Les déterminants de la saine alimentation chez les personnes âgées vivant dans la collectivité

Designing a Community-Based Health Promotion Program for Older Adults Based on Perceived Usefulness, Service Experience, Perceived Value, and Behavioral Intention

Improving nutritional intake contributes to maintaining the health and quality of life of the older population and reducing individual and societal healthcare costs. We collaborated with two community service hubs and a public health center in Taipei's Daan District to develop a personalized community-based health and nutrition program using service design. The design was validated through a model encompassing perceived usefulness, service experience, perceived value, and behavioral intention, analyzed using PLS-SEM modeling on 76 individuals. The results showed bidirectional influences among these factors. This study provides practical recommendations for formulating public health policies and health promotion programs for older adults.

Sociodemographic and Health Indicators of Diet Quality in Pre-Frail Older Adults in New Zealand

This study aimed to identify sociodemographic and health indicators of diet quality in pre-frail community-dwelling older adults. Pre-frail older adults are those at risk of progression to clinical manifestations of frailty and are targets for preventative intervention. We previously reported that pre-frail older adults have reasonably good overall diet quality. However, further analyses found a low intake of energy, protein and several micronutrients.

METHODS

We collected detailed dietary intake from pre-frail (FRAIL scale 1-2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality.

RESULTS

The median age in this sample (n = 468) was 80.0 years (77.0-84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m2, living with others and younger than 80 years were likely to have a lower diet quality.

CONCLUSIONS

We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality.

Service Awareness Among Older Adults Experiencing Barriers to Food and Eating

OBJECTIVE

To explore (1) the services older adults use to address the barriers to food access they face and (2) how they found out about these services.

DESIGN

Semistructured, basic descriptive qualitative in-person interviews.

SETTING

Senior center and participants' homes.

PARTICIPANTS

A convenience sample of 24 older adults recruited from suburban and urban settings. Primarily Black females, living alone, and able to leave home without help.

PHENOMENON OF INTEREST

Financial and nonfinancial barriers to food access, awareness of services available.

ANALYSIS

Codes were assigned to portions of the text in which participants described how they learned about a service. These codes were categorized into one of the 3 larger themes that emerged: (1) intentionally sought by the participant, (2) intentional outreach by the service, and (3) encounters in daily life and environment.

RESULTS

Most connections to services were made through encounters in participants' daily life and environment; for example, word of mouth from family, friends or neighbors; connection through other services; referral from health care professionals; and seeing the service in their neighborhood.

CONCLUSIONS AND IMPLICATIONS

Robust social networks, medical screening, and referral may promote awareness of food assistance services. Future research and outreach should target those who are most isolated.

Opportunities and barriers for food intake in older age - a Norwegian perspective

Background

The ageing processes occur slowly over time and are often not detectable by the individual. Thus, preparing for dietary needs in later years should start at an earlier age than most people realise.

Objective

This study aims at better understanding what characterises food-related practices in active, home-living older adults, in order to identify food-related factors that act as barriers and those that promote healthy ageing.

Design

Three experiments were conducted: First, a web-based quantitative survey to collect information about home-living older adults' food-related behaviours (67+ years, N = 1,005). Second, two focus groups with respondents 67-74 years (N = 7) and 75-84 years (N = 6) to elicit aspects not adequately covered in the survey. Third, 10 individual interviews to provide in-depth insights.

Results

Two distinct groups were identified in the survey; 67-79 years and 80+ years. The older age group experienced more barriers and restrictions in food intake and food-related behaviours compared to the younger group. Good taste, routines and social settings were important for appetite and food intake.

Discussion

Using a mixed-methods approach proved valuable for extracting information and a better understanding of what impacts on food-related aspects amongst older adults. Strategies for upholding a healthy food intake involve establishing daily routines and meeting arenas where older adults can socialise and eat food together.

Conclusion

This study confirmed that knowledge of older adults' physical needs, barriers and abilities must be a part in preparation for a healthy diet.

Beyond the Individual -A Scoping Review and Bibliometric Mapping of Ecological Determinants of Eating Behavior in Older Adults

Objectives: The objective of this scoping review was to summarize and provide a visual overview of the present-day knowledge on ecological determinants of eating behavior in community-dwelling elderly persons in relation with nutrition communication, considering the evolution of the field. The second objective was to integrate results in recommendations for the development of nutrition communication strategies.

