Indicators of nutritional risk in a rural elderly Hispanic and non-Hispanic white population: San Luis Valley Health and Aging Study

Comparison of nutritional screening tools to assess nutritional risk and predict clinical outcomes in Mexican patients with digestive diseases

BACKGROUND

The prevalence of malnutrition remains high in hospitals but no "gold standard" has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases.

METHODS

This was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression.

RESULTS

The NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were: NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51-65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality.

CONCLUSIONS

The proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.

Digital Commensality: Eating and Drinking in the Company of Technology

Commensality is a key aspect of social dining. However, previous research has identified a number of pros and cons associated with the incorporation of digital technology into eating and drinking episodes. For instance, those who are distracted by digital technology may eat/drink more (that is, they may overconsume) as a result of their failure to attend to the food-related sensations that are thought to cue the termination of eating. Similarly, it has often been suggested that the use of mobile devices at mealtimes can disrupt the more commensal aspects of dining/drinking (at least among those who are physically present together). At the same time, however, looking to the future, it seems clear that digital technologies also hold the promise of delivering opportunities for enhanced multisensory experiential dining. For instance, they might be used to match the auditory, visual, or audiovisual entertainment to the eating/drinking episode (e.g., think only about watching a Bollywood movie while eating a home-delivery Indian meal, say). Indeed, given the growing societal problems associated with people dining by themselves, there are a number of routes by which digital technologies may increasingly help to connect the solo diner with physically co-located, remote, or even virtual dining partners. In this review of the literature, our focus is specifically on the role of technology in inhibiting/facilitating the more pleasurable social aspects of dining, what one might call "digital commensality." The focus is primarily on Westernized adults with reasonable access to, and familiarity with, digital technologies.

Nutrition Screening Tools and the Prediction of Clinical Outcomes among Chinese Hospitalized Gastrointestinal Disease Patients

Nutrition risk Screening 2002 (NRS-2002) and Subjective Global Assessment (SGA) are widely used screening tools but have not been compared in a Chinese population. We conducted secondary data analysis of a cross-sectional study which included 332 hospitalized gastrointestinal disease patients, collected by the Gastrointestinal department of Peking Union Medical College Hospital (PUMCH) in 2008. Results of NRS-2002 and SGA screening tools, complications, length of stay (LOS), cost, and death were measured. The agreement between the tools was assessed via Kappa (κ) statistics. The performance of NRS-2002 and SGA in predicting LOS and cost was assessed via linear regression. The complications and death prediction of tools was assessed using receiver operating characteristic (ROC) curves. NRS-2002 and SGA identified nutrition risk at 59.0% and 45.2% respectively. Moderate agreement (κ >0.50) between the two tools was found among all age groups except individuals aged ≤ 20, which only slight agreement was found (κ = 0.087). NRS-2002 (R square 0.130) and SGA (R square 0.140) did not perform differently in LOS prediction. The cost prediction of NRS-2002 (R square 0.198) and SGA (R square 0.190) were not significantly different. There was no difference between NRS-2002 (infectious complications: area under ROC (AUROC) = 0.615, death: AUROC = 0.810) and SGA (infectious complications: AUROC = 0.600, death: AUROC = 0.846) in predicting infectious complication and death, but NRS-2002 (0.738) seemed to perform better than SGA (0.552) in predicting non-infectious complications. The risk of malnutrition among patients was high. NRS-2002 and SGA have similar capacity to predict LOS, cost, infectious complications and death, but NRS-2002 performed better in predicting non-infectious complications.

Nutritional Risk Among Urban, Community-Dwelling Older Hispanics: Influence of Demographic and Cultural Characteristics

This investigation explored nutritional risk and dietary characteristics of older Hispanics (52 years or older) living independently in a large, urban metropolitan area. Fifty-nine participants (93% female) completed a 16-item nutrition assessment questionnaire, and dietary intake data were collected on 49 of these participants. Of participants, 65% were well-nourished, although 35% were at risk of malnutrition or were malnourished. Participants'diets were lacking adequate amounts of dietary fiber, vitamin E, folate, zinc and calcium as well as energy foods, protein, and complex carbohydrates. A culturally sensitive nutrition intervention to meet the needs of older Hispanics should emphasize adequate fluid intake and traditional food sources of fiber, vitamin E, folate, zinc, and calcium. In addition, knowledge of different types of carbohydrates and dietary fats should be incorporated into interventions that also provide opportunities for social interactions among older Hispanics.

