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Hernández-Moreno A, Vásquez-Palma O, Gutiérrez-Gutiérrez F, Cordero-Ahiman O, Celedón-Celis N, Hochstetter-Diez J. Analysis of Food Security of Older Rural Indigenous People in Latin America and the Caribbean. Foods 2024; 13:1772. [PMID: 38891000 PMCID: PMC11172135 DOI: 10.3390/foods13111772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
Food insecurity is a critical issue in the Americas, with severe impacts in the Caribbean, Mesoamerica, and South America, particularly affecting older adults in Indigenous and rural contexts where it intersects with poverty, gender, and ethnicity. This study aims to provide an in-depth understanding of the current research about food insecurity among older Indigenous adults in Latin America and the Caribbean. A comprehensive literature review was conducted, utilizing specific search queries and the population, intervention, comparison, and outcome (PICO) strategy across multiple databases to identify the pertinent studies. The findings indicate an increase in academic output on this topic since 2018, with significant emphasis on the interplay between climate change and food insecurity. The review highlights the importance of developing targeted food programs, reforming policies, and fostering collaboration between academia and local communities to implement practical interventions. Despite the growing body of literature, a notable research gap persists in rural areas of Latin America and the Caribbean. This study underscores the necessity of balancing the geographic distribution of research and emphasizes the preservation of cultural practices and the adaptation of public policies to support traditional food practices. It advocates for culturally sensitive interventions and interdisciplinary collaboration to formulate comprehensive strategies. The originality and value of this study lie in its focused analysis of older Indigenous adults, contributing crucial insights to the international literature on food security.
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Affiliation(s)
- Angélica Hernández-Moreno
- Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile; (A.H.-M.); (N.C.-C.)
- Centro de Estudios y Promoción de los Derechos Humanos, Universidad de La Frontera, Temuco 4780000, Chile
| | - Olga Vásquez-Palma
- Departamento de Procesos Terapéuticos, Universidad Católica de Temuco, Temuco 4780000, Chile;
| | | | - Otilia Cordero-Ahiman
- Departamento de Economía, Empresa y Desarrollo Sostenible, Universidad de Cuenca, Cuenca 010201, Ecuador;
| | - Natalia Celedón-Celis
- Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco 4780000, Chile; (A.H.-M.); (N.C.-C.)
| | - Jorge Hochstetter-Diez
- Departamento de Ciencias de la Computación e Informática, Universidad de La Frontera, Temuco 4780000, Chile;
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Kumar A. Medicare advantage initiative to improve social determinants of health. J Am Geriatr Soc 2024. [PMID: 38801152 DOI: 10.1111/jgs.19017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
This editorial comments on the article by Richards et al.
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Affiliation(s)
- Amit Kumar
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Lee MJ, Almidani L, Samuel L, Swenor BK, Ehrlich JR, Varadaraj V. Vision impairment and food insecurity in the national health and aging trends study. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1353083. [PMID: 38751732 PMCID: PMC11094228 DOI: 10.3389/fepid.2024.1353083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
Introduction Vision impairment (VI) may further exacerbate older adults' vulnerability to experiencing food insecurity and may be a unique and important target for policies addressing access to nutritional food. The purpose of this study is to determine the association of VI in older adults with food insecurity. Methods This is a cross-sectional analysis of round 11 (2021) of the National Health and Aging Trends Study (NHATS), a nationally representative survey of U.S. Medicare beneficiaries ages 65 and older. Participants include 2,815 older adults with complete data on at least one objective measure of vision (distance, near or contrast sensitivity) and food insecurity. Food insecurity was assessed using a previously developed indicator of food insecurity in NHATS. VI was defined as binocular visual acuity (VA) worse than 0.3 logMAR (Snellen equivalent 20/40) at distance or its near equivalent, or contrast sensitivity (CS) worse than 1.55 logUnits. Continuous VI measures included distance and near VA (per 0.1 logMAR), and CS (per 0.1 logCS). Results Participants were majority White (82%) and female (55%), and 3% had food insecurity. Older adults with any VI had a greater prevalence of food insecurity than adults without VI (5.0% vs. 2.0%, p < 0.05). In fully adjusted regression analyses, individuals with any VI experienced double the odds of food insecurity than individuals without VI (OR: 2.1, 95% CI: 1.2-3.6). Distance VI (measured continuously) was associated with 1.2 times the odds of food insecurity (OR = 1.2; 95% CI: 1.0-1.3, per 0.1 logMAR). All other vision measures trended towards higher odds of food insecurity, though not statistically significant. Discussion Older adults with VI experience higher rates of food insecurity than their peers. Interventions to improve food security should be targeted towards addressing the specific barriers faced by visually impaired older adults.
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Affiliation(s)
- Moon J. Lee
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Louay Almidani
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laura Samuel
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - Bonnielin K. Swenor
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Varshini Varadaraj
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, United States
- Johns Hopkins University School of Nursing, Baltimore, MD, United States
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Flores AC, Sarpong C, Dou N, Na M. Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS). Nutr J 2024; 23:25. [PMID: 38414001 PMCID: PMC10898009 DOI: 10.1186/s12937-024-00918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Studies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults. METHODS Our study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants' experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes. RESULTS In 2013-2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (𝛽 = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance. CONCLUSIONS Among older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.