Methods: A literature review was performed on Medline, PubMed and Google Scholar, according with the PRISMA protocol for scoping reviews. An a-priori analysis was executed by categorizing determinants from the literature according with the different levels represented in the ecological framework and an a-posteriori analysis by using VosViewer for a chronological bibliometric mapping analysis.

Results: Of 4029 articles retrieved, 77 were selected for analysis. Initial publications focused more on individual determinants of eating behavior. Over time, there was a shift towards a holistic view of eating behavior considering the “food environment”, including social networks, physical settings and public policy.

Conclusion: Beyond the individual, all ecological levels are relevant when targeting eating behavior in the elderly. Nutrition communication strategies should be structured considering these influences.

Older Adults' Age-Related Communication and Routine Dietary Habits

Using the communicative ecology model of successful aging (CEMSA), this study examined whether or not older adults' ways of communicating about a variety of age-related issues (e.g., making age-related excuses for their shortcomings, teasing other people about their age) predict older adults' dietary habits. Participants were classified as engaged, bantering, and disengaged agers based on their own patterns of age-related communication. The probability of being an engaged ager positively predicted fruit consumption and negatively predicted soft drink consumption. The probability of being a bantering ager negatively predicted vegetable consumption. Results suggest the potential to expand the CEMSA's boundary conditions to include routine dietary habits. Future researchers can build on these findings by utilizing additional methods to assess dietary habits and testing whether or not dietary habits mediate the associations between age-related communication and a variety of health problems.

An Overview of the Sociological and Environmental Factors Influencing Eating Food Behavior in Canada

This review extensively discusses various socio environmental factors affecting eating behavior of the general public within Canada including the development and implementation of national policies. A framework representing the determinants of healthy eating can be grouped into four categories i.e., the individual determinants, the economic environment, the social environment and the physical environment. This framework allowed for addressing food insecurity and social economic ecosystem of Canadians. Lastly, we investigate the role in which biotechnology plays in improving food security and addresses the significant impact biotechnology has contributed toward on agriculture and the food market. Overall, this review using such sources as Web of Science, Pub Med and Scopus provides significant contribution toward understanding the social economic environment and eating behavior of people living in Canada. In conclusion, this has led to identify a research gap as there is a significant need to address the development and implementation of policies in the food and nutrition environment.

Factors Influencing Food Choice for Independently Living Older People-A Systematic Literature Review

Unyielding, disproportionate growth in the 65 years and older age group has precipitated serious concern about the propensity of health and aged-care services to cope in the very near future. Preservation of health and independence for as long as possible into later life will be necessary to attenuate demand for such services. Maintenance of nutritional status is acknowledged as fundamental for achievement of this aim. Determinants of food choice within this age group need to be identified and better understood to facilitate the development of pertinent strategies for encouraging nutritional intakes supportive of optimal health. A systematic review of the literature consistent with PRISMA guidelines was performed to identify articles investigating influences on food choice among older people. Articles were limited to those published between 1996 and 2014 and to studies conducted within countries where the dominant cultural, political and economic situations were comparable to those in Australia. Twenty-four articles were identified and subjected to qualitative analysis. Several themes were revealed and grouped into three broad domains: (i) changes associated with ageing; (ii) psychosocial aspects; and (iii) personal resources. Food choice among older people is determined by a complex interaction between multiple factors. Findings suggest the need for further investigations involving larger, more demographically diverse samples of participants, with the inclusion of a direct observational component in the study design.

The food environment and diet quality of urban-dwelling older women and men: Assessing the moderating role of diet knowledge

OBJECTIVES

The relationships between local food environments and dietary patterns are important for older adults and could be different in men and women. We examined associations between exposure to neighbourhood food sources and food consumption and the moderating role of diet knowledge separately among older women and men living in Montreal in 2003-2005 (n = 722).

METHODS

The proportion of fast-food outlets relative to all restaurants (%FFO) and the proportion of healthy food stores relative to all stores (%HFS) were estimated for 500 m buffers around participants' homes. Two dietary patterns, designated "Western" and "prudent", reflecting lower- and higher-quality diets respectively, were identified from food frequency questionnaire data. The unique and interactive effects of diet knowledge and food-source exposure on diet scores were tested with separate linear regression models for women and men.

