Enhancing Sleep Quality for Nursing Home Residents With Dementia - R33 Phase

NCT ID: NCT05820919

Last Updated: 2024-03-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

456 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-09-07

Study Completion Date

2027-05-29

Brief Summary

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This study seeks to improve clinical outcomes for an important, growing, and vulnerable population-nursing home residents with Alzheimer's disease or related dementias-by testing an evidence-based intervention to improve these residents' sleep. It will also examine the implementation and sustainment of this intervention.

Detailed Description

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Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet nursing home (NH) routines frequently disturb residents' sleep through use of noise and light or efforts, for example, to reduce incontinence. NH residents with Alzheimer's disease or related dementias-almost two-thirds of long-stay NH residents-are likely to be particularly affected by sleep disturbance. This study tackles these important issues and substantially moves forward goals of the National Plan to Address Alzheimer's Disease 2018 Update by proposing to implement an evidence-based intervention to improve sleep: a NH frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.

This is an incomplete stepped-wedge randomized controlled trial to test the impact and sustainability of the LOCK sleep program. In 24 community nursing homes (NHs)-eight from each of 3 national NH corporations-our multi-disciplinary team will examine these aims: (1) Implement the LOCK-based sleep program for residents with ADRD using the train-the-trainer model. (2) Estimate impact of the LOCK sleep program on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). (3) Examine factors, using mixed methods, associated with variation in the program's implementation and its sustainability.

Conditions

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Alzheimer Disease Dementia Sleep Disorder Sleep Disturbance

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

This is a wedge- based cluster randomized, controlled trial (RCT) design with each NH acting as its own control. The unit of random assignment is the NH. There are 24 NHs - 8 from each of 3 corporations. Each NH serves as its own control. Control data are collected for 1 week, then the intervention will begin with intervention data collected for 15 weeks (10-week active intervention period, and five-week sustainment period). All NHs are assigned to the control group and then phased into the intervention group at 37-week intervals (steps). Our stepped wedge design has 4 steps with 6 NHs per step (2 NHs per corporation per step). We will randomly assign the order in which the 8 NHs within each corporation are phased into the intervention group. We will randomize NHs within corporations to steps after matching on bed size and number of long-stay residents with ADRD diagnoses.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control (each NH acts as its own control):

Each nursing home serves as its own control. Control data will be collected for 1 week (then the intervention will begin).

Group Type OTHER

No intervention (control period/baseline data collection)

Intervention Type OTHER

Each NH serves as its own control. During the control period, baseline data will be collected.

Intervention (all NHs receive the intervention):

The intervention arm includes a ten-week active intervention phase, then a five-week sustainment phase.

Group Type EXPERIMENTAL

LOCK Sleep Program

Intervention Type BEHAVIORAL

The LOCK sleep program is a program that trains NH staff in a NH frontline staff huddling approach. It is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Staff learn how to work together as a team to collaboratively problem-solving about resident sleep challenges (e.g., evidence-based sleep promoting best practices and daytime meaningful activity best practices).

Interventions

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LOCK Sleep Program

The LOCK sleep program is a program that trains NH staff in a NH frontline staff huddling approach. It is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Staff learn how to work together as a team to collaboratively problem-solving about resident sleep challenges (e.g., evidence-based sleep promoting best practices and daytime meaningful activity best practices).

Intervention Type BEHAVIORAL

No intervention (control period/baseline data collection)

Each NH serves as its own control. During the control period, baseline data will be collected.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Nursing home residents aged \>=50 years with an Alzheimer disease or related dementia (ADRD) diagnosis, identified by nursing home staff participating in frontline LOCK sleep huddles as having sleep problems

Exclusion Criteria

* Residents with a high risk of OSA who are not being treated for OSA because actigraph measurements are inaccurate in that population.
* Residents who have a persistent bilateral resting tremor or paralysis in both arms (a subset of persons with Parkinson's disease and related significant tremor-causing diagnoses), due to actigraph measurement inaccuracies
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Massachusetts, Lowell

OTHER

Sponsor Role collaborator

The University of Texas Health Science Center, Houston

OTHER

Sponsor Role collaborator

University of Texas at Austin

OTHER

Sponsor Role collaborator

Brown University

OTHER

Sponsor Role collaborator

University of Alabama, Tuscaloosa

OTHER

Sponsor Role lead

Responsible Party

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A. Lynn Snow

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lynn Snow, PhD

Role: PRINCIPAL_INVESTIGATOR

The University of Alabama

Locations

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Vivage/Beecan Corporation

Lakewood, Colorado, United States

Site Status RECRUITING

National HealthCare Corporation

Murfreesboro, Tennessee, United States

Site Status RECRUITING

Caraday Healthcare, LLC

San Marcos, Texas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Lynn Snow, PhD

Role: CONTACT

205-201-0312

Brian Cox, MS

Role: CONTACT

205-348-7518

Facility Contacts

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Hope Carwile, MSW

Role: primary

720-217-9043

Vicki Dodson, RN

Role: primary

Angela Westergard, LPN

Role: backup

615-631-6146

Paul Gerharter, RN,C

Role: primary

512-641-8805

Catherine McGuire, RN,MPAff

Role: backup

Other Identifiers

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R33AG065619

Identifier Type: NIH

Identifier Source: org_study_id

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