Brief Summary of Minutes of Annual Meeting

Accomplishments/Station Reports University of Massachusetts, Nancy Cohen Nancy Cohen (with graduate students Amanda Sylvie and Qianzhi Jiang) Objective 1, Experiment 1: Environmental changes to increase fruit, vegetable, and whole grain intakes in older adults Researchers in MA are examining recommendations for changes to the community environment to support increased consumption of fresh fruits, vegetables, and other high-nutrient foods in older adults. In 2011-12, we used a qualitative ranking tool to identify the most important and most changeable environmental determinants to improve nutritional status among older adults. Two online brainstorming sessions were held among 12 national experts in community nutrition and geriatric nutrition, including Northeast Regional Project collaborators from NH, IA, and NY. Based on social-ecological theory, the expert panel reviewed factors that enable healthy eating and community settings where nutrition behaviors are practiced. A hierarchy model was used to identify the most important and modifiable enablers to improve older adults eating behaviors. In this model, enablers were considered as determinants that could influence senior nutrition at the environmental level. Open-ended questions were used to stimulate ideas of possible changes in different behavioral settings at community levels. Audio recordings of the discussions were reviewed, and major themes were summarized. As a result, accessibility, affordability, social support, and living accommodations were identified as the factors that can enable improvement in nutritional status. Among enablers, accessibility had the highest percent of importance related to the goal of healthy eating in older adults, followed by social support. Based on the results of the hierarchy model, food stores had the highest priority score when considering accessibility and affordability. Congregate nutrition sites ranked high when considering social support and living accommodations. Senior housing was also important as related to living accommodations. Congregate nutrition sites and food stores were most important in contributing overall to the goal of healthy eating in older adults, followed by senior housing, health care settings, religious settings, and restaurants. Possible changes in each of these behavioral settings include: providing cooking demonstrations, nutrition screening and education, and cultural and ethnic foods at congregate nutrition sites, as well as more funding; providing easier-to-reach items and easier-to-read nutrition information in food stores with advertising of healthy foods and smaller packaging; building community gardens, holding health fairs, and offering nutrition education programs and healthy cooking demonstrations at senior housing through peer training; offering healthy vending and cafeteria food and nutrition information at health care sites; offering congregate meals, health screenings and nutrition education at religious settings; and offering smaller portions, healthier choices, discounts for healthy choices, and nutrition labels in restaurants. Further research on recommended environmental changes to improve the nutritional intake of older adults is ongoing. Iowa State University, Sarah Francis Life & Chef Charles OUTPUTS: The Living well through Intergenerational Fitness and Exercise [LIFE] Program pilot tested a community-based, intergenerational exergaming program for older and young adults. The central hypothesis was that the LIFE Program would increase functional fitness, subjective well-being and physical activity readiness to change among older adults while improving aging perceptions among young adults. We tested this hypothesis by pursuing the following research objectives: 1. Determine the effects of the LIFE program on older adult health and subjective well-being; 2. Determine the influence that a reversed intergenerational approach utilizing service learning has on young adults perceptions on aging and older adults; and 3. Determine the current and future health promotion needs and preferences of Iowans (age 45 and older) currently not eligible for or participating in congregate meal site health promotion programs. For this project we developed: recruitment information, questionnaires, program logo, wellness newsletters (8), a Trainer workshop curriculum (handouts, PowerPoint slides) and program user guide (10 Chapters, plus appendices). We provided two Trainer workshops, tested the program at seven locations (5 senior centers, 2 senior apartment complexes), and conducted three program focus groups. Four statewide needs assessment focus groups were conducted. The LIFE project has been presented at the 2011 Urban 4-H Conference and the 2011 Gerontological Society of America meeting. In fall 2011, funding was also received for the Chef Charles revision project through the Wellmark Foundation. The Chef Charles program a newsletter-based nutrition education program for congregate meal site participants that is led on-site by a nutrition educator or volunteer. Chef Charles encourages: fruit, vegetable and calcium-rich food consumption; physical activity; food safety practices; and promotes food security. The Chef Charles Revision Project will integrate information attained through qualitative program evaluation, professional