Targeted interventions to promote sleep for hospitalized older adults: a narrative review

Nearly two-thirds of older adults experience sleeping difficulties in the hospital setting, which can lead to delirium, mood instability, and delayed healing. Many members of the interprofessional hospital team are positioned to promote restorative sleep, but knowledge about how to intervene is limited. The purpose of this review is to provide members of the hospital care team with specific interventions to promote restorative sleep in hospitalized older adults.

A narrative literature review was performed in PubMed and CINAHL to identify studies focusing on pharmacological and non-pharmacological sleep promoting interventions in hospitalized older adults. A review of basic sleep biology is also provided to create a common understanding of this phenomenon for a wide range of interprofessional hospital care team members.

A three-pronged approach focused on interventions related to staff culture, specific patient care activities, and hospital policies provides an organizing framework of non-pharmacological sleep promoting interventions. A judicious and cautious approach to the use of pharmacological and nutraceutical interventions is provided.

The hospital care team should implement patient-centered and customized interventions to promote sleep for hospitalized older adults. Sleep promotion should include, at a minimum, non-pharmacological interventions (e.g. increasing familiarity, reducing sensory stimulation as bedtime approaches, maintaining environmental and behavioral zeitgebers). Pharmacological (e.g. ramelteon, trazadone, doxepin, dual orexin receptor antagonists) and nutraceutical (e.g. melatonin, magnesium) interventions may be appropriate, Certain pharmacological options are considered potentially unsafe for older adults (e.g. benzodiazepines, Z-drugs, antihistamines) and should be avoided in this population.