According to the Centers for Disease Control and Prevention, six out of every ten adults in the United States have at least one chronic disease, and about four in ten have two or more chronic diseases [...]

The prevalence of dementia is growing as the population and longevity increase. Caregivers of adults with dementia report stress and fatigue and often neglect their health. They also indicate the need for information to address health-related issues, including nutritional problems, of their family members with dementia (FMWD). This study examined the impact of coaching to improve family caregiver (FCG) stress and well-being and to increase the protein intake of both FCGs and their FMWD. All participants received nutrition education including a protein prescription (1.2 g/kg body weight/day) and FCGs received stress-reduction materials. Coached-group randomized participants also received weekly diet coaching and stress-reduction coaching. At baseline and 8 weeks, anthropometrics, a mini-nutritional assessment questionnaire, and diet (protein intake) were assessed in FCGs and FMWD; well-being, fatigue and strain were assessed in FCGs. Repeated two words measures analysis of variance and Fisher's exact tests examined within group and intervention effects. Twenty-five FCGs (13 coached group, 12 not-coached group) and 23 FMWD (12 coached group, 11 not-coached group) completed the study. No significant differences were found between coached and not-coached FCGs and FMWD at baseline. After 8- weeks, FCGs' protein intake significantly increased from 1.00 ± 0.17 to 1.35 ± 0.23 g/kg/body weight in the coached group and from 0.91 ± 0.19 to 1.01 ± 0.33 g/kg/body weight in the not-coached group; there was also an intervention effect (p=.01, η2 = .24). The percentage of FCGs with baseline protein intake less than prescription guidelines and with an end-of-study protein intake meeting/exceeding the prescription significantly differed, with 60% of coached FCGs versus 10% of not coached FCGs meeting the prescription. No intervention effects were shown for protein intake in FMWD or for well-being, fatigue or strain among FCGs. Diet coaching with nutrition education successfully assisted FCGs with improving their protein intake versus nutrition education alone.

Describe the impact of nutrition education with and without diet coaching on the protein intakes of caregivers and their family members with dementia.

Physical activity is important for healthy aging, but few older adults achieve the goal of 150 min per week of moderate activity. The purpose of this study was to employ a robust statistical approach in the analysis of the factors related to physical activity in a diverse sample of older adults. A secondary analysis of factors associated with calculated MET-h/week was conducted in a sample of 601 African Americans, Afro-Caribbeans, European Americans, and Hispanic Americans age 59 to 96 living independently in the community. Age, education, social network, pain, and depression were the five variables that accounted for a statistically significant proportion of unique variance in the model. The strongest correlation to total MET-h/week was with depression. Directionality of the relationship between these variables and physical activity is complex: while pain and depression can reduce physical activity, activity may also help to reduce pain and depression. Additionally, of note is that many of these factors may be modified, calling for the design and testing of individual, group, and community level interventions to increase physical activity in the older population.

Background and objective: An adequate dietary protein intake is critical to preventing sarcopenia, a condition characterized by reductions in muscle mass, strength, and function. The objectives of this investigation were to determine the effectiveness and how telephone-based diet coaching by a nurse practitioner contributed to improving dietary protein intakes in middle-aged women.Methods: Middle-aged women were recruited, and those randomized to receive nutrition education (including a protein prescription) and weekly diet coaching (focused on improving protein intake) provided weekly responses to three semi-structured interview questions. Qualitative content analysis was used to examine the responses to these questions. Dietary protein intake was analyzed at baseline and the end of the 12-week study from three 24-hour diet recalls at each time point using diet-analysis software and repeated measures analysis of variance.Results: Coached participants (n = 25) significantly increased dietary protein intake (55.3 ± 10.3 g at baseline to 83.7 ± 14.5 g/day at the end of the study); 19 of the 25 participants (76%) met their recommended dietary protein prescription by the study’s end. Three themes “Identifying Opportunities for Behavior Change”, “Beneficial Behavior Changes”, and “Tailoring Individual Interventions” were identified as a result of the coaching and led to the overarching theme “Empowered by Knowledge, Successful by Support” depicting how coaching contributed to the behavior changes.Conclusions: Nurse-led coaching is an effective approach enabling middle-aged women to improve dietary protein intake. These improvements are especially important in reducing the risk for the development of sarcopenia.

