Nutrition and the Elderly: A Resource Guide for Community Educators

This Food and Nutrition Information Center (FNIC) Resource List is a quick guide to materials that address nutrition education for the non-institutionalized elderly. It is designed to help community educators identify background information and educat ional materials related to the above topic matter. While some of these resources include material on physical activity, this list is focused on general nutrition education. Educators may also find other FNIC Resource Lists that address nutrition and chro nic disease topics helpful in their work with older adults. These Lists are available on the Web at http://www.nal.usda.gov/fnic/pubs_and_db.html.

To find materials, we searched AGRICOLA and MEDLINE databases and the World Wide Web. The resources listed contain accurate nutrition information and are available nationwide. Opinions expressed in the publications do not necessarily reflect the view s of the U.S. Department of Agriculture.

Your local library or bookstore can help you find these resources. An "ISBN number" is listed for some of the materials below. This number will help you order it from a bookstore or publisher. Contact information is provided for Web sites and organizations. Resources that are part of the National Agricultural Library (NAL) collection have a "NAL Call Number" listed. For information about NAL lending and copy services, call (301) 504-6041 or visit our Web site at http://www.nal.usda.gov/fnic/general/
lending.html. You cannot purchase these materials from NAL. Please contact the publisher or bookstore if you wish to buy any materials on this list.

I. Background Information for Educators (ordered alphabetically)

Articles

The ability of elderly women to perform Nutrition Facts Label tasks and judge nutrient content claims. Carol Byrd-Bredbenner and Laurie Kiefer. Journal of Nutrition for the Elderly, 20(2):29-46. 2000.
NAL Call Number: TX361 A3J63
Abstract: Not available.

The association between health beliefs and health behavior change in older adults. Rebecca Ferrini, et al. Preventive Medicine, 23(1):1-5. 1994
Abstract: Background. Previous studies have reported weak relationships between health beliefs and behavior change; few studied elderly populations. Methods. We examined the relation between self-reported behavior change and health-related beliefs among an educated, upper-middle-class population age 50 to 89 years. Results. More women reported decreasing dietary salt and fat, changing diet, and reading self-help materials than men. Younger respondents (age 50 to 69 years) reported more positive hea lth behavior changes in diet and exercise than did older respondents (age 70 to 89 years). Respondents who agreed that diet and exercise were important for optimal health and/or spent money on healthful items reported more positive behavior change than th ose who disagreed. Those who reported confusion about how to stay healthy or a lack of motivation to engage in healthful behaviors were less likely to make positive lifestyle changes. Older respondents reported a higher rate of confusion regarding which f oods to eat (53% vs. 39%) and how to stay healthy (29% vs. 19%) than younger respondents, while younger respondents were more likely to report a problem with motivation (40% vs. 34%). Conclusions. These results suggest that increasing age does not diminis h the relation between health beliefs and health behaviors. Health promotion campaigns aimed at older adults should strive to reduce confusion to improve health behavior.

Caregivers of the elderly: lack of nutrition knowledge.
Cass Ryan. Journal of Nutrition for the Elderly, 17(2):35-43. 1997.
NAL Call Number: TX361 A3J63
Abstract: A Program of All-inclusive Care for the Elderly (PACE) was utilized to determine the nutritional knowledge of the caregivers of the clients. To obtain demographic data on the clients a chart review was conducted, which also yielded the na me and telephone number of the client's primary caregiver. A questionnaire was administered to the caregiver to determine knowledge of nutrition and specific nutritional care behaviors. Seventy-eight caregivers completed the questionnaire. Scores indicate d that the caregivers' knowledge of nutrition was minimal, despite the fact that many of the caregivers were educated beyond high school. However, the majority of caregivers did believe their elder received proper nutrition on a daily basis. Data suggest that caregivers' perceptions of proper nutrition may not be based on accurate nutrition knowledge. Focus on the education of caregivers regarding nutritional needs of older adults and recognition of signs and symptoms of malnutrition may better maintain n utritional status and quality of life of the elderly adult. Nutrition education programs should be made available to caregivers to increase their knowledge of nutrition.

Characteristics of older adult learners: a guide for dietetics practitioners. Jana R. Kicklighter. Journal of the American Dietetic Association, 91(11):1418-1422. 1991.
NAL Call Number: 389.8 AM34
Abstract: Characteristics of older adult learners are described and related to program development, implementation, and evaluation. The framework for designing learning experiences consists of four steps: assessment of the needs of the learner; de velopment of learning objectives and determination of content; selection and implementation of appropriate learning activities; and evaluation of the results of learning. Four major assumptions about older adult learners are discussed based on a model des igned specifically for adult learners. Active involvement through self-administered questionnaires, interviews, or focus groups helps ensure that nutrition education programs are responsive to the older adult's needs. Age-related changes (i.e., in senses of sight and hearing, reaction time, and memory) and psychological and social changes (i.e., loneliness, depression, illness, financial difficulties, or loss of a loved one) may occur in many older learners and need to be considered when selecting appropr iate learning activities. A single approach to nutrition education is unlikely to meet the needs and preferences of all older adults. To maximize their effect as educators, dietetics practitioners need to adjust their teaching styles and program developme nt strategies to better fit the characteristics of older adult learners.

Chronic disease and dietary management in the elderly: alive and kicking! Johanna T. Dwyer. Journal of Nutrition, Health & Aging, 5(2):103-7. 2001.
The paper reviews progress in chronic disease prevention and dietary management strategies in the elderly to help them remain independent with a high quality of life for as long as possible. Progress in public health over the past century is briefly revie wed. The similarities and differences in preventive measures for elders and younger adults are summarized. The goals for the prevention and management of chronic disease in the elderly are similar, but the strategies may differ, and quality of life is esp ecially important. Especially effective preventive strategies for the elderly are discussed. Selected strategies to manage conditions already present by delaying or controlling diet-related disease progression while maintaining an acceptable quality of li fe are discussed. Finally, selected new research on managing chronic disease in elders is reviewed. Taken together, these strategies promise to keep our elders "alive and kicking" for as long as possible.

Demographic factors, nutrition knowledge, and health-seeking behaviors influence nutrition label reading behaviors among older American adults. Suzanne M. Elbon, et al. Journal of Nutrition for the Elderly,19:31-48. 2000.
NAL Call Number: TX361 A3J63
Abstract: A telephone survey was completed by a national probability based sample of 475 older Americans aged in their 60s (n = 151), 70s (n = 183), and 80s (n = 141). The objectives were to examine use of labels to identify calorie, protein, chole sterol, saturated fat, and calcium content of foods and to identify factors associated with reading nutrition labels. Participants read labels for saturated fat and cholesterol more than for protein and calcium. Being female, high nutrition knowledge, and positive nutrition related health-seeking behaviors were most strongly and consistently associated with the use of food labels. Label reading behaviors were lowest in 80 year olds and may be related to functional impairments such as poor vision or limita tions of activities such as grocery shopping. Promotion of the food label as an information resource for older adults must be based on consideration of demographic, behavioral and physiological factors.

