This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of our research program is to promote healthy aging through exercise and nutrition. In this specific study, we target elements of nutritional care as we examine immunologic correlates of nutritional status in elderly Veteran patients hospitalized for inpatient rehabilitation over extended periods of time. Hospital-acquired infections have been documented to occur five times as frequently in rehabilitation patient stays than in other patient admissions. Something subtle, not yet understood and properly controlled, is occurring in these patients relative to immunocompetency, and we postulate that much of it may be due to nutritional problems so frequently experienced in this patient population. As the synergism of nutrition and immune function is well documented in other populations, we propose to better characterize the role of nutrition in immunocompetency in light of the unique challenges faced in inpatient gero-rehabilitation. Information obtained will help to develop primary and secondary prevention measures to protect or restore the dynamic equilibrium of patients' normal line of defense (immune function) to decrease the high rates of infection now experienced. IMMEDIATE AND LONG TERM OBJECTIVES Phase 1: construct study design and assessment model and pilot data collection tools and procedures. Phase 2: characterize nutrition's role in immunocompetency and clinical outcome over time Phase 3: develop and test interventions to prevent or reverse nutritional deficits that compromise immunocompetency in gero-rehabilitation. RESEARCH OVERVIEW Phase 1 is completed. Phase 2 (present study) wil be a longitudinal cohort study in which we test hypotheses about in-hospital malnutrition and the relationship of gero-rehabilitation inpatient nutrition and immunologic outcomes. We will conduct secondary analyses to examine the relationship of patient consumption and indicators of nutritional status and immune function to assist nurses in identifying and decreasing possible nutrition risk factors associated with poor immune function. We plan to design for immediate clinical use a nutritional assessment model to facilitate early case finding, treating symptoms, and planning interventions targeted to where patients' normal lines of resistance are weakest. We will also develop an operational definition of malnutrition relative to immunocompetency for future research efforts. Last, in Phase 3, we will test clinical interventions to prevent and reverse nutritional deficits identified as contributors to immunocompromise and infections in elderly patients in inpatient rehabilitation.
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