independent program review, and future needs and preference assessment to create an evidence-base nutrition education program for older adults. The research objectives for this project include: 1. Determine the effects of the revised Chef Charles program on older adult nutritional risk, self-efficacy of healthful eating, and fruit and vegetable consumption. The working hypothesis for this research objective is that in incorporating components of the HBM and the target audiences needs and preferences in the Chef Charles program design, we will evoke changes in older adult nutritional risk, self-efficacy and fruit and vegetable intakes; and 2. Determine the effects of the revised Chef Charles program on participant satisfaction. The working hypothesis for this research objective is that the proposed modifications in the revised program will lead to higher participant program satisfaction. To date we have identified four congregate meal sites to participate in the study (2 treatment, 2 control), designed a new Chef Charles newsletter template for the treatment groups, and started participant recruitment. OUTCOMES/IMPACTS: The LIFE Program has a 67.6% (46 out of 68 participants) completion rate for older adult participants and 100% completion rate for Trainers. Pre- (Week 1), post- (Week 8), and follow-up (Week 25) data were collected for all participants and trainers. For participants who were classified as inactive at Week 1 (21 total), five became active by Week 8 (p-value equal to 0.021), and six additional from Week 8 to Week 25 (p-value equal to 0.010). This was a 51 percent increase. Significant (p-value equal to or less than 0.005) improvement was seen in the number of chair stands participants were able to complete in 30 seconds from Week 1 to Weeks 8 and 25. Additionally, right handgrip strength improved (p-value equal to or less than 0.005) from Week 1 to Week 25. Furthermore, flexibility, as measured by the back scratch test, for the left arm significantly improved from Week 1 to Weeks 8 (p-value equal to or less than 0.038) and 25 (p-value equal to or less than 0.005). All other fitness and subjective well-being variables indicated improvement, however none were significant. Almost all participants (40 out of 46) stated they would recommend the LIFE Program to friends or family. Trainers demonstrated significant improvement in aging knowledge (p-value equal to 0.027), expectations regarding aging and mental health (p-value equal to 0.017), expectations regarding aging and cognitive function (p-value equal to 0.043), total expectations regarding aging score (p-value equal to 0.046), and a reduction in the number of aging stereotypes believed (p-value equal to 0.016) from Week 1 to Week 8. Trainer follow-up data are currently being analyzed. No changes were detected with anxiety about aging. Finally, focus groups transcripts are currently being analyzed to identify key themes. There are no outcomes to report for the Chef Charles revision project at this time. PARTICIPANTS: Individuals: Sarah L. Francis, Ph.D., MHS, RD (PI), Assistant Professor/State Nutrition Extension Specialist, Dept. of Food Science and Human Nutrition; Warren D. Franke, Ph.D., FACSM (Co-investigator), Professor/Director, The Exercise Clinic at Dept. of Kinesiology; Jennifer A. Margrett, Ph.D. (Co-investigator), Assistant Professor, Department of Human Development and Family Studies; Marc Peterson (collaborator), Grant Coordinator Dept. of Food Science and Human Nutrition (at the time of the study Peterson was a Program Specialist, 4-H Youth Development, Iowa State University Extension); Kara Strand and Rebecca Brotzman, Graduate Students, Dept. of Food Science and Human Nutrition. Organizations: Aging Resources of Central Iowa (congregate mealsites in Story and Polk Counties Iowa), Iowa Department on Aging, and Iowa Department of Public Health. TARGET AUDIENCES: The LIFE program utilized an intergenerational design towards health promotion of older adults. We recruited a convenience and snowball sample of 100 rural older adults age 60 years and older (68 started the program; 46 completed) and 48 young adults ages 16 years and older (18 started the program; all completed). Young adults served as the on-site program trainers and older adults were the program participants. Trainers were female (17 out of 18 total) between ages 21 and 25 years (13 out of 18 total) in their junior and senior year of college (14 out of 18 total) with occasional daily contact with older adults (11 out of 18 total) who had not lived with an older adult in the last five years (13 out of 18). Participants were independently-living (37 out of 46 total) widowed (27 out of 46 total) females (40 out of 46 total) with a mean age of 75.3 years in somewhat to very good health (28 out of 46 total) who had occasional daily contact with youth (32 out of 46 total). Needs assessment focus group participants (27 total) were married (17 out of 27 total), white (26 out of 27 total), educated (23 out of 27 total) females (21 out of 27 total) with a mean age of 62.5 years who lived in rural areas (19 out of 27 total) and worked at least 31 hours weekly (15 out of 27 total). For the Chef Charles revision project, 64 individuals have expressed interest in participating. PROJECT MODIFICATIONS: Reported modifications refer to the LIFE