RESULTS

For men, greater %FFO exposure was related to lower prudent diet scores (β = -0.18, p = 0.02), but no effect of %HFS exposure was observed and no interactions were statistically significant. For women, an inverse relationship between %FFO and prudent diet scores was strongest among those with low diet knowledge (β = -0.22, p < 0.01). No other associations were statistically significant.

CONCLUSION

Older men's diet patterns may reflect unhealthy cues associated with fast-food outlets. Among women, diet knowledge potentiated both negative and positive relationships with the food environment. In the absence of consistent main effects of the food environment on diet scores, subgroup analysis is a promising avenue for research.

Intakes of folate, vitamin B6 and B12 and risk of depression in community-dwelling older adults: the Quebec Longitudinal Study on Nutrition and Aging

BACKGROUND/OBJECTIVES

Depression can decrease quality of life and affect health outcomes in older population. We investigated whether different intake levels of folate, vitamin B6 and B12 were associated with a 3-year depression incidence among generally healthy, community-dwelling older men and women.

SUBJECTS/METHODS

Participants in the Québec Longitudinal Study on Nutrition and Aging (NuAge), free of depression (that is, 30-item Geriatric Depression Scale (GDS) <11) at baseline (N=1368; 74 ± 4 years old; 50.5% women), were screened annually for incident depression (GDS ⩾ 11) or antidepressant medication. Tertiles of intakes (food only and food+supplements) were obtained from the mean of three non-consecutive 24-h recalls at baseline. Sex-stratified multiple logistic regression models were adjusted for age, physical activity, physical functioning, stressful life events and total energy intake.

RESULTS

Over 3 years, 170 participants were identified as depressed. Women in the highest tertile of B6 intake from food were 43% less likely to become depressed when adjusting for demographic and health factors (multivariate odds ratio (OR) 0.57, 95% confidence interval (CI) 0.39-0.96), but adjustment for energy intake attenuated the effect. Men in the highest tertile of dietary B12 intake had decreased risk of depression (energy-adjusted multivariate OR 0.42, 95% CI 0.20-0.90). No other association was observed.

CONCLUSIONS

This study provides some evidence of decreased depression risk among women with higher intakes of vitamin B6 from food, which was dependent on total energy intake, and among men with higher intakes of B12 from food, independently of energy intake.

Impact of dining out on nutritional intake and metabolic syndrome risk factors: data from the 2011 Korean National Health and Nutrition Examination Survey

The frequency of dining out has rapidly increased; however, the independent associations between dining out, metabolic syndrome risk factors and nutritional status have not been well characterised. The aim of the present study was to investigate the associations between dining out, nutritional intakes and metabolic syndrome risk factors among Korean adults, using data from the 2011 Korean National Health and Nutrition Examination Survey. Frequency of dining out was significantly associated with intake of nutrients such as energy, water, protein, fat, carbohydrate, Ca, Na, vitamin A and carotene. Especially, the result revealed that Korean adults had insufficient Ca intake compared with the Korean reference intake (700 mg). As the frequency of dining out increased, so did energy intake. In addition, individuals who dined out seven or more times per week experienced a 64 % higher likelihood of blood pressure abnormalities, an 88 % higher likelihood of waist circumference abnormalities, and a 32 % higher likelihood of low HDL-cholesterol levels than those who dined out less than once per week. BMI was not associated with the frequency of dining out. Our findings suggest that strategies to modify dining-out behaviour could reduce metabolic syndrome risk factors via improved nutrition.

Decline in functional capacity is unaffected by diet quality alone or in combination with physical activity among generally healthy older adults with T2D from the NuAge cohort

BACKGROUND

Both diet quality (DQ) and physical activity (PA) have been shown to play a role in the prevention of functional capacity (FC) decline. Because older adults (OA) with T2D are at a higher risk of FC decline compared to their non-diabetic counterparts, our aim was to determine if DQ alone, or combined with PA is associated with FC decline in OA with T2D over a 3-year follow-up in a secondary analysis of the NuAge cohort.

