Food Intake In Older Adults Research Articles

Mortality from decreased food intake in older adults in nursing homes: A retrospective cohort study using electronic care record data

AimTo our knowledge, no studies have examined the risk of mortality in nursing homes using the routinely collected electronic care record information. We aimed to assess the risk of mortality using food intake data documented in electronic care records from Japanese nursing homes. MethodsThis academic–industry collaborative research included 814 older adults from five nursing homes in Japan. The study period was from January 1, 2016 to June 23, 2020. We used the rate of food intake data recorded by care workers in the electronic care records of the residents. We defined decreased food intake as the percentage decrease between admission and 90 days after admission into the nursing home, with cutoffs of 10%, 20%, and 30%. ResultsThe number of older adults whose food intake decreased between admission and 90 days after admission was 114 (14.0%) at a 10% rate, 58 (7.1%) at a 20% rate, and 35 (4.3%) at a 30% rate. All three rates were significantly associated with mortality (10%: hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.30–3.15; 20%: HR 3.03, 95% CI 1.68–5.47; and 30%: HR 4.50, 95% CI 2.15–9.44). ConclusionsWe found that the risk of mortality could conveniently be assessed from the food intake data collected routinely and comprehensively and documented in electronic care records in nursing homes. Our findings can be utilized in nursing homes, where medical staff are limited, to assess high-risk residents and to encourage a discussion regarding the management of end-of-life care.

Factors related to subjective evaluation of difficulty in chewing among community-dwelling older adults.

Awareness of difficulty chewing may limit the diversity of food intake in older adults. However, few studies have clarified which factors are related to subjective difficulty in chewing. The aim was to identify factors related to subjective difficulty in chewing in 70- and 80-year-old Japanese older adults. A total of 1680 participants (792 men, 888 women) were surveyed. Difficulty in chewing was assessed with questionnaires regarding food intake, such as rice, apples, beef, and hard rice crackers. The participants were classified into two groups, the "with difficulty" group (participants who answered "cannot eat," "can eat with difficulty," and "can eat if small") and the "without difficulty" group (participants who answered "can eat without problems"), according to their answers to questionnaires for each food. A logistic regression analysis with subjective difficulty in chewing as the dependent variable was performed for each food. Subjective difficulty in chewing was associated with age, occlusal force, and depression for rice; age, number of remaining teeth, occlusal force, and depression for apples; number of remaining teeth, occlusal force, and depression for beef; and number of remaining teeth and occlusal force for hard rice crackers. Age, number of remaining teeth, and occlusal force, as well as depression, might be related to subjective evaluation of difficulty chewing in community-dwelling Japanese older adults. Geriatr Gerontol Int 2024; 24: 327-333.

Exploring Whether Weight-Related Cues Affect Food Intake in Older Adults with Dementia.

Past research has shown that exposure to the image of a slim person reduces food consumption among young adults. However, it remains unknown whether this paradigm could be adapted and applied to increase food intake among older adults with dementia by exposing them to the image of a higher-weight person to mitigate weight loss and malnutrition. The present study explored whether weight-related visual cues affect the amount of food consumed by older adults with dementia. In the experiment, twenty-one elderly people with dementia living in a nursing home were visually exposed to one of four conditions (a cartoon image of a normal-weight chef, a higher-weight chef, a flower or no image) during real-life daily lunch situations over the course of four weeks, during which each condition was presented for one week. Results demonstrate that participants finished their meals more frequently when they were exposed to the image of the higher-weight chef than when they were not exposed to any images. These results suggest that exposure to a cartoon chef character representing a stereotyped social group related to body weight activates the stereotype and increases stereotype-consistent behavior in older adults with dementia. The present findings will contribute to understanding the effect of visual information on eating behavior and to designing eating environments which facilitate sufficient nutrition intake among older adults with dementia.

Food literacy and its relationship with food intake: a comparison between adults and older adults using 2021 Seoul Food Survey data.

This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake. In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire. With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile. Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.

