Change in fruit and vegetable intake over 24 months in older adults: results of the SENIOR project intervention.

PURPOSE: We test the efficacy of an intervention based on the transtheoretical model to increase the intake of fruits and vegetables and to describe differences in psychosocial variables based on the achievement of the 5 A Day Program target. DESIGN AND METHODS: This study is a randomized controlled trial comparing a 12-month fruit and vegetable intervention to a control condition with a 12-month follow-up. Participants included 1,277 community-residing persons who were 60 years of age or older; 834 provided dietary data at all three time points and are included in our outcome analyses. RESULTS: The intervention group increased intake by 0.5 to 1.0 serving more than the control group over 24 months as measured by the NCI Fruit and Vegetable Screener and the 5 A Day Program screener. The majority of the participants (58%) perceived that they maintained 5 or more servings per day for 24 months. These maintainers had a higher intake at each time point for all dietary measures and differed from those who failed to progress (11%) for most transtheoretical model variables. IMPLICATIONS: The intervention was effective in increasing the intake of fruits and vegetables in older adults. Those who maintained their level of perceived intake as 5 or more servings per day consumed 2-4 servings per day more than those who failed to progress.

Differences in psychosocial variables by stage of change for fruits and vegetables in older adults.

OBJECTIVE: To describe differences in demographic and psychological variables by stage of change for five servings of fruits and vegetables per day in older adults. DESIGN: Cross-sectional survey with data collected in the participant's home or the project office by interviewers. SUBJECTS: 1,253 community-residing individuals 60 years or older (mean age=75 years) living in East Providence, RI. MEASURES: Stage of change; decisional balance; processes of change; self-efficacy; dietary intake measured by the National Institutes of Health (NIH) Fruit and Vegetable Screener, the 5 A Day Screener, and the NIH Fat Scan; demographics; and anthropometrics. STATISTICAL ANALYSES: Variables were compared by stage of change using analysis of variance for continuous variables and chi(2) analysis for categorical variables. Servings of fruits and vegetables were transformed (square root) prior to analyses. RESULTS: There was a strong effect of stage of change on intake measured by the Fruit and Vegetable Screener [F(2, 1203)=109, P<.001, eta(2)=.154] and the 5 A Day Screener [F(2, 1203)=128, P<.001, eta(2)=.175] with a linear increase from precontemplation to action/maintenance. There was an overall stage effect on decisional balance, processes of change, and self-efficacy [Wilks's lambda=.703, F(30, 2132)=13.72, P<.001, multivariate eta(2)=.162], and significant univariate effects for all variables. CONCLUSIONS: Self-assessed servings ("How many servings do you usually eat?") can be used for stage classification for older adults. Interventions for older adults in early stages should focus on increasing perceived benefits of healthful eating and cognitive process use. Self-efficacy as well as behavioral processes seem to be important in attaining maintenance.

Elderly food stamp participants are different from eligible nonparticipants by level of nutrition risk but not nutrient intake.

Nutrition risk, nutrient intake, and selected socioeconomic characteristics of elderly food stamp recipients were compared with elderly people who were eligible for food stamps but did not participate in the program. Data were collected by survey using a convenience sample of 200 low-income elderly people living in subsidized housing. Although there were no significant differences in food group or nutrient intake between participants and nonparticipants, overall, these low-income subjects did not meet minimum Dietary Reference Intake (DRI) standards for many nutrients and had caloric and food group serving intakes that were below recommendations. Food Stamp Program participants were at significantly higher nutrition risk than their nonparticipating peers as detected by the Nutrition Screening Initiative Checklist (P< or =.01) and other indicators of disability. It seems that those already at highest risk were in fact participating in the Food Stamp Program because those eligible but not participating had significantly higher incomes and were at significantly lower nutritional risk.