Optimizing Mealtime Care (OPTIMAL): Development and Pilot Testing of a Person-Centered Mealtime Care Intervention for Nursing Home Residents with Alzheimer's Disease and Related Dementias (ADRD)

Project Summary/Abstract – Funded/Parent Project The overall goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to support the candidate, Dr. Wen Liu, in developing an independent clinical program of research to optimize mealtime care quality, function, and nutrition in aging and ADRD population. Her long-term career goal is to become an independent investigator and national leader conducting patient-centered, interdisciplinary clinical research to optimize mealtime care and patient outcomes across a broad range of care settings. Dr. Liu’s three training goals are: 1) Behavioral intervention science to develop knowledge and skills on the development, delivery, evaluation, and refinement of behavioral interventions for dementia mealtime care in clinical care settings; 2) Advanced methodologies in clinical trials to develop knowledge and skills in a) design and conduct of clinical trials, and b) the use of qualitative and mixed methods to inform feasibility of the intervention and guide refinement of the intervention; and 3) Advanced quantitative statistical methods to analyze large clustered data coded from video-taped mealtime observations that are collected from behavioral clinical trials. Under the mentorship of an accomplished team of investigators, Dr. Liu will achieve the training goals through completion of systematically planned formal and informal training activities at the University of Iowa, a research-intensive organization with significant and long-standing resources for early career investigators. The training plan will provide her with knowledge and skills necessary to address two significant and intertwined dementia mealtime care problems - mealtime difficulties and insufficient intake - both requiring immediate and joint resolution. Emerging evidence supports the negative association of full assistance provision and the positive association of person-centered care with resident mealtime difficulties and intake. Current interventions are lacking on the use of person-centered care strategies, and fail to address care providers’ needs for knowledge and skills to provide optimal mealtime care. To address this gap, the proposed research aims to complete the development and pilot testing of a theory-based, person-centered mealtime care intervention, Optimizing Mealtime Care (OPTIMAL), to effectively engage residents in eating and maintain their highest level of function possible. The three specific aims are: 1) Develop, evaluate, and refine the OPTIMAL intervention protocol and training materials; 2) Determine feasibility, fidelity, and usefulness of OPTIMAL; and 3) Describe resident outcomes. This study will use a mixed methods approach integrating focus group interviews and a pilot two- group parallel cluster RCT. Data obtained will be used to further refine the OPTIMAL intervention protocol and study procedures, as well as to estimate effect sizes for a future larger trial. Dr. Liu will develop and submit an R01 application to evaluate the efficacy of the refined OPTIMAL by middle of Year 4. This study is a critical first step to achieve Dr. Liu’s long-term career goal, and complements the NIA strategic focus to support and conduct behavioral research to improve health, well-being, and function in the aging and ADRD population. Project Summary/Abstract - Administrative Supplement The PI has experienced a critical life event during the award period, which along with pandemic-related delays and challenges has impacted the progress of the funded project and increased the needs for more time and personnel support for the completion of the remaining study activities of the funded project. The administrative supplement is critical to provide 1-year personnel support for a full-time research support coordinator and research assistants in the team. The support will be critical to ensure the continuity of the research project and collaboration of the currently established research team who have been well trained with study procedures, have a good understanding of the data collected and procedures to complete remaining activities, and have been working collaboratively with the PI in the previous year. The administrative supplement will be used to support the research team members to complete the following activities which are within the scope of the funded project: 1. Ongoing research activities in Aim 2 and Aim 3 including data coding, cleaning, entry, and management; development of multi-level data structure/datasets, and data analysis. 2. dissemination of results through manuscripts, presentations, stakeholder/community engagement activities, and other sources 3. preparation and submission of a large R-series grant application to NIH/NIA. Support from the administrative supplement will greatly ensure the successful completion of the remaining activities of the funded project. Completion of these research activities will support the continuity of the PI (Dr. Wen Liu)’s program of research in dissemination of person-centered care to optimize mealtime care and outcomes in ADRD, support the PI to return to full productivity at the end of the supplement period, and facilitate PI’s transition from mentored career development award to research independence.