Position paper of the American Dietetic Association: Nutrition across the spectrum of aging

Healthy Aging-Nutrition Matters: Start Early and Screen Often

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression-and in some cases effectively treat-many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

Perceived environmental supports for fruit and vegetable consumption among older adults in the US

BACKGROUND

The physical and social environments surrounding food, whether perceived or observed, can influence consumers' food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur.

AIM

To describe older adults' perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults' recommendations for communities to facilitate fruit and vegetable consumption.

METHODS

Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption.

RESULTS

The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables.

CONCLUSION

Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers' perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.

Aging and nutrition. Paving the way to better health

Sufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition.

The Role of Nutrition in Attenuating Age-Related Skeletal Muscle Atrophy

The elderly population is increasing rapidly worldwide, and we are faced with the significant challenge for maintaining or improving physical activity, independence, and quality of life. Sarcopenia, the age-related decline of skeletal muscle mass, is characterized by loss of muscle quantity and quality resulting to a gradual slowing of movement, a decrease in strength and power, elevated risk of fall-related injury, and often frailty. Supplemental, hormonal, and pharmacological approaches have been attempted to attenuate sarcopenia but these have not achieved outstanding results. In this review, we summarize the current knowledge of nutrition-based therapies for counteracting sarcopenia.

Nutrition as a Health Determinant in Elderly Patients

BACKGROUND

An adequate caloric intake is a major determinant for the health status especially when degenerative conditions become a predominant risk for difficult-to-treat diseases as in aging.

METHODS

A structured search of literature on the major databases was performed using terms as nutrition, elderly and malnutrition.

RESULTS

According to most referenced articles, it appears to be unquestionable that both organic and social risk factors [economic hardship, loneliness, institutionalization] are important as determining causes of protein-caloric malnutrition. Some anthropometric, clinical and laboratory parameters can help to make diagnosis and quantify malnutrition. However, most of them are not cheap or are not simple to perform especially in the setting of General Practice. The application of a simple questionnaire [Mini Nutritional Assessment, MNA] allows to obtain in a fast, easy and non-invasive way a valid assessment of the nutritional status in geriatric patients. The maintenance of the nutritional status is the best measure to counteract the risk of proteincaloric malnutrition and its complications which often sneakily affects elderly population and in particular frail patients.

CONCLUSION

This review, based on updated concepts, examines all the above mentioned points together with some aspects associated with malnutrition as an indicator of disease severity and health costs in the elderly population. Finally, the impact of nutritional intervention and nutrients supplementation on general indices of malnutrition are discussed as a promising strategy.

Dietary and Physical Activity Outcomes Determine Energy Balance in U.S. Adults Aged 50-74 Years

This study identified which energy expenditure (EE) and dietary intake outcomes determine EE from doubly-labeled water (DLW) in U.S. older adults (n = 681; 45.9% male; mean age 63.2). A secondary data analysis using baseline data from The Interactive Diet and Activity Tracking in AARP (IDATA) study was conducted. Stepwise linear regressions identified predictor outcomes of EE from DLW within sexes. Outcomes included data from ActiGraph accelerometers, Community Healthy Activities Model Program for Seniors (CHAMPS) self-report activity questionnaire, Automated Self-Administered 24-hour dietary recall, Dietary History Questionnaire II (DHQ II), and resting EE. Energy expenditure by ActiGraph in males predicted EE from DLW (R² = 0.33, p < .001). EE from ActiGraph and total dietary fiber from DHQ II predicted EE from DLW in females (R² = 0.44, p < .001). The CHAMPS closely matched EE from DLW when considering resting EE. These findings can be used to assess energy balance in a non-invasive manner in older adults.

