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Mills CM, Boyar L, O'Flaherty JA, Keller HH. Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e56714. [PMID: 38696645 PMCID: PMC11234053 DOI: 10.2196/56714] [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: 01/24/2024] [Revised: 03/10/2024] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors' knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. OBJECTIVE The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs. METHODS This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk. RESULTS The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. CONCLUSIONS Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56714.
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Affiliation(s)
- Christine Marie Mills
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Liza Boyar
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Geary R, Mantik J, Moore V, Schuller J, Fedoruk R, Atkins M, Chan CB. COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada. Can J Aging 2024; 43:287-296. [PMID: 37811554 DOI: 10.1017/s0714980823000582] [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: 10/10/2023] Open
Abstract
This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.
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Affiliation(s)
- Rebecca Geary
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Mantik
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Valerie Moore
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Schuller
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Rani Fedoruk
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Marlis Atkins
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
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Marie Mills C, Keller H, DePaul VG, Donnelly C. Social factors associated with changes in nutrition risk scores measured using SCREEN-8: data from the Canadian Longitudinal Study on Aging. CAN J DIET PRACT RES 2024; 85:83-90. [PMID: 38829673 DOI: 10.3148/cjdpr-2024-014] [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: 06/05/2024]
Abstract
Purpose: To examine the social network factors associated with changes in nutrition risk scores, measured by SCREEN-8, over three years, in community-dwelling Canadians aged 45 years and older, using data from the Canadian Longitudinal Study on Aging (CLSA).Methods: Change in SCREEN-8 scores between the baseline and first follow-up waves of the CLSA was calculated by subtracting SCREEN-8 scores at follow-up from baseline scores. Multivariable linear regression was used to examine the factors associated with change in SCREEN-8 score.Results: The mean SCREEN-8 score at baseline was 38.7 (SD = 6.4), and the mean SCREEN-8 score at follow-up was 37.9 (SD = 6.6). The mean change in SCREEN-8 score was -0.90 (SD = 5.99). Higher levels of social participation (participation in community activities) were associated with increases in SCREEN-8 scores between baseline and follow-up, three years later.Conclusions: Dietitians should be aware that individuals with low levels of social participation may be at risk for having their nutritional status decrease over time and consideration should be given to screening them proactively for nutrition risk. Dietitians can develop and support programs aimed at combining food with social participation.
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Affiliation(s)
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, and Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON
| | - Vincent G DePaul
- School of Rehabilitation Therapy and Health Services and Policy Research Institute, Queen's University, Kingston, ON
| | - Catherine Donnelly
- School of Rehabilitation Therapy and Health Services and Policy Research Institute, Queen's University, Kingston, ON
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Trinca V, Anderson ND, Fiocco AJ, Ferland G, Laurin D, Keller HH. Nutrition risk and cognitive performance in community-living older adults without cognitive impairment: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Appl Physiol Nutr Metab 2023; 48:896-906. [PMID: 37590990 DOI: 10.1139/apnm-2023-0211] [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: 08/19/2023]
Abstract
Malnutrition is correlated with poor cognition; however, an understanding of the association between nutrition risk, which precedes malnutrition, and cognition is lacking. This study aimed to determine if nutrition risk measured with the SCREEN-8 tool is associated with cognitive performance among cognitively healthy adults aged 55+, after adjusting for demographic and lifestyle covariates. Sex- and age-stratified analyses were also explored. Baseline data from the Canadian Longitudinal Study on Aging was used. Cognition was determined using a 6-measure composite score based on four executive functions and two memory tasks, taking into account age, sex, and education. Multivariable linear regression was performed while adjusting for body mass index (BMI), lifestyle, and health covariates in the entire sample (n = 11 378) and then stratified by sex and age. Approximately half of participants were female (54.5%) aged 65+ (54.1%). Greater nutrition risk was associated with poorer cognitive performance in the entire sample (F[1, 11 368] = 5.36, p = 0.021) and among participants aged 55-64 (n = 5227; F[1, 5217] = 5.45, p = 0.020). Sex differences in lifestyle and health factors associated with cognition were apparent, but nutrition risk was not associated with cognition in sex-stratified models. Based on this analysis, there may be an association between nutrition risk and cognitive performance in older adults. When screening for either cognitive impairment or nutrition risk, complementary assessments for these conditions is warranted, as early intervention may provide benefit.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Nicole D Anderson
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Departments of Psychology & Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexandra J Fiocco
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Guylaine Ferland
- Département de Nutrition, Université de Montréal, Montreal, QC, Canada
| | - Danielle Laurin
- Centre de recherche du CHU de Québec-Université Laval, VITAM-Centre de recherche en santé durable, CIUSSS-Capitale Nationale and Institut sur le vieillissement et la participation sociale des aînés, Québec, QC, Canada
- Centre d'excellence sur le vieillissement de Québec, Québec, QC, Canada
- Faculté de pharmacie, Université Laval and Institut sur la nutrition et les aliments fonctionnels (INAF) de l'Université Laval, Québec, QC, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Mills CM, Trinca V. The Evidence for Screening Older Adults for Nutrition Risk in Primary Care: An Umbrella Review. CAN J DIET PRACT RES 2023; 84:159-166. [PMID: 36920030 DOI: 10.3148/cjdpr-2022-043] [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: 03/16/2023]
Abstract
It is not known if nutrition risk screening of older adults should be a standard practice in primary care. The evidence in support of nutrition risk screening of older adults in primary care was examined and critically analyzed using an umbrella review. The peer reviewed and grey literature were searched for clinical practice guidelines (CPGs) and systematic reviews (SRs). Titles and abstracts were independently screened by the two authors. Resources were excluded if they did not apply to older adults, did not discuss nutrition/malnutrition risk screening, or were in settings other than primary care. Full texts were independently screened by both authors, resulting in the identification of six CPGs and three SRs that met the review criteria. Guidelines were appraised with the AGREE II tool and SRs with the AMSTAR 2 tool. The quality of the CPGs was high, while the quality of the SRs was low. The CPGs and SRs acknowledged a lack of high-quality research on the benefits of regular nutrition risk screening for older adults in primary care; however, CPGs recommended annual screening for older adults in primary care practices or other community settings. High-quality research investigating nutrition risk screening of older adults in primary care is needed.
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Affiliation(s)
- Christine Marie Mills
- Aging & Health Program, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Vanessa Trinca
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Keller HH, Trinca V. Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA). CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:593-612. [PMID: 36947396 PMCID: PMC10349003 DOI: 10.17269/s41997-023-00745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Nutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline. METHODS Secondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression. RESULTS Models stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (- 0.83; CI [- 1.44, -0.22]), living alone at follow-up (- 1.98; CI [- 3.40, -0.56]), and lack of dental care at both timepoints (- 0.91; CI [- 1.62, -0.20]) and at follow-up only (- 1.32; CI [- 2.45, -0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (- 2.56; CI [- 4.36, -0.77]) and low chair-rise scores (- 1.98; CI [- 3.33, - 0.63]) were associated with lower SCREEN-8 scores at follow-up. CONCLUSION Determinants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.
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Affiliation(s)
- Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
| | - Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mills CM, Keller HH, DePaul VG, Donnelly C. Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging. Fam Med Community Health 2023; 11:fmch-2022-002112. [PMID: 36813466 PMCID: PMC9950914 DOI: 10.1136/fmch-2022-002112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. DESIGN A retrospective cross-sectional study. SETTING Data from the Canadian Longitudinal Study on Aging (CLSA). PARTICIPANTS 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. RESULTS CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. CONCLUSIONS Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.
