Development of a short questionnaire to assess diet quality among older community-dwelling adults

Objective

To evaluate the use of a short questionnaire to assess diet quality in older adults.

Design

Cross-sectional study.

Setting

Hertfordshire, UK.

Participants

3217 community-dwelling older adults (59-73 years).

Measurements

Diet was assessed using an administered food frequency questionnaire (FFQ); two measures of diet quality were defined by calculating participants’ ‘prudent diet’ scores, firstly from a principal component analysis of the data from the full FFQ (129 items) and, secondly, from a short version of the FFQ (including 24 indicator foods). Scores calculated from the full and short FFQ were compared with nutrient intake and blood concentrations of vitamin C and lipids.

Results

Prudent diet scores calculated from the full FFQ and short FFQ were highly correlated (0.912 in men, 0.904 in women). The pattern of associations between nutrient intake (full FFQ) and diet scores calculated using the short and full FFQs were very similar, both for men and women. Prudent diet scores calculated from the full and short FFQs also showed comparable patterns of association with blood measurements: in men and women, both scores were positively associated with plasma vitamin C concentration and serum HDL; in women, an inverse association with serum triglycerides was also observed.

Conclusions

A short food-based questionnaire provides useful information about the diet quality of older adults. This simple tool does not require nutrient analysis, and has the potential to be of value to nonspecialist researchers.

     

Development and validation of a multidimensional questionnaire assessing non-adherence to medicines

The study aimed to develop and validate an instrument capable of measuring non-adherence to drug treatment in its multiple dimensions. The Questionário de Ades?o a Medicamentos (Adherence to Medicines Questionnaire) with three questions was applied to 46 people with arterial hypertension in the city of Blumenau, Southern Brazil, in 2006. Non-adherence measures obtained were compared to four other methods (Haynes, Morisky, pill count and clinical outcome). Non-adherence measures varied according to the method. The combined Questionário de Ades?o a Medicamentos non-adherence measure was 47.8% (95% CI: 32.9;63.1), whereas the gold standard was 69.6% (95% CI: 54.3;82.3). Accuracy measures to detect non-adherence showed a sensitivity of 62.5% and specificity of 85.7%, ROC curve area of 74.1%, and positive predictive value of 90.9%. Results suggest the Questionário de Ades?o a Medicamentos has a good fit.     

Health care needs of community-dwelling older adults

OBJECTIVE: To identify, assess, and rank the importance of health care needs of community-dwelling older adults. METHOD: A structured telephone interview with 107 respondents (physicians, direct service providers and administrators) about the importance of a list of 31 health care needs of older adults. Respondents also identified the single most important health issue facing local older adults now and in the next 5 to 10 years. RESULTS: The five most important health care needs, in descending order, are: care-giver support services, community long-term care services, services for people with dementia/Alzheimer's disease, palliative/end-of-life care, and services for cancer patients and their families. Community long-term care services were identified as the single most important health issue both now and in the next 5 to 10 years. CONCLUSION: The study findings should be of value to health and social service researchers, planners, providers and administrators regarding the needs of community-dwelling older adults.     

Mixed care networks of community‐dwelling older adults with physical health impairments in the Netherlands

As part of long‐term care reforms, home‐care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home‐dwelling older adults. Information on the variety in mixed care networks may help home‐care organisations to develop network type‐dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home‐care organisations in Amsterdam, the Netherlands, we selected 74 frail home‐dwelling clients who were receiving care in 2011–2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal–informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients’ activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home‐care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning co‐ordination tasks to specific dyads in large mixed care networks.     

Development,validation and reproducibility of a food frequency questionnaire to measure flavonoid intake in older Australian adults

Aim

To develop and assess the validity and reproducibility of a food frequency questionnaire (FFQ) to measure total flavonoid intake, and individual flavonoid subclasses, in older adults.