Community food environments and healthy food access among older adults: A review of the evidence for the Senior Farmers' Market Nutrition Program (SFMNP)

Although an array of federal, state, and local programs exist that target food insecurity and the specific nutritional needs of seniors, food insecurity among older adults in the United States remains a persistent problem, particularly in minority and rural populations. Food insecurity is highly predictive of inadequate fresh fruit and vegetable (FFV) consumption in particular. The Senior Farmers' Market Nutrition Program (SFMNP) is a community-based program to help seniors purchase FFVs at farmer's markets in their neighborhoods. The SFMNP continues to grow; however, little is known about the effectiveness of the program. The purposes of this article are to (1) highlight the importance of community and neighborhood based food insecurity programs, specifically emphasizing the importance of FFV access for seniors, (2) review the current state of the evidence on the SFMNP, and (3) provide recommendations for researchers and policy-makers wishing to continue to advance the knowledge base in neighborhood-based food security among older adults.

American Society of Parenteral and Enteral Nutrition Presidential Address: Food for Thought: It's More Than Nutrition

Three issues were highlighted in the 30(th) Presidential Address to the society: (1) A.S.P.E.N.'s unique interdisciplinary structure; (2) support of the A.S.P.E.N. Rhoads Research Foundation; and (3) the meaning of food from the perspective of the patient who is receiving life-sustaining home enteral or parenteral nutrition. A.S.P.E.N., founded as a multidisciplinary society in the 1970s has evolved into an interdisciplinary society with an expanded and diverse membership of health care professionals and scientists with overlapping interests in clinical nutrition and metabolism. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. The society is committed to advancing the science and practice of nutrition support therapy. In support of this direction, the A.S.P.E.N. Rhoads Research Foundation exists to fund research grants, promote evidence-based practice, and foster training and mentorship in nutrition and metabolic research. The scientific advances and technologic innovations that have enabled our profession to provide enteral and parenteral nutrition to patients has caused practitioners to forget that the meaning of food extends beyond nutrient value. Some individuals receiving long term enteral nutrition or home parenteral nutrition have expressed feelings of anger, anxiety, and depression resulting from the inability to eat normally, from losses of independence, and control of body functions. The ritual of eating may be altered when the enteral or intravenous feedings provide nourishment and, for some, the loss of the eating function is a distressing experience, especially given the cultural focus on social gatherings and meals. The emotional meaning attributed to food, and changes in food preferences and eating behaviors, may become a source of conflict for individuals who have substantial dietary restrictions, or for those individuals dependent on enteral or parenteral nutrition therapy. The value of food intake on social patterns, self-esteem, pleasure, and enjoyment, may impact quality of life. While nutrition support can provide the basic need for nutrients, its impact on human needs associated with food requires further investigation.

Sex-Specific Sociodemographic Correlates of Dietary Patterns in a Large Sample of French Elderly Individuals

This cross-sectional analysis provides up-to-date information about dietary patterns (DP) and their sociodemographic correlates in European elderly individuals. We studied 6686 enrollees aged 65+ (55% women) in the ongoing French population-based NutriNet-Santé e-cohort. Diet was assessed via three 24 h records. The sex-specific correlates of factor analysis derived DP were identified with multivariable linear regression. Using 22 pre-defined food groups, three DP were extracted. The "healthy" DP (fruit, vegetables, grains, nuts, fish) was positively associated with education, living alone, and being a former smoker (women), and negatively associated with being overweight, current smoker (men), age 75+ years, having hypertension, and obesity (women). The "western" DP (meat, appetizers, cheese, alcohol) was positively associated with BMI (men) and being a former/current smoker; it was negatively associated with age 75+ years (women) and living alone. The "traditional" DP (bread, potatoes, milk, vegetables, butter, stock) was positively associated with age and negatively associated with being a former/current smoker, education (men), and residing in an urban/semi-urban area. The findings support the diversity of DP among the elderly, highlighting sex-specific differences. The "healthy" DP explained the largest amount of variance in intake. Future studies could replicate the models in longitudinal and international contexts.

