A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial.
A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial.
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DOI：
10.2196/50870
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发表时间：
2023-11-15
影响因子：
2.2
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中科院分区：
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虚弱是一种常见的老年综合症，使老年人容易出现功能衰退。没有任何药物可以改变虚弱的轨迹，但营养干预可能有助于支持独立性。本文提出了一项随机对照试验，旨在调查移动健康干预措施“Olitor”的可行性和有效性，该干预措施旨在增强体弱老年人对地中海饮食的依从性，无需外部帮助。研究样本由 15 名年龄 66-77 岁（平均 70.5，SD 3.96）岁的参与者组成，随机分为干预组（n=8；8 名女性；平均 72.4，SD 4.8 岁）和对照组（n=7；6 名女性，1 名男性；平均 70.0，SD 3.9 岁）。干预涉及一个名为“Olitor”的面向患者的移动应用程序和一个基于网络的安全管理仪表板。参与者被要求在 3 个月内至少每周使用该应用程序，该应用程序提供有关他们的食物选择、个性化食谱推荐和应用程序内消息传递功能的反馈。使用 Mann-Whitney 检验比较变化评分和 Hedges g 统计来估计效应大小，主要疗效结果是遵守地中海饮食评分和胰岛素抵抗措施。次要结果包括作为可行性衡量标准的保留率、参与度和用户应用程序质量评级的可接受性，以及评估功效的其他指标。对模型进行了多重比较调整。研究结果表明，与对照组相比，干预组的地中海饮食依从性评分显着改善（W=50.5；调整后的 P=0.04），中位变化评分分别为 2（IQR 2-4.25）和 0（IQR –0.50 至 0.50）。胰岛素抵抗测量的稳态模型评估有小幅且不显着的降低（W=23；调整后的 P=.85）。此外，豆类摄入量显着增加（W=54；调整后的 P<.01）。干预措施对多种结果的影响很大，例如地中海饮食依从性（Hedges g=1.58；95% CI 0.34-2.67）和蔬菜摄入量（Hedges g=1.14；95% CI 0.08-2.21）。保留率为100%。该应用程序的整体质量评级良好，每周平均交互时间为 12 分钟。这项试点研究揭示了移动干预“Olitor”在促进体弱老年人更健康饮食习惯方面的潜力。它表现出高保留率、对地中海饮食的依从性显着改善以及推荐食物的摄入量增加。胰岛素抵抗显示出轻微但不显着的改善。一些次要结果，例如下肢功能和地中海饮食知识，具有很大的效应量。尽管该应用程序的行为改变功能与以前的数字干预措施相似，但对行为改变中涉及的理论指导机械措施的独特关注，例如自我调节、自我效能和预期的负面结果，可能增强了其潜力。有必要在更多样化和更具代表性的人群中进行进一步的研究，重点关注胰岛素敏感性受损的个体，以验证这些初步发现。 ClinicalTrials.gov NCT05236712； https://clinicaltrials.gov/study/NCT05236712
Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, “Olitor,” designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called “Olitor” and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR –0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. This pilot study revealed the potential of the mobile intervention “Olitor” in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712