Methods

Retrospective analysis of flavonoid intake in older adults informed the development of a FFQ to measure flavonoid intake and determine the flavonoid subclasses consumed (anthocyanins, flavan‐3‐ols, flavones, flavonols and flavanones). Older adults (n = 42, mean age 75.3 ± 8.6 years) attended two interviews 1 month apart where anthropometrics (height and weight), blood pressure (BP), demographic data and a 93‐item self‐administered FFQ were collected. A 4‐day food record (FR) was randomly administered between the two interview dates, and each food item was assigned a flavonoid and flavonoid subclass content using the United States Department of Agriculture flavonoid database. The criterion validity and reproducibility of the FFQ was assessed against a 4‐day FR using the Wilcoxon signed‐rank sum test, Spearman's correlation coefficient (r), Bland‐Altman Plots and Cohen's kappa.

Results

Total flavonoid intake was determined (median intake FFQ = 919.3 mg/day, FR = 781.4 mg/day). Tests of validity indicated that the FFQ consistently overestimated total flavonoid intake compared with the 4‐day FR. There was a significant difference in estimates between the FFQ and the 4‐day FR for total flavonoid intake (Wilcoxon signed‐rank sum P < 0.001; Bland‐Altman plots indicated large bias and wide limits of agreement), but they were well correlated (Spearman's r 0.93, P < 0.001; Cohen's kappa κ = 0.619, P < 0.001). For individual flavonoid subclasses, the tests of validity indicated greater discrepancy compared with 4‐day FR. The FFQ showed high reproducibility for estimating total flavonoid intake (FFQ1vsFFQ2: Wilcoxon signed‐rank sum test, P > 0.05; Spearman's r 0.91, P < 0.001; Bland‐Altman plots visually showed small, non‐significant bias and wide limits of agreement; and Cohen's kappa κ = 0.619, P < 0.001), with a small mean percentage difference (6.7%). For individual flavonoid subclasses, the tests of reproducibility between FFQ1 and FFQ2 showed similarly high reproducibility.

Conclusions

The developed FFQ appears suitable for satisfactorily ranking individuals according to total flavonoid intake. The FFQ shows limitations for estimating absolute total flavonoid intake and intake of flavonoid subclasses in comparison to a 4‐day FR in terms of overestimating intake. Refinement and further validation of this tool may be required.     

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls’ excess mortality persists.     

Development and application of a questionnaire for assessing parent satisfaction with care.

OBJECTIVE: The development and application of a questionnaire that eventually could be used as a management tool and a means of promoting the quality of care provided in 'P. & A. Kyriakou' Children's Hospital. DESIGN: Parents' survey; during treatment of their children. SETTING: 'P. & A. Kyriakou' Children's Hospital, Athens, Greece. PARTICIPANTS: Sample of 240 parents. MAIN OUTCOME MEASURE: Parent satisfaction. RESULTS: The most important finding of the study, although normative statements cannot be made, appears to be signalling of low satisfaction with care. The general mean observed (45 on a scale of 100) is not close to the mean (76) derived from a systematic review of 221 satisfaction studies. Moreover, satisfaction appears to be very low (14/100) for the procedures of the hospital, low for the outpatient dimension (42/100) and rather satisfactory for the inpatient dimension (61/100). CONCLUSION: Data-based feedback as a management tool has been associated with improved organizational functioning. However, systematic use of this intervention within Greek hospitals has been limited. Therefore, the next phase of the project will be used as feedback to the Governing Board and the personnel of the hospital. Finally, a study will be planned to investigate the effects of implementing changes based on parents' ratings of staff performance.     

Assessing perceived health promotion needs and interests of low-income older women

This study focuses on an assessment of perceived health promotion needs and interests among predominantly older low-income women (76%) in the state of Pennsylvania. A questionnaire was completed by a convenience sample of 140 individuals attending four senior centers and two nutrition sites. In addition, 14 focus groups with an average of 8 members per group were conducted for a total of 105 people from two of the four senior centers. The health topics of greatest interest to women were exercise (57.6%), making friends (50.9%), nutrition (37.5%), losing weight (33.6%), and home safety (34.6%). Compared with women, men were significantly more interested in exercise and its effect on mood (41.3% versus 24.0%) and love and sex after 60 (44.8% versus 18.2%) and significantly less interested in nutrition (17.2% versus 37.5%). The fitness activities of greatest interest to women were walking (63.1%), back exercises (37.5%), toning to music (22.1%), and self-defense (18.2%), none of which was significantly different from the men in the sample. Results suggest that many of the key health needs perceived by low-income older women could be addressed by a combination of fitness activities and health education, especially if they are also designed to facilitate social interactions. The barriers to participation in such programs most often cited were transportation, scheduling, and cost factors. Fortunately, many communities already have the resources to offer low-cost interventions in the areas of need, such as walking groups, self-defense, and home safety. Communities interested in serving low-income older women should more closely examine the barriers and the unmet needs of this group when designing intervention programs.     

