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Yisak H, Zemene MA, Arage G, Demelash AT, Anley DT, Ewunetei A, Azanaw MM. Undernutrition and associated factors among older adults in Ethiopia: systematic review and meta-analysis. BMJ Open 2023; 13:e062845. [PMID: 36693689 PMCID: PMC9884872 DOI: 10.1136/bmjopen-2022-062845] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Undernutrition contributes to decreased physical and cognitive functional status, higher healthcare consumption, premature institutionalisation and increased mortality. So, the objective of this study was to determine the pooled prevalence and factors associated with undernutrition among older adults in Ethiopia. DESIGN Systematic review and meta-analysis was used. Articles that presented original data on undernutrition using body mass index (BMI) were included. We made an inclusive literature search from PubMed, Medline and Google Scholar. The I2 test was used to examine the heterogeneity of the studies considered in this meta-analysis. Stata software V.14 and METANDI command were used. SETTING Studies conducted in Ethiopia were included. PARTICIPANTS Eight independent studies were eligible and enrolled for final analysis. OUTCOME Prevalence and determinants of undernutrition. A selection of publications, data extraction and reported results for the review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of eight unique studies were enrolled for final analysis. The pooled prevalence of undernutrition was 20.53% (95% CI 17.39% to 23.67%). The study revealed that males had lesser odds of being undernutrition with AOR 0.17 (95% CI 0.15 to 0.20). Older adults in the age range of 65-74 years were less likely to be undernourished as compared with those whose age was above 85 years with Adjusted Odds Ratio (AOR) 022 (95% CI 0.22 to 0.25). Older adults who were depressed had higher odds of undernutrition as compared with their counterparts with AOR 1.27 (95% CI 1.19 to 1.37). However, older adults from households with poor wealth indexes were two times more likely to be undernourished as compared with those who were from rich households. CONCLUSION The burden of undernutrition in Ethiopia is significant. The limitation of the current study was that all included studies were observational, mainly cross-sectional.
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Affiliation(s)
- Hiwot Yisak
- Department of Public Health, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Child Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Nutrition and Dietetics, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Agmasie Tigabu Demelash
- Department of Adult Health Nursing,College of Heath sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amien Ewunetei
- Department of pharmacy,College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Yisak H, Maru I, Abie M, Arage G, Ewunetei A, Azanaw MM, Teshome F. Determinants of undernutrition among older adults in South Gondar Zone, Ethiopia: a community-based study. BMJ Open 2022; 12:e056966. [PMID: 35017256 PMCID: PMC8753413 DOI: 10.1136/bmjopen-2021-056966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were to assess the prevalence and determinants of undernutrition among older adults aged 65 years in the south Gondar Zone, Ethiopia, in 2020. DESIGN A community-based cross-sectional study. SETTING The study was conducted from 1 October to 15 December 2020, in the South Gondar Zone, Ethiopia. Study participants were selected by systematic random sampling. A pretested and structured questionnaire adapted from different literature was used to collect data. Anthropometric measurements were taken following the standard procedure. PARTICIPANTS A total of 290 older adults aged greater than or equal to 65 years of age were included in the study. DATA ANALYSIS Descriptive and summary statistics were employed. Multiple logistic regression was fitted to identify determinants of undernutrition. ORs and their 95% CIs were computed to determine the level of significance. OUTCOME MEASURES Undernutrition was assessed by using Body Mass Index and Mini Nutritional Assessment (MNA) tool. RESULTS The prevalence of undernutrition was 27.6% (95% CI 22.4 to 32.8), and 2.1% (95% CI 0.7 to 3.8) of the study participants were overweight. Based on the MNA tool, 29.7% (95% CI 24.5 to 35.2) of the study participants were undernourished and 61.7% (95% CI 55.5 to 67.2) were at risk of undernourishment. Rural residence adjusted OR (aOR)=10.3 (95% CI 3.6 to 29.4), inability to read and write aOR=3.5 (95% CI 1.6 to 7.6), decrease in food intake aOR=13.5 (95% CI 6.1 to 29.5) and household monthly income of less than US$35.6 aOR=4.3 (95% CI 1.9 to 9.4) were significantly and independently associated with undernutrition. CONCLUSION The level of undernutrition among older adults in the study area was high, making it an important public health burden. The determinants of undernutrition were a place of residence, educational status, food intake and monthly income.
