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Driggers A, Kennedy RE, Williams BR, Brown CJ, Buys DR. Changes in Life-Space Mobility With Loss of Relatives and Friends Among Older Adults: Results From the UAB Study of Aging. Gerontologist 2024; 64:gnad116. [PMID: 37638853 PMCID: PMC10943496 DOI: 10.1093/geront/gnad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Increasing age brings a greater risk of death of friends and family (hereafter referred to as loss) potentially impacting individuals' life-space mobility (LSM) trajectory. RESEARCH DESIGN AND METHODS Using the UAB study of aging, we examined differences in LSM trajectories of 1,000 community-dwelling older Alabamians (65 + years) with and without loss over 8.5 years. We measured LSM using UAB's Life-Space Assessment (LSA), a validated instrument assessing movement through zones ranging from their bedroom to out of town. We assessed loss every 6 months using a standard bereavement questionnaire capturing spousal, other relative, or friend loss. We used piecewise linear mixed-effects models to compare LSA trajectories. RESULTS At baseline, those who later experienced loss, compared with those who did not were younger, more likely to be female, and overall in better health. Those without loss had a baseline mean LSA score of 49.5 and a decline of 0.08 points per year (p < .001). Those with loss had a baseline LSA score of 60 and declined by 1.0 point per year before loss (p < .001), accelerating to 1.8 points per year after loss (p < .001). DISCUSSION AND IMPLICATIONS Those with loss do not experience acute decline postloss but do have an acceleration of the preexisting decline. Although additional research may explain the impact of loss on LSM; this finding suggests that more interventions such as social, mental, or health care services, may be needed for those who experience loss. Specifically, bereaved individuals may benefit from it.
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Affiliation(s)
- Amelia Driggers
- Department of Agricultural and Biological Engineering, Mississippi State University, Starkville, Mississippi, USA
| | - Richard E Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beverly Rosa Williams
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David R Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, Mississippi, USA
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2
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Seitz HH, Robertson MN, Steen J, Dulaney SG, Buys DR. Development and Pretesting of Prescription Opioid Misuse Prevention Messages: Results and Implications for Practice. Health Commun 2023; 38:2865-2883. [PMID: 36127799 DOI: 10.1080/10410236.2022.2124059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Well-designed health communication campaigns can contribute to the uptake of preventive behaviors, but there has been a lack of attention on using communication research to develop opioid misuse prevention messages. We report the results of two studies designed to inform the development of prescription opioid misuse prevention messages for adults ages 30-59. In Study 1, 16 adults across 4 counties participated in semi-structured interviews to provide input on message concepts addressing six key prescription opioid misuse prevention behaviors. In Study 2, 1,335 adults completed an online, survey-based between-subjects experiment in which participants were randomized to a no message control condition or a message condition that aligned with a prevention behavior. The survey examined Reasoned Action Approach (RAA) predictors of intention in no message control participants and examined differences in intention to perform prevention behaviors among experimental conditions. The qualitative interviews yielded insights about message preferences and perceived facilitators and barriers related to the prevention behaviors. The online survey demonstrated that attitude and descriptive norms are important determinants of preventive behaviors and potential targets for communication interventions. Message testing results demonstrated that the draft messages were effective in changing intentions to safely store, securely dispose of, and monitor the use of prescription opioids, but they were not effective in increasing intentions to talk to healthcare providers, older adults, or children about proper opioid use. A communication campaign addressing attitudes and perceived descriptive norms may be successful in increasing intentions to engage in opioid misuse prevention behaviors.
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Affiliation(s)
- Holli H Seitz
- Department of Communication, Mississippi State University
- Social Science Research Center, Mississippi State University
| | - Mary Nelson Robertson
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University
| | - Je'Kylynn Steen
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University
| | - Sarah G Dulaney
- Social Science Research Center, Mississippi State University
| | - David R Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University
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3
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Davis EM, Sansing AP, Harris-Speight JR, Robertson MN, Buys DR. Challenges, Opportunities, and Adaptations of a College Preparatory 4-H Youth Development Program during COVID-19. JYD 2022. [DOI: 10.5195/jyd.2022.1065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
SARS-CoV-2 (COVID-19) has proliferated across the United States, and in the process, it has disrupted all sense of normalcy. Because adolescents are in a critical period for growth and development, youth are particularly susceptible to negative impacts of disruption from COVID-19. Therefore, sustaining youth development programs is essential to ensuring positive youth development occurs despite significant challenges. Unfortunately, the implementation of programs that maintain safety precautions can be challenging. Many programs have been forced to either cancel all activities or to transition program elements to a virtual format. Rural Medical and Science Scholars (RMSS) program administrative staff made the decision to transition to a virtual delivery. Despite only having a few weeks to reshape the program, RMSS administrative staff were able to innovatively adapt to new challenges in order to deliver a successful program. The success of the program extends beyond its participants. By understanding potential program barriers and successful adaptation methods, other youth development programs will be better equipped to sustain program activities and youth outreach during the COVID-19 pandemic. Ultimately, this will ensure negative developmental impacts of COVID-19 are lessened in adolescents and positive youth development is cultivated through program support, stability, and structure.
