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Article Title

Sleep Deprivation in Hospitalized Patients Over the Age of 60: An Approach to Recruitment Challenges in an Inpatient Setting

Publication Date

8-10-2017

Keywords

human subjects research, aging, elderly, geriatrics, observational studies, survey research and methods, acute inpatient care, hospitals, dissemination and implementation of innovations, patient-reported outcomes/functional status, quality improvement

Abstract

Background: Chronic sleep deprivation in older adults contributes to dementia, cardiovascular disease and mortality, but has not been studied in a hospital setting. We conducted a pilot study in a Northern California hospital to evaluate the quantity and quality of sleep among inpatients age 60 years and older. The study goal was to evaluate the association between sleep and hospital outcomes such as length of stay (LOS), delirium and readmissions. The focus of this abstract is to describe our approach to recruitment challenges in a hospital setting.

Methods: This study was conducted at an 81-bed community acute-care hospital in rural Tracy, California. Our goal was to recruit 100 patients in a 1-year period. We began with strict eligibility criteria, exclusively recruiting patients admitted with an expected LOS ≥ 2 days and without cognitive impairments. We measured sleep with 24-hour wrist actigraphy and sleep diaries, and collected patient-reported outcomes through in-person questionnaire. Study staff included more than 25 volunteers from local universities. We also included an education component for bedside nursing staff and volunteers.

Results: In the first 5 months we recruited 12 patients and worked with leadership to revise eligibility requirements and recruitment methods in an attempt to increase yield. Specifically, we relaxed the 2-day expected LOS and extended recruitment efforts to the emergency department. We also added Spanish-language materials. In the 4 months since making these changes, we have recruited 28 patients. We determined that the Spanish materials and recruitment effort from the emergency department did not impact recruitment rates; however, modifications to the eligibility criteria led to better recruitment.

Conclusion: There are several important elements to successful recruitment and participant retention for research in a hospital setting. Flexibility and creativity are essential; in our case, we relaxed restrictions on estimated LOS. In addition, having assistance from highly trained volunteers and nursing staff was equally valuable. Finally, the support of leadership (chief medical executive and nursing administration) allowed us to make some of the necessary changes throughout the process. With our new processes in place, we hope to complete recruitment within 6 months.

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