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Hetherington MM, Thomas JM, McLeod CJ. "I see it very much as an end-of-life food" - Barriers to oral nutritional supplement adherence, views from healthy older adults. Appetite 2024; 197:107327. [PMID: 38555018 DOI: 10.1016/j.appet.2024.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Malnutrition affects approximately one quarter of UK adults aged 65 years and over. As the global demographic shift continues, malnutrition is expected to increase. Oral nutritional supplements (ONS) are used both to prevent and to treat malnutrition. However, their effectiveness is compromised by poor adherence, and it is not well understood what contributes to this. Therefore, the current research was designed to explore ONS adherence from the parallel perspectives of ONS as a prescribed "medication" and as a food supplement/substitute. Eighteen older adults (13F, 5M; mean age = 73.4 yr; range: 70-80 yr) participated in focus groups (three in-person and one online), to investigate experiences of taking prescribed medications, including dietary supplements, and what should be factors to consider in supporting regular intake of ONS for trial development, as well as any potential improvements to products. Focus group sessions were recorded and then transcribed. Thematic Analysis was applied to the transcripts by the first author, and themes were discussed in depth, using exemplar quotes from participants. Five dominant themes were identified from the data: Disgust, Palatability and Acceptance; End-of-Life Care; Resistance to Medicines; Rituals and Reminders; and Real Food Displacement. Nutritional supplements were characterised as "disgusting", "manufactured", and associated with serious, chronic illness, as well as end-of-life care, in contrast to probiotics which were linked with health and wellness. The sweet taste of ONS was identified as a barrier to intake, given that it is generally associated with a signal to stop eating, and low hunger. As a group, participants tried to "avoid taking medicines", and viewed the need to have them negatively, yet most regularly took prescribed medication and/or vitamin supplements. Participants identified several, rituals and reminders to take medicines, including meal-based, or time-of-day-based prompts (e.g., before, with or after meals). To improve adherence, savoury products were suggested, as well as a more person-centred approach to individual nutritional needs and preferences. Overall, the group discussion mainly identified barriers to intake, but that improving taste, adding to "real food" (not replacing meals), and offering variety of flavour and form (e.g., savoury soups as well as sweet drinks) could be included in future trials to improve appeal and therefore intake. Future work should continue to explore how best to formulate, market and/or prescribe ONS, and how this might vary for malnutrition prevention vs treatment strategies.
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Affiliation(s)
| | - Jason M Thomas
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Chris J McLeod
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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2
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Roberts S, Collins P, Rattray M. Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review. Nutrients 2021; 13:nu13072316. [PMID: 34371823 PMCID: PMC8308465 DOI: 10.3390/nu13072316] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4219, Australia
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Peter Collins
- Dietetics and Food Services, Mater Health, Brisbane 4101, Australia;
- Mater Research Institute, University of Queensland, Brisbane 4101, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
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3
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Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries. Nutrients 2021; 13:nu13062064. [PMID: 34208726 PMCID: PMC8234175 DOI: 10.3390/nu13062064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants’ health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70–97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.
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Kunvik S, Rautakallio-Järvinen P, Laaksonen M, Valve R, Salonoja M, Fogelholm L, Suominen MH. Effects of Home-Delivered Meals on Older People's Protein Intake, Physical Performance, and Health-Related Quality of Life: The Power Meals Randomized Controlled Trial. J Nutr Gerontol Geriatr 2021; 40:125-149. [PMID: 33684023 DOI: 10.1080/21551197.2021.1892562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This trial examined the effectiveness of an 8-week home meal service on protein and other nutrient intake, physical performance (PP) and health related quality of life (HRQoL) among older people living at home (≥65 years; home care clients, caregivers and care recipients). Participants were randomized into three groups; (1) protein-rich meal, snack, and bread (INT1), (2) regular meal (INT2) and (3) control group. Nutrient intake was assessed with 3-day food diaries, PP with Short Physical Performance Battery (SBBP) and HRQoL with 15 dimensional Health-related quality of life instrument. Total of 67 (59.7% women, mean age 78.2 years) participants (n = 22 INT1, n = 24 INT2, n = 21 CG) completed the trial. At baseline, mean protein intake was 0.92 (SD 0.32) g/kg adjusted body weight (aBW)/d. At 8 weeks, protein-rich home meal service in INT1 increased protein intake (+ 0.11 (95%CI -0.01 to 0.21) g/kg aBW/d, 9.4 (95%CI 1.0 to 17.8) g/d) compared to other groups. It also increased calcium intake (+169.9 (95%CI 26 to 314) mg/d) and improved results in Sit-to-Stand Test (-4.8 (95%CI -6.8 to -2.7) sec) in INT1 compared to CG. Both home meal services increased saturated fat intake (INT1; 4.6 (95%CI 1.0-8.2) g/d, INT2;7.8 (95%CI 1.9 to 13.7)g/d) and decreased salt intake (INT1;-2330.9 (95%CI -2998 to -1664) mg/d, INT2; -2371.9 (95%CI -3399 to -1345) mg/d) compared to CG. There was no effect on overall HRQoL.
