Development and Validation of a Diet Screening Tool for Older Adults

Open Access
- Author:
- Bailey, Regan Lucas
- Graduate Program:
- Nutrition
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 21, 2007
- Committee Members:
- Helen Smiciklas Wright, Committee Chair/Co-Chair
Terryl Johnson Hartman, Committee Member
Penny Margaret Kris Etherton, Committee Member
Sherry Lynn Willis, Committee Member
Frank R Lawrence, Ph D, Committee Member - Keywords:
- screening
older adults
nutrition - Abstract:
- The proportion of older adults in the United States is increasing dramatically. Unfortunately the aging process is associated with chronic diseases. Taken together, these trends will place significant demands on the healthcare system. Thus, it is important to identify modifiable factors that may help lessen the burden of chronic diseases of aging. Diet is a well-established modifiable factor that is directly related to risk and treatment of the major causes of death in adults over the age of 65: cardiovascular disease, cancer, and stroke. Identification of individuals that are at nutrition risk may be an effective intervention strategy to lessen the burden of morbidity. A variety of tools have been developed to assess risk of inadequate dietary intakes for specific dietary components. However, no known total dietary screening tools exist for older adults. Therefore, the overall purpose of this study was to evaluate a newly developed population-specific diet screening tool (DST) to identify community-dwelling older adults that may be at nutritional risk. The overall hypothesis of this study was that a diet screening tool could be used to identify individuals at nutrition risk. In this study, a population-specific diet screening tool was developed and the subsequently tested. Psychometric evaluation of the screening tool revealed strong test-retest reliability and adequate sensitivity, specificity, and positive predictive value. The screening tool had the ability to differentiate between individuals at varying degrees of nutrition risk, and DST scores were related to dietary intakes estimated from multiple 24-hour recalls and well as biomarkers of nutritional status. The tool was developed on a cross-section of the Geisinger Rural Aging Study (n=179). Extensive secondary dietary pattern analysis revealed several food groups that were related to nutrition risk and thus would be ideal targets for the questionnaire. The first draft of the screening tool was subjected to cognitive interviewing in a new sample of older adults (n= 17). After cognitive interviewing feedback, the DST had 37 items: 28 food specific questions, 5 yes and no questions, and four behavior-related questions. The total point range was 0 -100. A new sample was recruited to test the DST (n=204 with a mean age of 78.5 ± 4 SD). All participants attended a local medical clinic where they completed a battery of questionnaires (including the DST), had height and weight measured, and provided a fasting blood sample. Individuals were classified by DST scores as follows: scores <55 were at nutrition risk (the lowest 25th percentile), scores in the range of 55-75 (the middle 50-75th percentile) were at moderate nutrition risk, and scores > 75 (highest 25th percentile) were not likely to be at nutrition risk. No energy differences were noted among the groups; however, percent of energy from fat and saturated fat, dietary fiber intake, and indicators of diet quality were significantly different among all groups. Biomarker differences were also observed among the groups in the expected directions; but, no differences in anthropometry were observed. Nutrition plays an integral role in the management of multiple chronic diseases. However, dietary assessment in clinical treatment of older adults is not a routine practice. Older adults are vulnerable to nutrition risk. Any strategies to help combat age-related chronic disease and improve quality of life for older adults are essential. The clinic setting provides an ideal place to screen older adults and the DST is a simple and practical diet screening tool that can help detect nutrition risk in older adults.