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Robertson MN, Seitz HH, Downey LH, Hardman AM, Steen JS, Buys DR. Increasing Uptake of Prescription Drug Take-Back Boxes: Eliciting Preferences and Applying the Theory of Planned Behavior to Predict Use. Health Educ Behav 2022:10901981221116778. [PMID: 36124431 DOI: 10.1177/10901981221116778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many are unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.
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Affiliation(s)
| | - Holli H Seitz
- Mississippi State University, Mississippi State, MS, USA
| | - Laura H Downey
- Mississippi State University, Mississippi State, MS, USA
| | | | | | - David R Buys
- Mississippi State University, Mississippi State, MS, USA
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5
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Halfacre K, Buys DR, Holmes ME, King E, Roach J. Barriers to Healthy Eating and Physical Activity in the Mississippi Delta. J Healthy Eat Act Living 2022; 2:32-44. [PMID: 37771839 PMCID: PMC10521985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Rural regions in the United States are home to approximately 15-20% of the country's population. These regions are often characterized by low access to medical care and high rates of disease and death. The literature has detailed the heterogeneous nature of rural health disparities, calling for research detailing regional factors that influence individual-level risk factors such as diet and physical activity. Approximately 54% of Mississippi residents live in rural areas. The Mississippi Delta population is largely characterized by high obesity rates, poor diet, and low levels of physical activity. This study presents detailed observations of the community-level barriers and facilitators to healthy eating and physical activity within Mississippi Delta communities, contextualizing the findings of a survey of 352 individuals across 25 communities to provide implications and direction for future activities aimed at reducing obesity in the Mississippi Delta. Study participants reported a high prevalence of overweight (22.9%) and obese (62.1%) body mass index classifications. Chi-square analyses revealed significant relationships between body mass index, age, and health conditions. Community food and physical activity environments and rural characteristics were largely implicated as barriers to fruit and vegetable consumption and physical activity. Next steps involve using qualitative research techniques to guide the development of programmatic strategies for reducing obesity through diet and physical activity in these communities and other rural regions in the United States.
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Affiliation(s)
- Katharine Halfacre
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University,
U.S.A
| | - David R. Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University,
U.S.A
| | - Megan E. Holmes
- Department of Kinesiology, Mississippi State University,
U.S.A
| | - Erin King
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University,
U.S.A
| | - Jacinda Roach
- Mississippi Public Health Institute, Ridgeland,
Mississippi
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Canales E, Fan L, Buys DR, Cantave MD. A Market Basket Assessment: Prices and Availability of Healthy Foods Across SNAP-Authorized Food Outlets in Counties With High Obesity Rates in Mississippi. Prev Chronic Dis 2021; 18:E99. [PMID: 34856116 PMCID: PMC8673945 DOI: 10.5888/pcd18.210173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction The Mississippi Delta is predominantly rural and ranks among the US regions with the highest obesity rates. Throughout the US, rural and low-income communities have limited access to healthy foods. Given the interrelation between the quality of the food environment and the healthfulness of diets and obesity rates, the food environment is an important public health concern in these communities. Methods We conducted a retail assessment in July 2019 in the Delta region of Mississippi and evaluated prices and availability of healthy foods at Supplemental Nutrition Assistance Program–accepting retail establishments using the validated Market Basket Assessment Tool. We used regression analysis to identify differences in prices and availability of healthy foods across food retail formats. Results The healthy foods availability and quality score for convenience stores, which comprise the highest proportion of store formats in the region, was 70% lower than for supermarkets. Compared with the prices at supermarkets, the prices at convenience stores were 48% higher for grains, 35% higher for fruit and vegetables, 73% higher for meats, and 95% higher for beans, seeds, and nuts. The healthfulness of foods available at dollar stores was also lower than the healthfulness at supermarkets, but prices were generally similar. Conclusion The availability of supermarkets and grocery stores was limited in the study area, but the concentration of convenience stores was high. Overall, access and affordability of healthy foods were restricted in the counties studied; these findings are useful for intervention development.
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Affiliation(s)
- Elizabeth Canales
- Department of Agricultural Economics, Mississippi State University, PO Box 5187, Mississippi State, MS 39762.
| | - Linlin Fan
- Department of Agricultural Economics, Sociology and Education, Pennsylvania State University, State College, Pennsylvania
| | - David R Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Starkville, Mississippi
| | - Marven D Cantave
- Mississippi State University Extension, Belzoni, Mississippi.,Now with Feeding America, Lexington, Mississippi
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Abstract
OBJECTIVE The goal of the current study is to evaluate the effectiveness of Mental Health First Aid (MHFA) in broadening the network of gatekeepers in rural communities. METHOD Extension agents in Mississippi who completed MHFA training were recruited via email to participate in a 22-item, web-based, quantitative and qualitative, six-month follow-up survey that measured demographic characteristics, which MHFA skills agents used post-training, barriers to skill use, and confidence in ability to use those skills (n = 80). RESULTS Over 60% of the agents reported using the skills learned from the MHFA training, and nearly 15% of agents reported having an encounter with someone in crisis since completing the MHFA training. Agent participants reported using the skills learned from the training with farmers, 4-H youth, volunteers, and parents, family members, colleagues, and friends. One agent commented that the training, "has been very helpful in speaking with various people and has increased confidence when encountering someone with mental health challenges." CONCLUSION MHFA trainings appear to increase the confidence and competence of Extension agents as community gatekeepers and may greatly enhance the reach of the mental health network of rural areas by increasing identification and referral of those requiring mental health services.