METHODS

In 159 OA with T2D (mean age=75 years), FC change was calculated as the difference in FC scores at T1 and T4 measured by the SMAF (Système de Mesure de l'Autonomie Fonctionnelle). Baseline DQ was calculated from three non-consecutive 24-h dietary recalls collected at T1 using the validated Canadian Healthy Eating Index (C-HEI). PA change was calculated from Physical Activity Scale for the Elderly (PASE) as T4-T1. Associations were evaluated between FC decline and four combinations of variables: C-HEI score < or ≥70 with PASE change < or > median and analyzed by GLM while controlling for covariates.

RESULTS

Neither DQ alone nor DQ combined with PA change were associated with FC decline over follow-up.

CONCLUSIONS

The absence of effect may be explained by characteristics of this healthy sample of OA with T2D who showed relatively good adherence to dietary recommendations (mean C-HEI=70) and were highly functional shown by minimal, clinically non-significant FC decline over 3 years. More research is needed to confirm the role of DQ in preventing FC decline in a larger diabetic sample showing clinically significant FC decline.

Effect of sociodemographic variables and time on food group contribution to total food availability in Portuguese elderly households

OBJECTIVE

To analyze the simultaneous effects of sociodemographic variables and time on each food group contribution to total Portuguese elderly household food availability.

DESIGN

Four cross sectional Portuguese Household Budget Surveys were used. A multivariate analysis of variance (MANOVA), using a general linear model (GLM), was applied to analyze the simultaneous effects of sociodemographic variables and time.

SETTING

Portuguese population.

SUBJECTS

Nationally representative samples of households with members aged ≥ 65 years were selected and categorized as solitary elderly female, solitary elderly male, or couple (one elderly female and one elderly male). Samples included 1,967 households in 1989-1990, 2,219 households in 1994-1995, 2,533 households in 2000-2001 and 2,441 households in 2005-2006.

RESULTS

The simultaneous effects of sociodemographic variables and time were significant for all food groups (P<0.001). The highest contribution for the total household food availability was found for cereals, potatoes, alcoholic beverages, non-alcoholic beverages and fruits. The effects were large for "household food availability" and medium for "elderly household type", "urbanization degree", "income", "food expenses" and "eating out expenses". Solitary elderly male households had the highest proportion of cereals and alcoholic beverages, whilst solitary elderly female households had higher availability of milk/milk products and fruits. Households located in urban areas had higher contribution of milk/milk products while rural, had higher contribution of potatoes.

CONCLUSIONS

The simultaneous effect of the studied variables on food group contribution to total household food availability can be considered when addressing dietary recommendation for providing an insight into the motivations associated with food purchases.

Effects of individual dietary counseling as part of a comprehensive geriatric assessment (CGA) on nutritional status: a population-based intervention study

BACKGROUND

Nutritional risk is relatively common in community-dwelling older people.

OBJECTIVE

To objective of this study was to evaluate the effects of individual dietary counseling as part of a Comprehensive Geriatric Assessment on nutritional status among community-dwelling people aged 75 years or older.

METHODS

Data were obtained from a subpopulation of participants in the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) intervention study in 2004 to 2007. In the present study, the population consist 173 persons at risk of malnutrition in the year 2005 in an intervention (n=84) and control group (n=89). Nutritional status, body weight, body mass index, serum albumin were performed at the beginning of the study and at a two-year follow-up. The nutritional screening was performed using the Mini Nutritional Assessment (MNA) test.

RESULTS

A increase in MNA scores (1.8 95% confidence interval [CI]: 0.7 to 2.0) and in serum albumin (0.8 g/L, 95% CI: 0.2 to 0.9 g/L) were a significant difference between the groups.

CONCLUSIONS

Nutritional intervention, even dietary counseling without nutritional supplements, may improve nutritional status.

Social influences and eating behavior in later life: a review

Food intake is often poor within the older population and many are at nutritional risk. Food intake is complex, as there are multiple individual, social, and environmental determinants that may interact and change over time. Social isolation has long been recognized as a key factor predicting nutrition risk in this population. However, the mechanisms by which social relationships influence diet among older adults remain poorly understood. The purpose of this review is two-fold: ( 1 ) to identify and, where possible, clarify the social concepts used in older adult nutrition research over the past two decades, specifically, the concepts of social integration, social support, companionship and commensality; and ( 2 ) to provide a review and summary of the empirical literature on social factors and diet among cognitively well older adults living in the community. Finally, challenges to studying social concepts in older adult nutrition and areas of future research will be discussed.