Sufficient dietary protein intake is vital to maintaining muscle health with aging. Yet protein intake among adults is often inadequate. This study’s main objective was to examine the impact of nutrition education (NE) and a per-meal protein prescription (PRx) with versus without diet coaching on protein intake. A secondary objective examined its effects on muscle health. Participants included 53 women, age 45–64 years. All participants received NE and PRx; those randomized to coached-group received 10-weeks of diet coaching. Assessments included: protein intake at baseline, weeks 4 and 12 and muscle health (muscle mass, grip strength, five-chair rise test, 4 mgait speed test). The Chi-square test examined percentages of participants meeting PRx between groups. Repeated measures analysis of variance assessed within group and intervention effects on protein intake and muscle health parameters. Protein intake (g/kg body weight) increased (p < 0.001): not-coached (n = 28) 0.8 ± 0.2 to 1.2 ± 0.3 and coached (n = 25) 1.0 ± 0.2 to 1.4 ± 0.3 with no significant difference between groups. A greater percentage of coached-group participants met (p = 0.04) breakfast (72%) and met (p < 0.001) three-meal (76%) PRx versus not-coached participants (25% and 53%, respectively). Participants in both groups exhibited significantly (p < 0.001) improved times for the five-chair rise test and 4 mgait speed test. Diet coaching in conjunction with a PRx and NE should be considered to assist individuals in improving protein intake through self-selection of protein-rich foods.

Over 80% of adults in the US fail to meet the ≥150 min weekly physical activity guideline; 40% age ≥ 75 are entirely inactive. The study purpose was to understand the reasons why community-dwelling older adults (age ≥ 60) from diverse backgrounds increase, sustain, or decline in their physical activity levels over time. Sixty-two older adults were interviewed. Two-thirds of the African Americans, 57% of the Afro-Caribbeans, and 50% of the European Americans reported being less active than 2–3 years ago. Reasons for activity decline included health issues (e.g., pain, shortness of breath), lack of time, interest, or motivation. Reasons for sustaining or increasing activity levels included meeting personal goals, having a purpose for remaining active, or feeling better when active (e.g., it is important to keep moving, good for the joints, going on a cruise). Themes identified were pride in maintaining activity, goal-driven activity, pushing oneself to get past pain or fatigue, and some confusion between social and physical activity in participant reports. The results indicate widespread acceptance that activity is beneficial, but that knowledge alone was insufficient to maintain activity levels over time unless individuals had a goal or purpose (“means to an end”) and could overcome their physical and psychological barriers to physical activity.

Critical illness leads to decline in muscle mass that promotes decline in physical function and psychological function and may lead to cognitive decline or dementia. Nurses are key to driving the multidisciplinary interventions that prevent protein loss and promote positive outcomes for critically ill patients.

OBJECTIVE:To describe food and beverage provisions by Faith Communities from one denomination in association with events for children.DESIGN, SAMPLE AND MEASURES:Foods and beverages provided at 32 child-focused activities were documented using direct observation methodology and analyzed for contribution to food groups and per serving energy, fat, saturated fat, sugar, and sodium contents.RESULTS:Main dishes were mostly (71%) convenience/casserole-type foods, and averaged 962 mg sodium and 436 kcal, with 36% of energy from fat and 14% as saturated fat. Cheese was the main source of dairy products. Grain-based side dishes, provided at 29% of meals, included white rice, pasta, and bread. Non-starchy vegetables were provided at three (29%) meals. Fruits were served at six events. Desserts, served at 75% of events, contained 41% of energy from fat, with 17% as saturated fat, and 22 g of added sugar. Snack chips, provided at 31% of events, contributed 165 kcal mostly from fat and 243 mg of sodium. Sugar-sweetened beverages, served at 71% of events, contributed 28 g of added sugar.CONCLUSIONS:This pilot investigation identified areas for improvements in the nutritional quality of foods/beverages served at faith community child-focused events and aligns with expanding public health efforts to improve child nutrition beyond traditional settings.

Theoretical frameworks have successfully guided researchers in implementing coaching interventions to effect dietary changes in adults for both prevention and management of chronic diseases. Three such frameworks include the Transtheoretical Model (TTM), Social Cognitive Theory (SCT), and the Theory of Integrative Nurse Coaching (TINC). This article introduces each theory, followed by an overview of the coaching interventions used to effect dietary behaviour changes within each theory. A condensed version of Turner's synthesis methodology is used to determine if a conceptual connection exists among the three models/theories. The condensed version includes synthesis preparation, synthesis (comparison of converging and diverging components), synthesis refinement (conceptual connection), and a concluding discussion of all three theories related to nursing practice. This synthesis will inform the focus of interventions that aim to promote dietary changes in adults at risk of developing sarcopenia.

