Nutrition Screening Initiative Checklist Research Articles

Nutritional risk and its relationship with physical function in community-dwelling older adults

BackgroundMalnutrition is a serious concern in older populations. Simple screening approaches are needed to identify signs of early nutritional risk in older people, to allow intervention before overt malnutrition develops, along with the poorer health outcomes associated with it, such as sarcopaenia and frailty. The main aim of this study was to compare nutrition risk scores, calculated from the DETERMINE Checklist (‘Determine Your Nutritional Health’, also known as the Nutrition Screening Initiative Checklist), with physical function variables in a group of community-dwelling older adults. Another aim was to assess the prevalence of nutrition risk using the DETERMINE and the MUST (Malnutrition Universal Screening Tool).MethodsParticipants of the Hertfordshire Cohort Study (HCS) were recruited and visited at home by a trained researcher. Self-reported physical function was assessed using the SF-36 PF (Short Form-36 Physical Function) scale. The Short Physical Performance Battery (SPPB) was performed, which included the assessment of gait speed, chair rise time and standing balance. Handgrip strength was measured using a Jamar dynamometer. Frailty was assessed according to the presence of at least three of the following Fried frailty criteria: unintentional weight loss, weakness, self-reported exhaustion, slow gait speed and low physical activity. Nutrition risk scores were calculated from the DETERMINE checklist (range 0–21). Nutritional risk was also assessed using the MUST. Analyses were adjusted for sex, age, age left education and number of comorbidities.ResultsIn the study, 176 participants (94 men and 82 women), median age 83.3 (IQR 81.5–85.7) years, were assessed. Almost half (47%) scored either ‘moderate’ (score 3–5) or ‘high’ (score ≥ 6) nutritional risk (9% were at high risk), using the DETERMINE checklist, whereas 8% were at risk using the MUST. Higher nutrition risk scores, calculated from DETERMINE, were associated with poorer self-reported physical function (difference in SF-36 PF score: − 0.36, 95% CI (− 0.60, − 0.12) SD per unit increase in nutrition risk score, P = 0.004) and higher odds of being frail (odds ratio Fried frailty: 2.23, 95% CI (1.15, 4.33), P = 0.017). There were no significant associations between DETERMINE nutrition risk scores and the other variables examined.ConclusionCross-sectional associations between higher nutrition risk scores, assessed from the DETERMINE checklist, and poorer self-reported physical function and greater likelihood of frailty suggest that this screening tool may have utility for screening older populations. Prospective studies are required to explore the ability of the tool to predict poor physical function and frailty, though these data suggest it has potential for early, simple detection of nutritional problems in community-living older adults.

Eating Alone and Cognitive Decline in Korean Older Adults: A 3-Year Prospective Study.

BackgroundEating alone is a critical factor in nutritional risk screening among older adults. We investigated whether changes in eating status (eating alone or with others) in late-life affected cognitive decline in community-dwelling older adults. MethodsWe used data from the Survey of the Living Conditions and Welfare Needs of Korean Older Persons. Nutritional risk, including eating status, was assessed using seven questions from the Nutrition Screening Initiative checklist, and cognitive function was measured using the Mini-Mental State Examination (MMSE). On the basis of changes in eating status between baseline (2008) and the 3-year follow-up (2011), the subjects were divided into four groups: group 1 (eating with others at both surveys), group 2 (eating alone in 2008 and eating with others in 2011), group 3 (eating with others in 2008 and eating alone in 2011), and group 4 (eating alone at both surveys). Generalized linear models were used to compare the changes in MMSE scores over the 3-year period among the four groups. ResultsAmong older women, group 2 had the least decline in MMSE scores (-0.55±0.46), whereas group 3 had the greatest decline (-1.76±0.37) (p=0.034). We observed no difference in the change in MMSE scores among the four eating groups in older men. Conclusion Deprivation of mealtime partners in late life showed significant cognitive decline compared with gaining mealtime partners. Eating alone may be a risk factor for cognitive impairment; thus, meal programs reinforcing social integration might help preserve cognitive function.

Efficacy of malnutrition screening tools in China for elderly outpatients.

Malnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients. This study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of <18.5 kg/m2 as a reference. The mean (range) age of the patients was 69.6±6.8 (60-100) years. Overall, 4.3% had BMI <18.5 kg/m2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p<0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively. NRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.

