Science and Knowledge Transfer - The SomnIA Project:

1. Science and Knowledge Transfer - The SomnIA Project: Understanding Quality of Sleep among Older People living in the Community and in Care Homes Sara Arber and Rebekah Luff Centre for Research on Ageing and Gender (CRAG) University of Surrey NDA Programme Meeting, Hilton London Euston Hotel 20th October 2010 www.somnia.surrey.ac.uk

2. Background Sleep in later life is an important topic because: Among older people, untreated chronic sleep disturbance degrades quality of later life, inhibits recovery following illness (Ersser et al, 1999) and rehabilitation (Stepanski et al, 2003), and is an independent risk factor for falls and depression (Leger 1994; Livingston et al. 1993). Lack of knowledge about sleep and ageing The specific aetiology of late-life sleep problems remains unclear (Montgomery and Dennis 2004). Concerns about current treatment practices for poor sleep To reduce hypnotic drug prescribing which increases confusion and falls among older people Effective non-pharmacological approaches to sleep management need to be explored and evaluated in the community and in care homes.

3. Aims of SomnIA To understand the meanings and determinants of poor quality sleep among older people in the community and in residential settings - by assessing the relative contributions of social, psychological and environmental factors, medication use and health status, and identifying potential solutions To develop a cost-effective approach to non-pharmacological self-management of insomnia among older people with chronic disease - by evaluating the impact of an evidence-based, Expert Patient 'supported' self-management programme. To develop and promote effective non-pharmacological treatment options for sleep problems, and evaluate their acceptability to users, e.g. ‘enriched’ blue light and novel sensors. To develop web-based user-friendly information and advice for older people with sleep problems. Created module on ‘Sleep Problems in Later Life’ for www.healthtalkonline.org

4. Multi-disciplinary focus of SomnIA A multi-disciplinary project, aiming to link approaches from different disciplines in order to better understand older people’s sleep problems and develop cost-effective ways to reduce sleep problems. Focus on ‘normal’ sleep disruption and sleep problems rather than specific sleep disorders.

5. Disciplines involved (and academic partners) Sociology (Prof Sara Arber, Surrey) (PI) Psychology (Prof Kevin Morgan, Loughborough) Neuroendocrinology (Prof Debra Skene, Surrey) Engineering (Prof Roger Orpwood, Bath) Nursing (Dr Ingrid Eyers, Surrey) Medicine (Prof David Armstrong, King’s College London) 4 year project, began 1 December 2006

6. Project Partners Philips Lighting (Dr Luc Schlangen) Expertise in the design of luminaries/fixtures for ‘blue light’ trials in the community and care homes North Nottinghamshire Health Community (Dr Maureen Tomeny) Supporting the training of 12 NHS primary care practitioners and 20 ‘expert patients’ to evaluate ‘supported’ sleep self-management The Relatives & Residents Association (Dr Gillian Dalley) Facilitating access and links with older service users, which is informing all aspects of the research and product development Age UK (formerly Help the Aged/Age Concern) (Prof James Goodwin) Helping to facilitate links with service users, and dissemination of findings, including publishing self-help material to improve sleep of older people in the community and care homes Healthtalkonline (Sue Ziebland/University of Oxford) Formerly DIPEx - producing a website module on ‘Sleep problems in Later Life’for their award-winning website (www.healthtalkonline.org) on patient experiences of illness

7. SomnIAWorkpackages

8. Some findings from 2 Workpackages - Dr Rebekah Luff • WP3: Understanding the social and environmental factors influencing quality of sleep in care homes - Ingrid Eyers, Rebekah Luff, Emma Cope, Theresa Ellmers - Surrey • WP7: Development and evaluation of sensor-based devices to improve sleep of older people in care homes and the community – Roger Orpwood, Bruce Carey-Smith, Nina Evans – Bath • - inter-connections between WPs

9. Research questions today (WP3) • How much time do care home residents spend in bed and how does this relate to likely time spent sleeping? • How does resident dependence level relate to bed times and getting up times? • How do staff shift changes and related staffing levels influence bed times and getting up times? • How can resident choice be understood within the context of their dependency and the care home routine?