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Affiliation(s)
- Ashley C Flores
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA
| | - Christopher Sarpong
- Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Nan Dou
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA
| | - Muzi Na
- Department of Nutritional Sciences, 108C Chandlee Laboratory, The Pennsylvania State University, University Park, University Park, PA, 16802, USA.
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Brech GC, da Silva VC, Alonso AC, Machado-Lima A, da Silva DF, Micillo GP, Bastos MF, de Aquino RDC. Quality of life and socio-demographic factors associated with nutritional risk in Brazilian community-dwelling individuals aged 80 and over: cluster analysis and ensemble methods. Front Nutr 2024; 10:1183058. [PMID: 38235441 PMCID: PMC10792032 DOI: 10.3389/fnut.2023.1183058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/26/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction The aim of the present study was to use cluster analysis and ensemble methods to evaluate the association between quality of life, socio-demographic factors to predict nutritional risk in community-dwelling Brazilians aged 80 and over. Methods This cross-sectional study included 104 individuals, both sexes, from different community locations. Firstly, the participants answered the sociodemographic questionnaire, and were sampled for anthropometric data. Subsequently, the Mini-Mental State Examination (MMSE) was applied, and Mini Nutritional Assessment Questionnaire (MAN) was used to evaluate their nutritional status. Finally, quality of life (QoL) was assessed by a brief version of World Health Organizations' Quality of Life (WHOQOL-BREF) questionnaire and its older adults' version (WHOQOL-OLD). Results The K-means algorithm was used to identify clusters of individuals regarding quality-of-life characteristics. In addition, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) algorithms were used to predict nutritional risk. Four major clusters were derived. Although there was a higher proportion of individuals aged 80 and over with nutritional risk in cluster 2 and a lower proportion in cluster 3, there was no statistically significant association. Cluster 1 showed the highest scores for psychological, social, and environmental domains, while cluster 4 exhibited the worst scores for the social and environmental domains of WHOQOL-BREF and for autonomy, past, present, and future activities, and intimacy of WHOQOL-OLD. Conclusion Handgrip, household income, and MMSE were the most important predictors of nutritional. On the other hand, sex, self-reported health, and number of teeth showed the lowest levels of influence in the construction of models to evaluate nutritional risk. Taken together, there was no association between clusters based on quality-of-life domains and nutritional risk, however, predictive models can be used as a complementary tool to evaluate nutritional risk in individuals aged 80 and over.
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Affiliation(s)
- Guilherme Carlos Brech
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, São Paulo, Brazil
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderlei Carneiro da Silva
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Angelica Castilho Alonso
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, São Paulo, Brazil
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Machado-Lima
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, São Paulo, Brazil
| | - Daiane Fuga da Silva
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, São Paulo, Brazil
| | | | - Marta Ferreira Bastos
- Postgraduate Program in Aging Sciences, Universidade São Judas Tadeu, São Paulo, Brazil
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Neves Freiria C, Arikawa A, Van Horn LT, Pires Corona L, Wright LY. Food Insecurity Among Older Adults Living in Low- and Middle-Income Countries: A Scoping Review. THE GERONTOLOGIST 2024; 64:gnac161. [PMID: 36306201 DOI: 10.1093/geront/gnac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Food insecurity is considered an increasing public health problem worldwide with adverse effects, especially among older adults. Although the literature related to food insecurity among older adults in low- and middle-income countries (LMIC) are expanding, little is known about existing patterns and knowledge gaps in these settings. This scoping review aims to provide a comprehensive overview of the current research related to food insecurity among older adults in LMIC. RESEARCH DESIGN AND METHODS A systematic search was conducted in November 2021 and revised in July 2022 on six databases using terms related to food insecurity and older adults. Data were extracted, and the emerging themes from the main findings were summarized using a social-ecological model (SEM). RESULTS Forty-one studies met the inclusion criteria. Almost half (48.8%) were published in the last 2 years and utilized a quantitative approach (n = 38). Only one study was conducted in a low-income country. Using the SEM, most studies included in this review focused on addressing the relationship between food insecurity with intrapersonal factors. DISCUSSION AND IMPLICATIONS Several gaps in the current literature were identified. There is a lack of longitudinal and qualitative studies available on this topic. Also, only 15 LMIC were represented in the literature. A critical point in this review is that only a few studies addressed the relationship between food insecurity and the policy/social structure, institutional, community, and interpersonal levels. These identified gaps can serve as a guide for future research on this topic.
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Affiliation(s)
| | - Andrea Arikawa
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | - Leslie T Van Horn
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | | | - Lauri Y Wright
- Department of Nutrition and Dietetics, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
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Crowther VB, Davis Weaver J, Green-Weir RR, Moton BA, Simmons MV, Alexander AK, Weatherspoon MA, Nash B, Jones JG, Robinson C. Factors Associated With Food Insecurity Among a Community-Based Sample of Older Adults in a North Florida County. Gerontol Geriatr Med 2024; 10:23337214231221328. [PMID: 38204920 PMCID: PMC10777757 DOI: 10.1177/23337214231221328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024] Open
Abstract
Food insecurity impacts the lives of 7.6 million U.S. adults aged 60 and older and is linked to numerous life challenges. This study examined the nature of food insecurity among community-based participants ≥65 years in a north Florida county and conceptualized food insecurity as encompassing the lack of food and individual adaptability. Thus, food insecurity was measured using three dependent variables: (1) worrying that food would run out, (2) cutting meal size or skipping meals, and (3) food not lasting. Logistic regression revealed that older participants, those with better-perceived health status, and those who were confident that they could find solutions to their problems had lower odds of reporting food insecurity. However, respondents who lived in low-income, low-access zip codes and those who received food assistance were more likely to report food insecurity. To improve outcomes and reduce healthcare disparities, solutions to food insecurity must vary in focus and approach.