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Affiliation(s)
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada,Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Vincent Gerard DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
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Borkent JW, Van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Diseases, Health-Related Problems, and the Incidence of Malnutrition in Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3170. [PMID: 36833865 PMCID: PMC9959926 DOI: 10.3390/ijerph20043170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Certain diseases and malnutrition are known to co-occur in residents of long-term care facilities (LTCF). We assessed which diseases and health-related problems are associated with malnutrition at admission or with incident malnutrition during stays and how different definitions of malnutrition affect these associations. Data of Dutch LTCF residents were obtained from the InterRAI-LTCF instrument (2005-2020). We analyzed the association of diseases (diabetes, cancer, pressure ulcers, neurological, musculoskeletal, psychiatric, cardiac, infectious and pulmonary diseases) and health-related problems (aspiration, fever, peripheral edema, aphasia, pain, supervised/assisted eating, balance, psychiatric, GI tract, sleep, dental and locomotion problems) with malnutrition (recent weight loss (WL), low age-specific BMI (BMI), and ESPEN 2015 definition (ESPEN)) at admission (n = 3713), as well as with incident malnutrition during stay (n = 3836, median follow-up ~1 year). Malnutrition prevalence at admission ranged from 8.8% (WL) to 27.4% (BMI); incident malnutrition during stay ranged from 8.9% (ESPEN) to 13.8% (WL). At admission, most diseases (except cardiometabolic diseases) and health-related problems were associated with higher prevalence of malnutrition based on either criterion, but strongest with WL. This was also seen in the prospective analysis, but relationships were less strong compared to the cross-sectional analysis. A considerable number of diseases and health-related problems are associated with an increased prevalence of malnutrition at admission and incident malnutrition during stays in LTCFs. At admission, low BMI is a good indicator of malnutrition; during stays, we advise use of WL.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Hein P. J. Van Hout
- Amsterdam University Medical Center, Department of General Practice and Medicine for Older Persons, Vrije Universiteit, Van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Elke Naumann
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
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Wei C, Beauchamp MK, Vrkljan B, Vesnaver E, Giangregorio L, Macedo LG, Keller HH. Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians. Appl Physiol Nutr Metab 2023; 48:38-48. [PMID: 36219874 DOI: 10.1139/apnm-2022-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% confidence interval [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.
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Affiliation(s)
- Cindy Wei
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute of Aging, Waterloo, ON, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Heather H Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute of Aging, Waterloo, ON, Canada
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Xue Q, Shen M, Lin Q, Wu X, Yang M. The Association between Dietary Protein Diversity and Protein Patterns with Frailty in Older Chinese Adults: A Population-Based Cohort Study. J Nutr Health Aging 2023; 27:1219-1227. [PMID: 38151873 DOI: 10.1007/s12603-023-2043-5] [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: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Frailty is a pervasive condition among older people worldwide. Despite the association between higher protein intake and lower frailty risk has been well documented, older individuals encounter barriers to enhancing their protein consumption due to reduced appetite and impaired digestive capacity. This study aims to delve into the potential correlation between dietary protein diversity, protein patterns, and the risk of frailty among older Chinese individuals. DESIGN Prospective cohort study. SETTING Community-based. PARTICIPANTS 2,216 participants aged 65 and above and not frail at the baseline were recruited from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset spanning from 2014 to 2018. MEASUREMENTS Dietary protein diversity was evaluated utilizing a protein diversity score (PDS), calculated based on the results of a food frequency questionnaire. Dietary protein patterns were identified by employing principal component analysis (PCA). Frailty was ascertained using a 40-item frailty index (FI) where FI > 0.21 indicated frailty. Logistic analysis was employed to investigate the association between dietary variables and frailty. RESULTS 541 participants were identified as frail after a 4-year follow-up. After adjusting for confounders, each 1-unit increase in PDS was linked to a 10% decrease in frailty risk. Compared to individuals with PDS ≤ 1, those with PDS scores of 2-3, 4-5, and 6 had lower risks of frailty, with OR (95% CI) of 0.78 (0.58-1.06), 0.58 (0.38-0.87), 0.42 (0.20-0.81), respectively (P trend = 0.038). Individuals who consistently maintained high PDS demonstrated a lower frailty risk in contrast to those who maintained low PDS (OR = 0.60, 95% CI, 0.41-0.87). Additionally, the "meat-fish" pattern exhibited a protective association with frailty, with OR Q4 versus Q1 (95% CI) of 0.54 (0.40-0.74), P trend < 0.001. CONCLUSION Maintaining a variety of dietary protein sources and following a "meat-fish" protein pattern might decrease the likelihood of frailty among the older Chinese population.
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Affiliation(s)
- Q Xue
- Min Yang, School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine 886 Yu-hang-tang RD, Hangzhou, China, Tel: 13516852440, E-mail:
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Coker MS, Barati Z, Murphy CJ, Bateman T, Newcomer BR, Wolfe RR, Coker RH. Essential amino acid enriched meal replacement improves body composition and physical function in obese older adults: A randomized controlled trial. Clin Nutr ESPEN 2022; 51:104-111. [PMID: 36184194 PMCID: PMC10162659 DOI: 10.1016/j.clnesp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older adults are threatened by the risk of muscle atrophy and excess accumulation of adipose tissue. The objective of this study was to determine whether an essential amino acid enriched meal replacement would reduce excess fat and foster skeletal muscle retention, potentially improving physical function in this cohort. METHODS Using a double blind, randomized controlled trial, we compared the influence of an experimental meal replacement enriched with essential amino acids (EMR) to a commercially available, widely used meal replacement (Optifast®) provided once/day (q.d.) for four weeks on body composition, skeletal muscle and physical function in obese older participants. Twenty-eight individuals completed either EMR (n = 13) or Optifast® (n = 15) supplementation protocols. Measurements of body composition, thigh skeletal muscle cross-sectional area (CSA), blood panels, intrahepatic lipid, and physical function were completed pre- and post-supplementation. RESULTS Body fat mass, visceral fat mass and volume, and intrahepatic lipid were reduced with EMR but not with Optifast®. Thigh muscle CSA increased (Δ 2.4 ± 3.0 cm2) with EMR but not Optifast® (Δ -1.8 ± 6.0 cm2). There was a significant increase in the distance covered during the 6-min walk test with EMR (Δ 23 ± 27 m) but no change in Optifast® (Δ 11 ± 37 m). CONCLUSIONS Beneficial alterations in fat and muscle support the use of EMR-based meal replacements in obese older adults. CLINICAL TRIAL REGISTRATION ISRCTN registry under Reference Number ISRCTN15814848.
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Affiliation(s)
- Melynda S Coker
- Montana Center for Work Physiology and Exercise Metabolism, University of Montana, Missoula, MT, USA
| | - Zeinab Barati
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Carl J Murphy
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Terry Bateman
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Robert R Wolfe
- Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert H Coker
- Montana Center for Work Physiology and Exercise Metabolism, University of Montana, Missoula, MT, USA.
