Important Nutrition Education Issues and Recommendations Related to a Review of the Literature on Older Adults

Abstract

The need for nutrition education for older adults is expanding rapidly as their numbers escalate, yet the quality and amount of nutrition education research for this group is quite limited and difficult to find. Both professionals and older adults themselves have been slow to recognize the benefits of nutrition and nutrition education in controlling health care costs and safeguarding quality of life. Difficulties encountered in conducting a search of nutrition education literature on programs designed for older adults are discussed. One of a series of literature reviews of topics related to nutrition education for older adults, this article draws conclusions about important issues related to the current situation and makes recommendations regarding future research.     

Incarceration as a Reason for US Alcohol and Drug Treatment Non-completion: a Multilevel Analysis of Racial/Ethnic and Sex Disparities

Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015–2016 Treatment Episode Dataset–Discharges. Among a sample restricted to treatment non-completers (n =?306,008), 5% terminated treatment because they became incarcerated (n =?13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR]?=?0.30, 95% confidence interval [95% CI]?=?0.26–0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR?=?1.37, 95% CI?=?1.29–1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment.

     

Is Religiosity a Protective Factor Against Substance Use in Young Adulthood? Only If You’re Straight!

PurposePrevious research has documented that substance use peaks during young adulthood and that religiosity provides a protective effect against binge drinking, marijuana use, and cigarette smoking. The majority of these studies do not examine sexual identity as it relates to these factors. Drawing on social influence and developmental theories, we tested the hypothesis that religiosity would provide a protective effect for heterosexual but not sexual minority young adults.MethodWaves 1 and 3 of the National Longitudinal Study of Adolescent Health provided data for the study. Three young adult sexual identity groups were formed: sexual minorities who did not report same-sex attraction at Wave 1 (NA), sexual minorities who did report same-sex attraction at Wave 1 (SSA), and heterosexuals (HET) (sample n = 764).ResultsReligiosity measured at baseline had no significant effect on past-year substance use, measured six years later in sexual minority young adults. For heterosexual young adults, each unit increase in religiosity reduced the odds of binge drinking by 9%, marijuana use by 20%, and cigarette smoking by 13%.ConclusionsReligiosity was not protective against substance use in sexual minority young adults, cautioning against over-generalizing previous findings about the protective effects of religiosity. Future studies that 1) consider the social context for sexual identity development, 2) model both risk and protective factors, and 3) use multidimensional measures of religiosity (and spirituality) and sexual identity are needed to build the necessary knowledge base for effective health promotion efforts among sexual minority youth and young adults.     

Association of culturally competent care with influenza vaccination coverage in the United States

BackgroundCultural minority groups in the United States have lower vaccination rates or worse influenza-related outcomes. Culturally competent care, which aims to engage the social, cultural, and linguistic needs of all patients, may address some of these disparities.ObjectiveWe investigate how self-reported measures of culturally competent care is associated with influenza vaccination rates in the United States.MethodsThe National Health Interview Survey (NHIS) 2017 was queried for respondents asked a set of questions which assessed respondents’ access to culturally competent care in the past year. The outcome of interest was self-reported receipt of the annual influenza vaccine. Sample-weighted multivariable logistic regressions estimated the adjusted odds ratios and 95 % confidence intervals (95 %CI) of influenza vaccination with response to the cultural competency survey questions as the dependent variable of interest. Subsequent marginal modeling predicted the adjusted vaccination rates among cultural minorities (racial/ethnic minorities, LGBTQ + adults, foreign-born individuals, and non-English speakers) and respondents with high-risk comorbidities for worse influenza outcomes. Models were adjusted for other known determinants of vaccination coverage.Results20,303 sample adults were included in the analyses. There were significantly higher odds of influenza vaccination among respondents who were “always” or “most of the time” treated with respect by their providers (aOR 1.53, 95 %CI [1.23–1.90], P < 0.001), given easy-to-understand information (aOR 1.37, 95 %CI [1.19–1.58], P < 0.001), asked about their opinions or beliefs about their care (aOR 1.29, 95 %CI [1.19–1.39], P < 0.001), and seen by providers who shared or understood their culture (aOR 1.15 95 %CI [1.01–1.30], P = 0.03), compared to their counterparts who responded with “some” or “none of the time” to the same survey questions. Higher adjusted influenza vaccination rates were seen among multiple racial/ethnic groups, LGBTQ + adults, foreign-born individuals, non-English speakers, and individuals with high-risk comorbidities who reported positive responses to the cultural competency survey questions.ConclusionsWe demonstrate a positive association between self-reported frequency of access to culturally competent care and receipt of the annual influenza vaccine. These findings support future efforts to evaluate vaccination outcomes among patients who receive components of culturally competent care, such as linguistically appropriate services, race-concordant healthcare workforce, and community engagement.     