10. Quantitative Methodology • 10 care homes in SE England • 145 residents with valid data • Male = 40, Female = 105 • Age range 65-102 (median 85-89) • Data collection for 14 consecutive days: • Actiwatches • Daily diaries: covering daytime activities and night • Socio-demographic information • Medication/ health • Dependency • Environment

11. Diary Data Every day for 14 days • Last night: • Time went to bed • Time went to sleep • Time woke up • Time got up • Sleep disturbances • Number of times woke up during the previous night • Why woke up • Evaluation of their sleep quality the previous night

12. Self-Reported Hours in Bed N= 125 Mean time spent in bed = 10hrs 50mins Mean time spent in bed ‘awake’ = 2hrs 25mins

13. Self-reported bed times:Residents in 8am-8pm shift homes N=36 N=24 Staff shift change

14. Self-reported getting up time:Residents in 8am-8pm shift homes N=24 N=36 Staff shift change

15. Findings from SomnIA care home observational studies and previously published work Interview care home staff and residents Identify technology concepts SomnIA Workshop 1 Interviews with care home staff Circulate concepts to SomnIA team Prioritise concepts Interviews with care home staff and residents SomnIA Workshop 2 Early prototypes Stage 2 Ethical approval User evaluation Technology development Sensor-Based Technology:Development Process (WP7) Stage 1 Ethical approval Collate results and summarise areas of need

16. Psychosocial Anxiety over provision of care Noise activated call system Supporting staff to provide timely and appropriate care Accessible call button Reassuring residents that care is available Enabling residents to reliably access appropriate care when it is needed Remote monitoring Environmental External disturbances Versatile lighting Minimising external sources of noise Providing appropriate ambient light levels Night-time communication Minimising disturbance associated with physical checks Personal radio or music player Comfort and accessibility of the environment Encouraging reluctant callers Improving ability to engage in soporific night-time activities Enabling residents to satisfy their physical needs Bedside item storage Factors contributing to poor sleep Technology Concepts Design ideas

17. ComfySound • What we know – comments from survey and demonstrations • Needs to provide a audio from a variety of sources (TV, radio, mp3) • Needs to be wipe-clean • Different pillow options important • Controls need to be simple to use • What we need to find out • Does it lead to reduce noise levels? • Does it lead to increased restfulness? • Are in-pillow controls suitable?

18. SpeakEasy • What we know – comments from survey and demonstrations • Needs to be wipe-clean • Needs to be soft and comfortable • Needs to be compact, light and portable • Primarily operated by staff • What we need to find out • Is sufficient amplification achievable without feedback? • Does its use lead to reduced disturbance?

19. Scientific and Knowledge Transfer – 1- Conferences and Publications • Academic Conferences – 65 Oral and 37 poster presentations (including 13 invited) • Practitioner/User Conferences – 13 Oral and 8 Poster presentations (including 10 invited) • Publications – long time lag for publications, outputs to date vary with timing of different WPs • 8 peer-reviewed articles • 2 practitioner articles • 2 book chapters • 4 articles under submission

20. Scientific and Knowledge Transfer – 2- Media, Briefing Papers, Website • Media – 3 TV; 4 radio; 22 newspaper/online blog - ??Concerns about possible ‘bad publicity, e.g. re: care home findings • Briefing Papers – 2 pages of A4, colour • 9 produced - one general, and one on each WP • Distributed widely, e.g. At Day conferences • On website, etc. • Website – Information about WPs, SomnIA Conferences, Findings etc.

21. Scientific and Knowledge Transfer – 3- Day Conferences and Dissemination Events • British Science Festival Symposium on ‘Sleep after 60’, Sept 2009 – generated media interest • Launch of ‘Sleep Problems in Later Life’ module on healthtalkonline website – Nov 2009, London • 2 Day Workshops for care home industry (July 2009, Guildford & July 2010, Bristol) – each attended by 80-90 care home managers • Conference with National Care Homes Research & Development Forum (Dec 2009, Surrey) • Day Conference – ‘Help yourself to sleep’ for health service practitioners – (Nov 2010, Loughborough)

22. Scientific and Knowledge Transfer – 4- Final ‘Policy and Practice’ Conference • ‘Sleep, Well-being and Active Ageing: New Evidence for Policy and Practice’ –28th October 2010, Church House Conference Centre, Westminster. • Mixture of key speakers from Ageing (e.g. Mike Nolan), Sleep (e.g. Colin Espie), Assistive Technology (Peter Lansley), Voluntary Sector (e.g. James Goodwin), plus SomnIA speakers • Key Findings Booklet - will be distributed • Press Releases – publicity. BUT some WPs still in early stages of analysis PLUS may not want to release ‘findings’ until they are published....

23. Acknowledgements This research is supported by the: New Dynamics of Ageing initiative, a multidisciplinary research programme supported by AHRC, BBSRC, EPSRC, ESRC and MRC. (Grant number RES-339-25-0009). Thanks to all our SomnIA colleagues Thank You S.Arber@surrey.ac.uk Rebekah.Luff@surrey.ac.uk www.somnia.surrey.ac.uk