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Affiliation(s)
- Mary Nelson Robertson
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Hilary L DeShong
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
| | - Je'Kylynn S Steen
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - David R Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Robertson MN, Downey LH, Seitz HH, Hardman AM, Buys DR. Rural adults' perceived role of family members in prescription opioid misuse prevention: Implications for family-based approaches. J Rural Health 2021; 38:100-111. [PMID: 33660900 DOI: 10.1111/jrh.12565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explored and documented rural adults' perceptions of family roles in prescription opioid misuse prevention and the predisposing, reinforcing, and enabling factors that influence family members from taking those roles. METHODS Nine focus groups with rural adults (n = 55) were conducted to evoke discussion about family roles in prescription opioid misuse prevention. Transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE-PROCEED program planning model. FINDINGS Findings suggest that rural adults perceive the opioid epidemic as partially a family problem. Additionally, rural adults perceive themselves as having a critical role in preventing prescription opioid misuse among family members. Participants identified specific predisposing, reinforcing, and enabling factors that influence whether or not family members take responsibility in preventing prescription opioid misuse within their families. Rural adults also perceive that family-based education is important in preventing prescription opioid misuse. CONCLUSIONS These results suggest that there is an interest in family-based approaches that enable or foster the skills and resources necessary to engage in prescription opioid misuse prevention behaviors. Specifically, family-based prevention programming should include efforts to shape knowledge and attitudes about prescription opioid misuse, increase resources to facilitate prevention behaviors, and build skills related to prevention.
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Affiliation(s)
- Mary Nelson Robertson
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, Mississippi, USA
| | - Laura H Downey
- School of Human Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | - Holli H Seitz
- Department of Communication, Mississippi State University, Mississippi State, Mississippi, USA
| | - Alisha M Hardman
- School of Human Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | - David R Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State, Mississippi, USA
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9
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Bolstad CJ, Moak R, Brown CJ, Kennedy RE, Buys DR. Neighborhood Disadvantage Is Associated with Depressive Symptoms but Not Depression Diagnosis in Older Adults. Int J Environ Res Public Health 2020; 17:ijerph17165745. [PMID: 32784478 PMCID: PMC7459514 DOI: 10.3390/ijerph17165745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023]
Abstract
Disadvantaged neighborhood environments may have low access to healthcare, perpetuating health disparities. Previous research has reported on associations between neighborhood disadvantage (ND) and depressive symptomology but not depression diagnoses, which may indicate access to healthcare. This study tested how ND relates to depressive symptomology and diagnosis to assess for neighborhood disparities in mental health care cross-sectionally. Data from 998 community-dwelling, Black and White individuals aged 65+ included in the University of Alabama at Birmingham Study of Aging were analyzed. We obtained participants’ depressive symptomology from the Geriatric Depression Scale (n = 100) and a verified depression diagnosis from self-report and review of medication, physician-report, and/or hospital discharge summaries (n = 84). We assessed ND from US Census data, divided the sample into tertiles of ND and fit models with Generalized Estimating Equations covarying for various other variables (e.g., sex, race, physical performance, socioeconomic status, etc.). We found living in the high and mid-ND tertiles to be associated with depressive symptomology, yet ND had no significant relation to depression diagnosis. Therefore, older adults living in high and mid-disadvantaged neighborhoods may be more likely to experience depressive symptomology but not receive a diagnosis, indicating a possible disparity in mental health care.
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Affiliation(s)
- Courtney J. Bolstad
- Department of Psychology, Mississippi State University, Mississippi State, MS 39762, USA
- Correspondence:
| | - Reagan Moak
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS 39762, USA; (R.M.); (D.R.B.)
| | - Cynthia J. Brown
- Division of Gerontology, Geriatrics, and Palliative Care and Integrative Center for Healthy Aging, University of Alabama Birmingham, Birmingham, AL 35294, USA; (C.J.B.); (R.E.K.)
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Birmingham, AL 35233, USA
| | - Richard E. Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care and Integrative Center for Healthy Aging, University of Alabama Birmingham, Birmingham, AL 35294, USA; (C.J.B.); (R.E.K.)
| | - David R. Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS 39762, USA; (R.M.); (D.R.B.)
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Buys DR, Rennekamp R. Cooperative Extension as a Force for Healthy, Rural Communities: Historical Perspectives and Future Directions. Am J Public Health 2020; 110:1300-1303. [PMID: 32673106 DOI: 10.2105/ajph.2020.305767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cooperative Extension (Extension), part of the land-grant university system, has been engaged in rural communities for more than a century. While the focus of Extension's efforts has largely centered on agriculture, there is an important thread of work that has similarities to public health.As Extension settles into its second century, we are working to be even more engaged in efforts that improve the health and well-being of rural communities in particular. Extension faculty and staff are accomplishing this through direct-to-the-population education and through partnerships with more classically oriented public health organizations able to leverage Extension's networks and positive reputation in communities to engage them and improve their health. A component of these partnerships includes Extension faculty and staff increasingly engaging in policy, systems, and environment work and other initiatives that help ensure longer-term, systemic changes more likely to improve health outcomes.In short, Extension clearly changed the agricultural system of the United States, and because of its reach into rural communities, it has the capacity to do for health in rural communities in this second century what it did for agriculture in the first century.
