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

Aryankhesal, Aidin ORCID:, Blake, Jessica, Wong, Geoff, Megson, Molly, Briscoe, Simon, Allan, Louise, Broomfield, Niall M. ORCID:, Eastwood, Zenahrai, Greene, Leanne, Hilton, Andrea, Killett, Anne ORCID:, Lazar, Alpar S., Litherland, Rachael, Livingston, Gill, Maidment, Ian, Reeve, Joanne, Rook, George, Scott, Sion ORCID:, Um, Jinpil, van Horik, Jayden and Fox, Chris (2024) Sleep disturbance in people living with dementia or mild cognitive impairment:a realist review of general practice. British Journal of General Practice, 74 (741). e233-e241. ISSN 0960-1643

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BACKGROUND: Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. AIM: To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. DESIGN AND SETTING: A realist review of existing literature conducted in 2022. METHOD: Six bibliographic databases were searched. Context-mechanism-outcome configurations (CMOCs) were developed and refined. RESULTS: In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients 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, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services.

Item Type: Article
Additional Information: Publisher Copyright: © The Authors.
Uncontrolled Keywords: caregivers,cognitive dysfunction,community health services,family practice,primary health care,sleep wake disorders,family practice ,/dk/atira/pure/subjectarea/asjc/2700/2714
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences

Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Science
Faculty of Science > School of Pharmacy
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
Faculty of Medicine and Health Sciences > Research Groups > Dementia & Complexity in Later Life
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 16 Apr 2024 12:30
Last Modified: 16 Apr 2024 12:30
DOI: 10.3399/BJGP.2023.0171


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