Victoria Lawton

Victoria Lawton

Purpose of the Program

The purpose of my Senior Nutrition educational program is to increase the nutritional knowledge and nutritional health of the senior participants through educational demonstrations, presentations, and activities.

Rationale

The average age of a person in the United States is 76, a number that increases drastically every century as we develop new ways to eradicate major diseases and increase the average person’s knowledge of health. As people age their health needs change drastically to the point that many persons cannot safely live in their own homes any longer. To address their health needs many families seek out assisted living facilities that can provide nutritious meals for their loved one. These facilities are becoming a more prominent option for elders, to the point that approximately “half a million people reside in assisted living facilities” in the United States. (Mitty, 2003, p. 32- 43) Many residents are depending on these facilities to provide them with nutritious meals, but do not have the knowledge to determine whether or not this expectation is being upheld. It is important to educate this population in order for them to be more aware of their health.

A study done to assess the risk of malnutrition in seniors, aged 75 years, living in a community, found that 21.3% had a medium risk and 1% had a high risk for malnutrition. (Bachrach-Lindström, Christensson, Johansson, Idvall & Söderhamn, 2009) These seniors were malnourished and didn’t realize that they are making themselves susceptible to many problems associated with deficiencies, including low body weight. Malnutrition and low body weight can go hand in hand if the subject is not aware of what classifies a healthy weight, and how to achieve a healthy weight while still satisfying all nutritional needs. A study done in a senior community defined low body weight as having a BMI of 21 or less, and sought to determine what factors contribute to low weight in seniors. The study found seniors had a “misconception of what a normal weight was for their age group.” (Kayser-Jones, Martin, Porter, Sivarajan Froelicher, Stotts, 2005) My survey data expressed that 63% of the participants had not been educated about the changes in their nutritional needs and had not been told about the RDAs as advised by the government. This data shows that there is a need to educate about what the RDAs are in general and how it can change depending on certain factors.

Most facilities that are considered assisted living or long term care plan their meals based on the government’s recommendations for consumption, ie the food guide pyramid or its equivalency. (Greenwood, Weinberg, Wendland, Young, 2003) A study done in a long-term care facility in Canada assessed two types of diets offered to determine if the nutritional value of the meals were actually meeting the recommended daily allowance for specific nutrients. The study found that “the diet(s) does not attain, on average, the RDA for a number of vitamins and minerals,” meaning that even if the person consumed the entire meal, which is not the norm for most seniors, they would still be deficient in these specific areas. Therefore, the study concluded that any malnutrition that occurred in the residents could be deemed “iatrogenic in nature,” meaning the fault of the facility because of the nutrient deficient meals being provided to them. (Greenwood, et al., 2003) These programs are designed to meet the needs of the “healthy” residents and do not account for the increased nutrient requirements of residents with healing wounds or diseases. My survey results yielded that 63% of the participants surveyed did not feel the meals provided were balanced and provide adequate calories and nutrients. Therefore, it is important to educate the residents about what their needs are, how they may change depending on the situation, and that they are responsible for tailoring their meals to fit their needs.

The research has also hit on the topic of availability as having an affect on the nutritional status of the residents. Ronni Chernoff states that “not having access to adequate food” can be a problem. (Chernoff, 2009, p. 177) Although he is talking about the elderly not living in a community, it is still a topic of interest. My survey assessed the availability of food choices present in the facility, besides the menu, and 100% of participants identified the village store as an option. I also surveyed about the accessibility of the grocery store as well as their own ability to cook. 100% of the participants indicated that they did have access to a store and 63% indicated that they were able to cook. Availability of choices does not appear to be an problem, but possibly the lack of education prevents them from utilizing what is available to them.

This research has identified critical issues that need to be addressed in a nutrition education program:

·  The importance of knowing what malnutrition is and the associated health risks

·  Individualized nutritional needs depending on health status

·  What are the generalized nutritional needs (government recommendations)

At Cardinal Village there are approximately 200 residents with varying health issues. Ronni Chernoff states that “establishing ranges of nutrient requirements for a heterogeneous population is difficult when they are healthy” but when they all have differing health conditions it becomes even more difficult. (Chernoff, 2009, p. 176) As stated above these types of facilities have to cater to the needs of the majority, and cannot tailor their services to 200 individual cases. Therefore, there is a need for an educational program to establish awareness of individual needs, so that each individual can tailor their choices to their own specific needs. Eighty-eight percent of the participants acknowledged that there is not an educational nutrition program present in the facility, and verbally expressed interest in such a program. I propose that we implement a nutrition program to education the residents of cardinal village about their nutritional needs, the generalized government recommendations, and the associated risks of becoming malnourished if one is not getting enough nourishment.

Target Population

There are approximately 100 residents residing in the independent living section of Cardinal Village and about thirty of these residents participate in the monthly group nutrition meetings run by the dietary services director. For the Senior Nutrition program, the individuals who reside in the independent living section of the facility and attend the monthly nutrition meetings, are the target population. The remainder of the residents who live in the independent section of Cardinal Village but do not attend the monthly nutrition meetings are the secondary target population.

