Sleep disturbance in dementia or mild cognitive impairment: a realist review of general practice

Aryankhesal, Aidin; Blake, Jessica; Wong, Geoff; Megson, Molly; Briscoe, Simon; Allan, Louise; Broomfield, Niall; Eastwood, Zenahrai; Greene, Leanne; Hilton, Andrea; Killett, Anne; Lazar, Alpar; Litherland, Rachael; Livingston, Gill; Maidment, Ian; Reeve, Joanne; Rook, George; Scott, Sion; Un, Jinpil; van Horik, Jayden; Fox, Chris

Abstract

Background
Sleep disturbance (SD) is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex due to the comorbidities, older age and cognitive impairment typical of this patient group.

Aim
This study aimed to explore how primary care clinicians assess, understand, and manage SD for PLwD or MCI; if and why such initiatives work; and how people and their carers experience SD and its treatment.

Design and setting
A realist review of existing literature was conducted in 2022.

Methods
Six bibliographic databases were searched. Context-Mechanism-Outcome Configurations (CMOCs) were developed and refined.

Results
Sixty records were included from 1,869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of SD among primary care clinicians and service users, combined with time and resource constraints, meant that identifying SD was difficult and not prioritised. Medication was perceived by clinicians and service users as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good quality sleep.

Conclusion
In primary care, SD among PLwD or MCI is not adequately addressed. Over-reliance on medication, under-utilisation of non-pharmacological strategies, and inflexible care home routines were reported due to low confidence and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of SD to the needs of individuals and their informal carers without overstretching services.

Citation

Aryankhesal, A., Blake, J., Wong, G., Megson, M., Briscoe, S., Allan, L., Broomfield, N., Eastwood, Z., Greene, L., Hilton, A., Killett, A., Lazar, A., Litherland, R., Livingston, G., Maidment, I., Reeve, J., Rook, G., Scott, S., Un, J., van Horik, J., & Fox, C. (online). Sleep disturbance in dementia or mild cognitive impairment: a realist review of general practice. The British journal of general practice : the journal of the Royal College of General Practitioners, https://doi.org/10.3399/BJGP.2023.0171

• Journal Article Type: Article
• Acceptance Date: Oct 23, 2023
• Online Publication Date: Nov 6, 2023
• Deposit Date: Oct 24, 2023
• Publicly Available Date: Sep 18, 2024
• Journal: The British journal of general practice : the journal of the Royal College of General Practitioners
• Print ISSN: 0960-1643
• Publisher: Royal College of General Practitioners
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.3399/BJGP.2023.0171
• Public URL: https://hull-repository.worktribe.com/output/4348642