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Affiliation(s)
| | | | | | - Brandon A. Moton
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | - Mary V. Simmons
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | | | | | - Brittany Nash
- Florida Agricultural and Mechanical University, Tallahassee, USA
| | - Jian G. Jones
- Florida Agricultural and Mechanical University, Tallahassee, USA
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Thomas KS, Bunker J, Gadbois E, Hilgeman M, McCreedy E, Mills W, Ornstein KA, Reckrey J, Gutman R. Home-Delivered Meals and Nursing Home Placement Among People With Self-Reported Dementia: A Pilot Pragmatic Clinical Trial. JAMA Netw Open 2023; 6:e2347195. [PMID: 38117500 PMCID: PMC10733798 DOI: 10.1001/jamanetworkopen.2023.47195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023] Open
Abstract
Importance Home-delivered meals promote food security and independence among homebound older adults. However, it is unclear which of the 2 predominant modes of meal delivery, daily-delivered vs mailed (or drop-shipped) frozen meals, promotes community living for homebound older adults with dementia. Objective To assess the risk of nursing home admission within 6 months between homebound individuals receiving daily-delivered vs drop-shipped frozen meals. Design, Setting, and Participants This pilot, multisite, 2-arm, pragmatic clinical trial included older adults with self-reported dementia on waiting lists for meals at 3 Meals on Wheels (MOW) programs in Texas and Florida between April 7 and October 8, 2021, to assess time to nursing home placement. Interventions Participants were randomized to receive either meals delivered by an MOW driver or frozen meals that were mailed to participants' homes every 2 weeks. Participants received their assigned intervention for up to 6 months. Main Outcomes and Measures The primary study outcome was days from randomization to a Minimum Data Set nursing home admission assessment within 6 months. Feasibility of conducting this type of study was examined by tracking enrollment, examining baseline characteristics, monitoring participants' intervention fidelity, measuring the proportion of participants linked with Centers for Medicare & Medicaid Services (CMS) data, and analyzing the primary study outcome. Results Among 325 eligible participants who were randomized, 243 enrolled in the study (mean [SD] age, 81 [8.0] years; 152 (62.6%) were female): 128 to the daily-delivered meals group and 115 to the drop-shipped frozen meals group; 119 participants (49.0%) lived alone. Among the total participants enrolled, 227 (93.4%) were linked deterministically to their CMS data; probabilistic methods were used to link the remaining 16 participants (6.6%). At 6 months from randomization, 160 participants (65.8%) were still receiving meals, and 25 (10.1%; 95% CI, 6.3%-14.0%) were admitted to a nursing home. After adjusting for sex, race and ethnicity, age, program, and living arrangement and the use of death as a censoring event, the adjusted log hazard ratio of nursing home placement between daily-delivered and drop-shipped frozen meals was -0.67 (95% CI, -1.52 to 0.19). Conclusions and Relevance This pilot randomized clinical trial demonstrated the feasibility of enrolling participants with self-reported dementia on waiting lists at MOW programs, linking their data, and evaluating outcomes. While this pilot study was not powered to detect meaningful, statistically significant differences in nursing home placement, its feasibility and initial results warrant exploration in a follow-on, adequately powered trial. Trial Registration ClinicalTrials.gov Identifier: NCT04850781.