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Teggart K, Ganann R, Sihota D, Moore C, Keller H, Senson C, Phillips SM, Neil-Sztramko SE. Group-based nutrition interventions to promote healthy eating and mobility in community-dwelling older adults: a systematic review. Public Health Nutr 2022; 25:1-32. [PMID: 35570675 PMCID: PMC9991860 DOI: 10.1017/s136898002200115x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/28/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status and improve physical mobility among community-dwelling older adults. DESIGN Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO and Sociological Abstracts were searched on July 15, 2020 for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute's tools) and data extraction were performed in duplicate by two independent reviewers. SETTING Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded. PARTICIPANTS Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded. RESULTS Thirty-one experimental and quasi-experimental studies with generally unclear to high risk of bias were included. Interventions included nutrition education with behaviour change techniques (BCT) (e.g. goal setting, interactive cooking demonstrations) (n 21), didactic nutrition education (n 4), interactive nutrition education (n 2), food access (n 2) and nutrition education with BCT and food access (n 2). Group-based nutrition education with BCT demonstrated the most promise in improving food and fluid intake, nutritional status and healthy eating knowledge compared with baseline or control. The impact on mobility outcomes was unclear. CONCLUSIONS Group-based nutrition education with BCT demonstrated the most promise for improving healthy eating among community-dwelling older adults. Our findings should be interpreted with caution related to generally low certainty, unclear to high risk of bias and high heterogeneity across interventions and outcomes. Higher quality research in group-based nutrition education for older adults is needed.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Davneet Sihota
- Global Health Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Christine Senson
- Healthy and Safe Communities Department, City of Hamilton Public Health Services, Hamilton, ON, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ONL8S 4L8, Canada
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Nutrition Risk, Resilience and Effects of a Brief Education Intervention among Community-Dwelling Older Adults during the COVID-19 Pandemic in Alberta, Canada. Nutrients 2022; 14:nu14051110. [PMID: 35268084 PMCID: PMC8912319 DOI: 10.3390/nu14051110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Up to two-thirds of older Canadian adults have high nutrition risk, which predisposes them to frailty, hospitalization and death. The aim of this study was to examine the effect of a brief education intervention on nutrition risk and use of adaptive strategies to promote dietary resilience among community-dwelling older adults living in Alberta, Canada, during the COVID-19 pandemic. The study design was a single-arm intervention trial with pre–post evaluation. Participants (N = 28, age 65+ years) in the study completed a survey online or via telephone. Questions included the Brief Resilience Scale (BRS), SCREEN-14, a brief poverty screen, and a World Health Organization-guided questionnaire regarding awareness and use of nutrition-related services and resources (S and R). A brief educational intervention involved raising participant awareness of available nutrition S and R. Education was offered via email or postal mail with follow-up surveys administered 3 months later. Baseline and follow-up nutrition risk scores, S and R awareness and use were compared using paired t-test. Three-quarters of participants had a high nutrition risk, but very few reported experiencing financial strain or food insecurity. Those at high nutrition risk were more likely to report eating alone, compared to those who scored as low risk. There was a significant increase in awareness of 20 S and R as a result of the educational intervention, but no change in use. The study shows increasing individual knowledge about services and resources in the community is not sufficient to change use of these services or improve nutrition risk.
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Geigl C, Loss J, Leitzmann M, Janssen C. Social Factors of Dietary Risk Behavior in Older German Adults: Results of a Multivariable Analysis. Nutrients 2022; 14:1057. [PMID: 35268032 PMCID: PMC8912758 DOI: 10.3390/nu14051057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
With this analysis, we aimed to examine the associations between social factors and dietary risk behavior in older adults. Data were collected through a full-population postal survey of German adults aged 65 years or older (n = 1687, 33% response proportion, 52% female, mean age = 76 years). Using principal component analysis (PCA), a data-driven Dietary Risk Behavior Index (DRB) was computed. Dietary risk behavior was defined as consumption frequencies of vegetables/fruit, whole grains, and dairy products below national dietary recommendations. By performing a multiple linear regression, we analyzed associations between sociodemographic, socioeconomic, psychosocial, and behavioral factors and dietary risk behavior. Physical activity, female gender, socioeconomic status, social support, and age (in the male sample) were negatively associated with dietary risk behavior. Alcohol consumption and smoking were positively associated with dietary risk behavior. A group-specific analysis revealed a higher goodness-of-fit for the low socioeconomic status group, older adults aged 65-79 years, and women. A comprehensive understanding of the relationships between social factors and dietary risk behavior in older adults assists the group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should account for underlying social conditions to reduce inequity in dietary risk behavior among older adults. The results of this work may be transferable to municipalities in high-income European countries.
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Affiliation(s)
- Christoph Geigl
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243 Munich, Germany
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053 Regensburg, Germany;
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 13353 Berlin, Germany;
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, 93053 Regensburg, Germany;
| | - Christian Janssen
- Department of Applied Social Sciences, Munich University of Applied Sciences, 81243 Munich, Germany
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15
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Bardon LA, Corish CA, Lane M, Bizzaro MG, Loayza Villarroel K, Clarke M, Power LC, Gibney ER, Dominguez Castro P. Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis. BMC Geriatr 2021; 21:676. [PMID: 34863118 PMCID: PMC8642873 DOI: 10.1186/s12877-021-02583-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malnutrition negatively impacts on health, quality of life and disease outcomes in older adults. The reported factors associated with, and determinants of malnutrition, are inconsistent between studies. These factors may vary according to differences in rate of ageing. This review critically examines the evidence for the most frequently reported sociodemographic factors and determinants of malnutrition and identifies differences according to rates of ageing. METHODS A systematic search of the PubMed Central and Embase databases was conducted in April 2019 to identify papers on ageing and poor nutritional status. Numerous factors were identified, including factors from demographic, food intake, lifestyle, social, physical functioning, psychological and disease-related domains. Where possible, community-dwelling populations assessed within the included studies (N = 68) were categorised according to their ageing rate: 'successful', 'usual' or 'accelerated'. RESULTS Low education level and unmarried status appear to be more frequently associated with malnutrition within the successful ageing category. Indicators of declining mobility and function are associated with malnutrition and increase in severity across the ageing categories. Falls and hospitalisation are associated with malnutrition irrespective of rate of ageing. Factors associated with malnutrition from the food intake, social and disease-related domains increase in severity in the accelerated ageing category. Having a cognitive impairment appears to be a determinant of malnutrition in successfully ageing populations whilst dementia is reported to be associated with malnutrition within usual and accelerated ageing populations. CONCLUSIONS This review summarises the factors associated with malnutrition and malnutrition risk reported in community-dwelling older adults focusing on differences identified according to rate of ageing. As the rate of ageing speeds up, an increasing number of factors are reported within the food intake, social and disease-related domains; these factors increase in severity in the accelerated ageing category. Knowledge of the specific factors and determinants associated with malnutrition according to older adults' ageing rate could contribute to the identification and prevention of malnutrition. As most studies included in this review were cross-sectional, longitudinal studies and meta-analyses comprehensively assessing potential contributory factors are required to establish the true determinants of malnutrition.
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Affiliation(s)
- Laura A Bardon
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland.
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.
| | - Clare A Corish
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Meabh Lane
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Maria Gabriella Bizzaro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Katherine Loayza Villarroel
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Michelle Clarke
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Lauren C Power
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Eileen R Gibney
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
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Rodrigues IB, Wang E, Keller H, Thabane L, Ashe MC, Brien S, Cheung AM, Funnell L, Jain R, Loong D, Isaranuwatchai W, Milligan J, Mourtzakis M, Papaioannou A, Straus S, Weston ZJ, Giangregorio LM. The MoveStrong program for promoting balance and functional strength training and adequate protein intake in pre-frail older adults: A pilot randomized controlled trial. PLoS One 2021; 16:e0257742. [PMID: 34559837 PMCID: PMC8462677 DOI: 10.1371/journal.pone.0257742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Balance and functional strength training can improve muscle strength and physical functioning outcomes and decrease the risk of falls in older adults. To maximize the benefits of strength training, adequate protein intake is also important. However, the number of older individuals that consume enough protein or routinely engage in strength training remains low at less than 5% and even lower for activities that challenge balance. Our primary aim was to assess the feasibility of implementing a model (MoveStrong) of service delivery to teach older adults about balance and functional strength training and methods to increase protein intake. METHODS This study was a closed cohort stepped wedge randomized controlled trial. We recruited individuals ≥60 years considered pre-frail or frail with at least one chronic condition who were not currently engaging in regular strength training from Northern (rural) and Southern (urban) Ontario sites in Canada. The primary outcome was feasibility of implementation, defined by recruitment, retention, and adherence, and safety (defined by monitoring adverse events). We also reported participants' and providers' experience with MoveStrong, adaptations to the model based on participant's and provider's experience, and program fidelity. RESULTS We recruited 44 participants to the study and the average adherence rate was 72% with a retention of 71%. The program had a high-fidelity score. One person experienced a fall-related injury during exercise, while two other participants reported pain during certain activities. Five individuals experienced injuries or health problems that were not related to the program. Suggestions for future trials include modifying some exercises, exploring volunteer assistance, increasing the diversity of participants enrolled, and considering a different study design. CONCLUSIONS Our pilot trial demonstrates the feasibility of recruitment and adherence for a larger multisite RCT of balance and functional strength training with attention to protein intake in pre-frail and frail older adults.