Combined effects of eating alone and living alone on unhealthy dietary behaviors, obesity and underweight in older Japanese adults: Results of the JAGES

We examined whether eating alone is associated with dietary behaviors and body weight status, and assessed the modifying effects of cohabitation status in older Japanese people. Data from the 2010 Japan Gerontological Evaluation Study, with a self-reported questionnaire for 38,690 men and 43,674 women aged ≥65 years, were used. Eating status was classified as eating with others, sometimes eating alone, or exclusively eating alone. We calculated adjusted prevalence ratios (APRs) of unhealthy dietary behaviors, obesity, and underweight, adjusting for age, education, income, disease, and dental status using Poisson regression. Overall, 16% of men and 28% of women sometimes or exclusively ate alone. Among those who exclusively ate alone, 56% of men and 68% of women lived alone. Men who exclusively ate alone were 3.74 times more likely to skip meals than men who ate with others. Among men who exclusively ate alone, those who lived alone had a higher APR than men who lived with others. Compared with subjects who ate and lived with others, the APRs of being obese (BMI ≥ 30.0 kg/m(2)) among men who exclusively ate alone were 1.34 (1.01-1.78) in those who lived alone and 1.17 (0.84-1.64) in those who lived with others. These combined effects of eating and living alone were weaker in women, with a potential increase in the APRs among those who ate alone despite living with others. Men who exclusively ate alone were more likely to be underweight (BMI < 18.5 kg/m(2)) than men who ate with others in both cohabitation statuses. Eating alone and living alone may be jointly associated with higher prevalence of obesity, underweight and unhealthy eating behaviors in men.

Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies

Protein-energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein-energy malnutrition in community-dwelling older adults. A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein-energy malnutrition were selected and a best evidence synthesis was performed to summarize the results. In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein-energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications. This review shows that protein-energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein-energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein-energy malnutrition in community-dwelling older adults.

Eating behaviors of older adults participating in government-sponsored programs with different demographic backgrounds

The purpose of this study was to determine the food behaviors of nutritionally high-risk seniors as a function of their racial background, gender, marital status, and education level. A total of 69 seniors were identified to be at high nutritional risk using the Nutrition Screening Initiative (NSI) checklist. A supplemental questionnaire (SQ) was created to examine the risk factors in relation to the participant's demographic background. Key results indicated that Asians practiced healthy food behaviors and women were more likely to eat alone (p?0.05). Married participants (90.9%) were most likely to consume 2 meals or more each day. College educated individuals practiced healthier eating, eating 5 servings or more of fruits and vegetables (p?0.01) and 2 or more servings of milk and milk products (p?0.01). These preliminary findings indicate that more studies should be conducted to focus on the demographic characteristics and food behaviors among older populations.

Healthy eating perceptions of older adults living in Canadian rural and northern communities

Aging produces physiologic changes that can affect the nutritional health of the older adult. It is estimated that 80% of community-dwelling older adults have inadequate intakes of four or more nutrients. Socioeconomic factors, such as income and geographic location, can also play an important role in nutritional status; however, limited research is available that specifically explores this. The purpose of this qualitative study was to examine the healthy eating perceptions of older adults residing in rural and northern communities in one Canadian province. Five focus groups were conducted in three rural and two northern Manitoba communities. Thirty-nine older adults participated in audio-recorded focus groups. Five themes emerged from the discussions. All respondents stated that healthy eating was important, but knowledge deficits were observed regarding label reading, understanding and visualizing portion sizes, and vitamin D recommendations and sources. Food programs were not commonly attended by participants due to availably and resistance. Regularly delivered nutrition education programs would assist in providing current nutrition information to older adults and their families in rural settings.

Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam

Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992–3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65–85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI < 20 kg/m2 or self-reported involuntary weight loss ≥  5 % in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutrition. In univariate analyses, female sex, depressive symptoms, anxiety symptoms, multiple chronic diseases, high medication use (women), poor appetite, no alcohol use v. light alcohol use, loneliness, not having a partner, limitations in performing normal activities due to a health problem, low physical performance (participants aged < 75 years) and reporting difficulties walking stairs (participants aged < 75 years) were statistically significantly associated with incident undernutrition. In a multivariate model, poor appetite and reporting difficulties walking stairs (participants aged < 75 years) remained early determinants. The results of the present study can be used to identify subgroups of older individuals with increased risk of undernutrition and to identify modifiable determinants for the purpose of prevention of undernutrition.

Personal and social determinants of health services utilization by Mexican older people

BACKGROUND

Increased healthcare needs among older individuals around the world demands a better understanding of factors influencing healthcare service utilization patterns.

OBJECTIVE

To examine personal and social correlates to health services utilization among Mexican older persons.

DESIGN AND METHODS

This was a cross-sectional study conducted between 2004 and 2006 with 2030 Mexican adults 60 years and older and based on a health services utilization framework. A two-stage cluster sampling with probability proportionate to size was used. Participants were randomly selected and recruited in four metropolitan areas in Northeastern Mexico. Chi-square and Pearson's chi-squared tests and logistic regression were used for data analyses.

RESULTS

Significantly more women than men had lost a spouse and were illiterate. Also, females reported significantly poorer health, higher nutritional risk and lower ability to perform activities of daily and instrumental living than males. Predictors of healthcare utilization were: Having a caregiver during an illness; perceiving to have a health problem; being able to afford food, and having children.

CONCLUSIONS

Predisposing, enabling and need factors are strong predictors of health services utilization among Mexican older persons. In addition, gender differences exist among this population in relation to health status, but not to health services demands.

Are reading and behavior problems risk factors for each other?

Two questions were investigated. First, are children with reading problems in first grade more likely to experience behavior problems in third grade? Second, are children with behavior problems in first grade more likely to experience reading problems in third grade? The authors explored both questions by using multilevel logistic regression modeling to analyze data from the Early Childhood Longitudinal Study-Kindergarten Class (ECLS-K). After statistically controlling for a wide range of potential confounds, they found that children with reading problems in first grade were significantly more likely to display poor task engagement, poor self-control, externalizing behavior problems, and internalizing behavior problems in third grade. They also found that children displaying poor task engagement in first grade were more likely to experience reading problems in third grade. Collectively, these findings suggest that the most effective types of interventions are likely to be those that target problems with reading and task-focused behaviors simultaneously.

Nutritional risk among Oklahoma congregate meal participants

OBJECTIVE

To determine if there were differences by demographic variables in response rates to Nutrition Screening Initiative (NSI) Checklist statements reported by over 50% of Oklahoma Older Americans Act Nutrition Program (OAANP) congregate meal participants categorized at high nutritional risk based on cumulative NSI Checklist scores.

DESIGN

This study evaluated Oklahoma State Unit on Aging statewide archival demographic and NSI Checklist data from 8892 OAANP congregate participants.

ANALYSIS

Data were analyzed using chi-square analyses.

RESULTS

Eighteen percent of congregate participants were categorized at high nutritional risk. Over 50% of participants categorized at high nutritional risk reported "yes" to having an illness or condition that affected food eaten; eating alone; taking 3 or more medications; and inability to shop, cook, and feed themselves. Significant differences were observed in participant "yes" response rates to these NSI Checklist statements by demographic variables. Participants responded "yes" more to these statements if they were female, of advanced age, and living alone or in rural areas.

CONCLUSIONS AND IMPLICATIONS

The results of this study indicate problem areas and population groups for targeting nutrition education programs and services among Oklahoma OAANP congregate meal participants.

Which are the most efficient items of mini nutritional assessment in multimorbid patients?

