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Sleep disturbance among older adults in long-term care: a significant problem in an important clinical setting.

Sleep disturbance is common among communitydwelling older adults, particularly those with comorbid medical and psychiatric illness. 1 Conversely, healthy older men and women often may have good nighttime sleep quality and little daytime sleepiness, both of which may be markers of, or may actually promote, successful aging. 2 Sleep disturbance is particularly common and important in the growing population of older adults in long-term care settings. Due to a high prevalence of psychiatric illness among these individuals, 3 mental health professionals have an important role in the care of older adults in long-term care and need to be aware of unique aspects of sleep disturbance in these settings. Long-term care involves a variety of services designed to meet a person’s health or personal care needs when they can no longer perform activities of daily living independently. 4 Such services may be provided in the home, in the community, or in facilities. Most home-based services involve provision of personal care or supervision by formal or informal, paid or unpaid caregivers. Community-based long-term care includes services such as adult day healthcare programs, senior centers, transportation assistance, meals programs, and respite care. Facility-based longterm care includes services such as adult foster care, board and care homes or assisted living facilities, nursing homes, and similar facilities. It has been estimated that 9 million older adults currently need longterm care services; this number is expected to rise to 12 million by 2020. Those who reach age 65 years have a 40% chance of entering a nursing home, and 10% of those who enter a nursing home will stay there for 5 years or more. 5 International consensus documents and existing guidelines can help focus efforts of mental health professionals who care for older adults in long-term care settings, particularly nursing homes and similar facilities. These guidelines suggest that there should be a continuum of services available based on the needs of the patient, there should be explicit focus on quality of care, and quality of life should be a primary objective in many of these individuals. 6 Important