研究背景：衰弱長者合併許多睡眠與憂鬱相關問題，且會對長者有著不良影響。不同居住型態的衰弱長者生心理社會健康特性可能有所不同，加上長者花費在戶外時間稀少，造成自然照光量不足，可能因而造成睡眠與憂鬱相關問題。但目前缺乏比較居住在社區或不同型式機構之衰弱長者，自然照光量與生心理社會健康及睡眠品質與憂鬱症狀相關的研究。

研究目的：透過收集居住在社區或不同型式機構之衰弱長者戶外照光時間、生心理社會健康與主客觀睡眠等資料，探討：(一)不同居住型態衰弱長者，其社會人口學與生活型態(生心理社會健康、服用鎮靜安眠藥物與身體活動量、戶外照光量及睡眠品質)是否不同；(二) 衰弱長者主客觀睡眠品質及憂鬱症狀與社會人口學特徵、戶外照光長短、身體活動與生心理社會健康因子之相關；(三) 若居住型態為衰弱長者主客觀睡眠品質與憂鬱症狀之相關因子，則在依序控制生心理社會健康、戶外照光量、身體活動跟鎮靜安眠藥物使用因子之後，是否仍為獨立預測因子；(四) 戶外照光量、身體活動量、服用鎮靜安眠藥物與生心理社會健康，如何調節居住於不同住宿型態之衰弱長者其主客觀睡眠品質與憂鬱症狀之相關。

研究方法：以方便取樣方式，在台灣中南部招募三組居住於不同型式(社區、傳統機構與單元照護機構)之65歲以上衰弱長者(衰弱量表介於4至8分)。以結構性問卷收集社會人口學、認知功能、心理狀態、健康狀況與主觀睡眠品質，以七日腕動計(actigraphy)收集客觀睡眠參數、戶外照光量與身體活動量。
研究結果：共納入91位受試者：(1) 衰弱長者報告主觀睡眠品質不佳狀況約占6至7成，而客觀睡眠效率則介於68至77%，入睡後醒來總時數介於106至158分鐘，以上狀況在三種居住型態之長者中無顯著差異；但居住於傳統機構顯著較居住於社區之衰弱長者有較高的憂鬱狀況(1.52 vs. 0.55, p = 0.006)；且居住於傳統機構(8.84分鐘)與單元照護(4.17分鐘)之衰弱長者，其每日平均戶外照光時間亦顯著較居住於社區組低(13.98分鐘)( p = 0.008)；(2)衰弱長者的主觀睡眠品質與居住型態、衰弱程度及有無服用鎮靜安眠藥物有關：居住傳統機構(B = -2.877, p = 0.025)與匹茲堡睡眠品質量表分數呈顯著負相關，但與較高衰弱程度(B = 1.772, p = 0.033)及服用鎮靜安眠藥物(B = 3.69, p < 0.001)顯著正相關；(3)衰弱長者客觀睡眠效率與服用鎮靜安眠藥物(B = 7.015, p = 0.014)成顯著正相關，但與輕度活動時間(B = -0.07, p < 0.001)成顯著負相關；入睡後醒來總時數與服用鎮靜安眠藥物(B = -51, p = 0.004)成顯著負相關，但與衰弱程度(B = 23.315, p = 0.041)和輕度活動時間(B = 0.314, p < 0.001)顯著正相關；(4) 居住在傳統機構可預測老年憂鬱症量表分數上升1.018分(p = 0.002)，但在控制生心理社會健康後變不顯著；孤獨感可預測老年憂鬱症量表分數上升(B = 0.09, p = 0.002)，但也在控制戶外照光後變得不顯著；最終僅衰弱程度可預老年憂鬱症量表分數上升，(B = 0.466, p = 0.006)；(5) 不同居住型態中，戶外照光與客觀睡眠的相關性有所不同，傳統機構相較於社區組，每分鐘多一分鐘戶外照光，可預測睡眠效率提升0.717% (p = 0.05)以及降低入睡後醒來總時數(WASO) 5.6分鐘(p = 0.006)。

結論：三組主客觀睡眠品質未見顯著差異，但憂鬱症狀中傳統機構組高於社區組，且兩組機構組戶外照光十分缺乏。後續發現傳統機構較嚴重的憂鬱症狀與衰弱程度相關。主觀睡眠品質較差，與衰弱程度較高及服用鎮靜安眠藥物相關；主觀睡眠品質較佳，與居住傳統機構相關；客觀睡眠品質較佳與較少輕度活動、衰弱程度較低及服用鎮靜安眠藥物與相關。此外相較於社區長者，傳統機構中戶外照光可預測較佳的客觀睡眠品質。本研究也存在許多限制，個案數較少可能造成資料分析的受限，且受限於橫斷性研究僅能討論相關性，未來仍需介入性研究，以確定戶外照光在不同居住型態對睡眠品質與憂鬱症狀的影響。

Elderly individuals usually experience various sleep problems and symptoms of depression. This can lead to numerous adverse effects on the elderly. The situation may be more serious in the institutions. The object of the study is to find out the risk factors that may affect sleep quality and depressive symptoms of frail elders in different living arrangements. Additionally, we aim to compare sociodemographic factors and lifestyle among frail elderly individuals residing in different living arrangements. Our study included three types of living arrangements: elders who live in community, conventional institutions, or unit care institutions. Questionnaires and actigraphy were used to collect data on sleep quality, depressive symptom, light exposure, etc. Eventually, we recruited 91 participates, and the number of participates in the three groups were similar. Participants with poor sleep quality was approximately 60% to 70%. The elderly in the community and unit care institutions live healthier and more actively. Poor subjective sleep quality is associated with more severe level of frailty and hypnotics use. Poor objective sleep quality was associated with more light physical activity times and hypnotics use. More severe depressive symptom was associate with more severe frailty level. We also observed an association between better objective sleep quality and outdoor light exposure in the conventional institutions. The result emphasizes the role of frailty levels, which may be negatively associated with sleep quality and depressive symptoms, and the importance of outdoor light exposure in institutions.

