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.

摘要 随着我们年龄的增长，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。我们的重点是一个这样的目标-患者的记忆 治疗内容-因为：(1)患者对治疗的记忆力差，(2)对治疗的记忆力差 (3)记忆支持策略可以改善儿童的记忆 治疗和(4)改善了治疗的记忆力，改善了结果。在此应用程序中，我们建议测试一个 新的、精简的和有效的方法来参与这一新的目标：记忆支持干预(MSI)。 MSI旨在为治疗改善患者的记忆力。它是从基础的非临床研究中提炼出来的 它由四个强大的记忆促进策略组成，它们是 主动地、战略性地和密集地整合到照常治疗中。重要的是，MSI没有添加 设置为会话长度，即所需的会话数量。这项提议的目的是进行一次确认性的 有效性试验，以测试微星是否改善中年人和老年人的预后。作为一个平台， 在研究这一方法的下一步，我们将重点放在睡眠和昼夜节律问题以及 睡眠和昼夜节律紊乱的干预(TRANS-C)。Trans-C是一个值得测试的平台 MSI是因为(1)睡眠和昼夜节律功能，包括失眠和失眠以外的，非常普遍 在中老年人中，(2)睡眠不佳和昼夜节律功能不佳有广泛的严重负面影响 结果，包括对记忆和(3)反式-C解决了一系列最常见的睡眠和 中老年人经历的昼夜节律问题。前景看好的飞行员数据表明， 与年轻人相比，中年和老年人中的反式-C可能更差，而且增加记忆力 支持有可能改善这个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、有睡眠和昼夜节律问题的成年人(N= 178人，包括20%的自然减员)。样本将被随机分配给TRANS-C加上MSI(“TRANS-C” C+MSI“)与单独的TRANS-C，所有人都将获得八个50分钟的每周单独会话。评估将 在基线、治疗后以及6个月和12个月的随访时进行。样本将从以下地点招募 两个以社区为基础的大型组织，服务于低收入和 经历行动不便。干预将通过现场远程保健提供，以改善可获得性。 我们将比较反式-C+MSI和单独使用反式-C的效果，以确定MSI是否可以改善睡眠和 昼夜功能、白天功能和幸福感(目标1)。我们将确定患者的记忆是否 治疗(目标)调解治疗条件和结果之间的关系(目标2)。我们会 评估以前报告的不良治疗反应亚组是否中等目标参与度(目标3)。这个 可以将MSI添加到一系列干预措施中，以增强中老年人的干预结果。