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

项目摘要 虚弱是一种常见的、严重的和潜在的可改变的老年综合征。尽管有证据表明 营养补充剂改善了身体虚弱者的功能措施，干预措施在 受控环境，可能会产生有限的遗产影响。最近的饮食指南建议， 坚持健康饮食有助于可持续的健康行为改变。还可以使用别墅 健康的饮食模式地中海饮食（MedD）是很好的研究，在老化，因为它的抗炎 和糖调节作用。考虑到胰岛素敏感性炎症和肌肉代谢的破坏 在虚弱中观察到，MedD理想地准备改善该人群的功能结局。然而，在这方面， 存在的局限性是，促进健康饮食选择的常用行为策略不可扩展 并且可能不适合用于个体患者。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的权能，使他们能够自我管理自己的健康。移动的健康 技术，包括应用程序，具有更高的复杂性和适应多种自我的能力， 管理特征（例如，自我监控，互动反馈）对提高老年人 个人参与自我管理。然而，迄今为止，这些移动的健康（mHealth）方法中很少有 是为脆弱的老年人开发的。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，将允许自助 监测、信息交流和促进对MedD的依从性。为患者提供了清晰的轨迹- 以候选人以前的流行病学和干预工作为基础的研究。在过去，他 探讨了营养和代谢因素对虚弱风险和预后的影响， 坚持MedD，独立于其他营养措施，与体弱者更好的健康有关。 在后者中，他成功地采用了移动的干预行为变化的背景下，在老年人和体弱的成年人。 这一初步工作为拟议项目提供了概念和经验基础。候选人的 职业目标是成为一名独立研究人员并领导增强技术的发展 采取适合老年人和弱势群体的干预措施，促进自我管理， 功能独立。职业发展计划将教学课程与实际指导相结合 研究经验，以实现以下培训目标：1）获得营养科学的培训; 2）发展 发展以人为本的移动健康干预措施的技能; 3）实现有效开展 移动的健康和以患者为导向的背景下的临床试验; 4）提高临床老年医学的能力; 5） 熟练掌握科学写作和语法。候选人已经制定了明确的研究 以患者为导向的干预研究的潜力，这符合NIA计划的优先事项，以促进使用 老年人和弱势群体自我管理的技术。

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.