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Affiliation(s)
- Isabel B. Rodrigues
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Ellen Wang
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Heather Keller
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Maureen C. Ashe
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Angela M. Cheung
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Ravi Jain
- Canadian Osteoporosis Patient Network, Osteoporosis Canada, Toronto, ON, Canada
| | - Desmond Loong
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Health Sciences Building, Toronto, ON, Canada
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Straus
- CLEAR Health Economics, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Zachary J. Weston
- Waterloo Wellington Local Health Integration Network, Waterloo, ON, Canada
- Faculty of Science, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Lora M. Giangregorio
- Department of Kinesiology and Health, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- * E-mail:
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17
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Bloom I, Pilgrim A, Jameson KA, Dennison EM, Sayer AA, Roberts HC, Cooper C, Ward KA, Robinson SM. The relationship of nutritional risk with diet quality and health outcomes in community-dwelling older adults. Aging Clin Exp Res 2021; 33:2767-2776. [PMID: 34255296 PMCID: PMC8531124 DOI: 10.1007/s40520-021-01824-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
Objectives To identify early nutritional risk in older populations, simple screening approaches are needed. This study aimed to compare nutrition risk scores, calculated from a short checklist, with diet quality and health outcomes, both at baseline and prospectively over a 2.5-year follow-up period; the association between baseline scores and risk of mortality over the follow-up period was assessed. Methods The study included 86 community-dwelling older adults in Southampton, UK, recruited from outpatient clinics. At both assessments, hand grip strength was measured using a Jamar dynamometer. Diet was assessed using a short validated food frequency questionnaire; derived ‘prudent’ diet scores described diet quality. Body mass index (BMI) was calculated and weight loss was self-reported. Nutrition risk scores were calculated from a checklist adapted from the DETERMINE (range 0–17). Results The mean age of participants at baseline (n = 86) was 78 (SD 8) years; half (53%) scored ‘moderate’ or ‘high’ nutritional risk, using the checklist adapted from DETERMINE. In cross-sectional analyses, after adjusting for age, sex and education, higher nutrition risk scores were associated with lower grip strength [difference in grip strength: − 0.09, 95% CI (− 0.17, − 0.02) SD per unit increase in nutrition risk score, p = 0.017] and poorer diet quality [prudent diet score: − 0.12, 95% CI (− 0.21, − 0.02) SD, p = 0.013]. The association with diet quality was robust to further adjustment for number of comorbidities, whereas the association with grip strength was attenuated. Nutrition risk scores were not related to reported weight loss or BMI at baseline. In longitudinal analyses there was an association between baseline nutrition risk score and lower grip strength at follow-up [fully-adjusted model: − 0.12, 95% CI (− 0.23, − 0.02) SD, p = 0.024]. Baseline nutrition risk score was also associated with greater risk of mortality [unadjusted hazard ratio per unit increase in score: 1.29 (1.01, 1.63), p = 0.039]; however, this association was attenuated after adjustment for sex and age. Conclusions Cross-sectional associations between higher nutrition risk scores, assessed from a short checklist, and poorer diet quality suggest that this approach may hold promise as a simple way of screening older populations. Further larger prospective studies are needed to explore the predictive ability of this screening approach and its potential to detect nutritional risk in older adults.
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Affiliation(s)
- Ilse Bloom
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Anna Pilgrim
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Karen A Jameson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE4 5PL, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Helen C Roberts
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Applied Research Collaboration (NIHR ARC) Wessex, University of Southampton, Southampton, SO16 7NP, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE4 5PL, UK
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18
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Blomberg K, Wallin AM, Odencrants S. An appealing meal: Creating conditions for older persons' mealtimes - a focus group study with healthcare professionals. J Clin Nurs 2021; 30:2646-2653. [PMID: 33434311 DOI: 10.1111/jocn.15643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthcare professionals' knowledge and attitudes may have an impact on older persons' nutritional status. Therefore, it is important to explore different healthcare professionals' perspectives on older persons' meals. AIM The aim of this study was to describe healthcare professionals' understanding of and views on the mealtime experience of older persons in municipal care. METHODS Seven focus group discussions with various healthcare professionals (nurse assistants, registered nurses and occupational therapists) (n = 52) working in nursing homes and/or home care for older persons were conducted and analysed using interpretive description. The COREQ checklist was used for reporting the findings. RESULTS The results revealed a striving to create conditions for an appealing meal, regardless of profession. This overall theme, 'An appealing meal - creating conditions for older persons' mealtimes', consisted of four sub-themes: 'Food is crucial', 'The mealtime as a social interaction', 'Identifying the individual older person's needs' and 'Integrating different perspectives of meal-related situations among the team'. CONCLUSION The findings show that the different professionals strive to prioritise meals in the everyday care of older persons, but at same time there is a lack of a common view on how to prioritise meal-related issues. This indicates that the care may be fragmented, being based on each professional's duties and interpretation of responsibility for older persons' meals, rather than constituting comprehensive integrated person-centred care provided by a multidisciplinary team. RELEVANCE TO CLINICAL PRACTICE To enhance older persons' mealtimes, we need to map how mealtimes are valued and implemented in clinical practice and approached in healthcare professionals' education. Education on older person's nutritional needs should be team-based, and not focus on the perspective of a single profession.
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Affiliation(s)
- Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Anne-Marie Wallin
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Sigrid Odencrants
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health 2021; 45:640-660. [PMID: 31571022 PMCID: PMC7188699 DOI: 10.1007/s10900-019-00739-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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20
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Eating Alone or Together among Community-Living Older People-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073495. [PMID: 33801775 PMCID: PMC8036467 DOI: 10.3390/ijerph18073495] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
Research on healthy aging commonly concerns problems related to loneliness and food intake. These are not independent aspects of health since eating, beyond its biological necessity, is a central part of social life. This scoping review aimed to map scientific articles on eating alone or together among community-living older people, and to identify relevant research gaps. Four databases were searched, 989 articles were identified and 98 fulfilled the inclusion criteria. In the first theme, eating alone or together are treated as central topics of interest, isolated from adjoining, broader concepts such as social participation. In the second, eating alone or together are one aspect of the findings, e.g., one of several risk factors for malnutrition. Findings confirm the significance of commensality in older peoples' life. We recommend future research designs allowing identification of causal relationships, using refined ways of measuring meals alone or together, and qualitative methods adding complexity.
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21
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Chopp-Hurley JN, Wiebenga EG, Keller HH, Maly MR. Diet and Nutrition Risk Affect Mobility and General Health in Osteoarthritis: Data from the Canadian Longitudinal Study on Aging. J Gerontol A Biol Sci Med Sci 2020; 75:2147-2155. [PMID: 31761950 DOI: 10.1093/gerona/glz277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study examined whether aspects of diet and nutrition risk explain variance in physical capacity and general health, after controlling for covariates, in Canadian adults with osteoarthritis (OA). METHODS This was a cross-sectional study of baseline data from the Canadian Longitudinal Study on Aging (CLSA). Data from 1,404 participants with hand, hip, and/or knee OA were included. A series of regression analyses were conducted with independent variables of food intake (fiber and high calorie snack intake) and nutrition risk; and dependent variables of physical capacity and general health. Physical capacity was characterized through grip strength and a pooled index of four mobility tests. General health was characterized through an index of self-reported general health, mental health, and healthy aging. RESULTS Higher fiber intake was related to greater mobility (p = .01). Food intake was not related to any other outcome. Nutrition risk was significantly associated with mobility (p < .001) and general health (p < .001); those with a high nutrition risk classification had poorer general health (p < .001, d = 0.65) than those at low nutrition risk. As well, those with moderate nutrition risk had poorer general health than those with low nutrition risk (p = .001, d = 0.31). CONCLUSIONS Nutrition risk screening for older adults with OA provides insight into behavioral characteristics associated with reduced mobility and poorer general health. Also, those consuming greater amounts of fiber demonstrated better mobility. Thus, this research suggests that quality of diet and nutritional behaviors can impact both physical and mental aspects of health in those with OA.
