The national epidemic of obesity is also affecting older adults, and is associated with an increased risk of functional impairment, nursing home placement and early mortality. Conventional weight loss programs have the potential to reduce body fat, but are difficult to access for older obese adults due to transportation and mobility challenges. They may also lead to a detrimental loss of muscle and bone, paradoxically resulting in increased disability. The overarching goal of this Mentored Career Development Award is to develop the skills to become an independent researcher in community-based translational geriatric obesity research integrating innovative technology including mobile Health (mHealth), sensors, and video-conferencing with behavioral management to improve physical function. I will build upon the knowledge gained in my prior work using descriptive research to acquire the necessary skills and knowledge in this 5-year award to become an independent R01 investigator in geriatric obesity interventions research. Mentored activities, training, and coursework in key content areas will include: clinical trial methods (qualitative and quantitative); delivery of community-based obesity interventions using applied methods of telemedicine in rural populations; and enhancing health promotion using mHealth and sensors to facilitate behavioral change in older obese adults. Concurrently, I will conduct a program of pilot research aimed at developing and evaluating a technology assisted wellness intervention for obese older adults. First, I propose to assess the acceptability, usability, utility and perceived value of mHealth technology for obese older adults using a novel, adaptable mHealth device (Amulet) with remote sensing and self-monitoring capabilities, including strength, function, activity type, and real-time feedback (Qualitative assessment and Adapting Amulet). Second, I will conduct a single-arm, pilot feasibility study evaluating the potential effectiveness of a mHealth obesity wellness intervention (MOWI) for older obese adults in improving physical function (Develop & Refine MOWI). MOWI integrates Amulet with a weekly individual dietician-led nutritional session, along with twice weekly physical therapist led group exercise session. I will pilot test MOWI in a research-based setting over a 3-month period, and then deliver the intervention in the home setting using video-conferencing over a 6-month period (Evaluate Home MOWI). The primary clinical outcome is physical function, measured by observed muscle strength, observed physical fitness, and observed and self-reported life-task functioning. Secondary (exploratory) outcomes will include behavioral activation, objective physical activity, subjective health status, and subjective physical activity. The findings on the feasibility, acceptability, and preliminary estimates of effectiveness will be used in a future competitive application for an extramural R01 assessing the effectiveness of a home Telehealth-delivered MOWI in improving physical function in high-risk obese older adults as compared to an in-person intervention.

Public Health Relevance

This career development award will assist the applicant in acquiring the skills to transition from large secondary epidemiological dataset analyses to health services interventions research allowing the development and testing of community based approaches to address the growing epidemic of obesity in older adults. A pilot study of the feasibility and effectiveness of a Mobile Health Obesity Wellness Intervention in older obese adults will be conducted to improve physical function and independence at home using a mobile health device. The strategy has the potential to improve the health of a rapidly aging demographic with obesity, reduce healthcare costs and if successful, allow program dissemination to distant, remote areas for improvement in healthcare quality.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
6K23AG051681-04
Application #
9840988
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Joseph, Lyndon
Project Start
2016-08-15
Project End
2021-04-30
Budget Start
2019-01-01
Budget End
2019-04-30
Support Year
4
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Dartmouth-Hitchcock Clinic
Department
Type
DUNS #
150883460
City
Lebanon
State
NH
Country
United States
Zip Code
03756
Batsis, J A; Mackenzie, T A; Vasquez, E et al. (2018) Association of adiposity, telomere length and mortality: data from the NHANES 1999-2002. Int J Obes (Lond) 42:198-204
Crow, Rebecca S; Lohman, Matthew C; Titus, Alexander J et al. (2018) Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. J Am Geriatr Soc 66:496-502
Rippberger, Peter L; Emeny, Rebecca T; Mackenzie, Todd A et al. (2018) The association of sarcopenia, telomere length, and mortality: data from the NHANES 1999-2002. Eur J Clin Nutr 72:255-263
Batsis, John A; Whiteman, Karen L; Lohman, Matthew C et al. (2018) Body Mass Index and Rural Status on Self-Reported Health in Older Adults: 2004-2013 Medicare Expenditure Panel Survey. J Rural Health 34 Suppl 1:s56-s64
Medina-Inojosa, Jose R; Batsis, John A; Supervia, Marta et al. (2018) Relation of Waist-Hip Ratio to Long-Term Cardiovascular Events in Patients With Coronary Artery Disease. Am J Cardiol 121:903-909
Brooks, J M; Titus, A J; Bruce, M L et al. (2018) Depression and Handgrip Strength Among U.S. Adults Aged 60 Years and Older from NHANES 2011-2014. J Nutr Health Aging 22:938-943
Steckbeck, Julia; McBain, Christi; Terrien, Kerry L et al. (2018) Implementation of a Workflow Initiative for Integrating Transitional Care Management Codes in a Geriatric Primary Care Practice. J Nurs Care Qual 33:348-353
Batsis, John A; Villareal, Dennis T (2018) Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol 14:513-537
Kramer, Neha M; Gazelka, Halena M; Thompson, Virginia H et al. (2018) Challenges to Safe and Effective Pain Management in Patients With Super Obesity: Case Report and Literature Review. J Pain Symptom Manage 55:1047-1052
Batsis, John A; Zagaria, Alexandra B (2018) Addressing Obesity in Aging Patients. Med Clin North Am 102:65-85

Showing the most recent 10 out of 22 publications