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

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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.