Older Americans Act Nutrition Programs: A Community-Based Nutrition Program Helping Older Adults Remain at Home.

Nutrition interventions are important as the older population, most of whom live in the community, increases in size and diversity. They are key to leading a healthy, functional life and mitigating chronic health conditions. The Older Americans Act Nutrition Program served 86.3 million congregate and 137.4 million home-delivered meals to 1.6 million and 850,000 older adults, respectively (2012). Congregate and home-delivered participants were older, poorer, sicker, more functionally impaired, and at a greater risk of institutionalization than the general U.S. older population. The Nutrition Program is publically and privately funded. About 44% of congregate and 30% of home-delivered expenditures are from federal sources, which dropped from $25 per older adult in 1990 to $12 in 2013. Despite multiple funding sources, funding is insufficient for the expanding older population. Health, nutrition, and social service professionals need to coordinate their community-based services to truly help older adults remain in their homes.

Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: food and nutrition programs for community-residing older adults.

Given the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services, it is the position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education that all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status. Appropriate food and nutrition programs include adequately funded food assistance and meal programs, nutrition education, screening, assessment, counseling, therapy, monitoring, evaluation, and outcomes documentation to ensure more healthful aging. The growing number of older adults, the health care focus on prevention, and the global economic situation accentuate the fundamental need for these programs. Yet far too often food and nutrition programs are disregarded or taken for granted. Growing older generally increases nutritional risk. Illnesses and chronic diseases; physical, cognitive, and social challenges; racial, ethnic, and linguistic differences; and low socioeconomic status can further complicate a situation. The beneficial effects of nutrition for health promotion, risk reduction, and disease management need emphasis. Although many older adults are enjoying longer and more healthful lives in their own homes, others, especially those with health disparities and poor nutritional status, would benefit from greater access to food and nutrition programs and services. Food and nutrition practitioners can play a major role in promoting universal access and integrating food and nutrition programs and nutrition services into home- and community-based services.

Position of the American Dietetic Association, American Society for Nutrition, and Society for Nutrition Education: Food and nutrition programs for community-residing older adults.

Given the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services, it is the position of the American Dietetic Association, the American Society for Nutrition, and the Society for Nutrition Education that all older adults should have access to food and nutrition programs that ensure the availability of safe, adequate food to promote optimal nutritional status. Appropriate food and nutrition programs include adequately funded food assistance and meal programs, nutrition education, screening, assessment, counseling, therapy, monitoring, evaluation, and outcomes documentation to ensure more healthful aging. The growing number of older adults, the health care focus on prevention, and the global economic situation accentuate the fundamental need for these programs. Yet far too often food and nutrition programs are disregarded or taken for granted. Growing older generally increases nutritional risk. Illnesses and chronic diseases; physical, cognitive, and social challenges; racial, ethnic, and linguistic differences; and low socioeconomic status can further complicate a situation. The beneficial effects of nutrition for health promotion, risk reduction, and disease management need emphasis. Although many older adults are enjoying longer and more healthful lives in their own homes, others, especially those with health disparities and poor nutritional status, would benefit from greater access to food and nutrition programs and services. Food and nutrition practitioners can play a major role in promoting universal access and integrating food and nutrition programs and nutrition services into home- and community-based services.

Multivitamin-mineral supplements in the Older Americans Act Nutrition Program: not a one-size-fits-all quick fix.

We challenge the suggestion of Congress that the Older Americans Act (OAA) Nutrition Program should provide multivitamin-mineral supplements (MVMs) in addition to meals. MVMs are not a quick fix for poor diets. They do not contain calories, protein, essential fatty acids, or fiber, nor do they adequately address nutritional gaps of some vitamins and minerals. Older adults with chronic health conditions who take multiple medications are at greater risk than the general healthy population for nutrient-drug interactions and toxicity. The OAA Nutrition Program is not an appropriate venue to indiscriminately distribute MVMs, because there is insufficient evidence of their benefits and safety. The program's limited funds and efforts should instead be directed to nutrient-dense healthy meals, quality food service, and greater accessibility to individualized nutrition services.