Different Methods to Assess the Nutritional Status of Alzheimer Patients

Objective To assess the body composition and nutritional state of patients with Alzheimer’s (Global Deterioration Scale GDS-4) using different methods and to investigate the correlation among methods. Methods A total of 25 Alzheimer GDS-4 patients participated in this transversal descriptive observational study, which used anthropometry, Mini Nutritional Assessment (MNA), the Nutrition Screening Initiative Check List (NSI) and a 24-hour recall questionnaire (R24h). Results Anthropometric observations pointed to obesity in patients of both sexes. The MNA showed that 76% of the population was “at risk of malnutrition”, and the NSI suggested that 32% had a high nutritional risk, 48% had an “average” nutritional risk, and the remaining 20% a low nutritional risk. The Bland-Alman concordance plot between the NSI and MNA tests pointed to a high degree of agreement, meaning that both tests provided similar results for the group of studied subjects. The nutritional analysis, based on the Kruskal-Wallis test, showed there were significant differences between R24h and MNA in the case of ascorbic acid, iron, zinc and potassium (p < 0.05), and between R24h and NSI in the case of the double unsaturation index and vitamin D3 (p < 0.05). These results suggest that both questionnaires are equally valid for evaluating the nutritional status of Alzheimer patients. Conclusion Although the NSI and MNA tests provide similar results, we recommend an initial nutritional assessment using the NSI since it is short but provides information on any alteration in food intake as a result of restrictions and/or metabolic alterations.

Multicenter Cross-sectional Community-based Nutrition Risk Screening in 3885 Chinese Elderly Adults

Objective To evaluate the nutrition risks in Chinese elderly adults in community and provide the basis for malnutrition prevention.Methods The study population comprised of adults aged 60 years or older selected from communities. A stratified multi-stage cluster sampling method was used to investigate older adults in rural and urban areas with structured questionnaire. Nutrition Screening Initiative (NSI) checklist was used to screen nutritional status. Analyses were stratified according to age,gender,different regions,rural and urban areas,and income.Results A total of 3885 older adults with complete information were enrolled for final analyses,among whom 1894 (48.8%) were males and 1991 (51.2%) were females; 56.2% aged 60-69 years,28.8% aged 70-79 years,and 15% aged over 80 years; 1665(42.9%) were urban residents; 1592(41.0%) were in the eastern region,1211(31.2%) in the central region,and 1082(27.8%) in the western region. Up to 48.4% of the elderly adults were at high nutritional risk,and the nutritional risk was significantly higher in females (50.7%) than in males (46.0%),in individuals aged over 80 years (53.0%) than in other age groups,in urban area (41.7%) than in rural area (53.9%),and in eastern region (52.9%) than in other regions. Significant differences were found between nutritional status and the following variables: age (Χ 2=33.7,P=0.000),gender (Χ 2=15.7,P=0.000),different regions (Χ 2=72.0,P=0.000),rural and urban areas (Χ 2=69.4,P=0.000),income (Χ 2=304.9,P=0.000),and living arrangement (Χ 2=128.1,P=0.000).Conclusion Elder adults in community are at high nutritional risk.

Achieving and Maintaining a Zero Central Line Bloodstream Infection Rate by Implementing a 3.15% Chlorhexidine gluconate/70% Alcohol Swab

To ascertain whether the NSI (Nutrition Screening Initiative Checklist) is a valid screening instrument for diagnosing nutritional risk in an older population from a medium-size city in the south of Brazil.The study population comprised individuals aged 60 years or older selected from a population-based cross-sectional survey. Data collection was carried out at two different timepoints: first, the NSI (instrument under test) was applied and later a dietary recall (gold standard) based on the previous day. Validity analyses were performed based on sensitivity and specificity as well as the Receiver Operating Characteristic Curve.A total of 183 older adults were studied. Agreement between the dietary recall and the NSI for positive and negative results was 54.6%.The sensitivity and specificity values were low for all cut-off points of the instrument. The area under the curve was 0.52 (95%CI: 0.44–0.62) for the cut-off point ≥6.Based on sensitivity and specificity values, the NSI proved ineffective for application in the population studied.

Association between Functional Capacity Decline and Nutritional Status Based on the Nutrition Screening Initiative Checklist: A 2-Year Cohort Study of Japanese Community-Dwelling Elderly.

