A Meal Delivery and Exercise Intervention to Increase Resilience in Homebound Older Adults

项目总结/摘要 无家可归的老年人往往在功能上依赖他人，有可能被安置在诸如 养老院大多数老年人更愿意在家中养老，因此需要进行研究。 以确定可以帮助他们保持自主性的干预措施。虚弱是一种与年龄相关的综合症， 预测功能下降和死亡率，这是非常普遍的，在我们的初步研究， 老年人（56%体弱，44%体弱前期，没有一个是健壮的），主要由缓慢的步行速度驱动（88%）。 由于在家的人群很难接触到，很少有研究，也没有临床试验， 这个人口。在我们的试点随机对照试验中， 车轮（MOW），9名参与者（5名治疗组，4名对照组）完成了为期12周的研究，研究显示步态 治疗组的速度和总虚弱评分有所改善。步态速度的改善尤其是 令人兴奋的是它在居家老年人中的流行。此外，没有不良事件， 参加者既享受运动的乐趣，又享受送饭的方便。 为了进一步评估在我们的试验中观察到的临床变化，我们评估了潜在的新型虚弱生物标志物。 这些生物标志物可以帮助比临床上看到的更早地识别虚弱，并提供有价值的信息 关于脆弱干预的影响。炎症生物标志物，如白细胞介素-6（IL-6）、C反应性 蛋白（CRP）和肿瘤坏死因子-α（TNF-α）与虚弱状态相关，但 与治疗有关。我们初步测试了热休克蛋白（HSP）70， 巨噬细胞炎性蛋白-1 β（MIP-1β）和可溶性白细胞介素-6 受体（sIL-6 R），看看它们是否可以成为更特异的脆弱生物标志物。我们的运动组减少了 HSP 70、MIP-1β和sIL-6 R与对照组比较，超过12周。 因此，我们有两个目标：1）评估家庭为基础的锻炼计划的效果，通过 MOW对体弱/体弱前期居家老年人的步态速度和虚弱状态的影响，以及2）评估相关性 新的血清生物标志物（HSP 70、MIP-1β、sIL-6 R）与已建立但非特异性的虚弱生物标志物之间的差异 (IL-6运动干预前后对体弱/体弱前期居家老年人血清CRP、TNF-α水平的影响。 来自该项目的数据将成为R 01或涉及多方面弱点的同等奖项的催化剂 干预措施，针对机械和临床途径，以帮助居家老年人为目标 年龄到位。该职业奖还将为Jessica Lee博士提供培训和指导， 一个拥有独立资金的科学家兼医生UTHealth为她提供了一个支持性的环境， 个性化的职业发展计划，以及在老年医学、临床医学、 试验，运动干预，生物标志物和生物统计学。作为一个家庭小学的医务主任 她的目标是成为干预措施的专家，以提高她的居家病人的复原力。

PROJECT SUMMARY/ABSTRACT Homebound older adults are often functionally dependent and at risk for placement in institutions such as nursing homes. The majority of older adults would prefer to age in place in their homes so research is needed to identify interventions that can help them maintain their autonomy. Frailty is an age-related syndrome highly predictive of functional decline and mortality, which is very prevalent in our preliminary studies of homebound older adults (56% frail, 44% prefrail, none were robust) and mainly driven by slow walking speed (88%). Because the homebound population is difficult to reach, there have been few studies and no clinical trials in this population. In our pilot randomized controlled trial of an exercise program administered by Meals on Wheels (MOW), 9 participants (5 treatment, 4 control) completed the 12-week study which showed that gait speed and total frailty score improved in the treatment group. The improvement in gait speed is particularly exciting given its prevalence in homebound older adults. In addition, there were no adverse events and the participants enjoyed the exercises as well as the convenience of the meal deliveries. To further evaluate the clinical changes seen in our trial, we assessed potential novel frailty biomarkers. These biomarkers could help identify frailty earlier than may be seen clinically and provide valuable information about the effects of frailty interventions. Inflammatory biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) have been associated with frailty status but not correlated with treatments. We preliminarily tested heat shock protein (HSP) 70, which induces muscle wasting in cancer cachexia, as well as macrophage inflammatory protein-1β (MIP-1β), and soluble interleukin-6 receptor (sIL-6R) to see if they could be more specific frailty biomarkers. Our exercise group had decreased HSP70, MIP-1β, and sIL-6R when compared to the control group over 12 weeks. Thus we have 2 aims: 1) evaluate the effects of a home-based exercise program administered through MOW on gait speed and frailty status in frail/prefrail homebound older adults, and 2) assess the association between novel serum biomarkers (HSP70, MIP-1β, sIL-6R) and established but non-specific frailty biomarkers (IL-6, CRP, TNF-α) in frail/prefrail homebound older adults before and after the exercise intervention. Data from this project will be the catalyst for an R01 or equivalent award involving multi-pronged frailty interventions, targeting mechanistic and clinical pathways, with the goal of helping homebound older adults age in place. This career award would also provide training and mentorship for Dr. Jessica Lee to develop into a physician-scientist with independent funding. UTHealth has provided her with a supportive environment, individualized career development plan, and expert mentors with long-standing experience in geriatrics, clinical trials, exercise interventions, biomarkers, and biostatistics. As the medical director of a home-based primary care service, her goal is to become an expert in interventions to improve resilience in her homebound patients.