Assessing the impact of the national ‘truth’ antismoking campaign on beliefs,attitudes, and intent to smoke by race/ethnicity

Objective. To examine racial/ethnic differences in the association between exposure to the ‘truth’ antismoking campaign and youth's beliefs and attitudes about cigarette companies and their intent to smoke.

Design. The data are for 31,758 youth aged 12–17 from seven waves of the Legacy Media Tracking Survey (LMTS), conducted in the USA between December 1999 and July 2003. LMTS was designed to include sufficient proportions of African Americans (n=4631), Hispanics (n=6311), and Asians (n=2469) to assess tobacco countermarketing campaign associations in individual racial/ethnic groups. Separate belief and attitude indices were created. An indicator for the respondent not intending to smoke during the next year was created for non-smokers only, and models were estimated separately by ever-/never-smoking status.

Results. Exposure to the truth campaign was positively associated with increased antitobacco beliefs and attitudes among youth overall. When analyzed by race/ethnicity, this association was statistically significant for white and African American youth. An examination of the individual belief and attitude items that composed the measurement indices suggests that different messages appealed to youth based on their race/ethnicity. Among never smokers, those exposed to the truth campaign had significantly higher odds of not intending to smoke. When analyzed separately by race/ethnicity, the estimates for African American youth were statistically significant and the estimates for white and Hispanic youth approached significance. Among ever smokers and across all racial/ethnic groups, those exposed to the truth campaign had significantly higher odds of not intending to smoke, and every racial/ethnic group had an odds ratio greater than one that was also statistically significant.

Conclusions. The findings suggest that the individual items comprising the indices may be less meaningful for some non-white groups of youth. Analyses of intention to smoke indicated that, among those who had never smoked, there were greater odds of not intending to smoke when examining all youth together without stratifying by race/ethnicity; however, a statistically significant effect was found only for the African American group when examining the effect by race/ethnicity. Among those who had ever smoked, a statistically significant effect was found for most racial/ethnic groups. This is a rich area for further research and is potentially critical to the success of future efforts to reach youth through behavior change messages.     

Ageing in the right place – a prototype of a web-based housing counselling intervention for later life

Abstract

Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one’s future housing needs.

Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design.

Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n?=?6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n?=?7) served as discussion points.

Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.

Conclusion and Significance: A user-centred design process can result in services that are aligned with older adults’ preferences for obtaining housing information. Services for planning and preparing future housing needs have the potential to increase older adults´ well-being at home as well as reduce costs for care and housing provision by the municipalities.     

Living race together: the role of partner's race in racial/ethnic differences in smoking

ABSTRACT

Objective: Crossing racial lines provides a unique context for understanding racial patterns in smoking. This research explores whether adults whose unions cross racial lines behave more similarly to their own group or their partner's

Design: Using a sample of respondents from the National Health Interview Survey (2001–2011), we compare the likelihood of current smoking and quitting smoking among adults in mixed-race unions to adults in same-race unions.

Results: Adults with different-race partners generally mirror their partner's group; people of color with White partners have a higher likelihood of being current smokers, similar to Whites, while Whites partnered with Asians and Latina/os are, like other Asians and Latino/as, less likely to smoke. There are fewer differences in the likelihood of quitting smoking.     