AimTo assess whether nutritional status based on the Nutrition Screening Initiative Checklist is useful for predicting functional capacity decline in community-dwelling Japanese elderly.MethodsThis two-year observational cohort study included 536 community-dwelling Japanese (65 years and older at baseline) who were independent in both activities and instrumental activities of daily living. Demographic attributes, chronic illness, lifestyle-related habits, nutritional status, functional capacity, and anthropometric measurements were assessed, with decline in functional capacity used as the outcome measure.ResultsSubjects were classified into three groups as follows based on the Nutrition Screening Initiative Checklist: low (59.5%), moderate (23.7%), and high (16.8%) nutritional risk. Significant differences were found between nutritional status and the following four baseline variables: age, hypertension, cerebrovascular diseases, and current smoking. However, no significant differences were evident between nutritional status and sex, body mass index, diabetes, drinking habit, or exercise habit. Logistic regression analysis adjusted for age, sex, body mass index, hypertension, cerebrovascular diseases and smoking habit showed that the high nutritional risk group was significantly associated with a decline in both activities of daily living (odds ratio: 4.96; 95% confidence interval (CI): 1.59–15.50) and instrumental activities of daily living (OR: 2.58; 95% CI: 1.31–5.06) compared with the low nutritional risk group.ConclusionsPoor nutritional status based on the Nutrition Screening Initiative Checklist was associated with a decline in functional capacity over a 2-year period in community-dwelling Japanese elderly. These results suggest that the Nutrition Screening Initiative Checklist is a suitable tool for predicting functional capacity decline in community-dwelling elderly.

Validity assessment of the nutrition screening initiative checklist in older adults

To ascertain whether the NSI (Nutrition Screening Initiative Checklist) is a valid screening instrument for diagnosing nutritional risk in an older population from a medium-size city in the south of Brazil. The study population comprised individuals aged 60 years or older selected from a population-based cross-sectional survey. Data collection was carried out at two different timepoints: first, the NSI (instrument under test) was applied and later a dietary recall (gold standard) based on the previous day. Validity analyses were performed based on sensitivity and specificity as well as the Receiver Operating Characteristic Curve. A total of 183 older adults were studied. Agreement between the dietary recall and the NSI for positive and negative results was 54.6%.The sensitivity and specificity values were low for all cut-off points of the instrument. The area under the curve was 0.52 (95%CI: 0.44-0.62) for the cut-off point ≥6. Based on sensitivity and specificity values, the NSI proved ineffective for application in the population studied.

Identification of Comprehensive Geriatric Assessment Based Risk Factors for Malnutrition in Elderly Asian Cancer Patients.

PurposeElderly cancer patients are at increased risk for malnutrition. We aim to identify comprehensive geriatric assessment (CGA) based clinical factors associated with increased nutritional risk and develop a clinical scoring system to identify nutritional risk in elderly cancer patients.Patients and MethodsCGA data was collected from 249 Asian patients aged 70 years or older. Nutritional risk was assessed based on the Nutrition Screening Initiative (NSI) checklist. Univariate and multivariate logistic regression analyses were applied to assess the association between patient clinical factors together with domains within the CGA and moderate to high nutritional risk. Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating characteristics curve (AUC). Internal validation was performed using simulated datasets via bootstrapping.ResultsAmong the 249 patients, 184 (74%) had moderate to high nutritional risk. Multivariate logistic regression analysis identified stage 3–4 disease (Odds Ratio [OR] 2.54; 95% CI, 1.14–5.69), ECOG performance status of 2–4 (OR 3.04; 95% CI, 1.57–5.88), presence of depression (OR 5.99; 95% CI, 1.99–18.02) and haemoglobin levels <12 g/dL (OR 3.00; 95% CI 1.54–5.84) as significant independent factors associated with moderate to high nutritional risk. The model achieved good calibration (Hosmer-Lemeshow test’s p = 0.17) and discrimination (AUC = 0.80). It retained good calibration and discrimination (bias-corrected AUC = 0.79) under internal validation.ConclusionHaving advanced stage of cancer, poor performance status, depression and anaemia were found to be predictors of moderate to high nutritional risk. Early identification of patients with these risk factors will allow for nutritional interventions that may improve treatment tolerance, quality of life and survival outcomes.

