Food access, diet quality, and nutritional status of older adults during COVID-19: A scoping review

Abstract COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. The objective of this study is to examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. An electronic search was conducted using three databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the age of participants was 50 years and older (average age range 50-98). In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n=5), analytical (n=6), and correlational (n=2). Studies were conducted among community-dwelling older adult populations (n=7) as well as those temporarily residing in hospital settings (n=6) in 10 countries. More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

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Food Access, Diet Quality, and Nutritional Status of Older Adults During COVID-19: A Scoping Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.763994 ◽

2021 ◽

Vol 9 ◽

Author(s):

Emily J. Nicklett ◽

Kimson E. Johnson ◽

Lisa M. Troy ◽

Maitreyi Vartak ◽

Ann Reiter

Keyword(s):

Older Adults ◽

Rural Communities ◽

Nutritional Status ◽

Older Adult ◽

Diet Quality ◽

Food Access ◽

English Language ◽

Final Analysis ◽

Community Dwelling ◽

The Impact

Background: COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed.Objective: To examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model.Methods: An electronic search was conducted on 3 databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019–3/1/2021 were considered for which the mean age of participants was 50 years and older. In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome.Results: The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n = 5), analytical (n = 6), and correlational (n = 2). Studies were conducted among community-dwelling older adult populations (n = 7) as well as those temporarily residing in hospital settings (n = 6) in 10 countries. None of the in-scope studies examined the impact of food programs or specific public policies or disaggregated data by race/ethnicity.Conclusions: More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

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Understanding Burden in Caregivers of Adults With Dysphagia: A Systematic Review

American Journal of Speech-Language Pathology ◽

10.1044/2021_ajslp-21-00249 ◽

2021 ◽

pp. 1-16

Author(s):

Daniella Rangira ◽

Hiba Najeeb ◽

Samantha E. Shune ◽

Ashwini Namasivayam-MacDonald

Keyword(s):

Older Adults ◽

Caregiver Burden ◽

Social Life ◽

English Language ◽

Community Dwelling ◽

Care Recipient ◽

Adult Care ◽

Care Recipients ◽

Meta Analyses ◽

The Impact

Introduction: A previous review suggested that dysphagia is negatively associated with burden in caregivers of community-dwelling older adults. Other literature suggests similar patterns of burden may be found across adult patient populations. The current study, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted to determine the impact of dysphagia on caregivers of adults, regardless of etiology. Method: Five electronic databases were searched using terms based on a review by Namasivayam-MacDonald and Shune (2018) but included all adults rather than only older adults. Searches were limited to English-language empirical studies discussing caregiver burden, included caregivers of adult care recipients, had some care recipients with dysphagia, did not include palliative care, and published in a peer-reviewed journal. Results: The search yielded 1,112 unique abstracts, of which 17 were accepted. Across studies, caregiver burden was found to increase due to dysphagia in care recipients. Commonly reported dysphagia-related causes of burden included changes in meal preparation, disruption in lifestyle, effects on social life, lack of support, insertion of feeding tubes, and fear of aspiration. In general, dysphagia-related caregiver burden was a common experience across caregivers, regardless of patient population, caregiver age, and relationship between caregiver and care recipient. Meta-analyses suggest 71% of caregivers of adults with dysphagia experience some degree of burden. Conclusions: These findings support that dysphagia negatively impacts caregiver burden and suggests sources of burden that clinicians can address within dysphagia management to support caregivers. However, more research is needed to better delineate sources of burden, especially those specific to various dysphagia etiologies, to better meet the needs of our patients.