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Affiliation(s)
- Hiwot Yisak
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ismael Maru
- Department of Medicine, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Abie
- Department of Medicine, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amien Ewunetei
- Department of Pharmacology, College of Health Sciences,Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of rural Uttarakhand, India. Public Health Nutr 2018. [PMID: 29540252 DOI: 10.1017/s1368980018000447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the prevalence and risk factors of underweight, overweight and obesity among a geriatric population living in a high-altitude region of India. DESIGN Community-based cross-sectional study. Data were collected on sociodemographic profile and anthropometric parameters. Weight and height measurements were utilized for calculation of BMI. Nutrient intake data were collected using 24 h dietary recall. SETTING High-altitude region of Nainital District, Uttarakhand State, North India. SUBJECTS Community-dwelling geriatric subjects (n 981) aged 60 years or above. RESULTS We found that 26·6 % of the elderly subjects were underweight (BMI<18·5 kg/m2). Overweight (BMI 25·0-29·9 kg/m2) and obesity (BMI≥30·0 kg/m2) was seen among 18·0 % and 4·6 %, respectively. After controlling for potential cofounders, risk factors such as low level of education and income, chewing problems and lower number of daily meals were found to be associated with underweight. On the other hand, risk factors for overweight/obesity were lower age, high income and unskilled work. CONCLUSIONS There is a need to develop and implement intervention strategies to prevent underweight, overweight and obesity among the geriatric population of India.
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Boulos C, Salameh P, Barberger-Gateau P. Factors associated with poor nutritional status among community dwelling Lebanese elderly subjects living in rural areas: results of the AMEL study. J Nutr Health Aging 2014; 18:487-94. [PMID: 24886735 DOI: 10.1007/s12603-014-0463-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study aimed to assess the nutritional status, measured by MNA, and its association with socio-demographic indicators and health related characteristics of a representative sample of community dwelling elderly subjects. DESIGN Cross-sectional study. SETTING Community dwelling elderly individuals living in rural communities in Lebanon. PARTICIPANTS 1200 elderly individuals aged 65 years or more. MEASUREMENTS Socio-demographic indicators and health related characteristics were recorded during a standardized interview. Nutritional status was assessed through Mini Nutritional Assessment (MNA). The 5-item GDS score and the WHO-5-A score were used to assess mood, whereas Mini Mental Status (MMS) was applied to evaluate cognitive status. RESULTS The prevalence of malnutrition and risk of malnutrition was 8.0% respective 29.1% of the study sample. Malnutrition was significantly more frequent in elderly subjects aged more than 85 years, in females, widowed and illiterate people. Moreover, participants who reported lower financial status were more often malnourished or at risk of malnutrition. Regarding health status, poor nutritional status was more common among those reporting more than three chronic diseases, taking more than three drugs daily, suffering from chronic pain and those who had worse oral health status. Also, depressive disorders and cognitive dysfunction were significantly related to malnutrition. After multivariate analysis following variables remained independently associated to malnutrition: living in the governorate of Nabatieh (ORa 2.30, 95% CI 1.35 -3.93), reporting higher income (ORa 0.77, 95% CI 0.61-0.97), higher number of comorbidities (ORa 1.22, 95% CI 1.12-1.32), chronic pain (ORa 1.72, 95% CI 1.24-2.39), and depressive disorders (ORa 1.66, 95% CI 1.47-1.88). On the other hand, better cognitive functioning was strongly associated with decreased nutritional risk (ORa 0.27, 95%CI 0.17-0.43). CONCLUSION Our results highlighted the close relationship between health status and malnutrition. The identification of potential predictive factors may allow better prevention and management of malnutrition in elderly people.
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Affiliation(s)
- C Boulos
- Christa Boulos, Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon,
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Boulos C, Salameh P, Barberger-Gateau P. The AMEL study, a cross sectional population-based survey on aging and malnutrition in 1200 elderly Lebanese living in rural settings: protocol and sample characteristics. BMC Public Health 2013; 13:573. [PMID: 23758758 PMCID: PMC3701550 DOI: 10.1186/1471-2458-13-573] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 06/05/2013] [Indexed: 11/26/2022] Open
Abstract
Background Lebanon is faced with a particular challenge because of large socioeconomic inequality and accelerated demographic transition. Rural residents seem more vulnerable because of limited access to transport, health and social services. No information is available regarding health, nutrition and living conditions of this specific population. The purpose of the AMEL (Aging and Malnutrition in Elderly Lebanese) study is to assess the nutritional status of community dwelling elderly people, aged 65 years and above, living in a rural settings in Lebanon, in line of socioeconomic factors, health and living conditions. The present paper will describe the gender specific characteristics of the study population. Methods AMEL is a cross-sectional population based study conducted between April 2011 and April 2012 including 1200 elderly individuals living in the 24 rural Caza (districts) of Lebanon. People aged greater than or equal to 65 y were randomly selected through multistage cluster sampling. Subjects were interviewed at their homes by trained interviewers. The questionnaire included the following measures: socio-demographic factors, nutritional status (Mini Nutritional Assessment, MNA), health related characteristics, functional ability, cognitive status, mood and social network. Results The sample included 591 men (49.3%) and 609 women (50.8%). Mean age was 75.32 years and similar between genders. Malnutrition (MNA < 17) and risk of malnutrition (MNA between 17 and 23.5) were present in 8.0% (95%CI 4.9%-11.1%) and 29.1% (95%CI 24.0%-34.2%) respectively of the participants, and more frequent in women (9.1% and 35.3% respectively). Regarding socio-demographic status, among women the level of illiteracy and poor income was significantly higher than in men. Moreover, chronic diseases, poor self perceived health, frailty, functional disability, depressive symptoms and cognitive impairment were particularly high and significantly more frequent in women than in men. Conclusion The present study provides unique information about nutritional status, health and living conditions of community dwelling rural residents of Lebanon. These findings may alert policy makers to plan appropriate intervention in order to improve the quality of life and increase successful aging.