Dietary fat reduction strategies used by a group of adults aged 50 years and older. Journal of the American Dietetic Association,101(9):1024-30. 2001.
NAL Call Number: 389.8 AM34
Abstract: Objective: To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer. Design: Participants completed 2 copies of a self-administered foo d frequency questionnaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change. Subjects: Participants were 65 free-living older adults (aged >50 years) who had maintained substantial changes to decrease fat intake in their diet for at least 5 years. Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies and to confirm and validate the fat-reduction strategy model. Confirmatory fact or analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study. Results: The majority of participants decreased their fat intake gra dually, at different time points in their lives, and over a long period of time (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consist ed of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr= 0.86), and use fat-modified foods (11 items; kr=0.80). Applications/conclusions: Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition e ducation interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable, and sustainable dietary changes over a prolonged period of time.

Effects of a health promotion program on sustaining health behaviors in older adults. Patrick J. Fox, et al. American Journal of Preventive Medicine, 13(4):257-64. 1997.
Abstract: Background: Controversy exists regarding the optimal way to provide health promotion education to the elderly. This prospective randomized study evaluated the effectiveness of individualized assessment and counseling coupled with the rece ipt of a written health plan on client adherence to health behavior recommendations. Methods: Two hundred thirty-seven ethnically diverse and predominantly low-income adults 60 and older, participating for the first time in an established statewide public health prevention program delivered in both rural and urban clinics, were recruited and randomly assigned to treatment and control groups. All participants received a standardized assessment that included a health history, nutrition assessment, and limit ed physical exam from a public health nurse. The treatment group additionally received a written personal health plan and individualized counseling to support implementation of the plan. Both groups were interviewed after one year to determine their adher ence to the original recommendations. Results: Seventeen preventive services and health behaviors were evaluated. There were no statistically significant differences between the groups on health care use and previous health behaviors at baseline. Using lo gistic regression and controlling for socioeconomic and demographic variables, we found that the treatment group that received a personal health plan and counseling completed significantly more preventive referrals and health behavior changes (P < .001 ). Conclusions: A client-centered planning process with supportive counseling by public health nurses, combined with health plans provided to clients, can significantly increase the prevention measures taken by older adults.

The Elderly Nutrition Program: an effective national framework for preventive nutrition interventions. Barbara E. Millen, et al. Journal of the American Dietetic Association, 102(2):234-240. 2002.
NAL Call Number: 389.8 AM34
Abstract: Objective: To guide national policy, Congress mandated the 1992 research evaluation of the Elderly Nutrition Program (ENP), the nation's oldest framework for providing community- and home-based preventive nutrition and health-related serv ices to older persons. This article summarizes key findings on the program's influence on nutritional health, the targeting and costs of its nutrition services, and the study's policy implications. Design: The research included a nationally representative sample of ambulatory and homebound ENP participants And a matched sample of nonparticipants drawn from the US Health Care Financing Administration's Medicare beneficiary listings. Interviews conducted in respondents' homes considered demographic and heal th characteristics and assessed anthropometry and physical functioning, nutrient intake and socialization patterns, and utilization of ENP program services (participants only). Administrative and service delivery data were gathered from all levels of the ENP infrastructure. Results: The ENP program currently provides congregate and home-delivered meals and other nutrition- and health-related services to about 7% of the older population overall, including an estimated 20% of the nation's poor elders. Compa red with nonparticipants, ambulatory and homebound ENP participants are better nourished (4% to 31% higher mean daily nutrient intakes; P<.001) and achieve higher levels of socialization (17% higher average monthly social contacts; P<.001). Federal spending on ENP nutrition services is efficiently leveraged by funding from other public and private sources, allowing ENP to more than double the nutrition services it provides to program participants. Conclusions: ENP is a well-targeted, effective, and efficient federal program available to dietetics and other professionals for providing elderly persons with community-based and home-delivered nutrition and related services. The ENP infrastructure offers a potential model for preventive nutrition interve ntion programs in ambulatory and homebound at-risk older populations.

The EVA-study: Meal patterns of women over 65 years.
Journal of Nutrition, Health and Aging. 5(4):263-5. 2001.
Abstract: What are the meal patterns of elderly women and how is eating and drinking integrated in every day life activities. In a qualitative study "eating and drinking in the life course" out of a sample of 60 women age 64 to 94 years, 43 women kept 3 day food records and activity protocols. All women were living independently in their homes in Giessen, a city 60 km north of Frankfurt/Main Germany. A total of 124 days including weekend and holidays with 592 reported meals were analyzed in respec t to duration, timing and meal patterns. Meals play an important role for structuring the day. Lunch is the main meal of the day, with cooked "meat-legume-starch" components. Breakfast and dinner are based on bread. Eating times can be characterized as "8 am-12 am-18 pm-pattern". Breakfast contributes 21%, lunch 31% and dinner 25%, all snacks and interim meals 22% of total daily energy intake. Nutrition counseling and education of elderly women has to acknowledge culturally based meal patterns as well as culturally based timing and duration of meals.

Extending the reach of nutrition education for older adults: feasibility of a train-the-trainer approach in congregate nutrition sites. Jacquelyn W. McClelland, et al. Journal of Nutrition Education and Behavior, 34(Suppl. 1):S48-52. 2002 .
NAL Call Number: TX341 J6
Abstract: Low-income older adults are difficult to reach with nutrition education. This study examines the feasibility of a Train-the-Trainer approach using congregate nutrition site (CNS) managers to deliver nutrition education. The study suggests th at CNS managers were receptive to the role of trainer, CNS participants were satisfied with this method, and the acceptability of managers as trainers did not vary with participants' levels of risk of malnutrition. Although the sample size (53 participant s and 4 managers) and convenience sampling method limit generalizability, the promising results suggest the potential benefits of this method and the need for further study.

