Insomnia and Physical Function in Older Veterans During and After CLC Rehabilitation Admission

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Sleep and physical function are highly interdependent in older adult populations (≥65 years old), even after controlling for underlying health conditions. Poor sleep, as well as complications from acute and chronic illness, leaves older adults more vulnerable to declines in physical functioning and negative safety consequences, such as falls leading to severe or fatal injuries. As such, older adults experiencing insomnia symptoms are at greater risk for hospitalization and subsequent rehabilitation. Insomnia symptoms are complex and multifactorial (e.g., sleep disturbances, increased daytime sleepiness, poor sleep quality) and are often unintentionally worsened by rehabilitation admission due to environmental factors (e.g., light, noise) and behavioral factors (e.g., increased time in bed) in this setting. If left undetected and untreated, insomnia symptoms can result in poorer treatment outcomes, such as longer rehabilitation stays, slower treatment progression, and decreased survival rates one-year post-discharge. Despite the comprehensive literature on sleep in older adults, there is less comprehensive literature on sleep in older Veterans receiving care in VA inpatient rehabilitation settings after hospitalization, for whom successful functional recovery and transition to home is critical for quality of life. We will determine the feasibility of simultaneously evaluating insomnia symptoms and physical function in older Veterans (N=15) receiving care in a VA subacute rehabilitation unit at admission, discharge, and one month after discharge. We will evaluate insomnia symptoms measured through self-report questionnaires, sleep diaries, and actigraphy. Actigraphs are activity monitors worn on the body that record continuous physical activity, which can be used to approximate sleep variables. We will evaluate physical function through self-report measures and performances tasks, including chair stands and gait speed. We will ask Veterans their perception of the importance of sleep and physical function in rehabilitation and their interest in and acceptability of behavioral sleep interventions through brief semi-structured interviews. Results will further indicate which approaches are most feasible and acceptable, allowing for a more focused battery in subsequent studies (RR&D CDA-2). Information from the feasibility component will indicate the degree to which evaluating sleep and physical function by multiple methods is feasible, informative, and necessary during and after VA subacute rehabilitation. Information gained will inform a larger-N evaluation for the purposes of statistically understanding the relationship between these variables and their impact on rehabilitation outcomes. Information from the acceptability component will inform future studies that will adapt effective Behavioral Sleep Medicine interventions by understanding when the intervention should be offered during the care trajectory and how the intervention should be adapted to improve physical function. This will also inform future focus groups evaluating specific components of a treatment addressing insomnia symptoms to optimize physical function. The CDA-1 project closely aligns with the proposed training objective categories: (1) physical function and recovery; (2) objective measures of sleep; (3) interdisciplinary research team leadership; and (4) career and professional development. Completion of these objectives through mentorship, education, and experiential learning, will prepare the applicant for an RR&D CDA-2 application and long-term goal of becoming an independent VA researcher focused on improving sleep to optimize functional recovery. This CDA-1 project will provide a critical first step of data collection and candidate training to prepare for a planned program of research with the goal of improving sleep and physical recovery in Veterans and improving safety and high reliability within the VA Healthcare System.