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

摘要 随着年龄的增长，促进健康和福祉的进展必须包括确定新的目标， 安全、强大、廉价且可部署。我们的重点是这样一个目标-病人的记忆， 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， 相关的较差的坚持和较差的结果，（3）记忆支持策略可以改善记忆， 治疗和（4）改善记忆治疗改善结果。在本申请中，我们建议测试一个 新的，精简的，有效的方法来吸引这个新的目标：记忆支持干预（MSI）。 MSI旨在改善患者对治疗的记忆。它是从1999年的基础非临床研究中提炼出来的， 认知科学和教育，包括四个强大的记忆促进策略， 主动、有策略地、集中地纳入常规治疗。重要的是，MSI不添加 会话长度或所需的会话数量。该提案的目的是进行一次验证性的 有效性试验，以测试MSI是否改善中年和老年人的结果。作为一个“平台”， 在研究这种方法的下一步中，我们将重点放在睡眠和昼夜节律问题以及跨诊断问题上。 睡眠和昼夜节律功能障碍的干预（Trans-C）。TransS-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，是非常普遍的 在中年和老年人中，（2）睡眠和昼夜节律功能不佳对健康有广泛的负面影响。 后果，包括对内存和（3）transs-c解决了一系列最常见的睡眠， 中年和老年人经历的昼夜节律问题。有希望的试验数据表明， 相对于年轻人，中老年人的transS-C可能更差， 支持有可能改善这一年龄组的治疗依从性和治疗结果。五年多来， 我们将招募50岁及以上的成年人，他们正在经历睡眠和昼夜节律问题（N = 10）。 178人，包括20%的自然减员）。将样本随机分配至Trans-C + MSI（“Trans-C + MSI”）组。 C+MSI”）与transS-C单独，所有将收到八个50分钟，每周，个人会议。评估将 在基线、治疗后以及6个月和12个月随访时进行。样本将从 两个大型社区组织，为低收入的中年和老年人提供服务， 有行动障碍干预措施将通过实时远程保健提供，以改善可及性。 我们将比较transS-C +MSI与transS-C单独使用的效果，以确定MSI是否改善睡眠， 昼夜节律功能、日间功能和幸福感（目标1）。我们将确定患者是否记得 治疗（目标）介导治疗条件和结果之间的关系（目标2）。我们将 评估既往报告的不良治疗反应亚组是否为中度靶点参与（目标3）。的 MSI可以被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。

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.