Factors associated with health behavior change among residents 50 to 96 years of age in Rancho Bernardo, California. Rebecca L. Ferrini. American Journal of Preventive Medicine, 10(1):26-30. 1994.
Abstract: Alterations in personal health habits can prevent disease and reduce morbidity and mortality. We examined the association between self-reported healthy behavioral change and age, sex chronic disease, plasma cholesterol, and body mass inde x in an older Caucasian population in southern California. Overall, about two thirds of respondents reported decreased dietary salt or fat intake over the last 15 years, whereas one third reported increased frequency of exercise. Women were more likely th an men to report increasing exercise, changing diet, or reading self-help materials. Individuals 50-69 years of age reported more positive health behavior changes than those 70 years and older. Those with diabetes and hypertension were more likely to decr ease salt intake, but less likely to increase exercise than those without disease. Hypertensive and diabetic men, but not women, were also more likely to change their diet or read self-help materials than their peers without disease. The presence of risk factors for cardiovascular disease, such as obesity, elevated serum cholesterol, diabetes, and hypertension, were generally associated with positive alterations in diet and inversely related to increasing exercise.

A focus on nutrition for the elderly: it's time to take a closer look
Center for Nutrition Policy and Promotion, Nutrition Insights, No.14. 1999
NAL Call Number: aTX360 U6N883
Electronic Version [PDF file]: http://www.usda.gov/cnpp/Insights/insight14.PDF
Abstract: Not Available.

Food insufficiency and the nutritional status of the elderly population
Center for Nutrition Policy and Promotion. Nutrition Insight, No. 18. 2000.
Electronic Version [PDF]: http://www.usda.gov/cnpp/Insights/Insight18.PDF
Abstract: Not Available.

Food security rates are high for elderly households. Mark Nord. Food Review, 25(2):19-24. 2002.
NAL Call Number: aHD9001 N2752
Electronic Version [PDF]: http://www.ers.usda.gov/publications/FoodReview/Sep2002/frvol25i2d.pdf
Abstract: Households that include elderly persons are generally more food secure than other U.S. households. Ninety-four percent of households with an elderly person present were food secure in 2000, compared with 88 percent of households without e lderly. Rates of food insecurity and hunger among households consisting entirely of elderly persons remain almost unchanged from 1995. Stable incomes provided by Social Security, pensions, and personal savings and assets, along with national and community food assistance programs, help ensure a high prevalence of food security among the Nation's elderly.

Food spending and the elderly. J. Michael Harris and Noel Blisard. Food Review, 25(2):14-18. 2002.
NAL Call Number: aHD9001 N2752
Electronic Version [PDF]: http://www.ers.usda.gov/publications/FoodReview/Sep2002/frvol25i2c.pdf
Abstract: In the next decade and beyond, significant demographic changes�especially the rising number of elderly�will offer new challenges for the U.S. food industry. Elderly people generally eat lesser amounts than teens and younger adults. Today' s elderly also dine out less frequently than their younger counterparts. If these eating and spending patterns continue and America's older population meets growth expectations, growth in real per capita food expenditures in the United States will likely stagnate.

Food stamp participation by eligible older Americans remains low. Parke Wilde and Elizabeth Dagata. Food Review, 25(2):25-29. 2002.
NAL Call Number: aHD9001 N2752
Electronic Version [PDF]: http://www.ers.usda.gov/publications/FoodReview/Sep2002/frvol25i2e.pdf
Abstract: Although the Food Stamp Program has special provisions to facilitate participation by low-income Americans age 60 and older, only about a third of eligible people in this age group join the program. No other age group participates at such a low rate. Commonly cited barriers to participation include pride, confusion about program rules, lack of transportation, and difficulty in using Electronic Benefit Transfer technology. Comparisons of demographic characteristics of program participants and nonparticipants among eligible older Americans show that those with the most severe concerns about health and food security are likely to join the program.

Fruit and vegetable consumption in later life. Angela E. Johnson, et al. Age and Aging, 27(6):723-728. 1998.
Abstract: Objective: to assess levels of fruit and vegetable consumption in elderly people, and to examine the socio-economic, physical and psychological factors which influence this consumption. Methods: a three-phase survey: face to face intervie ws; self-completed dietary diaries with a food frequency questionnaire; and follow-up face-to-face interviews. Participants: 445 elderly people (aged 65+) randomly selected from general practitioner lists in urban Nottingham and rural Nottinghamshire, Lin colnshire and Leicestershire. Results: the recommended target of five portions of fruit and vegetables a day was achieved by less than half the respondents: 37% of those living in the urban area and 51% of those living in the rural area. Low fruit and veg etable consumption was particularly associated with being male, smoking and having low levels of social engagement. Conclusions: most elderly people consume less than the recommended levels of fruit and vegetables. Health programs promoting fruit and vege table consumption may not be successfully reaching elderly people and need to target those particularly at risk of low consumption.

The interaction of physical, psychosocial, socioeconomic and sociodemographic variables on the Body Mass Index (MINDEX) of community-dwelling elderly. Angela J.M. Donkin, et al. Journal of Nutrition, Health & Aging, 2(3):143-148. 199 8.
Abstract: Two cohorts of older people 65-74, and 75 or more years of age living at home in Nottingham or in a nearby rural area in the UK were interviewed and anthropometric measurements were taken (n=1037). Bivariate analyses showed significant r elationships between mindex and variables previously associated with food choice. Those with a mindex above the 95th percentile were more likely to live in a rural area, and were less likely to smoke than those between the 5th and 95th percentiles. Those with a low mindex, below the 5th percentile, were more likely to smoke than those between the 5th and 95th percentiles (45% compared to 17%), and were also more likely to live in an urban area, to have difficulty carrying shopping bags, not to use a car f or shopping, to have a poorer appetite, and to live alone. Those overweight and underweight had lower levels of social engagement and were more likely to be of a lower social class. In multivariate analysis, socioeconomic variables and psychosocial variab les were not significantly associated with mindex, when controlling for physical and sociodemographic variables. Advancing age, female gender, smoking and decreased appetite were significantly associated with decreased mindex (Adjusted R2 = .168).

Low-income elderly adults' needs and preferences for nutrition education. Pamela L. Stewart, et al. Journal of Nutrition for the Elderly, 18(2):1-20. 1998.
NAL Call Number: TX361 A3J63
Abstract: Four focus groups were conducted with low-income elderly adults (28 females and 7 males), ages 55+ years, to understand their needs and preferences for nutrition education. Adults were Congregate Meal Program participants in Virginia. Dis cussion questions addressed food purchasing and preparation, importance of food to health, and education methods. Discussions were audio taped and written transcripts were made for use in data analysis. The influence of health conditions on food choices w as the predominant theme of the discussions; adults made choices according to dietary restrictions. Food preferences and sensory characteristics also were important. Some experienced food insecurity. Most wanted to receive information on disease-specific food choices through group discussions and written materials.

