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 i s 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.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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King, Jonathan W
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University of Alabama Birmingham
Internal Medicine/Medicine
Schools of Medicine
United States
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