Nutritional risk in community-dwelling older men: the Manitoba follow-up study

PURPOSE

The role of nutrition in older men's health and successful aging has been inadequately studied. We examined the relationships among nutritional risk, self-rated health, and successful aging in community-dwelling Canadian older men.

METHODS

The surviving cohort of the Manitoba Follow-up Study (n=690, mean age = 86.8 years) were sent a self-administered nutrition survey in December 2007. The survey consisted of the Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II), a validated tool for assessing nutritional risk of cognitively intact community-living older adults, and questions about successful aging and health.

RESULTS

Of the 553 surveys returned (80% response), 522 with complete SCREEN II data were included in the analysis. Forty-four percent of respondents were at high nutritional risk, 24% were at moderate risk, and 32% were at low risk. Significant relationships were found between nutritional risk and self-rated health (P<0.0001) and successful aging (P=0.008), with greater nutritional risk associated with lower self-ratings of health and successful aging. Higher use of prescription medication was related to greater nutritional risk (P=0.004).

CONCLUSIONS

Nutritional screening programs for community-dwelling older men are warranted as two-thirds of the study participants were at nutritional risk. Identifying older men at nutritional risk is a critical step in the process of nutritional assessment, and subsequent nutrition interventions and follow-up are required to prevent further health decline.

Nutrient Patterns and Their Food Sources in Older Persons from France and Quebec: Dietary and Lifestyle Characteristics

Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

Assessing the nutritional status of older individuals in family practice: Evaluation and implications for management

BACKGROUND & AIMS

Malnutrition is emerging as a multidimensional concern of ageing with a high prevalence among nursing home residents. This study investigated the extent of malnutrition among old subjects in family practice and its relationship with major complications.

METHODS

Over 75 years old subjects (n = 274) filled the Mini Nutritional Assessment questionnaire. Appearance of major events in the following 6 months were registered.

RESULTS

MNA scored were 11.5 ± 3.1, with 175 (64%) subjects showing no malnutrition, 69 (25%) resulted at risk, and 30 (11%) malnourished. Within at risk group, 1.4% was resident, 7% bed rested, 8% had a history of major bone fracture, 33% was demented and 24.6% hospitalized at least once in the last year. Among malnourished patients, 10% was resident, ten bed rested with 70% showing multiple bedsores, 20% have had bone fractures, 60% were demented and 13% hospital admitted in the previous year. In over 90% of them, malnutrition had neither diagnosed nor considered before. During follow-up, a significantly higher number of major events including death occurred in the malnourished group. By multivariate logistic regression, n = 56 (20.4%) patients resulted at risk of major complications. The sensitivity of the questionnaire in identifying these patients was 84% with the cut-off value of 7 associated with the highest prediction (positive predictive value, 0.92; negative predictive value, 0.71) yielding a specificity of 92%.

CONCLUSIONS

The prevalence of malnutrition is high among older subjects in the setting of family practice. The Mini Nutritional Assessment allows to identify malnourished subjects better than BMI and effectively predicts the risk of major events.

The BRIGHT Trial: what are the factors associated with nutrition risk?

OBJECTIVES

To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial).

DESIGN

A cluster randomised controlled trial.

SETTING

Three main centres in New Zealand.

PARTICIPANTS

A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Māori).

MEASUREMENTS

Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established.

RESULTS

Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Māori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account.

CONCLUSION

Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

The Occupational Performance Measure of Food Activities: Item Pool Development and Measurement Properties

Introduction:

Occupational therapists have the knowledge and skills to improve nutritional risk in community-living older adults by improving performance of food-related occupations. However, few tools are available to evaluate these interventions. We developed the first item pool that measures community-living older adults' occupational performance of food activities.

Method:

In Phase 1 of the research we developed an item pool within a qualitative exploratory study with five older adults. In Phase 2 we designed the Occupational Performance Measure of Food Activities. In Phase 3 we formally assessed the measurement properties of the 15-item measure, using survey responses from 77 community-living older adults. Construct validity, reliability, and utility were evaluated.