Biomedical gastronomy in the interventions of smell and taste disorders in ‘altered eating’

Biomedical gastronomy in the interventions of smell and taste disorders in ‘altered eating’

Effects of food neophobia and oral health on the nutritional status of community-dwelling older adults

BackgroundFood preferences and oral health of older adults greatly affect their nutritional intake, and old-age–related increase in food neophobia may consequently reduce food intake in older adults. This study aimed to determine the impact of food neophobia and oral health on nutritional risk in community-dwelling older adults.MethodsThis cross-sectional study included 238 independent adults aged ≥ 65 years (mean, 76.3 ± 7.3 years). The survey items included a Food Neophobia Scale, frequency of protein intake, oral-health–related quality of life (QOL) assessment, and oral diadochokinesis (ODK; /pa/, /ta/, /ka/) as an index of oral function. Nutritional status was assessed using the Mini Nutritional Assessment®, and based on a cutoff value of 24 points, respondents were categorized as well-nourished (≥ 24 points, Group 1) or at risk of malnutrition (< 24 points, Group 2). A logistic regression model was used to calculate the adjusted odds ratio (adj-OR) with 95% confidence interval (CI) to identify risks factors for malnutrition associated with food neophobia and oral health.ResultsFactors associated with the risk of malnutrition in the older population were higher food neophobia (adj-OR = 1.036, 95% CI: 1.007–1.067) and lower oral function (OR = 0.992, 95% CI: 0.985–0.999) and lower oral-health–related QOL (adj-OR = 0.963, 95% CI: 0.929–0.999).ConclusionsOlder adults at risk of developing malnutrition may have higher food neophobia and lower oral function and oral-health–related QOL. Factors contributing to preventing malnutrition include predicting the risk of malnutrition based on the oral health indicators that older people are aware of, signs appearing in the oral cavity, minor deterioration, and providing dietary guidance about food neophobia. Notably, these approaches represent novel strategies for nutrition support that can be implemented based on a multifaceted understanding of the eating habits of older adults.

Understanding Anorexia and Eating Capability of Older Adults in Attempt to Prevent Malnutrition

Because of the rise of life expectancy, the older adults are now a big part of world’s population. In United States, prevalence of adults aged more than 65 years old increased from 36.6 million in 2005 to 47.8 million in 2015. In Indonesia, percentage of older adults increased two-fold from 1971 – 2019 as much as 9,6% or more than 25 million people. Along with this aging population, eating problems and malnutrition are getting more frequent. Aging causes several changes and degradation of body function which physiologically lead to anorexia and eating difficulty in older adults. Moreover, the other age-related factors such as social factor, economic factor, psychological factor, diseases and polypharmacy also have significant impact on food intake in older adults. Prevalence of inadequate energy intake and malnutrition in older adults are increasing, which lead them to become susceptible to acute and chronic diseases or worsening of their disease, increase hospitalization, and increase mortality rate. Even so, the signs of malnutrition of older adults are often late to be recognized, whereas the recovery of malnutrition in older adults is much more complicating than in younger adults. This review discusses about problems encountered by older adults that decrease their intake and cause malnutrition, to help clinicians recognize the cause of malnutrition in older adults earlier.

Adding Flavours: Use of and Attitudes towards Sauces and Seasonings in a Sample of Community-Dwelling UK Older Adults.

Adding flavours can encourage food intake in older adults for health benefits. The use and attitudes of 22 community-dwelling UK older adults (15 females, aged 65–83 years) towards foods and products that add flavour, e.g., sauces and seasonings, were investigated. Participants used foods/products to add flavour when cooking and eating from 0 to 17 times/day. Taste and flavour were important, and foods/products could add flavour, make foods more pleasant and did not cause discomfort. There were concerns, however, over the healthiness of some foods/products, while consuming a healthy diet and one’s health were important. Reasons for adding flavours largely centred around ‘meal enhancement’, reasons for not adding flavours focused on ‘the product itself’ and ‘characteristics of the meal’, but there was ‘variation’ and many ‘individual differences’. Our findings highlight the benefits of adding flavours for food intakes, particularly the use of naturally flavoursome foods, such as herbs, spices, onion and garlic.

Development of an olfactory test method for measuring perception of everyday food odors among older adults

AbstractAge related decline in olfactory function has major implications for food intake in older adults as the sense of smell is essential to the perception of food. The aim of this study was to develop an olfactory test method that addresses the consequences of decline in intensity perception in relation to food appreciation. This test was developed in four steps: (a) Selection of diverse food odors, evaluated on perceived familiarity. (b) Standardization of an intensity reference level for food odors in relation to 1‐butanol. (c) Assessment of shelf‐life stability. (d) Test–retest reliability for intensity and identification. Fourteen food odors comprising asparagus, bacon, banana, cinnamon, curry, coffee, fried meat, mushroom, onion, orange, raspberry, thyme, toasted bread, and vanilla obtained satisfactory familiarity score, test–retest reliability, and a stable shelf‐life except for cooked fish which was therefore excluded. This food odor test is a promising tool for evaluating olfactory performance in older people in relation to common foods and changes in preferences. However, more work is needed to further evaluate the method in practice in a larger cohort including older adults and a reference group.Practical ApplicationsThis food odor test using complex food odors is relevant in settings where meals are customized to improve food intake in older adults.