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Affiliation(s)
- David R Buys
- David R. Buys is with Mississippi State University, Starkville. Roger Rennekamp is with Extension Committee on Organization and Policy, Association of Public and Land-Grant Universities, Washington DC
| | - Roger Rennekamp
- David R. Buys is with Mississippi State University, Starkville. Roger Rennekamp is with Extension Committee on Organization and Policy, Association of Public and Land-Grant Universities, Washington DC
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Buys DR, Evans MW, Kennedy RE, Locher J, Buys K, Brown CJ. NUTRITIONAL RISK IS ASSOCIATED WITH LOW BACK PAIN AMONG OLDER ADULTS: RESULTS FROM THE UAB STUDY OF AGING. Innov Aging 2019. [PMCID: PMC6841087 DOI: 10.1093/geroni/igz038.2628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Poor nutritional status is associated with adverse health outcomes across the life course, affecting older adults’ ability to maintain overall well-being, limiting physical strength, and affecting mobility. International research has demonstrated associations between nutritional risk and general musculoskeletal pain; however, no research has explored relationships between nutritional risk and low back pain. Using the University of Alabama-Birmingham Study of Aging, we examined this relationship among 1000 community-dwelling older Alabamians (65+years). We used the DETERMINE Checklist, a well-validated nutritional risk assessment and assessed presence and severity of low back pain over the past 4 weeks. We completed univariate and bivariate analysis and multivariate logistic regression, adjusting for factors significant in the bivariate analyses: sex, body mass index, depression, and co-morbidities. More than half of the participants were at nutritional risk (55.2%). In multivariate analyses, one point increases in nutritional risk were associated with a 14% increase in the likelihood of low back pain 95% CI (1.087,1.213); in categorical analyses, moderate nutritional risk and high nutritional risk were associated with an increase in likelihood of low back pain [46% (95% CI 1.07,2.02) and 164% (95% CI 1.80,3.94), respectively]. While this cross-sectional analysis should be interpreted cautiously, it further emphasizes the importance of nutritional health for older adults. Clinicians treating patients with low back pain or nutritional risk may consider assessing for the other condition. When nutritional risk is detected, clinicians should refer to services such as counseling with a registered dietitian or to a social worker for assistance identifying community-based nutritional supports.
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Affiliation(s)
- David R Buys
- Mississippi State University, Starvkille, Mississippi, United States
| | - Marion W Evans
- Mississippi State University, Starvkille, Mississippi, United States
| | - Richard E Kennedy
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Julie Locher
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Katie Buys
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia J Brown
- University of Alabama at Birmingham, Birmingham, Alabama, United States
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Buys DR, Kennedy RE, Zhang Y, Locher J, Brown CJ. NUTRITIONAL RISK PREDICTS HEALTH SERVICES UTILIZATION AND DEATH OVER 1 YEAR: RESULTS FROM THE UAB STUDY OF AGING II. Innov Aging 2019. [PMCID: PMC6840414 DOI: 10.1093/geroni/igz038.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nutritional risk has been demonstrated to be associated with poor health outcomes, increased risk of health services utilization (HSU), and mortality among older adults. The aim of this study was to assess the prospective relationship between nutritional risk; HSU focusing separately on emergency department visits, hospitalization, and nursing home admission; and mortality. Using the University of Alabama-Birmingham Study of Aging II, we examined this relationship among 419 community-dwelling older Alabamians (75+years). We used the Mini-Nutrition Assessment (MNA), a well-validated nutritional risk assessment, which classifies individuals as either well-nourished, at-risk or malnourished, collected at baseline. We assessed HSU by asking about healthcare encounters since the last monthly follow-up call for 12 months and verified death with family reports and official documents. We completed univariate, bivariate, and Cox proportional hazards regression analyses with one-year of follow-up data, adjusting for social support, social isolation, comorbidities, and demographic variables. Accounting for covariates, being either at-risk or malnourished, relative to well-nourished, was associated with emergency department visits (HR: 1.30, 95% CI:1.14,1.48), hospitalization (HR: 1.58, 95% CI:1.37,1.82), nursing home admission (HR: 8.94, 95% CI:3.99,20.02), and mortality (HR: 1.90, 95% CI:1.25,2.88). These findings underscore the growing awareness that nutritional risk, particularly for older adults, is a significant factor affecting their well-being and particularly their ability to continue living in the community. Nutrition assessment, interventions, and services for community-dwelling older adults may lead to a reduction in health care utilization, particularly nursing home placement, and ultimately to reduced healthcare costs to families and taxpayers.