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Affiliation(s)
- Jaclyn N Chopp-Hurley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Emily G Wiebenga
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Heather H Keller
- Department of Kinesiology, University of Waterloo, Ontario, Canada.,Schlegel-University of Waterloo Research Institute for Aging, Ontario, Canada
| | - Monica R Maly
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Department of Kinesiology, University of Waterloo, Ontario, Canada
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Borkent JW, Schuurman LT, Beelen J, Linschooten JO, Keller HH, Roodenburg AJC, De van der Schueren MAE. What do screening tools measure? Lessons learned from SCREEN II and SNAQ 65. Clin Nutr ESPEN 2020; 38:172-177. [PMID: 32690153 DOI: 10.1016/j.clnesp.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. METHODS Dutch community-dwelling older adults (n = 200, 78.2 ± 6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ65+ (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ65+ and SCREEN II. RESULTS Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ65+). Agreement between the two tools was poor (kappa < 0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ65+. CONCLUSION SCREEN II and SNAQ65+ measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ65+ is solely focused on protein-energy malnutrition.
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Affiliation(s)
- Jos W Borkent
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, The Netherlands.
| | - Lisanne T Schuurman
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, The Netherlands
| | - Janne Beelen
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, The Netherlands
| | - Joost O Linschooten
- HAS University of Applied Sciences, Department of Food Science & Technology, 's-Hertogenbosch, The Netherlands
| | - Heather H Keller
- Schlegel-University of Waterloo, Research Institute for Aging; Department of Kinesiology, Waterloo, Canada
| | - Annet J C Roodenburg
- HAS University of Applied Sciences, Department of Food Science & Technology, 's-Hertogenbosch, The Netherlands
| | - Marian A E De van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Health, Nijmegen, The Netherlands
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Borkent JW, Keller H, Wham C, Wijers F, de van der Schueren MAE. Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults. Healthcare (Basel) 2020; 8:E151. [PMID: 32498433 PMCID: PMC7349548 DOI: 10.3390/healthcare8020151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Department of Kinesiology, University of Waterloo, Waterloo, ON N2G 0E2, Canada;
| | - Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand;
| | - Fleur Wijers
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
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Chatindiara I, Sheridan N, Kruger M, Wham C. Eating less the logical thing to do? Vulnerability to malnutrition with advancing age: A qualitative study. Appetite 2020; 146:104502. [DOI: 10.1016/j.appet.2019.104502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/02/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
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Factors affecting safe and healthy diet in older adults in Italy: results of a preliminary study performed in a community-dwelling sample. Public Health Nutr 2019; 23:432-438. [PMID: 31439061 DOI: 10.1017/s1368980019002301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate, through a questionnaire, older adults' demographic and socio-economic characteristics, knowledge, attitudes and practices in terms of food safety and healthy diet; and to develop dietary and hygiene indices able to represent participants' nutritional and food safety behaviour, exploring their association with demographic and socio-economic factors. DESIGN One-year cross-sectional study. SETTING Gemelli Teaching Hospital (Rome, Italy). PARTICIPANTS People aged ≥65 years, Italian speaking, accessing the Centre of Ageing Medicine. RESULTS Mean age of the sample was 74 (sd 7·7) years. Subjective perception of a safe diet was high: 64·2 % of respondents believed they have a balanced diet. Interviewees got informed about proper nutrition mainly from television, magazines, newspapers, Internet (29·9 %) and from health professionals (34·8 %) such as dietitians, whereas 15·4 % from general practitioners. Regarding food safety, 33·8 % of participants reported to consume expired food, even more than once per month; between 80 and 90 % of participants reported to follow food safety practices during preparation and cooking, even though 49·3 % defrosted food at room temperature. Calculated dietary and hygiene indices showed that the elderly participants were far from having optimal nutritional and food safety behaviours. CONCLUSIONS These results suggest it is necessary to increase the awareness of older adults in the matter of healthy diet and food safety. Specific and targeted educational interventions for the elderly and their caregivers could improve the adoption of recommended food safety practices and safe nutritional behaviours among older adults.
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Borkent JW, Naumann E, Vasse E, van der Heijden E, de van der Schueren MAE. Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091562. [PMID: 31060212 PMCID: PMC6539798 DOI: 10.3390/ijerph16091562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/18/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.
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Affiliation(s)
- Jos W Borkent
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Elke Naumann
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Emmelyne Vasse
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Department of Dietetics, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Ellen van der Heijden
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
| | - Marian A E de van der Schueren
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117; 1081 HV Amsterdam, The Netherlands.
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SCREEN III: working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data. Eur J Clin Nutr 2019; 73:1260-1269. [PMID: 30820028 DOI: 10.1038/s41430-019-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/12/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Screening for nutrition risk in community-dwelling older adults increases the likelihood of early intervention to improve nutritional status, with short screening tools preferred. SCREEN-II-AB is a valid 8-item tool. The current study determines whether SCREEN-III, a proposed 3-item version, adequately classifies nutrition risk in comparison. SUBJECTS/METHODS Baseline data from the Canadian Longitudinal Study on Aging were used. Seventy-two percent (n = 24,456) of eligible participants (>55 years, complete SCREEN-II-AB) were included. Sensitivity and specificity of various SCREEN-III values compared with SCREEN-II-AB risk determined a nutrition risk cut-point and the proportion misclassified (False[-]) was calculated. Construct validity was tested against a composite variable summarizing outcomes associated with nutrition risk (e.g., self-reported health, hospitalization) using logistic regression adjusted for individual factors (e.g., marital status). RESULTS A SCREEN-III cut-point of <22 performed best on sensitivity (0.83 [95% CI = 0.82, 0.84]) and specificity (0.73 [95% CI = 0.72, 0.74]) compared to SCREEN-II-AB (Cramer's V = 0.53). Of those at-risk using SCREEN-II-AB, 16.7% were misclassified as False(-) by SCREEN-III. The False(-) group did not differ significantly from the True(-) group. Based on SCREEN-III, 45.3% of individuals were at nutrition risk, 44% of whom reported the outcome composite. SCREEN-III nutrition risk was associated with greater odds of the outcome composite compared to those not at-risk (OR = 1.40, 95% CI = 1.33, 1.48, P < 0.0001). CONCLUSION The proposed version of SCREEN-III demonstrated construct validity, but misclassification of risk may be problematic; further validation of a 3-item version is recommended.
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Whitfield KC, da Silva L, Feldman F, Singh S, McCann A, McAnena L, Ward M, McNulty H, Barr SI, Green TJ. Adequate vitamin B 12 and riboflavin status from menus alone in residential care facilities in the Lower Mainland, British Columbia. Appl Physiol Nutr Metab 2018; 44:414-419. [PMID: 30248270 DOI: 10.1139/apnm-2018-0459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Older adults have potential increased risk of nutrient deficiencies because of age-related decreased dietary intake and malabsorption; it is important to ensure nutrient needs are met to avoid adverse health outcomes. B vitamins are of particular interest: vitamin B12 deficiency can cause irreversible neurodegeneration; there is mandatory folic acid fortification in Canada; and suboptimal riboflavin status has been reported among older adults in the United Kingdom. In this exploratory secondary analysis study we assessed vitamin B12 and riboflavin biochemical status (via microparticle enzyme immunoassay and erythrocyte glutathione reductase activity coefficient (EGRac), respectively), and the vitamin B12, riboflavin, and folate content of menus served to a convenience sample of older adults (≥65 years) from 5 residential care facilities within the Lower Mainland of British Columbia, Canada. Diet was assessed from customized 28-day cycle meal plans. Participants (n = 207; 53 men and 154 women) were aged 86 ± 7 years, largely of European descent (92%), and nonsmokers (95%). The menus served had a low prevalence of inadequacy for vitamin B12 and riboflavin (only 4% and 1% of menus contained less than the estimated average requirement (EAR), respectively), but 93% contained less than the EAR for folate. Mean ± SD serum total vitamin B12 concentration was 422 ± 209 pmol/L, and EGRac was 1.30 ± 0.19. The majority of older adults in residential care were provided with adequate vitamin B12 and riboflavin menu amounts, and only 5% were vitamin B12 deficient (<148 pmol/L). However, 26% were riboflavin deficient (EGRac ≥ 1.4), which may warrant further investigation.