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Affiliation(s)
- Kali S. Thomas
- Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | - Jen Bunker
- Brown University School of Public Health, Providence, Rhode Island
| | - Emily Gadbois
- Brown University School of Public Health, Providence, Rhode Island
| | - Michelle Hilgeman
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
- Department of Psychology, The University of Alabama, Tuscaloosa
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, Rhode Island
| | - Whitney Mills
- Brown University School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
| | | | | | - Roee Gutman
- Brown University School of Public Health, Providence, Rhode Island
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Mostafa N, Sayed A, Rashad O, Baqal O. Malnutrition-related mortality trends in older adults in the United States from 1999 to 2020. BMC Med 2023; 21:421. [PMID: 37936140 PMCID: PMC10631109 DOI: 10.1186/s12916-023-03143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Malnutrition mortality in older adults is underrepresented in scientific literature. This obscures any recent changes and hinders needed social change. This study aims to assess malnutrition mortality trends in older adults (≥ 65 years old) from 1999 to 2020 in the United States (U.S.). METHODS Mortality data from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiology Research (WONDER) database were extracted. The ICD-10 Codes E40 - E46 were used to identify malnutrition deaths. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) were extracted by gender, age, race, census region, and urban-rural classification. Joinpoint regression analysis was used to calculate annual percentage changes (APC) of AAMR by the permutation test and the parametric method was used to calculate 95% confidence intervals. Average Annual Percentage Changes (AAPC) were calculated as the weighted average of APCs. RESULTS Between 1999 and 2020, 93,244 older adults died from malnutrition. Malnutrition AAMR increased from 10.7 per 100,000 in 1999 to 25.0 per 100,000 in 2020. The mortality trend declined from 1999 to 2006 (APC = -8.8; 95% CI: -10.0, -7.5), plateaued till 2013, then began to rise from 2013 to 2020 with an APC of 22.4 (95% CI: 21.3, 23.5) and an overall AAPC of 3.9 (95% CI: 3.1, 4.7). Persons ≥ 85 years of age, females, Non-Hispanic Whites, residents of the West region of the U.S., and urban areas had the highest AAPCs in their respective groups. CONCLUSION Despite some initial decrements in malnutrition mortality among older adults in the U.S., the uptrend from 2013 to 2020 nullified all established progress. The end result is that malnutrition mortality rates represent a historical high. The burden of the mortality uptrends disproportionately affected certain demographics, namely persons ≥ 85 years of age, females, Non-Hispanic Whites, those living in the West region of the U.S., and urban areas. Effective interventions are strongly needed. Such interventions should aim to ensure food security and early detection and remedy of malnutrition among older adults through stronger government-funded programs and social support systems, increased funding for nursing homes, and more cohesive patient-centered medical care.
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Affiliation(s)
| | - Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar Rashad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Omar Baqal
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
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Jones HN, Leiman DA, Porter Starr KN, North R, Pieper CF, Robison RD, Cohen SM. Dysphagia in Older Adults is Associated With Food Insecurity and Being Homebound. J Appl Gerontol 2023; 42:1993-2002. [PMID: 37249305 PMCID: PMC10811649 DOI: 10.1177/07334648231177568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Objective: Our aim was to evaluate relationships between swallowing difficulty (dysphagia) and social determinants of health (SDOH) in older adults ≥65 years. Method: Cross-sectional analyses were performed in community-dwelling Medicare beneficiaries from the National Health & Aging Trends Study (NHATS). The primary exposure was self-reported difficulty chewing/swallowing in the prior month. Dependent measures included a variety of SDOH outcomes (e.g., food insecurity [FI]). Weighted logistic regression models were estimated to determine associations between dysphagia and SDOH outcomes. Results: Of 4041 participants, 428 (10.6%) self-reported dysphagia. In the adjusted model, dysphagia was associated with significantly increased odds for FI (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.06, 2.07, p = .023) and being homebound (OR = 1.32, 95% CI = 1.13, 1.55, p= < .001). Discussion: Older adults with dysphagia had increased odds of FI and being homebound. These associations have implications for health-promoting interventions at the individual and policy levels in older adults.
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Affiliation(s)
- Harrison N. Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David A. Leiman
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Kathryn N. Porter Starr
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Durham VA Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC
| | - Rebecca North
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Raele D. Robison
- Department of Medicine, University of Wisconsin-Madison, Madison, WI
| | - Seth M. Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
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Kim B, Samuel LJ, Thorpe RJ, Crews DC, Szanton SL. Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older. JAMA Netw Open 2023; 6:e234674. [PMID: 36961460 PMCID: PMC10313147 DOI: 10.1001/jamanetworkopen.2023.4674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
Importance Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults. Objective To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults. Design, Setting, and Participants This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022. Exposures Self-reported food insecurity assessed from 2012 to 2019. Main Outcomes and Measures Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year's cognitive functions were linked to the prior year's food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011. Results Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was -0.04 (95% CI, -0.09 to -0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, -0.05 to 0.08] and -0.01 [95% CI, -0.08 to 0.06], respectively). Conclusions and Relevance Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults' cognitive outcome.
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Affiliation(s)
- Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Laura J. Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Roland J. Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
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12
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Tari Selcuk K, Atan RM, Arslan S, Sahin N. Relationship between food insecurity and geriatric syndromes in older adults: A multicenter study in Turkey. Exp Gerontol 2023; 172:112054. [PMID: 36513213 DOI: 10.1016/j.exger.2022.112054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
AIMS In this study, the aim was to determine the prevalence of geriatric syndromes such as frailty, sarcopenia risk and malnutrition in older adults and to investigate the relationship between food insecurity, and frailty, risk of sarcopenia and malnutrition. METHODS The study was cross-sectional. It was conducted between February 2022 and June 2022 with 707 older adults. The data were collected through the face-to-face interview method with a questionnaire including the Descriptive Information Form, Household Food Insecurity Access Scale (HFIAS), Frail Scale, Sarcopenia Risk Screening Scale (SARC-F) and Mini Nutritional Assessment-Short Form (MNA-SF). Numbers, percentages, mean, standard deviation, Pearson chi-square test and binary logistic regression analysis were used in data analysis. RESULTS In the present sample, 30% of the participants experienced some degree of food insecurity. The prevalence of frailty, sarcopenia risk, and malnutrition in the participants was 15.3%, 19.5%, and 1.3%, respectively. We determined that food insecurity was not associated with pre-frailty/frailty and sarcopenia risk. After adjusment for potential counfounders moderate and severe food insecurity was associated with higher odds of malnutrition risk and malnutrition (AOR: 2.06, 95% CI: 1.21-3.51, p:0.007). CONCLUSION While food insecurity is not associated with pre-frailty/frailty and sarcopenia risk, moderate and severe food insecurity is a modifiable risk factor for malnutrition risk and malnutrition. Thus, economic and social policies to eliminate food insecurity should be implemented, and efforts to prevent food insecurity should be planned through inter-sectoral cooperation.