Alessi, C. A., Martin, J. L., Webber, A. P., Cynthia Kim, E., Harker, J. O., & Josephson, K. R. (2005). Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. Journal of the American Geriatrics Society, 53(5), 803-810. https://doi.org/10.1111/j.1532-5415.2005.53251.x
Ancoli-Israel, S., Clopton, P., Klauber, M. R., Fell, R., & Mason, W. (1997). Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep, 20(1), 24-27. https://doi.org/10.1093/sleep/20.1.24
Anderson, J. L., Rosen, L. N., Mendelson, W. B., Jacobsen, F. M., Skwerer, R. G., Joseph-Vanderpool, J. R., Duncan, C. C., Wehr, T. A., & Rosenthal, N. E. (1994). Sleep in fall/winter seasonal affective disorder: effects of light and changing seasons. Journal of Psychosomatic Research, 38(4), 323-337.
Barakat, S., Abujbara, M., Banimustafa, R., Batieha, A., & Ajlouni, K. (2019). Sleep Quality in Patients With Type 2 Diabetes Mellitus. Journal of Clinical Medicine Research, 11(4), 261-266. https://doi.org/10.14740/jocmr2947w
Barsasella, D., Syed-Abdul, S., Malwade, S., Kuo, T. B. J., Chien, M.-J., Núñez-Benjumea, F. J., Lai, G.-M., Kao, R.-H., Shih, H.-J., Wen, Y.-C., Li, Y.-C., Carrascosa, I. P., Bai, K.-J., Broekhuizen, Y. C. B., & Jaspers, M. W. M. (2021). Sleep Quality among Breast and Prostate Cancer Patients: A Comparison between Subjective and Objective Measurements. Healthcare, 9(7), 785. https://www.mdpi.com/2227-9032/9/7/785
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304123/pdf/healthcare-09-00785.pdf
Blume, C., Garbazza, C., & Spitschan, M. (2019). Effects of light on human circadian rhythms, sleep and mood. Somnologie, 23(3), 147-156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/pdf/11818_2019_Article_215.pdf
Brouwer, W. B., van Exel, N. J. A., & Stolk, E. A. (2005). Acceptability of less than perfect health states. Social Science and Medicine, 60(2), 237-246. https://www.sciencedirect.com/science/article/pii/S0277953604002230
Burns, A. C., Saxena, R., Vetter, C., Phillips, A. J. K., Lane, J. M., & Cain, S. W. (2021). Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: A cross-sectional and longitudinal study in over 400,000 UK Biobank participants. Journal of Affective Disorders, 295, 347-352. https://doi.org/10.1016/j.jad.2021.08.056
Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Calkins, M., Szmerekovsky, J. G., & Biddle, S. (2007). Effect of Increased Time Spent Outdoors on Individuals with Dementia Residing in Nursing Homes. Journal of Housing For the Elderly, 21(3-4), 211-228. https://doi.org/10.1300/J081v21n03_11
Çavuşoğlu, Ç., Deniz, O., Tuna Doğrul, R., Çöteli, S., Öncül, A., Kızılarslanoğlu, M. C., & Gçker, B. (2021). Frailty is associated with poor sleep quality in the oldest old. Turkish Journal of Medical Sciences, 51(2), 540-546. https://doi.org/10.3906/sag-2001-168
Chan, D. C., Hao, Y. T., & Wu, S. C. (2009). Characteristics of outpatient prescriptions for frail Taiwanese elders with long-term care needs. Pharmacoepidemiology and Drug Safety, 18(4), 327-334. https://doi.org/10.1002/pds.1712
Chang, S. J. (2013). Lived experiences of nursing home residents in Korea. Asian Nursing Research, 7(2), 83-90. https://www.sciencedirect.com/science/article/pii/S1976131713000212?via%3Dihub
Chen, Y., Zhou, Y. C., Li, M., Hong, Y. Y., Chen, H. K., Zhu, S. S., Zhou, Y. Y., Yang, S. Y., Wu, X. L., & Wang, D. H. (2023). Social capital and loneliness among older adults in community dwellings and nursing homes in Zhejiang Province of China. Frontiers in Public Health, 11, Article 1150310. https://doi.org/10.3389/fpubh.2023.1150310
Chin, W.-C., Liu, C.-Y., Lee, C.-P., & Chu, C.-L. (2014). Validation of five short versions of the Geriatric Depression Scale in the elder population in Taiwan. Taiwan J Psychiatr, 28(3), 156-163.
