Food choice among homebound older adults: motivations and perceived barriers.

OBJECTIVES: The purpose of this paper is to identify: motivations and perceived barriers associated with food choices made by homebound older adults; whether motivations and perceived barriers vary according to social demographic characteristics; and whether motivations and perceived barriers are associated with dietary quality. DESIGN: This was an observational study using standard interview methods where participants were administered a questionnaire and completed three 24-hour dietary recalls. SETTING: Participants were interviewed in their homes. PARTICIPANTS: 185 homebound older adults were included. MEASUREMENT: Motivations were assessed using a modification of The Food Choice Questionnaire and perceived barriers were assessed using the Vailas Food Enjoyment Questionnaire. Participants answered questions regarding social demographic characteristics. Dietary quality measures of adequate intakes of calories, protein, vitamin D, and vitamin B12 were obtained from the three 24-hour dietary recalls. RESULTS: Mean age was 78.9; 80% were female; and 36% were African American. Key motivations in food choice included sensory appeal, convenience, and price. Key barriers included health, being on a special diet, and being unable to shop. These varied little by social demographics, except for age. Dietary quality varied according to different motivations and barriers. CONCLUSION: Food choices are based upon a complex interaction between the social and environmental context, the individual, and the food. Efforts to change eating behaviors, especially community-based interventions involving self-management approaches, must carefully take into account individuals' self-perceived motivations and barriers to food selection. Incorporating foods that are tasty, easy to prepare, inexpensive, and that involve caregivers are critical for successful interventions.

Self-reported versus measured weight and height in an older adult meal program population.

BACKGROUND: Self-reported weight and height are used to compute ponderal indices in studies where it is impractical to obtain objectively measured data. Little is known about the associations between self-reported and measured weight and height in older adults. METHODS: Participants in congregate and home-delivered meal programs in a rural Wisconsin county recorded their height and weight on a questionnaire as part of a study on nutritional risk and quality of life. Objective measurements of height and weight were made on the same day. Data for 131 subjects, ranging in age from 62-92 years, were analyzed to evaluate associations between self-reported and measured weights and heights. RESULTS: Correlation coefficients between self-reported and measured values suggested that self-reported weight was somewhat more valid than self-reported height in this population. However, self-reported weight was misreported by 10 pounds or more in 20% of the sample. CONCLUSIONS: More data are needed to evaluate the utility of self-reported data for weight and height in groups of older people. Judging from this study, self-reported height and weight data, if used at all for older adults, should only be used as a continuous variable rather than for classifying subjects into relative weight categories.

Risk indicators for malnutrition are associated inversely with quality of life for participants in meal programs for older adults.

OBJECTIVE: To evaluate the nature and strength of associations between quality of life and factors commonly linked with malnutrition in participants in a meal program for the elderly. DESIGN: A questionnaire that assessed quality of life, nutritional risk, quality of health, depression, social satisfaction, functional status, food security, and food enjoyment was administered. SUBJECTS/SETTING: All persons aged 60 years and older enrolled in the Title III-C meal program in Pepin County, Wisconsin, during a 1-month period were asked to participate. Of 180 eligible subjects, data were available for 155; 108 received meals at congregate sites and 47 received home-delivered meals. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to characterize the population. Independent-samples t tests and chi 2 analysis were used to test for differences between the congregate-meal group and home-delivered-meal group. Spearman correlation coefficients were used to determine the direction and magnitude of associations between scale variables and quality of life. RESULTS: Quality of life and quality of health were positively correlated (r = .83, P < .0001). Nutritional risk, food insecurity, decreased enjoyment of food, depression, and impaired functional status were all negatively associated with quality of life. This research offers evidence that there are measurable associations between nutritional factors and quality of life. APPLICATIONS: Our finding could be helpful to dietitians in justifying, planning, and evaluating nutrition programs and interventions. Quality of life in older adults may be further enhanced by programs that include social and psychological components in addition to elements oriented to reduce nutritional risk.

Screening for risk of malnutrition in Wisconsin's elderly.

In older adults, nutritional status is related to chronic disease risk, ability to maintain independent lifestyles, and rate and duration of hospitalizations. Significant numbers of American elders are either malnourished or at risk of malnutrition. Data from a recent survey of 21,000 Wisconsin participants in home-delivered or congregate meals 60 years of age and older indicated that in this group, over one fourth were at high risk for malnutrition. The Nutrition Screening Initiative, a collaborative effort of the American Academy of Family Physicians, the American Dietetic Association, and the National Council on the Aging, has identified risk factors for malnutrition in the elderly and is promoting systematic nutrition risk screening and intervention within the health care system. Risk factors for malnutrition in older adults, screening techniques available to medical practices, and resources for intervention are described in this paper.

Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS).