Findings:

A 13-item measure of the occupational performance of food activities showed acceptable validity and reliability in three subscales (Cronbach's α ranged from .70 to .75). The item pool demonstrated good utility. We had comparable results for administration via self-completion survey (n = 38) and interview (n = 39).

Conclusion:

This unique item pool showed promising validity and reliability for the measurement of the occupational performance of food activities. Occupational therapists are cautioned against modifying existing measurement tools without thorough testing of the resulting new measure of occupational performance.

A state-level examination of the association between home and community-based services and rates of nursing home residency with special attention to nutrition programs

Federal food and nutrition programs implemented by the Administration on Aging and funded by the Older Americans Act (OAA) seek to enable older adults to remain in their homes and communities through a comprehensive, coordinated, and cost-effective array of services. We hypothesized that expenditures devoted to nutrition programs for home and community-based nutrition services were inversely related to changes in state-level rates of institutionalization for older adults from one year to the next, such that states that spend more money per capita on community-based nutrition programs would have smaller increases or greater decreases in rates of institutionalization, controlling for expenditures on other home and community-based services. We found, however, that there was not an effect of OAA Nutrition Services on the change in rates of nursing home residency. We noted, though, that states that direct a greater proportion of their long-term care expenditures to home and community-based services appear to have more reduction in their rates of nursing home residency. Further longitudinal work at the state and individual levels is warranted.

Snacking may improve physical function among older Americans

BACKGROUND/OBJECTIVES

Snacking was reported to provide nutritional benefits among older adults, but the association between such dietary behavior and health outcomes has not been clearly established. The purpose of this study is to examine the associations between snacking and gait speed, a performance-based measure of physical function.

DESIGN

Cross-sectional population-based survey.

SETTING

The 1999-2002 National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

A nationally representative sample of Americans aged 60 and older（n = 2,333).

MEASUREMENTS

Participants were classified by snacking frequency (0, 1, 2, 3, ≥4 snacks/d) and by the contribution of snacking to their daily energy intake (0 to <10%, 10% to <20%, 20% to <30%, ≥30%). Physical function was assessed by measurement of gait speed over 20 feet.

RESULTS

After adjusting for age, gender, education, race/ethnicity, smoking status, and marital status, older adults who snacked four times or more daily had a faster gait speed (P = 0.033) than non-snackers. Snacking that contributed 20% to <30% (P = 0.017) of energy was associated with a faster gait speed than snacking that contributed 0 to <10% of energy. Similar associations were observed after further adjustment for potential confounders.

CONCLUSION

Both snacking frequency and percentage of energy from snacking are positively associated with gait speed among older adults. The benefits of snacking on older adults' physical function may warrant their inclusion in this population's diet.

Active aging promotion: results from the vital aging program

Active aging is one of the terms in the semantic network of aging well, together with others such as successful, productive, competent aging. All allude to the new paradigm in gerontology, whereby aging is considered from a positive perspective. Most authors in the field agree active aging is a multidimensional concept, embracing health, physical and cognitive fitness, positive affect and control, social relationships and engagement. This paper describes Vital Aging, an individual active aging promotion program implemented through three modalities: Life, Multimedia, and e-Learning. The program was developed on the basis of extensive evidence about individual determinants of active aging. The different versions of Vital Aging are described, and four evaluation studies (both formative and summative) are reported. Formative evaluation reflected participants' satisfaction and expected changes; summative evaluations yielded some quite encouraging results using quasi-experimental designs: those who took part in the programs increased their physical exercise, significantly improved their diet, reported better memory, had better emotional balance, and enjoyed more cultural, intellectual, affective, and social activities than they did before the course, thus increasing their social relationships. These results are discussed in the context of the common literature within the field and, also, taking into account the limitations of the evaluations accomplished.

Nutritional status in Parkinson's disease patients undergoing deep brain stimulation surgery: a pilot study

OBJECTIVES

People with Parkinson's disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy.