Cho, C.-H., Lee, H.-J., Yoon, H.-K., Kang, S.-G., Bok, K.-N., Jung, K.-Y., Kim, L., & Lee, E.-I. (2016). Exposure to dim artificial light at night increases REM sleep and awakenings in humans. Chronobiology International, 33(1), 117-123.
Conte, F., Malloggi, S., Albinni, B., Cerasuolo, M., Ficca, G., & Giganti, F. (2020). The Role of Environmental Context in Modulating Subjective Sleepiness and Sleep Quality in the Elderly: A Comparison Between Home-Dwelling Subjects and Nursing Home Residents. Home Health Care Management & Practice, 32(2), 81-86.
Cottle, M. (2021). Nobody wants to live in a nursing home. Something’s got to give. New York Times.
Cui, Y., Gong, Q., Huang, C., Guo, F., Li, W., Wang, Y., & Cheng, X. (2021). The relationship between sunlight exposure duration and depressive symptoms: A cross-sectional study on elderly Chinese women. PloS One, 16(7), e0254856. https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0254856&type=printable
Czeisler, C. A., Duffy, J. F., Shanahan, T. L., Brown, E. N., Mitchell, J. F., Rimmer, D. W., Ronda, J. M., Silva, E. J., Allan, J. S., Emens, J. S., Dijk, D. J., & Kronauer, R. E. (1999). Stability, precision, and near-24-hour period of the human circadian pacemaker. Science, 284(5423), 2177-2181. https://doi.org/10.1126/science.284.5423.2177
Daglar, G., Pinar, S. E., Sabanciogullari, S., & Kav, S. (2014). Sleep quality in the elderly either living at home or in a nursing home. Australian Journal of Advanced Nursing, The, 31(4), 6-13.
Dautovich, N. D., Schreiber, D. R., Imel, J. L., Tighe, C. A., Shoji, K. D., Cyrus, J., Bryant, N., Lisech, A., O'Brien, C., & Dzierzewski, J. M. (2019). A systematic review of the amount and timing of light in association with objective and subjective sleep outcomes in community-dwelling adults. Sleep health, 5(1), 31-48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814154/pdf/nihms-1054544.pdf
De Lepeleire, J., Bouwen, A., De Coninck, L., & Buntinx, F. (2007). Insufficient lighting in nursing homes. Journal of the American Medical Directors Association, 8(5), 314-317. https://doi.org/10.1016/j.jamda.2007.01.003
de Paula Rebouças, C. M., Ribeiro, M. R., Zangilorami-Raimundo, J., de Lima Bezerra, P. C., das Chagas de Souza Junior, A. M., da Silva Souza, N., Pereira, J. R., Soares Júnior, J. M., de Paula Reboucas da Costa, L. M., & de Abreu, L. C. (2021). Association between sleep quality and depression among institutionalized and community older people-Brazilian Western Amazonia. BMC Psychiatry, 21, 1-10.
Dement, W., & Kleitman, N. (1957). The relation of eye movements during sleep to dream activity: an objective method for the study of dreaming. Journal of Experimental Psychology, 53(5), 339-346. https://doi.org/10.1037/h0048189
den Ouden, M., Bleijlevens, M. H., Meijers, J. M., Zwakhalen, S. M., Braun, S. M., Tan, F. E., & Hamers, J. P. (2015). Daily (in) activities of nursing home residents in their wards: an observation study. Journal of the American Medical Directors Association, 16(11), 963-968. https://www.sciencedirect.com/science/article/pii/S1525861015003837?via%3Dihub
Deng, M., Qian, M., Lv, J., Guo, C., & Yu, M. (2023). The association between loneliness and sleep quality among older adults: A systematic review and meta-analysis. Geriatric Nursing, 49, 94-100. https://doi.org/https://doi.org/10.1016/j.gerinurse.2022.11.013
Dowling, G. A., Hubbard, E. M., Mastick, J., Luxenberg, J. S., Burr, R. L., & Van Someren, E. J. (2005). Effect of morning bright light treatment for rest-activity disruption in institutionalized patients with severe Alzheimer's disease. International Psychogeriatrics, 17(2), 221-236. https://doi.org/10.1017/s1041610205001584
Duzgun, G., & Durmaz Akyol, A. (2017). Effect of Natural Sunlight on Sleep Problems and Sleep Quality of the Elderly Staying in the Nursing Home. Holistic Nursing Practice, 31(5), 295-302. https://doi.org/10.1097/HNP.0000000000000206
Ensrud, K. E., Blackwell, T. L., Ancoli-Israel, S., Redline, S., Cawthon, P. M., Paudel, M. L., Dam, T.-T. L., & Stone, K. L. (2012). Sleep disturbances and risk of frailty and mortality in older men. Sleep Medicine, 13(10), 1217-1225. https://doi.org/https://doi.org/10.1016/j.sleep.2012.04.010
Espiritu, R. C., Kripke, D. F., Ancoli-Israel, S., Mowen, M. A., Mason, W. J., Fell, R. L., Klauber, M. R., & Kaplan, O. J. (1994). Low illumination experienced by San Diego adults: association with atypical depressive symptoms. Biological Psychiatry, 35(6), 403-407. https://doi.org/10.1016/0006-3223(94)90007-8
Flores-Villa, L., Unwin, J., & Raynham, P. (2020). Assessing the impact of daylight exposure on sleep quality of people over 65 years old. Building Services Engineering Research and Technology, 41(2), 183-192. https://doi.org/10.1177/0143624419899522
Foley, D., Ancoli-Israel, S., Britz, P., & Walsh, J. (2004). Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. Journal of Psychosomatic Research, 56(5), 497-502. https://doi.org/10.1016/j.jpsychores.2004.02.010
Gooneratne, N. S., & Vitiello, M. V. (2014). Sleep in older adults: normative changes, sleep disorders, and treatment options. Clinics in Geriatric Medicine, 30(3), 591-627. https://doi.org/10.1016/j.cger.2014.04.007
Gorman, E., Hanson, H. M., Yang, P. H., Khan, K. M., Liu-Ambrose, T., & Ashe, M. C. (2014). Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis. European Review of Aging and Physical Activity, 11(1), 35-49. https://doi.org/10.1007/s11556-013-0132-x
Grandner, M. A., Kripke, D. F., Yoon, I.-Y., & Youngstedt, S. D. (2006). Criterion validity of the Pittsburgh Sleep Quality Index: Investigation in a non-clinical sample. Sleep and Biological Rhythms, 4(2), 129-136.
