What is occupational therapy's role in addressing sleep problems among older adults?

The Paper
Leland, N. E., Marcione, N., Niemiec, S. L. S., Kelkar, K., & Fogelberg, D. (2014). What is occupational therapy's role in addressing sleep problems among older adults?. OTJR: occupation, participation and health, 34(3), 141-149.

The Problem
For over 10 years now, the American Occupational Therapy Association (AOTA) has considered sleep its own category of occupation.

We're also sure you can probably think of at least one person you know (and it may be you!) dealing with frustrating and challenging sleep issues.

The good news is OTs can have a positive and important role in supporting better sleep, particularly in adults and older adults.

The challenge is that although there is a ton of research on sleep assessment and treatment, there is a lack of OT specific evidence and guidelines on which to base your practice.

The Study
The authors in this paper did a scoping review of relevant literature to answer the question: What is occupational therapy’s role in addressing sleep problems among older adults?  

NOTE: A scoping review is a research method that explores a broad range of literature within a given topic (investigates “what’s out there” on a topic).  It’s different from a systematic review which typically has a more focussed research question and aggregates research data (usually in the context of “does this intervention work?”)

The Outcome
34 studies were used for the review which “represented four intervention areas within the scope of occupational therapy: Cognitive Behavioural Therapy for Insomnia (CBT-I; n=11), physical activity (n=11), multi-component interventions (n=9), and other sleep strategies (n=3)”.

Here are their key findings which supported better sleep in older adults - you can use these to help guide your assessment and intervention:

  1. Cognitive Behavioural Therapy for Insomnia (CBTi): shows good outcomes for older adults and sleep. Most interventions included sleep restriction/compression and stimulus control as the core interventions.  An important note we’ve touched on before is that using sleep hygiene alone has not been found to be effective.

  2. Physical activity: the selected studies used a wide variety of activities (eg. resistance training, dancing, walking), intensities and frequencies of exercise - but overall a majority of studies showed positive results for sleep outcomes.

  3. Multi-component interventions: included things like CBT-I strategies along with physical activity and environmental modifications. Again, a majority of the studies showed positive results for sleep.

  4. Other sleep strategies included light therapy, use of sleep masks and earplugs or music therapy.  Results were mixed.

The authors also identified 4 major areas of intervention as appropriate for OT scope of practice and use, and across the studies, there was consistency with a few treatment options:

  1. Modifying existing habits and routines to support sleep

  2. Modifying the environment

  3. Participating in physical activity

  4. Engagement in activities that comply with sleep restriction/constriction recommendations