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. 2013:8:565-72.
doi: 10.2147/CIA.S44926. Epub 2013 May 22.

Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

Mei Sian Chong  1 , Keng Teng Tan, Laura Tay, Yoke Moi Wong, Sonia Ancoli-Israel
Affiliations

Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults

Mei Sian Chong et al. Clin Interv Aging. 2013.

Abstract

Objective: Delirium is associated with poor outcomes following acute hospitalization. A specialized delirium management unit, the Geriatric Monitoring Unit (GMU), was established. Evening bright light therapy (2000-3000 lux; 6-10 pm daily) was added as adjunctive treatment, to consolidate circadian activity rhythms and improve sleep. This study examined whether the GMU program improved sleep, cognitive, and functional outcomes in delirious patients.

Method: A total of 228 patients (mean age = 84.2 years) were studied. The clinical characteristics, delirium duration, delirium subtype, Delirium Rating Score (DRS), cognitive status (Chinese Mini-Mental State Examination), functional status (modified Barthel Index [MBI]), and chemical restraint use during the initial and predischarge phase of the patient's GMU admission were obtained. Nurses completed hourly 24-hour patient sleep logs, and from these, the mean total sleep time, number of awakenings, and sleep bouts (SB) were computed.

Results: The mean delirium duration was 6.7 ± 4.6 days. Analysis of the delirium subtypes showed that 18.4% had hypoactive delirium, 30.2% mixed delirium, and 51.3% had hyperactive delirium. There were significant improvements in MBI scores, especially for the hyperactive and mixed delirium subtypes (P < 0.05). Significant improvements were noted on the DRS sleep-wake disturbance subscore, for all delirium-subtypes. The mean total sleep time (7.7 from 6.4 hours) (P < 0.05) and length of first SB (6.0 compared with 5.3 hours) (P < 0.05) improved, with decreased mean number of SBs and awakenings. The sleep improvements were mainly seen in the hyperactive delirium subtype.

Conclusion: This study shows initial evidence for the clinical benefits (longer total sleep time, increased first SB length, and functional gains) of incorporating bright light therapy as part of a multicomponent delirium management program. The benefits appear to have occurred mainly in patients with hyperactive delirium, which merits further in-depth, randomized controlled studies.

Keywords: delirium; elderly; function; sleep.

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Figures

Figure 1
Figure 1
GMU patient sleep data (n = 228). Abbreviations: GMU, Geriatric Monitoring Unit; TST, total sleep time.
See this image and copyright information in PMC

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