Gulia, K. K., & Kumar, V. M. (2018). Sleep disorders in the elderly: a growing challenge. Psychogeriatrics, 18(3), 155-165. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/psyg.12319?download=true
Hays, R. D., & DiMatteo, M. R. (1987). A short-form measure of loneliness. Journal of Personality Assessment, 51(1), 69-81.
Hertenstein, E., Feige, B., Gmeiner, T., Kienzler, C., Spiegelhalder, K., Johann, A., Jansson-Fröjmark, M., Palagini, L., Rücker, G., Riemann, D., & Baglioni, C. (2019). Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Medicine Reviews, 43, 96-105. https://doi.org/10.1016/j.smrv.2018.10.006
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., & Kheirandish-Gozal, L. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep health, 1(1), 40-43.
Hjetland, G. J., Nordhus, I. H., Pallesen, S., Cummings, J., Tractenberg, R. E., Thun, E., Kolberg, E., & Flo, E. (2020). An Actigraphy-Based Validation Study of the Sleep Disorder Inventory in the Nursing Home. Front Psychiatry, 11, 173. https://doi.org/10.3389/fpsyt.2020.00173
Hong, Z., Zhang, H., Xu, L., Zhou, J., Kong, F., Li, J., Hu, F., & Gao, Z. (2021). Negative life events and self-harm among the elderly: Result from a survey of 7070 people aged≥ 60 in China. Psychiatry Research, 298, 113727.
Howell, C. M., McCullough, S. J., Doyle, L., Murphy, M. H., & Saunders, K. J. (2021). Reliability and validity of the Actiwatch and Clouclip for measuring illumination in real‐world conditions. Ophthalmic and Physiological Optics, 41(5), 1048-1059. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/opo.12860?download=true
Hoyl, M. T., Alessi, C. A., Harker, J. O., Josephson, K. R., Pietruszka, F. M., Koelfgen, M., Mervis, J. R., Fitten, L. J., & Rubenstein, L. Z. (1999). Development and testing of a five-item version of the Geriatric Depression Scale. Journal of the American Geriatrics Society, 47(7), 873-878. https://doi.org/10.1111/j.1532-5415.1999.tb03848.x
Hsiao, S. H., Chiu, H. C., & Liu, H. W. (1994). [A replication of multidimensionality of activities of daily living(ADL): on the elderly in southern Taiwan]. Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences, 10(8), 449-457. http://europepmc.org/abstract/MED/7799466
Hubalek, S., Brink, M., & Schierz, C. (2010). Office workers’ daily exposure to light and its influence on sleep quality and mood. Lighting research & technology, 42(1), 33-50.
Hughes, J. M., Song, Y., Fung, C. H., Dzierzewski, J. M., Mitchell, M. N., Jouldjian, S., Josephson, K. R., Alessi, C. A., & Martin, J. L. (2018). Measuring sleep in vulnerable older adults: a comparison of subjective and objective sleep measures. Clinical Gerontologist, 41(2), 145-157. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809246/pdf/nihms932695.pdf
Ibrahim, S. A. S., & Dahlan, A. (2015). Engagement in occupational activities and purpose in life amongst older people in the community and institutions. Procedia-Social and Behavioral Sciences, 202, 263-272. https://www.sciencedirect.com/science/article/pii/S1877042815048788
Ibuka, N., & Kawamura, H. (1975). Loss of circadian rhythm in sleep-wakefulness cycle in the rat by suprachiasmatic nucleus lesions. Brain Research, 96(1), 76-81. https://doi.org/10.1016/0006-8993(75)90574-0
Jerez-Roig, J., de Oliveira, N. P. D., de Lima Filho, B. F., de Farias Bezerra, M. A., Matias, M. G. L., Ferreira, L. M., dos Santos Amaral, F. L. J., Souza, D. L. B., & Lima, K. C. (2016). Depressive symptoms and associated factors in institutionalized elderly. Experimental Aging Research, 42(5), 479-491.