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Affiliation(s)
- Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
| | - Nursel Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey.
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13
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Na M, Dou N, Brown MJ, Chen-Edinboro LP, Anderson LR, Wennberg A. Food Insufficiency, Supplemental Nutrition Assistance Program (SNAP) Status, and 9-Year Trajectory of Cognitive Function in Older Adults: The Longitudinal National Health and Aging Trends Study, 2012-2020. J Nutr 2023; 153:312-321. [PMID: 36913467 PMCID: PMC10196579 DOI: 10.1016/j.tjnut.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite findings from cross-sectional studies, how food insecurity experience/Supplemental Nutrition Assistance Program (SNAP) status relates to cognitive decline over time has not been fully understood. OBJECTIVES We aimed to investigate the longitudinal associations between food insecurity/SNAP status and cognitive function in older adults (≥65 y). METHODS Longitudinal data from the National Health and Aging Trends Study 2012-2020 were analyzed (n = 4578, median follow-up years = 5 y). Participants reported food insecurity experience (5-item) and were classified as food sufficient (FS, no affirmative answer) and food insufficient (FI, any affirmative answer). The SNAP status was defined as SNAP participants, SNAP eligible nonparticipants (≤200% Federal Poverty Line, FPL), and SNAP ineligible nonparticipants (>200% FPL). Cognitive function was measured via validated tests in 3 domains, and the standardized domain-specific and combined cognitive function z-scores were calculated. Mixed-effect models with a random intercept were used to study how FI or SNAP status was associated with combined and domain-specific cognitive z-scores over time, adjusting for static and time-varying covariates. RESULTS At baseline, 96.3% of the participants were FS and 3.7% were FI. In a subsample (n = 2832), 10.8% were SNAP participants, 30.7% were SNAP eligible nonparticipants, and 58.6% were SNAP ineligible nonparticipants. Compared with the FS group in the adjusted model (FI vs. FS), FI was associated with faster decline in the combined cognitive function scores [-0.043 (-0.055, -0.032) vs. -0.033 (-0.035, -0.031) z-scores per year, P-interaction = 0.064]. Cognitive decline rates (z-scores per year) in the combined score were similar in SNAP participants (β = -0.030; 95% CI: -0.038, -0.022) and SNAP ineligible nonparticipants (β = -0.028; 95% CI: -0.032, -0.024), both of which were slower than the rate in SNAP eligible nonparticipants (β = -0.043; 95% CI: -0.048, -0.038; P-interaction < 0.0001). CONCLUSIONS Food sufficiency and SNAP participation may be protective factors preventing accelerated cognitive decline in older adults.
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Affiliation(s)
- Muzi Na
- Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA.
| | - Nan Dou
- Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lenis P Chen-Edinboro
- Public Health Program, School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Loretta R Anderson
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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14
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Cheung ESL. Food Insecurity among Older Adults in New York City: Does Location Matter? JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2143738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Fonseca-Pérez D, Arteaga-Pazmiño C, Maza-Moscoso CP, Flores-Madrid S, Álvarez-Córdova L. Food insecurity as a risk factor of sarcopenic obesity in older adults. Front Nutr 2022; 9:1040089. [PMID: 36337623 PMCID: PMC9630347 DOI: 10.3389/fnut.2022.1040089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Sarcopenic obesity is characterized by the loss of muscle strength, mass and muscle functionality and increased adipose tissue (obesity) according to different criteria and cut-off points. The prevalence of sarcopenic obesity among older adults is growing worldwide, and many factors are involved in its development. Diet and food security have been described as the main contributors to the development of obesity and sarcopenia. Food insecurity consists of limited or uncertain access to adequate and nutritious foods. This narrative review aims to summarize the existing data on food insecurity as a risk factor for sarcopenic obesity in the elderly.
