Staffing Costs and Behavioral Nutritional Interventions

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DESCRIPTION (provided by applicant): The purpose of this NIA Career Development Award (CDA) application is to provide the investigator with the knowledge, analytical skills, and preliminary database to delineate the nursing home (NH) staff resources necessary to implement behavioral and environmental interventions to improve nutritional intake in NH residents. The proposed CDA will allow the investigator to receive training in three primary areas, each of which compliments her existing knowledge: (1) undernutrition in older adults, which will compliment her existing expertise in the health and associated quality-of-life issues facing the NH population; (2) cost analysis, and (3) operations-research modeling, both of which compliment her existing knowledge in research methodology and statistical analysis. This CDA application is designed to provide the investigator with the necessary knowledge and analytical skills to pursue her immediate career goal of refining and validating three methodological tools related to the development of behavioral and environmental interventions to improve nutritional status among NH residents: (1) a mealtime preference-satisfaction interview; (2) a nutritional assessment instrument to identify behavioral and environmental determinants of food intake; and (3) an evaluation tool to examine residents responsiveness to a behavioral and environmental intervention to improve intake and to assess the staff time required to implement the evaluation. The proposed CDA program of training incorporates formal coursework and individualized tutorials to provide the investigator with the requisite knowledge and skills to accomplish her immediate career goals. Dr. David Reuben, a geriatrician and expert in nutritional issues among older adults, will serve as the investigator s sponsor and primary mentor. [Dr. Gail Harrison, a nutritionist and expert in nutritional assessment issues, will serve as a mentor in the development of the nutritional assessment tools.] [Dr. John Schnelle, a behavioral psychologist and expert in applied research, will serve as her mentor for the development, implementation, and evaluation of behavioral and environmental interventions in the NH setting. [Dr. Shan Cretin, a senior operations-research scientist at RAND,] will be her mentor in operations-research modeling, which will be used to project the NH staff resources necessary to implement the interventions; while, Dr. Emmett Keeler, a senior statistician at RAND, will provide training in cost analysis related to the interventions and the necessary staff resources. Such training will permit the investigator to pursue her long-term career goal of developing behavioral and environmental interventions to improve quality of life among the institutionalized elderly and determine the NH staff resources and the associated costs necessary to implement such interventions in the NH setting. Thus, the proposed CDA training would be central to the investigator s ability to develop as an independent scientist within her chosen area of gerontological research.