Reaching Out to Racial/Ethnic Minority Older Persons for Elderly Nutrition Programs

Enriching Nutrition Programs to Better Serve the Needs of a Diversifying Aging Population

Racial minorities experience a high burden of food insecurity relative to non-Hispanic whites. Government-subsidized nutrition programs can positively impact food insecurity and nutritional risk among older adults. Yet, in New York City, where nearly 60% of people over 65 years are non-white, older minorities participate in government nutrition programs at very low rates. In this commentary, we focus on 2 programs: the Child and Adult Care Food Program and Older Americans Act Nutrition Services Programs. We identify opportunities for strengthening these programs to improve their reach and engagement with diverse older adults in New York City and similarly diverse urban communities.

Are visible minorities “invisible” in Canadian health data and research? A scoping review

Purpose

Canada’s visible minority population is increasing rapidly, yet despite the demographic significance of this population, there is a surprising dearth of nationally representative health data on visible minorities. This is a major challenge to undertaking research on the health of this group, particularly in the context of investigating racial/ethnic disparities and health disadvantages that are rooted in racialization. The purpose of this paper is to summarize: mortality and morbidity patterns for visible minorities; determinants of visible minority health; health status and determinants of the health of visible minority older adults (VMOA); and promising data sources that may be used to examine visible minority health in future research.

Design/methodology/approach

A scoping review of 99 studies or publications published between 1978 and 2014 (abstracts of 72 and full articles of 27) was conducted to summarize data and research findings on visible minority health to answer four specific questions: what is known about the morbidity and mortality patterns of visible minorities relative to white Canadians? What is known about the determinants of visible minority health? What is known about the health status of VMOA, a growing segment of Canada’s aging population, and how does this compare with white older adults? And finally, what data sources have been used to study visible minority health?

Findings

There is indeed a major gap in health data and research on visible minorities in Canada. Further, many studies failed to distinguish between immigrants and Canadian-born visible minorities, thus conflating effects of racial status with those of immigrant status on health. The VMOA population is even more invisible in health data and research. The most promising data set appears to be the Canadian Community Health Survey (CCHS).

Originality/value

This paper makes an important contribution by providing a comprehensive overview of the nature, extent, and range of data and research available on the health of visible minorities in Canada. The authors make two key recommendations: first, over-sampling visible minorities in standard health surveys such as the CCHS, or conducting targeted health surveys of visible minorities. Surveys should collect information on key socio-demographic characteristics such as nativity, ethnic origin, socioeconomic status, and age-at-arrival for immigrants. Second, researchers should consider an intersectionality approach that takes into account the multiple factors that may affect a visible minority person’s health, including the role of discrimination based on racial status, immigrant characteristics for foreign-born visible minorities, age and the role of ageism for older adults, socioeconomic status, gender (for visible minority women), and geographic place or residence in their analyses.

A State-Level Review of Diversity Initiatives in Congregate Meal Programs Established Under the Older Americans Act

The Older Americans Act (OAA) congregate meal program (CMP) targets those most at risk for nutritional deficiencies, social isolation, and institutionalization. Social minorities (racial, ethnic, cultural, and sexual minorities) are at high risk for all three. This study explores state-level diversity initiatives to welcome these social minorities in CMPs. A national survey was distributed to each State Unit on Aging, all but three states participated. The majority of states (64.6%) target CMPs to a specific racial, ethnic, or cultural minority; five states target sexual minorities (lesbian, gay, bisexual, and transgender [LGBT]). Negative binomial regression results find state minority population percentage is a significant predictor of the number of diversity initiatives at CMPs. States with LGBT CMPs reported the highest levels of racial/ethnic/cultural diversity initiatives and high levels of statewide LGBT protective policies. Recommendations are suggested that build upon the diversification success of states to further the mission of OAA in reaching high-risk older adults.