A study of challenges and opportunities for long-term care dietitians in British Columbia

While demand for long-term care (LTC) in Canada is expected to grow in the coming years, little is known about the current LTC dietetic workforce or its members' practice-related concerns. A web-based survey was developed and distributed to and subsequently completed by 75 LTC dietitians in British Columbia. The survey was intended to characterize dietitians' demographic characteristics, educational and employment experiences, salaries and benefits, future employment plans, and concerns about current practice. Regression models were used to examine the associations between demographic, educational, and employment characteristics and self-reported hourly wages. The majority of respondents were employed at more than one facility (57%) and did not belong to a union (71%). The mean hourly wage for LTC dietetics positions was $37.50 ± $5.85, and was significantly higher for positions that did not provide additional employee benefits (p < 0.05). Hourly wages were not significantly higher for dietitians with more years of experience or graduate-level education. Concerns were raised about potential implications of revised residential care regulations for workload, and only 36% of respondents reported being committed to working in the area of LTC dietetics in the future. This study highlights practice-related challenges and future opportunities to build the LTC dietetic workforce, and can inform planning for training, recruitment, and retention.

Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets

Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older people's awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older people's nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.

Older Australians' perceptions and practices in relation to a healthy diet for old age: a qualitative study

OBJECTIVE

To explore older independently-living Australians' perceptions and practices about what constitutes a healthy diet for older people.

DESIGN

Qualitative methodology, focus groups.

SETTING

Independently-living retirees in Northern NSW, Australia.

PARTICIPANTS

A total of 29 participants in five focus groups, ranging in age from 60-93 years, with a mean age of 73.3 ± 8.8years; the majority (79%) were women.

RESULTS

Thematic analysis of the focus group interviews revealed four themes that best represent older people's perceptions and practices in relation to healthy eating for old age. These included: 1) healthy foods - participants believed in a hierarchy of perceived healthfulness or importance of foods; 2) quantity - participants believed that ageing was associated with a reduced dietary intake and less need for meat; 3) personal circumstances - participants acknowledged that food costs, social situations and health conditions influenced their food choices; and 4) good intention - participants acknowledged that the desire to regain or maintain wellbeing and to preserve health positively influenced their food choices. Participants were unaware of the national nutrient targets for older Australians.

CONCLUSION

The trend towards reduced dietary intake of meat and the indifference to dairy products expressed by many participants in this study suggests that they are at risk of not achieving the requirements for protein and calcium in particular. Failure to meet these age-adjusted nutrient targets has important implications for the health and functional capacity of older people.

Changes in food group consumption and associations with self-rated diet, health, life satisfaction, and mental and physical functioning over 5 years in very old Canadian men: the Manitoba Follow-Up Study

OBJECTIVE

To identify longitudinal food group consumption trends and the relationship to perceived changes in diet, health, and functioning.

DESIGN

A prospective longitudinal study.

SETTING

Canada.

PARTICIPANTS

Seven hundred and thirty-six community-dwelling Canadian men (mean age: 2000=79.4 yrs; 2005=84.5 yrs) participating in the Manitoba Follow-up Study.

MEASUREMENTS

Self-reported food consumption, self-rated diet and health, life satisfaction, physical and mental functioning from questionnaires completed in 2000 and 2005.

RESULTS

The majority of participants did not consume from all four food groups daily, based on Canada's Food Guide recommendations, with only 8% in 2000 and up to 15% in 2005. However, over a five year period, more men improved their consumption in each food group than declined. An association was found between change in the self-rating of the healthiness of their diet and change in consumption of vegetables and fruit, or grain products. Men whose self-rating of the healthiness of their diet remained high or improved between 2000 and 2005, were 2.15 times more likely (95% CI=1.45, 3.17) to also have increased consumption of vegetables and fruit, and 1.71 times more likely (95% CI=1.51, 2.54) to have increased consumption of grain products, relative to men whose self-rating of the healthiness of their diet declined between 2000 and 2005. Men who consumed more food groups daily had better mental and physical component scores.

