The fifth vital sign

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James M. Berklan
James M. Berklan

It turns out Linda Shell's hero had modern medicine right all along, even if her last utterance was well over 100 years ago.

Leave it to the founder of modern nursing to put all we need to know in perspective. There are really only four things people need for good health and well-being, she said:

• Nutrition

• Physical activity

• Sunlight

And ...

• Sleep

Thank you very much, Florence Nightingale. And Linda Shell, DNP, MA, RN.

It was the latter who impressed so much last week in delivering a McKnight's special webinar for our Senior Living Online Expo. Shell skillfully reminded that all types of eldercare professionals owe it to their residents — and ultimately their organizations — to seek optimal sleep for those in their care. 

This space has previously written about the value of sleep for healthy professionals in their own lives. But Shell's presentation really resonated in another way because it showed the ripple effects of short sleep for residents.

Sleep is so vital, in fact, she calls it "the fifth vital sign."

The consequences (and symptoms) of sleep deprivation are many for the elderly, including: agitation behaviors, cognitive impairment, decline in activities of daily living, more falls/accidents, and anxiety or depression, to name a few. The threat of lawsuits looms over much here.

"Four hours of uninterrupted sleep is essential" as part of a night's rest, Shell emphasized, adding that sleep problems in the elderly are NOT a "normal part of aging," as many believe.

"Sleep is not a luxury ... and lack of it may be a root cause of falls, pain, behaviors and polypharmacy," she added.

So, what to do? Shell has 10 tips for improving sleep hygiene that should be prominently placed at every nursing station and in every eldercare facility in the country.

The most important thing, she says, is education of older adults and their family members about the necessity of adequate sleep, and how to get it. Next comes education of, yes, caregivers. "We did a study and found out often providers are too loud," she noted.

She goes on to mention what good "snooze foods" are — and how they can help induce sleep naturally. There are seven other "Top 10 tips," but I won't give them all away here. 

You can easily find them yourself by tapping into our archived version of the webinar. It's all still free and can be accessed here, at your leisure, of course. (Just re-enter your email address or fill out registration blanks for the first time at the right. No obligations.)

The details are just too rich too pass up or ignore. From the science of sleep to strategies for making your worklife easier, this is must-see stuff.

Remember: If unattended to, your residents' sleep problems can quickly become your own stay-awake-at-night problems.

Follow James M. Berklan @JimBerklan. Email him at


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.