OBJECTIVE

The aim of the study was to identify the most significant MNA-items to accelerate the determination of nutritional risk of elderly patients in routine clinical practice in a geriatric hospital. Since MNA requires 10-15 min it is hardly applicable to clinical routine.

DESIGN

The study was a cross-sectional study.

SETTING

The study centre was an acute geriatric hospital.

PARTICIPANTS

In total 808 multimorbid elderly patients were recruited.

METHODS

We applied the MNA in 808 (528 f/280 m) geriatric multimorbid patients (78.5+/-8.7f / 74.6+/-9 m yrs) without cognitive impairment 48 h after hospital admission. Admission diagnoses covered orthopaedical (40%), internal (34%) and cerebrovascular (24%) diseases. According to analysis of reliability the consistency of the MNA scale for multimorbid patients has been verified. In preparation for scale reduction a factor analysis was applied. A reduced scale with selected cutoffs was configured and compared with MNA.

RESULTS

According to MNA, 15% of patients were well-nourished, 65% at risk of malnutrition and 20% were malnourished. The reliability analyses showed a Cronbach's Alpha of 0.60 that represented a satisfactory result. By means of factor analysis the MNA-items were reduced from 18 to 7 items (weight loss, mobility, BMI, number of full meals, fluid consumption, mode of feeding, health status). with new cutoffs (12.5-15 well-nourished, 9-12 at risk of malnutrition, <9 malnourished). According to the modified MNA (m-MNA) 21.7% of the patients were well-nourished, 54.5% at risk of malnutrition and 21.7% were malnourished. The score of the MNA and m-MNA correlated with r=0.910. Furthermore, there was a strong correlation between MNA and m- MNA group classification of 83%.

CONCLUSION

The m-MNA enables a rapid (3 min) and efficient screening of malnutrition in multimorbid geriatric patients. The m-MNA is easy to apply and may also be suitable in multimorbid patients with cognitive dysfunction. Due to the variety of items the m-MNA seems to be superior to other screening tools.

Risk for Low Weight in Community-Dwelling, Older Adults

PURPOSE

The purpose of this study was to describe nutritional risk and low weight in community-dwelling elderly.

METHOD

This cross-sectional exploratory study used in-depth interviews conducted on older adults with a body mass index <24 kg/m. Depression, mental state, nutrition, and demographic data were measured.

RESULTS

These elders (n = 130) were mostly female (55%, n = 71), married, white (84%, n = 109), and had a greater than a high school education. In a multivariate logistic regression analysis, 3 variables were statistically significantly associated with being severely underweight: those who self-reported having an illness or condition that changed the kind and/or amount of food eaten, unintentional weight loss of 10 lb in the last 6 months, and needing assistance with traveling outside the home.

CONCLUSION

Awareness of the high nutritional risk should prompt consideration of early, appropriate assessment and therapy to prevent malnutrition and a declining quality of life.

Benefits of snacking in older Americans

OBJECTIVE

Because energy intakes decline with age, the purpose of this study was to evaluate the influence of snacking on energy intakes and energy density in older adults.

DESIGN

Twenty-four-hour dietary recall data from the National Health and Nutrition Examination Survey 1999-2002 were used to compare the diets of snackers and nonsnackers.

SUBJECTS

This study included 2,002 adults aged 65 years and older.

STATISTICAL ANALYSIS PERFORMED

All statistical analyses accounted for the survey design and sample weights. Linear regression was used to estimate energy and energy-yielding nutrient intakes, eating occasions, energy intake per eating occasions, and energy density of eating occasions.

RESULTS

The prevalence of snacking was high (84%) among this age group, and snackers had significantly higher daily intakes of energy, protein, carbohydrate, and total fat. Alcohol intakes were not significantly different. For those who snacked, it contributed almost a quarter of their energy and carbohydrate intakes and a fifth of their daily fat intakes. Snacking contributed 14% of their daily protein intakes. Snackers had, on average, two and a half snacking occasions per day, with each snacking occasion contributing 150 kcal. The average energy contribution of meals was not different between snackers and nonsnackers. The energy density of meals is significantly greater for snackers than for nonsnackers.

