Dian O. Weddle

Position of the American Dietetic Association: Nutrition, Aging, and the Continuum of Care

Scientific evidence increasingly supports that good nutrition is essential to the health, self-sufficiency, and quality of life of older adults. With the population of the United States living longer than ever before, the older adult population will be more diverse and heterogeneous in the 21st century. The oldest-old and minority populations will grow more quickly than the young-old and non-Hispanic white populations, respectively. For the current 34 million adults 65 years of age and older living in the United States, there are about 12 million caregivers who provide formal or informal care. A broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults is needed. With changes and lack of coordination in health care and social-support systems, dietetics professionals need to be proactive and collaborate with aging-services and other health care professionals to improve policies, interventions, and programs that service older adults throughout the continuum of care to ensure nutritional well-being and quality of life. The American Dietetic Association supports both the provision of comprehensive food and nutrition services and the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.

The Professional Development Portfolio Process:Setting Goals for Credentialing

Professional Development Portfolio (PDP), the new credentialing system for dietetics professionals, places the responsibility for learning, professional development, and career direction on the individual practitioner. This study used questionnaires and focus group interviews to determine whether dietitians engage in reflection, self-assessment, and goal setting, the critical components of PDP recertification. Volunteers (n = 132) participated in 16 focus groups held during 8 state dietetic association meetings. Content analysis was conducted. Some subjects reflected using an informal non-structured process (42 text units), almost half (41%) performed annual self-assessments, and 25% set goals. Job availability, new practice areas, family obligations, and employer needs were key factors in goal formulation. Opportunities for self-direction, independent decision-making, and application of technical expertise were also considered in career choices and goal setting. Although few participants were currently performing PDP critical components, we conclude dietetic practitioners can gain the necessary skills for professional development with the newly available PDP Guide to support the portfolio process. We recommend that dietitians (a) allow sufficient time for the reflection process, including the use of additional tools; (b) develop personal mission statements to drive the goal-setting process; and (c) use effectiveness criteria to critique their goals.

Elder Insecurities: Poverty, Hunger, and Malnutrition

Between 8% and 16% (2.5 to 4.9 million) of the elder population have experienced food insecurity within a 6-month period. Federal programs to combat food insecurity reach only one-third of needy elders. While hunger and poverty are linked directly to malnutrition, the multifaceted nature of elderly malnutrition cuts across all economic, racial, and ethnic groups. Malnourished patients experience 2 to 20 times more complications, have up to 100% longer hospital stays, and compile hospital costs

The Relationship among Cardiovascular Risk Factors, Diet Patterns, Alcohol Consumption, and Ethnicity among Women Aged 50 Years and Older

2,000 to

Maintaining Functionality in Later Years: A Review of Nutrition and Physical Activity Interventions in Postmenopausal Women

10,000 higher per stay. Dietitians can advocate routine nutrition screening to target elders at highest risk and lobby for expansion of appropriate nutrition services in home, community, and institutional settings.

Interactive learning for congregate nutrition site nutrition education: a pilot study.