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Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults

British Journal Of Nutrition ◽

10.1017/s0007114518000843 ◽

2018 ◽

Vol 119 (10) ◽

pp. 1185-1194 ◽

Cited By ~ 7

Author(s):

Marije N. van Doorn-van Atten ◽

Annemien Haveman-Nies ◽

Marit M. van Bakel ◽

Monique Ferry ◽

Maite Franco ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Nutritional Status ◽

Nutrition Education ◽

Diet Quality ◽

Physical Functioning ◽

Intervention Group ◽

Community Dwelling

AbstractThis study aimed to evaluate the effects of an intervention including nutritional telemonitoring, nutrition education, and follow-up by a nurse on nutritional status, diet quality, appetite, physical functioning and quality of life of Dutch community-dwelling elderly. We used a parallel arm pre-test post-test design with 214 older adults (average age 80 years) who were allocated to the intervention group (n97) or control group (n107), based on the municipality. The intervention group received a 6-month intervention including telemonitoring measurements, nutrition education and follow-up by a nurse. Effect measurements took place at baseline, after 4·5 months, and at the end of the study. The intervention improved nutritional status of participants at risk of undernutrition (β(T1)=2·55; 95 % CI 1·41, 3·68;β(T2)=1·77; 95 % CI 0·60, 2·94) and scores for compliance with Dutch guidelines for the intake of vegetables (β=1·27; 95 % CI 0·49, 2·05), fruit (β=1·24; 95 % CI 0·60, 1·88), dietary fibre (β=1·13; 95 % CI 0·70, 1·57), protein (β=1·20; 95 % CI 0·15, 2·24) and physical activity (β=2·13; 95 % CI 0·98, 3·29). The intervention did not have an effect on body weight, appetite, physical functioning and quality of life. In conclusion, this intervention leads to improved nutritional status in older adults at risk of undernutrition, and to improved diet quality and physical activity levels of community-dwelling elderly. Future studies with a longer duration should focus on older adults at higher risk of undernutrition than this study population to investigate whether the impact of the intervention on nutritional and functional outcomes can be improved.

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Depressive symptoms with cognitive dysfunction increase the risk of cognitive impairment: analysis of the Korean Longitudinal Study of Aging (KLoSA), 2006–2018

International Psychogeriatrics ◽

10.1017/s1041610220003622 ◽

2020 ◽

pp. 1-11

Author(s):

Minyoung Shin

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Longitudinal Study ◽

Cognitive Dysfunction ◽

Healthcare Providers ◽

Final Analysis ◽

Community Dwelling ◽

The Impact ◽

Community Dwelling Older Adults

ABSTRACT Objectives: Geriatric depression complicates cognitive health in older adults. This study aims to investigate the impact of depressive symptoms on cognitive impairment in community-dwelling older adults, depending on whether cognitive dysfunction accompanied. Design: A community-based longitudinal cohort study. Setting: This study analyzed data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2018. Participants: Among 10,254 individuals who were registered in the KLoSA study, a total of 9119 subjects met the criteria, and 4547 subjects were included in the final analysis. The subjects were grouped into 4 categories based on depressive symptoms and cognitive dysfunction at baseline assessment: “normal control” (NC, n = 3341), “depression only” (Dep-only, n = 652), “cognitive dysfunction only” (CD-only, n = 393), and “depression with cognitive dysfunction” (Dep-CD, n = 161). Measurements: Cognitive impairment 10 years later was defined as K-MMSE scores below two percentile on demographically adjusted norms. Results: Ten-year survival, that is, not experiencing cognitive impairment, was 80 $$ \pm \,$$ 1% in NC group, 72 $$ \pm $$ 2% in Dep-only group, 52 $$ \pm $$ 3% in CD-only group, and 44 $$ \pm $$ 5% in Dep-CD group. The hazard ratio (HR) of the Dep-only group (HR = 1.18, 95% CI, 0.97–1.43, n.s.) did not differ from that of the NC group, but the HR of the Dep-CD group was significantly higher (HR = 2.85, 95% CI, 2.23–3.66, p < 0.001) than the NC group. When the Dep-CD group was compared to the CD-only group, the HR was 1.13 (95% CI, 0.85–1.49, n.s.), which indicates that it did not significantly differ from the CD-only group. Conclusions: Our findings suggest that depressive symptoms with cognitive dysfunction are associated with a higher risk of cognitive impairment. Furthermore, cognitive dysfunction occurring with depressive symptoms is as much a risk for cognitive impairment as is pure cognitive dysfunction. Thus, healthcare providers should pay close attention to the community-dwelling elderly when depressive symptoms occur with cognitive dysfunction.