Weight, nutrition, food choice, and physical activity in adults with intellectual disability.

The aim of this study was to describe the nutrition, food choice, physical activity and weight status in a group of adults with intellectual disability (ID) in Victoria, Australia. Disability workers and adults with ID were recruited through disability services. In total, 51 disability workers (11 men, 40 women) and 68 (47 men, 21 women) adults with ID participated in the research. Disability workers provided information about the nutrition, food choice and physical activity levels of adults with ID through a questionnaire administered by a general practitioner or research nurse. The questionnaire also included The Australian Nutrition Screening Initiative checklist. Body Mass Index was in the healthy range for only 37.5% of participants and in the obese range for almost half (41%). Similarly, the majority of participants had an abdominal circumference in a range that put them at increased or substantially increased risk of metabolic complications. The mean score obtained on the Australian Nutrition Screening Initiative checklist indicated a moderate risk of malnutrition (M = 4.2); however, 17.6% of participants achieved scores that put them in the high-risk category. More than half of the participants were reported to have a little choice in the type of food they ate and when they ate. Physical activity data indicated that the majority of participants (60.3%) did not meet national physical activity guidelines. These findings suggest that people with ID are at risk of developing diseases associated with obesity, inactivity, and poor nutrition. Strategies to encourage people with ID to engage in physical activity and healthy eating are, therefore, a matter of priority and should involve their disability workers.

농촌고령자 생활안전서비스 개발을 위한 식생활 상태 평가

This study investigates the dietary risk factors in elderly individuals in rural Korea by focusing on the development of service programs that can improve their health. The sample included 1,000 free-living elderly individuals aged 65 and over in rural Korea. A three-stage stratified random sampling method based on 2010 Korean census data was employed. Data on the dietary status and the need for assistance in meal management were collected through face-to-face interviews. The dietary status was evaluated based on the Nutrition Screening Initiative (NSI) checklist, and the outcomes for three groups classified base on their family type were examined. According to NSI scores, more than 70% of the subjects faced some nutritional risk. The activities most requiring assistance in meal management included preparing meals (18.3%) and purchasing food items (11.7%). More than half of the subjects reported that having meals at community senior centers at least once a week. The results indicate that those subjects from single-individual households were most likely to face some nutritional risk and require, assistance in purchasing food items and preparing meals. In addition, these subjects were least likely to be satisfied with their health and dietary management. To improve the dietary status of elderly individuals in rural Korea, any service programs should facilitate their daily activities by focusing on improving their diet, particularly that of those from low-income, single-individual households.

Eating behaviors of older adults participating in government-sponsored programs with different demographic backgrounds.

The purpose of this study was to determine the food behaviors of nutritionally high-risk seniors as a function of their racial background, gender, marital status, and education level. A total of 69 seniors were identified to be at high nutritional risk using the Nutrition Screening Initiative (NSI) checklist. A supplemental questionnaire (SQ) was created to examine the risk factors in relation to the participant’s demographic background. Key results indicated that Asians practiced healthy food behaviors and women were more likely to eat alone (p≤0.05). Married participants (90.9%) were most likely to consume 2 meals or more each day. College educated individuals practiced healthier eating, eating 5 servings or more of fruits and vegetables (p≤0.01) and 2 or more servings of milk and milk products (p≤0.01). These preliminary findings indicate that more studies should be conducted to focus on the demographic characteristics and food behaviors among older populations.

Assessing nutritional status of acute intermittent porphyria patients

Acute intermittent porphyria (AIP) is a metabolic disease of haem synthesis, whose haem precursors may accumulate in the body. A well-balanced diet may prevent the symptoms, so that porphyric patients should be monitored closely during therapy for possible complications concerning any progression of acute porphyria. The aim was to evaluate the nutritional status of patients with AIP and to assess their compliance with nutritional recommendations, comparing the findings with a control group and assessing any possible nutritional deficiency. Sixteen patients with AIP and a control group were evaluated by means of a lifestyle questionnaire, the Nutrition Screening Initiative checklist and a dietary questionnaire. The following diet quality indicators were calculated: animal and vegetal proteins, protein quality index, PUFA/SFA and MUFA + PUFA/SFA ratios, insoluble dietary fibre (DF)/total DF, soluble DF/total DF and insoluble DF/soluble DF ratios, thiamine, riboflavin and niacin density and the vitamin B6/protein ratio. Differences in continuous variables were compared using the unpaired Student's t-test and the chi-square test for nonparametric variables. The odds ratio (OR) of malnutrition was also used. Our patients showed a low intake of carbohydrates, a high lipid intake and very high protein intake, and accompanied by an inadequate intake of zinc, folic acid and tocopherol, increasing the risk of malnutrition for energy, Ca, Fe, Mg, K, folic acid and tocopherols. The patients with AIP studied individually show an increased risk of malnutrition and, given the potential increase of oxidative stress in patients with porphyria, it is recommended that they should increase their intake of carbohydrates, minerals and antioxidant nutrients.

