Activity Limitation and Food Intake in Community-Living Seniors

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

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

Food security in older adults: community service provider perceptions of their roles

Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

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

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

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch

OBJECTIVE

This study evaluated the influence that expanding a home-delivered meals service to include breakfast and lunch would have on the nutritional status and quality of life of at-risk older adults.

DESIGN

This cross-sectional field study compared two groups. The breakfast group (n=167) received a home-delivered breakfast and lunch, 5 days per week. The comparison group (n=214) received a home-delivered lunch 5 days per week. Participants' 24-hour food recall, demographics, malnutrition risk, functional status, and surveys of quality of life as health, loneliness, food enjoyment, food security, and depression were obtained.

PARTICIPANTS

Study participants were recruited from five Elderly Nutrition Programs involved in the Morning Meals on Wheels breakfast service demonstration project. They formed a geographically and racially/ethnically diverse sample. Participants ranged in age from 60 to 100 years, were functionally limited, and at high nutritional risk. Most were low income, lived alone, and had difficulty shopping or preparing food.

STATISTICAL ANALYSIS

Descriptive statistics were used to assess group comparability. Independent sample t tests were used to examine group differences, with Bonferroni's method used to control for familywise Type I error.

RESULTS

Breakfast group participants had greater energy/nutrient intakes (P<.05), greater levels of food security (P<.05), and fewer depressive symptoms (P<.05) than comparison group participants.

CONCLUSIONS

The addition of a breakfast service to traditional home-delivered meals services can improve the lives of frail, homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service to a targeted population.

Nutritional risk in vulnerable community-living seniors

The purpose of this study was to quantify nutritional risk in a convenience sample of vulnerable, community-living seniors, and to determine patterns of nutritional risk in these seniors. The sample consisted of 367 seniors who provided health, functional, and nutritional risk information during an interview in which the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire was used. The majority (73.6%) of the sample was female, and the mean age was 79 years. Nutritional risk was identified in 68.7% of the sample, with 44.4% being at high nutritional risk. Common nutritional risk factors were weight change, restricting food, low fruit and vegetable intake, difficulty with chewing, cooking, or shopping, and poor appetite. Principal components analysis identified four independent components within the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire; these components can be described as low food intake, poor appetite, physical and external challenges, and instrumental activity challenges. Data are sparse on nutritional risk in community-living Canadian seniors; despite methodologic limitations in the recruitment process, this study provides some indication of the level of nutrition problems. The patterns of nutritional risk identified in this vulnerable population may help providers identify useful strategies for ameliorating risk. The Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire could be used to identify risk and patterns of risk in Canadian seniors, so that treatment could be individualized.

Dietary intake of older adults in the Kingston area

The objectives of this research were to describe the dietary intake and identify risk factors for poor dietary intake in community-dwelling older adults living in the Kingston, Frontenac, and Lennox & Addington Health Unit area. Dietary intake information was collected from a convenience sample of 105 relatively healthy, active older adults (84 women, 21 men) using 24-hour recalls from three non-consecutive days. Risk factors for poor dietary intake were identified through a structured interview. Multiple linear regression was used to generate a model to predict dietary intake, which was measured using a diet score based on Canada's Food Guide to Healthy Eating. Group averages reflected reasonable diet quality, but some subjects had very low nutrient intakes, particularly of zinc and vitamins B6, B12, and C. On average, women had a lower-than-recommended intake from all food groups, while men consumed adequate amounts of all food groups except milk products. Higher scores indicated better overall diet quality, and the following were significant predictors of a high diet score: "almost always" preparing one's own meals, food "almost always" or "sometimes/never" tasting good, eating lunch every day, and taking fewer prescription medications. This model requires validation with a larger and more diverse population of community-dwelling older adults.