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Affiliation(s)
- David R Buys
- Mississippi State University, Starkville, Mississippi, United States
| | - Richard E Kennedy
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Yue Zhang
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Julie Locher
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cynthia J Brown
- University of Alabama at Birmingham, Birmingham, Alabama, United States
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13
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Mays LC, Drummonds JW, Powers S, Buys DR, Watts PI. Identifying Geriatric Patients at Risk for Malnutrition: A Quality Improvement Project. J Nutr Gerontol Geriatr 2019; 38:115-129. [PMID: 31017072 DOI: 10.1080/21551197.2019.1604464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Malnourishment leads to poor outcomes in the geriatric surgical population and national guidelines recommend preoperative nutrition screening. However, care practices do not reflect current recommendations. As a quality-improvement project, a validated nutritional screening tool, the Mini Nutritional Assessment-Short Form (MNA-SF), was implemented in the preoperative clinic of a large academic health center to identify patients at-risk for malnutrition prior to elective surgery. Patients were screened during the nursing intake process and categorized as no nutritional risk; at-risk for malnourishment; or severely malnourished. During the four-week screening period, 413 patients met inclusion criteria with 67.8% (n = 280) screened. No nutritional risk was identified in 77.5% (n = 215) of patients, 18.2% (n = 51) were at-risk, and 4.3% (n = 12) were malnourished. This project will inform and guide a prehabilitation plan for nutrition optimization to improve healthcare quality, outcomes, and costs in the geriatric surgical population.
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Affiliation(s)
- Lauren C Mays
- a University of Alabama at Birmingham School of Nursing , Birmingham , AL , USA
| | - Jennifer W Drummonds
- b University of Alabama at Birmingham Medical Center, Division of Perioperative Services , Birmingham , AL , USA
| | - Summer Powers
- a University of Alabama at Birmingham School of Nursing , Birmingham , AL , USA
| | - David R Buys
- c Mississippi State University , Department of Food Science, Nutrition, and Health Promotion , Starkville , MS , USA
| | - Penni I Watts
- a University of Alabama at Birmingham School of Nursing , Birmingham , AL , USA
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14
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Buys KC, Selleck C, Buys DR. Assessing Retention in a Free Diabetes Clinic. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Buys DR, Gamble A, Tomlinson S. Volunteers create backpack meals program to reach students at risk of weekend hunger *. Journal of Hunger & Environmental Nutrition 2018. [DOI: 10.1080/19320248.2017.1364195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David R. Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State, Mississippi, USA
| | - Abigail Gamble
- Department of Preventive Medicine, John D. Bower School of Population Health, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Buys DR, Kennedy RE, Williams CP, Brown CJ, Locher JL. Social and Demographic Predictors of Nutritional Risk: Cross-sectional Analyses From the UAB Study of Aging II. Fam Community Health 2018; 41 Suppl 2 Suppl, Food Insecurity and Obesity:S33-S45. [PMID: 29461314 PMCID: PMC5822745 DOI: 10.1097/fch.0000000000000180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Social factors may disparately affect access to food and nutritional risk among older adults by race and gender. This study assesses these associations using the Mini Nutritional Assessment among 414 community-dwelling persons 75+ years of age in Alabama. Descriptive analyses on the full sample and by African American men, African American women, white men, and white women showed that mean scores for the full Mini Nutritional Assessment differed by groups, with African American men and African American women having the highest nutritional risk. Multivariable analyses indicated that social factors affect nutritional risk differently by race and gender. Nutritional risk interventions are warranted for older adults.
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Affiliation(s)
- David R Buys
- Department of Food Science, Nutrition and Health Promotion, Mississippi State University, Mississippi State (Dr Buys); Division of Gerontology, Geriatrics and Palliative Care (Drs Kennedy, Brown, and Locher and Ms Williams), Department of Health Care Organizations and Policy, University of Alabama at Birmingham (Dr Locher); and Atlanta Geriatric Research, Education, and Clinical Center, Veterans Affairs Hospital, Birmingham, Alabama (Dr Brown)
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Ard JD, Gower B, Hunter G, Ritchie CS, Roth DL, Goss A, Wingo BC, Bodner EV, Brown CJ, Bryan D, Buys DR, Haas MC, Keita AD, Flagg LA, Williams CP, Locher JL. Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2017; 73:73-80. [PMID: 28003374 DOI: 10.1093/gerona/glw237] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/11/2016] [Indexed: 01/27/2023] Open
Abstract
Background We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life. Methods We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life. Results A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events. Conclusions While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.