Mailed-home nutrition education for rural seniors: a pilot study. Susan J. Crockett, et al. Journal of Nutrition Education, 24(6):312-315. 1992.
NAL Call Number: TX341 J6
Abstract: This article reports the pilot evaluation of a six-week, mailed-home nutrition education intervention. A pretest-posttest design was used to determine the degree to which seniors altered their eating patterns, knowledge, attitudes and bel iefs. Format of the study packets, selection of messages and content for the mailed-home materials were based on opinions expressed in focus group interviews. Focus group results indicated that 60- to 70-year-old seniors were more interested in changing t heir eating patterns than were seniors older than 75 years. In addition, the results provided information about influential sources of health information, interesting nutrition education topics, preferred educational channels and recommended incentives fo r participation.

Meals-on-wheels applicants are a population at risk for poor nutritional status. Ann M. Coulston, et al. Journal of the American Dietetic Association, 96(6):570-573. 1996.
NAL Call Number: 389.8 AM34
Abstract: Objective: To identify older adults with poor nutritional status among the independent-living elderly applying for meals-on-wheels, and to compare how a self-assessment tool and more traditional criteria identify nutritional risk. Design: Descriptive study. Subjects/Setting: Meals-on-wheels applicants (n = 230 between 60 and 90 years of age (mean age = 77.4 +/- 7 years) who were free from terminal illness. Nutrition assessment data were collected in the home of each participant. Main Outc ome Measures: Risk assessment for poor nutritional status was determined using anthropometric, dietary, and laboratory data and with a Nutrition Screening Initiative (NSI) self-assessment tool-the "DETERMINE Your Nutritional Health" checklist. Statistical Analyses: Differences were assessed using Student's t test for unpaired data. Results: Seventy-four percent of study participants were found to be at risk for poor nutritional status according to the study criteria, and 98% were at risk for poor nutritio nal status according to the NSI self-assessment tool. Conclusions: The majority of the applicants for meals-on-wheels were at risk for poor nutritional status. Thus, many independent-living older adults may need additional nutrition assessment and interve ntion to remain independent and in good nutritional status.

Modified food guide pyramid for people over seventy years of age. Robert M. Russell, et al. Journal of Nutrition, 129(3):751-753. 1999.
Abstract: Not Available.

The National Meals on Wheels Foundation/Vegetarian Resource Group Vegetarian Initiative: two year follow-up. Suzanne Havala and Catherine Conway. Journal of Nutrition for the Elderly, 19(4):31-39. 2000.
NAL Call Number: TX361 A3J63
Abstract: A previous report described a unique collaboration between The National Meals on Wheels Foundation (NMOWF), the National Association of Nutrition and Aging Services Programs (NANASP), and the Vegetarian Resource Group (VRG) in the formati on of the Vegetarian Initiative, a program to introduce meatless meal options into senior feeding programs (1997). This article presents results from a two-year demonstration of the program in 25 meal sites throughout the New York City metropolitan area. Recommendations are given for practitioners and others who seek to bring about similar changes in other feeding programs.

Need for physician referral of low-income, chronic disease patients to community nutrition education programs. Gregory Shawver and Ruby Cox. Journal of Nutrition Education for the Elderly, 20(1):17-33. 2000.
NAL Call Number: TX361 A3J63
Abstract: To ascertain levels of dietary counseling and propensity of primary care physicians toward referral of older low-income, chronic disease patients to community nutrition programs and the desire of such patients for dietary counseling, two surveys were conducted. An 18-item mail-out questionnaire was administered with 209 primary care physicians and another 13-item questionnaire was administered in interviews with 57 Food Stamp Nutrition Education Program (FSNEP) participants. Physicians (8 1%) reported providing dietary counseling, but limited referral of chronic disease patients to registered dietitians or community nutrition education programs. FSNEP participants indicated dissatisfaction with their physician's nutrition advice and a desi re for more dietary guidance to manage chronic diseases.

A new efficacious nutrition education tool for seniors (50 +years). Amy Peterson. Journal of Nutrition for the Elderly, 21(3):55-63. 2002.
NAL Call Number: TX361 A3J63
Abstract: Not Available.

The nutrient intake of elderly men living alone and their attitudes toward nutrition education. K.E. Charlton. Journal of Human Nutrition and Dietetics, 10:343-352. 1997.
Abstract: Not Available.

Nutrition and health promotion in older adults. Ronni Chernoff. Journals of Gerontology Biological Sciences and Medical Sciences, 56A(Suppl. 2):47-53. 2001.
Abstract: During recent decades, the concept of health promotion has become a legitimate part of health care because of the aging of the postwar baby boom generation. As this population ages, the potential strain on health care systems will increas e because the greatest use of health care services occurs during the last years of life. In older adults there are many correctable health factors that can be assessed through screening protocols. Hypertension, cholesterol, hearing, vision, diabetes, and cancer screening are well integrated into health promotion programs; nutrition promotion programs are not as well integrated. Reluctance to develop health promotion programs for older adults exists because of a perception that they would not follow such p lans or change their lifestyles. However, longitudinal studies have shown that health promotion activities extend the number of years of health in older people although the relationship weakens in older age. Changes in diet and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early in life, but positive effects can occur at any age. If nutritional interventions are instituted early, a substantial reduction in health care expenditures may resul t from a decrease in the incidence or the delayed onset of these conditions. Changes in behaviors (reducing salt and fat intake) were positively associated with a belief that consuming a healthful diet would contribute to better health. The use of a varie ty of adult education theories and models will enhance behavior changes that lead to more healthful habits and enable a health educator to be successful in effecting change.

Nutrition education for Black Elders: a strategic approach for delivery. Penny A. Ralston and Nancy Cohen. Journal of Nutrition Education, 31(4):230-234. 1999.
NAL Call Number: TX341 J6
Abstract: This paper examines nutrition education for current and emerging cohorts of Black elders. Three contextual factors affecting nutrition education for Black elders are discussed, including diversity of the older Black population, historical and cultural influences, and barriers to educational programming. In light of these contextual factors, six strategic principles are presented that provide a central organizing mechanism and process for nutrition education programming for Black elders.

Nutrition education for older adults. The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research. Isobel Contento, et al. Journal of Nutrition Education, 27(6):33 9-346. 1995
Abstract: Not available.

Nutrition education for the healthy elderly population: isn't it time? Journal of Nutrition Education and Behavior, 34(1):S42-7. 2002.
NAL Call Number: TX341 J6
Abstract: In the United States, people are living longer, healthier lives. A major goal of our public health system is to maintain health among successful agers and prevent or delay chronic disease morbidity. Major strides are being made in identif ying the dietary needs of elderly people that are different from those of younger adults. However, nutrition education programs to promote those dietary needs have lagged behind. This report reviews dietary needs, demographic information, and recent nutri tion policies for older adults as a basis for nutrition education programs. This report suggests that it is time to keep pace with recent findings and develop national and state-sponsored programs that will provide nutrition education and information tran sference to older people in the communities.

