Improving sleep and circadian functioning, daytime functioning, and well-being for midlife and older adults by improving patient memory for a transdiagnostic sleep and circadian treatment

通过改善患者对跨诊断睡眠和昼夜节律治疗的记忆，改善中年和老年人的睡眠和昼夜节律功能、日间功能和福祉

• 批准号: 10708424
• 负责人: Allison G Harvey
• 金额: $ 65.94万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10708424
• 关键词: Address; Adherence; Adult; Aftercare; Age; Age Years; Aging; Circadian Dysregulation; Cognitive Science; Data; Dependence; Diagnostic; Education; Elderly; Elements; Health; Health Promotion; Health Services; Impairment; Individual; Intervention; Learning; Length; Life; Life Expectancy; Literature; Low income; Mediating; Memory; Memory impairment; Modeling; Outcome; Participant; Patients; Personal Satisfaction; Persons; Provider; Random Allocation; Reporting; Research; Sampling; Sleep; Sleep Disorders; Sleep disturbances; Sleeplessness; Strategic Planning; Subgroup; Testing; Treatment outcome; United States; United States National Institutes of Health; absorption; age group; behavior change; circadian; cognitive function; community organizations; compliance behavior; confirmatory trial; disability; experience; follow-up; health service use; healthy aging; improved; improved outcome; improvement on sleep; innovation; middle age; novel; poor sleep; recruit; telehealth; treatment adherence; treatment as usual; treatment comparison; treatment effect; treatment response; young adult

Abstract Progress toward promoting health and well-being as we age must include the identification of novel targets that are safe, powerful, inexpensive, and deployable. Our focus is on one such target—patient memory for the contents of treatment—because: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated poorer adherence and poorer outcome, (3) memory support strategies can improve memory for treatment and (4) improved memory for treatment improves outcome. In this application, we propose to test a new, streamlined, and potent approach to engaging this novel target: the Memory Support Intervention (MSI). The MSI aims to improve patient memory for treatment. It was distilled from the basic, non-clinical research in cognitive science and education and is comprised of four powerful memory promoting strategies that are proactively, strategically, and intensively integrated into treatment-as-usual. Importantly, the MSI does not add to session length, or the number of sessions needed. The aim of this proposal is to conduct a confirmatory efficacy trial to test whether the MSI improves outcomes for midlife and older adults. As a “platform” for the next step in investigating this approach, we focus on sleep and circadian problems and the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C is a worthy platform on which to test the MSI because (1) sleep and circadian functioning, including and beyond insomnia, is highly prevalent among midlife and older adults, (2) poor sleep and circadian functioning has a wide range of serious negative consequences, including on memory and (3) TranS-C addresses a range of the most common sleep and circadian problems experienced by midlife and older adults. Promising pilot data suggest that memory for TranS-C may be poorer among midlife and older adults, relative to younger adults, and that adding memory support has potential to improve treatment adherence and treatment outcome for this age group. Over 5 years, we will recruit adults who are 50 years and older and who are experiencing sleep and circadian problems (N = 178, including 20% for attrition). The sample will be randomly allocated to TranS-C plus the MSI (“TranS- C+MSI”) vs. TranS-C alone, and all will receive eight 50-minute, weekly, individual sessions. Assessments will be conducted at baseline, post-treatment, and at 6- and 12-month follow-up. The sample will be recruited from two large community-based organizations that serve midlife and older adults who are low-income and experiencing mobility impairments. The intervention will be delivered via live telehealth to improve accessibility. We will compare the effects of TranS-C+MSI vs. TranS-C alone to determine if the MSI improves sleep and circadian functioning, daytime functioning, and well-being (Aim 1). We will determine if patient memory for treatment (the target) mediates the relationship between treatment condition and outcome (Aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (Aim 3). The MSI could be added to a range of interventions to enhance intervention outcomes for midlife and older adults.

抽象的 随着年龄的增长，促进健康和福祉的进展必须包括对新目标的识别 安全，强大，便宜且可部署。我们的重点是一个这样的目标 - 患者的记忆 治疗内容 - 因为：（1）治疗患者记忆不佳，（2）治疗记忆不佳是 （3）记忆支持策略可以改善记忆的依从性和较差的结果 治疗和（4）改善记忆的治疗可改善预后。在此应用程序中，我们建议测试 新的，简化的和潜在的方法来参与这一新目标：内存支持干预（MSI）。 MSI旨在改善患者记忆以进行治疗。它是从基本的非临床研究中提取的 认知科学和教育，并完成了四种强大的记忆促进策略 主动，战略性地并强化整合到与治疗一样。重要的是，MSI不添加 会话长度或所需的会话数。该提议的目的是进行确认 有效试验测试MSI是否改善了中年和老年人的结果。作为一个“平台” 调查这种方法的下一步，我们专注于睡眠和昼夜节律问题和转诊性问题 睡眠和昼夜节律功能障碍（Trans-C）的干预措施。 Trans-C是一个可以测试的宝贵平台 MSI是因为（1）睡眠和昼夜节律功能，包括失眠和超越失眠，非常普遍 在中年和老年人中，（2）睡眠不良和昼夜节律功能范围很广。 后果，包括记忆和（3）Trans-C解决了最常见的睡眠范围 中年和老年人遇到的昼夜节律问题。有希望的飞行员数据表明​​记忆 相对于年轻人，在中年和老年人中，trans-c可能较差，并且增加了记忆 支持有可能改善该年龄段的治疗依从性和治疗结果。超过5年， 我们将招募50岁以上并且经历睡眠和昼夜节律问题的成年人（n = 178，包括20％的损耗）。样品将随机分配给trans-C加上MSI（“ Trans- C+MSI”）仅与trans-c，所有人都将获得八个50分钟的每周一次。评估将 请在基线，治疗后以及6个月和12个月的随访中进行。样本将从 两个大型社区组织，为中年和低收入和老年人提供服务 经历流动性障碍。干预措施将通过现场远程医疗进行，以提高可访问性。 我们将比较单独的反式C+MSI与Trans-C的影响，以确定MSI是否改善了睡眠和 昼夜节律功能，白天的功能和福祉（AIM 1）。我们将确定患者的记忆是否 治疗（目标）介导治疗状况与结果之间的关系（AIM 2）。我们将 评估先前报道的治疗反应较差的亚组中等目标参与（AIM 3）。这 可以将MSI添加到一系列干预措施中，以增强中年和老年人的干预效果。