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Affiliation(s)
- Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Gary Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham.,Department of Human Studies, University of Alabama at Birmingham
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Amy Goss
- Department of Nutrition Sciences, University of Alabama at Birmingham
| | - Brooks C Wingo
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Eric V Bodner
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Cynthia J Brown
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - David Bryan
- Department of Nutrition Sciences, University of Alabama at Birmingham.,Department of Human Studies, University of Alabama at Birmingham
| | - David R Buys
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville
| | - Marilyn C Haas
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Akilah Dulin Keita
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island
| | - Lee Anne Flagg
- Department of Sociology, University of Alabama at Birmingham
| | - Courtney P Williams
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Julie L Locher
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
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Buys DR, Campbell AD, Godfryd A, Flood K, Kitchin E, Kilgore ML, Allocca S, Locher JL. Meals Enhancing Nutrition After Discharge: Findings from a Pilot Randomized Controlled Trial. J Acad Nutr Diet 2017; 117:599-608. [PMID: 28065635 DOI: 10.1016/j.jand.2016.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited. OBJECTIVE This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. The aims of the study were to evaluate successful recruitment, randomization, and retention of at least 80% of the 24 participants sought; to compare the outcomes of hospital readmission and total daily caloric intake between participants in the intervention and control groups; and to assess patient acceptability and satisfaction with the program. DESIGN This study used a two-arm randomized controlled trial design, and baseline data were collected at enrollment; three 24-hour food recalls were collected during the intervention period; and health services utilization and intervention satisfaction was evaluated 45 days post-discharge. PARTICIPANTS/SETTING Twenty-four patients from the University of Alabama at Birmingham Hospital's Acute Care for Elders (ACE) Unit were enrolled from May 2014 to June 2015. They were 65 years or older; at risk for malnutrition; cognitively intact; able to communicate; discharged to a place where the patient or family was responsible for preparing meals; and diagnosed with congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, or pneumonia. Final analysis included 21 participants. INTERVENTION The intervention group received 10 days of home-delivered meals and nutrition education; the control group received usual care and nutrition education. MAIN OUTCOME MEASURES The main outcome was intervention feasibility, measured by recruitment and retention goals. Hospital readmissions, caloric intake, and satisfaction with the intervention were also evaluated. STATISTICAL ANALYSES PERFORMED Univariate and bivariate parametric statistics were used to evaluate differences between groups. Goals for success were identified to assess feasibility of conducting a full-scale study and outcomes were measured against the goals. RESULTS Of the randomized participants, 87.5% were retained for final data collection, indicating that this intervention study is feasible. There were no significant differences between groups for hospital readmissions; however, caloric intake during the intervention period was greater for intervention vs control participants (1,595 vs 1,235; P=0.03). Participants were overwhelmingly satisfied (82% to 100% satisfied or very satisfied) with staff performance, meal quality, and delivery processes. CONCLUSIONS Conducting a randomized controlled trial to assess outcomes of providing home-delivered meals to older adults after hospital discharge in partnership with a small nonprofit organization is feasible and warrants future research.
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Affiliation(s)
- David R Buys
- a Department of Food Science, Nutrition, and Health Promotion , Mississippi State University, Mississippi State , Mississippi , USA
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Buys DR, Howard VJ, McClure LA, Buys KC, Sawyer P, Allman RM, Levitan EB. Association between neighborhood disadvantage and hypertension prevalence, awareness, treatment, and control in older adults: results from the University of Alabama at Birmingham Study of Aging. Am J Public Health 2014; 105:1181-8. [PMID: 25322309 DOI: 10.2105/ajph.2014.302048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effect of neighborhood disadvantage (ND) on older adults' prevalence, awareness, treatment, and control of hypertension. METHODS Data were from the University of Alabama at Birmingham Study of Aging, an observational study of 1000 community-dwelling Black and White Alabamians aged 65 years and older, in 1999 to 2001. We assessed hypertension prevalence, awareness, treatment, and control with blood pressure measurements and self-report data. We assessed ND with US Census data corresponding with participants' census tracts, created tertiles of ND, and fit models with generalized estimating equations via a logit link function with a binomial distribution. Adjusted models included variables assessing personal advantage and disadvantage, place-based factors, sociodemographics, comorbidities, and health behaviors. RESULTS Living in mid-ND (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.2, 2.1) and high-ND tertiles (AOR = 1.8; 95% CI = 1.3, 2.3) was associated with higher hypertension prevalence, and living in high-ND tertiles was associated with lower odds of controlled hypertension (AOR = 0.6; 95% CI = 0.4, 0.6). In adjusted models, ND was not associated with hypertension awareness or treatment. CONCLUSIONS These findings show that neighborhood environmental factors matter for hypertension outcomes and suggest the importance of ND for hypertension management in older adults.
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Affiliation(s)
- David R Buys
- At the time of the study, David R. Buys and Richard M. Allman were and Patricia Sawyer is with the Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham. Virginia J. Howard and Emily B. Levitan are with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham. Leslie A. McClure is with the Department of Biostatistics, School of Public Health, University of Alabama at Birmingham. Katie Crawford Buys is with the Department of Community Health, Systems, and Outcomes, School of Nursing, University of Alabama at Birmingham
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Buys DR, Roth DL, Ritchie CS, Sawyer P, Allman RM, Funkhouser EM, Hovater M, Locher JL. Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up. J Gerontol A Biol Sci Med Sci 2014; 69:1146-53. [PMID: 24589863 DOI: 10.1093/gerona/glu024] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years. METHODS Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures. RESULTS In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models. CONCLUSIONS Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.