Nutrition education may reduce burden in family caregivers of older adults. Heidi Silver and Nancy Wellman. Journal of Nutrition Education and Behavior, 34(1):S53-58. 2002.
NAL Call Number: TX341 J6
Abstract: The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrit ion education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.

A nutrition education program for older adults at congregate nutrition sites. Patricia A. Sharpe, et al. Journal of Nutrition for the Elderly, 16(2):19-31. 1996.
NAL Call Number: TX361 A3J63
Abstract: Nutrition education sessions were evaluated using a quasi-experimental design. Learning activities targeted basic nutrition knowledge, attitudes and behaviors. Ninety-two older adults (53 intervention and 39 comparison subjects) from sev en congregate meal sites participated. The intervention group showed significant gains in three of seven knowledge variables and in one of eight behavioral variables compared to the comparison group. No improvements were found in attitude. Because of logi stical barriers, attendance was less than optimal. The potential impact of environmental factors on older adults' control over food choices is discussed.

Nutrition interventions for low-income, elderly women. Cheryl J. Rainey and Katherine L. Cason. American Journal of Health Behavior, 25(3):245-51. 2001.
Abstract: Objective: To help low-income, older South Carolinian women bring their food choices and nutritional practices in closer alignment with broadly accepted recommendations for healthful eating. Methods: Included the creation of an infrastruc ture of collaborators to examine existing data, develop research questions, and collect and analyze focus group data. Results: Include identification of socioenvironmental, personal, and behavioral factors affecting the nutritional health of elderly women used in the development of nutrition education modules and messages to be delivered through lay educators and videos. Conclusion: Effective nutrition interventions involving low-income, elderly women must use an ecological approach including behavioral a nd organizational change.

Nutrition programs for the elderly: a view from the trenches. William R. Moyer and Alan Balsam. Journal of Nutrition for the Elderly, 16(2):33-42. 1996.
NAL Call Number: TX361 A3J63
Abstract: The Nutrition Programs for the Elderly, established and funded through the Older Americans Act in 1972 are reviewed from both a historical and current perspective. Participant characteristics, participation/meal levels, funding and progra m operational changes are noted. Major issues to include increasing competition, data collection changes, customer sensitivity, service expansion, new technologies and the relationship of Nutrition Programs to managed care are discussed together with some implications for the future.

Nutritional beliefs, attitudes and practices of elderly, rural, southern women. Cheryl J. Rainey, et al. Journal of Nutrition for the Elderly, 20(2):3-27. 2000.
NAL Call Number: TX361 A3J63
Abstract: Not available.

Nutritional risk in inner-city-dwelling older black Americans. Douglas K. Miller, et al. Journal of the American Geriatrics Society, 44(8):959-962. 1996.
Abstract: Objective: To define the degree of nutritional risk in older inner-city black Americans and to identify important underlying factors associated with high nutritional risk. Design: Cross-sectional descriptive study. Setting And Participant s: A population-based sample of 400 noninstitutionalized persons older than 69 years of age in north St. Louis (NSL), Missouri, and a community-based sample of 115 residents aged 50 years and older living in public housing in East St. Louis (ESL), Illinoi s. Both study areas have high levels of poverty. Measurements: Nutritional risk was measured using the Nutrition Screening Initiative Checklist. Demographic information, economic status, self-rated health, Geriatric Depression Scale score, and body mass i ndex were assessed using established standardized instruments. Main Results: Forty-eight percent of NSL and 66% of ESL subjects scored high on the Checklist. Compared with a mostly white (96%) comparison group from New England, both samples demonstrated p articularly high prevalence for limited intake of fruits, vegetables, and milk; tooth and mouth problems; lack of money for food; eating alone; polypharmacy; and inability to shop, cook or feed on their own. High levels of depressive symptoms, fair or poo r self-rated health, perceived inadequacy of income, and low income levels were associated with high risk, but even those subjects with no or few such predisposing factors were still high on the Checklist score compared with the New England sample. Conclu sions: If confirmed, these results indicate that inner-city-dwelling older black Americans are at high nutritional risk. Attempts to reduce their nutritional risk should focus on improving nutritional content of their diet, oral health, polypharmacy, depr essive symptoms, and poor general health; offering group meals; and providing assistance with shopping and cooking.

Older adults at risk of complications from microbial foodborne illness. Jean C. Buzby. Food Review, 25(2):30-35. 2002.
NAL Call Number: aHD9001 N2752
Electronic Version [PDF]: http://www.ers.usda.gov/publications/FoodReview/Sep2002/frvol25i2f.pdf
Abstract: Although older adults have lower rates of infection from some foodborne pathogens than most or all other age groups, they are more likely to have some of the more severe complications from these infections. Low rates of infection may be p artly due to the elderly's more cautious approach to food handling and food consumption than younger persons. However, poor nutrition and decreased food consumption, combined with normal age-related decreases in immune system functioning, may weaken older adults' ability to fight foodborne pathogens. In particular, the elderly are more vulnerable to gastroenteritis-induced deaths.

Older Americans need to make every calorie count. Joanne F. Guthrie and Biing-Hwan Lin. Food Review, 25(2):8-13. 2002.
NAL Call Number: aHD9001 N2752
Electronic Version [PDF]: http://www.ers.usda.gov/publications/FoodReview/Sep2002/frvol25i2b.pdf
Abstract (author): As individuals age, their declining energy needs mean they must eat better while eating less. ERS computed benchmark food densities to show the number of servings per 1,000 calories older individuals would need to consume to meet Food Guide Pyramid recommendations, compared with younger adults. Benchmark servings for the five food groups are highest for older women, the group with the lowest calorie intake. Food group intake levels indicate that older men and women eat fewer serv ings of most food groups than younger individuals. Intakes of all food groups except fruit decline as people age.

Position of the American Dietetic Association: nutrition, aging, and the continuum of care. Journal of the American Dietetic Association, 100(5):580-95. 2000.
NAL Call Number: 389.8 AM34
Abstract: Scientific evidence increasingly supports that good nutrition is essential to the health, self-sufficiency, and quality of life of older adults. With the population of the United States living longer than ever before, the older adult popu lation will be more diverse and heterogeneous in the 21st century. The oldest-old and minority populations will grow more quickly than the young-old and non-Hispanic white populations, respectively. For the current 34 million adults 65 years of age and ol der living in the United States, there are about 12 million caregivers who provide formal or informal care. A broad array of culturally appropriate food and nutrition services, physical activities, and health and supportive care customized to accommodate the variations within this expanding population of older adults is needed. With changes and lack of coordination in health care and social-support systems, dietetics professionals need to be proactive and collaborate with aging-services and other health c are professionals to improve policies, interventions, and programs that service older adults throughout the continuum of care to ensure nutritional well-being and quality of life. The American Dietetic Association supports both the provision of comprehens ive food and nutrition services and the continuation and expansion of research to identify the most effective food and nutrition interventions for older adults over the continuum of care.

