Sleep disruption in older adults living with Alzheimer?s disease and related dementias (ADRD) is very debilitating and contributes to increased institutionalization, reduced cognitive function, and accelerated disease progression. Furthermore, sleep disruption is linked to poor health outcomes in caregivers (CGs), such as poor quality of life and increased CG burden. Given the potential harmful side effects of pharmacologic treatment, non-pharmacologic approaches, such as music, may provide a safer alternative to reducing sleep disruption in this vulnerable population. Listening to music has been shown to decrease agitation, anxiety and depression in nursing home residents with ADRD. A growing body of literature suggests that individualized music may improve sleep quality in older adults with early memory loss, but its efficacy has not been demonstrated in older adults with ADRD in the community, where most older adults with ADRD live. If proven feasible and acceptable, tailored music interventions can then be tested for efficacy in reducing sleep disruption. The purpose of this individual National Research Service Award (NRSA) application is to provide post-doctoral research training for a candidate to gain the knowledge and skills essential for an independent research career. In a cross-sectional dissertation study (funded by NIA F31AG055148) the applicant has previously examined cognitive abilities associated with engagement in music activities and music-related behaviors in older adults with mild cognitive impairment. The applicant?s long-term career objective is to address sleep disruption in older adults with ADRD using palliative non-pharmacologic approaches.
The specific aims of this proposal are to examine the 1) feasibility; 2) acceptability; and 3) preliminary efficacy of a tailored music intervention in home-dwelling older adults with ADRD suffering from sleep disruption. Sixty dyads (older adults with ADRD and their CGs) will be randomized to receive the tailored music intervention immediately or following a four week delay. Music selections will be individualized to older adults with ADRD and account for known sleep-inducing properties. Feasibility of processes that are key to the success of the subsequent study will be examined. Preliminary efficacy of the intervention will be assessed using objective (actigraphy) and subjective (proxy reported) sleep quality measures. In addition, qualitative data will be solicited from the dyads examining the acceptability and satisfaction with the intervention. Under the guidance of the mentoring team, the applicant has carefully selected research training activities to gain knowledge and expertise in five core areas: 1) behavioral intervention research, 2) clinical trial methodology; 3) sleep assessment measures in older adults; 4) advanced statistical methods pertaining to the analysis of clinical trials; and 5) novel remote monitoring applications. Results from the proposed research project will not only inform a future efficacy trial, but also provide an opportunity for the applicant to gain the necessary skills to launch her career as an independent investigator.
Untreated sleep disruption, one of the most distressing symptoms in older adults with Alzheimer?s disease and related dementias (ADRD), contributes to increased institutionalization and accelerated disease progression. Non-pharmacologic approaches, such as music, may provide a safer alternative to drug treatments, however there is little evidence for music?s efficacy in improving sleep quality in this vulnerable population. Examining the feasibility and acceptability of a tailored music intervention aimed to reduce sleep disruption in older adults with ADRD will inform future efficacy trials, potentially increasing the number of evidence-based options for palliative non-pharmacologic approaches.
