1
|
Mishra B, Pradhan J, Dhaka S. Identifying the impact of social isolation and loneliness on psychological well-being among the elderly in old-age homes of India: the mediating role of gender, marital status, and education. BMC Geriatr 2023; 23:684. [PMID: 37864212 PMCID: PMC10589928 DOI: 10.1186/s12877-023-04384-1] [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: 02/23/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Social isolation and loneliness can be detrimental to the overall functioning of the older adults. The study examines the impact of social isolation and loneliness on the psychological well-being of older adults residing in various old-age homes in India and investigates the mediating role of gender, marital status, and education level in the way social isolation and loneliness affect psychological well-being. METHODS Data has been collected from 320 individuals aged sixty years or above. Data were collected using standardized measures like Lubben Social Network Scale- 6, revised UCLA Loneliness Scale, and shortened version of psychological well-being scale by Ryff & Keyes (1995). Multivariate and mediation analysis were performed to understand the associations of social isolation and loneliness with psychological well-being. RESULTS A statistically significant MANOVA effect was obtained for social isolation (F = 3.836, p < .01), and loneliness (F = 3.782, p < .01). Gender and education as independent factors were significantly associated with the psychological well-being of individuals. However, both gender and education did not mediate the impact of social isolation and loneliness on the psychological well-being of older adults. Further, marital status had a partial mediating effect on the relationship between social isolation, loneliness, and psychological well-being. CONCLUSIONS The findings of the study can be incorporated into measures aiming at alleviation of feelings of social isolation and loneliness among the elderly. Further, the findings can be used to design various intervention strategies aimed at the reduction of social isolation and loneliness among older adults and the restoration of their psychological well-being.
Collapse
Affiliation(s)
- Bijeta Mishra
- National Institute of Technology, Rourkela, Odisha, India
| | | | - Suman Dhaka
- Indian Institute of Technology, Jodhpur, Rajasthan, India.
| |
Collapse
|
2
|
Matsumoto K, Hatakeyama Y, Seto K, Onishi R, Hirata K, Wu Y, Hasegawa T. Cost of illness in a super-aged society—comparison of breast, lung, and prostate cancer in Japan. BMC Geriatr 2022; 22:964. [PMCID: PMC9749159 DOI: 10.1186/s12877-022-03683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Aging increases the disease burden because of an increase in disease prevalence and mortality among older individuals. This could influence the perception of the social burden of different diseases and treatment prioritization within national healthcare services. Cancer is a disease with a high disease burden in Japan; however, the age-specific frequency and age-specific mortality rates differ according to site. In this study, we evaluated the relationship between the aging of the Japanese society and the disease burden by comparing the features of three cancers with different age-specific frequency rates in Japan. Furthermore, we made projections for the future to determine how the social burden of these cancers will change. Methods We calculated the social burden of breast, lung, and prostate cancers by adding the direct, morbidity, and mortality costs. Estimates were made using the cost of illness (COI) method. For future projections, approximate curves were fitted for mortality rate, number of hospital admissions per population, number of outpatient visits per population, and average length of hospital stay according to sex and age. Results The COI of breast, lung, and prostate cancers in 2017 was 903.7, 1,547.6, and 390.8 billion yen, respectively. Although the COI of breast and prostate cancers was projected to increase, that of lung cancer COI was expected to decrease. In 2017, the average age at death was 68.8, 76.8, and 80.7 years for breast, lung, and prostate cancers, respectively. Conclusions Patients with breast cancer die earlier than those with other types of cancer. The COI of breast cancer (“young cancer”) was projected to increase slightly because of an increase in mortality costs, whereas that of prostate cancer (“aged cancer”) was projected to increase because of an increase in direct costs. The COI of lung cancer (“aging cancer”) was expected to decrease in 2020, despite the increase in deaths, as the impact of the decrease in human capital value outweighed that of the increase in deaths. Our findings will help prioritize future policymaking, such as cancer control research grants.
