indicating they could "eat when I want" increased 75% to 81% at follow-up and decreased 17% for NRU residents.Sixty-seven percent of RU residents reported bathing "when they want" in contrast to 40% of NRU residents.Most RU residents agreed, "staff act on my suggestions."MoreRU residents (68% vs 53%) agreed: "I spend time with other like-minded residents" and more RU residents (86% vs 43%) reported opportunity to explore new skills, interests.RU residents more often reported (50% vs 37%) "people ask for my help or advice."Similar differences were observed with "it is easy to make friends here," 67% RU residents responding affirmatively.RU residents reporting "feeling down" improved, moving from 46% to 50% disagreeing with this item with while increased number of NRU residents (18% to 22%) reported "feeling down" at follow-up.Improvement with independent performance of bed mobility, transfer, walking, and dressing among RU residents was observed while NRU residents had decreased percentages of independence.Evaluation of resident outcomes demonstrated improvement with personal choice, activities, personal relationships, functional independence and mood.Physical unit renovations appear to enhance implementation of person-centered care model.

DO DAYTIME ACTIVITY, MOOD AT BEDTIME AND UNIT TUMULT PREDICT NIGHTTIME SLEEP QUALITY OF LONG-TERM CARE RESIDENTS?
Murad Taani, 1 and Christine Kovach, 2 1.University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States, 2. University of Wisconsin Milwaukee, Milwaukee, Wisconsin, United States Sleep quality declines in old age and is particularly poor for long-term care (LTC) residents with dementia.Compromised sleep quality is associated with severe cognitive and neuropsychiatric symptoms, agitation, aggressiveness, and poor quality of life.Based on the premise that stressors can have a cumulative effect on people with dementia throughout the day that contributes to negative consequences later in the day, we examined if daytime activity, mood, and unit tumult were associated with sleep quality.A convenience sample of 53 LTC residents with dementia participated in this correlational study.Objective sleep quality and activity variables were measured using Actigraphy, and mood was measured by the Observed Emotion Rating Scale.Unit tumult was defined as events in the residents living area that are deviations from the typical day (i.e., census changes, being cared for by a certified nursing assistant from a temporary staffing agency, and lower than usual staffing level).Comorbid illness and level of dementia were control variables.Half of the sample had a sleep efficiency that was less than .85and were awake for more than 90 minutes at night.Comorbid illness, negative mood at bedtime, and daytime activity level accounted for 26.1% of the variance in total sleep minutes.Census changes and the use of temporary agency staff were associated with poor total sleep time and sleep efficiency.Findings suggest that daytime activity, mood at bedtime, and unit tumult should be considered when designing and testing interventions to improve sleep quality among LTC residents with dementia.

FACTORS INFLUENCING RETENTION INTENTION OF NURSES AT LONG-TERM CARE HOSPITALS IN KOREA
So Young Shin, 1 and Joo Hee Kim, 2 1. Global Brain Health Institute, University of California, San Francisco / Inje University, Busan, Pusan-jikhalsi, Republic of Korea,

Busan Hangun Hospital, Busan, Pusan-jikhalsi, Republic of Korea
Purpose: This study aimed to investigate the levels and correlations of role conflict, nursing professionalism, nursing work environment and retention intention, and the factors influencing retention intention of nurses at long-term care hospitals.Methods: The subjects included 183 nurses at nine long-term care hospitals in one metropolitan city in Korea.A set of self-reported questionnaires was administered to assess general characteristics, role conflict, nursing professionalism, nursing work environment, and retention intention of the subjects.Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple linear regression.Results: 183 subjects with a mean (±SD) age of 41.66 (±12.29) years were included in the final analyses.Retention intention had a significant positive correlation with nursing professionalism (r=.39, p<.001) and nursing work environment (r=.51, p<.001).Nursing work environment had a significant negative correlation with role conflict (r=-.30,p<.001) and a significant positive correlation with nursing professionalism (r=.48, p<.001).In the final multiple regression analysis, the factors influencing retention intention of subjects were number of beds (β=-.15p<.026), nursing professionalism (β=.19, p=.007) and nursing work environment (β=.36, p<.001).The explanatory power of number of beds, nursing professionalism and nursing work environment on retention intention was 34.0% (F=16.66,p<.001).Conclusion: Improving nursing professionalism and nursing work environment of nurses at long-term care hospitals will ultimately enhance their retention intention and positively impact on the quality of gerontological nursing service.

FAILURE TO THRIVE: NURSING HOME STAFF EXPERIENCES IN CARING FOR RESIDENTS DURING THE COVID-19 PANDEMIC
Yu-Ping Chang, 1 Audrieanna Raciti, 2 Cristina de Rosa, 1 Margaret Doerzbacher, 1 Yanjun ZHou, 1 Chia-Hui Chen, 1 and Amy Lyons, 1 1.University at Buffalo, Buffalo, New York, United States, 2. University at Buffalo, 7168292015, New York, United States Nursing home residents and staff have accounted for roughly 40% of Coronavirus-related deaths in the U.S. The burden of caring for vulnerable residents coupled with isolation policies has taken a significant emotional toll among direct health care staff in long term care facilities.This study explores nursing home staff's experiences in caring for residents during the COVID-19 pandemic.A qualitative descriptive approach with a semi-structured guide was used to conduct individual interviews.We recruited nursing home staff employed during the COVID-19 pandemic in long term care facilities located in New York State.Interviews were recorded, transcribed verbatim, and then analyzed using Braun and Clarke's Reflexive Thematic analysis.Twelve nursing home staff were interviewed.Participants consistently refer to failure-to-thrive as an extremely concerning problem because many residents demonstrate decreased appetite and poor nutrition, inactivity, and depressive symptoms due to social isolation.They also often feel frustrated and overwhelmed due to uncertainty and shortages of staff.Five main themes were identified, including doing their best to manage residents' failure-to-thrive, working as a team, keeping family members informed and connected, struggling to balance competing personal and professional demands, and needing support to reduce stress and build strength.Our study findings indicate that nursing home staff experienced a high level of stress and identified failure-to-thrive caused by isolation and loneliness as a common phenomenon among nursing home residents during the COVID-19 pandemic.Interventions are urgently needed to reduce isolation and loneness in nursing home residents and to provide support for staff.

HUMAN CAPITAL AND EMPLOYMENT OUTCOMES AMONG FOREIGN EDUCATED AND US NURSES WORKING IN LONG TERM CARE
Roy Thompson, 1 Susan Silva, 1 Kirsten Corazzini, 2 Thomas Konrad, 3 Michael Cary, Jr., 1 and  Eleanor McConnell, 4 1.Duke University, Durham,  North Carolina, United States, 2. University of Maryland  School of Nursing, Baltimore, Maryland, United States, 3.  University of North Carolina at Chapel Hill, Chapel Hill,  North Carolina, United States, 4. Duke University School of  Nursing, Durham, North Carolina, United States  Employing Foreign Educated Nurses (FENs) helps address Registered Nurse (RN) shortages in long-term care (LTC) in the United States (US).However, examination of factors explaining differences in their employment outcomes relative