DESIGN

This was an observational study using a convenience sample.

SETTING

Participants were seen during their hospital admission for their deep brain stimulation surgery.

PARTICIPANTS

People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15).

MEASUREMENTS

The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status.

RESULTS

Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss.

CONCLUSION

Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.

Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women

OBJECTIVES

We evaluated the relationship between financial hardship and self-reported oral health for older men and women.

METHODS

We focused on adults in the 2008 Health and Retirement Study (n = 1,359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health.

RESULTS

In the non-gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12% greater prevalence of poor self-reported oral health (95% confidence interval [CI] = 1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24% greater prevalence of poor self-reported oral health than women with zero (95% CI = 1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50% lower prevalence of poor self-reported oral health (95% CI = 0.32, 0.76).

CONCLUSIONS

Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults' oral health should account for gender-based heterogeneity in financial hardship experiences.

Omega 3 fatty acids in the elderly

Population ageing affects the entire world population. Also at world level one can observe a sharp increase in the proportion of older people. The challenge posed by population ageing translates into ensuring that the extra years of life will be as good as possible, free from high-cost dependency. Omega-3 fatty acids are now generally recognized as potential key nutrients to prevent the pathological conditions associated to the aging process. Ageing physiological process, its association with quality of life and the impact of omega-3 fatty acids intake and/or status is the focus of the present review. This report deals with the effects of omega-3 fatty acids on normal aging of older adults ( ≥  65 years) mainly on the effects such as nutritional status itself, cognition, bone health, muscle tonus, and general health status. The preliminary broad search of the literature on the effects of omega-3 fatty acids on normal aging yielded 685 citations. Forty two full text papers were checked for inclusion and thirty six studies were finally included in this review. It may be concluded that paradoxically even though the elderly population is the largest one, the number of studies and the methodology employed clearly lacks of sufficient evidence to establish definite conclusions on the effects of omega-3 fatty acids on aging metabolism without pathological conditions and on quality of life.

Identifying geriatric malnutrition in nursing practice: the Mini Nutritional Assessment (MNA®)-an evidence-based screening tool

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.

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 effects of diet education plus light resistance training on coronary heart disease risk factors in community-dwelling older adults

OBJECTIVES

To examine the effects of diet education (DE) plus light resistance training (RT) on coronary heart disease risk (CHD) factors, specifically dietary quality, blood lipid and C-Reactive protein (CRP) concentrations in overweight and obese older adults in a community setting.

DESIGN

Community outreach intervention with a quasi-experimental design.

PARTICIPANTS AND SETTING

A total of 96 subjects, 16 males and 80 females, aged 69.2 ± 6.2 years, community-dwelling, and from one of four senior centers in Rhode Island.

INTERVENTION

Subjects participated in 30 minutes of DE (once per week) and ~80 minutes of RT (two separate sessions per week) for eight weeks. The DE sessions were led by a registered dietitian.

MEASUREMENTS

Anthropometrics (height, weight, waist circumference, hip circumference, and body composition), clinical (blood pressure), biochemical (lipid profile, glucose, and CRP concentrations), and diet quality measured by the Dietary Screening Tool (DST).

RESULTS

A significant change was seen in DST risk categories from baseline to post-intervention, χ² (2)=20.43, p < 0.01. Significant differences were seen in triacylglycerol (p=0.028) as well as in systolic and diastolic blood pressures, weight, waist circumference, hip circumference, percent body fat, fat mass, and body mass index (all p<0.05).

CONCLUSION

This intervention effectively decreased CHD risk in overweight and obese older adults. Future research is needed to examine the effects of longer DE plus RT interventions with greater weight loss on the lipid profile and CRP concentrations in overweight and obese older adults at risk for CHD.

