An Insomnia Internet Intervention for Older Adults

 描述(由申请人提供)：失眠是老年人的一个重大公共卫生问题，具有重大的医疗、心理和经济后果。由于多达20-30%的老年人(年龄=55岁)符合慢性失眠的诊断标准，找到可获得的、有效的和低成本的治疗方法至关重要。认知行为治疗失眠(CBT-I)是一种非药物干预，已被证明是有效的，当为老年人量身定做。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，利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，卫生保健领域一直不愿对老年患者使用技术提供的解决方案，因为他们担心老年人要么无法获得，要么无法获得 不想用科技。然而，美国的老年人是正在增长的最大的互联网用户群体，他们通常都有学习新技术的愿望。当老年人确实使用以技术为基础的计划来促进健康时，他们会对这些计划给予好评。互联网为老年人提供的CBT-I很有可能对公共健康产生重大影响，因为它允许广泛获得所需的干预，增加了获得护理的便利性，并在失眠率较高的年龄组中降低了治疗成本，已知失眠率高会加剧其他担忧(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化干预措施，适用于65岁以下的成年人(SHUTI：使用互联网健康睡眠，R34MH70805和R01MH086758)。对55-65岁的一组用户的试点数据表明，互联网干预在这一年龄段是可行和有效的；然而，这一年龄段与年轻一组的不同之处在于辍学较多，改善幅度较小(尽管仍有显著意义)。这笔赠款的主要目标是进行第一次针对患有失眠的老年人(OAWI)的互联网干预的随机对照试验。我们将招募309名OAWI，采用3(患者教育(PE)网站与SHUTI老年患者教育网站VS SHUTI-OA+分级护理(SC))×4(前、后、6个月和12个月随访)设计。我们假设，与PE网站上的人相比，接受SHUTI-OA(或SHUTI-OA+SC)治疗的成年人将在睡眠和白天变量方面表现出更大的改善。我们还预计，与没有支持的SHUTI-OA相比，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)将产生更高的利用率和更好的结果，但成本更高。成本效益分析和可接受性曲线将确定通过增加费用获得的增量效益。如果互联网干预在大型随机对照试验中被证明是有效的， 它将为美国增长最快的人群(失眠率最高的老年人)提供一个有效、相对低成本且易于扩展的失眠解决方案。

 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.