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THE IMPACT OF ANKLE-FOOT ORTHOSES ON BALANCE IN OLDER ADULTS: A SCOPING REVIEW

Canadian Prosthetics & Orthotics Journal ◽

10.33137/cpoj.v4i1.35132 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Jenna Laidler

Keyword(s):

Older Adults ◽

Older Adult ◽

Scoping Review ◽

Community Dwelling ◽

Foot Orthoses ◽

Ankle Foot Orthosis ◽

Ankle Foot Orthoses ◽

The Impact ◽

Community Dwelling Older Adults ◽

Foot Orthosis

BACKGROUND: Balance impairment is a contributing factor to falls. Falls are a leading cause of injury and death in older adults. An ankle-foot orthosis (AFO) is a device that can be prescribed as an intervention to help individuals with compromised balance to ambulate safely. OBJECTIVE: The purpose of this review was to investigate the role ankle-foot orthoses have in affecting balance in community-dwelling older adults. METHODOLOGY: A scoping review was conducted searching MEDLINE, CINAHL, EMBASE, and REHABDATA databases to obtain the appropriate literature to meet the following criteria: 1) quantitative research design; 2) studies with participants over age 65; 3) studies with participants with drop-foot or sensory deficits in the lower extremity; 4) the treatment intervention was unilateral or bilateral AFOs; 5) the outcome measure was balance or stability. The retrieved articles were assessed based on the internal validity, external validity, objectivity, and reliability of the study design and the interpretation of results. FINDINGS: 11 articles were identified that met the inclusion criteria. Four major themes emerged in the analysis about the impact that ankle-foot orthoses have on balance in older adults: (1) AFOs improved lateral stability, (2) AFOs improved balance under static conditions, (3) AFOs provided a reduction in postural sway and (4) AFOs increased walking speed in community-dwelling older adults. CONCLUSIONS: The evidence from the findings of the review indicate that ankle-foot orthoses have a generally positive affect on balance in older adults. Clinicians can consider the ankle-foot orthosis an effective intervention that can improve balance in some older adult patient populations. Layman's Abstract Falls are a serious cause of injury and death in older adults over age 65. Poor balance can lead to an increased number of falls in the older population. The use of a brace, called an ankle-foot orthosis, can be prescribed to community living older adults to augment their balance. Ankle-foot orthoses can improve the stability and positioning of the ankle joint and foot to aid in balance during walking and standing, however ankle-foot orthoses have also been found to restrict natural movements and interrupt sensory feedback from the lower leg and foot. The purpose of this article was to investigate how the balance of older adults living in the community is impacted by wearing ankle-foot orthoses. Through conducting a database search to obtain appropriate literature on the topic, four trends were identified for how ankle-foot orthoses impact the balance of older adult wearers. Based on the findings of this review, ankle-foot orthoses were found to improve stability and standing balance, decrease bodily sway, and increase the walking speed of older adult wearers. These findings suggest that ankle-foot orthoses have a largely positive impact on the balance of older adults and can be considered to help improve balance in certain patient populations. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35132/27291 How To Cite: Laidler J.L. The impact of ankle-foot orthoses on balance in older adults: A scoping review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.1. https://doi.org/10.33137/cpoj.v4i1.35132 Corresponding Author: Jenna LaidlerAging and Health Program, School of Rehabilitation Therapy,Queen’s University, Kingston, Canada.E-mail: [email protected]

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Rural Residence, Nutrition Risk, and Falls In Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.764 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 237-237

Author(s):

Nancy Gell ◽

Caitlin Eckert ◽

Jennifer Schollmeyer ◽

Mariana Wingood ◽

Emily Tarleton

Keyword(s):