Eat better & move more: a community-based program designed to improve diets and increase physical activity among older Americans.

OBJECTIVES: We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Aging's You Can! campaign. METHODS: A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. RESULTS: Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. CONCLUSIONS: This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging.

From nutrition scientist to nutrition communicator: why you should take the leap.

Media reports about new nutrition research are abundant, but they may confuse the public when unqualified sources are quoted, findings are reported out of context, or results appear to contradict previous studies. The nutrition scientist who conducts the research is best qualified to communicate the findings accurately and within context. Yet, some nutrition scientists hesitate to speak out in the media because of barriers such as a lack of time, media skills, and support from administrators or fear that their results will be miscommunicated or sensationalized. Scientists who do grant media interviews enjoy benefits such as positively affecting the public's eating habits, influencing health and nutrition policy, and receiving heightened attention to their work, which can lead to future research funding. Scientists who want to improve their media skills can seek support from their institution's public relations professionals and can learn from continuing education opportunities at conferences and self-study through articles and other resources.

Nutrition concerns in discharge planning for older adults: a need for multidisciplinary collaboration.

This survey of 84 case managers (CMs) (88% response rate) in 11 south Florida hospitals, in one for-profit health care system, sought to identify their discharge planning concerns regarding the food and nutrition needs of older patients, how they addressed these concerns, and the degree to which registered dietitians (RDs) were involved. Most CMs were female (82 of 84, 98%), older than age 40 (59 of 84, 70%), and were registered nurses (51 of 84, 61%). Almost all (82 of 84, 98%) reported job barriers, including excessive patient loads and responsibilities and limited community services. Almost all said that nutrition-related diseases and factors (eg, chewing/swallowing problems, poor appetite, modified diets, poor dentition) strongly influenced discharge planning. Many perceived community nutrition resources (eg, congregate meals, food stamps, shopping assistance, outpatient dietitians) as not readily available. While physicians, nurses, social workers, and physical therapists were identified as very important in discharge planning, RDs were not; almost half of CMs consulted them infrequently, if at all. Strategies for the six nutrition-related case scenarios were inconsistent. Home-health agencies were chosen most often and outpatient RDs least often. Comprehensive discharge planning must include more attention to nutrition with greater input from clinical, outpatient, home health, and community RDs through, for example, attendance at hospital discharge planning rounds, inservices for CMs, and better marketing of RD services. More RDs can and should become CMs to help serve the number of older adults with nutrition-related chronic conditions.

Aging in community nutrition, diet therapy, and nutrition and aging textbooks.

Using content analysis, this study evaluated the aging content and context in 11 nutrition sub-specialty textbooks: community nutrition (n = 3), diet therapy (n = 4), and nutrition and aging (n = 4). Pages with paragraphs on aging were identified in community nutrition and diet therapy textbooks, and 10% random samples of pages were evaluated in nutrition and aging textbooks. Paragraphs were assigned to one of four categories: gerontology, nutrition as primary, nutrition as secondary, or tertiary prevention. A total of 310 pages was qualitatively analyzed using NUD*IST 5 software and quantitatively with percentages. Only 7% of community nutrition and 2% of diet therapy pages were devoted to aging. There was little integration of aging beyond the chapters on aging. Community nutrition had the most gerontology (30%) and primary prevention (43%) content. Diet therapy and nutrition and aging had more secondary prevention (33% and 42%, respectively) and tertiary prevention (27% each) content. Some important databases and studies were absent. Of the 1,239 ageism words, 10% were positive, 53% neutral, and 36% negative. Photographs were generally positive. Women, but not minorities, reflected current older adult demographics. Future textbook editions should address aging more comprehensively and positively to better prepare dietitians for the job market. Recommendations for authors, course instructors, and publishers are given.

Holocaust survivors report long-term effects on attitudes toward food.