Practices and perceptions of food safety among seniors who prepare meals at home. Mary Alice Gettings and Nancy Ellen Kiernan. Journal of Nutrition Education, 33(3):148-154. 2001.
NAL Call Number: TX341 J6
Abstract: Given senior citizens' vulnerability for food-borne illness, a need exists to determine the necessity and focus for education. Focus groups at senior centers reveal that the seniors (N=74) who prepare more than five meals a week at home u se both inappropriate and appropriate practices to cook, cool, and thaw foods. Seniors rely of the distant past for knowledge and identify barriers to altering practices but state that information from educators about the health effects of inappropriate p ractices will convince them to change. For future food safety education, seniors recommend programs, videotapes, television, newspapers, radio, church bulletins, and written educational pieces.

Private versus public relief: Use of food pantries versus food stamps among poor households. Beth Osborne Daponte. Journal of Nutrition Education, 32(2):72-83. 2000.
NAL Call Number: TX341 J6
Abstract: The research presented examines the role of Food Stamps versus food pantries in alleviating food shortages among poor households. First, multinomial logit models are used to examine which factors affect four alternate food assistance choi ces poor households make: (a) to use Food Stamps, (b) to use a food pantry, (c) to use both programs, or (d) to use neither program. Second, the efficacy of food pantries and Food Stamps in alleviating food shortages is investigated by using binomial prob it models, which estimate whether using Food Stamps and/or food pantries have an effect on (a) whether the household perceives food shortages and (b) whether a child's physical well-being is being compromised by a lack of food. The research uses data coll ected by the Food Distribution Research Project, which in 1993 surveyed 405 households below 185% of the poverty level in Allegheny County, PA. The research shows a preference among the nonelderly for the Food Stamp program over food pantries. Conversely, elderly households tend to use the food pantry system over the Food Stamp program.

Review and analysis of evaluation measures used in nutrition education intervention research. Isobel Contento, et al. Journal of Nutrition Education and Behavior, 34(1):2-25. 2002.
NAL Call Number: TX341 J6
Abstract: The purpose of this review is to provide a summary of the kinds of evaluation measures used in 265 nutrition education intervention studies conducted between 1980 and 1999 and an analysis of psychometric issues arising from such a review. The data are summarized in terms of tables for interventions with each of six key population groups: preschool children, school-aged children, adults, pregnant women and breast-feeding promotion, older adults, and in-service preparation of professionals and paraprofessionals. Measures evaluating knowledge and skills or behavioral capabilities were most widely used in studies with preschool, school-aged, and in-service populations (50%-85%) and less widely used in studies with the other groups, particular ly breast-feeding promotion (5%). Measures of potential psychosocial mediators or correlates of behavior such as outcome expectancies, self-efficacy, or behavioral intention were used in 90% of behaviorally focused studies with school-aged children and in about 20% of studies with adults. Dietary intake measures were used in almost all studies, primarily food recalls, records, and quantitative food frequency questionnaires. Short frequency instruments involving only foods targeted in the intervention such as fruits and vegetables are increasingly being used. Measures of specific observable behaviors are also increasingly being used. Physiologic parameters were used in about 33% of behaviorally focused interventions with school-aged children and adults, 20 % with older adults, and 65% with pregnant women and/or their infants. Criterion validity of newly developed intake instruments and content validity of instruments measuring mediating variables were reported in the majority (range 50%-90%) of studies. Rel iability and stability of measures of mediating variables were reported in 50% to 75% of studies, with reliability coefficients mostly about .6 to .7. Two major conclusions from this review are that evaluation measures should be appropriate to the purpose , duration, and power of the intervention and that measures should have adequate validity and reliability in relation to both the outcomes and characteristics of the target audience. Major implications are that considerable preliminary work needs to be do ne before any intervention study to develop and test evaluation instruments so that they are appropriate and have adequate psychometric properties, and cognitive testing of published instruments with each new target audience is essential. We will then be better able to make judgments about the effectiveness of nutrition education.

Service innovations in the Elderly Nutrition Program: two decades of accomplishments. Alan Balsam, et al. Journal of Nutrition for the Elderly, 19(4):41-48. 2000.
NAL Call Number: TX361 A3J63
Abstract: The aging of the U.S. population has brought national attention to programs and services that enhance the health and quality of life of older Americans. Established in 1972, the Elderly Nutrition Program (ENP) provides congregate and home delivered meals to people 60 years and older, particularly low-income elders. This paper summarizes the results of two national studies on service innovations in the ENP. Evidence demonstrates continuing breadth, variety, and innovation in services provi ded to elderly clients. Programs provide a variety of services beyond the provision of congregate and home meals to their clients. Given that there will be an estimated 70 million people over 65 by 2020, coupled with increasing racial diversity, and socia l, health, and nutritional needs for the elderly, the ENP is both beneficial and essential for this population.

Stages of change across ten health risk behaviors for older adults. Claudio Nigg, et al. Gerontologist, 39:473-82. 1999.
Abstract: Owing to the recent success of the Transtheoretical Model of behavior change and the possible relationships between health behaviors, this study investigated the stage distribution of 10 healthy behaviors (seatbelt use, avoidance of high fat food, eating a high-fiber diet, attempting to lose weight, exercising regularly, avoiding sun exposure, sunscreen use, attempting to reduce stress, stopping smoking, and conducting cancer self-exams) and their interrelationships in a representative sa mple of health maintenance organization (HMO) members. The majority of older adults were found to be in either precontemplation or maintenance, illustrating the need to target interventions to precontemplation. Most older individuals were in precontemplat ion for losing weight and/ or sunscreen use and exercise, making these behaviors a priority for intervention research. Possible gateway behaviors to general health could be identified; however, these results are preliminary and require longitudinal follow -up.

