Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Committee Chair

Meeks, Suzanne

Author's Keywords

Circadian rhythm; Sleep; Depression; Social rhythm; Chrontotype; Aging


Nursing home patients; Sleep; Circadian rhythms


Older adults entering a nursing home face many physical and psychosocial challenges, all at a point in life when their bodies may be least equipped to handle such adversity. Data for the present study were collected for 186 incoming residents from 6 nursing homes over the course of 1 year. Fifty-six participants were interviewed at the earliest possible time point following admission and rest-activity data were collected via actigraphy for 1 week, after which participants were interviewed a second time. Newly admitted residents in this sample were functionally dependent, highly medicated, and diagnosed with many conditions associated with sleep and/or mood disturbances. Sleep disorders appear to be underreported or underdiagnosed on the Minimum Data Set (MDS) which documented only 5.9% of patients with sleep-related diagnoses. A large number of residents, 63%, reported sleep disturbances consistent with clinical sleep pathology. The MDS indicated that 7.4% were prescribed hypnotics but this figure is deceiving in regard to medication use for sleep. Medication administration records showed 35% used sleep-related medications, and 39% of patients reported using medications to sleep. Consistent with other studies, these nursing home residents received inadequate bright light exposure with an average of 11 minutes at or above 1000 lux per day and none above 2000 lux. Approximately 35% were diagnosed with depression on the MDS. Self-reports showed approximately 29% with mild and 32% with moderate to moderately severe depression. A primary aim of this study was to identify sleep timing changes during the transition to the nursing home because adjustment to this type of change can be difficult for older adults. The average change in sleep timing fell between 1 and 2 hours, with a range from 0 to 6½ hours. As expected, participants preferred morning activity which is consistent with other studies of older adults and may reflect an age-related advance of the endogenous circadian rhythm. On average, all chronotypes experienced advances in sleep timing which is consistent with our hypothesis that the early morning routine typical of nursing homes would require residents to modify their sleep routines. Greater evening preference predicted a larger advance in sleep timing. Sleep phase changes are an important concern, particularly in light of the widespread rest-activity rhythm disturbances found in this setting and this study confirmed that rest-activity rhythms are disturbed in incoming nursing home residents. Another aim was to investigate the role of social rhythms, or the frequency and regularity of a daily routine, during this transition. A unique pattern of relationships was found among rest-activity rhythms, social rhythms, sleep and mood in the presence of certain types of sleep timing changes. This was not identified or explained based on the hypothesized model proposed in this study. Future studies should further evaluate these relationships based on a more nuanced model that accounts for the type (bed- versus wake-time) and direction (advance versus delay) of sleep timing change.