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Affiliation(s)
- Susanna Kunvik
- Pori Social and Health Services, Pori, Finland.,Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | | | | | - Raisa Valve
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | | | | | - Merja H Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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5
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Hutchings A, Charlton K, do Rosario VA, Walton K. Nutritional screening and intervention of older adults living in the community referred by the My Aged Care online portal. Australas J Ageing 2021; 40:e215-e222. [PMID: 33683796 DOI: 10.1111/ajag.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess whether nutritional screening and intervention improve the nutritional status of older adults living in the community. METHODS The Kiama MOW service performed nutrition screening, after being trained by the research team and maintained the dataset. De-identified data was provided to the research team for analysis. Meals on Wheels staff also kept detailed notes during the nutrition screening process and in discussions with clients. These notes were provided to the research team along with the de-identified quantitative data, a summary of the measures taken following screening, including interventions that were recommended to clients by MOW staff. Staff were not formally interviewed about their experiences in conducting nutrition screening but their open-ended text comments were retrospectively summarised, as well as anecdotal comments made to the research team who were involved in training and supporting the MOW team during the intervention period. RESULTS Forty-one individuals (25 women, mean age = 79.8 ± 8.9 years) were referred (21 well-nourished, 16 at risk of malnutrition and 4 malnourished). After reassessment (n = 19), nutritional status had significantly improved (P = .008 for all referrals and P < .001 for those at risk of malnutrition or malnourished). The main interventions provided were as follows: nutrition education (100%), home-delivered meals (78%) and social outings including meals (17%). CONCLUSIONS The My Aged Care portal may be a feasible source of referral of this population to perform routine nutrition screening for appropriate intervention.
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Affiliation(s)
- Allison Hutchings
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Charlton
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Vinicius Andre do Rosario
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen Walton
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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6
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Fleury S, Tronchon P, Rota J, Meunier C, Mardiros O, Van Wymelbeke-Delannoy V, Sulmont-Rossé C. The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review. Front Nutr 2021; 8:629580. [PMID: 33763442 PMCID: PMC7982843 DOI: 10.3389/fnut.2021.629580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.
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Affiliation(s)
- Ségolène Fleury
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France.,Saveurs et Vie, Orly, France
| | | | - Juliane Rota
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France
| | - Charlotte Meunier
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France
| | - Oliver Mardiros
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France
| | - Virginie Van Wymelbeke-Delannoy
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France.,Centre Hospitalier Universitaire Dijon Bourgogne, Unité de Recherche Pôle Personnes Âgées, Dijon, France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Université de Bourgogne Franche-Comté, Dijon, France
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7
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Coenen A, Clancy A, Charlton KE, McMahon AT, Ringland E, Williams P, Tapsell LC, Walton K. The views, experiences and expectations of Australian Meals on Wheels customers: A national survey. Australas J Ageing 2021; 40:e273-e278. [PMID: 33656240 DOI: 10.1111/ajag.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/08/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services. METHODS A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned 337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data. RESULTS Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P = .001). Delivery of pantry items was the most popular additional option for future services. CONCLUSION Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.
