Lessons Learned: Recruiting Aging Adults for Research

Aging adults are the fastest-growing population in the United States, but they are underrepresented in health care research. Evidence-based decisions for aging adults need to be made using research done with this population. However, recruiting aging adults into research has many challenges. This article presents multiple cases of recruiting aging adults into nutrition research studies in 3 different US geographic locations. The challenges, successes, and lessons learned are presented. The lessons learned can provide guidance to others already doing research with aging adults and those clinical and community dietitians who want to start doing research with aging adults

Perceive Symptom-Related Barriers to Eating and Associated Quality of Life in Head and Neck Cancer Survivors

Background: Head and neck cancer (HNC) survivors experience significant symptom burden as a result of tumor location and treatment received. These symptoms may negatively impact quality of life (QOL) and compromise dietary intake into the post-treatment survivorship phase. Few studies have examined how symptoms are associated with quality of life in HNC survivors beyond the acute phase of care. Purpose: The objective of this research was to examine associations between perceived symptom-related barriers to eating and quality of life (QOL) in post-treatment head and neck cancer (HNC) survivors who participated in a dietary intervention trial. Methods: This was an exploratory analysis of 23 post-treatment HNC survivors who had previously participated in a 12-week randomized dietary intervention trial to assess the feasibility of increasing cruciferous (CV) and green leafy vegetable (GLV) intake. For this analysis, both treatment groups were combined into one. Participants completed a pre-intervention survey that assessed HNC-specific QOL (FACT-HN) and ranked self-perceived symptom-related barriers to eating on a 5-point Likert scale (1 = “never” to 5 = “very often”). A summary score for all symptom-related barriers was computed (maximum of 80 points) and Pearson correlations between the summary score and QOL were examined. Pearson correlations were also examined between scores for individual symptom-related barriers and QOL. Results: A lower symptom-related barrier summary score was significantly correlated with improved physical, emotional, and functional QOL (p < 0.01 for all). Lower individual symptom-related barrier scores for dry mouth, food does not taste good, feeling full too quickly, choking, phlegm production in mouth, difficulty swallowing, and lack of appetite were significantly associated with improved physical QOL (p < 0.05 for all). Symptom-related barrier summary score was not correlated with overall QOL. Conclusions: In this analysis of post-treatment HNC survivors, the degree of perceived symptom related barriers was associated with reduced QOL in several domains. Many individual perceived symptom related barriers were positively correlated with the physical domain of QOL. Although this was a small and exploratory secondary data analysis, these results suggest that perceived symptom related barriers and reduced QOL may be unmet needs in this survivor population and a larger study is warranted. Funding for the original study was provided by a NIH/NCI Cancer Prevention and Control Training Grant: R25 CA047888 and a Research Enhancement Project Grant from the University of Alabama at Birmingham Center for Palliative and Supportive Care.NIH/NCI Cancer Prevention and Control Training GrantR25 CA047888Research Enhancement Project Grant from the University of Alabama at Birmingham Center for Palliative and Supportive CareOpe

Improving osteoporosis care in high-risk home health patients through a high-intensity intervention

PURPOSE: We developed and tested a multi-modal intervention, delivered in the home health care setting, aimed at increasing osteoporosis treatment rates to prevent fractures. MATERIAL AND METHODS: The intervention focused on home health nurses. Key components included: nursing education; development of a nursing care plan; patient teaching materials and creation of physician materials. Nursing education consisted of a lecture covering osteoporosis, fracture risks and prevention, and the effectiveness of anti-osteoporosis treatment options. Patients received education materials concerning osteoporosis and anti-osteoporosis medications. A pocket-sized treatment algorithm card and standardized order sets were prepared for physicians. Focus groups of physicians and nurses were conducted to obtain feedback on the materials and methods to facilitate effective nurse-physician communication. Successful application required nurses to identify patients with a fracture history, initiate the care plan, prompt physicians on risk status, and provide patient education. The intervention was piloted in one field office. RESULTS: In the year prior to the intervention, home health patients (n=92) with a fracture history were identified in the pilot field office and only 20 (22%) received osteoporosis prescription therapy. In the three months following the intervention, 21 newly enrolled patients were identified and 9 (43%) had received osteoporosis prescription medications. CONCLUSIONS: Home health care provides a venue where patients and physicians can be informed by nurses about osteoporosis and fracture risks and, consequently, initiate appropriate therapy. This multi-modal intervention is easily transportable to other home health agencies and adaptable to other medical conditions and settings

Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial

We conducted a cluster randomized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care. The trial did not find a significant difference in medication use in the intervention arm. INTRODUCTION: This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures. METHODS: We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide home health agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications. A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre-post design. RESULTS: There were 11 offices randomized to each of the treatment and control arms; these offices treated 337 and 330 eligible patients, respectively. Among the offices in the intervention arm, the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 %, compared with 15.7 % in the usual care arm (difference in proportions 3.4 %, 95 % CI, -2.6 to 9.5 %). The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward, a nonsignificant difference. CONCLUSIONS: The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients

Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.

BackgroundNutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years.MethodsData are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (&lt;18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures.ResultsIn adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models.ConclusionsNutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults

Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.

BackgroundNutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years.MethodsData are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (&lt;18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures.ResultsIn adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models.ConclusionsNutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults