A multidimensional approach to understanding under-eating in homebound older adults: The importance of social factors

Purpose: The purpose of this study was to identify relationships between medical, functional, economic, oral health, social, religious, and psychological fac-tors and under-eating in homebound older adults. The focus of the study was on identifying potentially modifiable factors amenable to social and behavioral interventions. Design and Methods: A total of 230 homebound older adults who were currently receiv-ing home health services participated in interviews in their homes using a questionnaire to assess eating behaviors and factors that could possibly affect those eating behaviors. Interviewers measured height and weight, and participants completed three 24-hr di-etary recalls. Results: The mean age of participants was 79.1 years. The sample comprised 78 % women and 38 % African Americans. We found that 70 % of participants were under-eating, defined as not con-suming enough calories to maintain their current body weight. Participants who were at higher risk of under-eating included men, those receiving either infrequent care or very frequent care by a caregiver, those who had been hospitalized prior to receipt of home health services, and those with a higher body mass index. Implications: Findings from the study have implica-tions for both practice and policy. Experts must develop evidence-based interventions targeted at under-eating in this particularly vulnerable and grow-ing population of homebound older adults. This study provides an initial foundation for the development of targeted evidence-based behavioral nutritional inter-ventions that are noninvasive and cost effective. Key Words: Under-eating, Undernutrition, Nutrition policy Undernutrition in older adults is a well-recognized and serious problem with significant health, eco-nomic, and social consequences (DiMaria-Glalili &amp