Collapse
Affiliation(s)
- Kunichika Matsumoto
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| | - Yosuke Hatakeyama
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| | - Kanako Seto
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| | - Ryo Onishi
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| | - Koki Hirata
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| | - Yinghui Wu
- grid.16821.3c0000 0004 0368 8293School of Nursing, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai, People’s Republic of China
| | - Tomonori Hasegawa
- grid.265050.40000 0000 9290 9879Department of Social Medicine, Toho University School of Medicine, 5-21-16 Omori-Nishi, Ota-Ku, Tokyo, 143-8540 Japan
| |
Collapse
|
3
|
Seah B, Espnes GA, Hong WT, Wang W. Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial. BMC Geriatr 2022; 22:932. [PMID: 36460959 PMCID: PMC9719210 DOI: 10.1186/s12877-022-03605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only. METHODS A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data. RESULTS Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention. CONCLUSION Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention. TRIAL REGISTRATION This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.
Collapse
Affiliation(s)
- Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore. .,Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore.
| | - Geir Arild Espnes
- NTNU Center for Health Promotion Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postbox 8905, Trondheim, N-7491, Norway
| | - Wee Tin Hong
- Health Concepts and Measurements-HealthierSG, 116B Rivervale Drive, #12-30, Singapore, 542116, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 3, 10 Medical Drive, Singapore, 117597, Singapore
| |
Collapse
|
4
|
Nicolson GH, Hayes CB, Darker CD. A Cluster-Randomised Crossover Pilot Feasibility Study of a Multicomponent Intervention to Reduce Occupational Sedentary Behaviour in Professional Male Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9292. [PMID: 34501882 PMCID: PMC8431104 DOI: 10.3390/ijerph18179292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022]
Abstract
Professional male office employees have been identified as those most at risk of prolonged sedentary time, which is associated with many long-term adverse health conditions. The aim of the study was to assess the acceptability and feasibility of a gender-sensitive multicomponent intervention, guided by the socio-ecological model, to reduce occupational sedentary behaviour by increasing physical activity in professional men. The main elements of the intervention comprised: a Garmin watch with associated web-based platform/smartphone application, an under-desk pedal machine, and management participation and support. A cluster-randomised crossover pilot feasibility trial recruiting professional males was conducted in two workplaces. Mixed methods were used to assess the primary outcomes of recruitment, retention, and acceptability and feasibility of the intervention. Secondary outcomes included objectively measured sedentary behaviour, standing and physical activity. Focus groups were used to explore the acceptability of the intervention in a real-world setting. Twenty-two participants were recruited (mean age 42.9 years (SD 11.0)). Recruitment and retention rates were 73.3% and 95%, respectively. Overall, participants found the intervention acceptable and feasible, and expressed enjoyment of the intervention, however desk set-up issues with the pedal devices were noted. The manual recording of the pedalling bouts was overly burdensome. Preliminary data indicate that the intervention may reduce occupational sedentary behaviour and increase physical activity. This intervention should be further tested in a definitive trial following consideration of the findings of this pilot feasibility trial.
Collapse
Affiliation(s)
- Gail Helena Nicolson
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH74 Dublin, Ireland; (C.B.H.); (C.D.D.)
| | | | | |
Collapse
|
5
|
The Impact of Stroke Public Awareness Campaigns Differs Between Sociodemographic Groups. Can J Neurol Sci 2021; 49:231-238. [PMID: 33875043 DOI: 10.1017/cjn.2021.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prehospital delays are a major obstacle to timely reperfusion therapy in acute ischemic stroke. Stroke sign recognition, however, remains poor in the community. We present an analysis of repeated surveys to assess the impact of Face, Arm, Speech, Time (FAST) public awareness campaigns on stroke knowledge. METHODS Four cross-sectional surveys were conducted between July 2016 and January 2019 in the province of Quebec, Canada (n = 2,451). Knowledge of FAST stroke signs (face drooping, arm weakness and speech difficulties) was assessed with open-ended questions. A bilingual English/French FAST public awareness campaign preceded survey waves 1-3 and two campaigns preceded wave 4. We used multivariable ordinal regression models weighted for age and sex to assess FAST stroke sign knowledge. RESULTS We observed an overall significant improvement of 26% in FAST stroke sign knowledge between survey waves 1 and 4 (odds ratio [OR] = 1.26; 95% CI: 1.02, 1.55; p = 0.035). After the last campaign, however, 30.5% (95% CI: 27.5, 33.6) of people were still unable to name a single FAST sign. Factors associated with worse performance were male sex (OR = 0.68; 95% CI: 0.53, 0.86; p = 0.002) and retirement (OR = 0.54; 95% CI: 0.35, 0.83; p = 0.005). People with lower household income and education had a tendency towards worse stroke sign knowledge and were significantly less aware of the FAST campaigns. CONCLUSIONS Knowledge of FAST stroke signs in the general population improved after multiple public awareness campaigns, although it remained low overall. Future FAST campaigns should especially target men, retired people and individuals with a lower socioeconomic status.
