NE1039: Changing the Health Trajectory for Older Adults through Effective Diet and Activity Modifications
Statement of Issues and Justification
- The need, as indicated by stakeholders
Inadequate diet and lack of physical activity are the roots of many of the chronic diseases and disabilities that plague our older population. Approximately 35% of adults over the age of 75 have 3 or more chronic conditions, including, hypertension, heart disease, diabetes, arthritis, and macular degeneration/blindness. Ethnic minorities and low income populations are most at risk. Older adults fall short of meeting both nutrition (fruit, vegetable and whole grain) and physical activity goals of Healthy People 2010 (USDHHS, 2000). Only 6% of older adults consume at least three daily servings of vegetables (with at least one-third of these servings being dark green or orange vegetables) and only 4% of older women and 11% of older men consume at least six daily servings of grain products (with at least three being whole grain). Currently, only 10% of adults 64-74 years, and 7% of those 75+ years engage in physical activities that enhance and maintain strength and endurance 2+ days per week. Similar statistics describe those who engage in physical activities promoting development and maintenance of cardiorespiratory fitness. Evidence is mounting to demonstrate that changes in diet and exercise that are implemented in the later years can be effective in both extending life and improving quality of life. However, there is also the need to examine factors in earlier years that may curb the chronic conditions affecting quality of life for our elders.
The project described herein builds on earlier work by this team of scientists. This proposal includes interventions to increase physical activity in combination with interventions to increase consumption of fruits, vegetables and whole grains and a determination of lifestyle choices (including number of pregnancies and breast feeding earlier in life) as factors related to the incidence of chronic conditions, including macular degeneration or blindness in later years. There is clearly a need for additional research that will lead to improvements in both diet and exercise behaviors in older Americans, and that will address health disparities that exist among the elderly, particularly those from minority groups and of lower socioeconomic status.
- The importance of the work, and what the consequences are if it is not done
A large body of evidence suggests that regular exercise and a diet rich in fruit, vegetables and whole grains are associated with a lower incidence of age-related diseases such as cardiovascular disease, eye disease, and certain cancers as well as obesity. The importance of both endurance and strength-type exercises in older adults is increasingly being recognized for lowering the risk of sarcopenia, the age-related loss of muscle mass which can lead to disabilities and loss of independence. The proposed research is important because it will (1) increase our knowledge of effective intervention strategies to help lower the risk of chronic diseases and age-related disabilities in older adults and (2) enhance our ability to identify appropriate biomarkers and our understanding of how biomarkers may be used as a tool for assessing improvements in diet and physical activity status in older adults. The proposed research supports the USDA strategic goal of improving the nation's health and nutrition. If the trajectory of health is not changed, we can anticipate ever-increasing health care costs as the baby boom generation enters into the expanding population of older adults.
- The technical feasibility of the research
Our multistate team has a successful record of research focused on the health and nutrition of older adults, addressing their dietary needs with respect to fruit, vegetable and grain intake, and the affect of diet on biomarkers. We propose herein protocols that integrate nutrition with physical activity and expand the types of interventions needed to increase fruit, vegetable and whole grain consumption. Additionally, we will add to the past research exploring determinants of macular pigment (MP) density as a biomarker of retinal health with two novel approaches. First, we propose to monitor how lifestyle modifications (weight loss and increased physical activity) influence changes in MP and second, we will test the hypothesis that life style factors earlier in life are risk factors for eye health in later years. The research team is comprised of experts in both nutrition and physical activity and with accomplishments in the applied and basic research which will be necessary to conduct the proposed work. Collectively this team brings experience in assessing the nutritional status of older adults and in developing, implementing, and evaluating nutrition and physical activity intervention and education programs. The team has the expertise with respect to state-of-the-art approaches and methodologies, as well as the requisite understanding of the theoretical underpinnings of the proposed project, to implement and carry out the proposed studies, assuring the success of the research.
- The advantages for doing the work as a multistate effort
There are numerous advantages to performing this work as a multistate effort. The members of the proposed project have a history of successful collaborative research in the area of nutrition and older adults (Fey-Yensan et al., 2004; Lammi-Keefe and Contois, 2004; Contois et al., 2004). By bringing together different experts in the region to solve common problems, the multistate project can be highly effective. For example, Dr. Curran-Celentano brings expertise in the assessment of macular pigment density and lutein/zeaxanthin (carotenoids that function as antioxidants and that are associated with a reduced risk of age related macular degeneration), and Dr. Lammi-Keefe has expertise in the assessment of fatty acid status (Loosemore, Judge and Lammi-Keefe, 2004; Judge, Harel, and Lammi-Keefe, 2007). As the macular pigment of the eye is a complex of carotenoids and omega-3 fatty acids, the partners comprising our team can assess the importance of these nutrients with respect to MP density and the risk of age related macular degeneration. Similarly, the multistate researchers in the proposed project bring in complementary expertise in physical activity interventions (Drs. Delmonico and Lofgren), extension education (Drs. Kantor, Violette, and Cohen), and dietary studies (all members ). Through pairing complementary expertise and sharing the responsibilities for planning and implementing studies, this regional research project can fulfill an innovative research agenda at an efficient cost.
Efficiencies occur when different researchers work individually or in teams to be responsible for different aspects of the project, pool resources to compensate for budget restrictions or limitations that may exist in individual states, or implement the same protocols in different states, thus dramatically increasing the sample size and diversity of subjects. One example of this is from our previous work in the NE1023 project. The protocol for this qualitative research experiment utilized cognitive interviewing principles in a semi-structured interview to assess how older adults identify whole grain foods. Five research stations participated in the experiment (NH, MA, MD, MN, DC). The participating researchers shared their expertise to develop the protocol and assessment instruments as a group. Each research station participated in recruiting subjects and conducting interviews. As a result, the multistate approach increased both the number and diversity of subjects participating in the experiments compared to what could be assessed if only one or two stations participated. In addition, many members of this research team previously have worked together effectively on other multistate projects which will facilitate communications and cooperation in meeting deadlines.
- What the likely impacts will be from successfully completing the work
Information gathered from the results of these research projects will assist nutrition and exercise professionals in designing effective physical activity and nutrition interventions for older adults emphasizing the need for fruits, vegetables and whole grains in the diet and based on factors relevant to them. Results will also be used to design community-wide food and environmental policies to promote improved plant food intake and physical activity among older adults. By improving the assessment of food, nutrient, and health status through biomarker indicators, nutritionists can increase their ability to measure intervention outcomes and disease risks. Together, these efforts can result in improved interventions and nutrition-related health outcomes in the growing and diverse population of older Americans.
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