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Affiliation(s)
- Diana Fonseca-Pérez
- Carrera de Nutrición y Dietética, Instituto de Investigación e Innovación en Salud Integral (ISAIN), Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Cecilia Arteaga-Pazmiño
- Carrera de Nutrición y Dietética, Facultad de Ciencias Médicas, Universidad de Guayaquil, Guayaquil, Ecuador
| | | | - Sara Flores-Madrid
- Carrera de Nutrición y Dietética, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Ludwig Álvarez-Córdova
- Carrera de Nutrición y Dietética, Instituto de Investigación e Innovación en Salud Integral (ISAIN), Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
- Carrera de Nutrición y Dietética, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
- *Correspondence: Ludwig Álvarez-Córdova,
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16
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Gajda R, Jeżewska-Zychowicz M, Styczyńska M, Jarossová MA. Food Insecurity in the Households of Polish Elderly: Diversity in the Perception of Its Causes by Demographic and Socioeconomic Characteristics. Foods 2022; 11:3222. [PMCID: PMC9601627 DOI: 10.3390/foods11203222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aging of societies and the quality of life of the elderly may be accompanied by food insecurity. The aim of the study was to find the relationships between the perceptions of various causes of food insecurity, i.e., financial, social, health, and spatial, and then between those and the selected sociodemographic characteristics. The survey was conducted in late 2018 and early 2019 among 760 people aged 65 and older in two regions of Poland. Factor analysis with the use of principal component analysis (PCA) was used to identify the main causes of the prevalence of food insecurity. Cluster analysis using Ward’s hierarchical classification and logistic regression analysis were used to assess the relationship between the identified reasons for food insecurity, demographic characteristics, and socioeconomic status (SES). Two groups of causes that favor the experience of food insecurity among the elderly were identified, i.e., economic–social reasons and spatial–health reasons. They relate to such situations of food insecurity as concerns about food shortages, lack of staple foods, limited size or frequency of meals, and skipping meals. The high importance of economic–social (HE-S) reasons was associated with the low importance of spatial–health (LS-H) reasons, and conversely, the high importance of spatial–health (HS-H) causes was associated with the low importance of economic–social (LE-S) causes. HE-S and LS-H reasons were combined with low SES and residence in a city of more than 100,000 inhabitants. HS-H causes, on the other hand, were associated with LE-S causes and living in rural areas or towns of fewer than 100,000 inhabitants, as well as high SES. This specificity should be considered in the development of strategies and interventions aimed at reducing the phenomenon of experiencing food insecurity in the elderly population.
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Affiliation(s)
- Robert Gajda
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
- Correspondence:
| | - Marzena Jeżewska-Zychowicz
- Department of Food and Consumption Market Research, Faculty of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Marzena Styczyńska
- Department of Human Nutrition, Faculty of Biotechnology and Food Sciences, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland
| | - Małgorzata Agnieszka Jarossová
- Department of Marketing, Faculty of Commerce, University of Economics in Bratislava, Dolnozemská Cesta 1, 852 35 Bratislava, Slovakia
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Falvey JR, Ye JZ, Parker EA, Beamer BA, Addison O. Rehabilitation Outcomes among Frail Older Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11021. [PMID: 36078737 PMCID: PMC9517853 DOI: 10.3390/ijerph191711021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/21/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current rehabilitation care paradigms are not well aligned with the needs of frail older adults, but the resultant impact on rehabilitation outcomes is unclear. Understanding how frailty may impact rehabilitation outcomes, and understanding some of the underlying mechanisms, may help inform payment policy changes. DESIGN This study was a cross-sectional analysis of data from Round 5 of the National Health and Aging and Trends Study (NHATS). We identified older adults who had completed one or more episodes of rehabilitation care and used a validated 5-item NHATS Fried Frailty scale to categorize patients as frail (3/5 or more) or non-frail (≤2/5). We then evaluated the association between frailty status and three key patient outcomes: (1) achievement of rehabilitation goals, (2) functional improvement during rehabilitation episodes, and (3) discontinuation of therapy after exhausting insurance benefits. Lastly, we used multivariable, survey-weighted logistic regression models to estimate adjusted relationships between frailty and rehabilitation outcomes. RESULTS An estimated 5.6 million survey-weighted older adults in the United States (95% CI 5.1 to 6.0 million) completed an episode of rehabilitation in the past year, an estimated 1,271,290 (95% CI 921,758 to 1,620,822; weighted: 22.8%) of whom were frail. Frail rehabilitation recipients were generally older, had a greater comorbidity burden, and had a higher prevalence of dementia. In adjusted models, frailty was associated with poorer functional outcomes, a lower probability of meeting rehabilitation goals and a greater likelihood of exhausting rehabilitation insurance benefits. CONCLUSIONS Exercise is a well-supported intervention for the management of frailty, but our results suggest that frail older adults are not getting the volume or intensity of rehabilitation treatment needed to maximally improve outcomes-in part due to limited payer coverage of rehabilitation services in the United States.
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Affiliation(s)
- Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Joanna Z. Ye
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Elizabeth A. Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Brock A. Beamer
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD 21201, USA
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD 21201, USA
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Wang W, Chen J, Peng L, Gao X, Lin L, Xiong Y, Zhang F, Ma Y, Qin F, Yuan J. Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data. Sex Med 2022; 10:100549. [PMID: 35930975 PMCID: PMC9537275 DOI: 10.1016/j.esxm.2022.100549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION While food insecurity is a global public health problem associated with obesity, diabetes, hypertension and coronary heart disease, literature regarding the relationship between food insecurity and erectile dysfunction (ED) is scarce. AIM We aimed to determine the associations between food insecurity and ED in the National Health and Nutrition Examination Survey. METHODS Data was extracted from 3,891 participants (aged ≥ 20 years) with ED in the 2001-2004 National Health and Nutrition Examination Survey. Multivariable logistic regression analysis with sampling weights was conducted to evaluate the associations. MAIN OUTCOME MEASURE Food security was assessed utilizing the Household Food Security Module. A single-question self-report from the Massachusetts Male Aging Study was utilized to evaluate ED status. RESULTS Approximately 10.2% of individuals had food insecurity. Food insecurity was significantly associated with ED after full adjustment (odds ratio [OR] 1.56; 95% confidence interval [95% CI] 1.16-2.09; P = .003). Men with very low food insecurity had 59% higher risks of ED compared with those having high food security (OR 1.59; 95% CI 1.13-2.27; P = .006). Moreover, the associations were stronger in the old people (age ≥ 60) (OR 2.15; 95% CI 1.26-3.66; P = .004). CONCLUSIONS Food insecurity might be associated with higher risks of developing ED. Wang W, Chen J, Peng L, et al. Food Insecurity May be an Independent Risk Factor Associated With Erectile Dysfunction in the United States: Analysis of the National Health and Nutrition Examination Survey Data. Sex Med 2022;XX:XXXXXX.