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Affiliation(s)
- Alison Coenen
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Annabel Clancy
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Karen E Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Anne-Therese McMahon
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emma Ringland
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peter Williams
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda C Tapsell
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Karen Walton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
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8
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Castro PD, Reynolds CM, Kennelly S, Geraghty AA, Finnigan K, McCullagh L, Gibney ER, Perrotta C, Corish CA. An investigation of community-dwelling older adults' opinions about their nutritional needs and risk of malnutrition; a scoping review. Clin Nutr 2020; 40:2936-2945. [PMID: 33422348 DOI: 10.1016/j.clnu.2020.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Understanding how older adults perceive their nutritional needs and malnutrition risk is important to inform strategies to improve prevention and management of the condition. This scoping review aimed to identify, characterize and summarize the findings from studies analysing community-dwelling older adults' opinions and perceptions towards their nutritional needs and malnutrition risk. METHODS An electronic literature search was carried out using three databases, Pubmed, Embase, and CINAHL up to January 2020. Articles were reviewed following PRISMA guidelines. RESULTS A total of 16,190 records were identified and reviewed with 15 studies being included, all of which were conducted in high income countries. Common conceptual categories that were identified included; older community-dwelling adults consider that a healthy diet for them is the same as that recommended for the general population, consisting of fruits, vegetables, reduced fat and reduced sugar. Weight loss was seen as a positive outcome and a normal component of the ageing process. Lack of appetite was identified by participants in the majority of studies as a barrier to food intake. CONCLUSIONS This review shows how older community-dwelling adults, with a high risk of malnutrition, follow dietary public health recommendations for the general population and have a greater awareness of the risks of overweight. The implementation of nutritional guidelines that consider the nutritional needs of all older adults and education of non-dietetic community healthcare professionals on providing appropriate nutritional advice to this population are warranted.
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Affiliation(s)
- Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Ciara Me Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Sharon Kennelly
- National Primary Care Division, Community Funded Schemes Service Improvement, Mountmellick Primary Care Building, Co. Laois, Republic of Ireland
| | - Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Karen Finnigan
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland; School of Agriculture and Food Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland.
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9
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Payne L, Harris P, Ghio D, Slodkowska-Barabasz J, Sutcliffe M, Kelly J, Stroud M, Little P, Yardley L, Morrison L. Beliefs about inevitable decline among home-living older adults at risk of malnutrition: a qualitative study. J Hum Nutr Diet 2020; 33:841-851. [PMID: 32840942 DOI: 10.1111/jhn.12807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately 14% of free-living adults aged ≥65 years are at risk of malnutrition. Malnutrition screen and treat interventions in primary care are few, show mixed results, and the advice given is not always accepted and followed. We need to better understand the experiences and contexts of older adults when aiming to develop interventions that are engaging, optimally persuasive and relevant. METHODS Using the Person-based Approach, we carried out 23 semi-structured interviews with purposively selected adults ≥65 years with chronic health or social conditions associated with malnutrition risk. Thematic analysis informed the development of key principles to guide planned intervention development. RESULTS We found that individuals' beliefs about an inevitable decline in appetite and eating in older age compound the many and varied physical and physiological barriers that they experience. Also, we found that expectations of decline in appetite and physical ability may encourage resignation, reduce self-efficacy to overcome barriers, and reduce motivation to address weight loss and/or recognise it as an issue that needs to be addressed. Fear of loss of independence may also reduce the likelihood of asking general practitioners for advice. CONCLUSIONS The key findings identified include a sense of resignation, multiple different barriers to eating and a need for independence, each underpinned by the expectation of a decline in older adulthood. Interventions need to address misperceptions about the inevitability of decline, highlight how and why diet recommendations are somewhat different from recommendations for the general population, and suggest easy ways to increase food intake that address common barriers.
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Affiliation(s)
- L Payne
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - P Harris
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - D Ghio
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - J Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - M Sutcliffe
- Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - M Stroud
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P Little
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - L Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - L Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
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10
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Harris PS, Payne L, Morrison L, Green SM, Ghio D, Hallett C, Parsons EL, Aveyard P, Roberts HC, Sutcliffe M, Robinson S, Slodkowska-Barabasz J, Little PS, Stroud MA, Yardley L. Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis. BMC FAMILY PRACTICE 2019; 20:100. [PMID: 31307402 PMCID: PMC6631945 DOI: 10.1186/s12875-019-0983-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. METHOD A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. RESULTS Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. CONCLUSION The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. REVIEW REGISTRATIONS PROSPERO: CRD42017071398 . The review protocol was registered retrospectively.