project. On-Site Leader Recruitment: A proposed sustainable LIFE Program component is the use of on-site leaders; however recruitment of on-site leaders has proven extremely difficult. Most participants state they would like the program to continue but are not interested in leading it. The most common reason is Im retired and dont want to commit to anything long term. In an attempt to aid the recruitment process the research team opted for on-the-job training rather than a two-hour workshop. The on-the-job trainer agenda includes a six week training agenda totaling four and one-half hours of training. It occurs 15 to 20 minutes before and after each session. These sessions are provided by the Trainers. Number of participants: The original grant application listed a goal of 100 participants (based on 10 participants per site; 10 sites total). Since the number of sites was reduced to seven the revised target participation numbers were 70 participants (10 per site; 7 sites total) and 21 trainers (3 per site; 7 sites total). Recruitment efforts were successful in garnering interest (100 participants and 48 trainers); however about two-thirds (68 out of 100) of participants and one-third (18 out of 48) of trainers chose to begin the program. University of New Hampshire, Joanne Curran-Celentano Objective 2, Experiment 2 Investigating determinants of macular pigment density as a biomarker of carotenoid status and eye disease risk in the elderly. 2a. Purpose. To determine the impact of pregnancy and lactation on lutein status, retinal health and MPOD; Does number of pregnancies impact lutein/n-3 FA status and health risk with aging. (LSU with UNH participating) Update - Women, compared to men, are at higher risk for developing age-related macular degeneration (AMD), one of the leading causes of blindness in the elderly. We explored if pregnancy, which is known to deplete women of docosahexaenoic acid (DHA, 22:6n-3), a long chain n-3 fatty acid that is essential to the structure and function of the eye, is a risk factor for development of AMD. Our data have shown that DHA is preferentially transferred across the placenta during a pregnancy that is not complicated by gestational diabetes, whereas lutein-zeaxanthin are not preferentially transferred. Our hypothesis was that women who had had more pregnancies would be at greater risk for developing AMD. In this case controlled study, women (n=501, 50+ years of age) diagnosed with and without AMD at three private eye care facilities in Louisiana were recruited to participate. Participants were asked questions about their physical and retinal health, past pregnancies, family histories, and vitamin and fish oil supplementation. The evaluation of each subjects macular health was assessed by their ophthalmologist or optometrist. Significant predictors of being diagnosed with AMD were: age, parity, and BMI by parity. As age, BMI and the number of pregnancies increase the probability of being diagnosed with AMD also increases. Thus, it is possible that supplementation with DHA during pregnancy may be protective against future AMD. 2b. (Modified 2011) Since the presence of macular pigment through the lifecycle is hypothesized to influence risk of aging eye disease and obesity is a known risk factor for AMD, we are assessing MPOD on normal, overweight and obese young adults in two studies. Data collection is ongoing in both a. Normal, mild and overweight college students are recruited for MPOD measurement using heterochromatic flicker photometry. In this study the retinal carotenoid density will be assessed relative to body weight, BMI, lifestyle questionnaire and dietary intake evaluation using the LZQ©" questionnaire (HNRCA and Tufts University) for lutein and zeaxanthin. b. Normal and overweight adults aged 18-50 are being actively recruited to participate in a 12 week lutein intervention to determine the impact of body weight, body composition and dietary pattern on absorption, transport and deposition of supplemented lutein (10 mg lutein, 2 mg zeaxanthin). The effect of supplementation on serum, macular density and markers of inflammation will be evaluated. Five measurements of MPOD are being assessed over 3 month intervention. MPOD will be measured using a Macular Metrics heterochromatic flicker photometry unit set-up at the laboratory at St Anslem College. At the time of each retinal measurement, blood samples will be collected for carotenoid analysis by HPLC at UNH. Changes in MPOD and carotenoids will be assessed along with changes in serum cholesterol, lipid profiles, dietary and anthropometric measures. Update on CRP data: In a sample of 54 individuals, macular pigment was inversely related to c-reaction protein (CRP), a biomarker for inflammation, and was significantly higher among individuals in the lowest quartile of CRP concentration. Perhaps the macular pigment or factors affecting the macular pigment, such as diet, directly or indirectly influence inflammatory status, and consequently, retinal health. Carotenoid data is currently being analyzed NH work on Objective 1: Supporting student participation in the NH effort in pretesting whole grain education diet assessment and tool evaluation program. University of Rhode Island Matthew Delmonico, Ingrid Lofgren, and Furong Xu Objective 2, Experiment 1 During our recent USDA-funded randomized clinical