The effect of physical activity on appetite and food intake in older adults

An abstract is not available for this content. As you have access to this content, full HTML content is provided on this page. A PDF of this content is also available in through the ‘Save PDF’ action button.

Prevalence of malnutrition risk and poor food intake in older adults in Indian hospitals: A prospective observational nutritionDay study with novel mapping of malnutrition risk to the Malnutrition Screening Tool.

Current literature regarding the prevalence and consequences of poor dietary intake and risk of malnutrition in older adults is limited to wealthier regions including the United States, Europe and Australasia. With a rapidly ageing population in India, this prospective observational study aimed to evaluate hospital food intake and malnutrition risk and their impact on hospital length of stay, readmission rates and in-hospital mortality of older adults in Indian hospitals. Data collected during nutritionDay worldwide audits (2014-2016), in five urban, private hospitals in India included baseline demographic and clinical data on patients aged ≥60 years. Proportion of food consumed at one main meal was recorded and data on length of stay, readmissions and in-hospital mortality were collected 30 days post-baseline. A total of 262 participants (mean age: 69 ± 8 years; 65% males) were recruited. Mapped malnutrition risk (mapped Malnutrition Screening Tool [mMST] score ≥ 2) on admission was 31% and increased to 44% during the course of hospitalisation. Over one quarter of participants consumed ≤50% of their meal (28%). Over half the participants were found to be eating poorly (59%) and those identified as at risk of malnutrition were not offered additional nutrition support. The median LOS was 8 days (range: 1-92), 30-day readmission rates were 7% and in-hospital mortality was 0.4%. Malnutrition risk and poor food intake were not associated with health-related outcomes. Older adults in Indian acute care hospitals have a noticeable prevalence of malnutrition risk and poor food intake. There is an opportunity for future research to focus on identifying and managing nutritional issues.

Investigating the importance of the local food environment for fruit and vegetable intake in older men and women in 20 UK towns: a cross-sectional analysis of two national cohorts using novel methods

BackgroundLocal neighbourhood environments can influence dietary behavior. There is limited evidence focused on older people who are likely to have greater dependence on local areas and may suffer functional limitations that amplify any neighbourhood impact.MethodsUsing multi-level ordinal regression analysis we investigated the association between multiple dimensions of neighbourhood food environments (captured by fine-detail, foot-based environmental audits and secondary data) and self-reported frequency of fruit and vegetable intake. The study was a cross-sectional analysis nested within two nationally representative cohorts in the UK: the British Regional Heart Study and the British Women’s Heart and Health Study. Main exposures of interest were density of food retail outlets selling fruits and vegetables, the density of fast food outlets and a novel measure of diversity of the food retail environment.ResultsA total of 1124 men and 883 women, aged 69 – 92 years, living in 20 British towns were included in the analysis. There was strong evidence of an association between area income deprivation and fruit and vegetable consumption, with study members in the most deprived areas estimated to have 27% (95% CI: 7, 42) lower odds of being in a higher fruit and vegetable consumption category relative to those in the least deprived areas. We found no consistent evidence for an association between fruit and vegetable consumption and a range of other food environment domains, including density of shops selling fruits and vegetables, density of premises selling fast food, the area food retail diversity, area walkability, transport accessibility, or the local food marketing environment. For example, individuals living in areas with greatest fruit and vegetable outlet density had 2% (95% CI: -22, 21) lower odds of being in a higher fruit and vegetable consumption category relative to those in areas with no shops.ConclusionsAlthough small effect sizes in environment-diet relationships cannot be discounted, this study suggests that older people are less influenced by physical characteristics of neighbourhood food environments than is suggested in the literature. The association between area income deprivation and diet may be capturing an important social aspect of neighbourhoods that influence food intake in older adults and warrants further research.

Poor Appetite and Dietary Intake in Community-Dwelling Older Adults.

