Mindfulness Meditation and Insomnia in Alzheimer Disease Caregivers: Inflammatory and Biological Aging Mechanisms

项目摘要/摘要 超过500万美国人提供非正式的阿尔茨海默病(AD)护理，这对 照顾者的健康，与非照顾者相比，死亡风险高出63% 控制。失眠发生在超过60%的AD照顾者中，并对照顾者产生独立的负面影响 疾病风险的健康和机制。尽管失眠是一种可改变的风险因素，但此前没有研究表明 AD照顾者中的靶向性失眠。 正在进行的随机对照试验CARE正在评估正念意识实践的非劣势 失眠症(MAP-I)与认知行为疗法(CBT-I)对失眠结局的影响 失眠的老年AD配偶照顾者的炎症和细胞衰老的基因组标志物 (n=150)超过一年的随访。本补充项目将衡量和估计与以下项目相关的成本 在CARE试验中实施MAP-I和CBT-I干预。 将使用微观成本计算方法逐项列出和抽象每个项目中包括的所有组件的成本 两项干预措施，用于估算每次干预措施的总成本和每个参与者的成本。对于每个干预中的每一步 所有投入--包括人员、病人时间、用品和设备--都将被清点和衡量。 单位成本将应用于每种此类资源的消耗量，并将结果相加为 获取每个MAP-I和CBT-I干预措施的每个组件的总成本和总体成本。每名参与者 成本将通过将总成本除以参与者数量来估算。分析将以敏感度结束 分析以评估估计对关键成本组成部分变化的稳健性。

Project Summary/Abstract Over 5 million Americans provide informal Alzheimer's Disease (AD) caregiving, which negatively impacts caregivers' health and is associated with a 63% greater risk of mortality as compared to non-caregiving controls. Insomnia occurs in over 60% of AD caregivers and has independent negative influences on caregiver health and mechanisms of disease risk. Although insomnia is a modifiable risk factor, no prior study has targeted insomnia in AD caregivers. The ongoing randomized control trial, CARES, is evaluating the non-inferiority of Mindful Awareness Practices for Insomnia (MAP-I ) vs. Cognitive Behavioral Therapy for Insomnia (CBT-I) on outcomes of insomnia, cellular and genomic markers of inflammation, and cellular aging in older adult AD spousal caregivers with insomnia (N=150) over one-year follow-up. This supplement project will measure and estimate the costs associated with implementing the MAP-I and CBT-I interventions in the CARES trial. A micro-costing method will be used to itemize and abstract costs of all components included in each of the two interventions to estimate total and per-participant costs per intervention. For each step in each intervention arm, all inputs – including personnel, patient time, supplies and equipment – will be inventoried and measured. Unit costs will be applied to the quantities of each such resource consumed, and results will be summed to obtain total costs per component and overall for each of the MAP-I and CBT-I interventions. Per-participant costs will be estimated by dividing total costs by number of participants. The analysis will end with sensitivity analyses to evaluate the robustness of estimates to changes in key cost components.