Inadequate protein intake contributes to poor nutritional status, reduced muscle mass, strength and function, and increased mortality. Evaluating differences in protein intake and related health indicators among racial/ethnic groups enables the development of targeted interventions. This study's purpose was to determine differences in protein intake, nutritional status, and muscle strength/function among 273 older African, European, and Hispanic Americans. Protein intake, nutritional status, grip strength, timed-up-and-go (TUG), and chair stand assessments were conducted. Protein intake was significantly greater among Hispanic Americans (0.96 g/kg body weight) followed by European Americans (0.83 g/kg body weight), and African Americans (0.64 g/kg body weight). Intakes by all groups were below recommendations. Low nutritional status, grip strength, chair rise, and TUG scores were observed in African Americans and European American females and were consistent with lower protein intakes. Results show significant differences among the groups and the need for interventions to improve diet and physical health.

Objective: Sarcopenia is a disease of low skeletal muscle mass and strength that occurs with aging. It is most commonly seen in individuals aged 50 years and over. Nurse practitioners can take a proactive approach to the understanding and screening of this disease in attempts to prolong its onset or to treat the condition before it leads to additional adverse consequences. Methods: A comprehensive review of the literature, including evidence-based literature from peer-reviewed articles, including randomized controlled trials, was conducted.Results: This review of the literature indicated patients can benefit greatly from nurse practitioner’s awareness and intervention by screening for sarcopenia as well as offering appropriate education and treatment to their patients. Once a diagnosis is reached, the nurse practitioner can then collaborate with other disciplines such as nutrition, medicine, exercise physiology and/or physical therapy to develop an intervention strategy that can treat or prevent this condition before it leads to decreased independence, early onset disability and decreased quality of life, among other adverse health outcomes.Conclusions: There is a call to action on the part of nurse practitioners in efforts to prevent and/or slow the onset of age-related sarcopenia and its adverse consequences.

Muscle mass, strength, and function have been shown to decline with aging, and if of sufficient magnitude can result in sarcopenia. This study’s objective was to determine the prevalence of low muscle mass in a group of adults living in a “premier” Florida residential continuing care retirement community. The sample consisted of 80 older adults, ranging from young old (65-74 years) to the oldest old (85+ years) with the oldest participant being 94 years. Skeletal muscle mass was assessed via bioelectrical impedance analysis. Skeletal muscle index values were calculated and compared with established cut-off values to classify each individual’s muscle mass as normal or low (sarcopenic). The prevalence of sarcopenia among the males was 66% and among females was 73%. When examined by age, 56% of those in their 70s, 73% of those in their 80s, and 79% of adults in their 90s had low muscle mass indicative of sarcopenia. This study found a higher prevalence for sarcopenia in females and males, especially among the oldest groups, than previously reported in a nationally representative sample of adults. This study’s findings also suggest the need for further studies examining whether the prevalence of low muscle mass among adults in either classification varies with socioeconomic status and ethnicity. Continuing care retirement communities may provide excellent environments for the screening, diagnosis, and implementation of exercise and nutritional programs for residents to help prevent or attenuate sarcopenia’s deleterious effects. Nurse practitioners must incorporate screening for sarcopenia in their wellness package for their patients. Screening, nutritional education and support and exercise prescriptions are vital to prevent associated decline from sarcopenia.

The aim of this study was to evaluate the psychometric properties of the Regulation of Eating Behavior Scale (REBS) in mixed-gender, American samples and to evaluate how responses differed across male and female respondents. Responses were examined in a sample of 535 undergraduate students in the Southeastern United States. A confirmatory factor analysis was used to confirm the predicted factor structure; male and female participants were analyzed in a multi-group, unconstrained configural model, with male and female participants analyzed simultaneously to allow for multi-group comparisons within the same model. Additional analyses evaluated measurement invariance, reliability of the measure in the new sample, gender differences in subscale scores, and correlations across factors. Results of confirmatory factor analysis, multi-group by gender comparisons suggested that the factor structure did not vary across genders. In addition, factor structure was consistent with the findings of the original studies examining the psychometric property of the REBS, with the exception of the 'introjected regulation' subscale, which measures regulation of eating behaviors to avoid self-enforced consequences. Consistent with expectations, female participants' ratings were higher, on average, on more autonomous forms of eating regulation; however, contrary to expectations, scores did not differ significantly between males and females on more external forms of eating regulation. Conclusions, limitations, and implications are discussed.

