Karlin Bradley E, Trockel Mickey, Spira Adam P, Taylor C Barr, Manber Rachel
Mental Health Services, US Department of Veterans Affairs Central Office, Washington, DC, 20420, USA; Education Development Center, Inc., New York, NY, 10014, USA; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
Int J Geriatr Psychiatry. 2015 Mar;30(3):308-15. doi: 10.1002/gps.4143. Epub 2014 May 29.
Limited research has examined the effects of cognitive behavioral therapy for insomnia (CBT-I) among older adults (age >65 years) receiving treatment in real-world clinical settings and even less has examined effects on outcomes beyond reducing insomnia, such as improved quality of life. The current article examines and compares outcomes of older versus younger (age 18-64 years) veterans receiving CBT-I nationally in nonsleep specialty settings.
Patient outcomes were assessed using the Insomnia Severity Index, Beck Depression Inventory-II, and the World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised.
A total of 536 younger veterans and 121 older veterans received CBT-I; 77% of older and 64% of younger patients completed all sessions or finished early due to symptom relief. Mean insomnia scores declined from 19.5 to 9.7 in the older group and from 20.9 to 11.1 in the younger group. Within-group effect sizes were d = 2.3 and 2.2 for older and younger groups, respectively. CBT-I also yielded significant improvements in depression and quality of life for both age groups. High and increasing levels of therapeutic alliance were observed for both age groups.
Older (and younger) patients receiving CBT-I from nonsleep specialists experienced large reductions in insomnia and improvements in depression and quality of life. Effects were similar for both age groups, and the rate of dropout was lower among older adults. The results provide strong support for the effectiveness and acceptability of CBT-I for older adults receiving care in routine treatment settings.
在现实临床环境中接受治疗的老年人（年龄>65岁）中，对失眠认知行为疗法（CBT-I）效果的研究有限，而考察其对失眠以外结果（如生活质量改善）影响的研究更少。本文考察并比较了在全国范围内非睡眠专科环境中接受CBT-I治疗的老年退伍军人与年轻退伍军人（年龄18 - 64岁）的治疗结果。
使用失眠严重程度指数、贝克抑郁量表第二版和世界卫生组织生活质量简表评估患者的治疗结果。使用工作联盟量表简版修订版评估治疗联盟。
共有536名年轻退伍军人和121名老年退伍军人接受了CBT-I治疗；77%的老年患者和64%的年轻患者完成了所有疗程或因症状缓解提前结束治疗。老年组的平均失眠评分从19.5降至9.7，年轻组从20.9降至11.1。老年组和年轻组的组内效应量分别为d = 2.3和2.2。CBT-I对两个年龄组的抑郁和生活质量也有显著改善。两个年龄组的治疗联盟水平都很高且不断提高。
在非睡眠专科医生处接受CBT-I治疗的老年（和年轻）患者失眠症状大幅减轻，抑郁和生活质量得到改善。两个年龄组的效果相似，老年患者的退出率较低。这些结果为CBT-I在常规治疗环境中对接受治疗的老年人的有效性和可接受性提供了有力支持。