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Affiliation(s)
- Kyly C Whitfield
- a Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS B3M 2J6, Canada
| | - Liz da Silva
- b Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Fabio Feldman
- b Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada.,c Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Sonia Singh
- b Fraser Health Authority, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada.,d Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Adrian McCann
- e Bevital AS, Laboratoriebygget, 9 etg, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Liadhan McAnena
- f Nutrition Innovation Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK
| | - Mary Ward
- f Nutrition Innovation Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK
| | - Helene McNulty
- f Nutrition Innovation Centre for Food and Health, Ulster University, Cromore Road, Coleraine BT52 1SA, UK
| | - Susan I Barr
- g Food, Nutrition and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tim J Green
- h Healthy Mothers, Babies and Children Theme, South Australia Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
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Craven DL, Pelly FE, Lovell GP, Isenring E. Nutrition Risk Measured Online in Community-Living Older Australians. J Nutr Gerontol Geriatr 2018; 37:241-254. [PMID: 30207896 DOI: 10.1080/21551197.2018.1490680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Many community-living older adults experience the condition of malnutrition and the causes are complex and multi-factorial. This study examined nutrition risk in a sample of community-living older Australians (n = 77, age ≥65 years) using an online, self-administered survey consisting of two validated questionnaires (SCREEN II and SF-12). We found a significant relationship between health status and nutrition risk; those with higher self-rated health status had lower nutrition risk. Forty percent of the participants were categorized at high nutritional risk, 26% at moderate nutritional risk and 34% not at nutritional risk. The most common nutrition risk factors were: (i) weight perception (perceiving weight to be more than it should); (ii) food avoidance; (iii) low intake of milk, milk products and alternatives; and (iv) finding meal preparation a chore. Many nutrition-risk factors were consistent with population survey data highlighting the need for greater awareness of nutritional requirements for healthy ageing.
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Affiliation(s)
- Dana L Craven
- a School of Health and Sport Sciences , USC Australia , Sippy Downs , QLD , Australia
| | - Fiona E Pelly
- a School of Health and Sport Sciences , USC Australia , Sippy Downs , QLD , Australia
| | - Geoff P Lovell
- b School of Social Sciences , USC Australia , Sippy Downs , QLD , Australia
| | - Elisabeth Isenring
- c Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport , Bond University , Robina , QLD , Australia
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Yannakoulia M, Mamalaki E, Anastasiou CA, Mourtzi N, Lambrinoudaki I, Scarmeas N. Eating habits and behaviors of older people: Where are we now and where should we go? Maturitas 2018; 114:14-21. [DOI: 10.1016/j.maturitas.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/02/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
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North SM, Wham CA, Teh R, Moyes SA, Rolleston A, Kerse N. High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Māori: LiLACS NZ. Aust N Z J Public Health 2018; 42:375-381. [PMID: 29888831 DOI: 10.1111/1753-6405.12793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/01/2017] [Accepted: 03/01/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non-Māori in advanced age. METHODS Within LiLACS NZ, 256 Māori and 399 non-Māori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all-cause hospital admissions and mortality. RESULTS For Māori but not non-Māori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95-0.99], p=0.009 and 0.91 [0.86-0.98], p=0.005, respectively). The 'Factors Affecting Intake' domain was associated with mortality (HR, [95%CI] 0.94 [0.89-1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living. CONCLUSION Improved dietary adequacy may reduce poor outcomes for older Māori. Implications for public health: Nutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met.
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Affiliation(s)
- Sylvia M North
- School of Food and Nutrition, Massey University, New Zealand
| | - Carol A Wham
- School of Food and Nutrition, Massey University, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Simon A Moyes
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Anna Rolleston
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, New Zealand
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The Role of Food Antioxidants, Benefits of Functional Foods, and Influence of Feeding Habits on the Health of the Older Person: An Overview. Antioxidants (Basel) 2017; 6:antiox6040081. [PMID: 29143759 PMCID: PMC5745491 DOI: 10.3390/antiox6040081] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023] Open
Abstract
This overview was directed towards understanding the relationship of brain functions with dietary choices mainly by older humans. This included food color, flavor, and aroma, as they relate to dietary sufficiency or the association of antioxidants with neurodegenerative diseases such as dementia and Alzheimer’s disease. Impairment of olfactory and gustatory function in relation to these diseases was also explored. The role of functional foods was considered as a potential treatment of dementia and Alzheimer’s disease through inhibition of acetylcholinesterase as well as similar treatments based on herbs, spices and antioxidants therein. The importance of antioxidants for maintaining the physiological functions of liver, kidney, digestive system, and prevention of cardiovascular diseases and cancer has also been highlighted. Detailed discussion was focused on health promotion of the older person through the frequency and patterns of dietary intake, and a human ecology framework to estimate adverse risk factors for health. Finally, the role of the food industry, mass media, and apps were explored for today’s new older person generation.
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Thompson J, Tod A, Bissell P, Bond M. Understanding food vulnerability and health literacy in older bereaved men: A qualitative study. Health Expect 2017; 20:1342-1349. [PMID: 28544135 PMCID: PMC5689239 DOI: 10.1111/hex.12574] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 11/26/2022] Open
Abstract
Background Older people are sometimes challenged in maintaining a healthy diet but, because of age and disadvantage, are also more vulnerable to the adverse health consequences of poor nutrition. It has been claimed that older adults have low levels of health literacy regarding food and struggle to discern which foods are healthy from the vast range available in developed counties. However, nutrition and eating behaviour are modifiable risk factors for health in old age and health benefits can accrue from promoting healthy eating later in life. In order to achieve these health benefits, it is necessary to understand more about the capabilities and vulnerabilities of older people in terms of acquiring and maintaining a healthy diet. Objective To understand the potential for issues around food vulnerability to arise in that group and to characterize that vulnerability, if present. Design Narrative interviews were conducted to collect the data. An interpretative thematic approach to analysis was utilized. Participants Twenty older, bereaved men from two communities in the North of England. Findings Five overarching themes were identified: financial security, social networks, cooking skills, food and routine and single servings. Discussion Our findings suggest that some older men experience cumulative benefit from resources at their disposal, which contributes towards their capabilities to avoid food vulnerability.
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Affiliation(s)
- Jill Thompson
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Angela Tod
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Paul Bissell
- Human and Health Sciences, The University of Huddesfield, Harold Wilson Building (HW2) Queensgate, Huddersfield HD1 3DH, UK
| | - Michael Bond
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Ivery JM, Benton L, Harrison A, Paul M, Cortés M. The DASH Pilot Project: Developing Community-Based Nutrition Education for Older Adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:286-299. [PMID: 28402217 DOI: 10.1080/01634372.2017.1318197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nutrition-related chronic health conditions among older adults are a growing concern. In this study, nutrition education materials were created for use in senior centers by graduate nutrition students. After the materials were presented, focus groups were conducted with participants (n = 62) to obtain feedback on the content and presentation. Findings related to the participant's knowledge of nutrition-related information, strategies to improve future class sessions, and participant recruitment will be discussed. These findings will be useful to program administrators as they develop nutrition programs for older adults who are vulnerable to nutrition-related health problems.