Older Adults ◽

Rural Communities ◽

Nutritional Status ◽

Fall Risk ◽

Community Dwelling ◽

Rural Setting ◽

Nutrition Status ◽

Rural Residence ◽

Nutrition Risk ◽

Community Dwelling Older Adults

Abstract Decreasing fall risk and maintaining independence is vital for community dwelling older adults. Nutritional status and rural residence may be independent predictors of falls. The aim of this study was to evaluate if nutritional status and rurality are positively associated with fall risk and predictive of future falls in community-dwelling older adults. We used data from a health risk assessment conducted by the Support and Services at Home organization serving Medicare beneficiaries in Vermont in 2017-2019 (N=3109; 79.6 years ±8.4, 75% female). Measures included the Fall Risk Questionnaire, Determine Nutrition Risk questionnaire, and fall history. Descriptive statistics from baseline measures and logistic regression analyses were used to identify predictors of a new fall with respect to rurality, fall risk, and nutritional status. At baseline, 67% of participants lived in rural communities, 37% had high nutrition risk, and 60% had elevated fall risk. Independently, rurality and high nutrition risk were significantly associated with fall risk (p<0.001) and high nutrition risk was associated with rurality (p<0.001). In the adjusted model, rural residence was not significantly associated with a fall within one year from baseline, whereas participants at high nutrition risk had a 50% higher odds of falling (p= 0.001). These findings suggest that falls may be associated with nutrition risk, but not living in a rural setting. Community-based initiatives should consider including nutrition screens as part of fall risk assessments. Further research is needed to understand the relationship between nutrition status and falls risk.

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KNOWLEDGE OF AGEISM AND ATTITUDES ABOUT AGING AS A CORE COMPETENCY FOR HEALTH PROFESSIONALS

Innovation in Aging ◽

10.1093/geroni/igz038.3067 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S832-S833

Author(s):

Sarah Marrs ◽

Tracey Gendron ◽

Leland Waters ◽

Jenny Inker ◽

Maddie McIntyre

Keyword(s):

Older Adults ◽

Medical Students ◽

Older Adult ◽

Medical Training ◽

Qualitative Content Analysis ◽

Health Professions ◽

Community Dwelling ◽

Mentoring Program ◽

Term Care ◽

The Impact

Abstract Senior mentoring programs have been established that provide medical students exposure to a community-dwelling older adult mentor with whom they meet multiple times throughout the program. The goal of these programs is to expose students to healthy older adults, increase knowledge of geriatrics, and prepare them to care for an aging population. However, even while participating in a senior mentoring program, health professions students still demonstrate some discriminatory language towards older adults (e.g., Gendron, Inker, & Welleford, 2018). In fact, research suggests ageist practices occur, intentionally or not, among health professions in disciplines such as medicine, nursing, and social work and even within assisted and long-term care facilities (e.g., Bowling, 1999; Dobbs et al., 2008; Kane & Kane, 2005). We evaluated a senior mentoring program to gauge the impact of a new pedagogical approach and to gain a deeper understanding of the learning gained in relation to ageism and elderhood. This qualitative content analysis explored first-year medical students’ opinions of their own aging and attitudes towards caring for older adults. Students (n = 216) participating in a brief curriculum model of a senior mentoring program responded to the following open-ended prompts before and after the program: 1) How do you feel about your own aging?; 2) How do you feel about working with older adult patients after you complete your medical training? Responses suggest that students’ views of their own aging and views towards towards working with older patients are positively impacted by their experiences in the senior mentoring program.

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DENTITION AND MALNUTRITION RISK IN COMMUNITYDWELLING OLDER ADULTS

Journal of Aging Research and Lifestyle ◽

10.14283/jarcp.2018.19 ◽

2018 ◽

pp. 1-8

Author(s):

R. Zelig ◽

L. Byham-Gray ◽

S.R. Singer ◽

E.R. Hoskin ◽

A. Fleisch Marcus ◽

...

