Predictors of change in sleep disturbance in Canadian long-term care facilities: a longitudinal analysis based on interRAI assessments.

Purpose: Sleep disturbance is prevalent in long-term care facilities (LTCFs), yet there is limited understanding of individual factors predicting changes in sleep within these populations. Our objective was to determine predictors of sleep disturbance in LTCFs and investigate variation in prevalence across facilities in two Canadian provinces-New Brunswick and Saskatchewan.

Method: This retrospective longitudinal cohort study used interRAI comprehensive health assessment data from 2016 to 2021, encompassing 21,394 older adults aged ≥ 65 years across 228 LTCFs. Generalised estimating equations were used to determine predictors of sleep disturbance, with separate models for new and resolved sleep disturbance. Funnel plots were employed to assess facility-level variation, with facilities exceeding the 99.8th percentile control limit identified as outliers.

Results: The overall prevalence of sleep disturbance was 21.7%, with rates ranging from 3 to 56% across facilities, and 8% of facilities showing outlying rates. Nine predictors were significantly associated with the onset of new sleep disturbance, including being a male, being newly admitted, cognitive impairment, pain, daytime sleeping, chronic obstructive pulmonary disease, coronary heart disease, antipsychotics use, and sedative-hypnotics use. Significant predictors of resolved sleep disturbance were stroke, polypharmacy, and being newly admitted. Conversely, lower odds of resolved sleep disturbance were observed among daytime sleepers and residents taking sedative-hypnotics.

Conclusion: This study underscores the high prevalence and variation of sleep disturbance in LTCFs, highlighting potential modifiable risk factors for improvement. Further research is needed to explore the interplay of institutional, environmental, and individual factors to develop targeted interventions that enhance the quality of care in LTCFs.