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

项目摘要/摘要 呆在家里的老年人通常在功能上依赖，并面临被安置在以下机构的风险 养老院。大多数老年人更愿意在家中安享晚年，因此需要进行研究。 以确定可以帮助他们保持自主权的干预措施。虚弱是一种高度与年龄相关的综合征 功能衰退和死亡率的预测，这在我们对居家旅行的初步研究中非常普遍 老年人(56%虚弱，44%早衰，没有健壮的人)，主要是因为步行速度慢(88%)。 由于居家人口很难接触到，因此很少有研究，也没有临床试验。 这群人。在我们的先导性随机对照试验中，一项由Meals在 轮子(MOW)，9名参与者(5名治疗组，4名对照组)完成了12周的研究，研究表明 治疗组治疗后速度、虚弱总分均有改善。步态速度的提高尤其明显。 考虑到它在呆在家里的老年人中的普遍程度，令人兴奋。此外，没有不良事件发生， 参与者喜欢这些练习，也喜欢送餐的便利。 为了进一步评估在我们的试验中看到的临床变化，我们评估了潜在的新的脆弱生物标记物。 这些生物标志物可以帮助比临床上更早地识别脆弱，并提供有价值的信息 关于脆弱干预的影响。炎症生物标志物，如白细胞介素6(IL-6)、C反应 蛋白质(C反应蛋白)和肿瘤坏死因子-α(肿瘤坏死因子-α)与虚弱状态有关，但与 与治疗相关。我们初步测试了热休克蛋白(HSP)70，它会导致肌肉萎缩 在癌症恶病质中，以及巨噬细胞炎性蛋白-1β(mip-1β)和可溶性白细胞介素6 受体(sIL-6R)，看看它们是否可以是更特异的脆性生物标记物。我们运动组的人数减少了 HSP70、MIP-1、β、sIL-6R与对照组比较超过12周。 因此，我们有两个目标：1)评估通过以下途径实施的家庭锻炼计划的效果 关于虚弱/虚弱在家老年人步速和虚弱状态的研究，以及2)评估两者之间的关系 新的血清标志物(热休克蛋白70、丝裂原蛋白-1β、sIL-6R)与已建立的非特异性脆性生物标志物之间的关系 运动干预前后体弱/体弱居家老年人血清IL-6、C反应蛋白、肿瘤坏死因子-α的变化。 来自该项目的数据将成为R01或同等奖项的催化剂，涉及多管齐下的脆弱性 以机械性和临床路径为目标的干预措施，目的是帮助在家的老年人 年龄已经到位了。这个职业奖项还将为杰西卡·李博士提供培训和指导，使其发展成为 一位独立资助的内科科学家。UTHealth为她提供了支持性的环境， 个性化的职业发展计划，以及在老年医学、临床和医学方面具有长期经验的专家导师 试验、运动干预、生物标记物和生物统计学。作为以家庭为基础的初选的医疗主任 作为一名护理服务专家，她的目标是成为一名干预专家，以提高她在家的患者的复原力。

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.