FNOA: Aging Programs (2012)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To assess the use of physician-prescribed special diets, food preferences, and daily and occasional drug use by elderly participants in a Title III-C Nutrition Program.

Inclusion Criteria:

Not addressed in this study; explained in a previously published study.

Exclusion Criteria:

Not addressed in this study; explained in a previously published study.

Description of Study Protocol:

Recruitment

Explained in previously published study

Design

Cross-sectional, descriptive study

Non-random subjects were interviewed one time either in home (for meals-on-wheels clients) or at the senior center (for congregate clients). The subjects responded to questions about:

  • Whether a special diet had been prescribed by a physician
  • The health condition for which the diet was prescribed
  • A list of favorite foods
  • Food likes and dislikes among items provided often in the noon meals
  • Dislikes in style of preparation of items in the noon meal
  • Frequency of serving certain food items
  • Daily and occasional medicinal intakes.

Names of medications were observed directly for meals-on-wheels subjects, whereas congregate meal subjects were later called on the telephone and asked to provide medication information.

Blinding used

Not applicable

Intervention

Not applicable

Statistical Analysis

Chi-square was used to assess whether food and drug behaviors were related to six population variables: ethnicity, age, gender, congregate vs. meals-on-wheels clients, proportion of noon meal usually eaten, and whether clients lived alone or with others.

Data Collection Summary:

Timing of Measurements

Subjects for meals-on-wheels were interviewed one time at home. The congregate subjects were interviewed at the senior centers and telephoned at home the evening after the interview for additional information on pharmaceutical intake.

Dependent Variable

  • Food behavior (obtained from survey)
  • Medication use (obtained from survey or telephone interview).

Independent Variables

  • Ethnicity
  • Age
  • Gender
  • Congregate client
  • Home delivery client
  • Proportion of noon meal usually eaten
  • Subject lives alone or with others.

Control Variables

Description of Actual Data Sample:
  • Initial N: 103 elderly subjects
  • Attrition (final N): As above
  • Age: Not reported
  • Ethnicity: Not reported
  • Other relevant demographics
  • Anthropometrics
  • Location: Georgia.

 

Summary of Results:

Special Diets

  • 60 of 103 subjects had never been advised to implement a special diet
  • Subjects who had been given diet prescriptions: 63% were for cardiovascular problems, 26% diabetes, 8% for gastritis/peptic ulcer/hiatal hernia, and 3% for colostomy/ileostomy
  • No significant relationship between six selected variables on subjects who had been given diet prescriptions.

 Food Preferences

  • One-third of subjects suggested that certain foods in the noon meal were served too infrequently: whole fish piece, rice, tossed salad, soft fruits, and more sweet potatoes
  • 43% wished certain food items were prepared differently. Requests included: more salt and seasonings, fewer gravies and greasy foods, elimination of pressed turkey, shorter cooking time for broccoli, more sliced and fewer mashed potatoes, less salad dressing on cole slaw, omission of celery and peppers in potato salad, baked instead of raw apples, more rice and less bread, and greens, beans, and peas cooked with meat.
  • 44% percent of subjects expressed no food dislikes. Those who did broccoli cited most frequently (21%).
  • 74% of subjects reported favorite foods. Fish and chicken were the meats cited by 42% of the positive respondents; turnip and collard greens were cited by 28% for positive vegetables; sweet potato pie (14%) and ice cream (8%) for favorite dessert.
  • White senior adults (57%) made more suggestions than blacks (16%) for foods they wanted served more often
  • Home delivery subjects (46%) made more suggestions than congregate subjects (23%) for specific foods to be served more often (P<0.0001)
  • Persons who regularly ate half or less of noon meal made more suggestions for cooking foods differently (P<0.005) and provided longer lists of favorite foods (P<0.001)
  • Persons who lived alone had more suggestions for cooking food differently (P<0.005) and serving certain items more often (P<0.05) than those who lived with other persons
  • Food dislikes did not relate significantly to any of the six variables in this study.

Medications

Daily

  • 82% of subjects used medications daily (71% men and 81% women)
  • Congregate medication users (80%) and home delivery participants (85%)
  • Most frequently used daily medications were analgesics, mainly non-steroidal, anti-inflammatory prescription drugs (39%)
  • 35% of subjects used drugs for congestive heart failure, ischemic heart disease, and other cardiac problems
  • Mood drugs were taken by 16% of subjects
  • Hormone replacement medication was taken by 15%
  • 13% of the subjects were diabetic and two thirds of these were taking oral hypoglycemic agents and one third was taking insulin
  • Laxatives and stool softeners were ingested daily by 11% of subjects
  • 10% of subjects took drugs for peptic ulcer and reflux esophagitis
  • 24% of subjects took vitamin supplements
  • 12% of subjects took mineral supplements: Calcium, iron and zinc
  • 50% of medication users were 70-80 years of age and subjects older than 85 constituted the smallest group (12%) of daily users.

Occasional

  • 42% of the subjects used occasional medications (43% men, 41% women and equal between congregate and home delivery subjects)
  • Most frequently used medications were analgesics and laxatives/stool softeners
  • Statistical analysis of the number of medications, daily and occasional, indicated that there was not a significant relationship to any of the six variables in this study.

 

Author Conclusion:

Elderly subjects who participate in Title III-C Nutrition Programs have food preferences which they articulate effectively and many of which may result in an increased in client satisfaction while simultaneously maintaining program compliance.

Polypharmacy and inadequate nutrient/energy intakes indicate an exceptional vulnerability of this population to both nutritional deficiency and drug-induced illness.

Funding Source:
University/Hospital: Small Grant Program from Georgia State University
Reviewer Comments:

Inclusion/exclusion criteria not reported; study sample not well described.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? No
  2.4. Were the subjects/patients a representative sample of the relevant population? No
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? ???
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes