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.     

Motivators,Barriers and Other Factors Related to Bean Consumption in Older Adults

Abstract

Beans are nutrient-dense and can reduce risk of chronic diseases. This is relevant to older adults who can benefit from consuming beans to reduce their elevated chronic disease risk. This study explored bean consumption in older adults (≥65 years) using mixed-methods including a researcher-administered questionnaire (n?=?250) and focus groups (n?=?49). Prevalence of bean consumption (daily or weekly) was 51.2%. Motivators to bean consumption were significantly more likely among bean consumers with the top three including nutritional value, taste/texture and versatility, which were also predictors of consuming beans (OR?=?3.54, 2.72, and 4.24, respectively). Conversely, barriers to bean consumption were significantly more likely among bean non-consumers with the top three including not part of traditional diet/do not think to include beans in meals, flatulence/abdominal discomfort and lack of knowledge about preparation/cooking, which were also predictors of not consuming beans (OR?=?3.85, 2.26, and 5.08, respectively). This research will inform dietary strategies to increase bean consumption.     

Whole Grain Nutrition Education Program Improves Whole Grain Knowledge and Behaviors Among Community-Residing Older Adults

U.S. older adults are not meeting the recommendation for whole grain (WG) intake. This pilot study determined the influence that a WG nutrition education program for community-residing adults aged 60?+?years has on WG knowledge and behaviors. The program included WG education and discussion, participation in hands-on activities and taste testing. Participants were mostly white, females. Total grain and WG dietary intake frequencies (WG frequency; p?≤?0.001), and “knowledge score” increased from PRE to POST (p?≤?0.001). Participants in PowerPoint-based classes had a higher “knowledge scores” at POST (p?=?0.002). Nearly all (n?=?139, 88.5%) intended to eat more WG foods, with almost two-thirds (n?=?93, 59.3%) reporting a “strong” intention to do so. There was a positive association between strength of intention to eat WG foods and “WG frequency” at POST (r?=?0.435, p?≤?0.001). Results suggest that this WG program is an effective strategy for improving WG knowledge and behaviors among older adults.     

Use of Song as an Effective Teaching Strategy for Nutrition Education in Older Adults

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t-test showed the knowledge gain mean scores for the treatment group were significantly (P < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.     

The Changing Face of Food and Nutrition in Canada and the United States: Opportunities and Challenges for Older Adults

ABSTRACT

Science and technology are modernizing the field of nutrition and are consequently increasing its complexity. New food developments such as fortified foods and functional foods are evidence of its modernization. The increased specificity of nutrient- and food-intake recommendations and the breadth of claims on food packages are evidence of nutrition's growing complexity. Unfortunately, research on the consumer acceptability of new food developments and nutrition education initiatives has not kept pace with advancements in the field. This is especially true for older adults, a subgroup of the population that appears to be under-researched and not commonly targeted with education initiatives. Older adults are the fastest growing segment of the North American population. Research and education aimed at this demographic is warranted to ensure older adults have the right knowledge and skill set to optimize their food selections and dietary patterns with the possibility of improving health and the quality and longevity of life.     

Understanding Barriers to Implementing Quality Lunch and Nutrition Education

Food services and nutrition education are priorities for the Coordinated School Health Program in Massachusetts, which is a CDC funded partnership between the Massachusetts Departments of Education and Public Health. Despite funding and resources provided by governmental and non-governmental agencies, schools are facing barriers in effectively creating a healthy nutritional environment. A qualitative survey was conducted to understand barriers to implementing quality lunch and nutrition education programs perceived by superintendents, principals, food service directors, nurses, and health educators in Massachusetts. The results suggest that while funding can initially enable schools to provide quality lunch, but without changes in students' preference for unhealthy food and parental and community involvement in fostering students' healthy eating behavior, the lunch programs cannot achieve a sustainable success. Lack of opportunity for communication among food service staff, health educators, and teachers appears to hinder the coordination necessary to promote school lunch as well as school-wide nutrition education. Respondents acknowledged that the state's academic assessment system is the priority issue in their schools, but expressed that the interests and initiatives of superintendents and principals in the lunch and nutrition education programs can be enhanced. Overall, the results suggest that successful implementation of quality lunch and nutrition education programs require not only the collaborative efforts of school administration and staff but also the support of parents, community, and the mass media.     