Keyword(s):

Older Adults ◽

At Risk ◽

Nutritional Status ◽

Nutritional Assessment ◽

Mini Nutritional Assessment ◽

Community Dwelling ◽

Nutrition Status ◽

Cross Sectional ◽

Increased Risk ◽

The Impact

Background and Objective: Older adults are at risk for both impaired oral health and suboptimal nutritional status. The objective of this study was to explore the relationships between malnutrition risk and missing teeth in community-dwelling older adults. Design: This was a retrospective cross-sectional analysis of data obtained from the electronic health records of 107 patients aged 65 and older who attended an urban northeast US dental school clinic between June 1, 2015 and July 15, 2016. Odontograms and radiographs were used to identify teeth numbers and locations; malnutrition risk was calculated using the Self-Mini Nutritional Assessment (Self-MNA). Relationships between numbers of teeth and malnutrition risk were assessed using bivariate logistic regression. Results: Participants (N=107) were 72.6 years (SD=5.6) of age; 50.5% were female. Mean Self-MNA score was 12.3 (SD=2.0) reflective of normal nutrition status; 20.6% were at risk for malnutrition, 4.7% were malnourished. Greater than 87% were partially or completely edentulous. Those with 10-19 teeth had lower Self-MNA scores (mean=11.6, SD=2.5) than those with 0-9 teeth (mean=12.7, SD=1.3) or 20 or more teeth (mean=12.6, SD=1.8) and had an increased risk for malnutrition (OR=2.5, p=0.076). Conclusion: The majority of this sample of older adults were partially edentulous and of normal nutritional status. Those with 10-19 teeth were more likely to be at risk for malnutrition. Further studies are needed to examine relationships between tooth loss and malnutrition risk and the impact of impaired dentition on the eating experience in a larger sample and to inform clinical practice.

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Depressive Symptoms Among Rural “Left-Behind” Older Adults: A Test of the High Outmigration Penalty Hypothesis

The Journals of Gerontology Series B ◽

10.1093/geronb/gbab040 ◽

2021 ◽

Author(s):

Qian Song ◽

Haowei Wang ◽

Jeffery A Burr

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Rural Communities ◽

Older Adult ◽

Psychological Health ◽

Economic Conditions ◽

Adult Density ◽

Chinese Adults ◽

Older Chinese ◽

Older Chinese Adults

Abstract Objectives We investigated whether there was a “high outmigration penalty” for psychological health among older adults in rural China by assessing 2 potential community stressors associated with major sociodemographic changes in the community—increased outmigration and older adult density. We also investigated whether disparities in community economic conditions moderated the association between community stressors and depressive symptoms. Methods We employed 3 waves of data from the China Health and Retirement Longitudinal Study (2011–2015), using multilevel negative binomial models to address our research questions. Results Our results supported the “high outmigration penalty” hypothesis. Older adults living in low-income rural communities may experience an aggravated mental health penalty compared to those living in high-income rural communities. Higher older adult density was also associated with more depressive symptoms but only in less wealthy communities. Community differences in economic conditions were key factors buffering the high outmigration disadvantage associated with the psychological health of older Chinese adults. Discussion Rural outmigration may have deepened existing intercommunity health disparities among older adults. Policies should be developed to address community-level factors negatively associated with the well-being of older Chinese adults living in high outmigration and less wealthy rural communities.

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Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

Journal of Aging and Health ◽

10.1177/0898264321993321 ◽

2021 ◽

pp. 089826432199332

Author(s):

Wanda Rietkerk ◽

Jannet de Jonge-de Haan ◽

Joris P. J. Slaets ◽

Sytse U. Zuidema ◽

Debby L. Gerritsen

Keyword(s):

Older Adults ◽

Behavior Change ◽

Older Adult ◽

Goal Setting ◽

Geriatric Assessment ◽

Well Being ◽

Community Dwelling ◽

Implementation Processes ◽

Adult Involvement ◽

Community Dwelling Older Adults

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.

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