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

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:

• sleep
• delirium
• function
• elderly

Acknowledgments

We would like to thank the GMU nurses and multidisciplinary team involved in the GMU.

This study was funded by FY2010 Ministry of Health Quality of Improvement Funding (MOH HQIF) “Optimising Acute Delirium Care in Tan Tock Seng Hospital” (Grant No HQIF 2010/17). CMS is supported by the National Healthcare Group (NHG) Clinician Scientist Career Scheme 2012/12002.

Disclosure

Dr Ancoli-Israel received a loan of light boxes from Lightbook, Inc for other research she is conducting. The authors report no conflicts of interest in this work.