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，在促进健康和福祉方面取得的进展必须包括确定新的目标， 安全、强大、廉价且可部署，我们的重点就是这样一个目标——患者记忆。 治疗内容——因为：（1）患者对治疗的记忆较差，（2）患者对治疗的记忆较差 相关的较差的依从性和较差的结果，（3）记忆支持策略可以改善记忆 治疗和（4）改善治疗记忆力可改善结果。在此应用中，我们建议测试一个。 一种新的、简化的、有效的方法来参与这个新的目标：记忆支持干预（MSI）。 MSI 旨在提高患者的治疗记忆。它是从基础非临床研究中提炼出来的。 认知科学和教育由四种强大的记忆促进策略组成： 积极、战略性地、集中地融入常规治疗中，重要的是，MSI 并没有增加。 该提案的目的是进行确认。 功效试验，测试 MSI 是否可以改善中年和老年人的结果。 在研究这种方法的下一步中，我们重点关注睡眠和昼夜节律问题以及跨诊断 睡眠和昼夜节律障碍干预 (TranS-C) 是一个值得测试的平台。 MSI 因为 (1) 睡眠和昼夜节律功能（包括失眠）非常普遍 在中年和老年人中，（2）睡眠和昼夜节律功能不佳具有广泛的严重负面影响 (3) TranS-C 解决了一系列最常见的睡眠和 中年人和老年人经历的昼夜节律问题有希望的试点数据表明记忆力。 相对于年轻人，TranS-C 在中年人和老年人中可能较差，并且可以增加记忆力 支持有可能提高该年龄组的治疗依从性和治疗结果超过 5 年， 我们将招募 50 岁及以上且有睡眠和昼夜节律问题的成年人 (N = 178，包括20%的损耗）样本将被随机分配给TranS-C加上MSI（“TranS-”）。 C+MSI”）与单独的 TranS-C 相比，所有人都将接受每周 8 次每次 50 分钟的单独评估。 在基线、治疗后以及 6 个月和 12 个月的随访中进行样本采集。 两个大型社区组织，为低收入和中老年人提供服务 干预措施将通过实时远程医疗体验进行，以提高可及性。 我们将比较 TranS-C+MSI 与单独 TranS-C 的效果，以确定 MSI 是否可以改善睡眠和 昼夜节律功能、白天功能和幸福感（目标 1）。 治疗（目标）调节治疗条件和结果之间的关系（目标 2）。 评估先前报告的治疗反应不佳的亚组是否中等目标参与度（目标 3）。 MSI 可以添加到一系列干预措施中，以提高中年和老年人的干预效果。