Signaling proteins that influence energy intake may affect unintentional weight loss in elderly persons

After age 70 to 75 years, average body weight decreases both in ailing and healthy people because of a loss of appetite that results in reduced energy intake and the loss of body fat and lean muscle tissue. This so-called anorexia of aging predisposes elderly people to continued pathologic weight loss and malnutrition-major causes of morbidity and mortality. Health care professionals must understand the many factors involved in the anorexia of aging to help older adults prevent unintentional weight loss. Psychological, social, and cultural factors are important effectors; however, physiological factors are emphasized here because they are not thoroughly understood and they make it inherently difficult for most people to alter their body weight. Monoamines, steroid hormones (glucocorticoids and mineralocorticoids), endocannabinoids, and proteins all influence body weight. This review is an analysis of proteins from the brain, pancreas, adipose tissue, and gastrointestinal tract that are known to affect energy intake and energy balance, with an attempt to identify those factors that may change with aging. The articles included in this review were obtained by a PubMed database search using the keywords mouse OR rat OR human AND aged OR aging OR older OR elderly AND adult AND anorexia OR "unintentional weight loss," and each of the individual proteins discussed, as well as from the reference lists of those articles. The results reveal that some proteins may be important in the development of unintentional weight loss in elderly persons, whereas others may not have a significant role. However, many of the proteins that could conceivably have a role in unintentional weight loss have not yet been studied with that question in mind. Preventing unintentional weight loss in older adults is an important goal and further research on the role of proteins important for the maintenance of energy balance and the development of unintentional weight loss in elderly persons is warranted.

Social Support and Dietary Quality in Older African American Public Housing Residents

This study examined the role of social support in influencing dietary quality in older African American public housing residents, specifically investigating individual (age, education, gender, marital status, and living arrangement), social support (help with meals, social network size, frequency of contact, and proximity or distance from network), and dietary factors (number of meals consumed daily, dietary quality). A random sample ( n = 80) of public housing residents age 55+ living in a Northeastern community was interviewed. Data were analyzed using Pearson correlation coefficients, multiple regression analyses, and structural equation modeling (SEM). Given the limited sample size, a SEM path model was developed based on observed associations in correlation and regression analyses. Results show that number of meals, frequency of contact, and proximity significantly influenced dietary quality. However, dietary quality was indirectly influenced by education, marital status, having a housemate, and help with meals, highlighting influence of both individual and social factors.

Country of origin predicts nutrition risk among community living older people

OBJECTIVES

To assess the nutrition risk status of community living older people and to identify associated risk factors.

DESIGN

A cross-sectional study using convenience sampling.

SETTING

North Shore City, Auckland, New Zealand. Data collection was carried out by a research nutritionist using computer assisted personal interviewing in the participant's own home.

PARTICIPANTS

Fifty-one independently living people aged between 80 and 85 years.

MEASUREMENT

A survey using three validated questionnaires: Practitioner Assessment of Network Type (PANT) to evaluate social networks; Elderly Assessment System (EASY-Care) to evaluate physical and mental wellbeing and Seniors in the Community: Risk Evaluation for Eating and Nutrition Version II (SCREEN II) to assess nutrition risk.

RESULTS

A third of the participants (31%) were at high risk of malnutrition (SCREEN II score <50; range 29-58 out of maximum score of 64). The majority of participants (82%) lived alone and nearly half (47%) had supportive social networks including close relationships with local family, friends and neighbours. Low self-rated health, disability and social factors (being born outside of New Zealand, losing a spouse and loneliness) were key underlying factors associated with being at nutrition risk.

CONCLUSION

Nutrition risk is common among aged individuals living in the community. Health and social factors that shape eating behaviours place older people at increased nutrition risk. Strategies are needed for the early identification of risk factors to prevent nutrition problems. Engaging older people at risk to share meal preparation and dining experiences may foster better outcomes.

What is associated with nutrition risk in very old age?

OBJECTIVES

To identify factors associated with nutrition risk among a purposive sample of those in advanced aged.

DESIGN

A cross sectional feasibility study.

SETTING

Three North Island locations in New Zealand.

