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

送餐和运动干预可提高居家老年人的适应能力

• 批准号: 10400086
• 负责人: Jessica Lan Lee
• 金额: $ 19.11万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400086
• 关键词: Accelerometer; Adverse event; Age; Age-Years; Award; Biological Markers; Biometry; Body Weight decreased; C-reactive protein; Censuses; Characteristics; Chronic Disease; Clinical; Clinical Pathways; Clinical Trials; Communities; Control Groups; Data; Development Plans; Early Intervention; Elderly; Enrollment; Etiology; Exercise; Fatigue; Fright; Funding; Future; Gait speed; Geriatrics; Goals; Grant; Hand Strength; Health; Heat-Shock Proteins 70; Home; Home visitation; Inflammatory; Institution; Interleukin 6 Receptor; Interleukin-6; Intervention; Intervention Studies; K-Series Research Career Programs; Lead; Link; Macrophage Inflammatory Proteins; Meals on Wheels; Measures; Mentors; Mentorship; Modality; Molecular; Monitor; Mus; Muscular Atrophy; Nursing Homes; Nutritional Support; Participant; Patients; Pattern; Persons; Phenotype; Physical activity; Physician Executives; Physicians; Population; Prevalence; Randomized Clinical Trials; Randomized Controlled Trials; Research; Risk; Risk Factors; Scientist; Serum; Services; Surveys; Syndrome; TNF gene; Testing; Therapeutic; Time; Toll-like receptors; Training; Treatment Effectiveness; age related; aging in place; base; cancer cachexia; career; career development; catalyst; cytokine; disability; exercise intervention; exercise program; experience; extracellular; frailty; functional decline; functional disability; improved; inflammatory marker; loss of function; macrophage; modifiable risk; mortality; multi-component intervention; muscle form; novel; prevent; primary care services; resilience; service delivery; skeletal muscle wasting; success; supportive environment; systemic inflammatory response; treatment group; tumor; walking speed

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.

项目摘要/摘要 家里老年人通常在功能上取决于依赖，并且有可能在诸如机构中安置的风险 护士房屋。大多数老年人宁愿在家中衰老，因此需要研究 确定可以帮助他们维持自主权的干预措施。脆弱是一种与年龄有关的综合症 预测功能下降和死亡率，这在我们对居家的初步研究中非常普遍 老年人（56％的脆弱，44％的预养，没有一个很健壮），主要由步行速度缓慢驱动（88％）。 由于很难到达家居人口，因此很少有研究，也没有临床试验 这个人口。在我们的试点随机对照试验中，对一项锻炼计划进行的锻炼计划 车轮（MOW），9名参与者（5次治疗，4个对照）完成了为期12周的研究，该研究表明步态 治疗组的速度和总脆弱得分提高。提高速度的改善尤其是 鉴于其在家庭生活的老年人中的流行率令人兴奋。此外，没有不良事件， 参与者喜欢练习以及饮食的便利性。 为了进一步评估试验中的临床变化，我们评估了潜在的新型脆弱生物标志物。 这些生物标志物可以帮助早于临床上看到的脆弱，并提供有价值的信息 关于脆弱的干预措施的影响。炎症生物标志物，例如白介素6（IL-6），C反应性 蛋白质（CRP）和肿瘤坏死因子-Alpha（TNF-α）与脆弱状态有关 与治疗相关。我们初步测试了热休克蛋白（HSP）70，它诱发肌肉浪费 在癌症恶病质以及巨噬细胞炎症蛋白1β（MIP-1β）和可溶性白介素-6中 受体（SIL-6R）查看它们是否可能是更具体的脆弱生物标志物。我们的运动小组有所改善 与对照组相比，HSP70，MIP-1β和SIL-6R在12周内。 我们有2个目标：1）评估通过 在脆弱/预冰路家中的聚集速度和脆弱状态上的割草，2）评估协会 在新型血清生物标志物（HSP70，MIP-1β，SIL-6R）之间，并建立但非特异性的脆弱生物标志物 （IL-6，CRP，TNF-α）在运动干预之前和之后脆弱/预防餐厅的老年人。 该项目的数据将是R01或同等奖项的催化剂 干预措施，针对机械和临床途径，目的是帮助家中老年人 年龄到位。该职业奖还将为杰西卡·李博士提供培训和心态，以发展成 具有独立资金的身体科学家。 Uthealth为她提供了一个支持环境， 个性化的职业发展计划以及具有长期经验的专家导师，临床 试验，运动干预，生物标志物和生物统计学。作为家庭主管的医疗总监 护理服务，她的目标是成为干预措施的专家，以提高其自居患者的韧性。