A Multi-Component Behavioral Nutrition Intervention for Homebound Elderly

针对居家老年人的多成分行为营养干预

• 批准号: 7666709
• 负责人: JULIE L. LOCHER
• 金额: $ 15.2万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7666709
• 关键词: Acute; Address; Area; Award; Behavior; Behavior Therapy; Behavioral; Body Composition; Body Weight; Body Weight decreased; Calories; Chronic; Clinical Research; Consumption; Control Groups; Counseling; Data; Development; Dietary Intervention; Eating; Eating Behavior; Economics; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Elderly; Energy Intake; Exploratory/Developmental Grant; Federal Government; Goals; Health; Health Care Costs; Health Services; Home environment; Individual; Institute of Medicine (U.S.); Intake; Intervention; Investigation; Maintenance; Malnutrition; Mediating; Medical; Medicare; Mission; Modeling; Morbidity - disease rate; National Institute on Aging; Nutrient; Nutritional; Outcome; Outcome Measure; Participant; Patients; Persons; Police; Population; Prevention; Quality of life; Randomized; Research; Research Personnel; Research Project Grants; Risk; Role; Sampling; Self Care; Self Efficacy; Self Management; Services; Social Environment; Testing; behavior change; behavioral health; cost; cost effectiveness; design; disability; disorder later incidence prevention; effective intervention; evidence base; experience; frailty; health care delivery; high risk; improved; intervention effect; nutrition; patient home care; prospective; psychologic; public health relevance; response; secondary outcome; social; social cognitive theory; standard care; standard of care

DESCRIPTION (provided by investigator): Undernutrition in older adults is a serious problem with significant health, social, and economic consequences. Older adults who have recently experienced an acute illness or an exacerbation of a chronic condition and who are receiving formal home health services are at especially high risk for experiencing under- eating and related adverse outcomes. The eating behavior of homebound older adults is influenced by many factors simultaneously that may contribute to undernutrition. These factors involve social, psychological, and environmental components that may be amenable to non-invasive and inexpensive individualized self-care management strategies developed and delivered in older adults' own homes. In fact, many experts believe that it is in the home care setting that nutritional services may be best provided to this at-risk group. The purpose of this study is to evaluate the efficacy and feasibility of a multi-component self-management behavioral intervention to improve nutritional intake in a group of homebound older adults who are at especially high risk for undernutrition. The intervention will be take place within participants' homes. This application is in response to PA-06-181, Exploratory Developmental Research Grant Award. The National Institute on Aging specifically solicits application in its major area of emphasis, interventions and behavior change. This application is consistent with NIA's larger mission to address frailty, co-morbidities, and disability across a broad spectrum of illnesses. The proposed research is guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory. Both of these emphasize the reciprocal relationship that exists between individual behavior and the social environment. The study will use a prospective randomized controlled design to estimate whether the intervention results in improved caloric intake and nutrition-related health outcomes. Participants will be 104 homebound older adults who are receiving Medicare home health services. They will be randomly assigned to either standard care or a multi-component self-management behavioral nutrition intervention. The primary aim of the study is to test whether the intervention increases caloric intake in homebound older adults. Secondary aims are to test whether the intervention improves other important outcomes, including prevention of unintentional weight loss; maintenance of body composition; increased consumption of macro- and micro- nutrients; improved quality of life and function; and reduced rates of adverse outcomes in homebound older adults. The third aim is to examine whether changes in self-efficacy, goal-setting, and relapse prevention occur as a result of the intervention; and, if so, whether these changes mediate the effect of the intervention on the primary and secondary outcomes. PUBLIC HEALTH RELEVANCE: The significance of this project, including its relevance for public health, is the evidence it will provide regarding whether a self-management behavioral nutritional intervention delivered in the home is beneficial to a group of homebound older adults who are either malnourished or at especially high risk for undernutrition. The focus of this study is on practical, cost-effective interventions in persons who can still eat orally and do not yet require medical intervention for nutrition-related problems.

描述（由研究者提供）：老年人营养不良是一个严重的问题，具有重大的健康，社会和经济后果。最近经历过急性疾病或慢性疾病恶化并正在接受正式家庭健康服务的老年人发生进食不足和相关不良后果的风险特别高。居家老年人的饮食行为同时受到许多可能导致营养不良的因素的影响。这些因素涉及社会，心理和环境的组成部分，可能是服从于非侵入性和廉价的个性化自我护理管理策略，制定和提供在老年人自己的家中。事实上，许多专家认为，在家庭护理环境中，营养服务可能是最好的提供给这一风险群体。本研究的目的是评估多成分自我管理行为干预的有效性和可行性，以改善一组在家的老年人谁是营养不良的风险特别高的营养摄入。干预将在参与者家中进行。本申请是在回应PA-06-181，探索性发展研究补助金奖。国家老龄问题研究所特别征求在其重点、干预和行为改变的主要领域的申请。该应用程序与NIA的更大使命一致，即解决各种疾病中的虚弱、合并症和残疾。本研究以生态模型和社会认知理论为理论指导。两者都强调个人行为与社会环境之间存在的相互关系。该研究将使用前瞻性随机对照设计来评估干预是否会改善热量摄入和营养相关的健康结果。参与者将是104名在家接受医疗保险家庭健康服务的老年人。他们将被随机分配到标准护理或多组分自我管理行为营养干预。这项研究的主要目的是测试干预是否会增加居家老年人的热量摄入。次要目的是测试干预是否改善了其他重要结果，包括预防意外体重减轻;维持身体组成;增加宏量和微量营养素的消耗;改善生活质量和功能;以及降低居家老年人的不良结果发生率。第三个目的是检查干预是否会导致自我效能、目标设定和复发预防的变化;如果是，这些变化是否会介导干预对主要和次要结局的影响。 公共卫生关系：该项目的意义，包括其对公共卫生的相关性，是它将提供的证据，关于在家中提供的自我管理行为营养干预是否有益于一组营养不良或营养不良风险特别高的居家老年人。这项研究的重点是对那些仍然可以口服并且还不需要对营养相关问题进行医疗干预的人进行实用的、具有成本效益的干预。

项目成果

A theoretically based Behavioral Nutrition Intervention for Community Elders at high risk: the B-NICE randomized controlled clinical trial.

• DOI: 10.1080/21551197.2011.623955
• 发表时间: 2011
• 期刊: Journal of nutrition in gerontology and geriatrics
• 作者: Locher JL;Bales CW;Ellis AC;Lawrence JC;Newton L;Ritchie CS;Roth DL;Buys DL;Vickers KS
• 通讯作者: Vickers KS

"Never the twain shall meet:" dual systems exacerbate malnutrition in older adults recently discharged from hospitals.

“两者永远不会相遇：”双重系统加剧了刚出院的老年人的营养不良。

• DOI: 10.1080/01639366.2011.545039
• 发表时间: 2011
• 期刊: Journal of nutrition in gerontology and geriatrics
• 作者: Locher,JulieL;Wellman,NancyS
• 通讯作者: Wellman,NancyS