Development and Evaluation of a Mobile Health Intervention to Support Healthful Dietary Choices in Older Persons with Frailty

开发和评估移动健康干预措施以支持体弱老年人的健康饮食选择

• 批准号: 9913439
• 负责人: Oleg Zaslavsky
• 金额: $ 15.16万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913439
• 关键词: Address; Adherence; Adult; Affect; Aging; Anti-Inflammatory Agents; Behavior Therapy; Behavioral; Biological; Biology; Chronic; Clinical; Competence; Conduct Clinical Trials; Data; Data Reporting; Databases; Development; Development Plans; Diet; Dietary Intervention; Dietary Practices; Effectiveness; Elderly; Ensure; Epidemiology; Evaluation; Feedback; Focus Groups; Food; Foundations; Funding; Future; Geriatrics; Goals; Health; Health Technology; Health system; Healthcare; Individual; Inflammation; Informal Social Control; Insulin Resistance; Intervention; Intervention Studies; Intuition; Knowledge; Laboratories; Lead; Measures; Mediterranean Diet; Mentors; Metabolic; Methodology; Mobile Health Application; Monitor; Nutrient; Nutritional; Nutritional Science; Older Population; Outcome; Outcome Measure; Participant; Patients; Persons; Pharmaceutical Preparations; Physical Function; Population; Positioning Attribute; Research; Research Personnel; Risk; School Nursing; Self Efficacy; Self Management; Social support; Structure; Syndrome; System; Technology; Testing; Training; Universities; Vulnerable Populations; Washington; Work; Writing; base; behavioral health; biobehavior; cardiovascular health; career; career development; cost; cost effective; design; dietary guidelines; dietary supplements; digital; early-career faculty; epidemiologic data; expectation; experience; frailty; functional independence; functional loss; functional outcomes; glucose metabolism; improved; individual patient; innovation; insulin sensitivity; interactive feedback; iterative design; mHealth; mobile computing; muscle metabolism; nutrition; outcome forecast; patient oriented; patient oriented research; person centered; pre-doctoral; preservation; primary outcome; programs; secondary outcome; skills; technology development; therapy design; treatment as usual; usability

PROJECT SUMMARY Frailty is common, serious and potentially modifiable geriatric syndrome. Although evidence accumulate that nutritional supplements improve functional measures in persons with frailty, the interventions are carried out in a controlled setting and might have limited legacy effect. Recent dietary guidelines suggest that overall adherence to a healthful diet is instrumental for a sustainable health behavioral change. Among available healthful dietary patterns Mediterranean Diet (MedD) is well studied in aging because of its anti-inflammatory and glucomodulating effects. Given disruptions in insulin sensitivity, inflammation, and muscle metabolism observed in frailty, MedD is ideally poised to improve functional outcomes in this population. However, limitations exist that commonly used behavioral strategies to facilitate healthful dietary choices are not scalable and might be inadequate for use with individual patients. In fact, few individualized dietary interventions have been designed to empower and enable older and frail persons to self-manage their heath. Mobile health technologies, including apps, with increased sophistication and capacity for accommodating multiple self- management features (e.g., self-monitoring, interactive feedback) hold great promise to heighten older person's involvement in self-management. However, to date, few of these mobile health (mHealth) approaches were developed for and engaged vulnerable older adults. The proposed research will use rapid iterative methodology to develop with end users, easy to use and intuitive mHealth system that will allow self- monitoring, information exchange and promote adherence to MedD. This work a clear trajectory for patient- oriented research building upon candidate's previous epidemiological and intervention work. In former he explored the impact of nutritional and metabolic factors on frailty risk and prognosis finding that increased adherence to MedD, independently of other nutritional measures, relate to better health in persons with frailty. In latter, he successfully employed a mobile intervention in behavioral change context in older and frail adults. This preliminary work provided conceptual and empirical ground for the proposed project. The candidate's career goal is to become an independent researcher and lead the development of technology augmented interventions, suitable for older and vulnerable populations, that facilitate self-management and promote functional independence. The career development plan integrates didactic coursework with practical mentored research experience to achieve the following training goals: 1) obtain training in nutritional science; 2) develop skills in development of person-centered mHealth interventions; 3) achieve capacity to effectively conduct clinical trials in mobile health and patient-oriented context; 4) improve competencies in clinical geriatrics; 5) obtain proficiency with scientific writing and grantsmanship. The candidate has developed a clear research potential for patient-oriented intervention research, which meets NIA programmatic priorities to promote use of technologies in self-management in older and vulnerable population.

项目总结 虚弱是常见的、严重的和潜在的可改变的老年综合征。尽管有证据表明 营养补充剂改善体弱者的功能措施，干预措施在 一种受控制的设置，可能会产生有限的遗留效果。最近的饮食指南表明，总体来说 坚持健康饮食有助于可持续的健康行为改变。在可用的 健康饮食地中海饮食(Medd)因其抗炎作用而在衰老过程中被广泛研究 和血糖调节效应。考虑到胰岛素敏感性、炎症和肌肉代谢的紊乱 在脆弱的情况下观察，MEDD是改善这一人群的功能结果的理想选择。然而， 存在的局限性是，促进健康饮食选择的常用行为策略是不可扩展的 可能不适合个别患者使用。事实上，很少有个性化的饮食干预措施 旨在增强老年人和体弱者自我管理健康的能力。移动医疗 技术，包括应用程序，具有更高的复杂性和适应多个自我的能力 管理功能(例如，自我监控、交互反馈)很有希望提升更老的 个人对自我管理的参与。然而，到目前为止，这些移动医疗(MHealth)方法很少 是为易受伤害的老年人制定的，并与之接触。拟议的研究将使用快速迭代 与最终用户一起开发的方法，易于使用和直观的mHealth系统，将允许自我 监测、信息交流和促进遵守MED。这项工作为患者提供了一个明确的轨迹- 以候选人先前的流行病学和干预工作为基础的定向研究。在以前的他 探讨了营养和代谢因素对虚弱风险和预后的影响，发现 坚持与其他营养措施无关的MED与身体虚弱的人的健康状况有关。 在后者中，他成功地在老年人和虚弱的成年人的行为改变背景下使用了移动干预。 这项初步工作为拟议项目提供了概念性和经验性依据。候选人的 职业目标是成为一名独立的研究员，并引领技术增强的发展 适合老年人和弱势群体的干预措施，促进自我管理和促进 功能独立。职业发展计划将授课课程与实际指导相结合 研究经验以实现以下培训目标：1)获得营养科学方面的培训；2)发展 开发以人为中心的移动健康干预措施的技能；3)具备有效开展 移动医疗和以患者为中心的临床试验；4)提高临床老年病学的能力；5) 熟练掌握科学写作和写作技巧。候选人已经进行了一项明确的研究 以患者为中心的干预研究的潜力，这符合NIA方案优先事项，以促进使用 老年和弱势群体自我管理方面的技术。