Tailoring Nutrition Education Intervention Programs to Meet Needs and Interests of Older Adults

Meeting Older Adults' Food Needs During the COVID-19 Pandemic: Lessons And Challenges from Washington State

The COVID-19 pandemic threatened the ability of nutrition providers to address food insufficiency among older adults. Findings from Household Pulse Survey data and interviews with 23 service leaders in Washington state during the summer of 2020 point to key organizational practices that should inform future emergency food assistance planning. Organizations deeply connected to and trusted by racially and ethnically diverse, unhoused, and low-income older adults are critical to addressing disparities in food insufficiency. Stable and flexible increases in funding would allow these organizations to maintain the effective and culturally-relevant service adaptations they implemented in the first months of the pandemic.

How to Ensure That Teaching Kitchens Are Age-Friendly

Health systems and community organizations have increasingly offered nutrition education through teaching kitchens. With an increasing number of older adults (>65 years) accessing these programs, teaching kitchens may consider age-friendly adaptations to their standard curriculum. Based on experiences with implementing Healthy Teaching Kitchens Across Veteran Affairs Health Care System, and by applying the 5M Geriatric Care Framework (Mind, Multicomplexity, Medications, Mobility, What Matters Most), several steps are proposed for teaching kitchens to be able to better accommodate older adults.

Identifying Barriers of Arthritis-Related Disability on Food Behaviors to Guide Nutrition Interventions

OBJECTIVE

To describe the impact of arthritis-related disability on aspects of food insecurity and to gain insight into the incentives and barriers to participating in a nutrition intervention.

DESIGN

Four focus groups were held in April to May, 2018. Participants completed questionnaires about socioeconomic status, diet, and health.

SETTING

The Perform Centre, Concordia University, Montreal, Canada.

PARTICIPANTS

A convenience sample of 27 adults diagnosed with arthritis.

PHENOMENON OF INTEREST

Perceived impact of arthritis-related disability on food behaviors as well as incentives and deterrents to participating in a nutrition intervention.

ANALYSIS

Transcriptions of the focus group discussions were coded using the constant comparative method. Basic descriptive statistics were used to analyze the questionnaire data.

RESULTS

The themes of pain, fatigue, knowledge, and social support emerged in discussions on food choices, procurement, preparation, consumption, and other lifestyle behaviors. Participants reported common barriers, although the extent to which they were affected varied. Questionnaire results revealed low disability. Timing, cost, and information quality were important incentives to participate in a nutrition intervention.

CONCLUSIONS AND IMPLICATIONS

Results highlight the need for further research among people with greater limitations related to arthritis and adapted nutrition interventions that provide both knowledge and experience to help individuals overcome the challenges of arthritis.

Intention of Older Women to Consume 100% Watermelon Juice for Vascular Health: An Application of Theory of Planned Behavior

To strengthen randomized controlled trials (RCT) evaluating the efficacy of 100% watermelon juice on vascular function of older women, theory-driven behavioral analysis as well as comparative sensory analysis of the intervention and placebo were conducted. The Theory of Planned Behavior was adopted to assess psychosocial determinants of intention to consume watermelon juice. Sensory attributes were assessed utilizing hedonic scales. Analysis included Structural Equation Modeling with maximum likelihood. The measurement model provided a good fit (x² = 70.22, df = 38; RMSEA = 0.07, CFI = 0.98; NFI = 0.95). Attitude (γ = 0.36), subjective norm (γ = 0.43), and perceived behavioral control (γ = 0.21,) were significant predictors (p < 0.001) of intention. Participants identified no significant differences in sensorial attributes between beverages, thereby minimizing sensory bias and discrimination. Similar approaches may help other RCT investigating novel foods and bioactive compounds bridge gaps between efficacy and effectiveness.

Whole Grain Nutrition Education Program Improves Whole Grain Knowledge and Behaviors Among Community-Residing Older Adults

U.S. older adults are not meeting the recommendation for whole grain (WG) intake. This pilot study determined the influence that a WG nutrition education program for community-residing adults aged 60 + years has on WG knowledge and behaviors. The program included WG education and discussion, participation in hands-on activities and taste testing. Participants were mostly white, females. Total grain and WG dietary intake frequencies (WG frequency; p ≤ 0.001), and "knowledge score" increased from PRE to POST (p ≤ 0.001). Participants in PowerPoint-based classes had a higher "knowledge scores" at POST (p = 0.002). Nearly all (n = 139, 88.5%) intended to eat more WG foods, with almost two-thirds (n = 93, 59.3%) reporting a "strong" intention to do so. There was a positive association between strength of intention to eat WG foods and "WG frequency" at POST (r = 0.435, p ≤ 0.001). Results suggest that this WG program is an effective strategy for improving WG knowledge and behaviors among older adults.

