Nutritional education for community dwelling older people: A systematic review of randomised controlled trials

Young, Kathryn Rose; Bunn, Frances; Trivedi, Daksha; Dickinson, Angela

doi:10.1016/j.ijnurstu.2011.03.007

Cited by 54 publications

(52 citation statements)

References 69 publications

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“…110 However, within a nutritional counselling review of 15 trials, interventions containing active participation and collaboration with older adults showed greater promise for improving dietary behaviour changes. 111 Certain BCTs, including 'barrier identification/problem-solving', 'plan social support/social change', 'goal-setting (outcome)', 'use of follow-up prompts' and 'provide feedback on performance' were associated with greater intervention effects across 22 trials of increasing fruit and vegetable consumption.…”

Section: Nutritionmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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Background Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting Community settings in London and Hertfordshire, UK. Participants A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work A large, definitive RCT of the HomeHealth service is warranted. Study registration This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information.

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Section: Nutritionmentioning

confidence: 99%

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Walters

Frost

Kharicha

et al. 2017

Health Technol Assess

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“…Health promotion through the encouragement of certain dietary habits are easier to incorporate into intervention programs and to be followed by the target audience (K. Young, et al, 2011 Depression is one of the most prevalent and costly of all mental health disorders and a leading cause of disability (Stanner, et al, 2009). Reports on the prevalence of clinically significant depressive symptoms among healthy older adults range from approximately 8% to 16% (Blazer, 2003).…”

Section: Manuscript 3: Reverse Causality Of Diet-depression Relationshipmentioning

confidence: 99%

Nutritional predictors of depression in a cohort of community-dwelling elderly Canadians: NuAge cohort

GougeonLaura¹

2014

Appl. Physiol. Nutr. Metab.

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Depression is associated with decreased quality of life and high mortality risk at all ages and, despite having lower prevalence in community-dwelling seniors compared to other stages of the life span or institutionalized elderly, it negatively affects seniors' health outcomes. Most evidence linking late-life depression, defined as first onset after 65 years of age, with dietary factors comes from cross-sectional studies, which cannot provide information on whether declines in diet were a consequence of depression-the reverse causality hypothesis. The Quebec Longitudinal Study on Nutrition and Aging (NuAge) provides an ideal setting to explore such a relationship among a healthy, community-dwelling elderly population. Diet is hypothesized to be a factor associated with depression. Some longitudinal evidence from studies with middle-aged adults suggests that dietary patterns such as the Mediterranean or patterns deemed "healthy" are protective against depression, while "western" and "unhealthy" patterns are risk factors for the disease. B-vitamins are important cofactors in neurotransmitter synthesis and in the enzymes of the one-carbon metabolism, which has been hypothesized to have an aetiological role in depression through its neurotoxic derivates, such as homocysteine. Nonetheless, it is still largely unknown how depression affects nutrient intake in the elderly population, raising the question of the directionality of the association. Therefore, ii the three objectives of this thesis were to explore the longitudinal associations of i) dietary patterns and macronutrient intake and of ii) B6, B12 and folate intakes with the incidence of depression in late life; and iii) to investigate whether depression significantly affects short-term nutrient intakes (reverse causality effect) in comparison to intakes among non-depressed seniors.Data for this study have been obtained from the NuAge cohort, a 4-y longitudinal study of 1,793 community-dwelling men and women aged 68 to 82 years at baseline. The main outcome is incidence of depression as defined by scores in the 30-item Geriatric Depression Scale ≥11 and or antidepressant medication use over the three years of follow-up. Participants were free of depression at the study's baseline through the exclusion of those with GDS scores ≥11 or antidepressant use at the time of the recruitment. Individuals with invalid or missing dietary information were also excluded. Dietary patterns were created through principal component analysis on amount (grams) of food items consumed in each of the 32 predefined food categories. Sex-specific tertiles of intake were created from the mean of three non-consecutive 24h-recalls. Multiple logistic regression models were adjusted for several demographic, health, and social confounders. For the study of the reverse causality hypothesis, we conducted a case-control nested within the NuAge cohort. Participants free of iii depression at baseline who developed depression at some point of follow-up were matched by age group and sex with...

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“…The findings from the pilot test suggest that already established routines and habits guided the choice of meals and eating patterns, but that the photos in APPETITT to a certain extent did influence the informants' choices during the trial period. Studies have shown that nutritional counselling may give increased knowledge on adequate nutrition, and this may influence the food intake (20,28). Eating habits are, however, very personal, and it is important to acknowledge that changes in diet can be difficult to make for those who need it the most (29).…”

Section: Meal Suggestions and Eating Habitsmentioning

confidence: 99%

Ny app kan gi ernæringsstøtte til hjemmeboende eldre

Farsjø¹,

Moen²

2016

Sykepleien

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The recently developed app APPETITT can inspire to a varied diet and increase the attention to dietary habits for home-dwelling elderly. Objective: To assess if the application was sufficiently adapted to the elderly inexperienced users of technology, and if the application had potential to contribute to encouragement and orientation about meals.Method: We did a pilot study in spring 2014. Four elderly used APPETITT for four weeks. Data was collected in a focus group interview and the informants demonstrated how they used APPETITT.Results: The informants used APPETITT daily and considered it easy to use. Meal suggestions presented as pictures inspired and influenced to some extent the informants' meal choices. Two informants found that reporting food choices could increase awareness, while two saw little need for this function in the prototype. The pilot test revealed that notification of meals did not work as anticipated; only one of them had paid attention to the notifications. INTRODUCTIONThe proportion of elderly in the Norwegian population will continue to increase in the coming decades (1). Health authorities thus encourage municipalities to focus on the development of competence and innovative service with novel technologies to meet the municipal health services' challenges related to the increasingly elderly population (1, 2).Welfare technology solutions as a part of the health services are important contributions to the national effort to help the elderly live independently and safely in their own homes as long as possible (1-4). Welfare technology focussing on promoting health and prevention through new communication possibilities, information collection and support for self-care, is called health-enabling technology (4, 5). Tablet computers are considered intuitive and easy to use, also for the elderly, and are therefore attractive for technological health-enabling solutions (6, 7). It may nevertheless be challenging to introduce this kind of technology to the elderly. Some studies point out that elderly have low motivation, self-management expectations, and technological experience, raising the threshold for starting to use technology (3,8). The cost of the tablet computer and loss of physical function may affect the elderly's introduction to using modern technology. They may need repeated instructions and follow-up during a training period (3,(8)(9)(10). Studies, in which elderly have been introduced to technology using a touch screen, show that the elderly often master this kind of technology. However, individuals with cognitive impairment have greater challenges and more limited possibilities for learning to use the technology independently (6-8,10, 11). Use of a tablet and applications may also be influenced by the applications' design, interactions and whether the topics for the app are considered interesting and relevant (6,7,10,11).From a nursing perspective, the purpose of the study was to explore whether the tablet application APPETITT (APPlikasjon for Eldre, TIltak mot vekTTap [Application...

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Nutritional education for community dwelling older people: A systematic review of randomised controlled trials

Abstract: Nutritional education, alone or as part of a complex intervention, can improve diet and physical function and may reduce depression in the over 65 s living at home.

Cited by 54 publications

References 69 publications

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT

Nutritional predictors of depression in a cohort of community-dwelling elderly Canadians: NuAge cohort

Ny app kan gi ernæringsstøtte til hjemmeboende eldre

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