CIRCADIAN INTERVENTIONS FOR THE RECENTLY RECENTLY BEREAVED ELDERLY

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

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Abstract

The aim of this Project is to test an intervention designed to help widows and widowers lead healthy well-functioning lives. Specifically, it seeks to protect recently bereaved elders from sleep disruptions and from resulting impairments in health, mood, alertness and daytime functioning. The intervention is designed to develop high levels of regularity in the subject's routine, and thus to enhance the amplitude and phase stability of her/his circadian rhythms, as well as encouraging healthy sleep practices. Comparisons will be made with an age and gender matched control group who will receive Emotion-Focused Therapy (EFT), which acts as a psychotherapy placebo. Sixty elderly (65y+) subjects (both genders), not currently using anti-depressants, will be recruited within 3 months of spousal bereavement. Half will be randomly assigned to the Social Rhythm Therapy (SRT) intervention (which will also include education in healthy sleep practices), and half to the EFT control condition. The SRT group will attend ten social rhythm therapy sessions (spread over 6 mos.) at which a therapist will discuss a weekly diary kept by the subject every day, encouraging a high level of regularity in daily events such as bedtimes, meals, social contacts, etc., as well as educating the subject in healthy sleep behaviors and theory. The control group will attend ten EFT sessions. There will be 4 evaluation points: T1 (baseline), T2 (3 mos. into treatment), T3 (at completion of treatment (6 mos.), T4 (12 month post-treatment follow-up). There will be a 36h laboratory evaluation of sleep, circadian rhythms, mood, alertness and performance at T1 and T3. This will involve 36h of continuous core body temperature measurement, 2 nights of polysomnography (PSG), an MSLT assessment of alertness, and a battery of mood, alertness and performance measures. Prior to each laboratory evaluation, and at T2 and T4, there will be a two-week field evaluation involving completion of the Social Rhythm Metric (SRM), as well as completion of a two-week Pittsburgh Sleep Diary (PghSD), one week of actigraphy, a performance battery and measures of mental and physical health, mood, alertness and well-being. The main hypothesis to be tested is that health, functioning, alertness well-being and performance levels in elderly widow(er)s are mediated by the quality and duration of their sleep, and that improvements can be wrought by a therapy involving increased lifestyle regularity and healthy sleep practices education. Program-wide analyses using other component project data will also be undertaken in order to evaluate daily lifestyle regularity (SRM score) as a mediating vadable in the link between sleep, health and well-being, in a fairly large group of seniors.