Poor appetite in older adults leads to sub-optimal food intake and increases the risk of undernutrition. The impact of poor appetite on food intake in older adults is unknown. The aim of this study was to examine the differences in food intake among older community-dwelling adults with different reported appetite levels. Cross-sectional analysis of data from a longitudinal prospective study. Health, aging, and body composition study performed in the USA. 2,597 community-dwelling adults aged 70-79. A semi-quantitative, interviewer-administered, 108-item food frequency questionnaire designed to estimate dietary intake. Poor appetite was defined as the report of a moderate, poor, or very poor appetite in the past month and was compared with good or very good appetite. The mean age of the study sample was 74.5 ± 2.8 years; 48.2% were men, 37.7% were black, and 21.8% reported a poor appetite. After adjustment for total energy intake and potential confounders (including biting/chewing problems), participants with a poor appetite had a significantly lower consumption of protein and dietary fiber, solid foods, protein rich foods, whole grains, fruits, and vegetables, but a higher consumption of dairy foods, fats, oils, sweets, and sodas compared to participants with very good appetite. In addition, they were less likely to report consumption of significant larger portion sizes. Older adults reporting a poor appetite showed a different dietary intake pattern compared to those with (very) good appetite. Better understanding of the specific dietary intake pattern related to a poor appetite in older adults can be used for nutrition interventions to enhance food intake, diet variety, and diet quality.

Industrial Applications of Selected JFS Articles

Industrial Applications of Selected <i>JFS</i> Articles

The Mealtime Audit Tool (MAT) - Inter-Rater Reliability Testing of a Novel Tool for the Monitoring and Assessment of Food Intake Barriers in Acute Care Hospital Patients.

Barriers to food intake (FI) exist in hospital that could exacerbate insufficient FI and malnutrition. The Mealtime Audit Tool (MAT) is a staff-administered clinical assessment tool to identify FI barriers for individual patients. Two studies were completed. The objectives of the first study were to test a draft version of the tool and characterize barriers to food intake in older adults in four diverse hospitals, while the second study aimed to demonstrate the inter-rater reliability of the revised MAT. Multi-site, cross sectional. Four acute care hospitals in Canada. Study 1: 120 older (65+ years, adequate cognition) medical or surgical patients. Study 2: 90 medical or surgical patients. In study 1, participants had barriers experienced at one mealtime assessed with MAT. Descriptive analyses characterized the prevalence of barriers across the hospitals. Revisions were made to the MAT based on recommendations from sites. A revised version was tested for inter-rater reliability in study 2. Intraclass correlation coefficient (ICC) was calculated for total MAT scores from 90 patient meals assessed by two raters. Kappa statistics were calculated for each of the 18 MAT items. Mean (+/- standard deviation) number of barriers experienced in Study 1 was 2.93 +/- 1.58, and in Study 2 was 2.51 +/- 1.19. The revised MAT was reliable with an ICC of 0.68 (95%CI: 0.52-0.79). Ten of 16 items in which kappa could be calculated had at least fair agreement. MAT is sufficiently reliable when used by auditors with minimal training. Routinely auditing mealtimes with MAT could be useful in identifying and removing barriers to food intake for older hospitalized patients.

Olfactory impairment in older adults is associated with poorer diet quality over 5 years.

Decreased smell could cause appetite suppression and malnutrition. However, there is a paucity of longitudinal data between olfaction and nutritional status in older adults. We aimed to prospectively examine the relationship between olfactory impairment and overall diet quality (reflecting adherence to dietary guidelines) in a population-based cohort of older adults. We used 5-year follow-up data from 557 adults (aged 60+ years at baseline) whose olfaction was measured using the San Diego Odor Identification Test (SDOIT). Dietary data were collected using a validated semiquantitative food frequency questionnaire. A total diet score (TDS) was calculated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Final scores ranged from 0 to 20; higher scores indicated closer adherence to dietary guidelines. After adjusting for all potential confounders, older adults with moderate/severe olfactory impairment (SDOIT score ≤ 3; lower scores indicate impairment) compared with those with no olfactory impairment had significantly lower adjusted mean (±SE) TDS, 9.09 (0.40) versus 9.94 (0.10), p = 0.04. Women with moderate/severe impaired olfaction (i.e., scored poorly on the odor identification test) compared with those with normal olfaction had significantly lower adjusted mean TDS, 8.87 (0.69) versus 10.31 (0.13), p = 0.04. No associations were observed between olfaction and TDS in men. Olfactory impairment in older women could signal an increased risk of poorer diet quality, defined as adherence to national dietary guidelines. Additional longitudinal studies are needed to confirm or refute the observed link between olfactory loss and overall patterns of food intake in older adults.