Optimism and the Socioeconomic Status Gradient in Adolescent Adiposity

Purpose

To assess whether dispositional optimism is associated with adiposity and to explore whether dispositional optimism mediates the relationship between parent education and adiposity (body mass index [BMI] z-score).

Methods

Multivariate regression analyses of data were collected from 1,298 non-Hispanic black and white adolescents aged 12–19 years from a single Midwestern public school district.

Results

Less optimistic adolescents had higher BMI z-scores (r = −.09, p < .001). Addition of dispositional optimism to the regression model caused an approximately 10% attenuation of the parent education and BMI z-score relationship. Sobel tests confirmed that this attenuation indicated partial mediation.

Conclusion

Lower dispositional optimism is associated with higher adiposity and this association accounts for some of the influence of parent education on adolescent adiposity.     

The impact of transvenous cardioverter-defibrillator implantation on quality of life,depression and optimism in dialysis patients: report on the secondary outcome of QOL in the randomized controlled ICD2 trial

Rationale

The impact of prophylactic implantable cardioverter-defibrillator (ICD) implantation on the psychological well-being of patients on dialysis is unknown.

Objective

We aimed to identify the effect of primary ICD implantation on quality of life (QoL), mood and dispositional optimism in patients undergoing dialysis.

Methods and results

We performed a prespecified subanalysis of the randomized controlled ICD2 trial. In total, 177 patients on chronic dialysis, with an age of 55–81 years, and a left ventricular ejection fraction of?≥?35%, were included in the per-protocol analysis. Eighty patients received an ICD for primary prevention, and 91 patients received standard care. The Short Form-36 (SF-36), Geriatric Depression Scale-15 (GDS-15), Revised Life Orientation Test (LOT-R) questionnaires were administered prior to ICD implantation (T0), and at 1-year follow-up (T1) to assess QoL, depression and optimism, respectively. The patients were predominantly male (76.0%), with a median age of 67 years. Hemodialysis was the predominant mode of dialysis (70.2%). The GDS-15 score difference (T1 ? T0) was 0.5 (2.1) in the ICD group compared with 0.3 (2.2) in the control group (mean difference ? 0.3; 95% CI ? 1.1 to 0.6; P?=?0.58). The LOT-R score difference was ? 0.2 (4.1) in the ICD group compared with ? 1.5 (4.0) in the control group (mean difference ? 1.1 (0.8); 95% CI ? 2.6 to 0.4; P?=?0.17). The mean difference scores of all subscales of the SF-36 were not significantly different between randomization groups.

Conclusions

In our population of patients on dialysis, ICD implantation did not affect QoL, mood or dispositional optimism significantly during 1-year follow-up.

Clinical Trial Registration

Unique identifier: ISRCTN20479861. http://www.controlled-trials.com.

     

COVID-19 Vaccine Perceptions,Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study

BackgroundUptake of the COVID-19 vaccine among US young adults, particularly those that belong to racial and ethnic minorities, remains low compared to their older peers. Understanding vaccine perceptions and their influence on vaccination uptake among this population remains crucial to achieving population herd immunity.ObjectiveWe sought to study perceptions of COVID-19 vaccines as well as intended and actual vaccine uptake among one population of college students, faculty, and staff.MethodsAs part of a larger study aimed at investigating the dynamics of COVID-19 transmission, serology, and perception on a college campus, participants were asked about their views on the COVID-19 vaccine in February 2021. Vaccination status was assessed by self-report in April 2021. Logistic regression was used to calculate prevalence ratios with marginal standardization.ResultsWe found that non-White participants were 25% less likely to report COVID-19 vaccination compared to White participants. Among those who were unvaccinated, Black and other non-White participants were significantly more likely to indicate they were unwilling to receive a COVID-19 vaccine compared to White participants. The most common reason for unwillingness to receive the vaccine was belief that the vaccine approval process was rushed.ConclusionsThere are racial differences in perceptions of the COVID-19 vaccine among young adults, and these differences might differentially impact vaccine uptake among young racial and ethnic minorities. Efforts to increase vaccine uptake among college populations might require campaigns specifically tailored to these minority groups.     

Willingness to use mental health counseling and antidepressants in older Korean Americans: the role of beliefs and stigma about depression

Objectives: Despite a high prevalence of mental health problems, racial/ethnic minorities are often reluctant to seek mental health services. Their reluctance may be shaped by cultural beliefs and stigma about mental health. The present study examined how beliefs and stigma about depression (e.g. disbelief in depression as a health-related condition, perception of depression as a normal part of aging, and/or depression as a sign of personal weakness/family shame) pose barriers to older Korean Americans’ willingness to use mental health counseling and antidepressants.

Method: Data were drawn from surveys with 420 Korean American older adults (M_age=?71.6, SD?=?7.6) living in the New York City metropolitan area in 2010. Using a separate logistic regression model, the role of beliefs and stigma about depression in predicting participants’ willingness to receive mental health counseling and to take antidepressants was tested. Based on Andersen’s behavioral health service use model, the analysis was conducted in consideration of predisposing characteristics (age, gender, marital status, education, and acculturation), mental health needs (anxiety, depressive symptoms, and self-rated mental health), and enabling/hindering factors (beliefs and stigma).

Results: Similar proportions of the sample (69–70%) indicated their willingness to use mental health counseling or antidepressants. Willingness was more likely among participants who had beliefs about depression as a health-related concern (OR?=?1.94, 95% CI?=?1.15?3.27 for mental health counseling; OR?=?4.47, 95% CI?=?2.59?7.70 for antidepressants) and less likely among those who associated depression with family shame (OR?=?.55, 95% CI?=?0.33?0.91 for mental health counseling; OR?=?.56, 95% CI?=?0.33?0.95 for antidepressants).

Conclusion: In addressing mental health problems and promoting the use of mental health services, cultural beliefs and stigma shared within an ethnic community should be considered. Given that disbelief in the medical model of depression and family shame reduced willingness to use mental health counseling and antidepressants, promoting mental health literacy for older immigrants could be beneficial.     

Barriers to Nutrition Education for Older Adults,and Nutrition and Aging Training Opportunities for Educators,Healthcare Providers,Volunteers and Caregivers

Abstract

Literature citations of barriers to nutrition education found in those who teach and care for older adults, as well as within older adults themselves, are discussed. No attempt was made to compare educational barriers for learners of varying ages. These obstacles need to be addressed in order for nutrition to be taught or learned effectively so that nutrition practices and health improve. Barriers for healthcare professionals to providing nutrition education include misconceptions and stereotypes about older adults and about their nutritional concerns; lack of attention to and lack of funding for older adult educational programs; and difficulties recruiting older learners. Hindrances for older adults in responding to nutrition education can be categorized as attitudinal, motivational, environmental, and related to low literacy and poverty. Published examples of opportunities for education and training about nutrition and aging that are in place for health educators, healthcare providers, volunteers and caregivers regarding nutrition and aging are discussed. Suggestions are presented regarding future efforts to minimize educational barriers and to provide training for healthcare professionals, volunteers and caregivers. New research is needed in this field of study in order to realize the potential quality of life benefits and reduced healthcare costs associated with providing effective nutrition education to older adults. This is one of a series of reviews of recent literature on nutrition education for older adults.     

Rehabilitation agency of older adults in group-based intervention

Aims: This study investigated the individual rehabilitation agency of older adults in a one-year group-based gerontological rehabilitation context. Here, rehabilitation agency is understood as being manifested when older adults make choices and decisions regarding their everyday lives, including notions of themselves.

Methods: The data were obtained via non-participant observation of the final individual goal evaluation sessions of 38 older adults with their personal counselor. In these sessions, older adults discussed their rehabilitation outcomes, actions, choices and decisions during the rehabilitation year, along with their future in home settings. The data were analyzed using qualitative content analysis and an agency-centred approach.

