Home-delivered meals for persons with dementia: Which model delays nursing home placement?

为痴呆症患者送餐上门：哪种模式会延迟疗养院安置？

• 批准号: 10397198
• 负责人: Kali St. Marie Thomas
• 金额: $ 27.76万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10397198
• 关键词: Administrative Supplement; Alzheimer' s disease diagnosis; Client; Community Hospitals; Contracts; Data Sources; Dementia; Elderly; Family; Feasibility Studies; Food; Freezing; Health; Healthcare; Home; Individual; Knowledge; Link; Meals on Wheels; Modeling; Nursing Homes; Outcome; Participant; Persons; Pilot Projects; Procedures; Process; Provider; Public Health; Randomized Controlled Trials; Reporting; Research; Risk; Safety; Sample Size; Socialization; Testing; Time; Treatment Efficacy; Visit; Waiting Lists; Work; aging in place; cost; delivered meals; design; effectiveness evaluation; elderly nutrition; food insecurity; insight; nutrition; phase III trial; prevent; primary outcome; programs; prospective; recruit; scale up; secondary outcome; trial comparing; volunteer

PROJECT SUMMARY Older adults with a diagnosis of Alzheimer’s disease and/or a related dementias (ADRD) are at increased risk of food insecurity. There is a strong, documented link between food insecurity and health. However, less is known about how home-delivered meals, designed to reduce food insecurity, enable older adults with ADRD to remain in their homes (vs moving to a nursing home). While meals have traditionally been provided daily to clients’ homes by a volunteer or paid driver who visits with the client and reports any concerns about the client to the meal provider, less frequent deliveries of frozen meals have emerged in recent years as a lower-cost alternative. In this model, participants are provided two weeks’ worth of meals in one bulk delivery via postal courier. Our R61 is a pilot pragmatic randomized controlled trial that compares the outcomes between these two common approaches for delivering meals to food insecure persons with ADRD. In order to generate preliminary evidence of efficacy to justify scaling up this pilot study to a Phase III trial, this administrative supplement seeks to expand the sample size from a feasibility study of 10 individuals at two Meals on Wheels programs to a pilot of 235 participants at three programs. In addition, we propose to incorporate two additional data sources to analyze from our prior work that, when combined, will give us the power needed to determine preliminary efficacy of the interventions. The research conducted during the R61 will not only test and validate procedures to recruit individuals with ADRD on Meals on Wheels waiting lists and evaluate their outcomes, but will also be the first to prospectively evaluate the time to nursing home placement among older adults with ADRD who receive the two predominant meal delivery options. The knowledge generated from this research will set the stage for a larger, Phase III trial that will evaluate the effectiveness of receiving daily home- delivered meals and accompanying wellness check and socialization versus frozen, mailed meals on the time to nursing home placement (primary outcome) as well as days in community and hospital transfers (secondary outcomes) among 2000+ food insecure older adults with ADRD; and 2) characterize differences in the context, processes, and mechanisms contributing to the outcomes observed between the two modes of meal delivery among older adults with ADRD. Ultimately, the knowledge generated from this line of research will help healthcare entities, senior nutrition programs, persons with ADRD, and their families choose between the meal delivery model that best meets the nutrition-related needs of persons with ADRD and prevents nursing home placement.

项目摘要 诊断为阿尔茨海默病和/或相关痴呆（ADRD）的老年人的风险增加 粮食不安全。粮食不安全与健康之间存在着有据可查的密切联系。然而， 了解旨在减少粮食不安全的家庭送餐如何使患有ADRD的老年人能够 留在家中（与搬到养老院相比）。虽然传统上每天提供膳食， 由志愿者或付费司机访问客户并报告客户的任何担忧 对膳食供应商来说，近年来，冷冻膳食的交付频率降低， 替代.在这种模式下，参与者通过邮政一次性批量交付两周的膳食 信使我们的R61是一项实用的随机对照试验，比较了 为患有ADRD的粮食无保障者提供膳食的两种常见方法。以便生成 有效性的初步证据，以证明扩大这一试点研究的III期试验，这一行政 一份补充报告试图扩大样本量，该样本量来自一项可行性研究，研究对象是两个“送餐上门”服务的10个人 在三个项目中，有235名参与者参加了试点项目。此外，我们建议加入两项新的 数据源，以分析我们以前的工作，当结合起来，将给我们所需的权力，以确定 干预措施的初步效果。在R61期间进行的研究不仅将测试和验证 招募患有ADRD的个人在轮上用餐等待名单上并评估其结果的程序，但 也将是第一个前瞻性地评估老年人养老院安置时间的人， 接受两种主要送餐方式的ADRD。从这项研究中获得的知识 将为一个更大的第三阶段试验奠定基础，该试验将评估每天接受家庭治疗的有效性， 送餐和伴随的健康检查和社会化与冷冻，按时邮寄餐 到疗养院安置（主要结局）以及社区和医院转移天数（次要结局 结果）在2000多名患有ADRD的粮食不安全老年人中; 2）描述背景差异， 两种送餐模式之间观察到的结果的过程和机制 老年ADRD患者中。最终，从这一研究中产生的知识将有助于 医疗保健实体、高级营养计划、ADRD患者及其家人在膳食中选择 最能满足ADRD患者营养相关需求的分娩模式， 安置

项目成果

Feasibility of conducting qualitative research with persons living with dementia and their caregivers during a home-delivered meals pilot trial.

• DOI: 10.1186/s40814-023-01302-5
• 发表时间: 2023-04-22
• 期刊: PILOT AND FEASIBILITY STUDIES
• 影响因子: 1.7
• 作者: Gadbois, Emily A.;Bunker, Jennifer N.;Hilgeman, Michelle;Shield, Renee;McAuliff, Kathleen E.;Mills, Whitney;Thomas, Kali
• 通讯作者: Thomas, Kali