Although nutrition education is important across the lifespan, research funding seems to be more focused on childhood, specifically childhood obesity. Certainly, no one can argue that this is not critical since childhood obesity can diminish health and quality of life for decades beyond those early years. However, since this issue includes our position paper on older adults,1 I wanted to draw some attention to the opposite end of the lifespan.
In a Viewpoint published in 1990 in JNEB by Nestle and Gilbride,2 an outline for priorities for new nutrition initiatives includes the establishment of nutrition objectives to improve the health of older adults by the year 2000. In this issue's position paper,1 advocacy for national nutrition goals to address and reduce malnutrition is included as a responsibility of nutrition practitioners. Issues such as hunger and food insecurity, the need for screening and counseling, and a description of food assistance programs can help frame what nutrition objectives should be set, but how far have we come since the 1990’s?
JNEB published a systematic review of the effectiveness of nutrition interventions for older adults in 2011.3 Ten randomized controlled trials involving education and counseling were identified, most with positive results. Active participation, personalized health plans, goal setting, and improved self-efficacy were characteristics of the most promising interventions for the community-living older adults. In an umbrella systematic review and meta-analysis, Poscia et al4 found 9 studies that focused on education or counseling, with 6 having positive results. Supplementation interventions were more effective, especially in relation to reducing falls, fractures, and risk of malnutrition. Combination strategies included environmental issues, supplementation and lifestyle changes. Are we as nutrition educators including supplementation advantages and disadvantages, fall risk management, and consequences of malnutrition in our programs?
In an exploratory study by Tucker and Reicks,5 205 older adults (mostly white women) were surveyed about their exercise and eating beliefs within a Stages of Change framework. The authors concluded that addressing exercise might provide a gateway to addressing healthful eating, but this association seemed only true for fruit and dairy products and not for vegetables or reducing dietary fat. Although not without limitations, the partnering of physical activity and healthful eating may be a successful intervention for some older adults. Once again though I must ask, are we as nutrition educators prepared to address physical activity?
Elicitation interviews with low-income older adults6 had some surprising results, at least to me. Concerns about the cost and access to fruits and vegetables were as expected, but concerns about interactions between medications and fruit and vegetable intakes were not. I certainly remember questions about vitamin K and blood thinning medications or grapefruit juice and statins from my long-ago diet counseling experiences, but I really have not seen much on this topic in JNEB.
I think we have continued to address issues in nutrition and the older adult, but I feel we have many opportunities to improve our skills, develop and implement meaningful programs, and push for policies that go beyond food assistance. The challenges of working in aging health are many, but nutrition educators and researchers can be at the forefront, as reflected in this issues’ position paper.
- Saffel-Shrier, S, Johnson, MA, and Francis, SL. Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and nutrition programs for community-residing older adults. J Nutr Educ Behav. 2019; 51: 81–97
- Nestle, M and Gilbride, JA. Nutrition policies for health promotion in older adults: Education priorities for the 1990s. J Nutr Educ Behav. 1990; 22: 314–318
- Bandayrel, K and Wong, S. Systematic literature review of randomized control trials assessing the effectiveness of nutrition interventions in community-dwelling older adults. J Nutr Educ Behav. 2011;43: 251–262
- Poscia, A, Milovanovic, S, La Milia, DI et al. Effectiveness of nutritional interventions addressed to elderly persons: umbrella systematic review with meta-analysis. Eur J Public Health. 2018; 28: 275–283
- Tucker, M and Reicks, M. Exercise as a gateway behavior for healthful eating among older adults: An exploratory study. J Nutr Educ Behav. 2002; 34: S14–S19
- Jung, SE, Shin, YH, Kim, S, Hermann, J, and Bice, C. Identifying underlying beliefs about fruit and vegetable consumption among low-income older adults: An elicitation study based on the Theory of Planned Behavior. J Nutr Educ Behav. 2017; 49: 717–723