Nutritional (High Protein) Perihabilitation in Older Veterans Undergoing Surgery

术后并发症在老年人中最常见。虽然有很多因素，但其中一个因素 关键决定因素是营养不良。营养不良-特别是蛋白质摄入量低-被认为是在高达86%的 老年人在入院时营养不良;然而，营养不良的患病率在老年退伍军人是未知的。 营养不良和术后并发症通过两个关键观察结果联系在一起：1）营养不良 显著降低老年人克服术后健康压力的能力，以及2）营养 在住院期间和出院后，状况可能进一步恶化。尽管有确凿的证据 围手术期营养干预可以改善手术结果，但这些干预措施尚未得到证实。 为我们的退伍军人制定和实施。因此，迫切需要采取必要步骤， 识别和减少营养不良的老年退伍军人谁是预期手术。的总体目标 建议的研究是：1）验证筛选和评估工具，以快速准确地识别 围手术期营养不良的退伍军人，和2）试点测试的“围手术期”干预蛋白质 加强补充，以确定其可行性，保真度和可接受性，和3）确定效果 为更大规模的临床试验做准备。老年人围手术期的优化 健康计划（VAPOSH）是达勒姆VAMC的一个新的跨学科计划，提供了一个独特的 有机会制定和试行解决围手术期营养不良的方法。示范 围手术期蛋白质补充对营养不良的老年退伍军人的功能影响将支持 本研究旨在确定和治疗围手术期营养不良， 老年退伍军人的结果。本项目的目的是：1）选择合适的营养筛查， VAPOSH退伍军人的评估工具，并利用它们来表征营养不良的患病率和严重程度 并建立与营养不良相关的截断值; 2）进行为期6周的随机对照试验 在营养不良的退伍军人中进行选择性补充蛋白质的试验 手术; 2.1）使用试点试验来评估围手术期蛋白质的可行性，保真度和可接受性- 与教育对照相比，加强干预; 2.2）确定计划干预的效应量。 未来的研究，加强蛋白质补充营养不良的退伍军人，与身体功能， 关注的主要结果。 Aim 1包括一项观察性前瞻性研究，筛选和评估75种VAPOSH 接受择期手术的患者1）报告营养不良的患病率或有营养不良风险的患者 VAPOSH患者的营养不良，2）确定营养风险筛查-2002的标准有效性 和患者生成的主观全局评估工具，以及3）确定与以下各项相关的临界值 营养不良目标2.1和2.2将对营养不良的老年人进行“围产期”干预试验。 退伍军人接受择期手术，以评估1）的可行性，保真度和可接受性，更高的蛋白质 补充手术前后和2）更高的蛋白质补充对原发性 结果测量、身体功能和关注的次要结果。营养不良的VAPOSH退伍军人 将被随机分配到教育（营养咨询）对照组或高蛋白组 高蛋白组的参与者将被提供高质量的蛋白质 补充剂，将使他们的蛋白质摄入量至少为30克，每一天的3餐。 这些目标的成功实现将提供重要的研究结果， 开发新的和急需的方法来干预退伍军人营养不良之前，期间 以及手术后。

Post-surgical complications are most common in older adults. While a number of factors contribute, one key determinant is malnourishment. Malnutrition – particularly low protein intake – is seen in up to 86% of older adults at hospital admission; however, the prevalence of malnutrition in older Veterans is unknown. Malnutrition and post-surgical complications are linked through two critical observations: 1) malnutrition dramatically reduces the ability of older adults to overcome postsurgical health stressors, and 2) nutritional status is likely to deteriorate further during hospitalization and after discharge. Despite convincing evidence that perioperative nutrition interventions can improve surgical outcomes, such interventions have not been developed and implemented for our Veterans. Thus, there is a critical need to initiate the required steps to identify and reduce malnutrition in older Veterans who are anticipating surgery. The overall objectives of the proposed research are: 1) to validate screening and assessment tools to quickly and accurately identify perioperative malnutrition in Veterans, and 2) to pilot test a “perihabilitation” intervention of protein enhanced supplementation to identify its feasibility, fidelity, and acceptability, and 3) to determine the effect size of physical function in preparation for a larger clinical trial. The Perioperative Optimization of Senior Health Program (VAPOSH), a new interdisciplinary program at the Durham VAMC, offers a unique opportunity to develop and pilot test approaches for addressing perioperative malnutrition. Demonstration of the functional impact of perioperative protein supplementation for malnourished older Veterans will support this research proposal seeking to identify and treat perioperative malnutrition and improve postoperative outcomes in older Veterans. The Aims of this project are: 1) to select the appropriate nutrition screening and assessment tools for VAPOSH Veterans and employ them to characterize malnutrition prevalence and severity and establish cut-off values associated with malnutrition, 2) to conduct a pilot randomized controlled 6-week trial of enhanced protein supplementation in a population of malnourished Veterans undergoing elective surgery; 2.1) use a pilot trial to evaluate the feasibility, fidelity, and acceptability of a perioperative protein- enhanced intervention compared to an educational control; and 2.2) to determine the effect size for planned future studies of enhanced protein supplementation in malnourished Veterans, with physical function as the primary outcome of interest. Aim1 encompasses an observational, prospective study that screens and evaluates 75 VAPOSH patients undergoing elective surgery 1) to report the prevalence of being malnourished or at risk of being malnourished in VAPOSH patients, 2) determine the criterion validity of the Nutrition Risk Screener-2002 and Patient Generated-Subjective Global Assessment tools, and 3) identify cut-off value associated with malnutrition. Aims 2.1 and 2.2 will pilot test a “perihabilitation” intervention in malnourished older Veterans undergoing elective surgery to assess 1) the feasibility, fidelity and acceptability of a higher protein supplement before and after surgery and 2) the effects of a higher protein supplement on the primary outcome measure, physical function and secondary outcomes of interest. Malnourished VAPOSH Veterans will be randomly assigned to either an education (nutritional counseling) control arm or high-protein perihabilitation arm. Participants in the high-protein arm will be provided with high quality protein supplements that will bring their protein intakes to at least 30 grams for each of the 3 meals per day. The successful completion of these aims will provide important findings that will support the development of novel and much needed approaches to intervene for malnutrition in Veterans before, during and after surgery.