Findings: The findings revealed that older adults made choices and decisions differently concerning their life in and beyond the rehabilitation context. Four forms of rehabilitation agency of older adults were identified: (i) renewable, (ii) widened, (iii) selective and (iv) fractured. These forms of agency were differently connected to older adults’ life courses and to their peer relations in the rehabilitation context.

Conclusions: An agency-centred approach could produce new theoretical ideas and practical implications for developing older adults’ rehabilitation to better meet their needs as well as the goals of group-based rehabilitation interventions.     

Racial disparities in health and health behaviors among gay,lesbian, bisexual and heterosexual men and women in the BRFSS-SOP

ABSTRACT

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n?=?557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR?=?3.92) and bisexual (OR?=?4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.     

Ethnic Variation in Attitudes toward Hypertension in Adults Ages 75 and Older

Background. Although critical to the management of hypertension, the attitudes of geriatric patients and possible ethnic group differences in attitudes concerning the disease are poorly understood.Methods. Data from a 1995–1996 population-based survey of 507 Hispanic American, African American, and non-Hispanic white adults ages 75 and older were used to assess ethnic differences in perceptions regarding the cause, prevention, and treatment of hypertension, as well as associations between perceptions and use of preventive health services.Results. African Americans were more likely to attribute hypertension to health behaviors and stress. In contrast, Hispanic Americans were more likely consider the disease a normal part of aging, whereas non-Hispanic whites were more likely to attribute hypertension to heredity or mechanistic causes. Non-Hispanic whites were less likely to perceive hypertension as preventable, whereas Hispanic Americans were less likely to feel that hypertension was treatable. The odds of having a primary care physician, blood pressure checked, or glaucoma checked were lower among older African Americans and Hispanic Americans than older non-Hispanic whites. The odds of having had a recent physical and of emergency room use were higher among African Americans and lower among Hispanic Americans, in relation to non-Hispanic whites.Conclusion. Ethnic differences regarding hypertension were clearly evident in this sample of older adults. In addition, attitudes regarding the cause and treatment of hypertension were found to be associated with both the use and the underuse of preventive health services in all three ethnic groups.     

Missed conceptions or misconceptions: perceived infertility among unmarried young adults in the United States

CONTEXT: Perceived infertility is an individual’s belief that she or he is unable to conceive or impregnate, regardless of whether this belief is medically accurate. This perception may lead to contraceptive nonuse, which may, in turn, lead to unintended pregnancy. Little research has examined perceived infertility among young adults, including potential associations with contraceptive behaviors. METHODS: The frequency of perceived infertility among young adults was assessed using 2009 data from a nationally representative telephone survey of 1,800 unmarried men and women aged 18–29. Multinomial regression analyses assessed associations between respondents’ perceived infertility and selected background, reproductive knowledge, sexual experience and contraceptive use characteristics. RESULTS: Overall, 19% of women and 13% of men believed that they were very likely to be infertile. Hispanic women and women who had received public assistance in the past year had elevated odds of perceived infertility (odds ratios, 3.4 and 3.0, respectively), as did Hispanic men and men of other racial or ethnic minorities, except blacks (2.5 and 6.1, respectively). Men who had some college education, had received sex education or were not in a current relationship had decreased odds of thinking they were very likely to be infertile (0.3–0.4). Among men, perceived infertility was associated with the belief that they were likely to have sex without using a contraceptive in the next three months (2.6). CONCLUSIONS: A substantial proportion of young adults believe they are infertile. Improved provider counseling and sex education may be useful in helping them to better understand their actual probability of infertility, and this knowledge may lead to improved contraceptive use.     