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Affiliation(s)
- Jan M Ivery
- a Georgia State University School of Social Work , Atlanta , Georgia , USA
| | | | - Ashley Harrison
- c Departmetn of Diabetes Services , Wellstar Health System , Atlanta , Georgia , USA
| | - Melissa Paul
- d Department of Clinical Nutrition , Children's Healthcare of Atlanta , Egleston, Atlanta , Georgia , USA
| | - Marielysse Cortés
- e College of Nursing and Health Innovation , Arizona State University , Phoenix , Arizona , USA
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Pettigrew S, Worrall C, Biagioni N, Talati Z, Jongenelis M. The role of food shopping in later life. Appetite 2017; 111:71-78. [DOI: 10.1016/j.appet.2016.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/02/2016] [Accepted: 12/24/2016] [Indexed: 11/26/2022]
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Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab 2017; 42:449-458. [PMID: 28322060 DOI: 10.1139/apnm-2016-0652] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is increasing awareness of the detrimental health impact of frailty on older adults and of the high prevalence of malnutrition in this segment of the population. Experts in these 2 arenas need to be cognizant of the overlap in constructs, diagnosis, and treatment of frailty and malnutrition. There is a lack of consensus regarding the definition of malnutrition and how it should be assessed. While there is consensus on the definition of frailty, there is no agreement on how it should be measured. Separate assessment tools exist for both malnutrition and frailty; however, there is intersection between concepts and measures. This narrative review highlights some of the intersections within these screening/assessment tools, including weight loss/decreased body mass, functional capacity, and weakness (handgrip strength). The potential for identification of a minimal set of objective measures to identify, or at least consider risk for both conditions, is proposed. Frailty and malnutrition have also been shown to result in similar negative health outcomes and consequently common treatment strategies have been studied, including oral nutritional supplements. While many of the outcomes of treatment relate to both concepts of frailty and malnutrition, research questions are typically focused on the frailty concept, leading to possible gaps or missed opportunities in understanding the effect of complementary interventions on malnutrition. A better understanding of how these conditions overlap may improve treatment strategies for frail, malnourished, older adults.
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Affiliation(s)
- Celia V Laur
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Tara McNicholl
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Renata Valaitis
- a Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
| | - Heather H Keller
- b Faculty of Applied Health Science, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada.,c Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Ave., Waterloo, ON N2L 3G1, Canada
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Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, Fielding RA, Cheng FW, Jensen GL, Wu D, Meydani SN. Nutritional Considerations for Healthy Aging and Reduction in Age-Related Chronic Disease. Adv Nutr 2017; 8:17-26. [PMID: 28096124 PMCID: PMC5227979 DOI: 10.3945/an.116.013474] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A projected doubling in the global population of people aged ≥60 y by the year 2050 has major health and economic implications, especially in developing regions. Burdens of unhealthy aging associated with chronic noncommunicable and other age-related diseases may be largely preventable with lifestyle modification, including diet. However, as adults age they become at risk of "nutritional frailty," which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high. This review highlights the role of nutrition science in promoting healthy aging and in improving the prognosis in cases of age-related diseases. It serves to identify key knowledge gaps and implementation challenges to support adequate nutrition for healthy aging, including applicability of metrics used in body-composition and diet adequacy for older adults and mechanisms to reduce nutritional frailty and to promote diet resilience. This review also discusses management recommendations for several leading chronic conditions common in aging populations, including cognitive decline and dementia, sarcopenia, and compromised immunity to infectious disease. The role of health systems in incorporating nutrition care routinely for those aged ≥60 y and living independently and current actions to address nutritional status before hospitalization and the development of disease are discussed.
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Affiliation(s)
- Julie Shlisky
- The Sackler Institute for Nutrition Science at the New York Academy of Sciences, New York, NY;
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
| | | | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Ontario, Canada
| | - Yvonne Freund-Levi
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatrics, Karolinska University Hospital, Huddinge, Sweden
- Department of Psychiatry, Tiohundra Hospital, Stockholm, Sweden
| | | | - Feon W Cheng
- The Pennsylvania State University, University Park, PA; and
| | | | - Dayong Wu
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Simin N Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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Abstract
OBJECTIVES To identify patterns of nutritional risk among older men over a four-year period and to project their survival rates over the next two and a half years. DESIGN A prospective longitudinal study. SETTING Canada. PARTICIPANTS Three hundred and thirty-six male survivors of the Manitoba Follow-up Study (MFUS) cohort with an average age of 90 years in 2011. MEASUREMENTS Four years of nutritional risk SCREEN II scores (five waves) from the male survivors of the MFUS cohort. The semi-parametric group-based trajectory approach and survival analysis were used to investigate the trajectories of nutritional risk. RESULTS Of the participants, 30% lived alone. Five distinct developmental trajectory groups for nutritional risk score were identified. Significant statistical differences were found among the five trajectory groups for SF-36 mental health (p=.02), SF-36 physical health (p=<.001), perception of aging successfully (p=.04) and living alone (p=<.001). Among the five groups, the most pairwise differences were found in appetite, intake of meat and alternatives, and vegetables and fruit, weight change, skipping meals and eating with others. Men in the poorest nutritional risk trajectory group were two times more likely to die within a 2 1/2 year period compared to men in the best nutritional risk trajectory group (hazard rate = 2.33, p=.07). CONCLUSION Distinct nutritional risk trajectories were found for older men over a four year period. Poor nutritional risk trajectories are associated with higher risk of mortality for very old men over a short period of time. Timely nutritional assessments by health professionals are needed to identify older men at nutritional risk. Subsequent nutrition education and follow-up may be important in preventing further decline.
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Affiliation(s)
- C O Lengyel
- Christina O. Lengyel, PhD, RD, Associate Professor, Department of Human Nutritional Sciences, University of Manitoba, 405 Human Ecology Building, 35 Chancellors Circle, Winnipeg, Manitoba, Canada, R3T 2N2, E-mail:
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Macronutrient intake in advanced age: Te Puāwaitanga o Ngā Tapuwae Kia ora Tonu, Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ). Br J Nutr 2016; 116:1103-15. [PMID: 27546175 DOI: 10.1017/s0007114516003020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As part of the 12-month follow-up of the longitudinal cohort study, Life and Living in Advanced Age: A Cohort Study in New Zealand, dietary intake was assessed in 216 Māori and 362 non-Māori octogenarians using repeat 24-h multiple pass recalls. Energy and macronutrient intakes were calculated, and food items reported were allocated to food groups used in the New Zealand Adult Nutrition Survey (NZANS). Intakes were compared with the nutrient reference values (NRV) for Australia and New Zealand. The median BMI was higher for Māori (28·3 kg/m2) than for non-Māori (26·2 kg/m2) P=0·007. For Māori, median energy intake was 7·44 MJ/d for men and 6·06 MJ/d for women with 16·3 % energy derived from protein, 43·3 % from carbohydrate and 38·5 % from fat. Median energy intake was 7·91 and 6·26 MJ/d for non-Māori men and women, respectively, with 15·4 % of energy derived from protein, 45 % from carbohydrate and 36·7 % from fat. For both ethnic groups, bread was the top contributor to energy and carbohydrate intakes. Protein came from beef and veal, fish and seafood, bread, milk and poultry with the order differing by ethnic groups and sex. Fat came mainly from butter and margarine. Energy-adjusted protein was higher for Māori than non-Māori (P=0·049). For both ethnic groups, the median energy levels were similar, percent carbohydrate tended to be lower and percent fat higher compared with adults aged >70 years in NZANS. These unique cross-sectional data address an important gap in our understanding of dietary intake in this growing section of our population and highlight lack of age-appropriate NRV.