PARTICIPANTS

One hundred and eight community-living residents aged 75- 85 years.

MEASUREMENTS

Nutrition risk was assessed using a validated questionnaire, Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II). A Physical Activity Scale for the Elderly (PASE) was used to determine level of physical activity. Markers of body composition, grip strength and fasting blood samples were collected.

RESULTS

Fifty-two percent of participants were at high nutrition risk (SCREEN II score < 50; range 29-58; out of maximum score 64). The mean score for SCREEN II was higher for older people who lived with others (50.3 ± 5.1) compared to those who lived alone (46.4 ± 5.8) p=0.001. The SCREEN II score was positively correlated with the total PASE score r= 0.20 (p=0.042), grip strength r=0.20 (p=0.041), and muscle mass percentage r=0.31 (p=0.004). Lower levels of haemoglobin, serum zinc and physical activity were associated with higher nutrition risk.

CONCLUSION

Half the participants were at high nutrition risk. They tended to be widowed or live alone and had lower levels of haemoglobin and serum zinc. Those at lower nutrition risk had greater muscle mass and strength, lower body fat, consumed alcohol more frequently and engaged in more physical activity. Strategies which encourage older people to eat meals and be physically active with others may assist to improve their health.

Maintaining functionality in later years: a review of nutrition and physical activity interventions in postmenopausal women

Independence and quality of life of postmenopausal women are influenced by functional status. Nutrition and physical activity impact functional changes through changes in body composition. The article presents a narrative review of the literature to identify interventions that improve the functionality of community-dwelling postmenopausal women. The authors used the Evidence Analysis Approach developed by the American Dietetic Association to appraise current research. Strong evidence does exist that interventions that incorporate both physical activity and nutrition can improve physical function of older women. However, research focusing on functional status and quality of life, in addition to nutrition and exercise, is extremely limited.

Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia

Low-income older adults are at increased risk of cutting back on basic needs, including food and medication. This study examined the relationship between food insecurity and cost-related medication non-adherence (CRN) in low-income Georgian older adults. The study sample includes new Older Americans Act Nutrition Program participants and waitlisted people assessed by a self-administered mail survey (N = 1000, mean age 75.0 + so - 9.1 years, 68.4% women, 25.8% African American). About 49.7% of participants were food insecure, while 44.4% reported practicing CRN. Those who were food insecure and/or who practiced CRN were more likely to be African American, low-income, younger, less educated, and to report poorer self-reported health status. Food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to practice CRN behaviors than their counterparts after controlling for potential confounders. Improving food security is important inorder to promote adherence to recommended prescription regimens.

Contribution of snacking to older adults' vitamin, carotenoid, and mineral intakes

Decreased food and beverage consumption among older adults can lead to inadequate intakes of energy and numerous micronutrients. Although older adults are prone to having inadequate diets, little research attention has been directed at their dietary behaviors, such as snacking. The purpose of this study was to examine the association between snacking frequency and older adults' daily intakes of vitamins, carotenoids, and minerals. Cross-sectional data for 2,056 older adults (65 years and older) from the 2003-2006 National Health and Nutrition Examination Survey were used for this study. Dietary data were collected through two 24-hour dietary recall interviews. Participants' snacking occasions and daily nutrient intakes were averaged during the two 24-hour recalls. Using linear regression models to adjust for multiple covariates, mean vitamin, carotenoid, and mineral intakes by snacking category were estimated. As snacking frequency increased, daily intakes of vitamins A, C, and E and beta carotene increased. Older adults' daily intakes of magnesium, copper, and potassium also increased as snacking frequency increased. As older adults' snacking frequency increased, their daily intake of selenium decreased, and their snacking frequency was not associated with their daily intakes of the B-complex vitamins, vitamin K, lycopene, phosphorus, iron, and zinc. Providing healthy snacks on a regular basis has practical implications for institutions, centers, or organizations that serve older adults; however, nutritional benefits obtained from snack food and beverages warrant their inclusion in older adults' diet.

Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: food and nutrition programs for community-residing older adults

Given the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services, it is the position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education that all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status. Appropriate food and nutrition programs include adequately funded food assistance and meal programs, nutrition education, screening, assessment, counseling, therapy, monitoring, evaluation, and outcomes documentation to ensure more healthful aging. The growing number of older adults, the health care focus on prevention, and the global economic situation accentuate the fundamental need for these programs. Yet far too often food and nutrition programs are disregarded or taken for granted. Growing older generally increases nutritional risk. Illnesses and chronic diseases; physical, cognitive, and social challenges; racial, ethnic, and linguistic differences; and low socioeconomic status can further complicate a situation. The beneficial effects of nutrition for health promotion, risk reduction, and disease management need emphasis. Although many older adults are enjoying longer and more healthful lives in their own homes, others, especially those with health disparities and poor nutritional status, would benefit from greater access to food and nutrition programs and services. Food and nutrition practitioners can play a major role in promoting universal access and integrating food and nutrition programs and nutrition services into home- and community-based services.

Food choice among homebound older adults: motivations and perceived barriers

OBJECTIVES

The purpose of this paper is to identify: motivations and perceived barriers associated with food choices made by homebound older adults; whether motivations and perceived barriers vary according to social demographic characteristics; and whether motivations and perceived barriers are associated with dietary quality.

DESIGN

This was an observational study using standard interview methods where participants were administered a questionnaire and completed three 24-hour dietary recalls.

SETTING

Participants were interviewed in their homes.

PARTICIPANTS

185 homebound older adults were included.

MEASUREMENT

Motivations were assessed using a modification of The Food Choice Questionnaire and perceived barriers were assessed using the Vailas Food Enjoyment Questionnaire. Participants answered questions regarding social demographic characteristics. Dietary quality measures of adequate intakes of calories, protein, vitamin D, and vitamin B12 were obtained from the three 24-hour dietary recalls.

RESULTS

Mean age was 78.9; 80% were female; and 36% were African American. Key motivations in food choice included sensory appeal, convenience, and price. Key barriers included health, being on a special diet, and being unable to shop. These varied little by social demographics, except for age. Dietary quality varied according to different motivations and barriers.

CONCLUSION

Food choices are based upon a complex interaction between the social and environmental context, the individual, and the food. Efforts to change eating behaviors, especially community-based interventions involving self-management approaches, must carefully take into account individuals' self-perceived motivations and barriers to food selection. Incorporating foods that are tasty, easy to prepare, inexpensive, and that involve caregivers are critical for successful interventions.

Diet quality is associated with better cognitive test performance among aging men and women

Most studies of association between diet and cognition among the elderly focus on the role of single nutrients or foods and ignore the complexity of dietary patterns and total diet quality. We prospectively examined associations between an index of diet quality and cognitive function and decline among elderly men and women of the Cache County Study on Memory and Aging in Utah. In 1995, 3634 resident men and women > or =65 y of age completed a baseline survey that included a 142-item FFQ. Cognition was assessed using an adapted version of the Modified Mini-Mental State Examination (3MS) at baseline and 3 subsequent interviews spanning approximately 11 y. A recommended food score (RFS) and non-RFS were computed by summing the number of recommended foods (n = 57) and nonrecommended foods (n = 23) regularly consumed. Multivariable-mixed models were used to estimate associations between the RFS and non-RFS and average 3MS score over time. Those in the highest quartile of RFS scored 1.80 points higher on the baseline 3MS test than did those in the lowest quartile of RFS (P < 0.001). This effect was strengthened over 11 y of follow-up. Those with the highest RFS declined by 3.41 points over 11 y compared with the 5.2-point decline experienced by those with the lowest RFS (P = 0.0013). The non-RFS was not associated with cognitive scores. Consuming a diverse diet that includes a variety of recommended foods may help to attenuate age-related cognitive decline among the elderly.