FACTORS RELATED TO ADHERENCE TO A 12-WEEK PARTICIPATORY NUTRITION AND PHYSICAL ACTIVITY PROGRAM FOR OLDER ADULTS IN COMMUNITY SETTINGS.

Abstract

Purpose/Hypothesis: Many community health education programs for older adults focus on increasing physical activity and improving nutrition. The purpose of this study was to describe factors related to adherence to a 12-week participatory educational program for older adults. Number of Subjects: Subjects were 759 participants over the age of 60 recruited from 8 Older Americans Act Nutrition Program sites across the US. Materials/Methods: Participants were enrolled in community educational programs utilizing the “Eat Better & Move More Guidebook,” part of the US Administration on Aging national campaign, “You Can! Steps to Healthier Aging”. The program consisted of 12 weekly sessions, with mini-lessons, participatory activities, goal setting, take home assignments, and incentives. Lessons were geared towards making healthier food choices and increasing physical activity using pedometers and weekly targets to increase number of steps taken per day by 10% per week. Demographic information, modified Katz and Lawton's ADL indices, and nutritional risk using the Nutrition Screening Initiative (NSI) Checklist were collected at baseline and at the end of the program. Adherence was defined as completion of the final session. Factors related to adherence were analyzed using chi-square analyses and t-tests. Results: Of the 759 participants beginning the program, 558 (73.5%) completed the final session. A lower percentage of people having difficulty with IADLs than people having no difficulty with IADLs finished the program (67% vs 78%, p=0.008); a lower percentage of smokers than non-smokers finished the program (45% vs 75%, p<0.001); and a lower percentage of participants with 8 or fewer years of education than those with more education finished the program (61% vs 75-79%, p=0.017). Conversely, a higher percentage of participants reporting a household income below the poverty level than those reporting higher incomes finished the program (79% vs 63%, p=0.005). Participants who were adherent reported fewer adverse health conditions than those who were not adherent (mean number of health conditions = 1.97 vs 2.34, p=0.02) and had lower NSI scores (mean score=3.04 vs 4.05, p=0.001). Conclusions: People who are dependent in at least one IADL, have more adverse health conditions, have higher nutritional risk, smoke, or have less than an 8th grade education may have a higher risk for not finishing this type of program. People who report household incomes below the poverty level might be more likely to finish this type of program than those with higher incomes. Clinical Relevance: Determining factors related to adherence to participatory community health education programs can help facilitators better identify those at higher risk for attrition. This project was supported, in part, by grant number 90AM2768 from the Administration on Aging, US Department of Health and Human Services.