Quality Indicators for the Care of Sleep Disorders in Vulnerable Elders

Sleep is a complex biological phenomenon that changes across the lifespan. In the context of normal aging, sleep becomes more fragmented, and there are shifts in the timing of circadian rhythms. In addition to these changes, subjectively reported sleep problems and objectively measured sleep disorders increase in prevalence with advancing age. Disruption of nighttime sleep can contribute to depression, cognitive problems (e.g., slowed reaction time), and reduced quality of life in older people. A growing number of recent studies show that sleep abnormalities are associated with higher mortality risk and adverse health conditions. Although there is little research on the actual quality of care for sleep problems in older people, findings generally suggest that sleep problems are underrecognized and undertreated and that identification and effective management of sleep disorders can improve health outcomes. This article presents quality indicators (QIs) that could be applied when screening and treating vulnerable elders (VEs) for sleep problems and reviews the available data in support of each indicator. For the purposes of the Assessing Care of Vulnerable Elders (ACOVE) project, VEs are defined as individuals aged 65 and older who are at risk for functional decline and death. METHODS: A total of 481 articles were considered in this review: 49 identified through a Web search, 18 through reference mining, and 414 through the ACOVE-3 literature searches. Two additional articles were included after peer review. RESULTS: Of the 13 potential QIs, the expert panel process judged 10 to be valid, were rejected. The literature supporting each of the indicators judged to be valid in the expert panel process is summarized.