Frailty is common, serious and potentially modifiable geriatric syndrome. Although evidence accumulate that nutritional supplements improve functional measures in persons with frailty, the interventions are carried out in a controlled setting and might have limited legacy effect. Recent dietary guidelines suggest that overall adherence to a healthful diet is instrumental for a sustainable health behavioral change. Among available healthful dietary patterns Mediterranean Diet (MedD) is well studied in aging because of its anti-inflammatory and glucomodulating effects. Given disruptions in insulin sensitivity, inflammation, and muscle metabolism observed in frailty, MedD is ideally poised to improve functional outcomes in this population. However, limitations exist that commonly used behavioral strategies to facilitate healthful dietary choices are not scalable and might be inadequate for use with individual patients. In fact, few individualized dietary interventions have been designed to empower and enable older and frail persons to self-manage their heath. Mobile health technologies, including apps, with increased sophistication and capacity for accommodating multiple self- management features (e.g., self-monitoring, interactive feedback) hold great promise to heighten older person's involvement in self-management. However, to date, few of these mobile health (mHealth) approaches were developed for and engaged vulnerable older adults. The proposed research will use rapid iterative methodology to develop with end users, easy to use and intuitive mHealth system that will allow self- monitoring, information exchange and promote adherence to MedD. This work a clear trajectory for patient- oriented research building upon candidate's previous epidemiological and intervention work. In former he explored the impact of nutritional and metabolic factors on frailty risk and prognosis finding that increased adherence to MedD, independently of other nutritional measures, relate to better health in persons with frailty. In latter, he successfully employed a mobile intervention in behavioral change context in older and frail adults. This preliminary work provided conceptual and empirical ground for the proposed project. The candidate's career goal is to become an independent researcher and lead the development of technology augmented interventions, suitable for older and vulnerable populations, that facilitate self-management and promote functional independence. The career development plan integrates didactic coursework with practical mentored research experience to achieve the following training goals: 1) obtain training in nutritional science; 2) develop skills in development of person-centered mHealth interventions; 3) achieve capacity to effectively conduct clinical trials in mobile health and patient-oriented context; 4) improve competencies in clinical geriatrics; 5) obtain proficiency with scientific writing and grantsmanship. The candidate has developed a clear research potential for patient-oriented intervention research, which meets NIA programmatic priorities to promote use of technologies in self-management in older and vulnerable population.
Improved diet is instrumental for sustaining functional independence in older persons with frailty. Although behavioral strategies exist to support healthful dietary choices, contemporary mobile health applications, being ubiquities and technologically advanced, have tremendous potential to facilitate dietary self-management interventions. To date, few of mobile health approaches were developed for and engaged vulnerable older adults.