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Affiliation(s)
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Patricia Sawyer
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and
| | - Richard M Allman
- Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center Alabama
| | | | | | - Julie L Locher
- Department of Health Care Organizations and Policy, University of Alabama at Birmingham
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Haas MC, Bodner EV, Brown CJ, Bryan D, Buys DR, Keita AD, Flagg LA, Goss A, Gower B, Hovater M, Hunter G, Ritchie CS, Roth DL, Wingo BC, Ard J, Locher JL. Calorie restriction in overweight seniors: response of older adults to a dieting study: the CROSSROADS randomized controlled clinical trial. J Nutr Gerontol Geriatr 2014; 33:376-400. [PMID: 25424512 PMCID: PMC4248142 DOI: 10.1080/21551197.2014.965993] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We conducted a study designed to evaluate whether the benefits of intentional weight loss exceed the potential risks in a group of community-dwelling obese older adults who were at increased risk for cardiometabolic disease. The CROSSROADS trial used a prospective randomized controlled design to compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition and adipose tissue deposition (Specific Aim #1: To compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition, namely visceral adipose tissue), cardiometabolic disease risk (Specific Aim #2: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on cardiometabolic disease risk), and functional status and quality of life (Specific Aim #3: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on functional status and quality of life). Participants were randomly assigned to one of three groups: Exercise Only (Control) Intervention, Exercise + Diet Quality + Weight Maintenance Intervention, or Exercise + Diet Quality + Weight Loss Intervention. CROSSROADS utilized a lifestyle intervention approach consisting of exercise, dietary, and behavioral components. The development and implementation of the CROSSROADS protocol, including a description of the methodology, detailing specific elements of the lifestyle intervention, assurances of treatment fidelity, and participant retention; outcome measures and adverse event monitoring; as well as unique data management features of the trial results, are presented in this article.
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Affiliation(s)
- Marilyn C Haas
- a Division of Gerontology, Geriatrics, and Palliative Care , University of Alabama at Birmingham , Birmingham , Alabama , USA
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Buys DR, Borch C, Kilgore M, Zizza CA, Locher JL. A state-level examination of the association between home and community-based services and rates of nursing home residency with special attention to nutrition programs. J Nutr Gerontol Geriatr 2013; 31:404-24. [PMID: 23157217 DOI: 10.1080/21551197.2012.722068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Federal food and nutrition programs implemented by the Administration on Aging and funded by the Older Americans Act (OAA) seek to enable older adults to remain in their homes and communities through a comprehensive, coordinated, and cost-effective array of services. We hypothesized that expenditures devoted to nutrition programs for home and community-based nutrition services were inversely related to changes in state-level rates of institutionalization for older adults from one year to the next, such that states that spend more money per capita on community-based nutrition programs would have smaller increases or greater decreases in rates of institutionalization, controlling for expenditures on other home and community-based services. We found, however, that there was not an effect of OAA Nutrition Services on the change in rates of nursing home residency. We noted, though, that states that direct a greater proportion of their long-term care expenditures to home and community-based services appear to have more reduction in their rates of nursing home residency. Further longitudinal work at the state and individual levels is warranted.
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Affiliation(s)
- David R Buys
- Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA.
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25
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Locher JL, Vickers KS, Buys DR, Ellis A, Lawrence JC, Newton LE, Roth DL, Ritchie CS, Bales CW. A randomized controlled trial of a theoretically-based behavioral nutrition intervention for community elders: lessons learned from the Behavioral Nutrition Intervention for Community Elders Study. J Acad Nutr Diet 2013; 113:1675-82. [PMID: 24021733 DOI: 10.1016/j.jand.2013.06.352] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 06/18/2013] [Indexed: 01/17/2023]
Abstract
Older adults with multiple comorbidities are often undernourished or at high risk for becoming so, especially after a recent hospitalization. Randomized controlled trials of effective, innovative interventions are needed to support evidence-based approaches for solving nutritional problems in this population. Self-management approaches where participants select their own behavioral goals can enhance success of interventions. The purpose of this study was to evaluate the feasibility and efficacy of a multilevel self-management intervention to improve nutritional status in a group of high-risk older adults. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether the intervention, compared to standard care, maintained or increased caloric intake (depending on baseline body mass index) and, consequently, stabilized or increased body weight. Participants were 34 Medicare-eligible, age 65 years old or older, homebound adults who were consuming insufficient calories and/or had a history of weight loss ≥2.5% over 6 months. The intervention took place within participants' homes. Outcome measures, including energy intake (based on collection of three 24-hour dietary recalls) and body weights were assessed at baseline and at 60 days post randomization. The primary analyses included analyses of covariance and Pearson's χ(2). We hypothesized that the intervention would result in increased caloric intake and weight gain in underweight older adults and increased or stabilized caloric intake and weight for everyone else. The intervention was feasible; however, it did not result in differences between groups for desired outcomes of either caloric intake or body weight. Future interventions might either deliberately involve caregivers or reduce burden for both patients and caregivers.