CONCLUSIONS

Results from this study demonstrate that snacking is an important dietary behavior among older adults. Whereas snacking may promote energy imbalance resulting in obesity among other age groups, our results suggest snacking may ensure older adults consume diets adequate in energy.

Nutritional risk and low weight in community-living older adults: a review of the literature (1995-2005)

Although many studies have examined weight loss and low weight in institutionalized persons, there has been little research exploring the community-living older adult's nutritional risk. The purpose of this literature review (1995-2005) is to describe our current understanding of nutritional risk and low weight in community-living older adults 65 years old and older. Computerized database searches and footnote reviews were used to find published studies on nutritional risk and low weight. Twenty-two research articles are reviewed and summarized. Each study was reviewed according to preset criteria.

Coaching Process Outcomes of a Family Visit Nutrition and Physical Activity Intervention

The purpose of this article is to report the process outcomes of a coaching methodology used in a study designed to increase fruit and vegetable consumption and physical activity in families. Eighty-eight families with second graders were recruited from a rural, biethnic community in Colorado and randomized to intervention and delayed intervention conditions. This article reports on the 27 families in the delayed intervention group. Families received up to 10 home visits over 10 months from a family advisor and completed activities to improve their dietary and physical activity behaviors. Coaching conversations took place during each home visit. Coaching process outcomes were evaluated by analysis of visit documentation, participant survey, and qualitative interviews. Results indicated that coaching, in conjunction with family activities, engaged families in the process of change and facilitated movement toward the achievement of their weekly nutrition or physical activity goals. Coaching methodology may be particularly useful for participatory research.

Adapting and implementing a long-term nutrition and physical activity curriculum to a rural, low-income, biethnic community

This study adapted an urban-based school nutrition program for delivery in a rural community. Specific aims were to adapt the curriculum; expand it to include physical activity; determine effectiveness on students' attitudes, knowledge, and self-efficacy; and assess teachers' impressions. Three cohorts were established: 173 students taught by a resource teacher, 170 students taught by classroom teachers, and 187 students who did not receive the curriculum. Pre- and posttest surveys measured outcomes, and classroom teachers were observed and interviewed. The curriculum was shown to be effective in enhancing student outcomes for both the resource teacher and classroom teacher cohorts. Teachers reported that lessons needed to be simplified and that children enjoyed them. Findings support the transferability of an urban-based nutrition curriculum to a rural community and the need for students to receive health education annually.

Aging in community nutrition, diet therapy, and nutrition and aging textbooks

Using content analysis, this study evaluated the aging content and context in 11 nutrition sub-specialty textbooks: community nutrition (n = 3), diet therapy (n = 4), and nutrition and aging (n = 4). Pages with paragraphs on aging were identified in community nutrition and diet therapy textbooks, and 10% random samples of pages were evaluated in nutrition and aging textbooks. Paragraphs were assigned to one of four categories: gerontology, nutrition as primary, nutrition as secondary, or tertiary prevention. A total of 310 pages was qualitatively analyzed using NUD*IST 5 software and quantitatively with percentages. Only 7% of community nutrition and 2% of diet therapy pages were devoted to aging. There was little integration of aging beyond the chapters on aging. Community nutrition had the most gerontology (30%) and primary prevention (43%) content. Diet therapy and nutrition and aging had more secondary prevention (33% and 42%, respectively) and tertiary prevention (27% each) content. Some important databases and studies were absent. Of the 1,239 ageism words, 10% were positive, 53% neutral, and 36% negative. Photographs were generally positive. Women, but not minorities, reflected current older adult demographics. Future textbook editions should address aging more comprehensively and positively to better prepare dietitians for the job market. Recommendations for authors, course instructors, and publishers are given.

Increasing hip fracture incidence in California Hispanics, 1983 to 2000

BACKGROUND

Hip fracture incidence in non-Hispanic whites (NHW) has decreased nationwide for the past 20 years. Little is known regarding hip fracture incidence among Hispanics, the largest, fastest growing minority in the United States.

