Date of Award


Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)


Occupational Therapy

First Advisor

Sclinda Janssen


Aged; Aged, 80 and Over; Occupational Therapy -- methods; Sleep Initiation and Maintenance Disorders -- complications; Sleep Initiation and Maintenance Disorders -- etiology; Sleep Initiation and Maintenance Disorders -- therapy


There is a growing population of older adults, or those people over 65 years old in long term care (LTC) facilities who report sleep deficiencies at a heightened rate, leading to decrease function, cognition, and social participation while increasing mortality, morbidity and the risk of falling (Booth & McMilliam, 2009; Cipolli, Mazzetti, & Plazzi, 2013; Crowley, 2011; Dzierewski et al., 2014; Helbig et al., 2013; Kuck, Pantke, & Flick, 2015). Occupational therapists (OTs) offer non-pharmacological sleep interventions in the long-term care facilities but are not present at many relevant sleeping times. This scholarly project is a flow chart aid to promote an interdisciplinary approach to non-pharmacological sleep interventions incorporating OTs and para professionals, who are available to assist in prescribed sleep interventions. These evidenced based interventions will include reduction of screen time prior to sleep, daily self-care scheduling, modifications to light, temperature, sound, notaria considerations, and participation in meaningful activities. The outcomes measures explored include actigraphy and The Pittsburgh Sleep Quality Index (PSQI)

The Ecology of Human Performance Model (EHP) was used to guide all aspects of the creation of the sleep flow chart. The EHP model was chosen due to its use of a common language among medical professions, structure to organize the components of sleep within LTC facilities, and identification of OT intervention types. The creation of this sleep intervention flow chart included a scoping review of older adult sleep intervention literature. The scoping review was used because of the paucity of literature that is specific to OT and the interdisciplinary nature of the sleep intervention flow chart.

There are three components to the scholarly project including an intuitive easy to read 24 by 36 inch sleep flow chart to be displayed for quick reference, an infographic that incorporates icons and includes additional information and citations for the use of OTs, and a user guide to the flow chart with additional references and instructions for further explanation to possible interventions.

All components of the final sleep flow chart project were reviewed by 5 individuals with limited knowledge of older adult sleep interventions for comprehension of material, this included a certified nurse assistant and an individual who spoke English as a second language to ensure the language presented would be understood. The sleep flowchart is unique to OT as it identifies the occupation of sleep to be interrelated with basic activities of daily living and the presence or absence of environmental supports at a LTC facility. The flowchart was intended to benefit OT by providing OTs with a simple visual display to assist with educating paraprofessionals on identifying intervention methods to improve their residents’ sleep.