CONCLUSION

Dietary improvements are possible in very old men. Greater daily food group consumption is associated with better mental and physical functioning. Given these positive findings, there is still a need to identify older men who require support to improve their dietary habits as nearly half of the participants consumed two or fewer groups daily.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

Learning you are "at risk": seniors' experiences of nutrition risk screening

Nutrition risk screening can help identify community-dwelling older adults who may benefit from nutrition education and interventions to improve food intake. Research has shown, however, that older adults who are found "at risk" through nutrition screening commonly do not see themselves at risk, and many do not follow through with accessing recommended nutrition services. Thus, the purpose of this qualitative study was to examine older adults' experiences of learning they were at risk through nutrition screening and to identify what influenced their perspectives and responses to their screening results. Face-to-face interviews were conducted with 22 older adults who had screened at risk (SCREEN II^© scores < 54) through a nutrition screening process conducted by mail. Participants received their screening results in a personalized letter before the interview, along with some recommendations to help improve food intake and decrease their nutrition risk. Interviews were transcribed and analyzed for themes. When participants reflected about receiving their screening results, some described feeling surprised or even upset by the message that they were at increased risk, whereas others felt unconcerned or reacted with heightened attentiveness to their nutrition. They also began to rationalize their screening score and found ways to explain away their risk. The message that they were at increased risk was poorly understood and not well received because it contradicted their perspective: they felt they were doing the right things, they saw room for improvement rather than seeing themselves at risk, and they tended to make comparisons that helped support the view that they were not truly at risk. Further, even though participants saw room for improvement, they described barriers to change and commonly felt that the recommendations were more applicable for others than themselves. Strategies to improve communication of nutrition screening results and recommendations are discussed to help seniors better understand their risk and take steps to improve their nutrition.

The relationships between food group consumption, self-rated health, and life satisfaction of community-dwelling canadian older men: the manitoba follow-up study

We conducted a cross-sectional evaluation nested within a long-term cohort study that was designed to examine the relationship between frequency of food group consumption (FGC), self-rated health, and life satisfaction of community-dwelling older men in the Manitoba Follow-up Study. Questionnaires returned from 1,211 Canadian male participants contained frequency of FGC (daily, most days, or rarely), self-reported nutrition, and health-related perceptions. Men consuming vegetables/fruit (V&F) daily versus rarely were four times more likely to report better self-rated health OR = 4.00 (95%CI = 1.31, 12.3) and three times more likely to rate greater life satisfaction OR = 3.08 (95%CI = 1.00, 9.45). Our findings indicate that frequent consumption of V&F is associated with the perception of better health and greater life satisfaction.

Food Tasting as Nutrition Education For Older Adults

Purpose: The likelihood of experiencing poor nutrition status increases as people age. Sampling new foods may promote a continued interest in food and enjoyment of eating. This pilot study was designed to describe and provide a preliminary evaluation of food-tasting activities integrated into nutrition displays directed at community-living older adults.

Methods: Three consecutivemonthly nutrition displays incorporating a food-tasting activity were presented at a Guelph, Ontario, recreation centre for seniors. Seniors had an opportunity to taste two recipes at each of three displays; 226 food samples and 155 copies of recipes were taken. Feedback forms were used to determine participants’ interest inmaking the recipes, and whether tasting influenced their interest in preparing the food.

Results: Among 54 participants who completed feedback forms about the program, 75.9%indicated that they intended to prepare one or both of the recipes tasted at the display; 70.4%indicated that they would not ormay not havemade the recipe without tasting it beforehand.

Conclusions:Dietitians working with community-living older adults could use food tastings to help translate key educational messages into practice, and to encourage eating enjoyment as people age.

Integrated electronic platforms for weight loss

What can be done to build effective weight loss solutions for the 1.5 billion people with obesity? It is self-evident that no one good solution exists for people who are overweight or obese, otherwise it would have been applied across the people who need it worldwide. There is, therefore, an urgent need for approaches that will afford weight loss; what is more, such approaches need to be scalable. For that reason, it is attractive to consider electronic platforms as an avenue for scalable weight loss solutions. Such platforms often do not require substantial investments but rather the integration of pre-existing off-the-shelf components. In this article we explore the concepts and design challenges for electronic platforms that precipitate weight loss.

Ten-year trends in dietary intake, health status and mortality rates in free-living elderly people

OBJECTIVE

To explore the trends of food preferences and nutrient intake over a 10-year follow-up in a group of successfully aging elderly.