Measuring the Impact of Nutrition Education and Physical Activity on Older Adults Participating in Government Sponsored Programs

A longitudinal, four-year study (2004–2007) with a cohort of 139 older adults (majority women;71%) was conducted to examine the impact of community-based nutrition and physical activity programs on health outcome measures. Demographic and anthropometric data were collected and nutrition screening was performed. Blood pressure, serum cholesterol and glucose levels, and pulse rate were also measured. The blood pressure, both mean systolic and diastolic, 141(± 19.0)/79.3 ± 9.7 (2004) vs. 127.8 ± 10.9/73.8 ± 10.2 mm Hg (2007), were improved (p < 0.05) in women. There were also improvements (p < 0.05 in both men and women) in pulse rate between 2004 and 2007. There is no doubt that nutrition education and exercise programs together enhanced the overall health and well being of these older adults. However, our findings emphasize the need for further systematic study and for appropriate biometric assessments to evaluate the full impact of nutrition education and physical activity interventions in older adults.     

Documenting the Need for Nutrition and Health Intervention for Middle-aged and Older Adults in the Lower Mississippi Delta Region

ABSTRACT

Multiple demographic, health, and environmental factors may influence the overall quality of diets among rural middle-aged and older adults. This project compared the diet quality of participants in Foods of Our Delta Survey (FOODS 2000) who were aged 55 years and older with national data. The data were assessed using 24-hour dietary recall methodology and a modified version of the United States Department of Agriculture Healthy Eating Index (HEI) that excluded the sodium component. The mean total Modified Healthy Eating Index (MHEI) study score was significantly lower than their counterparts from the national survey (61.0±0.68 vs. 65.6±3.65, P < 0.0001). Race and educational attainment were associated with higher MHEI scores. This study emphasized a critical need for implementing nutrition and health interventions in rural communities with special attention to subpopulations at risk.     

Best Practices in Family Life Education Programming for Midlife and Older Adults

Due to dramatic changes in the U.S. population's aging demographic, family life educators have begun offering more programming for midlife and older adults. This shift began in the early 1990s, after several family scholars and practicing professionals urged the National Council of Family Relations to revise its Framework for Life Span Family Life Education to include “later adulthood” as a fourth age-group categorization. Since this revision, family life educators and family scholars alike have gradually expanded their programming and scholarship efforts to address the challenges and concerns associated with midlife and older adulthood. In this article, we review best practices in family life education (FLE) programming for midlife and older adults, including programming needs, program design preferences, and contextual variation. To conclude, we suggest future directions for research on best practices in FLE for midlife and older audiences and recommend using the life course perspective as a complement to the Framework when planning and designing FLE programming to meet the needs of the heterogeneous aging population.     

Instructional Techniques and Environmental Considerations in Family Life Education Programming for Midlife and Older Adults*

We review the theory and practice of education with midlife and older adult populations and empirically address two theoretically guided research questions: (a) What are older adults' preferences for instructional strategies and techniques in programs? (b) What environmental considerations (e.g., lighting) do older adults perceive as important in influencing their attendance, participation, and satisfaction with programs? Data were collected from and compared among 264 adults representing four age groups: 50–64 (midlife), 65–74 (young old), 75–84 (old old), and 85 and over (oldest old). Recommendations for family life education practices with older adults are addressed.     

Eat Smart,Live Strong Intervention Increases Fruit and Vegetable Consumption Among Low-Income Older Adults

This study evaluated the impact of a four-session interactive nutrition education program—Eat Smart, Live Strong (ESLS)—on the consumption of fruit and vegetables by low-income older adults. A pre–post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants’ self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants’ average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.     

Low Health Literacy and Older Adults: Meanings,Problems, and Recommendations for Social Work

Many older adults struggle to manage their health care problems. Low health literacy exacerbates such struggles and contributes to a variety of adverse health behaviors and outcomes. Addressing how health literacy impinges on the lives of older adults is a neglected area of social work practice and knowledge. This article explores seven areas: defining health literacy, the problem and prevalence of low health literacy among older adults, health inequalities and health literacy, a brief literature review, neglected issues in the literature, suggestions for macro and micro social work interventions to improve health literacy for older adult populations, and conclusion.     

Peer Educators' Perceptions of Training for and Implementing a Community-Based Nutrition Intervention for Older Adults

Abstract

This study aimed to evaluate the use of peer educators in nutrition interventions with older people. A sample of 22 people aged 60+ were recruited and trained using an accredited course for Community Nutrition Assistants which included basic nutrition and group skills. They were paid to work as peer educators in a 20-week food club intervention which ran in 13 sheltered accommodation schemes for older people in northeast England. Clubs ran for 2 hours each week and included food preparation, food tasting and sharing information and ideas about food and health. This paper reports key findings from qualitative interviews with peer educators on their perspectives on their motivation to participate, their training and their implementation of the food club intervention. It discusses some of the issues involved in the training and use of peer educators and presents lessons learned, particularly the need to target training, according to prior experience and skills.     