Collapse
|
6
|
O’Regan A, García Bengoechea E, Clifford AM, Casey M, Gallagher S, Glynn L, Doyle C, Woods C. How to improve recruitment, sustainability and scalability in physical activity programmes for adults aged 50 years and older: A qualitative study of key stakeholder perspectives. PLoS One 2020; 15:e0240974. [PMID: 33119669 PMCID: PMC7595437 DOI: 10.1371/journal.pone.0240974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/06/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Physical inactivity among adults aged 50 years and over is a worldwide health concern. The objectives of the study were to investigate the perspectives of those involved with existing physical activity programmes on optimising recruitment, sustainability and scalability of physical activity programmes for adults aged 50 years and over. METHODS The study was conducted in Ireland's Midwest region, where community-based physical activity programmes are delivered to groups by state-funded Local Sports Partnerships. Programme attendees, physical activity professionals and community advocates were recruited. One-to-one interviews and focus groups were conducted in 2018, recorded, transcribed and analysed by an interdisciplinary team experienced in qualitative research. Over a series of meetings, a thematic approach was used to code and analyse the transcripts, categorising data into higher order codes, themes and overarching themes with the purpose of making meaning of the data. Twenty-nine people participated in four focus groups and 18 participated in one-to-one interviews. FINDINGS Data analysis produced three overarching themes. "Age appropriate" explains how communication and the environment should be adapted to the needs of adults aged 50 years and older. "Culture and connection" refer to the interplay of individual and social factors that influence participation, including individual fears and insecurities, group cohesion and added value beyond the physical gains in these programmes. "Roles and partnerships" outlines how key collaborations may be identified and managed and how local ownership is key to success and scalability. CONCLUSION Successful recruitment, sustainability and scalability require an understanding that the target population has unique needs that must be catered for when planning interventions, communicating messages and choosing personnel. The findings of this study can inform the development of community-based programmes to increase physical activity in adults aged 50 years and older.
Collapse
Affiliation(s)
- Andrew O’Regan
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Amanda M. Clifford
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
- Health Research Board Primary Care Clinical Trial Network, Galway, Ireland
| | - Ciaran Doyle
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Catherine Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| |
Collapse
|
7
|
Perceived Barriers to Rural Elderly Women's Health-Promoting Behaviors: An Ecological Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176107. [PMID: 32825801 PMCID: PMC7503892 DOI: 10.3390/ijerph17176107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
This study multidimensionally examines rural elderly women's subjective barriers to practicing health-promoting behaviors. Twenty-six rural elderly women participated in three focus group interviews. Content analysis and a qualitative research method were used. The results, based on an ecological model, show that the implementation of health-promoting behaviors in rural elderly women was comprehensively related to intrapersonal (functional decline, passive attitude, and lack of implementation), interpersonal (lack of social support), community (restrictive conditions, accessibility issues, and lack of infrastructure), and public policy (lack of policy support) factors. Interventions addressing each factor can help reduce or eliminate the perceived barriers to health-promoting behaviors through interactions. Our findings can contribute to the development of health-promoting programs focused specifically on the socialization of rural elderly women and community-centered health policies in the future.