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Affiliation(s)
- Christa Boulos
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon.
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Alam I, Larbi A, Pawelec G, Paracha PI. Relationship between anthropometric variables and nutrient intake in apparently healthy male elderly individuals: a study from Pakistan. Nutr J 2011; 10:111. [PMID: 21992515 PMCID: PMC3207878 DOI: 10.1186/1475-2891-10-111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 10/12/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The elderly population is increasing worldwide, which warrants their nutritional status assessment more important. The present study was undertaken to establish the nutritional status of the least-studied elderly population in Pakistan. METHODS This was a cross-sectional study with a sample of 526 generally healthy free-living elderly men (mean age: 68.9 yr; range: 50-98 yr) from Peshawar, Pakistan. Anthropometric measurements (weight, height, WC) were measured and BMI and WHR were calculated from these measurements following WHO standard procedures. Dietary intake was assessed by 24-hr dietary recall. Nutrients were calculated from the information on food intake. Nutrients in terms of % of RNI were calculated using WHO data on recommended intakes. RESULTS Based on BMI, the numbers of obese, overweight and underweight elderly were 13.1, 3.1 and 10.8%, respectively. Age was negatively and significantly correlated with BMI (p = 0.0028). Energy (p = 0.0564) and protein intake (p = 0.0776) tended to decrease with age. There was a significant increase in % BF with age (p = <0.0001). The normal weight elderly had significantly (p < 0.05) higher intake of all nutrients studied, except energy which was significantly (p < 0.05) higher in obese and overweight elderly. Overall, however, the majority of subjects had lower than adequate nutrient intake (67.3 - 100% of recommendation). CONCLUSIONS Malnutrition is common in apparently healthy elderly Pakistani men. Very few elderly have adequate nutrient intake. Obese and overweight had higher % BF as compared to normal weight elderly. Older age is associated with changes not only in anthropometrics and body composition but also in intake of key nutrients like energy and protein.
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Affiliation(s)
- Iftikhar Alam
- Tübingen Aging and Tumour Immunology group, Sektion für Transplantationsimmunologie und Immunohämatologie, University of Tübingen, Zentrum für MedizinischeForschung, Waldhörnlestraße 22, 72072 Tübingen, Germany
- Abdul Wali Khan University Mardan, Department of Agriculture, Khyber Pakhtunkhwa (Previously: NWFP), Pakistan
| | - Anis Larbi
- Singapore Immunology Network (SIgN), 8A Biomedical Grove, IMMUNOS Bd.03, Biopolis, A*STAR, 138648, Singapore
| | - Graham Pawelec
- Tübingen Aging and Tumour Immunology group, Sektion für Transplantationsimmunologie und Immunohämatologie, University of Tübingen, Zentrum für MedizinischeForschung, Waldhörnlestraße 22, 72072 Tübingen, Germany
| | - Parvez I Paracha
- Department of Human Nutrition, Faculty of Nutrition Sciences, NWFP Agricultural University, Peshawar, Khyber Pakhtunkhwa (Previously: NWFP), 25000, Pakistan
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Da Silva Coqueiro R, Rodrigues Barbosa A, Ferreti Borgatto A. Nutritional status, health conditions and socio-demographic factors in the elderly of Havana, Cuba: data from SABE survey. J Nutr Health Aging 2010; 14:803-8. [PMID: 21125196 DOI: 10.1007/s12603-010-0126-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the association of nutritional status with sex, age, race/color, education, smoking, physical activity, hypertension, diabetes, and hospitalization in older adults residing in the city of Havana, Cuba. METHODS This was a cross-sectional, population-based household survey. A total of 1,905 persons (1,197 women and 708 men; ≥ 60 years) were examined between 1999 and 2000, selected by probabilistic sampling. Nutritional status was assessed by body mass index (BMI): BMI < 22.0 kg/m2 = underweight; BMI > 27.0 kg/m2 = overweight. Multinomial logistic regression analysis (crude and adjusted) was used. RESULTS The estimation of the prevalence of underweight was 33.0% and that of overweight was 29.6%. The adjusted regression model showed that the probability of underweight was higher in older age groups (OR = 1.63, 70-79 years; OR = 2.05, ≥ 80 years) and among smokers (OR = 1.83). There was negative association between underweight, and hypertension and diabetes. Hypertension (OR = 1.99) was positively associated with overweight. The lower likelihood of overweight was observed among men, smokers, and those aged 80 years and more. CONCLUSION The elderly population of Havana presents a vulnerable nutritional status in view of the prevalence of underweight and overweight. Increasing age, smoking, gender, and hypertension are the factors positively associated with vulnerable nutritional status.