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Affiliation(s)
- Wei Wang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jiawei Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiaoshuai Gao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lede Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yang Xiong
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Fuxun Zhang
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yucheng Ma
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Feng Qin
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiuhong Yuan
- Andrology Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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19
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Dondero KR, Falvey JR, Beamer BA, Addison O. Geriatric Vulnerabilities Among Obese Older Adults With and Without Sarcopenia: Findings From a Nationally Representative Cohort Study. J Geriatr Phys Ther 2022; 46:168-173. [PMID: 35981333 PMCID: PMC9938079 DOI: 10.1519/jpt.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Sarcopenic obesity is associated with loss of independence among older adults, but the epidemiology of sarcopenic obesity and associated geriatric vulnerabilities are poorly understood. Thus, our objectives were to: (1) estimate the prevalence of older adults with sarcopenic obesity and (2) examine rates of geriatric vulnerabilities among obese older adults, with and without sarcopenia. METHODS A nationally representative sample of 1600 community-dwelling older adults 65 years and older with obesity and documented measures of muscle function from the National Health and Aging Trends Study (NHATS) was identified as sarcopenic using sex-adjusted grip strength and Short Physical Performance Battery scores. Differences in the prevalence of geriatric vulnerabilities (including pain, depression, disability, and social isolation) were compared between obese older adults with and without sarcopenia. RESULTS AND DISCUSSION Among obese older adults, 18% (n = 318/1600) were sarcopenic. After adjusting for age and sex, sarcopenic obese older adults had 3.7 times the odds of having 2 or more comorbid conditions (odds ratio [OR] = 3.7; 95% CI 2.2-5.0) and 6.4 times the odds of being frail (OR = 6.4; 95% CI 4.4-9.5) as compared with nonsarcopenic obese older adults. Sarcopenic obese older adults were also more likely to have 1 or more activities of daily living disabilities (OR = 3.7; 95% CI 2.5-5.4), be socially isolated (OR = 2.1; 95% CI 1.3-3.2), and report activity-limiting pain (OR = 2.0; 95% CI 1.5-2.7) as compared with nonsarcopenic obese older adults. These findings, in a nationally representative cohort, suggest obese older adults who are sarcopenic have higher rates of geriatric vulnerabilities that could impact delivery and outcomes of exercise and nutrition interventions. CONCLUSIONS Concomitant obesity and sarcopenia are associated with higher rates of geriatric vulnerabilities among a nationally representative sample of older adults. More comprehensive interventions, beyond exercise and diet modifications, may be necessary to additionally address these newly identified social and physiological risks.
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Affiliation(s)
- Kathleen R Dondero
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Jason R Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Brock A Beamer
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore
- Baltimore Geriatric Research, Education, and Clinical Center, VAMHCS, Baltimore, Maryland
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore
- Baltimore Geriatric Research, Education, and Clinical Center, VAMHCS, Baltimore, Maryland
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20
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Thorndike AN, Gardner CD, Kendrick KB, Seligman HK, Yaroch AL, Gomes AV, Ivy KN, Scarmo S, Cotwright CJ, Schwartz MB. Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association. Circulation 2022; 145:e1077-e1093. [PMID: 35535604 DOI: 10.1161/cir.0000000000001072] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.
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Ornstein KA, Liu SH, Husain M, Ankuda CK, Bollens-Lund E, Kelley AS, Garrido MM. Prospective assessment of dementia on transitions in homeboundness using multistate Markov models. J Am Geriatr Soc 2022; 70:1117-1126. [PMID: 34951008 PMCID: PMC8986556 DOI: 10.1111/jgs.17631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/26/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND One in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions. METHODS Using 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries. Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model. RESULTS Less than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. DISCUSSION Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.
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Affiliation(s)
- Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Shelley H. Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Mohammed Husain
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
- James J Peters Veterans Affairs Medical Center, Bronx, NY
| | - Melissa M. Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Boston VA Healthcare System, Boston, MA
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22
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Sharma A. Older Adult Mortality From COVID-19: Food Access as a Determinant Within a Socio-ecological Framework. THE GERONTOLOGIST 2022; 62:452-463. [PMID: 35072729 PMCID: PMC8807209 DOI: 10.1093/geront/gnab159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Low access to food can have an adverse impact on health yet there is limited research on how it is related to coronavirus disease 2019 (COVID-19). The objective of this study was to (a) better understand how inadequate food access was associated with older adult mortality from COVID-19 and (b) determine the spatial distribution of mortality from low food access utilizing a socio-ecological framework. RESEARCH DESIGN AND METHODS This study area was the larger Midwest, a region of the United States, which included the following states: Minnesota, Wisconsin, Iowa, Illinois, Indiana, Michigan, Ohio, and Pennsylvania. Data were aggregated from multiple sources at the county-level. Because the spatial data used in this study violated several assumptions of the global regression framework, geographically weighted regression (GWR) was employed. RESULTS Results from GWR revealed low access to food was positively associated with mortality from COVID-19 for older adults but the association varied in (a) magnitude and (b) significance across the larger Midwest. More specifically, the socio-ecological framework suggested low access to food, female-headed households, and percentage Hispanic played a meaningful role in explaining older adult mortality for the western region of the larger Midwest. This was not as evident for the eastern portion. DISCUSSION AND IMPLICATIONS Such a finding calls attention to the importance of capturing the local context when devising policies to reduce mortality for older adults from COVID-19. Regional policymakers can collaborate with public health professionals when applying these results to formulate local action plans that recognize variations across geographic space.