Collapse
|
8
|
Hartono RK, Hamid SA, Hafizurrachman M. Do the Number of Cigarettes Smokes per Day Contribute to
the Incident of Malignant Cancer? Asian Pac J Cancer Prev 2019; 20:1403-1408. [PMID: 31127899 PMCID: PMC6857885 DOI: 10.31557/apjcp.2019.20.5.1403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The incident of malignant cancer due to smoking habit becomes a public health problem especially in the developing countries. Active smokers neglect to stop smoking even though various studies proved that smoking increases the risk of cancer. While, previous studies have assessed the incident risk of cancer but have not performed the validity of the measurement. The aim of this study is to know the number of cigarettes that contribute to the incidence of malignant cancer. Methods: A study with retrospective cohort design has been conducted by using a set of public data of Indonesia Family Life Survey (IFLS) in 2007 and 2014. All active smokers (n= 748) who were in good health condition in 2007, were traced in 2014 and then being diagnosed with cancer with considering age, gender, healthy eating habit, and regular physical activity. Data has been analysed by using logistic regression by performing Adjusted Risk Ratio (ARR) and the result of validity measurement. Results: The incident of malignant cancer in 2014 were skin, liver, stomach and oral cavity. Smoking 21-30 per day in 2007 were significantly increased risk of having malignant cancer in 2014 at ARR: 6.88; SE: 6.13 with the accuracy were 93.8%. The risk and accuracy were higher if smoke >30 cigarettes per day (ARR: 7.523;SE: 7.019; accuracy 95.5%). This study also found that the risk of cancer was significantly increase with age (99% CI; ARR: 1.065; SE: 0.026). Conclusions: Cigarette smoking behaviour increased the risk any types incident of cancer. Total number >20 cigarettes smoked per day contributes to the incidence of malignant cancer.
Collapse
Affiliation(s)
- Risky Kusuma Hartono
- Sekolah Tinggi Ilmu Kesehatan Indonesia Maju, Jakarta, Indonesia. ,Cyberjaya University College of Medical Science, Cyberjaya, Malaysia
| | | | | |
Collapse
|
9
|
Fullen MC. Defining Wellness in Older Adulthood: Toward a Comprehensive Framework. JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
10
|
Abstract
Alongside declining activity levels, energy needs fall in older age and eating less is expected. However, as total food consumption declines, intakes of many nutrients are also likely to fall; while energy requirements may be met, other nutrient needs may not. Although this highlights the importance of nutrient-dense foods and overall diet quality in older age to ensure nutrient intakes are sufficient, maintaining or increasing diet quality may be difficult at a time when food access and preparation are becoming more challenging, and diets may be more monotonous. Poor nutrition, even in developed settings, is common. Older malnourished adults are more likely to have poorer health outcomes, longer hospital stays and increased mortality. Thus, apart from the evident personal costs, the economic burden of disease-related malnutrition is significant, and effective preventive strategies to promote good nutrition among older populations are needed. In particular, there is a need for wider recognition of malnutrition risk among older adults, including implementation of routine screening of nutritional status and early diagnosis. Design of future interventions to support older community-dwelling adults requires a clear understanding of the personal and contextual influences that affect patterns of food choice and consumption, including consideration of the importance of social and psychological factors. In addition, there are opportunities to intervene earlier in the lifecourse; the most effective preventive efforts to promote good nutrition in older age may need to start ahead of age-related changes in physiology and function, including younger adulthood and at the retirement transition.
Collapse
|
11
|
Huffman FG, Vaccaro JA, Vieira ER, Zarini GG. Health-Related Characteristics of Older Adults Who Attend Congregate Meal Sites in the United States. Geriatrics (Basel) 2017; 2:geriatrics2030022. [PMID: 31011032 PMCID: PMC6371172 DOI: 10.3390/geriatrics2030022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to determine health-related characteristics of a representative sample of older adults who attend congregate meal sites in the United States, and compare races/ethnicities and sexes. Participants were adults, aged 60 years and older, (N = 901) of the 2015 Tenth Annual National Survey of Older American Act Participants (NSOAAP). Difficulties with mobility and Activities of Daily Living were common among older adults who attended congregate meals. Health-related characteristics differed by race/ethnicity and sex. Higher percentages of men reported eating more than half their calories from the site: 61.0% (53, 68), compared to women: 41.2% (33,50); while twice the number of women reported exercising at the site: 42.7% (36, 50), compared to 21.8% (16, 29) for men. Hispanics reported poor/fair health, food insecurity, diabetes, and poverty more often than White non-Hispanics. The odds of reporting that meals helped maintain independence were higher for persons with food insecurity: OR = 2.67 (1.05, 6.80) and those who reported eating half or more of their calories from the site: OR = 5.78 (2.36, 14.30). Strategies that consider preferences by sex and race/ethnicity are required at congregate meal sites to encourage mobility and healthy eating.
Collapse
Affiliation(s)
- Fatma G Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA.
| | - Joan A Vaccaro
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA.
| | - Edgar R Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33199, USA.
| | - Gustavo G Zarini
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33199, USA.
| |
Collapse
|