Candidate: Dr. Biren Kamdar, MD, MBA, MHS is an Assistant Professor of Medicine and intensive care unit (ICU) physician with a career goal of making novel discoveries regarding delirium and sleep in the ICU setting, particularly in the ever-expanding population of older critically ill patients. Bringing a strong research back- ground, including prior leadership of an NIH-supported ICU sleep promoting effort, Dr. Kamdar's short-term goal is to gain the skills necessary to independently design, implement, evaluate and sustain multi-site inter- ventions to improve delirium and sleep-wake rhythms in older ICU patients. Over the long term, he aims to gain national and international recognition as a health services and aging researcher with a deep expertise and publication record on the underlying mechanisms of delirium, sleep, and sleep-wake rhythms in the critically ill, and with the knowledge and experience necessary to implement interventions in various ICU settings. Research Project: Older patients in the ICU are predisposed to delirium, poor sleep quality, and misaligned sleep-wake rhythms, placing them at high risk for adverse outcomes following ICU discharge. As older adults now comprise the majority of critically ill patients and a rapidly expanding proportion of the ICU survivor popu- lation, ICU-based interventions are needed to focus on this particularly vulnerable population. With the support of a strong mentorship and interdisciplinary stakeholder team, this proposal involves implementation and test- ing of a multicomponent nighttime and daytime intervention in two academic ICUs. As a novel method to re- duce delirium and improve nighttime sleep quality in older ICU patients, this proposal aims to align sleep-wake rhythms by coupling components of Dr. Kamdar's prior nighttime-focused sleep promoting effort with a robust daytime intervention, derived from the Hospital Elder Life Program and prior non-ICU interventions conducted in older inpatients by members of his mentorship team. Key outcome measures will include delirium/coma-free days and sleep-wake rhythms, as measured using advanced analyses from wrist actigraphy data. Additionally, to evaluate and refine the intervention for future implementation, this proposal will include 24-hour sound and light level measurements and, 6 months after intervention completion, semi-structured interviews with ICU staff regarding the intervention itself. Career Development: Dr. Kamdar's career development plan includes formal coursework and mentored training on (a) sleep-wake rhythms and aging; (b) advanced actigraphy methods; (c) intervention development; and (d) implementation science and healthcare leadership. Ultimately, this K76 award will provide the final important stepping stone to establish his independence, thus providing the founda- tion for future leadership of large multi-site interventions aimed at improving delirium, sleep and sleep-wake rhythms in older critically ill patients.
Page 1 of 12 (remove for final draft) PROJECT NARRATIVE Older adults (?65 years old) now comprise the majority of patients in intensive care units (ICUs). In the ICU setting, these older patients frequently experience delirium and misaligned sleep-wake rhythms, placing them at high risk of poor outcomes after ICU discharge. In this proposed study, we will enroll an interdisciplinary team to implement a multicomponent nighttime and daytime intervention in two academic ICUs, with the goal of improving delirium and sleep-wake rhythms (as measured using wrist actigraphy) in vulnerable older ICU patients.
