Optimizing Mealtime (OPTIMAL): Development and Pilot Testing of a Person-Centered Mealtime Care Intervention for Nursing Home Residents with Alzheimer's Disease and Related Dementias (ADRD)

这个以患者为导向的导师研究职业发展奖(K23)的总体目标是支持 候选人刘文博士正在开发一项独立的临床研究计划，以优化进餐时间 老龄化和ADRD人群的护理质量、功能和营养状况。她的长期职业目标是成为一名 独立研究员和国家领导者，以患者为中心，进行跨学科临床研究，以 在广泛的护理环境中优化用餐时间护理和患者结果。刘博士的三项训练 目标是：1)行为干预科学，发展关于发展、交付、 评估和改进临床护理环境中痴呆症就餐护理的行为干预；2) 临床试验中的先进方法，以发展a)临床设计和实施方面的知识和技能 试验，以及b)使用定性和混合方法告知干预的可行性和指导 干预措施的精细化；以及3)先进的定量统计方法，用于分析大型集群 从行为临床试验收集的视频用餐时间观察中编码的数据。在.之下 在一支卓有成效的调查团队的指导下，刘博士将通过完成培训来实现培训目标 在爱荷华大学有系统地计划了正式和非正式的培训活动，这是一个研究密集型大学 具有为早期职业调查人员提供大量和长期资源的组织。培训计划将 向她提供必要的知识和技能，以解决两个重大且相互交织的痴呆症就餐时间 护理问题--用餐困难和摄入量不足--都需要立即和联合解决。 新出现的证据支持全面提供援助的负面关联和积极关联 以人为本的护理，有住院用餐困难和进食困难。关于使用的当前干预措施 缺乏以人为本的护理，未能满足护理提供者对提供知识和技能的需求 最佳就餐时间护理。为了解决这一差距，拟议的研究旨在完成开发和 基于理论的以人为中心的就餐护理干预的可行性检验，优化就餐护理 (最佳)，使居民有效地参与饮食，并尽可能保持他们的最高功能水平。这个 三个具体目标是：1)开发最佳干预和培训材料；2)确定 成功提供最佳干预的可行性；以及3)确定治疗的保真度 提供最佳的。这项研究将使用混合方法，结合定性访谈和 一组岗前设计。这项研究的数据将被用来提炼最佳干预、培训 材料和研究程序，所有这些都将在未来更大的试验中使用。刘博士将开发并提交 一个R01应用程序，使用RCT设计评估改进的最优方案的效果。这项研究是一项关键的 实现刘博士长期职业目标的第一步，补充NIA的战略重点，以支持和 开展行为研究，以改善老龄化和ADRD人群的健康、福祉和功能。

The overall goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to support the candidate, Dr. Wen Liu, in developing an independent clinical program of research to optimize mealtime care quality, function, and nutrition in aging and ADRD population. Her long-term career goal is to become an independent investigator and national leader conducting patient-centered, interdisciplinary clinical research to optimize mealtime care and patient outcomes across a broad range of care settings. Dr. Liu’s three training goals are: 1) Behavioral intervention science to develop knowledge and skills on the development, delivery, evaluation, and refinement of behavioral interventions for dementia mealtime care in clinical care settings; 2) Advanced methodologies in clinical trials to develop knowledge and skills in a) design and conduct of clinical trials, and b) the use of qualitative and mixed methods to inform feasibility of the intervention and guide refinement of the intervention; and 3) Advanced quantitative statistical methods to analyze large clustered data coded from video-taped mealtime observations that are collected from behavioral clinical trials. Under the mentorship of an accomplished team of investigators, Dr. Liu will achieve the training goals through completion of systematically planned formal and informal training activities at the University of Iowa, a research-intensive organization with significant and long-standing resources for early career investigators. The training plan will provide her with knowledge and skills necessary to address two significant and intertwined dementia mealtime care problems - mealtime difficulties and insufficient intake - both requiring immediate and joint resolution. Emerging evidence supports the negative association of full assistance provision and the positive association of person-centered care with resident mealtime difficulties and intake. Current interventions on the use of person-centered care is lacking, and fail to address care providers’ needs for knowledge and skills to provide optimal mealtime care. To address this gap, the proposed research aims to complete the development and feasibility testing of a theory-based person-centered mealtime care intervention, Optimizing Mealtime Care (OPTIMAL), to effectively engage residents in eating and maintain their highest level of function possible. The three specific aims are: 1) Develop the OPTIMAL intervention and training materials; 2) Determine the feasibility of successfully delivering the OPTIMAL intervention; and 3) Determine the treatment fidelity of delivering OPTIMAL. This study will use a mixed methods approach integrating qualitative interviews and a one-group pre-post design. Data from this study will be used to refine the OPTIMAL intervention, training materials, and study procedures, all of which will be used in future larger trials. Dr. Liu will develop and submit an R01 application to evaluate the efficacy of the refined OPTIMAL using an RCT design. This study is a critical first step to achieve Dr. Liu’s long-term career goal, and complements the NIA strategic focus to support and conduct behavioral research to improve health, well-being, and function in aging and ADRD population.