OBJECTIVE: To assess the effects of lipid-lowering therapy with lovastatin on coronary angiographic findings in patients with coronary artery disease and to compare the findings with those of two lipid-lowering angiographic trials using similar end points. DESIGN: Randomized, double-blind, placebo-controlled, multicenter coronary angiographic trial. SETTING: Community- and university-based cardiac catheterization laboratories. PARTICIPANTS: A total of 270 patients, 37 to 67 years old, with total cholesterol ranging from 4.92 to 7.64 mmol/L (190 to 295 mg/dL) and angiographically defined coronary artery disease. INTERVENTION: A cholesterol-lowering diet and either lovastatin, 80 mg/day, or placebo. OUTCOME: Per-patient change in percent diameter stenosis as determined by quantitative coronary angiography (primary end point). Global change score, based on the consensus of blinded expert readers regarding angiographic change (secondary endpoint). RESULTS: Lovastatin lowered total cholesterol level by 32%, low-density lipoprotein cholesterol by 38%, and the apolipoprotein B by 26% and raised the high-density lipoprotein cholesterol by 8.5% (P < 0.001). Average percent diameter stenosis increased 2.2% in placebo recipients and 1.6% in lovastatin recipients (P > 0.20). For lesions 50% or greater, average percent diameter stenosis increased 0.9% in placebo recipients and decreased 4.1% in lovastatin recipients (P = 0.005). The mean global change score was +0.9 (indicating progression) in the placebo group and +0.4 in the lovastatin group (P = 0.002); 13 placebo recipients and 28 lovastatin recipients had global change scores indicating regression (P < 0.02). CONCLUSION: Treatment with lovastatin plus diet slows the rate of progression and increases the frequency of regression in coronary artery lesions (by global change score), especially in more severe lesions (by quantitative angiography). This is the third lipid-lowering trial to show a benefit using the global change score, an end point predictive of clinical coronary events. Differences between two of these trials, using quantitative coronary angiographic end points, may have theoretical bearing on the mechanisms by which lipid-lowering therapy operates at the level of the arterial wall.

Regression and stabilization of coronary artery lesions. Angiographic trials move beyond the NCEP treatment guidelines.

National Cholesterol Education Program Guidelines for the diagnosis and treatment of hypercholesterolemia have been formulated from population studies relating coronary events to blood lipids. Such population studies may not be relevant to patients with established coronary disease. Recent coronary angiographic studies allow meaningful comparisons of small groups of patients. These studies suggest that atherosclerotic lesions in coronary arteries can be stabilized, and further, that regression of coronary lesions can occur. The cholesterol and LDL levels achieved in angiographic studies are well below NCEP guidelines. Careful attention to correcting lipid abnormalities in patients with established coronary disease may alter the course of their illness.

The influence of diet on the appearance of new lesions in human coronary arteries.

The Cholesterol Lowering Atherosclerosis Study, a randomized, placebo-controlled trial of blood lipid lowering, demonstrated significant benefit in 2-year coronary angiograms. Using angiograms of subjects in the Cholesterol Lowering Atherosclerosis Study who received a placebo and 24-hour dietary recall data, we performed an epidemiologic study of risk factors for formation of new atherosclerotic lesions. Age and baseline plus on-trial lipid levels, blood pressure levels, and diet variables were included. Significant dietary energy sources were protein, carbohydrate, alcohol, total fat, and polyunsaturated fat. Each quartile of increased consumption of total fat and polyunsaturated fat was associated with a significant increase in risk of new lesions. Increased intake of lauric, oleic, and linoleic acids significantly increased risk. Subjects in the Cholesterol Lowering Atherosclerosis Study in whom new lesions did not develop increased dietary protein to compensate for reduced intake of fat by substituting low-fat meats and dairy products for high-fat meats and dairy products. These results indicate that when total and saturated fat intakes are reduced to levels recommended by the National Cholesterol Education Program, protein and carbohydrate are preferred substitutes for fat calories, rather than monounsaturated or polyunsaturated fat.

A computerized quantitative food frequency analysis for the clinical setting: use in documentation and counseling.

Documentation of nutrition counseling effectiveness is essential to reinforce its value in an era of escalating health care costs. Counseling effectiveness can be determined definitively only if dietary assessment is made both before and after intervention. Unfortunately, methods currently available have drawbacks that limit feasibility of routine use. A directly computer-readable Quantitative Food Frequency Analysis method, which eliminates the need for manual data entry, has been developed and instituted at the University of Southern California School of Medicine, Los Angeles, for outpatient counseling. A 1-hour interview, focusing upon "usual" intake, is conducted using pictorial menus for food items. Feedback is available to the patient and health care team immediately. The data base is derived from the National Heart, Lung, and Blood Institute Food Table; the intake of 61 nutrients, including 23 fatty acids, is computed. The computer printout consists of four components: a summary; an alert for foods high in fat, cholesterol, sucrose, alcohol, and/or sodium; a listing of all foods consumed by frequency, accompanied by their nutrient contribution to daily intake; and a bar graph relating current nutrient intake to recommended levels. This document serves as a counseling tool and can support claims for third-party payment.