The DASH Pilot Project: Developing Community-Based Nutrition Education for Older Adults

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.

Use of song as an effective teaching strategy for nutrition education in older adults

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t -test showed the knowledge gain mean scores for the treatment group were significantly ( P  < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.

Older adults attending Georgia senior centers increase preventive behaviors for falls and fractures following a community-based intervention

A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a physical activity component. Interviewer-administered pre- and posttests evaluated fall preventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. Following the intervention, there were significant increases in the intake of calcium- and vitamin D-rich foods (p < 0.001), the use of calcium- or vitamin D-containing supplements (p < 0.05), days of week with physical activity (p < 0.001) and fall preventive home safety behaviors (p < 0.001), and decreases in overall modifiable fall- and fracture-related risk factors (≥4 to 5 risk factors: pre: 32% vs. post: 18%; p < .001). This evaluation provides evidence that a multi-factorial fall prevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults.

Nutrition-related practices and attitudes of Kansas skipped-generation(s) caregivers and their grandchildren

Despite growing numbers, the nutrition practices and attitudes of skipped-generation(s) kinship caregivers regarding feeding the dependent children in their care have not been examined. In this qualitative study, transcriptions of semi-structured interviews with 19 female and four male skipped-generation(s) Kansas caregivers (ages 47 to 80, 92% non-Hispanic whites, 83% female, 78% grandparents and 22% great-aunt or great-grandparent caregivers; caring for a range of one to four children, ages three to 18, for an average of nine years) were content analyzed for how their nutrition-related practices and attitudes had changed since parenting the first time. Sub-themes regarding practices included: being more nutrition and food safety conscious now, and shifting their child feeding style. The children seemed to be adversely affected by an on-the-go lifestyle and the use of more electronics. Caregivers described their sources for child feeding advice as being based mostly on information from their mothers, physicians, and their past parenting experiences. Sub-themes for attitudes included opinions that nutrition and safe food handling are important and that nutritious food is expensive. They preferred printed or video nutrition education materials and wanted to receive information through organizations they trusted. This population could benefit from education on: infant, child, adolescent, and sports nutrition; feeding "picky eaters"; healthful recipes, "fast foods" and packaged foods; quick, inexpensive meals and snacks low in fat, sugar, and salt; limiting sedentary time; family meals; using food thermometers; and intergenerational gardening and cooking.

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.

Improving Effectiveness of Nutrition Education Resources for Older Adults

This article discusses published reports and studies from the past decade that focused primarily on using written or other tangible nutrition educational resources with older adults, such as brief "handouts," newsletters, brochures, booklets, curricular lessons, board games, audiotapes and videotapes. Studies of health professionals' needs and desires for such materials are also reviewed. Thirteen articles, of which four were theory-based, were found. They are summarized in tables that include details regarding the educational resource(s) used; a description of the subjects and controls, if any; the evaluation methods used; and results obtained. Ten practical suggestions are offered to help educators select or develop more effective printed, audiotape, videotape and other tangible nutrition education resources appropriate for older adults. Much research remains to be done in this area. This article is one of a series of literature reviews of topics related to nutrition education for older adults.

Concepts, Theories and Design Components for Nutrition Education Programs Aimed at Older Adults

This article examines characteristics of older adult learners and discusses adult education theory and empowerment concepts, along with nutrition education and behavioral change strategies for older adult nutrition education programs. Design components for older adult nutrition education programs are presented. Educational and behavioral change strategies should be selected based on characteristics of the intended audience, including their nutrition needs, wants and desires, and should be based on appropriate theory. Multi-disciplinary research is needed to develop behavioral and educational theoretical frameworks, as well as designs, intervention strategies, and evaluation methods for educational programs that lead to older adults adopting more healthful nutrition practices. This is one of a series of recent literature reviews on nutrition education for older adults.