Informal care and health care use of older adults

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.     

Development and validation of a shelf inventory to evaluate household food purchases among older adults with diabetes mellitus

OBJECTIVE: Valid measures of behavioral outcomes are needed to evaluate interventions. The purpose of this research was to validate a shelf inventory and evaluate food purchases using the inventory among older adults with diabetes. DESIGN: A 166-item shelf inventory of household food was assessed for face, content, and criterion validity. The sensitivity and specificity of the inventory were determined by comparing participant- and interviewer-completed inventories. A randomized pretest/post-test control group design was used to evaluate household food purchases following an intervention. Setting: The intervention was held in an outpatient setting. PARTICIPANTS: Study participants were > or = 65 years old with type 2 diabetes mellitus for > or = 1 year. INTERVENTION: The intervention included 10 weekly group sessions and emphasized applying food label information to food purchases. MAIN OUTCOME MEASURES: Each food on the inventory was defined as "encouraged" or "discouraged" according to intervention messages. ANALYSIS: Inventory sensitivity was the proportion of foods present in households that were accurately identified on the self-reported inventory as present; specificity was the proportion of foods not present that were accurately identified as not present. Two-sample t tests compared intervention scores for encouraged/discouraged foods by treatment group. RESULTS: Overall sensitivity and specificity were.90 and.97, respectively. Intervention results found more encouraged than discouraged foods present at post-test (t [91] = 2.3, P =.02). CONCLUSIONS AND IMPLICATIONS: The shelf inventory is a sensitive, specific, and valid tool for assessing household food purchases and can be used to evaluate food choice interventions among older adults with type 2 diabetes mellitus.     

Relative validation of a short food frequency questionnaire to assess calcium intake in older adults

OBJECTIVE: To develop and validate a food frequency questionnaire (FFQ) for estimating calcium intake in community-dwelling older adults using a food record as the reference method. METHOD: A validation study involving 102 subjects (67 females) aged > or =65 years and residing independently in Adelaide, Australia, between 2002-06 was performed. Estimates of calcium intake over the last year were calculated from two versions (35 and 15 items) of the FFQ and compared with average intake from four days of non-consecutive food records (4DFR). RESULTS: Mean calcium intake from the 4DFR was 987 mg/day (95% CI 922-1051). The 35 and 15-item questionnaires gave mean intakes of 992 mg/day (95% CI 913-1,071) and 1017 mg/day (95% CI 927-1,106) respectively. Mean difference (95% limits of agreement) between the food record and the 35 and 15-item questionnaires was 5 mg (-739-729) and 28 mg (-936-879) respectively. The 15-item questionnaire demonstrated 82% sensitivity for classifying subjects with calcium intake below the estimated average requirement (EAR, 840 mg for males 51-70 years; 1,100 mg for females >51 years and males >70 years of age) and 46% specificity for classifying subjects with intake above the EAR. CONCLUSION: The FFQ evaluated as part of this study is one of very few that has been tested across both genders and in older adults specifically. The 15-item version has demonstrated a level of sensitivity and specificity comparable with other FFQs for evaluating calcium intake. Implications: The 15-item FFQ can be confidently used for measuring group mean calcium intake in older Australians or as a screening tool to allow health professionals to identify those who are most at risk of inadequate dietary calcium intake.     

