Insomnia and Physical Function in Older Veterans During and After CLC Rehabilitation Admission

老年退伍军人 CLC 康复入院期间和之后的失眠和身体功能

• 批准号: 10746207
• 负责人: Julia T Boyle
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746207
• 关键词: Active Learning; Acute; Address; Admission activity; Age; Beds; Behavior Therapy; Behavioral; Caring; Categories; Chronic Disease; Cladribine; Cognitive Therapy; Complex; Data; Data Collection; Development; Drowsiness; Education; Elderly; Eligibility Determination; Environmental Risk Factor; Evaluation; Fatal injury; Focus Groups; Future; Gait speed; Goals; Health; Healthcare Systems; Home; Hospitalization; Injury; Inpatients; Interdisciplinary Study; Intervention; Interview; Investigation; Investigator-Initiated Research; K-Series Research Career Programs; Lead; Leadership; Left; Light; Link; Literature; Measures; Medicine; Mentorship; Methods; Monitor; Noise; Pain; Patient Self-Report; Patients; Perception; Physical Function; Physical activity; Population; Post-Traumatic Stress Disorders; Preparation; Process; Program Reviews; Quality of life; Questionnaires; Recovery; Recovery of Function; Rehabilitation Centers; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Safety; Self Administration; Series; Severities; Sleep; Sleep disturbances; Sleeplessness; Structure; Survival Rate; Symptoms; Task Performances; Time; Training; Treatment outcome; Veterans; Work; acceptability and feasibility; actigraphy; career; community living; design; diaries; experience; fall risk; falls; follow up assessment; follow-up; health care service utilization; human old age (65+); improved; improvement on sleep; interest; medical complication; poor sleep; preference; programs; recruit; severe injury; sleep quality

Sleep and physical function are highly interdependent in older adult populations (≥65 years old), even after controlling for underlying health conditions. Poor sleep, as well as complications from acute and chronic illness, leaves older adults more vulnerable to declines in physical functioning and negative safety consequences, such as falls leading to severe or fatal injuries. As such, older adults experiencing insomnia symptoms are at greater risk for hospitalization and subsequent rehabilitation. Insomnia symptoms are complex and multifactorial (e.g., sleep disturbances, increased daytime sleepiness, poor sleep quality) and are often unintentionally worsened by rehabilitation admission due to environmental factors (e.g., light, noise) and behavioral factors (e.g., increased time in bed) in this setting. If left undetected and untreated, insomnia symptoms can result in poorer treatment outcomes, such as longer rehabilitation stays, slower treatment progression, and decreased survival rates one-year post-discharge. Despite the comprehensive literature on sleep in older adults, there is less comprehensive literature on sleep in older Veterans receiving care in VA inpatient rehabilitation settings after hospitalization, for whom successful functional recovery and transition to home is critical for quality of life. We will determine the feasibility of simultaneously evaluating insomnia symptoms and physical function in older Veterans (N=15) receiving care in a VA subacute rehabilitation unit at admission, discharge, and one month after discharge. We will evaluate insomnia symptoms measured through self-report questionnaires, sleep diaries, and actigraphy. Actigraphs are activity monitors worn on the body that record continuous physical activity, which can be used to approximate sleep variables. We will evaluate physical function through self-report measures and performances tasks, including chair stands and gait speed. We will ask Veterans their perception of the importance of sleep and physical function in rehabilitation and their interest in and acceptability of behavioral sleep interventions through brief semi-structured interviews. Results will further indicate which approaches are most feasible and acceptable, allowing for a more focused battery in subsequent studies (RR&D CDA-2). Information from the feasibility component will indicate the degree to which evaluating sleep and physical function by multiple methods is feasible, informative, and necessary during and after VA subacute rehabilitation. Information gained will inform a larger-N evaluation for the purposes of statistically understanding the relationship between these variables and their impact on rehabilitation outcomes. Information from the acceptability component will inform future studies that will adapt effective Behavioral Sleep Medicine interventions by understanding when the intervention should be offered during the care trajectory and how the intervention should be adapted to improve physical function. This will also inform future focus groups evaluating specific components of a treatment addressing insomnia symptoms to optimize physical function. The CDA-1 project closely aligns with the proposed training objective categories: (1) physical function and recovery; (2) objective measures of sleep; (3) interdisciplinary research team leadership; and (4) career and professional development. Completion of these objectives through mentorship, education, and experiential learning, will prepare the applicant for an RR&D CDA-2 application and long-term goal of becoming an independent VA researcher focused on improving sleep to optimize functional recovery. This CDA-1 project will provide a critical first step of data collection and candidate training to prepare for a planned program of research with the goal of improving sleep and physical recovery in Veterans and improving safety and high reliability within the VA Healthcare System.

睡眠和身体机能高度相互依存在老年人人群（≥65岁）中，甚至 控制了潜在的健康状况之后。睡眠不佳，急性和慢性的并发症 疾病，使老年人更容易受到身体机能下降和负面安全性的影响 后果，例如导致严重或致命伤害的跌倒。因此，老年人患有失眠症 症状有更大的住院风险和随后的康复风险。失眠符号很复杂 和多因素（例如，睡眠障碍，日常嗜睡，睡眠质量差），并且通常是 由于环境因素（例如，光，噪声）和 在这种情况下，行为因素（例如，床上的时间增加）。如果未被发现且未治疗，失眠症 症状可能导致治疗结果较差，例如康复时间更长，治疗较慢 进展并扩大了一年入院后的存活率。尽管有全面的文献 在老年人中睡觉，在弗吉尼亚州接受护理的老年退伍军人的睡眠文献较少 住院后住院的康复环境，成功的功能恢复并过渡到 家对生活质量至关重要。 我们将确定简单评估失眠症状和身体功能的可行性 在老年退伍军人（n = 15）中，在入院，出院时在VA亚急性康复单元中接受护理 出院后一个月。我们将通过自我报告问卷调查，睡眠评估失眠症状 日记和行为。 Actigraphs是在身体上戴着的活动监测器，记录了连续物理的 活动，可用于近似睡眠变量。我们将通过自我报告评估身体机能 措施和绩效任务，包括椅子架并获得速度。我们将询问退伍军人的看法 睡眠和身体机能在康复中的重要性以及他们对 行为睡眠干预通过简短的半结构访谈进行。 结果将进一步指出哪些方法最可行和可接受，从而使得 随后的研究（RR＆D CDA-2）进行了聚焦电池。可行性组件中的信息将表明 通过多种方法评估睡眠和身体功能的程度是可行的，信息性的，并且 在VA亚急性康复期间和之后所必需的。获得的信息将为大N评估提供信息 从统计学上理解这些变量之间的关系及其对它们对它们的影响的目的 康复结果。来自可接受性部分的信息将为未来的研究提供信息，以适应 有效的行为睡眠医学干预措施通过了解何时应提供干预措施 在护理轨迹期间，以及应如何调整干预措施以改善身体机能。这也会 告知未来的焦点小组，评估针对失眠符号的治疗的特定组成部分 优化身体功能。 CDA-1项目与拟议的培训目标类别紧密一致：（1）身体机能 和恢复； （2）客观的睡眠措施； （3）跨学科研究团队的领导； （4）职业和 专业发展。通过指导，教育和专家完成这些对象 学习，将为RR＆D CDA-2应用程序做好准备，并成为成为一个长期目标 独立的VA研究人员致力于改善睡眠以优化功能恢复。这个CDA-1项目将 提供数据收集和候选培训的关键第一步，以准备计划的研究计划 目的是改善退伍军人的睡眠和身体恢复，并提高安全性和高度可靠性 VA医疗保健系统。