A Meal Delivery and Exercise Intervention to Increase Resilience in Homebound Older Adults

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PROJECT SUMMARY/ABSTRACT Homebound older adults are often functionally dependent and at risk for placement in institutions such as nursing homes. The majority of older adults would prefer to age in place in their homes so research is needed to identify interventions that can help them maintain their autonomy. Frailty is an age-related syndrome highly predictive of functional decline and mortality, which is very prevalent in our preliminary studies of homebound older adults (56% frail, 44% prefrail, none were robust) and mainly driven by slow walking speed (88%). Because the homebound population is difficult to reach, there have been few studies and no clinical trials in this population. In our pilot randomized controlled trial of an exercise program administered by Meals on Wheels (MOW), 9 participants (5 treatment, 4 control) completed the 12-week study which showed that gait speed and total frailty score improved in the treatment group. The improvement in gait speed is particularly exciting given its prevalence in homebound older adults. In addition, there were no adverse events and the participants enjoyed the exercises as well as the convenience of the meal deliveries. To further evaluate the clinical changes seen in our trial, we assessed potential novel frailty biomarkers. These biomarkers could help identify frailty earlier than may be seen clinically and provide valuable information about the effects of frailty interventions. Inflammatory biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) have been associated with frailty status but not correlated with treatments. We preliminarily tested heat shock protein (HSP) 70, which induces muscle wasting in cancer cachexia, as well as macrophage inflammatory protein-1β (MIP-1β), and soluble interleukin-6 receptor (sIL-6R) to see if they could be more specific frailty biomarkers. Our exercise group had decreased HSP70, MIP-1β, and sIL-6R when compared to the control group over 12 weeks. Thus we have 2 aims: 1) evaluate the effects of a home-based exercise program administered through MOW on gait speed and frailty status in frail/prefrail homebound older adults, and 2) assess the association between novel serum biomarkers (HSP70, MIP-1β, sIL-6R) and established but non-specific frailty biomarkers (IL-6, CRP, TNF-α) in frail/prefrail homebound older adults before and after the exercise intervention. Data from this project will be the catalyst for an R01 or equivalent award involving multi-pronged frailty interventions, targeting mechanistic and clinical pathways, with the goal of helping homebound older adults age in place. This career award would also provide training and mentorship for Dr. Jessica Lee to develop into a physician-scientist with independent funding. UTHealth has provided her with a supportive environment, individualized career development plan, and expert mentors with long-standing experience in geriatrics, clinical trials, exercise interventions, biomarkers, and biostatistics. As the medical director of a home-based primary care service, her goal is to become an expert in interventions to improve resilience in her homebound patients.