Nutritional (High Protein) Perihabilitation in Older Veterans Undergoing Surgery

手术后并发症在老年人中最为常见。虽然有许多因素起作用，但有一个因素 关键的决定因素是营养不良。营养不良--特别是蛋白质摄入量低--高达86%的人 老年人入院；然而，老年退伍军人营养不良的患病率尚不清楚。 营养不良和手术后并发症通过两个关键观察联系在一起：1)营养不良 显著降低老年人克服手术后健康压力的能力，以及2)营养 在住院期间和出院后，情况可能会进一步恶化。尽管有令人信服的证据 围手术期营养干预可以改善手术结果，但此类干预尚未得到 为退伍军人开发和实施的。因此，迫切需要启动必要的步骤，以 确定并减少期待手术的老年退伍军人的营养不良。该计划的总体目标 建议的研究是：1)验证筛查和评估工具，以快速准确地识别 退伍军人围手术期营养不良，以及2)试行蛋白质“康复”干预 增强补充，以确定其可行性、保真度和可接受性，以及3)确定效果 身体机能的大小，为更大的临床试验做准备。高龄患者围手术期的优化 健康计划(VAPOSH)是达勒姆VAMC的一个新的跨学科计划，它提供了一个独特的 有机会开发和试验解决围手术期营养不良问题的测试方法。演示 围手术期补充蛋白质对营养不良的老年退伍军人的功能影响 这项研究计划旨在识别和治疗围手术期营养不良，并改善术后 在老年退伍军人中的结果。该项目的目标是：1)选择适当的营养筛查和 VAPOSH退伍军人评估工具，并利用它们来表征营养不良的患病率和严重程度 并建立与营养不良有关的临界值，2)进行为期6周的随机对照试点 在营养不良退伍军人中进行强化蛋白质补充的试验 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- 与教育控制相比，加强干预；以及2.2)确定计划的效果大小 在营养不良的退伍军人中加强蛋白质补充的未来研究，身体机能作为 感兴趣的主要结果。 AIM1包含一项观察性、前瞻性研究，筛选和评估75个VAPOSH 接受择期手术的患者1)报告营养不良或有患病风险的患病率 VAPOSH患者的营养不良，2)确定营养风险筛查的标准效度-2002 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截止值 营养不良。AIMS 2.1和2.2将在营养不良的老年人中试行“康复”干预 接受择期手术的退伍军人评估1)更高蛋白质的可行性、保真度和可接受性 术前术后补充及2)高蛋白补充对原发心脏功能的影响 结果测量、身体功能和感兴趣的次要结果。营养不良的退伍军人 将被随机分配到教育(营养咨询)控制组或高蛋白组 康复手臂。高蛋白质组的参与者将获得高质量的蛋白质 每天三餐中每餐的蛋白质摄入量至少达到30克的补充剂。 这些目标的成功完成将提供重要的发现，将支持 开发新的和迫切需要的方法，在退伍军人营养不良之前、期间进行干预 而且在手术后。

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.