A qualitative study of sleep and the night-time in care homes for older people.

Sleep is an essential contributor to health, well-being and quality of life. This thesis explores sleep and the night-time in care homes for older people. To date there has been a lack of qualitative research to explore what happens in a care home throughout the night and further our understanding of care home residents' experiences of sleep and the night-time. Forming part of the New Dynamics of Ageing funded Sleep in Ageing project, (www.somnia.surrev.ac.uk) the study aims to explore this previously under-researched area using qualitative methodology including interviews with 38 care home residents and 39 staff, together with observations in each home. The research findings from this study identify aspects of the social and physical environment of a care home which influence the experience of the night-time and the quality of residents' sleep, as perceived by both staff and residents. In particular, residents expressed difficulties exerting control over their sleep environment and lacked strategies and support to do this. Personal control over sleeping routines and bedroom privacy was found to be related to levels of physical and cognitive ability. The dominance in care homes of a risk-averse culture which focuses on the ageing body as the centre of risk, and organisational routines during the night-time, facilitated an environment where disturbed sleep becomes a normal part of the sleep experience and an accepted consequence of night-time care. This thesis concludes that the current model of 'care' within care homes is unable to provide individualised support to care home residents that makes possible choice and control over the night time sleep environment, and which does not contribute to the promotion of good quality sleep