Evaluation of Diversity of Clinical Trials Informing Health Technology Assessments in the United States: A 5-Year Analysis of Institute for Clinical and Economic Review Assessments

ObjectivesThis study aimed to evaluate the diversity of clinical trials informing assessments conducted by the Institute for Clinical and Economic Review.MethodsThis was a cross-sectional study of pivotal trials included in completed Institute for Clinical and Economic Review assessments over 5 years (2017-2021). Representation of racial/ethnic minority groups, females, and older adults was compared with the disease-specific and US population, using a relative representation cutoff of 0.8 for adequate representation.ResultsA total of 208 trials, evaluating 112 interventions for 31 unique conditions, were examined. Race/ethnicity data were inconsistently reported. The median participant-to-disease representative ratio (PDRR) for Blacks/African Americans (0.43 [interquartile range (IQR) 0.24-0.75]), American Indians/Alaska Natives (0.37 [IQR 0.09-0.77]), and Hispanics/Latinos (0.79 [IQR 0.30-1.22]) were below the adequate representation cutoff. In contrast, Whites (1.06 [IQR 0.92-1.2]), Asians (1.71 [IQR 0.50-3.75]), and Native Hawaiian/Other Pacific Islanders (1.61 [IQR 0.77-2.81]) were adequately represented. Findings were similar when compared with the US Census, except for Native Hawaiian/Pacific Islanders, which was substantially worse. Relative to all trials, a higher proportion of US-based trials adequately represented Blacks/African Americans (61% vs 23%, P < .0001) and Hispanics/Latinos (68% vs 50%; P = .047), but a lower proportion adequately represented Asians (15% vs 67%, P < .0001). Females were adequately represented in 74% of trials (PDRR: 1.02 [IQR 0.79-1.14]). Nevertheless, older adults were adequately represented in only 20% of trials (PDRR: 0.30 [IQR 0.13-0.64]).ConclusionsThe representation of racial/ethnic minorities and older adults was inadequate. Efforts are needed to enhance the diversity of clinical trials. Standardized and transparent evaluation of trial diversity should be part of the health technology assessment process.     

Perceived Spousal Religiosity and Marital Quality Across Racial and Ethnic Groups

The relationship between the perceived religiosity of one's spouse and marital quality varies across racial and ethnic groups (i.e., Asians, Blacks, Hispanics, and non‐Hispanic Whites) in the United States. In this study, data were drawn from a nationally representative sample of married Americans (N = 1,162). Although perceived spousal religiosity predicted higher marital quality across all racial and ethnic groups, this effect was stronger for Asians, Blacks, and Hispanics than for Whites. Compared to Whites, the 3 racial and ethnic minority groups experienced a larger boost in frequency of expressive forms of love as perceived spousal religiosity increased. This effect was also found regarding marital satisfaction for Asians and Blacks relative to Whites, but not for Hispanics. Moreover, although racial and ethnic minorities tended to report lower marital quality than Whites at low levels of perceived spousal religiosity, their marital quality tended to be higher than Whites at high levels of perceived spousal religiosity. Three‐way interactions indicated that these trends hold regardless of gender.     

Malnutrition and Physical Frailty among Nursing Home Residents: A Cross-Sectional Study in China

Objectives

To assess the association between malnutrition and physical frailty among nursing home older adults in China.

Design and setting

A cross-sectional study in 15 nursing homes in Changsha, China.

Participants

A total of 705 nursing home residents who were aged 60 and older.

Measurements

Physical frailty was identified based on the following five components: slow gait speed, low physical activity, weight loss, exhaustion, and low grip strength. Nutritional status was assessed using the Mini Nutritional Assessment. Multinomial logistic regression models were used to analyze the association between nutritional status and physical frailty.

Results

The mean (SD) age of the participants was 82.5 (8.1) years old (range, 60–106 years), and 226 (32%) was men. Of those participants, 5.1% and 55.6% were malnourished and at risk of malnutrition, respectively; 60.3% and 36.2% were identified as being frail and prefrail, respectively. Compared with participants who were well-nourished, those who were at risk of malnutrition or malnourished were two times more likely to be physically frail (adjusted odds ratio 2.66, 95% confidence interval 1.01 to 7.00), after adjustment for age, education level, cognitive status, depressive symptoms, and disability in activities of daily living. No significant association was observed between malnutrition and physical prefrailty.

Conclusion

Our findings suggest that poor nutritional status and physical frailty are highly prevalent in nursing home older adults in China, and that poor nutritional status is associated with increased odds of physical frailty.