F&N 6-7

06/05

Abstract

Using Factors Associated with High Nutrition Risk Among Oklahoma Older Americans Act Nutrition Program Participants to Target Nutrition Education

Prepared by: Kim Quigley, M.S., R.D./L.D. Janice Hermann, Ph.D., R.D./L.D.

Nutrition Therapist IV Nutrition Education Specialist

Oklahoma Department of Human Services 333 HES/NSCI

Aging Services Division Cooperative Extension Service

Oklahoma City, OK 73105 Stillwater, OK 74078-6111

(405) 744-6824

Source: Quigley, K. & Hermann, J. (2004) Evaluating Factors Associated with High Nutritional Risk Among Oklahoma Older Americans Act Nutrition Program Participants. Association of Gerontology in Higher Education Annual Conference.

IMPLICATIONS FOR COOPERATIVE EXTENSION. With the continuing increase in the older population, the importance of nutrition education to assist older adults in achieving good nutritional status cannot be under estimated. Nutrition plays many roles in successful aging. Nutrition not only contributes to physical well-being but also contributes to social and emotional well-being. Evaluating factors associated with nutritional risk among Oklahoma Older Americans Act Nutrition Program participants can help indicate potential problem areas for targeting nutrition education programs to reduce nutritional risk among Oklahoma OAANP participants.

Purpose

The purpose of this study was to investigate characteristics and factors associated with high nutritional risk among 18,488 Oklahoma Older Americans Act Nutrition Program (OAANP) participants. The results of this study can assist targeting nutrition education programs to reduce participant’s nutritional risk and maintain independence.

Methods

Congregate and home delivered meal participants in the 2003 Oklahoma OAANP completed the Nutrition Screening Initiative “Determine Your Nutritional Health (DYNH)” checklist. The DYNH checklist is a tool used to screen for older adults for risk of malnutrition.

Demographic data also was collected on 2003 Oklahoma OAANP participants including age, gender, race, living arrangement, geography, poverty level, and type of meal received. Age categories included 60-69 years, 70-79 years, 80-89 years, and 90 years and above. Race categories included Caucasian, African American, Native American, Hispanic, Asian and Other. Living arrangement categories included living alone or living with others. Geographical categories included rural and urban. Poverty categories included above or below poverty. Types of meals received included congregate and home delivered meals.

Oklahoma 2003 OAANP DYNH checklist and demographic data were analyzed using the Statistical Analysis System, Version 8 means,

Using Factors Associated with High Nutrition Risk Among Oklahoma Older Americans Act Nutrition Program Participants to Target Nutrition Education (continued)

frequencies, independent test and analysis of variance procedures. Significance was P ≤ 0.05.

Results: Differences in Nutrition Risk by Among OAANP Participants

Significant differences were observed in DYNH scores based on age, gender, race, geographic location, poverty level, living arrangement and type of meal received. For those who scored at high nutritional risk:

• Males had significantly higher DYNH scores
• Asians and “Others” had significantly higher DYNH scores than Native Americans
• The 60-69 year age group had significantly higher DYNH scores
• Participants below the poverty level had significantly higher DYNH scores
• Those living in urban areas had significantly higher DYNH scores
• Those living with others had significantly higher DYNH scores
• No significant difference was observed in DYNH scores by type of meal received

Results: Differences in OAANP Participants Responses to DYNH Statements

Differences were observed in OAANP participants’ responses to DYNH checklist statements by nutritional risk. For those who scored at high nutritional risk:

• 69% answered “yes” to the statement “I have an illness or condition that made me change the way I eat.”
• 16% answered “yes” to the statement “I eat less than two meals per day.”
• 21% answered “yes” to the statement “I eat few fruits, vegetables or milk.”
• 1% answered “yes” to the statement “I have three or more drinks of beer, alcohol or wine.”
• 31% answered “yes” to the statement “I have tooth or mouth problems that make it hard for me to eat.”
• 24% answered “yes” to the statement “I don’t always have enough money to buy the food that I need.”
• 72% answered “yes” to the statement “I eat alone most of the time.”
• 89% answered “yes” to the statement “I take three or more prescribed or over the counter drugs.”
• 45% answered “yes” to the statement “I have lost or gained ten pounds without wanting to.”
• 86% answered “yes” to the statement “I am not always able to shop, cook, or feed myself.”