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Affiliation(s)
- Andy Sharma
- Public Policy Studies, Northwestern University, Chicago, Illinois, USA
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Abstract
IMPORTANCE Poor diet is a major risk factor for chronic diseases, disability, and death in the US. As older adults comprise the fastest-growing population segment in the US, it is crucial to describe dietary trends among older adults to identify opportunities and challenges for improving health in old age. OBJECTIVE To characterize trends in overall dietary quality and key food components and nutrients among older US adults by age, sex, race and ethnicity, marital status, educational level, and income. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used 24-hour dietary recall data from 10 837 adults aged 65 years or older in 9 National Health and Nutrition Examination Survey cycles (2001-2002 to 2017-2018). Statistical analysis was conducted from June 1 to October 1, 2021. EXPOSURES Calendar year and sociodemographic subgroups. MAIN OUTCOMES AND MEASURES Survey-weighted, energy-adjusted mean diet scores and proportions of older US adults with poor, intermediate, or ideal diet scores based on the American Heart Association (AHA) 2020 Strategic Impact Goals for diet. Additional outcomes included the AHA secondary score and the Healthy Eating Index (HEI)-2015 score. RESULTS A total of 10 837 individuals (5423 women [50.0%]; 6339 White participants [58.5%]; mean [SD] age, 73.9 [0.1] years) were analyzed. Overall dietary quality deteriorated from 2001 to 2018 among older adults. The mean primary AHA score (total = 50 points) decreased from 19.84 (95% CI, 19.40-20.29) to 18.28 (95% CI, 17.84-18.73; a decrease of 7.9%; P < .001 for trend). The mean secondary AHA score (total = 80 points) decreased from 34.75 (95% CI, 34.11-35.39) to 31.83 (95% CI, 31.17-32.48; a decrease of 8.4%; P < .001 for trend). The mean HEI-2015 score (total = 100 points) decreased from 47.82 (95% CI, 47.11-48.52) to 45.25 (95% CI, 44.53-45.98; a decrease of 5.4%; P < .001 for trend). Based on the primary AHA score, the proportion of US older adults with a poor diet quality significantly increased from 50.9% to 60.9%, the proportion with an intermediate diet quality significantly decreased from 48.6% to 38.7%, and the proportion with ideal diet quality remained consistently low (0.4% in both 2001-2002 and 2017-2018). Dietary variations were identified by sociodemographic subgroups. We found a significant decreasing trend in diet scores among both sexes and all age groups except for those aged 75 to 79 years. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that dietary quality worsened for most dietary components among older US adults between 2001 and 2018. Despite improvement in some dietary components, more than half of older US adults still have poor dietary quality.
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Affiliation(s)
- Tingxi Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Kehan Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Yan Chen
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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Lee JY, Shen S, Nishita C. Development of Older Adult Food Insecurity Index to Assess Food Insecurity of Older Adults. J Nutr Health Aging 2022; 26:739-746. [PMID: 35842765 DOI: 10.1007/s12603-022-1816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Quantifying the number of older adults that are food insecure in a specific geographic area is critical in developing and scaling public health prevention and response programs at the local level. However, current estimates of older adult food insecurity only consider financial constraints, following the same methodology as the general population, even though the drivers for older adults are different and multidimensional. This study aims to build a general approach to quantify the food-insecurity among older adults at the local level, using publicly available data that can be easily obtained across the country. METHODS 13 risk factors for food insecurity among older adults were identified leveraging existing studies, following the Social Ecological Model (SEM), and the weighted impact of each factor was determined. Publicly available data sources were identified for each factor, ZIP code level data was compared to national averages, and the weighted data for each factor were aggregated to determine the overall food insecurity at the local level. RESULTS Based on the averaged odds ratios across all the studies, of the 13 risk factors, beyond financial constraints, having a disability was the most impactful factor and distance to the nearest grocery store was the least impactful. A ZIP code level model of Honolulu County was developed as an example to demonstrate the approach, showing that food insecurity among older adults in the county was 2.5 times that which was reported from the Current Population Survey (16.5% versus 6.5%). CONCLUSION This evidence-based model considered factors that impact food insecurity among older adults across all the spheres of the SEM. The drivers of food insecurity among older adults are different than the drivers for the general population, resulting in a higher percentage of older adults being food insecure than currently reported.
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Affiliation(s)
- J Y Lee
- Jenny Jin Young Lee, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, HI, USA,
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