trial (UR-IDEAL V, spring 2012), 54 obese older women aged 55-80 years underwent 16 weeks of dietary education (1 session a week for 30 minutes) for weight loss and Tai Chi (TC) (2 sessions a week for 45 minutes) at two different Rhode Island senior centers (North Kingstown and South Kingstown). All orientations, testing, and intervention delivery were done at the senior centers. Participants were community-dwelling older women who are obese (body mass index (BMI) between 30.0-50.0 kg/m2) and who were in need of weight loss based on national guidelines. Subjects were assigned to an intervention group (n=41) or to a waitlist control group (n=13). Those in the intervention group participated in a Tai Chi exercise program (two times per week for 16 weeks. Additionally, the dietary intervention (once per week) was based on the Dietary Approaches to Stop Hypertension (DASH) program, which focused on increasing whole grain, unsaturated fats, and fiber intake while reducing sodium, saturated/trans fat, and sugar intake. The DASH program has been successfully implemented in older adult populations, resulting in decreased body weight and CHD risk and increased weekly physical activity. Participants assigned to the waitlist control group were asked to maintain their normal lifestyle during the intervention but had the opportunity to participate in a two week Tai Chi program after post testing. Outcomes included changes in physical and muscle function, diet quality, blood lipids, blood pressure, physical activity, quality of life, body weight and composition, body girths, sleep quality, cognitive function, and BMI. We are now in the development stage of completing a similar intervention next year in a senior center in Providence, Rhode Island that has a high percent of minority women who attend. The TC exercise intervention will occur three times a week and will incorporate resistance training twice a week. The dietary intervention will focus on maintaining a healthy weight rather than weight loss. Future Grant Proposals We plan on submitting an R15 in conjunction with Iowa State University in February 2013. Iowa State University is also a member of the NE1039 multistate. University of the District of Columbia Prema Ganganna, Ph.D., R.D., Principal Investigator William Rice, M.A., Research Associate Objective 1, Experiment 3 The goals of the UDC NE-1039 project are to design and implement intervention strategies that will increase fruit, vegetable, and whole grain consumption in multicultural elderly individuals in the District of Columbia who have been identified as low consumers of these foods. These interventions will be designed using data collected using a nutritional knowledge and behavior survey instrument, and a four day written and photographic food diary. (Each subject is provided with a digital camera both as participation incentive and as a means of validating of food consumption.) The objectives of the data analysis will be to: "Compare knowledge, priorities, and attitudes of high fruit, vegetable, and whole grain consumers with low fruit, vegetable, and whole grain consumers. "Compare the cognitive and affective characteristics of these two groups in order to assess their effect on food choices and consumption. "Determine the extent to which elderly citizens provide nutritional care to children. The assumption is that the nutritional knowledge and behavior of these care givers will have direct impact on the nutritional behavior of the children they care for. Subjects are randomly selected from elderly (over 65) adults who are registered participants in congregate sites provided by the District of Columbia Office on Aging through a senior service network. Five research assistants trained in cognitive interview techniques, have completed individual survey interviews of 45 subjects. These subjects have completed the written and photographic food diary. Interviews and food diaries of at least 55 additional subjects will be completed by September 2012. The table below summarizes results of 45 completed surveys. High FV Low FV High WG Low WG Cares for Children Diet Change Obese Male 3 9 2 10 4 3 4 Female 9 24 4 29 14 10 13 Descriptive analysis of the data provided by 45 subjects suggests: "Subjects can be partitioned into high and low fruit and vegetable and whole grain consumption groups. (Subjects were given a definition of whole grains.) "Subjects seemed generally aware of the benefits of fruits, vegetables, and whole grains, even when they were not consumed in adequate quantities. "Diagnosis of illness changes eating choices and behavior. "It is not unusual for elderly individuals to prepare regular meals for children under 13 years of age. "Nutritional knowledge is a byproduct of the individual interview process. Data analysis will provide guidance for the development of interventions for low consumers of fruits, vegetables, and whole grains. Subjects will participate in intervention development. Cooperative projects that will occur concurrently with data collection and analysis will be compilation of a recipe book that will include family recipes with healthy nutritional modifications, together with personal, cultural, and historical entries; and creation of innovative instructional games and activities. Special consideration will be given to interventions for child care givers.