OBJECTIVE: To gather information from survivors on the effects that the Holocaust had on their current attitudes toward food. DESIGN: Qualitative study: one-on-one semistructured interviews with a script shaped by a pilot study. SETTING: South Florida homes and community sites, including the Miami Beach Holocaust Memorial. PARTICIPANTS: Convenience sample of 25 Holocaust survivors: 14 men, 11 women; ages 71 to 85 years. PHENOMENON OF INTEREST: Current attitudes toward food in relation to Holocaust experiences. ANALYSIS: Themes and illustrative quotations from transcriptions of audiotaped interviews. RESULTS: Food attitudes were influenced by Holocaust experiences. Five themes emerged: (1) difficulty throwing food away, even when spoiled; (2) storing excess food; (3) craving certain food(s); (4) difficulty standing in line for food; and (5) experiencing anxiety when food is not readily available. Empathy for those currently suffering from hunger was also reported. CONCLUSIONS AND IMPLICATIONS: Food-related issues from the Holocaust remain for survivors. Now in their 70s and 80s, many use health care and related services. Nutritionists, educators, and health professionals should be aware of such issues. Food and nutrition programs should minimize uncomfortable food-related situations for Holocaust survivors and others who experienced food deprivation.

Continued need for increased emphasis on aging in dietetics education.

This study examined the content on aging in dietetics curricula via the Internet and a follow-up questionnaire. Only 14% to 15% of programs were not online. The 203 undergraduate and 88 graduate program Web sites listed 44 (22%) undergraduate and 39 (44%) graduate courses in aging. However, more maternal and child courses were listed. The number of undergraduate aging courses was similar to the 20% reported in 1989, although methodologies differed among the studies. Life cycle and community nutrition courses had the most aging content. More than half of program directors were not satisfied with the aging curriculum content. Integrating aging material into existing courses was the most acceptable way of increasing aging content. The common barriers were "curriculum already full" and "lack of faculty expertise." As the nation's changing demographics are reshaping the dietetics marketplace, a greater emphasis on aging would enable students to be more effective in serving this booming population.

Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes.

BACKGROUND: Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes. METHODS: In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months). RESULTS: Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05). CONCLUSION: The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.

Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving.

OBJECTIVES: We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use. DESIGN: Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit. SUBJECTS/SETTING: In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables. RESULTS: Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03). CONCLUSIONS: Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving tasks. Multidisciplinary interventions, involving dietitian expertise, are needed to better prepare caregivers to improve both caregiver effectiveness and enteral nutrition outcomes.

Aging in introductory and life cycle nutrition textbooks.

The aging content in 11 undergraduate nutrition textbooks (8 introductory, 3 life cycle) was evaluated using content analysis. Repeated measures ANOVAs with Bonferroni post hoc procedures and t- tests were used. The 259 relevant pages largely focused on geriatrics (physiological decline, chronic diseases). Gerontological aspects were underemphasized. Mean number of pages on aging was significantly higher in life cycle (M = 37) than in introductory textbooks (M = 18), t (9) = 3.42, p < .008. In introductory textbooks, mean percentage of pages on aging (M = 3.2%) was significantly less than for maternal (M = 4.6%) and childhood topics (M = 6.2%), p < .05. Overall, topic omissions included discussion of ageism, death, dying, and dignity; and end-of-life decisions related to nutrition and hydration. Women and minorities were proportionately represented in generally positive photographs. Aging terminology was 81% neutral (older, aging), 14% negative (impaired, senile), and 5% positive (active, independent). These textbooks may not help students acquire the broad knowledge needed to work with older adults or develop positive attitudes about aging. Recommendations for authors, publishers, and instructors are provided.

Content analysis: review of methods and their applications in nutrition education.

Content analysis is a set of qualitative and quantitative methods for collecting and analyzing data from verbal, print, or electronic communication with numerous applications in nutrition education research. Textual information from interviews, focus groups, and open-ended survey questions can be evaluated using content analysis. Selection of method(s) depends on the type(s) and length of material to be analyzed, results desired, and researchers' preferences and technological capabilities. This article reviews options available to content analysts--from manual to fully computerized. Overcoming the challenges inherent in using these methodologies is recommended because of their usefulness in the information-based messaging discipline of nutrition education.

Nutrition education may reduce burden in family caregivers of older adults.

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.