DESIGN

Longitudinal study.

SETTING

City of Padua, Italy.

PARTICIPANTS

Randomly stratified sample of 97 men and 94 women born between 1913 and 1918.

MEASUREMENTS

The study involved a dietary assessment conducted in 1988/89 and repeated in 1999. Data were collected by means of a modified validated dietary history.

RESULTS

Nutrient and energy intake remained fairly stable over a decade, despite changes in eating habits, with a higher intake of sweets and a lower consumption of soft drinks in both genders. All individuals significantly increased their daily intake of water.

CONCLUSION

Despite changes in eating habits, no significant decline in total energy and macronutrient intake was recorded in a decade in our elderly. The increased daily consumption of water and decreased use of soft drinks would suggest that these people were still receptive to nutritional advice even in very old age, while the increase in their sweet-eating might be because aging itself increases a person's sweet tooth, and this could be regarded as an age-related effect on dietary habits.

Defining malnutrition risk for older home care clients

PURPOSE

The Resident Assessment Instrument-Home Care (RAI-HC) is widely used to assess needs of home care clients and includes five items used to screen for malnutrition. This study involved defining malnutrition risk and identifying other items within the RAI-HC that might improve malnutrition screening among adults aged 65 or older receiving home care.

METHODS

A literature review, three focus groups of community care access centre case managers (n=29), and five key informant interviews with registered dietitians were used to identify malnutrition risk factors and indicators. A nominal group (n=5) was used to rank RAI-HC malnutrition risk items. Data were charted and integrated to create the final list of potential risk factors.

RESULTS

Seven malnutrition indicators (dietary intake, appetite, dysphagia, nutrition support, end-stage disease, weight status, and fluid intake) and seven risk factors (health status, functional ability, self-reported poor health, mood status, social function, cognitive performance, and trade-offs) were considered important concepts in the construct of malnutrition for older home care clients.

CONCLUSIONS

These items identified through divergent methods form the basis for developing a screening-for-malnutrition-risk tool for home care.

The changing face of food and nutrition in Canada and the United States: opportunities and challenges for older adults

Science and technology are modernizing the field of nutrition and are consequently increasing its complexity. New food developments such as fortified foods and functional foods are evidence of its modernization. The increased specificity of nutrient- and food-intake recommendations and the breadth of claims on food packages are evidence of nutrition's growing complexity. Unfortunately, research on the consumer acceptability of new food developments and nutrition education initiatives has not kept pace with advancements in the field. This is especially true for older adults, a subgroup of the population that appears to be under-researched and not commonly targeted with education initiatives. Older adults are the fastest growing segment of the North American population. Research and education aimed at this demographic is warranted to ensure older adults have the right knowledge and skill set to optimize their food selections and dietary patterns with the possibility of improving health and the quality and longevity of life.

Helping older adults meet nutritional challenges

Prevention of premature chronic diseases is an important component of healthy aging. Nutrition education can help to reduce the risk of premature chronic diseases in some older adults. Home delivered meals and congregate dining services assist vulnerable elderly persons by providing opportunities for nutritional and social support. Screening and assessment tools identify factors affecting nutritional health and can also provide specific directions for planning, implementation, and evaluation of tailored interventions. Dietitians and allied health professionals are well positioned to assist a heterogeneous population of older adults in securing nutritional adequacy.

Community nutrition policy for older adults in Canada

PURPOSE

Current prevention-focused nutrition policy for community-dwelling older adults in Canada is discussed.

METHODS

Government websites were searched and key informants asked to identify relevant documents and policies specific to older adults. These were reviewed to find specific legislation on community nutrition programs for older adults.

RESULTS

Despite this population's known nutritional risk, policies guiding community nutrition programs are extremely limited. Current policies and significant documents and organizations that could influence legislation are acknowledged.

CONCLUSIONS

Dietitians in diverse settings need to advocate for specific policy concerning preventive nutrition programs for older adults in Canada.