OBJECTIVE

To assess the change in standardized hip fracture incidence from 1983 through 2000 in California Hispanics relative to other racial groups.

DESIGN

Hospitalizations for individuals older than 55 years with hip fracture requiring repair in acute care hospitals. Annual population estimates based on US Census Bureau estimates. Incidence standardized to national gender-age strata. Change in annual incidence calculated by weighted linear regression with robust variance estimates.

RESULTS

372,078 hip fractures were identified. Age-adjusted annual incidence of hip fractures declined by 0.74% per year among women (655 to 568 per 100,000), but was unchanged among men (247 to 238 per 100,000). Among NHW women, the standardized annual incidence fell by 0.6% (4.0 fractures per 100,000) per year. Annual incidence among Hispanic women increased 4.9% (11.1 fractures per 100,000) per year. Annual incidence among Hispanic men increased by 4.2% (4.5 fractures per 100,000) per year and among NHW men by 0.5% (1.2 fractures per 100,000) per year. No significant change occurred among black or Asian women or men.

CONCLUSIONS

Among California women, hip fracture incidence has doubled among Hispanics since 1983, while remaining unchanged or declining in other groups. Greater attention should be given to identification of individuals at risk for hip fracture and initiation of preventive measures in Hispanic populations.

Health-promoting lifestyle behaviors of Spanish-speaking Hispanic adults

The study purpose was to determine (a) health-promoting lifestyle behaviors of Spanish-speaking Hispanics, (b) differences in these behaviors by demographics and acculturation, and (c) the extent to which perceived health status, demographics, and acculturation explain health-promoting lifestyles. The Spanish-language Health-Promoting Lifestyle Profile II (HPLPII) and other instruments were completed by a convenience sample of 545 Hispanic adults recruited in several midwestern communities. Of the six behavioral dimension scores of the HPLPII, scores were lowest for physical activity and highest for spiritual growth. They differed by age, gender, employment status, marital status, and acculturation. Perceived health status, demographics, and acculturation explained 12% of the variance in overall health-promoting lifestyle. These findings can help guide culturally appropriate interventions designed to improve this population's overall health.

Modifiable risks of incident functional dependence in Hispanic and non-Hispanic white elders: the San Luis Valley Health and Aging Study

PURPOSE

This study identified modifiable risks associated with incident functional dependence, compared their effects, and estimated the percent risk attributable to each factor, by ethnicity.

DESIGN AND METHODS

The prospective study cohort comprised 751 rural Hispanic and non-Hispanic White elders from southern Colorado who reported no dependence in basic and instrumental activities of daily living (ADLs and IADLs) at baseline. Logistic regression modeled the effects of physical inactivity, nutritional risk, smoking, and falls on incident disability 22 months later, with and without adjustment for baseline ADL and IADL difficulty. Population attributable risk percentages assessed these modifiable risks by ethnicity.

RESULTS

Each risk factor multiplied the likelihood of incident dependence by 1.4 or more, adjusted for covariates. Attributable risk percentages ranged from 8% to 32% depending on risk factor, ethnicity, and baseline ADL and IADL difficulty status. Attributable risk was generally greater among Hispanic elders, the result of higher prevalence of most of the risk factors.

IMPLICATIONS

Interventions targeted at inadequate nutrition, inactivity, smoking, and preventable falls offer opportunities to reduce incident functional disability, especially among Hispanic elders.

Using ethnography to improve intervention design

PURPOSE

The purpose of this research was to use a three-phase ethnographic approach to examine the range of factors that affect people's decisions about physical activity and diet.

DESIGN

We used open-ended data collection strategies, analyzed inductively, to inform, the development of a family intervention.

SETTING

The study was conducted in a small low-income town in Colorado.

SUBJECTS

Families with young children were selected to include social, economic, and ethnic diversity. Twenty-nine of 31 invited families participated (94%).

MEASURES

The measures consisted of 21 open-ended interviews in the first phase; 12 semistructured interviews in the second phase, and six home visits in the third phase. The Atlas.ti program25 was used for data analysis.