Supplementing the Nutrition Screening Initiative survey to characterize nutritionally at risk older adults

The Nutrition Screening Initiative (NSI) was developed as a quick and easy method to determine if an older individual may be at nutritional risk. It has been widely used to determine, by scoring, those at nutritional risk. The questions on the NSI targeted to identify seven risk factors such as inappropriate food intake, poverty, social isolation, dependency/disability, acute/chronic conditions, chronic medication use, and advanced age. The purpose of the current study is to further characterize at risk older adults. A supplemental questionnaire (SQ) was developed and administered to 69 participants who were identified as high‐risk based on NSI checklist. Participants’ responses on SQ were analyzed with demographic characteristics such as gender, ethnicity and education. Education level was a major contributor to influence eating behaviors among older adults p≤0.01. Fifty five percent (55%) of those participants who graduated college consumed 5 servings of fruits and vegetables per day compared to (11.9%) of high school graduates and (16.7%) of middle school graduates (p &lt;0.001). Examining the risk factors on NSI can help health providers to determine whether further nutrition intervention is needed. However, more in depth questions should be added to determine the basis for the nutritional risk score.

The effect of a nutritional education program on the nutritional status of elderly patients in a long-term care hospital in Jeollanamdo province: health behavior, dietary behavior, nutrition risk level and nutrient intake

This study was conducted to assess improvements in nutritional status following the application of nutrition education to elderly patients in a long-term care hospital. The study was carried out from January to May 2009, during which a preliminary survey, a pretest, the application of nutrition education, and a post-test were applied in stages. The number of subjects at pretest was 81, and the number of participants included in the final analysis was 61 (18 men, 43 women), all of whom participated in both the nutrition education program and the post-test. The survey consisted of general demographic items, health behaviors, dietary behaviors, the Nutrition Screening Initiative checklist, and nutrient intake assessment (24 hour recall method). The nutrition education program lasted for four weeks. It included a basic education program, provided once a week, and mini-education program, which was offered daily during lunch times. The survey was conducted before and after the education program using the same assessment method, although some items were included only at pretest. When analyzing the changes in elderly patients after the nutritional education program, we found that, among subjective dietary behaviors, self-rated perceptions of health (P < 0.001) and of depression (P < 0.001) improved significantly and that dietary behavior scores also improved significantly (P < 0.001), while nutritional risk levels decreased. In terms of nutrient intake, subjects' intake of energy, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, and vitamin C all increased significantly (P < 0.001). These results indicated that nutritional education is effective in improving the nutritional status of elderly patients. We hope that the results of this study can be used as preliminary data for establishing guidelines for nutrition management tailored to elderly patients in long-term care hospitals.

Evaluation of a Nutrition and Health Educational Online Computer Program for Older Adults

Background: Many older adults are at increased risk for nutritional deficiencies and foodborne illnesses. The objective of this study was to develop and evaluate the effectiveness of a user-friendly computer application that provides nutrition, food safety, and health information tailored to the needs of older adults. Methods: To determine the effectiveness of the program, a 12-month intervention study was conducted in which subjects were assigned to an experimental (HE-HA) group (access to the computer program) or a control (CON) group (no access to computer program). Computers were placed in each of two Vermont rural congregate meal sites. One site served as the HE-HA group site and the other as the CON site. Forty-one adults congregate meal users (HE-HA group: n=16; CON group: n=25) age ? 55, were recruited to participate in the study. The Nutrition Screening Initiative (NSI) checklist, food behavior checklist, and computer attitude surveys were completed by participants at baseline, 3, and 12 months. Focus groups were conducted between 8 and 9 months. Between and within group over time differences were statistically analyzed by Chi-square analyses and repeated measures ANOVA. Results and Conclusions: A significant positive impact of our program was noted on fruit and vegetable consumption (p < 0.005) and attitude regarding use of computers (p < 0.02). Focus group results indicated that all HE-HA participants claimed to have changed at least one aspect of his/her diet and that the Website contributed to this positive change. They also noted that the help of the “peer mentors” was a significant factor in their positive experience with using the Web application and with the use of computers in general. In this study, we demonstrated the successful use of a nutrition and health computer application in improving both nutrition behavior and computer skills and attitudes in older adults.