Recruiting older patients with peripheral arterial disease: evaluating challenges and strategies

Peripheral arterial disease (PAD) is a group of syndromes characterized by chronic and progressive atherosclerosis with a high burden of physical disability and cardiovascular morbidity and mortality. Recruiting patients for clinical research is therefore challenging. In this article, we describe and evaluate our methods for recruiting participants for a cross-sectional feasibility study of PAD, nutritional status, and body composition. We used convenience and purposive sampling approaches to identify potential participants. Between May 2012 and April 2013, 1,446 patients were identified, and 165 patients (11.4%) responded to recruitment requests. The final enrollment was 64 participants (64/1,446; 4.4%), and four subjects (6.3%) subsequently withdrew from the study. Recruiting PAD patients presents a variety of challenges, due largely to the burdens of living with coexistent illnesses, and patients' reluctance or inability to travel for research. In this article, we delineate suggestions for improving the efficacy of recruitment methods in future PAD studies.

Nutrition initiatives in the context of population aging: where does the United States stand?

In 2011, the earliest segment of the baby boom generation turned 65 years of age. This event marks the beginning of a new phase of growth of the older adult population in the United States and is in line with what is referred to worldwide as "population aging." By 2030, older adults will comprise 20% of the U.S. population. With the impending increase in the older adult population, the United States is unprepared to handle the accompanying social and economic impact of growing rates of age-related diseases such as diabetes, hypertension, and cardiovascular disease. These diseases have nutritional determinants and, as such, they signify the need for effective preventive nutrition initiatives to address population aging in the United States. Comparatively, the European Union (EU) is projected to reach an older adult population of 24% by 2030. In this special article we evaluate nutrition initiatives for older adults in the United States and also examine nutrition initiatives in the European Union in search of an ideal model. However, we found that available data for EU initiatives targeted at population aging were limited. We conclude by offering the proposal of a physician-based model that establishes the primary care physician as the initiator of nutrition screening, education, referrals, and follow-up for the older adult population in the United States as a long-term goal. Apropos of the immediate future, we consider barriers that underscore the establishment of a physician-based model and suggest objectives that are attainable. Although the data are limited for the European Union, this model may serve to guide management of chronic diseases with a nutritional component in economies similar to the United States worldwide.

Evaluating nutrition risk factors and other determinants of use of an urban congregate meal program by older African Americans

Rapid growth in both the number of older U.S. adults and diversity in the population suggests increased and disparate demands for nutrition services. Funded by the Older Americans Act (OAA), the primary purpose of congregate meal services is to keep older Americans nutritionally secure and living independently in the community. Understanding characteristics that influence older African Americans' use of congregate meal services is important for development of culturally sensitive networks and program policies. With a sample of 151 community-dwelling older African Americans, a descriptive exploratory design was used to explore predisposing, enabling, and need characteristics that influence use of a congregate meal service and to examine the relationship between nutritional risk and service use. Provider-oriented structural enablers (awareness and transportation) that promote or impinge on elderly persons' use of a congregate meal service were also examined. Multivariate analysis indicated that among program participants, nutrition risk and living arrangement had significant influence on service use. Additionally, nutrition risk was higher among respondents who did not participate in congregate meal service compared to their participant counterparts.

Boomers' prospective needs for senior centers and related services: a survey of persons 50-59

The future service needs of baby boomers are unclear. A survey addressing work/retirement, family, civic engagement, health, caregiving, leisure, and perceptions of senior services was mailed to 800 addresses randomly selected from a upper Midwestern county voter registration list. The response rate was 28%. Fifty-three percent of the respondents (N = 225) intended to work and increase civic engagement. They expected more time for hobbies and friends, and to travel more. Family will continue to be their highest priority. These findings will be useful to service providers who are invested in providing services that are attractive to boomers.

Area agencies on aging: a community resource for patients and families

This article presents an overview of the Older Americans Act (OAA) so that home health clinicians may become more knowledgeable about this healthcare legislation. The OAA was passed in 1965 and has evolved significantly over time. The purpose of the OAA is to help older adults maintain their highest level of functional activity to remain in their homes as long as possible. Embedded within the OAA are key programs and services for older adults called Area Agencies on Aging (AAAs). It is vital that home health clinicians understand how the AAAs can help their patients and families. This article educates clinicians about the available services that AAAs have to offer.

