Nutrition and Healthy Aging in the Community Workshop Summary (2012) / Chapter Skim
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5 Successful Intervention Models in the Community Setting
5 Successful Intervention Models in the Community Setting
Pages 83-104
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From page 83... ...
The interventions that were discussed include the following: • Community telephonic interventions -- Vision is Precious Program -- Improving Diabetes Outcome Study • The Diabetes Prevention Program • Medical nutrition therapy -- Dietary Approaches to Stop Hypertension (DASH) Diet • Nutrition interventions for frailty and sarcopenia • Eat Better, Move More program DIABETES SELF-MANAGEMENT SUPPORT IN THE COMMUNITY: HEALTHY EATING CONSIDERATIONS Presenter: Elizabeth A
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From page 84... ...
reducing risks Since types 1 and 2 diabetes are chronic conditions, Walker suggested that psychosocial interventions should focus on treatment adherence through motivating behavior change and emotional support. These interventions include goal setting, problem solving, maintenance strategies, continuing support, and treatment of distress and psychiatric disorders such as depression.
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From page 85... ...
Improving Diabetes Outcome Study The Improving Diabetes Outcome Study was a randomized controlled trial focused on adults 30 years and older who were prescribed oral diabetes medication, had HbA1c levels at or below 7.5 percent, were members or spouses of the health care workers labor union, and had less than optimal medication adherence. The aims of the study are listed in Box 5-1.
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From page 86... ...
While the third finding was not surprising because higher levels are somewhat easier to improve, Walker did note that the first two results suggest that the intervention was well tailored to this group. Participants received, on average, eight calls totaling about 109 minutes over 12 months.
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From page 87... ...
Diabetes self-management or prevention interventions, including those conducted over the telephone, can result in improved medication adherence, behavior change, weight loss, reduced glucose intolerance, and lowered diabetes risk if the intervention focuses on behaviors selected by the participants. Since selfmanagement interventions may address various diabetes self-care behaviors, including healthy eating and medication, experts in diverse fields should be involved as participants decide what behavior they would like to change.
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From page 88... ...
and therapeutic meals to older adults with cardiovascular disease in their homes, including data on adherence to a modified diet, changes in dietary knowledge, health outcomes, and cost effectiveness. Medical Nutrition Therapy The Institute of Medicine recommended MNT to promote the health of older adults with chronic illnesses (IOM, 2000)
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From page 89... ...
. Clinical Trial This intervention considered the effects of MNT and therapeutic meals on changes in adherence to the DASH diet and changes in dietary knowledge among community-dwelling adults ages 60 years and older diagnosed with high cholesterol, high blood pressure, or both.
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From page 90... ...
The effects of MNT on knowledge gain were higher for whites, those not living alone, those with less than a high school diploma, and those with income below the poverty level. Increases in dietary knowledge produced few significant results and no positive change in adherence to a DASH diet.
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Elena Volpi, professor of internal medicine–geriatrics at the University of Texas Medical Branch, presented research illustrating the importance of protein intake and intake patterns in determining the rates of muscle protein synthesis
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From page 92... ...
," said Volpi, "aerobic exercise can do that as well." Preliminary data from Timmerman and colleagues also suggest that aerobic exercise can improve the response of muscle protein synthesis to a meal in older adults. "So," Volpi summarized, "physical activity is fundamental, it looks like, for maintenance of the anabolic stimulation of muscle protein synthesis by a meal." Protein Intake to Maximize Muscle Protein Synthesis How much protein should older adults consume to maximize muscle protein synthesis?
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From page 93... ...
Paddon-Jones and Rasmussen (2009) introduced the theory of an ideal distribution of protein across meals that would maximize protein synthesis and improve muscle protein retention in older adults.
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Research shows that muscle protein synthesis in older adults can be stimulated by exercise or intake of about 30 g of protein at each major meal. Additional protein intake above the current RDA may help prevent muscle loss and loss of function in hospitalized older adults.
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From page 95... ...
Grantees were selected based on size, lack of existing physical activity programs, geographic location, and capacity to collect and report data. A facilitator from each site was trained on protocol implementation and outcome measurement, with a focus on physical activity outcomes since most facilitators were nutritionists.
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From page 96... ...
The presence of a chronic condition did not seem to be related to completion of the program, with the exception of much higher rates of reported dizziness among those who dropped out of the physical activity component. She noted that dizziness may be a factor that prevents people from grocery shopping and scanning the shelves.
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From page 97... ...
. Participants who completed the physical activity component of the program reported increasing the number of blocks walked daily from 10 to 15, the number of stairs climbed daily, their amount of vigorous activity, and their amount of moderate weekend activity.
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From page 98... ...
Similar changes were seen among those who completed the physical activity component; 67 percent increased by one more stage and 35 percent increased by more than two stages. Three-quarters of participants moved from the Preparation stage to the Action or Maintenance stage, and the number of people in the Pre-Contemplation and Contemplation stages decreased by 21 percent.
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From page 99... ...
DISCUSSION Moderator: Douglas Paddon-Jones During the discussion, points raised by participants included protein intake and recommendations, and aspects of MNT. Chronic Versus Acute Feeding of Protein Robert Russell revisited the idea of changing the Dietary Reference Intakes (DRIs)
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From page 100... ...
Volpi noted that animal proteins are higher quality than plant proteins because they contain a proportion of amino acids, particularly essential amino acids, that is similar to that of our bodies. There have been small acute studies and short-term clinical trials that compared proteins and how protein quality is measured.
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From page 101... ...
2009. 10-year follow-up of diabetes inci dence and weight loss in the Diabetes Prevention Program Outcomes Study.
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2009. Supra physiological hyperinsulinaemia is necessary to stimulate skeletal muscle protein anabo lism in older adults: Evidence of a true age-related insulin resistance of muscle protein metabolism.
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2011. The effect of medical nutrition therapy on changes in dietary knowledge and DASH diet adherence in older adults with cardiovascular disease.
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From page 104... ...
2011. Nutrition intervention for cardiovascular disease: Home-delivered medical nutrition therapy and DASH.
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