In 2007–2010, more than one-third of U.S. older adults
were classified as having obesity, which corresponds to approximately 13 million older adults.
Complex patients encounter complex systems of care and cycle through community-based, acute, and post-acute care. This cycle raises patient costs, incurs systemic waste, and often does little to improve patient health. In rural areas, patients face additional barriers to effective treatment, such as distance and weather, as well as fewer options for community-based care, counseling, and other health behavior therapies.
This circumstance is particularly true for frail older adults (aged 65 and older) in the United States, more than a third of whom are classified as having obesity. Obesity in older adults 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 also may lead to a detrimental loss of muscle and bone, paradoxically resulting in increased disability.
An interdisciplinary team of researchers is conducting the Mobile Wellness Obesity Intervention in order to improve the health of elderly individuals with obesity through weight loss and improved strength, physical function, and quality of life. Ultimately, the aim is to develop a new model for high-quality healthcare delivery that is accessible in distant, remove areas.
The Mobile Wellness Obesity Intervention is a collaborative effort that brings together experts from across Dartmouth—The Dartmouth Institute, Thayer School of Engineering, Department of Computer Science, Geisel School of Medicine, and Dartmouth-Hitchcock Medical Center—to address the health needs of frail elderly individuals. The intervention provides access to health promotion and therapy using telehealth, including video conferencing and personal monitoring devices, as well as coaching by health care providers.
The research team has developed a mobile health product prototype that combines sensor technology, Bluetooth, and a simple Theraband with a health tracking device. This system not only measures steps and activity, but increases upper and lower body strength, providing feedback back to the participant and physical therapist in real-time. We are assessing the acceptability, usability, utility, and perceived value of the mobile health device.
Additionally, a single-arm, pilot feasibility study is evaluating the potential effectiveness of an intervention that integrates use of the mobile device with a weekly individual dietician-led nutritional session, along with twice weekly physical therapist-led group exercise sessions. The intervention is being conducted in a research-based setting over a 3-month period and also delivered in the home setting using video-conferencing over a 6-month period. We are assessing changes in physical function, measured by observed muscle strength, observed physical fitness, and observed and self-reported life-task functioning.