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Affiliation(s)
- Philine S Harris
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Liz Payne
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Sue M Green
- Bournemouth University, Bournemouth House B236, 19 Christchurch Road, Bournemouth, BH1 3LH, UK
| | - Daniela Ghio
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Claire Hallett
- Friarsgate Surgery, Stockbridge Road, Winchester, SO22 6EL, UK
| | - Emma L Parsons
- Wessex Academic Health Science Network and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Level E Centre Block, Mailpoint 807, University Hospital Southampton, Southampton, SO16 6YD, UK
| | - Michelle Sutcliffe
- Community Dietetic Department, Southampton NHS Treatment Centre, Royal South Hampshire Hospital, Brintons Terrace, Southampton, SO14 0YG, UK
| | - Siân Robinson
- AGE Research Group, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Paul S Little
- Primary Care and Population Sciences, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Michael A Stroud
- Gastroenterology and Clinical Nutrition, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Building 44, Highfield Campus, Southampton, SO17 1BJ, UK.,Centre for Academic Primary Care and School of Psychological Science, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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11
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Charlton KE, Tjong M, North J, Walton K. Meals on Wheels: Who's referring and what's on the menu? Australas J Ageing 2019; 38:e50-e57. [DOI: 10.1111/ajag.12618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/11/2018] [Accepted: 12/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Karen E Charlton
- School of MedicineFaculty of Science, Medicine and HealthUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Melissa Tjong
- School of MedicineFaculty of Science, Medicine and HealthUniversity of Wollongong Wollongong New South Wales Australia
| | - Joanne North
- Kiama Meals on Wheels Kiama New South Wales Australia
| | - Karen Walton
- School of MedicineFaculty of Science, Medicine and HealthUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
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12
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Clancy A, Walton K, Charlton K, Mcmahon A, Ringland E, Williams P, Tapsell L. Service providers' and health professionals' views and suggestions for the Australian National Meal Guidelines for the Commonwealth Home Support Program. Nutr Diet 2018; 76:290-295. [DOI: 10.1111/1747-0080.12485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/21/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Annabel Clancy
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Walton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Charlton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | | | - Emma Ringland
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Peter Williams
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Linda Tapsell
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
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13
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Food Services Using Energy- and Protein-Fortified Meals to Assist Vulnerable Community-Residing Older Adults Meet Their Dietary Requirements and Maintain Good Health and Quality of Life: Findings from a Pilot Study. Geriatrics (Basel) 2018; 3:geriatrics3030060. [PMID: 31011097 PMCID: PMC6319248 DOI: 10.3390/geriatrics3030060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
The effects of “standard (STD)” vs. “protein- and energy-enriched (HEHP)” food-service meals on the nutrient intake, nutritional status, functional capacity, and wellbeing of older adults was investigated using a 12 week, double-blinded, parallel group design. All participants received dietetics counseling and either an STD (2.3 MJ and 30 g protein per meal) or a HEHP (4.6 MJ and 60 g protein) hot lunchtime meal for at least 3 days/week; those who did not want food-service meals were included in the control group (CON). Twenty-nine participants completed the study (STD = 7; HEHP = 12; CON = 10). From baseline to week 12, the HEHP subjects increased their mean daily energy intake from 6151 ± 376 kJ to 8228 ± 642 kJ (p = 0.002 for effect of time) and protein intake from 67 ± 4 g to 86 ± 8 g (p = 0.014 for effect of time). The MNA (Mini Nutritional Assessment) score was increased significantly in HEHP by 4.0 ± 1.1 points (p = 0.001), but not in the STD and CON groups (2.8 ± 2.1 points and 1.8 ± 1.1 points, p > 0.05). No difference was found for other clinical outcomes between the groups. The findings indicate that provision of HEHP-fortified food-service meals can increase energy and protein intake and improve the nutritional status of nutritionally at-risk older people.
