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 on the use of person-centered care is lacking, 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 feasibility 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 the OPTIMAL intervention and training materials; 2) Determine the feasibility of successfully delivering the OPTIMAL intervention; and 3) Determine the treatment fidelity of delivering OPTIMAL. This study will use a mixed methods approach integrating qualitative interviews and a one-group pre-post design. Data from this study will be used to refine the OPTIMAL intervention, training materials, and study procedures, all of which will be used in future larger trials. Dr. Liu will develop and submit an R01 application to evaluate the efficacy of the refined OPTIMAL using an RCT design. 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 aging and ADRD population.

Project Narrative Despite the recognized increased risks and consequences of mealtime difficulties and insufficient intake, people with ADRD are not provided with optimal person-centered mealtime care to manage the two interrelated and important health care problems (i.e., mealtime difficulties, insufficient intake). Developing an effective behavioral intervention that integrates person-centered mealtime care and management of risks of inadequate intake and malnutrition will address a significant long-term care need in adults with ADRD in diverse care settings, because such an intervention may have great potential to decrease mealtime difficulties, and optimize intake, and improve nutrition and quality of life which are fundamental health needs as cognition declines. As a logical first step in intervention development and testing, data on feasibility and treatment fidelity of the OPTIMAL intervention from the proposed study will provide critical information to guide the refinement of the intervention protocol and clinical trial procedures, which will be used to evaluate the efficacy of the intervention on resident outcomes (i.e., mealtime difficulties, intake) in future large-scale clinical trials.