David R. Buys

Higher Healthy Eating Index-2005 Scores Are Associated With Better Physical Performance

BACKGROUND Little is known regarding the relationship between overall diet quality and physical performance among older adults. We examined the association between overall diet quality, as measured by the US Department of Agricultures Healthy Eating Index-2005 (HEI-2005), and physical performance, as measured by gait speed (n = 2,132) and knee extensor power (n = 1,392), among adults aged 60 years or older. METHODS Using data from the 1999-2002 National Health and Nutrition Examination Survey, multiple linear regression models controlling for age, gender, race/ethnicity, education, smoking status, comorbidities, medication use, cognitive function, body mass index, and physical activity were used in the analyses. RESULTS After adjusting for age, gender, race/ethnicity, education, and smoking status, total HEI-2005 scores were positively associated with both gait speed (p for trend = .02) and knee extensor power (p for trend = .05). Older adults with higher HEI-2005 scores had a faster gait speed (p = .03 for both Quartile 3 and Quartile 4 vs quartile 1) compared with those with HEI-2005 scores in the lowest quartile. Those with HEI-2005 scores in Quartile 4 had a greater knee extensor power compared with those with HEI-2005 scores in the lowest quartile (p = .04). The associations between HEI-2005 scores and physical performance remained after further adjustment for comorbidities, medication use, cognitive function, and body mass index. However, the associations were no longer statistically significant after further adjustment for physical activity. CONCLUSION Adherence to overall dietary recommendations is associated with better physical performance among older adults.

Nutritional Risk and Body Mass Index Predict Hospitalization, Nursing Home Admissions, and Mortality in Community-Dwelling Older Adults: Results From the UAB Study of Aging With 8.5 Years of Follow-Up

BACKGROUND Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. METHODS Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. RESULTS In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. CONCLUSIONS Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review

Participation in home-delivered meals programs may contribute to the health and independence of older adults living in the community, especially those who are food insecure or those who are making transitions from acute, subacute, and chronic care settings to the home. The purpose of this study was to conduct a comprehensive and systematic review of all studies related to home-delivered meals in order to shed light on the state of the science. A complete review of articles appearing in PubMed using the keyword “Meal” was conducted; and titles, abstracts, and full-texts were screened for relevance. Included in this review are 80 articles. Most studies are descriptive and do not report on outcomes. Frequently reported outcomes included nutritional status based on self-reported dietary intake. Additionally, most studies included in this review are cross-sectional, have a small sample size, and/or are limited to a particular setting or participant population. More rigorous research is needed to (1) gain insight into why so few eligible older adults access home-delivered meals programs, (2) support expansion of home-delivered meals to all eligible older adults, (3) better identify what home-delivered meals models alone and in combination with other services works best and for whom, and (4) better target home-delivered meals programs where and when resources are scarce.

Favorite foods of older adults living in the Black Belt Region of the United States. Influences of ethnicity, gender, and education

The purpose of this study was to examine food preferences of older adults living in the Black Belt Region of the Southeastern United States and the extent to which food preferences vary according to ethnicity, gender, and educational level. 270 older adults who were receiving home health services were interviewed in their home and were queried regarding their favorite foods. Descriptive statistics were used to characterize the sample. Chi-square analysis or one-way analyses of variance was used, where appropriate, in bivariate analyses, and logistic regression models were used in multivariate analyses. A total of 1,857 favorite foods were reported (mean per person=6.88). The top ten favorite foods reported included: (1) chicken (of any kind), (2) collard greens, (3) cornbread, (4) green or string beans, (5) fish (fried catfish is implied), (6) turnip greens, (7) potatoes, (8) apples, (9) tomatoes, fried chicken, and eggs tied, and (10) steak and ice cream tied. African Americans and those with lower levels of education were more likely to report traditional Southern foods among their favorite foods and had a more limited repertoire of favorite foods. Findings have implications for understanding health disparities that may be associated with diet and development of culturally-appropriate nutrition interventions.

Recruitment of volunteers for a home-delivered meals programme serving homebound older adults: a theoretically derived programme among faith communities.

OBJECTIVE Home-delivered nutrition programmes that are federally subsidized by the US Administration on Aging seek to ensure that socially isolated older adults who are unable to purchase and prepare their own food have nutritious meals delivered to them regularly by both employed and volunteer staff. Unfortunately, there are long waiting lists in some neighbourhoods that are often due to a shortage of volunteers. The present paper describes a theoretically driven community-based project designed to increase volunteer participation in serving Meals on Wheels (MOW) clients. DESIGN A Support Team model was applied in the project wherein existing social capital among religious faith communities, and social networks within those organizations, was joined with a local MOW programme to create a sustainable meal delivery route to vulnerable homebound older adults. SETTING The programme participants were in one underserved neighbourhood in Birmingham, Alabama, an urban city in the south-eastern USA. SUBJECTS The subjects under consideration are both MOW clients and volunteers. MOW clients are those individuals aged 60 years and above who qualify for the service; the volunteers are from community churches. RESULTS One volunteer route, comprising six congregations that delivered meals to sixteen homebound older adults, was created. The route served more than 2000 meals in 2006 (the year the programme began) and continues to serve clients today. CONCLUSIONS The programmes successful implementation provides evidence that reliance on theory is critical in planning and developing effective community-based programme interventions.

Neighborhood Disadvantage and Life-Space Mobility Are Associated with Incident Falls in Community-Dwelling Older Adults

To determine the relationship between neighborhood‐level socioeconomic characteristics, life‐space mobility, and incident falls in community‐dwelling older adults.

Farmers' Market Produce Delivery Program for Mitigating Nutritional Risk in Older Adults

Community-dwelling older adults in disadvantaged neighborhoods may face nutritional risks not mitigated by existing programs. The Senior Market Basket Program, administered by nonprofit organization P.E.E.R., Inc., is a unique approach to serving community-dwelling senior adults and a valuable model for integrating targeted social services into local food systems. The program ensures access to fresh produce during the growing season for a defined target population.

Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial.

Background We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life. Methods We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life. Results A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events. Conclusions While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.

A State-Level Examination of the Association Between Home and Community-Based Services and Rates of Nursing Home Residency with Special Attention to Nutrition Programs

Federal food and nutrition programs implemented by the Administration on Aging and funded by the Older Americans Act (OAA) seek to enable older adults to remain in their homes and communities through a comprehensive, coordinated, and cost-effective array of services. We hypothesized that expenditures devoted to nutrition programs for home and community-based nutrition services were inversely related to changes in state-level rates of institutionalization for older adults from one year to the next, such that states that spend more money per capita on community-based nutrition programs would have smaller increases or greater decreases in rates of institutionalization, controlling for expenditures on other home and community-based services. We found, however, that there was not an effect of OAA Nutrition Services on the change in rates of nursing home residency. We noted, though, that states that direct a greater proportion of their long-term care expenditures to home and community-based services appear to have more reduction in their rates of nursing home residency. Further longitudinal work at the state and individual levels is warranted.

Food Insecurity and Hunger Among Older Adults

Meeting nutritional needs is necessary for optimal health across the lifespan and especially for older adults [1, 2]. However, it is not always feasible to access the foods needed to obtain desirable health outcomes. Therefore, it is important to understand what factors enable, constrain, or are associated with individuals’ ability to access and consume healthful foods. This is especially true for older adults who may be susceptible to irreversible changes in their diet as they encounter illnesses and changes in their eating behaviors with advancing age [3, 4]. Food (in)security is a helpful construct in trying to understand forces that may promote or impede how people obtain and consume nutrition