Needs Assessment

In order to assess the needs of the population I would begin by surveying and collecting data from the senior citizens living at Cardinal Retirement Village. The four major steps to be taken for this assessment would be: 1. Determine their current situation as it relates to their health 2. Analyze the data collected from the survey 3. Rank the needs expressed in order of importance 4. Validate that the needs identified are truly the needs the community views as most important. (Mckenzie, 2009, p. 100-107)

When first determining the current health status of the population, I would use the PRECEDE model that includes the following: 1. Social diagnosis 2. Epidemiological diagnosis 3. Environmental/Behavioral Diagnosis 4. Educational/organizational diagnosis 5. Administrative diagnosis. For this target population of senior citizens living at Cardinal Retirement Village in Sewell, NJ the social diagnosis would be used to assess the quality of life of these individuals. To do this assessment a survey would be distributed to residents prior to brunch service. Questions would focus on the risk factors associated with living in the Cardinal Village complex. Also, focus groups could be conducted at Resident council or the monthly nutrition meetings to obtain a more concise view of the needs being expressed by the general population and then more specifically by those who are more active in the community.

Next, I would do an epidemiological diagnosis to determine the health of the residents. This would be done by gathering information from the marketing and dietary departments about the number of residents living in the community as well as the types of foods provided to the residents. Information could also be gathered from the nursing department about the extra nutritional attention that some residents need.

The survey would also include questions that would diagnose any environmental/behavioral issues present in the community. Questions concerning the availability of nutritional resources in the community and in the surrounding area would also be asked.

Next, when referring to the organizational/educational diagnosis, I would need to determine the predisposing factors (provides motivation/rationale such as knowledge, attitudes, and beliefs), enabling factors (enable motivation to be realized; availability of resources, health care facilities), and reinforcing factors (subsequent to behavior; provides rewards for continuum of behavior) (McKenzie, 2009, p.22). Questions that reflect these areas would be present in the resident surveys given to the general population and the focus groups at resident council and the monthly nutrition meetings. An example of predisposing factors would be the residents knowledge, attitudes, and beliefs about nutrition options. Enabling factors, could includes the types of food available in the facility. Finally, reinforcing factors could include staff support and promotion of good nutritional habits and peer role models. If the residents were to have more healthy options and have the support of their healthcare providers and peer role models they can make better choices.

Finally, using an administrative diagnosis, I would determine what resources are available for us in the intervention. To obtain this information I would have to meet with the Business Director and the Administrator to figure out what funds are available to put towards a educational program.

After obtaining all of the information I will be able to analyze the data. The analysis would be done by tallying the results from the survey and finding an average response to the open-ended questions. After doing this I would list any concerns I have with the data collected.

When I prioritize the needs indicated, I would determine the importance of the concerns expressed because with limited resources the most important needs should be addressed first. After we determine the nature and the severity of the problems, we can start to develop appropriate interventions and set about implementing them.

Finally, to validate the prioritized needs, I would have to go back through the needs expressed by the general population are the same as those expressed by the focus groups, and are the actual needs of the community.

Theoretical Basis

Constructs from the Social Cognitive Theory will guide the development of this program. This theory acknowledges that personal beliefs, social interaction, and environmental factors all simultaneously influence a person’s health decisions. This theory is useful for a group nutrition education program because this population, senior citizens, is more likely to participate in programs when there is a social element involved. The social element will draw more residents into the program, and as a result there will be a decrease in disease associated with overindulgence in one food or mineral group such as high cholesterol, hypertension, and type two diabetes.

This theory helps to predict behavioral choices of the target population by identifying internal and external factors that either encourage or discourage the target behavior. “In this model of reciprocal causality, internal personal factors in the form of cognitive, affective, and biological events, behavioral patterns, and environmental influences all operate as interacting determinants that influence one another bidirectionally” (Bandura, 2001, pp. 14-15) This means that it is not just one thing influences behavior, but a culmination of all of these factors influencing each other that creates the change.

The constructs from the SCT that will be emphasized are self-control, observational learning, behavioral capability, reciprocal determinism, and collective efficacy. At the beginning of this program the residents will be asked to record their food choices for a few days which will make them more aware of the choices they are making, and begin their development of self-control over their eating habits. In this program the residents will be taught what the proper portion sizes of food groups are, and how to make a balanced plate, this way the residents will know how to perform this behavior (observational learning). The residents typically eat all of their meals together in a communal dining room so individuals observe others demonstrating the ideal behavior and will learn how to perform the behavior themselves (behavioral capability). These persons live in a senior community where their meals are prepared for them, so their environment affects the food choices that are available to them. If the residents come together as a group and request changes to the menu they can influence their environment by regulating the choices offered to them (reciprocal determinism). In order for the change to occur the group must first believe that they have the ability to make that big of a change to their environment (collective efficacy).

Intervention Behavioral Determinants Intermediate Behavioral Outcomes

Group Nutrition Educationî çObservational Learningè Increased Knowledge about portion sizes