Evaluating a CBT-I Intervention in Older Adults

Background: Insomnia negatively impacts quality of life and is associated with increased morbidity and mortality. Although national guidelines recommend cognitive behavioral therapy for insomnia (CBT-I), providers serving those 65 years of age and over may not have the expertise or resources to provide this treatment option. Objective: This study aimed to implement a brief online group CBT-I to adults 65 years of age and over, consisting of 4-week, 1-hour CBT-I classes at a virtual practice. Methods: The Insomnia Severity Index questionnaire was used to assess insomnia. A sleep diary was used to record an individual's quality and quantity of sleep to understand sleep patterns. A satisfaction survey was used to collect feedback on providers' experiences and perceptions during this quality improvement project. Results: The 17 patients evaluated had a mean CBT-I score of 22.53 (standard deviation [SD] = 2.57) preintervention and 14.88 (SD = 3.01) postintervention (t[16] = 10.51, p < .001). The mean difference of 7.65 (95% confidence interval [6.11, 9.18]) indicated a substantial reduction in insomnia symptoms. The effect size was large, with a Cohen's d of 2.48, indicating a strong impact of the intervention on reducing insomnia symptoms. Conclusions: A brief cognitive behavioral intervention for patients with insomnia in a practice serving those 65 years of age and over is feasible. Additional studies are needed to determine whether this type of intervention can be used to improve patient care or patient outcomes at other practices serving older adults.Implementation of nurse-supported cognitive behavioral therapy for insomnia (CBT-I) in primary care practices serving older adults may reduce insomnia severity and improve health-related quality of life through individualized education, behavioral guidance, and ongoing support.