Promoting food intake in older adults living in the community: a review

Older adults (>65 y) living in the community have the potential to have significant nutrition concerns and deficits owing to the physiological, social, and psychological changes that occur with ageing. However, poor nutrition should not be considered an inevitable consequence of ageing. Older adults are quite heterogenous, including those ageing "successfully", "usually", and at "accelerated" rates. By improving the nutritional status of older adults, significant health and quality of life gains can be realized. These three subgroups of older adults have different concerns and risk factors and thus need different interventions. A substantial amount of research on older adult nutrition needs, determinants of food intake, risk of poor nutrition, and interventions has occurred in the past decade in Canada. The purpose of this review is to summarize this research and identify how nutrition promotion for older adults can be improved. Research to date indicates that the need for nutrition promotion is substantial. A variety of interventions have improved food intake and health of participants, although most programs are provided at a tertiary prevention level. Nutrition screening can help to identify in a timely manner those older adults who may benefit from limited services and which secondary prevention activities need to be increased. Nutrition promotion policy is currently lacking for older adults in Canada and is an important barrier to improving food intake in this growing segment of the population.

Dining-out behaviors of residents in Chuncheon city, Korea, in comparison to the Korean National Health and Nutrition Survey 2001

Dining-out behavior is associated not only with socio-demographic characteristics such as gender, education, occupation, residence, and marital status, but also with individual preferences, such as eating-out activities, interests, and opinions. We investigated dining-out behaviors and their associated factors. Announcements by health practioners and the Chief of Dong Office were used to recruit 739 residents (217 males and 522 females) in Chuncheon, Korea. Information on the frequency and reasons for eating out, the standards for meal selection, and the overall satisfaction with restaurants, based on taste, nutrition, amount, price, service, sanitation, and subsidiary facilities of restaurants, was obtained through personal interviews with a structured questionnaire. Among all respondents, 46.3% of subjects ate outside of the home once or twice a month, and 33.8% reported that they ate out only a few times a year, or never. This was much higher than the national average of 52.0% as reported by the Korean National Health and Nutrition Survey (KNHNS) in 2001. The frequency of eating out differed significantly according to age (p=0.001), family income (p<0.001), residential area (p<0.001), and educational level (p<0.001). The most common reasons for dining out were meetings (46.7%), followed by special celebrations (15.4%), and enjoyment (11.2%). Korean food (55.3%) was the most frequently selected type of meal when eating out, and food was most often selected based on personal preferences (41.4%) and taste (29.8%); only 5.5% and 7.7% of subjects considered nutrition or other factors (e.g., sanitation), respectively. The results showed that the frequency of eating out for Chuncheon residents was much lower than the national average; in addition, eating-out behaviors depended on the residents' socio-demographic and personal characteristics.

Factors associated with Oklahoma Older Americans Act Nutrition Program participants ability to shop, cook, and feed themselves

Oklahoma Older Americans Act Nutrition Program participants' (n = 859) ability to shop, cook, and feed themselves was evaluated using factor analysis and logistic regression. Congregate participants who reported they were not able to shop, cook, and feed themselves had significantly lower "mobility," "financial management," and "financial security" factor scores; home-delivered participants had significantly lower "mobility," "living arrangement" and "financial security," and higher "social interaction" factor scores. For congregate meal participants the factors "mobility" and "financial management" and for home-delivered meal participants, the factors "mobility" and "social interaction" were significantly associated with reported ability to shop, cook, and feed themselves.

Nutrition as a determinant of functional autonomy and quality of life in aging: a research program

With the aging of the Canadian population, functional autonomy and quality of life among seniors are now important public health issues. We hypothesized that nutrition is an important determinant of the quality of aging because of its potential to modulate the transitions from vulnerability to frailty and dependence. Over the past 15 years, our research program addressed the prevalence, the determinants, and the consequences of undernutrition among seniors, especially the free-living frail elderly. Very low energy and nutrient intakes were observed as well as a high prevalence of involuntary weight loss. These chronic conditions were associated with early institutionalization and increased mortality rates. Intervention strategies were then developed and evaluated, including the Nutrition Screening Program and the Nutrition Support Program. The effectiveness of these programs was shown with respect to improvement of nutritional status. However, this improvement was not sufficient to produce significant changes in functional autonomy or quality of life. Methodological issues related to the conduct of intervention studies in this specific population were addressed. A conceptual framework of nutritional intervention is currently being validated. A large longitudinal study that is being undertaken will further contribute to our understanding of the aging process as determined by a modifiable factor such as nutrition.Key words: aging, nutrition, autonomy, nutrition screening, nutrition intervention.