Leveraging social networks to improve sleep and mindfulness among older adults in residential housing facilities

Poor sleep health (e.g., insufficient sleep duration, fragmented sleep, untreated sleep disorders) is associated with increased risk of Alzheimer’s Disease (AD). Poor sleep health also increases soluble Amyloid βeta and tau concentrations in cerebrospinal fluid suggesting a potential mechanism for sleep disturbance to promote AD pathogenesis. All of these could increase the risk for AD, meaning that poor sleep health and untreated sleep disorders are potential catalysts for AD risk, and that improving sleep may be a modifiable target for AD prevention among older adults. Sleep difficulties remain unaddressed among many older adults, especially those in low resource settings, such as among residents of low-income housing facilities. Our team (the Sleep Matters Initiative) has an established, effective Sleep Health and Wellness (SHAW) program, comprised of sleep and sleep disorders education. We propose to expand the SHAW program to include mindfulness, the Eastern practice of focused concertation in the present moment, which has been shown to improve sleep, reduce stress, and strengthen cognitive function in older adults. Guided by User Centered Design, we will conduct iterative stages of feedback from older adults and prototyping, that will ensure the sleep and mindfulness messages and materials are accessible, usable, and feasible for cognitively unimpaired older adults (age 55 years and above) in low-income housing in Boston. Given that networks of trusted other seniors are essential sources of information and influence, we propose a novel social network approach, that will identify opinion leaders in low-income housing facilities and engage these individuals as Sleep Health Champions (SHCs) to aid in diffusing the adapted SHAW materials and resources through interpersonal communication and small group sessions. Our objective in this R34 is to culturally adapt the SHAW and mindfulness modules to the needs of cognitively unimpaired older adults in low-income housing facilities, then conduct a feasibility and acceptability pilot study of the proposed social network approach to deliver the adapted SHAW program to cognitively unimpaired older adults in low-income housing in Boston with the aim of improving sleep, quality of life (QoL), and cognitive function. We will conduct the proposed planning activities and feasibility study in close collaboration with our longtime partner, the City of Boston Age Strong Commission. The culturally adapted SHAW and mindfulness program will be evaluated in a planned cluster randomized controlled trial in cognitively unimpaired seniors in low-income housing in Boston on sleep health behaviors, QoL, and cognitive function in a planned R01 that will be submitted in Year 3 of this award. It is hypothesized that exposure to the adapted, SHC-deployed SHAW and mindfulness intervention in the planned R01 will be associated with improved sleep, QoL, and markers of cognitive decline.