Jirong, Y., Changquan, H., Hongmei, W., & Bi-Rong, D. (2013). Association of sleep quality and dementia among long-lived Chinese older adults. Age (Dordr), 35(4), 1423-1432. https://doi.org/10.1007/s11357-012-9432-8
Johns, M. W. (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 14(6), 540-545. https://doi.org/10.1093/sleep/14.6.540
Kane, R. A., Lum, T. Y., Cutler, L. J., Degenholtz, H. B., & Yu, T. C. (2007). Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program. Journal of the American Geriatrics Society, 55(6), 832-839. https://doi.org/10.1111/j.1532-5415.2007.01169.x
Kay, D. B., Buysse, D. J., Germain, A., Hall, M., & Monk, T. H. (2015). Subjective-objective sleep discrepancy among older adults: associations with insomnia diagnosis and insomnia treatment. Journal of Sleep Research, 24(1), 32-39. https://doi.org/10.1111/jsr.12220
Kim, D. E., & Yoon, J. Y. (2020). Factors that Influence Sleep among Residents in Long-Term Care Facilities. International Journal of Environmental Research and Public Health, 17(6), 1889. https://doi.org/10.3390/ijerph17061889
Kim, W. H., Kim, B. S., Kim, S. K., Chang, S. M., Lee, D. W., Cho, M. J., & Bae, J. N. (2013). Prevalence of insomnia and associated factors in a community sample of elderly individuals in South Korea. International Psychogeriatrics, 25(10), 1729-1737. https://doi.org/10.1017/s1041610213000677
Kloos, N., Trompetter, H. R., Bohlmeijer, E. T., & Westerhof, G. J. (2019). Longitudinal associations of autonomy, relatedness, and competence with the well-being of nursing home residents. The Gerontologist, 59(4), 635-643. https://doi.org/10.1093/geront/gny005
Kobayashi, R., Kohsaka, M., Fukuda, N., Sakakibara, S., Honma, H., & Koyama, T. (1999). Effects of morning bright light on sleep in healthy elderly women. Psychiatry and Clinical Neurosciences, 53(2), 237-238.
Kripke, D. F., Jean-Louis, G., Elliott, J. A., Klauber, M. R., Rex, K. M., Tuunainen, A., & Langer, R. D. (2004). Ethnicity, sleep, mood, and illumination in postmenopausal women. BMC Psychiatry, 4(1), 1-7.
Kume, Y., Kodama, A., Sato, K., Kurosawa, S., Ishikawa, T., & Ishikawa, S. (2016). Sleep/awake status throughout the night and circadian motor activity patterns in older nursing-home residents with or without dementia, and older community-dwelling people without dementia. International Psychogeriatrics, 28(12), 2001-2008. https://doi.org/10.1017/S1041610216000910
Kuo, C.-E., Liu, Y.-C., Chang, D.-W., Young, C.-P., Shaw, F.-Z., & Liang, S.-F. (2016). Development and evaluation of a wearable device for sleep quality assessment. IEEE Transactions on Biomedical Engineering, 64(7), 1547-1557. https://ieeexplore.ieee.org/stampPDF/getPDF.jsp?tp=&arnumber=7575654&ref=
Lai, S.-W., Liao, K.-F., Lin, C.-L., Lin, C.-C., & Lin, C.-H. (2020). Longitudinal data of multimorbidity and polypharmacy in older adults in Taiwan from 2000 to 2013. Biomedicine, 10(2), 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608846/pdf/bmed-10-02-001.pdf
Landry, G. J., Best, J. R., & Liu-Ambrose, T. (2015). Measuring sleep quality in older adults: a comparison using subjective and objective methods. Frontiers in Aging Neuroscience, 7, 166. https://doi.org/10.3389/fnagi.2015.00166
Li, J., Vitiello, M. V., & Gooneratne, N. S. (2018). Sleep in Normal Aging. Sleep Medicine Clinics, 13(1), 1-11. https://doi.org/10.1016/j.jsmc.2017.09.001
Li, J., Yao, Y. S., Dong, Q., Dong, Y. H., Liu, J. J., Yang, L. S., & Huang, F. (2013). Characterization and factors associated with sleep quality among rural elderly in China. Archives of Gerontology and Geriatrics, 56(1), 237-243. https://doi.org/10.1016/j.archger.2012.08.002
Liao, H., Liao, S., Gao, Y.-j., Mu, J.-p., Wang, X., & Chen, D.-s. (2022). Correlation between Sleep Time, Sleep Quality, and Emotional and Cognitive Function in the Elderly. BioMed Research International, 2022, 9709536. https://doi.org/10.1155/2022/9709536
Lieverse, R., Van Someren, E. J. W., Nielen, M. M. A., Uitdehaag, B. M. J., Smit, J. H., & Hoogendijk, W. J. G. (2011). Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive Disorder: A Randomized Placebo-Controlled Trial. Archives of General Psychiatry, 68(1), 61-70. https://doi.org/10.1001/archgenpsychiatry.2010.183
Lorber, M., Kmetec, S., Davey, A., Mlinar Reljić, N., Fekonja, Z., & Kegl, B. (2023). Associations between Sleep Quality, Frailty, and Quality of Life among Older Adults in Community and Nursing Home Settings. International Journal of Environmental Research and Public Health, 20(6). https://doi.org/10.3390/ijerph20064937
Loving, R. T., Kripke, D. F., Elliott, J. A., Knickerbocker, N. C., & Grandner, M. A. (2005). Bright light treatment of depression for older adults [ISRCTN55452501]. BMC Psychiatry, 5, 1-14.