Background: Cardiovascular disease is a major cause of death for people living in the United States. African Americans bear a disproportionate burden of cardiovascular disease. Interventions designed to target multiple risk factors may facilitate elimination of cardiovascular disease health disparities. Objective: The purpose of this study was to evaluate a culturally relevant cardiovascular health promotion intervention that could potentially reduce cardiovascular disease risk among a group of rural African American adults by improving intentions, attitudes, norms, and self-efficacy to increase produce consumption, reduce dietary saturated fat intake, and increase exercise. Methods: A cluster randomized controlled trial design was used to evaluate the effect of the “With Every Heartbeat Is Life” cardiovascular health promotion program among rural African Americans. The African American congregants of 12 rural churches located in northern Florida were randomly assigned to either an intervention group that received a culturally relevant cardiovascular health promotion intervention or a control group. Data analysis using linear mixed model was performed to compare group differences from pretest to posttest. Results: The cardiovascular health promotion intervention had a positive influence on the intentions, attitudes, norms, and self-efficacy of rural African Americans to increase produce consumption and reduce dietary saturated fat. The intervention also enhanced participants' attitudes and self-efficacy regarding exercise. Conclusion: The culturally relevant cardiovascular health promotion program presented to cluster groups of rural African American participants had positive influences on psychosocial variables associated with engaging in cardiovascular health recommendations. Nurse-led interventions in community settings can potentially reduce cardiovascular disease risk.

ObjectiveTo explore the food culture within faith communities (FC) in order to examine the consumption of away-from-home foods, and to provide an evidence base for the future development of healthy away-from-home meal initiatives though FCs. Design and SampleA qualitative descriptive design informed by an ethnographic method of free listing was utilized. A purposive sample of 34 FC leaders from seven distinct FCs participated in this study. ResultsThe top five salience scores for five research questions are considered in detail. Of note, food is provided at multiple FC events including at worship time and Bible or group study, but also as part of school, youth programming, and special events. The purposes of serving food were reported to be not only for modes of entertainment and fellowship but also for promoting attendance and providing basic nutrition needs. ConclusionsProfessionals practicing in public health, faith community nursing, or in community health nursing are apt to engage in focused dialogues regarding the multidimensional health problem of childhood obesity. This research study directs nurses to consider food culture as a dimension of importance, especially within FCs. Appreciating FC food culture is important because many families engage in the settings for years, decades, and possibly a life span.

Older Caribbeans are migrating to the US in increasing numbers. They have difficulty integrating and often become isolated and deconditioned. The objective of this pilot study was to evaluate the feasibility and effects of an exercise program on walking during street crossing situations and on the dorsiflexion strength of older Caribbean Americans. Ten older Caribbean Americans completed a 30 to 40 minutes long group exercise program twice a week for 6 months with assessments at baseline, 3 and 6 months including measures of walking velocity, cadence, step length, base support, swing and stance time, single and double support time, knee flexion, and dorsiflexion strength. Participants walked 3 times at preferred speed (reference to normalize the street crossing simulations), and at simulated street crossing with regular time and with reduced time. There were no significant differences between street crossing conditions at baseline, but there were significant differences between conditions at 3 and 6 months for velocity (P < 0.005) and peak knee flexion (P < 0.013), and at 6 months for cadence (P = 0.009), step length (P = 0.012), swing time (P = 0.045), single (P = 0.036) and double support time (P = 0.013). Dorsiflexion strength at 6 months was significantly higher than during baseline (p<0.001) and 3 months (P = 0.004). The program was feasible, acceptable, and showed some positive effects on walking and knee flexion during street crossing situations, and on the dorsiflexion strength.

The aim of this article is to provide clarity of the concept of health habit. Using Walker and Avant's (1983; 2010) method for conducting a concept analysis, the authors identify the attributes and characteristics of health habit, its theoretical and practical application to nursing, and sample cases to further illustrate the concept. Empirical and conceptual literature was used to inform this concept analysis. Articles and one book from 1977 to 2014 were reviewed from PsycINFO, Medline, Cumulative Index to Nursing Health Literature (CINAHL), Science Direct, EBSCOhost and Web of Science. Offering a clear definition and conceptual model of health habit provide the foundation to identify/develop appropriate measures of the concept and guide further investigation of understanding the development and sustainability of healthy habits. Additional research is needed to test the conceptual relationships between health habits and outcome variables as they apply to different groups across the age continuum.

Overweight and obesity prevalence is especially high among children from racial/ethnic minority and lower income populations. These populations are also more likely to rely on afterschool programs. This pilot study examined snacks provided in 21st Century Community Learning Center-based afterschool programs. Snacks were analyzed for energy and selected nutrient contents and for their contributions to a healthy diet. Findings from this study illuminate practical implications in the areas of educational opportunities, the need for partnerships with local businesses and community organizations, and advocacy for healthier environments where children and families are dependent on food offerings.