An Insomnia Internet Intervention for Older Adults

 描述（由申请人提供）：Incidence是老年人的一个重大公共卫生问题，具有实质性的医疗，心理和经济后果。由于多达20-30%的老年人（年龄=55）符合慢性失眠的诊断标准，因此找到方便，有效和低成本的治疗方法至关重要。认知行为治疗（CBT-I）是一种非药物干预，已被证明是有效的，当为老年人量身定制。令人遗憾的是，获得这种治疗的机会受到严重限制， 缺乏训练有素的临床医生和费用。为了克服面对面护理的障碍，使用互联网已成为提供健康信息和治疗的一种可行和有效的方法。不幸的是，医疗保健领域一直不愿意将技术交付的解决方案用于老年患者，因为担心老年人无法获得或无法获得 不想使用技术。然而，美国的老年人是互联网用户中最大的增长群体，他们通常有学习新技术的愿望。当老年人确实使用基于技术的健康促进计划时，他们对这些计划的评价是有利的。互联网提供的CBT-I对老年人具有重大公共卫生影响的可能性很高，因为它允许广泛获得所需的干预措施，增加获得护理的便利性，并降低患有高失眠率的年龄组的治疗成本，已知失眠会加剧其他问题（健康，情绪，认知）。我们的研究团队之前开发并测试了一种基于CBT-I主要租户的互联网交付的自动干预，适用于65岁以下的成年人（SHUTi：使用互联网进行健康睡眠，R34 MH 70805和R 01 MH 086758）。55-65岁用户子集的试点数据表明，互联网干预在这一年龄组是可行和有效的;然而，这一年龄组与年轻组的不同之处在于辍学率较高，改善幅度较小（尽管仍然很大）。这项补助金的主要目标是进行针对老年人失眠症（OAWI）的互联网干预的第一个RCT。我们将招募309名OAWI，采用3（患者教育（PE）网站、SHUTi（老年人）、SHUTi-OA +阶梯式护理（SC））× 4（术前、术后、6个月和12个月随访）设计。我们假设接受SHUTi-OA（或SHUTi-OA+SC）的成年人与PE网站上的人相比，在睡眠和日间变量方面会有更大的改善。我们还预计，SHUT-OA+SC（向未完成指定任务的参与者提供个性化电子邮件或电话）将比没有支持的SHUTi-OA带来更高的利用率和更好的结果，但成本会增加。成本效益分析和可接受性曲线将确定在增加成本的情况下取得的增量效益。如果互联网干预在大型随机对照试验中证明有效， 它将为美国增长最快的人口（老年人）提供有效的、相对低成本的、易于扩展的失眠解决方案，这些人经历最大的失眠率。

 DESCRIPTION (provided by applicant): Insomnia is a significant public health problem for older adults with substantial medical, psychological and financial ramifications. With as many as 20-30% of older adults (age =55) meeting diagnostic criteria for chronic insomnia, finding accessible, effective, and low-cost treatments is critical. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is a non-pharmacological intervention that has been shown to be efficacious when tailored for older adults. Regrettably, access to this treatment is significantly limited by a lack of trained clinicians and expense. To overcome barriers to face-to-face care, use of the Internet has emerged as a feasible and effective method to provide health information and treatment. Unfortunately, the health care field has been reluctant to use technology-delivered solutions with older patients out of a concern that older adults either do not have access to or do not want to use technology. However, older adults in the U.S. are the largest growing group of Internet users, and they generally have a desire to learn new technologies. When older adults do use technology-based programs for health promotion, they rate these programs favorably. Internet-delivered CBT-I for older adults has a high likelihood of major public health impact by allowing wide- spread access to a needed intervention, increasing the convenience of obtaining care, and decreasing treatment costs among an age group with high rates of insomnia known to exacerbate other concerns (health, mood, cognition). Our research team previously developed and tested an Internet-delivered, automated intervention based on the primary tenants of CBT-I for adults under 65 (SHUTi: Sleep Healthy Using The Internet, R34MH70805 and R01MH086758). Pilot data with a subset of users aged 55-65 indicates that the Internet intervention is feasible and efficacious in this age group; however, this age group differs from the younger cohort in terms of greater dropout and smaller magnitude of improvement (although still significant). The primary goal of this grant is to conduct the first RCT of an Internet intervention tailored for older adults with insomnia (OAWI). We will recruit 309 OAWI in a 3 (Patient Education (PE) website vs. SHUTi for Older Adults vs. SHUTi-OA + Stepped Care (SC)) X 4 (Pre, Post, 6 and 12 month follow-up) design. We hypothesize that adults who receive SHUTi-OA (or SHUTi-OA+SC) will show greater improvements in sleep and daytime variables compared to those in the PE website. We also expect that SHUT-OA+SC (provision of personalized emails or phone calls to participants not completing assigned tasks) will result in greater utilization and better outcomes than SHUTi-OA without support, but at increased cost. Cost-effectiveness analyses and acceptability curves will determine the incremental benefit achieved with the additional costs. If the Internet intervention proves efficacious in a large RCT, it would yield an effective, relatively low-cost, and readily scalable insomnia solution for the fastest-growing demographic in the U.S. (older adults) who experiences the greatest rates of insomnia.