RESULTS

Significant barriers to regular exercise and good dietary habits were grouped as social/structural (e.g., working parents, costs of exercise) and cultural (e.g., perception that fast food is normal). Behavioral facilitators include disease in the family and community opportunities for exercise. Results revealed family values and dynamics that other methods would have missed.

CONCLUSIONS

These data suggest that families are embedded in a multicomponent "web" of factors that influence diet and physical activity. It is feasible and desirable to use ethnographic methods to discern the interactions of these factors that make each household unique. These results argue for dynamic intervention designs that operate from a broad contextual perspective.

Sociodemographic diversity and behavioral medicine

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.

A concept analysis of malnutrition in the elderly

PURPOSE

Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts.

SCOPE, SOURCES USED

Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss.

CONCLUSIONS

The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.

Nutrition and healthy functioning in the developing world

There is a general lack of data for studying the relationship between nutrition and healthy functioning among the elderly in developing countries. Nevertheless, knowledge of biological relationships from studies in other countries can be applied to gain an understanding of what can be expected in the developing world. In this respect, the concept of the nutrition transition is important. However, nutrition transition as related to elderly populations in developing countries has not yet been adequately studied. The developing world is not homogeneous with respect to patterns of nutritional status among the elderly, and problems of both under- and overnutrition exist among different populations of the elderly and both will be important factors for future functional status levels. In addition, there are many extrinsic factors (such as socioeconomic, political and cultural factors) in these countries that are even more important in determining nutritional status and its relation to function. Unless research and policy development in developing countries escalate and keep pace with the nutrition and demographic transitions in these countries, high levels of disability and dependency are likely in the near future.

Nutritional and health consequences are associated with food insecurity among U.S. elderly persons

The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.

Understanding needs is important for assessing the impact of food assistance program participation on nutritional and health status in U.S. elderly persons

This study aimed to assess the impact of food assistance programs on nutritional and health status of nutritionally needy elderly persons. Two cross-sectional and one longitudinal data sets were used: Third National Health and Nutrition Examination Survey (1988-94), Nutrition Survey of the Elderly in New York State (1994) and Longitudinal Study of Aging (1984-1990). Multiple logistic and linear regression analyses were used to examine whether food assistance participants among food insecure elderly (i.e., those whose needs for food assistance programs are met) have better nutrient intake, skinfold thickness and self-reported health status and less nutritional risk, hospitalization and mortality than nonparticipants (i.e., those whose needs are unmet) and whether the benefit is larger than that among food secure elderly persons. Across three data sets, food insecure elderly persons had poorer nutritional and health status than food secure elderly persons. Contrary to the hypotheses, among food insecure elderly persons, food assistance participants had similar or poorer nutrient intakes, skinfold thickness, nutritional risk, self-reported health status, hospitalization and mortality than nonparticipants. Food secure participants had similar nutritional and health status as food secure nonparticipants. Lack of information on the dynamic nature and changes in needs with program participation in the three data sets likely did not allow accurate estimation of the impact of food assistance participation. Different study designs, as well as theory and knowledge of needs that clarifies need status and its change within each older individual across an appropriate time interval, are necessary to accurately assess impacts of food assistance programs.

Position of the American Dietetic Association: nutrition, aging, and the continuum of care

Scientific evidence increasingly supports that good nutrition is essential to the health, self-sufficiency, and quality of life of older adults. With the population of the United States living longer than ever before, the older adult population will be more diverse and heterogeneous in the 21st century. The oldest-old and minority populations will grow more quickly than the young-old and non-Hispanic white populations, respectively. For the current 34 million adults 65 years of age and older living in the United States, there are about 12 million caregivers who provide formal or informal care. A broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults is needed. With changes and lack of coordination in health care and social-support systems, dietetics professionals need to be proactive and collaborate with aging-services and other health care professionals to improve policies, interventions, and programs that service older adults throughout the continuum of care to ensure nutritional well-being and quality of life. The American Dietetic Association supports both the provision of comprehensive food and nutrition services and the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.