Using the Nutrition Screening Initiative to survey the nutritional status of clients participating in a home delivered meals program. AS Herden. Journal of Nutrition for the Elderly, 14(4):15-29. 1995.
NAL Call Number: TX361 A3J63
Abstract: A large percentage of older Americans are at risk for malnutrition. This puts them at risk for premature institutionalization, creating a financial burden. The objective of this survey was to determine the nutritional health of clients re ceiving home delivered meals in Lake County, Indiana and the impact that home delivered meals had on them. Nutrition Screening Initiative (NSI) Determine Your Nutritional Health Checklists were mailed to recipients of meals; 58.3% were returned. Twenty-ei ght percent were found to be at no nutritional risk, 39% at moderate nutritional risk and 33% at high nutritional risk. One-hundred-thirty clients that scored three or more on the "Checklist" were visited by a Registered Dietitian for further screening us ing the NSI Level I Screen. This screen found many nutritional problems but the fact that the clients did receive home delivered meals decreased the risk. It was determined by the author that 68% of these clients could not function in their own homes with out home delivered meals.

Reports, Books and Book Chapters

Communicating with: older adults
Helen Osborne
Chapter 2 in: Overcoming Communication Barriers in Patient Education
Gaithersburg, MD: Aspen Publishers, Inc., c2001. 65 p.
NAL Call Number: R118 O83 2001
ISBN: 083422030X
Description: This chapter provides strategies for communicating health information to older adults. A case example and references are also included.

Counseling gays and lesbians, women, the elderly, and persons with disabilities.
p. 304-325, in Counseling the Culturally Different: Theory and Practice, 3rd edition.
Derald Wing Sue and David Sue
New York: J. Wiley & Sons, c1999. 368 p.
NAL Call Number: BF637.C6 S85
ISBN: 0471148873
Description: Primarily geared to mental health professionals, this book discusses effective multicultural counseling and therapy, culturally appropriate intervention strategies, multicultural family counseling and therapy. This section discusses st ereotypes and misconceptions associated with aging and offers suggestions on counseling older adults.

Factors Affecting Nutrient Intake of the Elderly
Jon P. Weimer
Washington, DC: Food and Rural Economics Division, 1998. 20 p.
NAL Call Number: A281.9 Ag8A no.769
Electronic Version: http://www.ers.usda.gov/publications/aer769/
Ordering Information: http://www.ers.usda.gov/AboutERS/Sales/index.asp?pdt=2&pid=1027
Description: Using data from U.S. Department of Agriculture's 1989-91 Continuing Survey of Food Intake by Individuals, this report correlates the socio-economic status of the elderly (age 60 and over) with their dietary consumption of calories and 11 nutrients: fat, protein, niacin, calcium, phosphorus, magnesium, iron, zinc, and vitamins E, C, and B-6. Participation in nutrition assistance programs, education level, race, gender, income and eating alone are among the factors explored.

Food Assistance: Options for Improving Nutrition for Older Americans: A Report to Congressional Requesters
Washington DC: U.S. General Accounting Office, August 2000. 47 p.
NAL Call Number: HV696 F6 U50434 2000
Electronic Version [PDF]: http://frwebgate.access.gpo.gov/cgi-bin/useftp.cgi?IPaddress=162.140.64.21&filename=r c00238.pdf&directory=/diskb/wais/data/gao
Description: This report examines four programs: the Food Stamp Program, Child and Adult Care Food Program, Elderly Nutrition Program and the Commodity Supplemental Program. Barriers to use and strategies to increase participation among older adult s are addressed.

Geriatric Nutrition: The Health Professional�s Handbook. 2^nd edition
Ronni Chernoff, editor
Gaithersburg, MD: Aspen Publishers, c1999. 518 p.
NAL Call Number: RC952.5 G44342 1999
ISBN: 0834210827
Description: This book provides guidance on how to meet the dietary and nutritional requirements of the "growing older" population. Emphasis is placed on the pre-geriatric or middle age years and the processes and habits that determine future healt h and independence.

Nutrition and Aging: Leading a Healthy, Active Life: 2000 Millennium Lecture Symposium
U.S. Department of Agriculture.
Washington, DC: Heritage Reporting Corporation. September 28, 2000. 200 p.
Electronic Version [PDF]: http://www.cnpp.usda.gov/Seminars/Aging/Proceedings.PDF
Description: A transcript from the U.S. Department of Agriculture�s Nutrition and Aging Symposium that featured the following speakers: Dan Glickman, Shirley Watkins, Julie Paradis, Jeanette Takamura, and Rajen Anand. Topics include: a description of the aging population; Healthy People 2010 objectives related to older adults; centenarians around the world; minority aging; nutrition's impact on healthy aging; physical activity and muscle function; nutrition and osteoarthritis; and mental health.

Nutrition Management & Restorative Dining for Older Adults: Practical Interventions for Caregivers
Gretchen E. Robinson, Betty J. Leif, editors
Chicago, IL: American Dietetic Association, c2001. 395 p.
NAL Call Number: RC620.6 N88 2001
ISBN: 0880911743
Description: This book discusses the nutritional needs and assessment of older adults, ways to maintain or improve independent eating, the eating environment, eating rehabilitation, physical and mental impairments, chronic and acute conditions, and enteral and parenteral nutrition support.

The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population
Committee on Nutrition Services for Medicare Beneficiaries, Food and Nutrition Board, Institute of Medicine.
Washington DC: National Academy Press, c2000. 366 p.
Electronic Version: http://books.nap.edu/books/0309068460/html/47.html#pagetop
ISBN: 0309068460
Description: This report examines: how nutrition services benefit older people in terms of morbidity, mortality, or quality of life; how the coverage policy should be approached and practiced with consideration given to cost and benefits; and the a reas of expertise needed by health professionals to provide nutrition services and therapy.

Seniors' Views of the Food Stamp Program and Ways to Improve Participation�Focus Group Findings in Washington State: Final Report
Vivian Gabor, et al.
Washington, DC: Economic Research Service, U.S. Department of Agriculture, 2002. 236 p.
Electronic Version: http://www.ers.usda.gov/publications/efan02012/
Description: This report explores factors that influence elderly adults� participation in the Food Stamp Program (FSP). Focus groups of senior FSP participants and nonparticipants, community-based organizations, and local FSP staff were conducted t o identify ways of increasing participation. Issues affecting non-English speaking seniors were also identified.

Serving Elders at Risk: The Older Americans Act Nutrition Programs; National Evaluation of the Elderly Nutrition Program, 1993-1995
Michael Ponza, et al, Mathematica Policy Research, Inc.
Washington, DC: U.S. Dept. of Health and Human Services, Office of the Assistant Secretary for Aging: Office of the Assistant Secretary for Planning and Evaluation, 1996. 3 volumes.
NAL Call Number (Volume 1 only): TX361 A3 P652 1996
Electronic Version: http://www.aoa.gov/aoa/pages/nutreval.html
Description: This report presents the results of an evaluation of the Elderly Nutrition Program. The study included an assessment of the program's effects on participants' nutritional status and socialization, impact on the program�s target audien ce, program administration and delivery, and funding. The text is divided into three volumes: Volume 1- Title III evaluation findings, Volume 2- Title VI evaluation findings, and Volume 3-Methodology and appendixes.

