Nancy S. Wellman

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.

Eat Better & Move More: A Community-Based Program Designed to Improve Diets and Increase Physical Activity Among Older Americans

OBJECTIVES We assessed outcomes of an integrated nutrition and exercise program designed for Older Americans Act Nutrition Program participants as part of the Administration on Agings You Can! campaign. METHODS A 10-site intervention study was conducted. Preintervention and postintervention assessments focused on nutrition and physical activity stages of change, self-reported health status, dietary intakes, physical activity, and program satisfaction. RESULTS Of 999 enrollees, the 620 who completed the program were aged 74.6 years on average; 82% were women, and 41% were members of racial/ethnic minority groups. Factors associated with program completion were site, health conditions, and nutrition risk. Seventy-three percent and 75% of participants, respectively, made a significant advance of 1 or more nutrition and physical activity stages of change; 24% reported improved health status. Daily intake of fruit increased 1 or more servings among 31% of participants; vegetables, 37%; and fiber, 33%. Daily steps increased 35%; blocks walked, 45%; and stairs climbed, 24%. Program satisfaction was 99%. CONCLUSIONS This easy-to-implement program improves diets and activity levels. Local providers should offer more such programs with the goal of enabling older Americans to take simple steps toward successful aging.

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

Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes.

2,000 to

Holocaust Survivors Report Long-Term Effects on Attitudes toward Food

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.

Multivitamin-Mineral Supplements in the Older Americans Act Nutrition Program: Not a One-Size-Fits-All Quick Fix

BACKGROUND Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes. METHODS In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months). RESULTS Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05). CONCLUSION The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.

Aging at home: more research on nutrition and independence, please.

OBJECTIVE To gather information from survivors on the effects that the Holocaust had on their current attitudes toward food. DESIGN Qualitative study: one-on-one semistructured interviews with a script shaped by a pilot study. SETTING South Florida homes and community sites, including the Miami Beach Holocaust Memorial. PARTICIPANTS Convenience sample of 25 Holocaust survivors: 14 men, 11 women; ages 71 to 85 years. PHENOMENON OF INTEREST Current attitudes toward food in relation to Holocaust experiences. ANALYSIS Themes and illustrative quotations from transcriptions of audiotaped interviews. RESULTS Food attitudes were influenced by Holocaust experiences. Five themes emerged: (1) difficulty throwing food away, even when spoiled; (2) storing excess food; (3) craving certain food(s); (4) difficulty standing in line for food; and (5) experiencing anxiety when food is not readily available. Empathy for those currently suffering from hunger was also reported. CONCLUSIONS AND IMPLICATIONS Food-related issues from the Holocaust remain for survivors. Now in their 70s and 80s, many use health care and related services. Nutritionists, educators, and health professionals should be aware of such issues. Food and nutrition programs should minimize uncomfortable food-related situations for Holocaust survivors and others who experienced food deprivation.

Beyond nutrition screening: A systems approach to nutrition intervention ☆: Challenges and opportunities for dietetics professionals

We challenge the suggestion of Congress that the Older Americans Act (OAA) Nutrition Program should provide multivitamin-mineral supplements (MVMs) in addition to meals. MVMs are not a quick fix for poor diets. They do not contain calories, protein, essential fatty acids, or fiber, nor do they adequately address nutritional gaps of some vitamins and minerals. Older adults with chronic health conditions who take multiple medications are at greater risk than the general healthy population for nutrient-drug interactions and toxicity. The OAA Nutrition Program is not an appropriate venue to indiscriminately distribute MVMs, because there is insufficient evidence of their benefits and safety. The programs limited funds and efforts should instead be directed to nutrient-dense healthy meals, quality food service, and greater accessibility to individualized nutrition services.

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

As highly as Americans prize independence, older Americans fear dependence even more. Yet nutrition’s effect on independence in later years is often overlooked as a research focus and is underappreciated by older adults themselves and by those working with them. Nutrition scientists can and should play a greater role in prolonging independence by focusing more attention on the health promotion and prevention aspects of nutrition (1). To rectify this research and service oversight and given the federal cost-containment policy to rebalance long-term care away from nursing homes to the ballooning area of homeand community-based services, the American Society for Nutrition with the American Dietetic Association and the Society for Nutrition Education recently issued a position statement that stated the following (2):

Content Analysis: Review of Methods and Their Applications in Nutrition Education

Abstract Malnutrition in older Americans involves many disparate and complex causes. Dietetics professionals need to broaden their scope of practice in dealing with nutrition screening and intervention themselves and in providing expert consultation to others. Health and social services generalists such as physicians, nurses, and social workers must become more aware of the presence and risk of nutrition-related problems in the elderly and must adopt a systematic, collaborative approach to their solution. Nutrition screening, intervention, appropriate referral, and consultation must be built into daily practice. The NSI is a challenge and a call to action for all dietetics professionals. Registered dietitians must become active participants on interdisciplinary teams. They must assume a leadership role in areas of nutrition screening, assessment, and intervention. Their knowledge, skills, and expertise must continue to keep pace not only with advances in the science and technology of nutrition but also with relevant areas of related fields. The tools provided by the NSI and partnerships between nutrition and other health and social services professionals provide opportunity for the widespread incorporation of a systematic approach to delivery of nutrition services. Attention to nutritional health is too important to be left solely to health specialists or to generalists; all must become active participants in maximizing the nutritional health of older Americans.