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Affiliation(s)
- R Da Silva Coqueiro
- Departamento de Saúde, Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brazil
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Ferdous T, Cederholm T, Razzaque A, Wahlin A, Nahar Kabir Z. Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh. Scand J Public Health 2009; 37:518-24. [PMID: 19251879 DOI: 10.1177/1403494809102778] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To investigate the impact of nutritional status on self-reported as well as performance-based indicators of physical function in a rural elderly population in Bangladesh. METHODS A cross-sectional study conducted in Matlab, Bangladesh, included 457 randomly selected community-living elderly persons aged 60 years or more (60-92 years; 69 +/- 7 years). Mobility, activities of daily living (ADL), performance tests, handgrip strength, the Mini Nutritional Assessment (MNA) and a structured questionnaire were used to assess physical function, nutritional status, socioeconomic status and health status, respectively. Descriptive and linear hierarchical regression analyses were applied. RESULTS Seven per cent of the participants reported limitations in mobility, and 8% reported limitations in ADL. However, more than half of the participants had difficulties in performing one or more items in the performance tests. According to the MNA, 26% of the participants were undernourished and 62% were at risk of malnutrition. More undernourished participants than well-nourished participants reported limited mobility, impaired ADL and difficulties in the performance tests. A corresponding reduction in grip strength was observed in the undernourished group. Accordingly, higher MNA scores, indicating better nutritional status, were significantly associated with higher mobility index, higher ADL index, higher performance tests index, and higher scores in handgrip strength. These associations remained after adjusting for demographic, socioeconomic and health status differences. CONCLUSIONS Good nutritional status is important for the physical function of elderly people, even after controlling for possible confounders. Performance tests indicated a higher degree of functional impairment than that observed by self-reported estimation.
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Affiliation(s)
- Tamanna Ferdous
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Fortunato L, Drusini AG. Socio-demographic, behavioral and functional characteristics of groups of community and institutionalized elderly Quechua Indians of Peru, and their association with nutritional status. J Cross Cult Gerontol 2006; 20:141-57. [PMID: 16917749 DOI: 10.1007/s10823-005-9088-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Socio-demographic, behavioral, functional and anthropometric data for groups of elderly Quechua Indians of Peru were used to investigate the effects of gender and lifestyle patterns on nutritional status. Two community-dwelling samples were selected for study, representative of divergent lifestyles in terms of their combination of socio-economic, demographic and cultural contexts, plus an ad-hoc sample of institutionalized individuals with controlled food intake and reduced physical activity. Results suggest that differences in socio-demographic, behavioral and functional characteristics exist between the sexes and across settings (low- vs. highland) and lifestyles (institutionalized vs. community-dwelling; semi-urban vs. rural). These factors are likely to be related to diverging dietary and physical activity patterns, and have considerable effects on the nutritional status of the respondents.
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Affiliation(s)
- Laura Fortunato
- Department of Biology, Physical Anthropology Unit, University of Padova, Padova, Italy.
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Nilsson J, Grafström M, Zaman S, Kabir ZN. Role and function: Aspects of quality of life of older people in rural Bangladesh. J Aging Stud 2005. [DOI: 10.1016/j.jaging.2004.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Demark-Wahnefried W, Morey MC, Clipp EC, Pieper CF, Snyder DC, Sloane R, Cohen HJ. Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors. CONTROLLED CLINICAL TRIALS 2003; 24:206-23. [PMID: 12689742 DOI: 10.1016/s0197-2456(02)00266-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The U.S. population is aging, bringing with it an increased prevalence of chronic disease and concomitant declines in physical function. The risk of developing cancer increases significantly with age, and functional decline is much more likely once a cancer diagnosis is rendered. Thus, functional status in later life is a key concern, one that is heightened among elders who have been diagnosed with cancer. To date, however, there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients, and to our knowledge, none has focused on preserving or enhancing physical functioning. This paper describes the study design and methodological considerations of a randomized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer. This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline, but also as a "teachable moment" - an opportune time when elders may be more receptive to making beneficial lifestyle changes. Undoubtedly, as cure rates for cancer increase and intersect with ever-growing numbers of elderly, there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome. In reporting our methods, we hope to give others "a leg up," so that they can hurdle with greater ease the barriers we experienced, and thus advance the field more rapidly.
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