Luo, J., Zhu, G., Zhao, Q., Guo, Q., Meng, H., Hong, Z., & Ding, D. (2013). Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: results from the Shanghai aging study. PloS One, 8(11), e81261. https://doi.org/10.1371/journal.pone.0081261
Ma, T., Shi, G., Zhu, Y., Wang, Y., Chu, X., Jiang, X., Liu, Z., Cai, J., Wang, H., Jin, L., Wang, Z., & Wang, X. (2017). Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study. Archives of Gerontology and Geriatrics, 73, 8-14. https://doi.org/10.1016/j.archger.2017.07.003
Maglione, J. E., Ancoli‐Israel, S., Peters, K. W., Paudel, M. L., Yaffe, K., Ensrud, K. E., & Stone, K. L. (2012). Depressive symptoms and subjective and objective sleep in community‐dwelling older women. Journal of the American Geriatrics Society, 60(4), 635-643. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517685/pdf/nihms350190.pdf
Magnusson, A., & Boivin, D. (2003). Seasonal affective disorder: an overview. Chronobiology International, 20(2), 189-207.
Marsa, R., Younesi, S. J., Barekati, S., Ramshini, M., & Ghyasi, H. (2020). A comparative study on stress, anxiety and depression between nursing-home elderly residents and home-dwelling elderly people. Iranian Journal of Ageing, 15(2), 176-187.
Martin, J. L., Webber, A. P., Alam, T., Harker, J. O., Josephson, K. R., & Alessi, C. A. (2006). Daytime Sleeping, Sleep Disturbance, and Circadian Rhythms in the Nursing Home. The American Journal of Geriatric Psychiatry, 14(2), 121-129. https://doi.org/https://doi.org/10.1097/01.JGP.0000192483.35555.a3
Martino, J. K., Freelance, C. B., & Willis, G. L. (2018). The effect of light exposure on insomnia and nocturnal movement in Parkinson's disease: an open label, retrospective, longitudinal study. Sleep Medicine, 44, 24-31. https://doi.org/https://doi.org/10.1016/j.sleep.2018.01.001
Martins da Silva, R., Afonso, P., Fonseca, M., & Teodoro, T. (2020). Comparing sleep quality in institutionalized and non-institutionalized elderly individuals. Aging & Mental Health, 24(9), 1452-1458. https://doi.org/10.1080/13607863.2019.1619168
Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nat Sci Sleep, 9, 151-161. https://doi.org/10.2147/nss.S134864
Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601-608. https://doi.org/10.1093/sleep/34.5.601
Neikrug, A. B., & Ancoli-Israel, S. (2010). Sleep disturbances in nursing homes. The Journal of Nutrition, Health & Aging, 14(3), 207-211. https://doi.org/10.1007/s12603-010-0051-8
Nelson, K. L., Davis, J. E., & Corbett, C. F. (2022). Sleep quality: An evolutionary concept analysis. Nursing Forum,
Obayashi, K., Saeki, K., Iwamoto, J., Okamoto, N., Tomioka, K., Nezu, S., Ikada, Y., & Kurumatani, N. (2012). Positive Effect of Daylight Exposure on Nocturnal Urinary Melatonin Excretion in the Elderly: A Cross-Sectional Analysis of the HEIJO-KYO Study. The Journal of Clinical Endocrinology & Metabolism, 97(11), 4166-4173. https://doi.org/10.1210/jc.2012-1873
Obayashi, K., Saeki, K., Iwamoto, J., Okamoto, N., Tomioka, K., Nezu, S., Ikada, Y., & Kurumatani, N. (2014). Effect of exposure to evening light on sleep initiation in the elderly: a longitudinal analysis for repeated measurements in home settings. Chronobiology International, 31(4), 461-467.
Obayashi, K., Saeki, K., & Kurumatani, N. (2016). Ambient Light Exposure and Changes in Obesity Parameters: A Longitudinal Study of the HEIJO-KYO Cohort. The Journal of Clinical Endocrinology & Metabolism, 101(9), 3539-3547. https://doi.org/10.1210/jc.2015-4123
Ohayon, M., Wickwire, E. M., Hirshkowitz, M., Albert, S. M., Avidan, A., Daly, F. J., Dauvilliers, Y., Ferri, R., Fung, C., Gozal, D., Hazen, N., Krystal, A., Lichstein, K., Mallampalli, M., Plazzi, G., Rawding, R., Scheer, F. A., Somers, V., & Vitiello, M. V. (2017). National Sleep Foundation's sleep quality recommendations: first report. Sleep Health, 3(1), 6-19. https://doi.org/https://doi.org/10.1016/j.sleh.2016.11.006
Olsen, C., Pedersen, I., Bergland, A., Enders-Slegers, M. J., Joranson, N., Calogiuri, G., & Ihlebaek, C. (2016). Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study. BMC Geriatrics, 16, 137. https://doi.org/10.1186/s12877-016-0312-4
Park, M., & Suh, E. E. (2022). Comparison of objective and subjective sleep time and quality in hospitalized recipients of hematopoietic stem cell transplantation. Asia-Pacific Journal of Oncology Nursing, 100082.
