Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

A Scoping Review of Nutrition Health for Older Adults: Does Technology Help?

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.

The feasibility and acceptability of a dementia care training program for registered dietitian nutritionists

There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia.

Depression, Is It Treatable in Adults Utilising Dietary Interventions? A Systematic Review of Randomised Controlled Trials

This systematic literature review examined whole food or whole diet interventions to treat depression. The inclusion criteria encompassed adults, depression, a recognized depression scale and a whole food or diet intervention. APA PsychINFO, CINAHL, the Cochrance Central Register of Controlled Trails, MEDLINE and Scopus were searched for original research addressing diet as a treatment for depression in adult populations. The quality of the study was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Seven studies; with 49,156 participants; met the eligibility criteria. All these studies found positive outcomes with depression levels decreasing after dietary intervention. The calculated effect size varied from small (Cohen’s d = 0.32) to very large (Cohen’s d = 1.82). The inconsistent nature of the studies limited the synthesis of the data. Recommendations are provided to enhance future study design and measurement outcomes. Overall, the findings show a positive result for diets that promote an increased intake of fresh produce, wholegrains, low-fat dairy and lean protein sources, while also decreasing the intake of processed and high-fat foods. No funding was provided for this review. The protocol for this review is registered with PROSPERO (CRD42020210426).

Individual and Interpersonal Factors Affecting Dietary Intake of Community-Dwelling Older Adults during the COVID-19 Pandemic

OBJECTIVE

As older adults are at higher risk for severe illness and mortality from SARS-CoV-2 infection, social distancing has been a primary means of mitigating risk. However, this lifestyle change may impact eating habits and food choices. The aim of this study was to explore individual and interpersonal factors affecting the eating behaviors and dietary intake of community-dwelling older adults during the COVID-19 pandemic.

DESIGN

Semi-structured individual interviews were conducted. All interviews were audio-recorded and transcribed verbatim. Qualitative data were analyzed using a deductive content analysis approach to identify themes.

SETTING

Southeastern United States.

PARTICIPANTS

Twenty-three men and women, 60 years of age and older (mean age 71.9 ± 7.7, 22% male) completed both the interview and questionnaire.

RESULTS

Themes that emerged at the individual level included changes in eating habits and foods eaten, with most participants reporting healthier food choices during the pandemic. Participants also reported more frequent cooking, improved cooking skills, and cooking as a form of stress relief. Although some older adults described increased snacking and consumption of "comfort foods", others noted no influence of mood on food choices. At the interpersonal level, an increased use of technology for social interaction and the importance of social support were identified as influencing factors.

CONCLUSIONS

Findings provide insight on how to help older adults maintain good nutrition amidst lifestyle changes imposed by social distancing. Nutrition educators may capitalize on positive behavior changes that occurred during the pandemic such as increased cooking and increased use of technology for social interaction.

Barriers to eating are associated with poor physical function in older women

Older adults have physical and social barriers to eating but whether this affects functional status is unknown. We examined associations between eating barriers and physical function in the Women's Health Initiative (WHI). In 2012-14, a subset of alive and participating women (n = 5910) completed an in-home examination including the Short Physical Performance Battery (SPPB) (grip strength, balance, timed walking speed, chair stand). WHI participants complete annual mailed questionnaires; the 2013-14 questionnaire included items on eating alone, eating < two meals/day, dentition problems affecting eating, physical difficulties with cooking/shopping and monetary resources for food. Linear regression tested associations of these eating barriers with SPPB, adjusting for BMI, age, race/ethnicity, and medical multimorbidities. Over half (56.8%) of participants were ≥ 75 years, 98.8% had a BMI ≥ 25.0 kg/m2 and 66% had multimorbidities. Eating barriers, excluding eating alone, were associated with significantly lower total (all p < .001) and component-specific, multivariate-adjusted SPPB scores (all p < .05). Compared to no barriers, eating < two meals/day (7.83 vs. 8.38, p < .0002), dentition problems (7.69 vs. 8.38, p < .0001), inability to shop/prepare meals (7.74 vs. 8.38, p < .0001) and insufficient resources (7.84 vs. 8.37 p < .001) were significantly associated with multivariate-adjusted mean SPPB score < 8. Models additionally adjusting for Healthy Eating Index-2010 had little influence on scores. As barriers increased, scores declined further for grip strength (16.10 kg for 4-5 barriers, p = .001), timed walk (0.58 m/s for 4-5 barriers, p = .001) and total SPPB (7.27 for 4-5 barriers, p < .0001). In conclusion, in this WHI subset, eating barriers were associated with poor SPPB scores.