Discussion

Factors associated with nutritional risk among 18,488 Oklahoma OAANP congregate and home delivered meal participants were evaluated using the “Determine Your Nutritional Health” checklist. The data indicated 18% of congregate participants and 42% of home delivered meal participants scored at high nutritional risk.

Among OAANP participants who scored at high nutritional risk, those who were male, aged 60-69 years, lived below poverty level, lived in urban areas and lived with others had significantly higher DYNH scores. In addition,

Using Factors Associated with High Nutrition Risk Among Oklahoma Older Americans Act Nutrition Program Participants to Target Nutrition Education (continued)

among those who scored at high nutritional risk, Asians and Others had significantly higher DYNH scores than Native Americans; however, no significant difference was observed in DYNH scores among those who scored at high nutritional risk by the type of meal received. These represent important groups to target nutrition education programs.

However, among OAANP participants who scored at high nutritional risk, important differences are apparent between those with significantly higher DYNH scores and the proportion of participants who scored at high nutritional risk. For example, although males had significantly higher DYNH scores than females among those who scored at high nutritional risk; over two and a-half times as many females scored at high nutritional risk than males.

In addition, although Asians and Others had significantly higher DYNH scores than Native Americans among those who scored at high nutritional risk; Asians and Others represent less than 1% of the OAANP participants who scored at high nutritional risk, whereas Native Americans represent 9% of participants who scored at high nutritional risk.

Although of those who scored at high nutritional risk, participants living in urban areas had significantly higher DYNH scores than those living in rural areas; almost twice as many participants who scored at high nutritional risk lived in rural areas. Similarly, although among those who scored at high nutritional risk participants living with others had significantly higher DYNH scores than those living alone; almost twice as many participants who scored at high nutritional risk lived alone.

No significant difference in DYNH scores was observed among those who scored at high nutritional risk by type of meal received; however, almost two and a-half times as many participants who scored at high nutritional risk received home delivered meals. Hence, when targeting nutrition education programs one must take into consideration not only significant differences in DYNH scores, but also the proportion of participants within different sociodemographic categories that could be reached.

Certain “Determine Your Nutritional Health” checklist statements also stand out among OAANP participants who scored at high nutritional risk as potential subject areas for targeting nutrition education program due to the high percentage of participants who responded “yes” to the statements. Eighty-nine percent of those who scored at high nutritional risk answered “yes” to the statement “I take three or more prescribed or over the counter drugs.” Although the Oklahoma OAANP cannot change the number of medications participants are taking, it may be an appropriate location to provide education programs addressing drug-nutrient interactions or drug-drug interactions. Eighty-six percent of those who scored at high nutritional risk answered “yes” to the statement “I am not always able to shop, cook, or feed myself.” In addition, seventy-two percent of those who scored at high nutritional risk answered “yes” to the statement “I eat alone most of the time.”

Conclusion

Although scoring high on the “Determine Your Nutritional Health” checklist is not a complete determinant of high nutritional risk, it may

Using Factors Associated with High Nutrition Risk Among Oklahoma Older Americans Act Nutrition Program Participants to Target Nutrition Education (continued)

certainly indicate potential problem areas and assist in targeting nutrition education programs. The results of this study indicate programs related to “taking three or more prescribed or over the counter drugs,” “ability to shop, cook and feed self” and “eating alone most of the time,” targeting those who score at high nutritional risk could be beneficial to reduce high nutritional risk among Oklahoma OAANP participants.