Influence of flavour enhancement on food liking and consumption in older adults with poor, moderate or high cognitive status

It is important to maintain adequate food consumption in older adults so as to prevent malnutrition, particularly among those with cognitive impairments who represent the majority of patients living in nursing homes. Indeed, these patients may reduce their food intake, which can be explained by a lack of pleasure in eating food. Few studies have tested the efficiency of strategies based on food pleasure to increase food intake in this population. To our knowledge, the influence of flavour enhancement has been widely investigated in non-cognitively impaired older adults, but not in those with cognitive impairments. Our objective was therefore to study the influence of flavour enhancement on food liking and then on food intake in older adults with different degrees of cognitive impairments. To achieve this, two food testing methods were compared: paired comparison and sequential monadic tests.104 subjects were recruited in four nursing homes and clustered into three groups as a function of their cognitive impairments (severe, moderate and without marked cognitive impairments). Two different samples of an appetizer were formulated: a reference sample and a flavour-enhanced sample. These appetizers were offered to the participants before lunch in standardised small portions during three tasting sessions organised at intervals of one week. During one session, the participants received both samples at the same time (paired comparison test) and during the two others, they were given a single sample at each session (sequential monadic test). Food intake and food liking were then evaluated with respect to each participant and each sample.The results showed a positive correlation between food liking and food intake, and a positive influence of flavour enhancement on food intake, regardless of the cognitive status of the participants. The sequential monadic test produced results similar to those of the paired-comparison test in terms of the effects of flavour enhancement. These findings suggest that this method could be used to investigate the influence of food interventions at mealtimes in older adults with cognitive impairments.Finally, this study shows that food intake could be increased by optimising the sensory properties of foods served to cognitively impaired older patients.

Liquid and Solid Meal Replacement Products Differentially Affect Postprandial Appetite and Food Intake in Older Adults

Liquid and solid foods are documented to elicit differential appetitive and food intake responses. This study was designed to assess the influences of liquid vs solid meal replacement products on postprandial appetite ratings and subsequent food intake in healthy older adults. This study used a randomized and crossover design with two 1-day trials (1 week between trials), and 24 adults (12 men and 12 women) aged 50 to 80 years with body mass index (calculated as kg/m 2) between 22 and 30 participated. After an overnight fast, the subjects consumed meal replacement products as either a beverage (liquid) or a bar (solid). The meal replacement products provided 25% of each subject's daily estimated energy needs with comparable macronutrient compositions. Subjects rated their appetite on a 100 mm quasilogarithmic visual analog scale before and 15, 30, 45, 60, 90, 120, and 150 minutes after consuming the meal replacement product. At minute 120, each subject consumed cooked oatmeal ad libitum to a “comfortable level of fullness.” Postprandial composite (area under the curve from minute 15 to minute 120) hunger was higher ( P=0.04) for the liquid vs solid meal replacement products and desire to eat ( P=0.15), preoccupation with thoughts of food ( P=0.07), and fullness ( P=0.25) did not differ for the liquid vs solid meal replacement products. On average, the subjects consumed 13.4% more oatmeal after the liquid vs solid ( P=0.006) meal replacement product. These results indicate that meal replacement products in liquid and solid form do not elicit comparable appetitive and ingestive behavior responses and that meal replacement products in liquid form blunt the postprandial decline in hunger and increase subsequent food intake in older adults.

Promoting food intake in older adults living in the community: a review

Older adults (>65 y) living in the community have the potential to have significant nutrition concerns and deficits owing to the physiological, social, and psychological changes that occur with ageing. However, poor nutrition should not be considered an inevitable consequence of ageing. Older adults are quite heterogenous, including those ageing "successfully", "usually", and at "accelerated" rates. By improving the nutritional status of older adults, significant health and quality of life gains can be realized. These three subgroups of older adults have different concerns and risk factors and thus need different interventions. A substantial amount of research on older adult nutrition needs, determinants of food intake, risk of poor nutrition, and interventions has occurred in the past decade in Canada. The purpose of this review is to summarize this research and identify how nutrition promotion for older adults can be improved. Research to date indicates that the need for nutrition promotion is substantial. A variety of interventions have improved food intake and health of participants, although most programs are provided at a tertiary prevention level. Nutrition screening can help to identify in a timely manner those older adults who may benefit from limited services and which secondary prevention activities need to be increased. Nutrition promotion policy is currently lacking for older adults in Canada and is an important barrier to improving food intake in this growing segment of the population.

Reliance on Others for Food-Related Activities of Daily Living

Reliance on others for help with food related activities (grocery shopping and meal preparation) [FADL] can influence food intake and can be considered part of the concept of food security for older adults. Data collected from 193 community living seniors identified that 29.5% of these seniors required help with these activities. Covariates independently associated with FADL were: muscle strength/size, gender, avoidance of activities due to a fear of falling and occurrence of functionally limiting diagnoses. Mediation analysis identified variables that explain the „how and why” of the association between FADL and food intake. Mediators included informal supports, frequency of informal support, perceived health status, and number of medications. By specifically analyzing covariates and mediators of reliance for FADL, there is further understanding of the relationship between this reliance and food intake in older adults.