Comparative effects of nonpharmacological interventions on sleep quality of institutionalized older adults without dementia: A systematic review and network meta-analysis

Sleep disturbances are common among institutionalized older adults, yet the optimal nonpharmacological intervention remains unclear. We performed a systematic review and network meta-analysis of randomized controlled trials to compare nonpharmacological interventions for sleep quality. Five databases were searched from inception to March 30, 2025. Treatment effects were synthesized using random-effects models, and certainty of evidence was evaluated using the Confidence in Network Meta-Analysis framework. Eighteen RCTs (1208 participants; 12 interventions) were included in the systematic review, with 15 RCTs contributing to the network meta-analysis. Compared with whole-body vibration training, acupressure (MD = −3.47, 95% confidence interval = −5.24 to −1.70), reminiscence therapy (−3.22, −5.42 to −1.02), aromatherapy (−2.78, −4.95 to −0.61), vitality acupunch (−2.63, −4.77 to −0.49), wheelchair-based elastic-band exercise (−2.22, −4.08 to −0.35), and yoga (MD −2.19, 95% CI −4.32 to −0.05) significantly improved sleep quality. Relative to reading, acupressure, reminiscence therapy, and yoga were superior; acupressure also outperformed sham acupressure and regular daily activity. Meta-regression analyses indicated no effect modification by trial country, proportion of female participants, or comorbidity prevalence. Overall, acupressure, reminiscence therapy, aromatherapy, vitality acupunch, wheelchair-based elastic-band exercise, and yoga appear to be a feasible and non-invasive options to improve sleep quality in long-term care settings.