Pedraza, S., Al Snih, S., Ottenbacher, K. J., Markides, K. S., & Raji, M. A. (2012). Sleep quality and sleep problems in Mexican Americans aged 75 and older. Aging Clinical and Experimental Research, 24(4), 391-397. https://doi.org/10.3275/8106
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(10), 433-441. https://doi.org/10.1111/j.1532-5415.1975.tb00927.x
Rejeski, W. J., Marsh, A. P., Brubaker, P. H., Buman, M., Fielding, R. A., Hire, D., Manini, T., Rego, A., & Miller, M. E. (2016). Analysis and Interpretation of Accelerometry Data in Older Adults: The LIFE Study. Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 71(4), 521-528. https://doi.org/10.1093/gerona/glv204
Riemersma-Van Der Lek, R. F., Swaab, D. F., Twisk, J., Hol, E. M., Hoogendijk, W. J., & Van Someren, E. J. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA, 299(22), 2642-2655. https://jamanetwork.com/journals/jama/articlepdf/273623/joc80051_2642_2655.pdf
Rockwood, K., & Theou, O. (2020). Using the clinical frailty scale in allocating scarce health care resources. Canadian Geriatrics Journal, 23(3), 210. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458601/pdf/cgj-23-210.pdf
Salive, M. E. (2013). Multimorbidity in older adults. Epidemiologic Reviews, 35, 75-83. https://doi.org/10.1093/epirev/mxs009
Sandman, N., Merikanto, I., Määttänen, H., Valli, K., Kronholm, E., Laatikainen, T., Partonen, T., & Paunio, T. (2016). Winter is coming: nightmares and sleep problems during seasonal affective disorder. Journal of Sleep Research, 25(5), 612-619. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jsr.12416?download=true
Sansal, K. E., Tanriover, S. H., & Aka, B. T. (2020). EFFECTS OF OUTDOOR NATURAL LIGHT EXPOSURE ON SLEEP QUALITY IN THE ELDERLY [Article]. Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 23(1), 138-146. https://doi.org/10.31086/tjgeri.2020.147
Scheuermaier, K., Laffan, A. M., & Duffy, J. F. (2010). Light exposure patterns in healthy older and young adults. Journal of Biological Rhythms, 25(2), 113-122.
Seol, J., Abe, T., Fujii, Y., Joho, K., & Okura, T. (2020). Effects of sedentary behavior and physical activity on sleep quality in older people: A cross‐sectional study. Nursing & Health Sciences, 22(1), 64-71. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/nhs.12647?download=true
Shishegar, N., Boubekri, M., Stine-Morrow, E. A. L., & Rogers, W. A. (2021). Tuning environmental lighting improves objective and subjective sleep quality in older adults. Building and Environment, 204, 108096. https://doi.org/https://doi.org/10.1016/j.buildenv.2021.108096
Shochat, T., Martin, J., Marler, M., & Ancoli-Israel, S. (2000). Illumination levels in nursing home patients: effects on sleep and activity rhythms. Journal of Sleep Research, 9(4), 373-379. https://doi.org/10.1046/j.1365-2869.2000.00221.x
Slettebø, Å. (2008). Safe, but lonely: Living in a nursing home. Vard i Norden, 28(1), 22-25.
Smagula, S. F., Stone, K. L., Fabio, A., & Cauley, J. A. (2016). Risk factors for sleep disturbances in older adults: Evidence from prospective studies. Sleep Medicine Reviews, 25, 21-30. https://doi.org/https://doi.org/10.1016/j.smrv.2015.01.003
Soysal, P., Veronese, N., Thompson, T., Kahl, K. G., Fernandes, B. S., Prina, A. M., Solmi, M., Schofield, P., Koyanagi, A., Tseng, P.-T., Lin, P.-Y., Chu, C.-S., Cosco, T. D., Cesari, M., Carvalho, A. F., & Stubbs, B. (2017). Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Research Reviews, 36, 78-87. https://doi.org/https://doi.org/10.1016/j.arr.2017.03.005
Spielman, A. J., Caruso, L. S., & Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America, 10(4), 541-553.
Spira, A. P., Covinsky, K., Rebok, G. W., Stone, K. L., Redline, S., & Yaffe, K. (2012). Objectively measured sleep quality and nursing home placement in older women. Journal of the American Geriatrics Society, 60(7), 1237-1243. https://doi.org/10.1111/j.1532-5415.2012.04044.x
Suzuki, E., Yorifuji, T., Ueshima, K., Takao, S., Sugiyama, M., Ohta, T., Ishikawa-Takata, K., & Doi, H. (2009). Sleep duration, sleep quality and cardiovascular disease mortality among the elderly: a population-based cohort study. Preventive Medicine, 49(2-3), 135-141.
Tam, E. M., Lam, R. W., Robertson, H. A., Stewart, J. N., Yatham, L. N., & Zis, A. P. (1997). Atypical depressive symptoms in seasonal and non-seasonal mood disorders. Journal of Affective Disorders, 44(1), 39-44.