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Lengyel CO, Tate RB, Bayomi DJ. Nutritional risk in community-dwelling older men: the Manitoba follow-up study. CAN J DIET PRACT RES 2016; 75:84-8. [PMID: 24897014 DOI: 10.3148/75.2.2014.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The role of nutrition in older men's health and successful aging has been inadequately studied. We examined the relationships among nutritional risk, self-rated health, and successful aging in community-dwelling Canadian older men. METHODS The surviving cohort of the Manitoba Follow-up Study (n=690, mean age = 86.8 years) were sent a self-administered nutrition survey in December 2007. The survey consisted of the Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II), a validated tool for assessing nutritional risk of cognitively intact community-living older adults, and questions about successful aging and health. RESULTS Of the 553 surveys returned (80% response), 522 with complete SCREEN II data were included in the analysis. Forty-four percent of respondents were at high nutritional risk, 24% were at moderate risk, and 32% were at low risk. Significant relationships were found between nutritional risk and self-rated health (P<0.0001) and successful aging (P=0.008), with greater nutritional risk associated with lower self-ratings of health and successful aging. Higher use of prescription medication was related to greater nutritional risk (P=0.004). CONCLUSIONS Nutritional screening programs for community-dwelling older men are warranted as two-thirds of the study participants were at nutritional risk. Identifying older men at nutritional risk is a critical step in the process of nutritional assessment, and subsequent nutrition interventions and follow-up are required to prevent further health decline.
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Clum G, Gustat J, O'Malley K, Begalieva M, Luckett B, Rice J, Johnson C. Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana. J Nutr Health Aging 2016; 20:678-84. [PMID: 27499299 DOI: 10.1007/s12603-016-0695-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND OBJECTIVES The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. DESIGN A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper. SETTING All participants were in the New Orleans metro area and were surveyed in 2011. PARTICIPANTS Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. MEASUREMENTS Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping. RESULTS Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men. CONCLUSIONS FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.
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Affiliation(s)
- G Clum
- Gretchen Clum, 1440 Canal st tw 19, New Orleans, LA 70112, USA,
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Ziylan C, Haveman-Nies A, van Dongen EJI, Kremer S, de Groot LCPGM. Dutch nutrition and care professionals’ experiences with undernutrition awareness, monitoring, and treatment among community-dwelling older adults: a qualitative study. BMC Nutr 2015. [DOI: 10.1186/s40795-015-0034-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gender differences in the roles for social support in ensuring adequate fruit and vegetable consumption among older adult Canadians. Appetite 2015; 92:102-9. [PMID: 25981151 DOI: 10.1016/j.appet.2015.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/17/2015] [Accepted: 05/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Adequate fruit and vegetable consumption has been linked to reductions in all-cause mortality, stroke, and cancer. Unfortunately, less than half of Canadians aged 65+ meet the standard international guideline for adequate consumption (≥5 servings per day). Among older adults, social isolation and low social support are barriers to proper nutrition, but the effects of specific types of social support on adequate fruit and vegetable consumption are unknown. OBJECTIVE This study sought to test hypotheses regarding direct and indirect pathways through which tangible and emotional/informational social support may facilitate adequate fruit and vegetable consumption among older adults. METHODS Analyzing 2008-2009 Canadian Community Health Survey - Healthy Aging component data (n = 14,221), logistic regression models were developed to examine associations between tangible and emotional/informational social support, eating behaviors (eating alone and preparing one's own meals), and meeting the recommended guideline of consuming ≥5 servings of fruit and vegetables per day. RESULTS In pooled models, emotional/informational support was positively associated with adequate fruit and vegetable consumption (OR = 1.16; 95% CI = 1.07, 1.27). Among men, neither social support form was directly or indirectly associated with adequate consumption; among women, adequate consumption was negatively associated with tangible support but positively associated with higher emotional/informational support. Both of these associations were mediated by not usually cooking one's own meals. CONCLUSIONS Programs and policies that seek to foster social support for older adults as a means of ensuring proper nutrition should consider the nuanced mechanisms through which different social support forms may operate for men and women.
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Stratton LM, Vella MN, Sheeshka J, Duncan AM. Food neophobia is related to factors associated with functional food consumption in older adults. Food Qual Prefer 2015. [DOI: 10.1016/j.foodqual.2014.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manafò E, Jose K, Silverberg D. Promoting nutritional well-being in seniors: feasibility study of a nutrition information series. CAN J DIET PRACT RES 2014; 74:175-80. [PMID: 24472165 DOI: 10.3148/74.4.2013.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Better Living Health and Community Services developed a 12-week community-based nutrition information series (NIS) for people aged 55 or older. The purpose of this feasibility study was to describe briefly the process of developing and implementing the 12-week NIS and to identify the practicality and plausibility of the program in terms of its process and content attributes, using Thorncliffe Park community as the test site. A pre- and post-test design was used to identify changes in participants' perception of their nutritional and overall well-being. Twenty-four participants who completed at least four sessions participated in the post-evaluation follow-up. Only participants' perception of their eating habits demonstrated a significant, positive improvement (t24=2.1, P<0.05). The results suggest that the NIS has the potential to promote the health and well-being of community-living seniors. The development and implementation of the NIS provided considerations for program practicality. However, additional work is needed to examine the plausibility of the program in meeting its stated objective to promote awareness of nutrition as an important concept for healthy aging. Community-practising dietitians are instrumental in providing credible nutrition information to facilitate healthy eating in older Canadians.
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Vesnaver E, Keller HH. Social influences and eating behavior in later life: a review. J Nutr Gerontol Geriatr 2013; 30:2-23. [PMID: 23286638 DOI: 10.1080/01639366.2011.545038] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Food intake is often poor within the older population and many are at nutritional risk. Food intake is complex, as there are multiple individual, social, and environmental determinants that may interact and change over time. Social isolation has long been recognized as a key factor predicting nutrition risk in this population. However, the mechanisms by which social relationships influence diet among older adults remain poorly understood. The purpose of this review is two-fold: ( 1 ) to identify and, where possible, clarify the social concepts used in older adult nutrition research over the past two decades, specifically, the concepts of social integration, social support, companionship and commensality; and ( 2 ) to provide a review and summary of the empirical literature on social factors and diet among cognitively well older adults living in the community. Finally, challenges to studying social concepts in older adult nutrition and areas of future research will be discussed.
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Affiliation(s)
- Elisabeth Vesnaver
- Department of Family Relations and Applied Nutrition, Macdonald Institute, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
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Manafò E, Wong S. eSEARCH©: A Tool to Promote the eHealth Literacy Skills of Older Adults. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2013. [DOI: 10.1080/15398285.2013.812914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fruit and vegetable intake among older adults: a scoping review. Maturitas 2013; 75:305-12. [PMID: 23769545 DOI: 10.1016/j.maturitas.2013.05.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 11/23/2022]
Abstract
Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.
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Brownie S, Coutts R. Focus group interviews with older Australians to explore their awareness of the national age-adjusted dietary recommendations and their suggestions for assisting them to meet these dietary targets. Aust J Prim Health 2013; 20:182-7. [PMID: 23477670 DOI: 10.1071/py13008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/15/2013] [Indexed: 11/23/2022]
Abstract
Promoting a healthy, nutritious diet is central to the goal of assisting individuals to age well. This study used focus groups to explore older people's awareness of the current age-adjusted nutrient recommendations and age-adjusted core food groups, and to capture their views about these dietary guidelines. Thematic analysis was applied to aggregate data into categories of frequently occurring responses. Data were collected from five focus groups: a total of 29 participants, aged 60-98 years of age. Analysis of responses revealed that participants were generally unaware of government-endorsed dietary guidelines or nutrient recommendations for older people. Their suggestions for assisting older people to meet these age-adjusted dietary targets included: targeted media campaigns to raise awareness about older people's nutrient requirements; the need for practical meal plans that do meet their dietary needs; and the removal of barriers to supermarket food choices, such as problems with opening jars and excessive packaging.
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Affiliation(s)
- Sonya Brownie
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia
| | - Rosanne Coutts
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia
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