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among women of all races and ethnicities. The risk of developing the disease is greater in postmenopausal women. OBJECTIVE The purpose of this study was to use cluster analysis to examine diet patterns and to examine the association between diet patterns and the presence of major cardiovascular disease risk factors. DESIGN Data from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2001-2002 were used. SUBJECTS/SETTING Women aged 50 years and older were included (n=1,313). MAIN OUTCOME MEASURES The following major CVD risk factors were examined: being overweight or obese (body mass index >24.9), having elevated systolic blood pressure (>120 mm Hg), and having low levels of high-density lipoprotein cholesterol (<50 mg/dL [<1.30 mmol/L]). Dietary patterns were derived by cluster analysis using data from a 24-hour dietary recall. STATISTICAL ANALYSES PERFORMED Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression to determine the probability of having a risk factor according to diet pattern while accounting for race/ethnicity, physical activity, age, and smoking. RESULTS Cluster analysis generated six nonoverlapping diet patterns labeled: Pasta and Yellow Vegetables; Sweets; Beef, Starches, Fruits, and Milk; Frozen Meals, Burritos, and Pizza; Meat Dishes; and Soft Drinks and Poultry. The majority of the women were grouped in the Sweets diet pattern. Factors associated with adequate levels of high-density lipoprotein cholesterol included being non-Hispanic African American (OR 0.59, 95% CI 0.44 to 0.81; P<0.0001), alcohol consumption (OR 0.76, 95% CI 0.69 to 0.84; P<0.0001), and being assigned to the Sweets diet pattern (OR 0.27, 95% CI 0.14 to 0.50; P<0.0001) or Meat dishes diet pattern (OR 0.94, 95% CI 0.54 to 1.65; P<0.0075). The Sweets pattern was also associated with having normal systolic blood pressure levels (OR 0.51, 95% CI 0.34 to 0.76; P<0.0001). Individuals grouped in the Beef, Starches, and Milk diet pattern were more likely to have an adequate body mass index (OR 0.42, 95% CI 0.23 to 0.77; P<0.0032). CONCLUSIONS Significant associations between dietary patterns and major CVD risk factors were observed. Food and nutrition professionals can use this information to assess unhealthful food choices observed in the dietary patterns to guide nutrition recommendations and help reduce the incidence of CVD risk factors. Future research should aim to evaluate dietary intake via complementary methods (ie, dietary patterns and nutrient assessment) to better understand diet-disease relationships.

Providing Food and Nutrition Choices for Home and Community Long Term Living

Independence and quality of life of postmenopausal women are influenced by functional status. Nutrition and physical activity impact functional changes through changes in body composition. The article presents a narrative review of the literature to identify interventions that improve the functionality of community-dwelling postmenopausal women. The authors used the Evidence Analysis Approach developed by the American Dietetic Association to appraise current research. Strong evidence does exist that interventions that incorporate both physical activity and nutrition can improve physical function of older women. However, research focusing on functional status and quality of life, in addition to nutrition and exercise, is extremely limited.

Pilot study: Patients' Perception of the Role of Nutrition in Hip Fracture Recovery.

Abstract Older adults who participate in the Older Americans Act Title III-C Elderly Nutrition Program often are at moderate to high nutritional risk. Although nutrition education is a component of the Elderly Nutrition Program, there are numerous barriers to promoting behavior change in older adults. Nutrition education programs targeted to congregate nutrition site participants must address their unique nutritional needs, while engaging them in activities that promote learning and motivate them to make positive behavior changes. This paper describes a pilot study of a theory-driven, five-lesson educational module designed to promote healthful eating behaviors among congregate nutrition site participants through interactive learning.

Facing a paradigm shift in professionalcredentialing preparedness of registered dietitians for professional development

Food and good nutrition are key factors in helping older adults remain healthy and independent in the community by reducing chronic disease risk and disability, promoting health and supporting increased mental and physical functioning. The current long term care system is shifting from a nursing facility focus to one that provides an array of services in home and community-based settings. A new long term care system is emerging led in part by two Federal agencies, the Centers for Medicare and Medicaid and the Administration on Aging. A philosophical and operational shift needs to be made from a provider/service driven model to one where consumers, families and caregivers are empowered to make their own long term care decisions.

A Pilot Project to Measure Hunger and Malnutrition Risk in an Urban Minority Elder Population

Abstract Poor nutrition may contribute to the incidence and complications of hip fractures. An interview survey was used to assess the nutrition knowledge and attitudes of 40 female and 10 male elderly subjects hospitalized with hip fractures at a local community hospital. Subjects were recruited from a sample of convenience able to respond appropriately. Ninety-two percent of the subjects were unaware of the potential role nutrition plays in recovery. Once counseled on the possible benefits, 80% of the participants were willing to implement some degree of nutrition therapy. While inferential statistics yielded no statistically significant correlations, the practical applications are of importance.