Tsai, P.-S., Wang, S.-Y., Wang, M.-Y., Su, C.-T., Yang, T.-T., Huang, C.-J., & Fang, S.-C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943-1952. https://link.springer.com/content/pdf/10.1007/s11136-005-4346-x.pdf
Tsai, Y. F., Wong, T. K., & Ku, Y. C. (2008). Self-care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes. Journal of Clinical Nursing, 17(9), 1219-1226. https://doi.org/10.1111/j.1365-2702.2007.02020.x
Tsou, M.-T. (2013). Prevalence and risk factors for insomnia in community-dwelling elderly in northern Taiwan. Journal of Clinical Gerontology and Geriatrics, 4(3), 75-79. https://doi.org/https://doi.org/10.1016/j.jcgg.2013.02.002
Turner, P. L., & Mainster, M. A. (2008). Circadian photoreception: ageing and the eye’s important role in systemic health. British Journal of Ophthalmology, 92(11), 1439-1444. https://bjo.bmj.com/content/bjophthalmol/92/11/1439.full.pdf
Vaz Fragoso, C. A., & Gill, T. M. (2007). Sleep Complaints in Community‐Living Older Persons: A Multifactorial Geriatric Syndrome: (See Editorial Comments by Dr. Michael V. Vitiello on pp 1882–1883). Journal of the American Geriatrics Society, 55(11), 1853-1866.
Videnovic, A., Klerman, E. B., Wang, W., Marconi, A., Kuhta, T., & Zee, P. C. (2017). Timed light therapy for sleep and daytime sleepiness associated with Parkinson disease: a randomized clinical trial. JAMA neurology, 74(4), 411-418. https://jamanetwork.com/journals/jamaneurology/articlepdf/2604133/jamaneurology_videnovic_2017_oi_160104.pdf
Visser, M., Pluijm, S. M., Stel, V. S., Bosscher, R. J., & Deeg, D. J. (2002). Physical activity as a determinant of change in mobility performance: the Longitudinal Aging Study Amsterdam. Journal of the American Geriatrics Society, 50(11), 1774-1781.
Wai, J. L. T., & Yu, D. S. F. (2020). The relationship between sleep–wake disturbances and frailty among older adults: A systematic review. Journal of Advanced Nursing, 76(1), 96-108. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jan.14231?download=true
Walker, M. (2017). Why we sleep: Unlocking the power of sleep and dreams. Simon and Schuster.
Wang, F., & Boros, S. (2021). The effect of physical activity on sleep quality: a systematic review. European Journal of Physiotherapy, 23(1), 11-18.
Wescott, D. L., Soehner, A. M., & Roecklein, K. A. (2020). Sleep in seasonal affective disorder. Current Opinion in Psychology, 34, 7-11. https://doi.org/https://doi.org/10.1016/j.copsyc.2019.08.023
Wu, C.-h., & Yao, G. (2008). Psychometric analysis of the short-form UCLA Loneliness Scale (ULS-8) in Taiwanese undergraduate students. Personality and Individual Differences, 44(8), 1762-1771.
Xu, M., Bélanger, L., Ivers, H., Guay, B., Zhang, J., & Morin, C. M. (2011). Comparison of subjective and objective sleep quality in menopausal and non-menopausal women with insomnia. Sleep Medicine, 12(1), 65-69.
Zeitlhofer, J., Schmeiser-Rieder, A., Tribl, G., Rosenberger, A., Bolitschek, J., Kapfhammer, G., Saletu, B., Katschnig, H., Holzinger, B., Popovic, R., & Kunze, M. (2000). Sleep and quality of life in the Austrian population [Article]. Acta Neurologica Scandinavica, 102(4), 249-257. https://doi.org/10.1034/j.1600-0404.2000.102004249.x
Zhi, T. F., Sun, X. M., Li, S. J., Wang, Q. S., Cai, J., Li, L. Z., Li, Y. X., Xu, M. J., Wang, Y., Chu, X. F., Wang, Z. D., & Jiang, X. Y. (2016). Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression [Article]. Archives of Gerontology and Geriatrics, 65, 211-217. https://doi.org/10.1016/j.archger.2016.03.023
Zielinski, M. R., McKenna, J. T., & McCarley, R. W. (2016). Functions and Mechanisms of Sleep. AIMS neuroscience, 3(1), 67-104. https://doi.org/10.3934/Neuroscience.2016.1.67
劉雅文, & 莊秀美. (2006). 探討失能老人家庭選擇長期照護福利服務之決策過程-老人自主權之分析研究. 東吳社會工作學報(14), 91-123.
曲同光, 彭美琪, & 白其怡. (2015). 規劃長照保險重要基礎資料庫-國民長期照護需要調查. 國土及公共治理季刊, 3(1), 108-114.
楊芝齡, & 鄭綺. (2019). 護理之家與社區老人睡眠品質及預測因子之比較. 新臺北護理期刊, 21(1), 31-44.
王品臻. (2017). 護理之家住民生活經驗之探討.
羅鈞令. (2008). 護理之家老年住民的日常活動: 住民的主觀感受. 職能治療學會雜誌, 26(1), 53-63.
羅鈞令, 黃小玲, 毛慧芬, 蔡宜蓉, 林惠冠, 李世代, & 張志仲. (2002). 護理之家服務現況與住民需求. 職能治療學會雜誌, 20, 95-106.
莊秀美. (2004). 長期照護的新趨勢日本的 [小團體單位照護].
莊秀美. (2008). “單位照顧”(unit care) 模式的環境建構與實踐理念之探討. 臺大社會工作學刊(16), 87-127.
陳政雄. (2009). 高齡社會失智症老人的新居住型態-團體家屋. 臺灣老人保健學刊, 5(1), 17-35.
陳曉梅, & 黃美智. (2013). 失能老人非自願入住機構自主權的提昇. 長期照護雜誌, 17(1), 57-66.