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

老年退伍军人 CLC 康复入院期间和之后的失眠和身体功能

• 批准号: 10746207
• 负责人: Julia T Boyle
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746207
• 关键词: Active Learning; Acute; Address; Admission activity; Age; Beds; Behavior Therapy; Behavioral; Caring; Categories; Chronic Disease; Cladribine; Cognitive Therapy; Complex; Data; Data Collection; Development; Drowsiness; Education; Elderly; Eligibility Determination; Environmental Risk Factor; Evaluation; Fatal injury; Focus Groups; Future; Gait speed; Goals; Health; Healthcare Systems; Home; Hospitalization; Injury; Inpatients; Interdisciplinary Study; Intervention; Interview; Investigation; Investigator-Initiated Research; K-Series Research Career Programs; Lead; Leadership; Left; Light; Link; Literature; Measures; Medicine; Mentorship; Methods; Monitor; Noise; Pain; Patient Self-Report; Patients; Perception; Physical Function; Physical activity; Population; Post-Traumatic Stress Disorders; Preparation; Process; Program Reviews; Quality of life; Questionnaires; Recovery; Recovery of Function; Rehabilitation Centers; Rehabilitation Outcome; Rehabilitation therapy; Reporting; Research; Research Personnel; Risk; Safety; Self Administration; Series; Severities; Sleep; Sleep disturbances; Sleeplessness; Structure; Survival Rate; Symptoms; Task Performances; Time; Training; Treatment outcome; Veterans; Work; acceptability and feasibility; actigraphy; career; community living; design; diaries; experience; fall risk; falls; follow up assessment; follow-up; health care service utilization; human old age (65+); improved; improvement on sleep; interest; medical complication; poor sleep; preference; programs; recruit; severe injury; sleep quality

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.

在老年人群(65岁的≥)中，睡眠和身体功能高度相互依赖，甚至 在控制了潜在的健康状况之后。睡眠不佳，以及急性和慢性并发症 疾病，使老年人更容易受到身体机能下降和负面安全的影响 后果，如跌倒导致严重或致命的伤害。因此，经历失眠的老年人 症状住院和随后康复的风险更大。失眠症状复杂 和多因素(例如，睡眠障碍、日间困倦增加、睡眠质量差)，通常 由于环境因素(如光线、噪音)而无意中因康复入院而恶化 在这种情况下的行为因素(例如，卧床时间增加)。如果没有发现和治疗，失眠 症状可能会导致较差的治疗结果，如康复时间较长，治疗较慢 病情进展，出院后一年存活率下降。尽管有全面的文献关于 老年人的睡眠，关于在退伍军人管理局接受护理的老年退伍军人睡眠的全面文献较少 住院后的康复设置，对谁的功能恢复和过渡成功 家对生活质量至关重要。 我们将确定同时评估失眠症状和身体功能的可行性。 老年退伍军人(N=15)入院、出院时在退伍军人管理局亚急性康复单元接受护理 出院后一个月。我们将通过自我报告问卷、睡眠状况来评估失眠症状 日记和活动记录仪。活动记录仪是佩戴在身体上的活动监测器，记录连续的身体状况 活动，这可以用来近似睡眠变量。我们将通过自我报告来评估身体功能 测量和表演任务，包括椅子站立和步态速度。我们将询问退伍军人他们的看法 睡眠和身体功能在康复中的重要性以及他们对康复的兴趣和接受度 通过简短的半结构化访谈进行行为睡眠干预。 结果将进一步表明哪些方法是最可行和最可接受的，允许更多 后续研究(RR&D CDA-2)中的重点电池。来自可行性部分的信息将表明 通过多种方法评估睡眠和身体功能的程度是可行的、信息丰富的和 在VA亚急性康复期间和之后是必要的。获得的信息将为以下项目提供更大的-N评估 统计了解这些变量之间的关系及其对 康复结果。可接受性部分的信息将为今后的研究提供信息，这些研究将适应 通过了解何时应该提供干预来进行有效的行为睡眠医学干预 在护理轨迹期间，以及如何调整干预以改善身体功能。这也将是 通知未来的重点小组评估针对失眠症状的治疗的特定成分以 优化身体机能。 CDA-1项目与拟议的培训目标类别密切一致：(1)身体机能 和康复；(2)客观的睡眠测量；(3)跨学科研究团队的领导力；以及(4)职业和 职业发展。通过指导、教育和体验来完成这些目标 学习，将使申请者为RR&D CDA-2申请和成为一名 独立的退伍军人事务部研究员专注于改善睡眠以优化功能恢复。这个CDA-1项目将 提供数据收集和候选人培训的关键第一步，为计划中的研究计划做准备 目标是改善退伍军人的睡眠和身体恢复，并提高安全和高可靠性 退伍军人医疗保健系统。