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Buys DR, Flood KL, Real K, Chang M, Locher JL. Mealtime assistance for hospitalized older adults: a report on the SPOONS volunteer program. J Gerontol Nurs 2013; 39:18-22. [PMID: 23786182 DOI: 10.3928/00989134-20130614-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 02/08/2013] [Indexed: 11/20/2022]
Abstract
Mealtime assistance may be necessary to prevent declines in hospitalized older adults' nutritional well-being. This article reports the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) volunteer assistance program. Patients were 65 and older, admitted to the Acute Care for Elders Unit at the University of Alabama at Birmingham Hospital, and in need of mealtime assistance. There were 236 documented patient-volunteer encounters at which social interaction (n = 217; 92%), assistance with tray set-up (n = 162; 69%), and prompting to eat (n = 161; 68%), among other activities, were performed. Mean time of interaction was 47.8 minutes, with an average estimated cost savings of $11.94 per encounter had the service been provided by a patient care technician and $26 per encounter had it been provided by an RN. This demonstration of the SPOONS program should be followed up with an evaluation of its effectiveness.
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Affiliation(s)
- David R Buys
- Agency for Healthcare Research and Quality, T32 Trainee, Center for Outcomes and Effectiveness Research and Education, Birmingham, AL 35294, USA.
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Dover SE, Buys DR, Allocca S, Locher JL. Farmers' Market Produce Delivery Program for Mitigating Nutritional Risk in Older Adults. Journal of Hunger & Environmental Nutrition 2013. [DOI: 10.1080/19320248.2012.758069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dover SE, Buys DR, Allocca S, Locher JL. FIELD NOTES: PEOPLE, PROGRAMS, & POLICIES Farmers' Market Produce Delivery Program for Mitigating Nutritional Risk in Older Adults. J Hunger Environ Nutr 2013; 8:1-10. [PMID: 23935771 DOI: 10.1080/19320248.2012.761573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Community-dwelling older adults in disadvantaged neighborhoods may face nutritional risks not mitigated by existing programs. The Senior Market Basket Program, administered by nonprofit organization P.E.E.R., Inc., is a unique approach to serving community-dwelling senior adults and a valuable model for integrating targeted social services into local food systems. The program ensures access to fresh produce during the growing season for a defined target population.
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Buys DR, Borch C, Drentea P, LaGory ME, Sawyer P, Allman RM, Kennedy R, Locher JL. Physical impairment is associated with nursing home admission for older adults in disadvantaged but not other neighborhoods: results from the UAB study of aging. Gerontologist 2012; 53:641-53. [PMID: 23034471 DOI: 10.1093/geront/gns118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aging adults face an increased risk of adverse health events as well as risk for a decrease in personal competencies across multiple domains. These factors may inhibit the ability of an older adult to age in place and may result in a nursing home admission (NHA). This study combines insights from Lawton's environmental press theory with the neighborhood disadvantage (ND) literature to examine the interaction of the neighborhood environment and individual characteristics on NHA. METHODS Characteristics associated with the likelihood of NHA for community-dwelling older adults were examined using data collected for 8.5 years from the UAB Study of Aging. Logistic regression models were used to test direct effects of ND on NHA for all participants. The sample was then stratified into 3 tiers of ND to examine differences in individual-level factors by level of ND. RESULTS There was no direct link between living in a disadvantaged neighborhood environment and likelihood of NHA, but physical impairment was associated with NHA for older adults living highly disadvantaged neighborhood environments in contrast to older adults living in less disadvantaged neighborhood environments, where no association was observed. DISCUSSION These outcomes highlight (a) the usefulness of linking Lawton's theories of the environment with the ND literature to assess health-related outcomes and (b) the importance of neighborhood environment for older adults' ability to age in place.
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Affiliation(s)
- David R Buys
- Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham UAB, Birmingham, Alabama.
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Xu B, Houston DK, Locher JL, Ellison KJ, Gropper S, Buys DR, Zizza CA. Higher Healthy Eating Index-2005 scores are associated with better physical performance. J Gerontol A Biol Sci Med Sci 2011; 67:93-9. [PMID: 22042723 DOI: 10.1093/gerona/glr159] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Little is known regarding the relationship between overall diet quality and physical performance among older adults. We examined the association between overall diet quality, as measured by the US Department of Agriculture's Healthy Eating Index-2005 (HEI-2005), and physical performance, as measured by gait speed (n = 2,132) and knee extensor power (n = 1,392), among adults aged 60 years or older. METHODS Using data from the 1999-2002 National Health and Nutrition Examination Survey, multiple linear regression models controlling for age, gender, race/ethnicity, education, smoking status, comorbidities, medication use, cognitive function, body mass index, and physical activity were used in the analyses. RESULTS After adjusting for age, gender, race/ethnicity, education, and smoking status, total HEI-2005 scores were positively associated with both gait speed (p for trend = .02) and knee extensor power (p for trend = .05). Older adults with higher HEI-2005 scores had a faster gait speed (p = .03 for both Quartile 3 and Quartile 4 vs quartile 1) compared with those with HEI-2005 scores in the lowest quartile. Those with HEI-2005 scores in Quartile 4 had a greater knee extensor power compared with those with HEI-2005 scores in the lowest quartile (p = .04). The associations between HEI-2005 scores and physical performance remained after further adjustment for comorbidities, medication use, cognitive function, and body mass index. However, the associations were no longer statistically significant after further adjustment for physical activity. CONCLUSION Adherence to overall dietary recommendations is associated with better physical performance among older adults.
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Affiliation(s)
- Beibei Xu
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA
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