Intervening to Prevent Nighttime Injuries in Cognitively-Impaired Persons Living at Home: A Case Report

The purpose of this case report is to illustrate the use of a novel interventio n used to prevent injuries in cognitively-impaired (CI) individuals living in t he home who arise during the night. A home monitoring system was developed to e nsure that the caregiver would be notified if the CI individual attempted to le ave the home at night. This case illustrates the effectiveness of the device in a situation in which the CI individual frequently attempted to leave the home during the night hours. Correspond and request reprints to: Meredeth A. Rowe, RN, PhD Decker School of Nursing Binghamton University Binghamton, NY 13902-1600 Grant support received from:Zeta Iota Chapter of Sigma Theta Tau; Decker Foundation; Faculty Development and Enhancement Grant, Binghamton University CLINICAL SIGNIFICANCE As the general population ages, the number of cognitivelyimpaired (CI) individuals will rise exponentially over the next 30 years placing a significant toll on caregivers and long term care institutions. Currently approximately 4 million individuals with Alzheimer’s disease and other cognitive impairments live in the United States with this number increasing by several hundred thousand in the next 5 years, and by more than a million in the next 15 years (1). Of these, more than 70% live at home with the majority of care provided by family and friends . Nighttime activity is a significant problem in home-dwelling dementia individuals. A number of researchers have demonstrated profound changes in their sleep – wake cycle, including increases in time awake and number of awakenings during the night . Pollack, Perlick, Alexopoulos and Gonzalez found that disruptive nighttime behaviors, those that awoke the caregiver, occurred in 53% of elders enrolled in day care programs . The reasons for awakening a caregiver at night included complaints of pain, complaints of sleeplessness, wanting to talk, needing help, and wandering. The deleterious effects on caregivers’ sleep and the ability to provide care often have the unfortunate consequence of institutional placement . Additionally, nighttime activity outside of the home in CI individuals can result in death . Thus, interventions developed to improve caregiver sleep may prevent injuries and delay institutional placement. The following case study illustrates a novel method designed to assist caregivers in managing the nighttime activity common in dementia.