Exploration of Functional Food Consumption in Older Adults in Relation to Food Matrices,Bioactive Ingredients,and Health

The functional food industry is expanding, yet research into consumer perceptions of functional foods is limited. Older adults could benefit from functional foods due to age-related food and health issues. This research gathered information about functional foods from community-dwelling older adults (n = 200) who completed a researcher-administered questionnaire about consumption, food matrices, bioactive ingredients, and health areas addressed through functional foods. Overall prevalence of functional food consumption was found to be 93.0%. Commonly consumed foods included yogurt with probiotics (56.0%), eggs with omega-3 fatty acids (37.0%), and bread with fiber (35.5%). Functional food matrices primarily consumed were yogurt (51.5%), bread (44.0%), and cereal (40.0%). The primary functional food bioactive consumed was dietary fiber (79.5%). Most participants (86.2%) indicated that they consume functional foods to improve health, and the major areas specified were osteoporosis/bone health (67.5%), heart disease (61.0%), and arthritis (55.0%). These results inform health professionals regarding the potential of functional foods to support health among older adults.     

Joint Health and safety Committee Education and the Value of Bipartite Cooperation in the Healthcare Sector in British Columbla,Canada

Abstract

In 1999, in British Columbia, Canada, the healthcare workforce, healthcare employers and unions partnered to develop the Occupational Health and Safety Agency for Healthcare (OHSAH), a bipartite (labor-management)-governed organization with amandate to implement evidence-based programs to reduce injury rates in health care. Within a year of its establishment, OHSAH began delivery of a province-wide joint committee education and development QCED) program. A telephone sUrvey after six months showed that the training program had modestly increased the establishment of new programs and had significantly increased positive health and safety behaviors and quality of JC functioning. The spirit of bipartite collaboration fostered by this and other OHSAH programs has been hugely successful at reducing injuries, time loss, and cost, and should be promoted.     

VNA HouseCalls of Greater Cleveland,Ohio: Development and Pilot Evaluation of a Program for High-Risk Older Adults Offering Primary Medical Care in the Home

ABSTRACT

The need for primary medical care in the home will increase with a growing elderly and disabled population. The effectiveness of the service must be assessed in light of its relatively high costs. The aim of this study was to evaluate VNA HouseCalls of Greater Cleveland, Ohio during its first year of operations. The program targets high-risk older adults using teams of advanced practice nurses and physicians. The pilot evaluation focused on the attainment of identified program goals. Data collection techniques included clinical record review (N = 139), mailed referral source satisfaction survey, and both mailed and telephone interview patient satisfaction surveys. The results showed that the typical patient served by VNA HouseCalls was a homebound woman in advanced old age with regular family contact and both physical and mental disorders. When asked, the typical patient indicated that without the program she would not have received the care that she needed. VNA HouseCalls helped in preventing functional decline and reducing hospitalization. It received high satisfaction ratings from both referral sources and patients. Study findings suggest that primary care in the home bears further examination for addressing community need and affecting positive patient outcomes for high risk older adults.     

Benefits of Adding an Aquatic Resistance Interval Training to a Nutritional Education on Body Composition,Body Image Perception and Adherence to the Mediterranean Diet in Older Women

The human population is increasing due to lengthening life expectancy, but the quality of life and health of people is moving in the opposite direction. The purpose of this study is to evaluate how aquatic resistance interval training can influence body composition, body image perception and adherence to the Mediterranean diet (MD) in older women participants in a nutrition education program and to study the relation between these variables. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training plus nutritional intervention) and control (nutritional intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week; 60 min each). Body composition, body image perception and adherence to MD diet were evaluated at baseline and 14 weeks. No significant differences were found between groups regarding body image perception and adherence to the MD. There was a significant increase in muscle mass (kg) (p < 0.001) and a significant decrease in fat mass (kg) (p < 0.001) in the intervention group when compared to the control group. The addition of aquatic resistance interval training to a nutritional intervention was not sufficient to change body image perception and adherence to MD but produced improvement in body composition (through an increase in muscle mass and decrease on fat mass) in older women.     

Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus,Indicating the Need for Improved Nutrition Education and Diet Care

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.