Relation between nutritional risk and metabolic syndrome in the elderly

Nutrition is regarded as a major factor in the development of metabolic syndrome (MS). Undernutrition or nutritional imbalance, rather than overnutrition, can be associated with MS. We evaluated the relationship between nutritional risk and MS in the elderly. We analyzed 2284 Koreans aged over 60 years (689 men and 1595 women) from baseline data of a large prospective study called the Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS). MS was determined according to the National Cholesterol Education Program Adult Treatment Panel III, and nutritional risk was evaluated using the Nutrition Screening Initiative (NSI) checklist. Among 2284 subjects, 1219 (53.4%) had MS. NSI score was higher in subjects with MS than in those without MS (2.46 ± 1.89 vs. 2.18 ± 1.87, p < 0.001). The risks of abdominal obesity, elevated blood pressure, elevated glucose, and MS were higher in subjects with moderate or high nutritional risk compared to subjects in a good nutritional state. Nutritional risk was independently associated with MS for subjects in their 60s, but not in their 70s or 80s and above. In conclusion, high nutritional risk is associated with increased risk of MS in the elderly. Measurement of nutritional status in the elderly may serve as a marker for MS, especially for the younger elderly.

Nutritional Risk among Oklahoma Congregate Meal Participants

Objective To determine if there were differences by demographic variables in response rates to Nutrition Screening Initiative (NSI) Checklist statements reported by over 50% of Oklahoma Older Americans Act Nutrition Program (OAANP) congregate meal participants categorized at high nutritional risk based on cumulative NSI Checklist scores. Design This study evaluated Oklahoma State Unit on Aging statewide archival demographic and NSI Checklist data from 8892 OAANP congregate participants. Analysis Data were analyzed using chi-square analyses. Results Eighteen percent of congregate participants were categorized at high nutritional risk. Over 50% of participants categorized at high nutritional risk reported “yes” to having an illness or condition that affected food eaten; eating alone; taking 3 or more medications; and inability to shop, cook, and feed themselves. Significant differences were observed in participant “yes” response rates to these NSI Checklist statements by demographic variables. Participants responded “yes” more to these statements if they were female, of advanced age, and living alone or in rural areas. Conclusions and Implications The results of this study indicate problem areas and population groups for targeting nutrition education programs and services among Oklahoma OAANP congregate meal participants.

地域在住要介護高齢者の低栄養リスクに関連する要因について

To define degree of nutritional risk in community-dwelling older disabled adults using translated Nutrition Screening Initiative (NSI) checklist and to identify important underlying factors associated with high nutritional risk. Community-based studies were conducted in Katsushika, Tokyo and Odate and Tashiro, Akita. A total of 695 and 381 older adults, respectively, designated for long-term care insurance were interviewed. Nutritional risk was measured using the Japanese-translated NSI checklist. Demographic information, ADL, IADL, MMSE, CES-D, PGC morale scale, self-perceived health, loneliness, perceived caregiver's care burden, relationship with caregiver, perceived inadequacy of income, perceived burden of care cost were assessed using standardized instruments. Self-perceived health strongly related to high NSI score in both areas. Nutritional risk was considered 'high' when simply added NSI score was 3 points and over (NSI-10) and weighed NSI score was 6 points and over (NSI-21). Logistic regression analysis demonstrated that high levels of depression symptoms, poor self-perceived health, female and area (Odate/ Tashiro) were associated with NSI-10-based high risk and high levels of depression symptoms, smaller family member, perceived inadequacy of income and area (Odate/Tashiro) were associated with NSI-21-based high risk. These results were completely same when CES-D scores were replaced with PGC morale scale scores. It is concluded that emotional well-being is the important factor for maintaining nutritional environment in community-dwelling disabled older adults.

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

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.