Community-based disability prevention programs for elders: predictors of program completion

Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. Program completion remains an important barrier to their effectiveness. We examined the association between provider relationships and client variables, and program completion in senior centers. Our mixed methods design used secondary data for 719 clients and primary data through telephone interviews with 20 nurses, 23 social workers, and 18 site managers. Quantitative data showed that higher client baseline self-efficacy positively influenced completion and minority status negatively influenced completion. Qualitative data showed that higher focus on provider-client relationships was associated with high completion.

Strategies for recruiting African American men into prostate cancer screening studies

BACKGROUND

Recruitment for research and clinical trials continues to be challenging. Prostate cancer is the most commonly diagnosed cancer in men and disproportionately affects African American men; thus, effective recruitment strategies are essential for this population.

OBJECTIVES

The aim of this study was to focus on innovative and effective recruitment strategies for research on prostate cancer with minorities.

METHODS

A systematic description is provided of the recruitment efforts for a hermeneutic phenomenological qualitative study of African American men's experiences in decision making on whether to have a prostate cancer screening.

RESULTS

Seventeen African American men were enrolled from rural Central Virginia. Recruiting strategies were targeted on places where African American men usually are found but that are rarely used for recruitment: barbershops, community health centers, and churches. Word of mouth was also used, and most of the participants (n = 11) were reached through this method.

DISCUSSION

Recruitment efforts have been noted to be particularly challenging among minorities, for numerous reasons. Making minority recruitment a priority in any research or clinical trial is essential in gaining a representative sample. Word of mouth is a powerful tool that is often forgotten but should be looked at in further detail.

Participant recruitment from minority religious groups: the case of the Islamic population in South Australia

BACKGROUND

Participant recruitment is a fundamental component of the research process and the methods employed to attract individuals will depend on the nature of the study. Recruitment may be more challenging when the study involves people from a minority religious group. However, this issue has not been well addressed in the literature.

AIM

To discuss the challenges of recruiting participants from a minority religious group (the Islamic population) to participate in an interpretive, hermeneutic study concerning the experience of hospitalization. The challenges of recruitment encountered during this study are used as the basis for a broader discussion of this important issue. To ensure the success of this phase of the study, a pre-planned recruitment strategy was essential.

METHODS

Multiple recruitment strategies were used, including hospital-based recruitment, snowball sampling, advertising and contact with key people. Despite the use of multiple strategies, recruitment of participants was difficult and required an extended period of time to achieve sufficiently rich data. Thirteen participants shared their lived experience to provide an in-depth understanding of the phenomenon. Recruiting participants from minority religious group involves potentially sensitive issues. There is an increased need for the researchers to carefully consider potential participants' rights and ensure that sound ethical principles underpin the study, as failure to do this may hinder the recruitment process.

FINDINGS

The two most effective strategies of recruitment were snowball sampling and contact with key Islamic people, with the least effective being advertising. This paper highlights the importance of anticipating potential difficulties and pre-planning strategies to overcome barriers to recruitment. Implementation of multiple strategies is recommended to ensure successful research recruitment.

Dietary fat reduction behaviors among African American, American Indian, and white older adults with diabetes

Dietary self-management of diabetes is often difficult for older adults to practice, particularly in rural communities. We describe patterns and correlates of dietary fat reduction among older rural adults with diabetes of any type. In-home interviews were conducted with a multiethnic random sample of 701 adults ≥ 65 with diabetes from two North Carolina counties. The Fat and Fiber Behavior Questionnaire was used to measure dietary behaviors. Separate multiple linear regressions assessed effects of gender, ethnicity, and diabetes education. In general, scores were more favorable for practices that involved modifying food preparation (e.g., avoiding frying) and less favorable for practices that involved changing foods consumed (e.g., substituting fruits and vegetables as desserts or snacks). American Indians and African Americans had less favorable scores than whites, and diabetes education was associated with greater fat restriction for women than men. Older men and ethnic minorities with diabetes should be targeted for dietary change education.