A study of attitudes toward medical care and health behaviors among older adults

In order to understand the attitudes of older adults toward medical care, we interviewed 480 persons living in Yokohama, and 180 persons living in Aikawa, Kanagawa, aged 45 to 84 years old. The following results were obtained; 1) Attitudes toward medical care can be classified into four types; self-determined medical care, self treatment attitudes, high dependence on the medical care system, and distrust of medical care. Those interviewees who had high self-determination in medical care and self treatment attitudes showed strong distrust of medical care. 2) There were two groups with trend toward low compliance to the advice of a physician for a physician diagnosed illness: the group that had strong self-determination in medical care, and the group that had high distrust of medical care. The interviewees who had a strong tendency to see a physician for potentially serious illness had high self treatment attitudes, but disease prevention behaviors was not associated with all of four types. 3) In both communities, those interviewees who were younger and with higher educational levels showed strong distrust of medical care and had more self-determination attitudes. Those interviewees who had actually experienced problems in medical treatment showed less dependence on medical care and more distrust of medical care compared to those who had not. In Yokohama, distrust of medical care appeared to be higher among those interviewees who did not have a family doctor than those who had. 4) Distrust of medical care and self-determination in medical care was significantly higher in Yokohama than in Aikawa. The differences in the distribution of educational level and family doctors were a part of the reason for area differences in attitudes of distrust of medical care.     

Development and validation of a patient-reported questionnaire assessing systemic therapy induced diarrhea in oncology patients

Background

Systemic therapy-induced diarrhea (STID) is a common side effect experienced by more than half of cancer patients. Despite STID-associated complications and poorer quality of life (QoL), no validated assessment tools exist to accurately assess STID occurrence and severity to guide clinical management. Therefore, we developed and validated a patient-reported questionnaire (STIDAT).

Methods

The STIDAT was developed using the FDA iterative process for patient-reported outcomes. A literature search uncovered potential items and questions for questionnaire construction used by oncology clinicians to develop questions for the preliminary instrument. The instrument was evaluated on its face validity and content validity by patient interviews. Repetitive, similar and different themes uncovered from patient interviews were implemented to revise the instrument to the version used for validation. Patients starting high-risk STID treatments were monitored using the STIDAT, bowel diaries and EORTC QLQ-C30. The STIDAT was evaluated for construct validity using exploratory factor analysis (EFA) using minimal residual method with Promax rotation, reliability and consistency. A weighted scoring system was developed and a receiver-operating characteristic (ROC) curve evaluated the tool’s ability to detect STID occurrence. Median scores and variability were analysed to determine how well it differentiates between diarrhea severities. A post-hoc analysis determined how diarrhea severity impacted QoL of cancer patients.

Results

Patients defined diarrhea based on presence of watery stool. The STIDAT assessed patient’s perception of having diarrhea, daily number of bowel movements, daily number of diarrhea episodes, antidiarrheal medication use, the presence of urgency, abdominal pain, abdominal spasms or fecal incontinence, patient’s perception of diarrhea severity, and QoL. These dimensions were sorted into four clusters using EFA – patient’s perception of diarrhea, frequency of diarrhea, fecal incontinence and abdominal symptoms. Cronbach’s alpha was 0.78; kappa ranged from 0.934–0.952, except for abdominal spasms (κ = 0.0455). The positive predictive value was 96.4%, with the minimum score of 1.35 predicting a positive STID occurrence. Patients with moderate or severe diarrhea experience significant decreases in QoL compared to those with no diarrhea.

Conclusions

This is the first patient-reported questionnaire that accurately predicts the occurrence and severity of diarrhea in oncology patients via assessing several bowel habit dimensions.

     

Development and content validation of a questionnaire to assess moral distress among social workers in long-term care facilities

ABSTRACT

Objective: Despite the significance of ethical issues faced by social workers, research on moral distress among social workers has been extremely limited. The aim of the current study is to describe the development and content validation of a unique questionnaire to measure moral distress among social workers in long-term care facilities for older adults in Israel. Methods: The construction of the questionnaire was based on a secondary analysis of a qualitative study that addressed the moral dilemma of social workers in nursing homes in Israel. A content validation included review and evaluation by two experts, a cognitive interview with a nursing home social worker, and three focus groups of experts and the target population. Results: The initial questionnaire consisted of 25 items. After the content validation process the questionnaire in its final version, consisted of 17 items and included two scales, measuring the frequency of morally loaded events and the intensity of distress that followed them. Conclusions: We believe that the questionnaire can contribute by broadening and deepening ethics discourse and research, with regard to social workers’ obligation dilemmas and conflicts.