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14
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Collins J, Huggins CE, Porter J, Palermo C. Factors influencing hospital foodservice staff's capacity to deliver a nutrition intervention. Nutr Diet 2017; 74:129-137. [DOI: 10.1111/1747-0080.12344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/15/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jorja Collins
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
- Dietetics Department; Eastern Health; Melbourne, Victoria Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food; Monash University; Notting Hill, Victoria Australia
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15
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Ziylan C, Kremer S, Eerens J, Haveman-Nies A, de Groot LC. Effect of meal size reduction and protein enrichment on intake and satiety in vital community-dwelling older adults. Appetite 2016; 105:242-8. [DOI: 10.1016/j.appet.2016.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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16
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Hamirudin AH, Walton K, Charlton K, Carrie A, Tapsell L, Milosavljevic M, Pang G, Potter J. Feasibility of home-based dietetic intervention to improve the nutritional status of older adults post-hospital discharge. Nutr Diet 2016; 74:217-223. [PMID: 28731606 DOI: 10.1111/1747-0080.12305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/19/2016] [Accepted: 06/10/2016] [Indexed: 11/30/2022]
Abstract
AIM To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. METHODS The Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment (MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status. RESULTS Mean body weight improved significantly (P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) (P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index (BMI) < 23 kg/m2 ) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight (BMI 23-27 kg/m2 ) (1.4 ± 0.3 g/kg) or overweight (BMI>27 kg/m2 ) (1.1 ± 0.3 g/kg) peers (P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day). CONCLUSIONS Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community.
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Affiliation(s)
- Aliza Haslinda Hamirudin
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Karen Walton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Amanda Carrie
- Illawarra Shoalhaven Local Health District, New South Wales Health, Wollongong, New South Wales, Australia
| | - Linda Tapsell
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Marianna Milosavljevic
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District, New South Wales Health, Wollongong, New South Wales, Australia
| | - Glen Pang
- Agency for Clinical Innovation, New South Wales Health, Sydney, New South Wales, Australia
| | - Jan Potter
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District, New South Wales Health, Wollongong, New South Wales, Australia
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17
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Walton K, Charlton KE, Manning F, McMahon AT, Galea S, Evans K. The nutritional status and energy and protein intakes of MOW clients and the need for further targeted strategies to enhance intakes. Appetite 2015; 95:528-32. [DOI: 10.1016/j.appet.2015.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
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18
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Campbell AD, Godfryd A, Buys DR, Locher JL. Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review. J Nutr Gerontol Geriatr 2015; 34:124-67. [PMID: 26106985 PMCID: PMC4480596 DOI: 10.1080/21551197.2015.1038463] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Anthony D Campbell
- a Department of Sociology , University of Alabama at Birmingham , Birmingham , Alabama , USA
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19
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Zhu H, An R. Impact of home-delivered meal programs on diet and nutrition among older adults: a review. Nutr Health 2014; 22:89-103. [PMID: 24916974 DOI: 10.1177/0260106014537146] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor diet quality and insufficient nutrient intake is of particular concern among older adults. The Older Americans Act of 1965 authorizes home-delivered meal services to homebound individuals aged 60 years and older. OBJECTIVE The purpose of this study was to review scientific evidence on the impact of home-delivered meal services on diet and nutrition among recipients. METHODS Keyword and reference searches were conducted in Cochrane Library, Google Scholar, PubMed and Web of Science. Inclusion criteria included: study design (randomized controlled trials, cohort studies, pre-post studies, or cross-sectional studies); main outcome (food and nutrient intakes); population (home-delivered meal program participants); country (US); language (articles written in English); and article type (peer-reviewed publications or theses). RESULTS Eight studies met the inclusion criteria, including two randomized controlled trial studies (from the same intervention), one cohort study, two pre-post studies, and three cross-sectional studies. All but two studies found home-delivered meal programs to significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life. CONCLUSIONS Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline.
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Affiliation(s)
- Huichen Zhu
- Department of Statistics, University of Illinois at Urbana-Champaign, USA
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, USA
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20
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Affiliation(s)
- J M Bauer
- Geriatrisches Zentrum Oldenburg, Rahel-Straus-Straβe, Oldenburg, Germany.
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