Community Nutrition Update: Older Adults Anne Hoisington OSU Extension, Multnomah Co. May 23, 2002

Outline Background: population trends, characteristics Health problems with nutritional implications Food Insecurity: definitions, prevalence, risks What should the educator know? What can the educator do?

Population Trends Number of older Americans increasing 1 in 8 >65; 1 in 4 by 2030 Fastest growing segment: 85+

Characteristics of Adults % live within community 5% live in LTC Oregon: 2/3 live with others (1/3 alone) Oregon: 4x as many women live alone (Oregon Gerontological Association, 1993)

Health Problems with Nutritional Implications Medical: cancer, diabetes, heart disease Physical: sensory: sight, smell, taste; pain, dentition Polypharmacy: absorption, metabolism, excretion, side effects (anorexia, nausea, drowsiness) Emotional: depression, boredom, anger, dementia

Nutrition problems, continued Health consequences of aging: Muscle mass, metabolism: weight, energy/caloric needs down, physical activity, need for nutrient density Bone mass, functional digestive system, changes in cholesterol, BP, salt sensitivity, changes in glucose metabolism

At Risk for Poor Nutrition Lower education level Women Black, Hispanic elderly Those living alone >85 1 in 5 older adults at or below 130% of poverty (Guthrie, 2002)

Food Security Having assured access at all times to enough food for an active, healthy life Food Insecurity The inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so (Anderson, 1990)

Food Insecurity Among Older Adults ~6% elderly households report some degree of food insecurity Compared to ~10% of all households (Current Population Survey 1999, Andrews et al.)

(Adapted from model by Wolfe et al., 1996) Factors Affecting Food Security in Older Adults Food Insecurity Experience Availability of Family Savings Unexpected Expenses Fixed Income Medical Costs Poor Health, Physical Disabilities Food Management Strategies Community Characteristics

Lower Income Fewer servings of fruit Lower caloric intake Lower intake of vitamin C, B vitamins Less likely to eat breakfast Skip lunch and dinner, fewer snacks (Guthrie et al., 2002)

Higher Income More reported use of dietary supplements More likely to have all key nutrients More total fat/saturated fat More foods prepared outside the home More sodium than recommended (Guthrie et al., 2002)

Food Insecure Lower mean intakes: protein, folate, iron, zinc Fewer servings of vegetables, meat Less dietary variety Higher risk of underweight ( NHANES III, 2000)

What should the educator know? Nutrition Programs USDA: Meals-on Wheels, Congregate Meals Food Stamps Supplemental Foods

How do older adults learn? Written materials most helpful; food labels (Krinke, 1990) Personalize the learning, multi-sensory education (Sharpe et al., 1996) Younger old more likely to believe in positive outcomes of behavior change (Contento et al., 1995)

Train the Trainer North Carolina Congregate Meals sites “Meals on a Budget”—8 weeks, ½ hr lessons Cutting food costs, eating healthfully, improving nutritional status Increased meal site managers’ confidence (McClelland et al., 2002) What can the educator do?

Senior Nutrition Awareness Program (SNAP) Connecticut, RI Congregate Meal sites Group nutrition education workshops Healthy cooking classes Handouts/fact sheets, website, cable TV

Summary Provide nutrition education within context: – Physical limitations – Psychological issues – Environmental factors – Socioeconomic

Community Nutrition Update— Conclusion Eating together is a critical component Environment influences eating patterns Learn the learning style Eating habits are established early But….changes may be made throughout lifecycle Education programs need evaluation App