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（调查员提供）：老年人的营养不良是一个严重的健康，社会和经济后果的严重问题。最近经历过急性疾病或对慢性疾病的恶化并接受正式家庭卫生服务的老年人尤其有饮食和相关不良后果的风险尤其高。家里老年人的饮食行为同时受到许多因素的影响，这可能导致营养不足。这些因素涉及社会，心理和环境组成部分，这些因素可能适合于在老年人自己家中制定和交付的非侵入性和廉价的个性化自我保健管理策略。实际上，许多专家认为，在家庭护理环境中，可以最好地提供营养服务。这项研究的目的是评估多组分自我管理行为干预措施的功效和可行性，以改善一群尤其是果营养不足风险的家庭居住老年人的营养摄入量。干预将在参与者的家中进行。该申请是响应PA-06-181，探索性发展研究赠款奖。美国国家衰老研究所在重点，干预和行为改变的主要领域中特别征求了应用。该应用与NIA更大的使命是解决广泛疾病的脆弱，合并症和残疾的任务。拟议的研究以生态模型和社会认知理论的理论方法为指导。这两个都强调了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控制设计来估计干预措施是否会改善热量摄入量和与营养相关的健康结果。参与者将是104名接受Medicare家庭健康服务的老年人。它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措施中。该研究的主要目的是测试干预措施是否增加了家中老年人的热量摄入量。次要目的是测试干预措施是否改善了其他重要结果，包括预防无意减肥；维持身体成分；宏观和微养分的消耗量增加；改善生活质量和功能；并降低了家中老年人的不良结果率。第三个目的是检查自我效能，目标设定和预防复发的变化是否发生由于干预而发生。而且，如果是这样，这些变化是否会介导干预对主要和次要结果的影响。 公共卫生相关性：该项目的重要性，包括其与公共卫生的相关性，是关于在家庭中提供的自我管理行为营养干预措施的证据，这对一群营养不良或对营养不良的风险特别高的老年人有益。这项研究的重点是对仍然可以口服且不需要医疗干预营养有关的问题的人进行的实用，具有成本效益的干预措施。

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