PROJECT SUMMARY 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.