Project summary
Monash University in partnership with BlueCross has been awarded an ARIIA grant for their project ‘Sleep Coaches for Older Adults: Upskilling aged-care workers to deliver evidence-based feasible sleep interventions for aged-care residents’.
Sleep and circadian disruption are common in older adults and affect more than 70% of people living with dementia. These nighttime issues are associated with poor daytime outcomes, including greater severity of dementia symptoms, increased risk of falls and poorer health and well-being. Sleep disturbances vary in their presentation, which can be challenging for those who care for them.
Sleep interventions are much needed to improve overall wellbeing for older adults as well as reducing carer burden. To address this, our team has co-designed a multifaceted sleep intervention with community-dwelling carers and people living with dementia. This 6-week intervention uses a toolkit approach to upskill carers in different strategies, such as light, physical activity, cognitive behavioural therapy and relaxation techniques to manage sleep and circadian issues in people living with dementia. In the current proposal, we will develop our intervention into a co-designed training program with and for the aged-care workforce, to upskill them as “sleep coaches” to better manage sleep and circadian disturbances that occur in their residents.
Project outcomes
Background and Aims
Sleep problems are common among older adults living in residential aged care facilities (RACF). However, aged care workers receive little to no training to support healthy sleep among residents. This means people go under-supported. Our research team aimed to develop a sleep coach training workshop to address common sleep challenges in aged care and equip workers with knowledge and practical skills to support residents’ sleep.
Specifically, we aimed to:
- Gain insights into the sleep and circadian issues with aged care and current treatments, explore barriers and enablers to non-medication sleep treatments, and feedback regarding the content, duration, and delivery of the workshop (Phase 1).
- Investigate the feasibility and preliminary efficacy of the sleep coach workshop (Phase 2).
What We Did
We undertook a focus group via Zoom with management staff members at Anglicare Australia (Marcus Loane House) to identify common sleep issues among residents, alongside the needs and current skills, knowledge, and practices around sleep. We additionally sought their feedback and recommendations to help us develop sleep education materials for their service.
Based on staff member feedback, a clinical psychologist and academic member of our team with expertise in sleep health (Dr Sumedha Verma) developed a two-hour training workshop for aged care staff members. This was designed to be a foundational sleep health seminar including:
- Sleep education: the impact of sleep, the key ingredients for good sleep, and common sleep disturbances for other adults.
- Methods for assessing sleep among aged care residents.
- Practical strategies to support sleep health among older adults.
- Resources for further support/information
All staff members who attended the sleep workshop were female and were aged between 21 to 69 years. The ethnicity of aged care worker participants were: | |
| Caucasian / White | 7 (43.8%) |
| Hispanic, Latino, Spanish | 2 (12.5%) |
| South Asian | 2 (12.5%) |
| Tibetan | 2 (12.5%) |
| Nepalese | 2 (12.5%) |
| Southeast Asian | 1 (6.2%) |
The feasibility of the workshop was evaluated based on:
(a) adoption: attendance rates and likelihood/actual use of workshop strategies,
(b) practicality: perceived and actual barriers and facilitators to applying workshop knowledge and skills, and
(c) acceptability and satisfaction: workshop satisfaction rating (out of 100).
Preliminary efficacy was assessed using:
(a) the Copenhagen Burnout Inventory (CBI) and a rating of the proportion of workload dedicated to sleep, to measure carer burden,
(b) a sleep knowledge quiz,
(c) a confidence and preparedness scale, and
(d) observations of changes in residents’ sleep.
Outcomes
Sleep among residents and recommendations for the workshop
Almost all participants (except one) reported that sleep issues were prevalent among their participants. On average, participants estimated that approximately 50% of their residents’ experience sleep difficulties. The majority of participants (93.8%) reported had not received training in sleep management prior to attending the workshop.
The team responded positively to the proposed workshop, particularly the psychoeducation on sleep and circadian rhythms components. They suggested the use of real-life scenarios / case studies and training on relaxation techniques. Moreover, they recommended the use of handouts during the workshop and a preference for delivering the workshop in person. A two-hour workshop was deemed the most feasible for staff attendance.
Feasibility
A total of sixteen workers attended the workshop. The majority of workers planned to apply the knowledge and skills in their roles after attending workshop. All workers reported using some strategies one-month after the workshop.
Following the workshop, barriers to using the workshop knowledge and skills included staffing challenges, scepticism from other staff members, and resident’s reluctance to engage. Facilitators included providing education to broader team, improving communication, adapting current procedures, consulting residents on how to support their sleep and having additional staff.
Participants reported high levels of satisfaction with the workshop, with an average satisfaction rating of 90.36% (out of 100).
Preliminary efficacy
There was a reduction in the percentage of the workload dedicated to addressing sleep issues (from 33.25% to 26.33%). However, mixed results were observed on the CBI, with client related stress remaining similar before and after the workshop, while work-related stress increased.
Aged care workers demonstrated a significant increase in their sleep knowledge after attending the workshop. There was a significant increase in confidence in supporting results with sleep issues and knowing where to seek further support for sleep-related issues. Participants felt significantly more prepared to address residents’ sleep difficulties,
Lastly, the majority of the participants did not report any observable changes in their residents’ sleep one month after the workshop.
Impact on Aged Care and Workforce
Our project showed that a two-hour sleep workshop targeting aged care workers was helpful at improving workers’ confidence, skills and knowledge around managing health among residents. There was a reduction in the percentage of worker’s workload spent on sleep issues from pre-workshop to one-month post-workshop. The mixed Copenhagen Burnout Inventory results suggests that while workshop may have alleviated some aspects of worker’s workload, it may have introduced new challenges in managing work demands. Aged care workers were highly satisfied with the workshop. Overall, equipping aged care workers with education and sleep management skills and knowledge can lead to better sleep outcomes for residents and potentially reduce behavioural, cognitive, and psychological impacts associated with poor sleep. Encouraging whole-organisation training in sleep management and health could mitigate barriers to implementing non-pharmacological strategies.
Resources
A 2-hour sleep training workshop including 56 PowerPoint slides and a “workshop overview” document provided to staff prior to the workshop. The research team may be contacted for access and inquiries.
Next Steps
Service providers at Anglicare are investigating avenues to seek funding to make this training delivered across other Anglicare sites. They are interested in expanding training and will investigate with their Learning and Development team about future collaboration. We also plan to engage other residential aged-care facilities to present the findings of the project, and offer the training program across the state and nationally.