Web Sites

Aging-Including Older Americans
National Agricultural Library, Food and Nutrition Information Center, October 2002
Web Site: http://www.nal.usda.gov/fnic/etext/000002.html
Description: Provides links to online aging resources pertaining to associations, dietary habits, government-related and more.

Dietary Reference Intakes for Older Adults
National Policy and Resource Center on Nutrition and Aging, October 8, 2002
Web Site: http://www.fiu.edu/~nutreldr/Resources/Resources/DRIs/DRI_references.htm
Description: Tables include Dietary Reference Intake (DRI) values for men and women ages 51 to 70 and over 70. Also compares the nutrient availability of Title III and Title VI meals with nutrient levels required to meet Older Americans Act Nutriti on Program (OAANP) requirements.

The Elderly Nutrition Program
Administration on Aging, U.S. Department of Health and Human Services, February 14, 2001.
Web Site: http://www.aoa.dhhs.gov/factsheets/enp.html
Description: Describes the administration and services of the Elderly Nutrition Program, eligibility requirements, and program outcomes.

Fact Sheet: Food Stamps and the Elderly
Food Research and Action Center, September 14, 2001
Web Site: http://www.frac.org/html/news/fsp/fsfactselderly.htm
Description: Provides data on food insecurity, Food Stamp Program participation, benefit levels, and income.

Food Stamp Nutrition Connection
National Agricultural Library, Food and Nutrition Information Center, October 28, 2002.
Web Site: http://www.nal.usda.gov/foodstamp
Description: This resource system provides many elderly-specific resources for educators working with low-income audiences. The Hot Topic A-Z section includes an Elderly Nutrition page that features links to statistics, reports, guidelines, onlin e tools and general information. The Resource Finder will search the Food Stamp Nutrition Connection database for nutrition education materials designed for older adults.

Food Stamp Program: Grants to Conduct Elderly Nutrition Pilots-Fiscal Year 2001
Food and Nutrition Service, U.S. Department of Agriculture, August 7, 2002
Web Site: http://www.fns.usda.gov/oane/MENU/ElderlyPilots/Awardees.htm
Description: Provides descriptions of six pilot programs exploring three different ways of eliminating barriers to participation in the Food Stamp Program by eligible persons age 60 years and older.

Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University
Tufts University, September 20, 2002
Web Site: http://www.hnrc.tufts.edu/
Description: Describes the research activities of the Center, which focus on determining the nutrient requirements necessary to promote well-being for older adults. Also provides links to other sites pertaining to nutrition and aging.

Meals on Wheels Association of America
Meals on Wheels Association of America, not dated
Web Site: http://www.mealsonwheelsassn.org
Description: Describes the history and purpose of the Meals On Wheels Association of America, an organization that represents those who provide congregate and home-delivered meal services to people in need. Links to various state Meals on Wheel pr ograms are provided.

MEDLINEplus: Nutrition for Seniors
National Library of Medicine, October 24, 2002
Web Site: http://www.nlm.nih.gov/medlineplus/nutritionforseniors.html
Description: Provides a list of links to articles on nutrition and food safety topics pertaining to older adults.

National Association of Nutrition and Aging Services Programs (NANASP)
Web Site: http://www.nanasp.org/pages/about/default.asp
Description: Describes the activities of this professional membership organization. Members include persons working with or interested in the field of aging, community-based services, and elderly nutrition.

Nutrition Services Incentive Program
U.S. Department of Agriculture, Food and Nutrition Service, July 31, 2002
Web Site: http://www.fns.usda.gov/fdd/programs/nsip/nsiphome.htm
Description: The Nutrition Services Incentive Program, formerly the Nutrition Program for the Elderly, rewards effective performance by states and tribal organizations in the efficient delivery of nutritious meals to older individuals through the u se of cash or commodities. This financial support, either as cash or commodities, is to support programs funded under Titles III and VI of the Older Americans Act. This web site provides links to the Older Americans Act Amendments of 2000 and commodity a nd state agency information.

Older Americans Act Nutrition Program
Washington, DC: Administration on Aging, U.S. Department of Health and Human Services, February 23, 2001
Web Site: http://www.aoa.dhhs.gov/nutrition/default.htm
Description: Provides informational articles and fact sheets pertaining to the Older Americans Act Nutrition Program, also known as the Elderly Nutrition Program. Contact information for State Agency on Aging Nutritionists/Administrators is also l isted.

Seniors Farmers� Market Nutrition Program
U.S. Department of Agriculture, Food and Nutrition Service, not dated
Web Site: http://www.fns.usda.gov/wic/SeniorFMNP/SFMNPmenu.htm
Description: Describes this new program in which grants are awarded to States, United States Territories, and federally-recognized Indian tribal governments in order to provide low-income seniors with coupons that can be exchanged for eligible food s at farmers' markets, roadside stands, and community supported agriculture programs.

Session V: Nutrition and Physical Activity Issues for an Aging Population
National Nutrition Summit: Information Resources. Current Bibliographies in Medicine 2000-3.
National Library of Medicine May 2000
Web Site: http://www.nlm.nih.gov/pubs/cbm/nutritionsummit.html#200
Description: This bibliography was developed for the 2000 National Nutrition Summit, sponsored by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services, in order to provide attendees with background information on nut rition and physical activity for older adults. The list consists of citations from the professional journal and monographic literature, prominent newspapers, legal materials, and links to Internet sites.

Consumer Education Materials

Pamphlets, Brochures, Booklets and Handouts

As You Age Series
Kathleen M. Stadler and Pamela B. Teaster.
Blacksburg, VA: Virginia Cooperative Extension, 2000-2002.

As You Age ... Eat the "Food Guide Pyramid" Way
Electronic Version [HTML]: http://www.ext.vt.edu/pubs/nutrition/348-195/348-195.html
Electronic Version [PDF]:
Description: These color newsletter-style pamphlets provide information about nutrition for older adults. Some information/references are specific to the state of Virginia. The series also includes some additional newsletters on other aging topi cs.
Ordering Information:
Extension Distribution Center
112 Landsdown Street
Blacksburg, VA 24060

Be Your Best: Nutrition After 50
Washington, DC: American Institute for Cancer Research, not dated.
Electronic Version (HTML): https://aicr.donortrust.com/include/BookformReadOnline/na50.htm
Description: This pamphlet emphasizes cancer prevention and encourages: eating a variety of plant-based foods; maintaining a healthy weight; choosing moderation when drinking alcohol; selecting foods low in fat and sodium; and storing foods safely . A question/answer section offers strategies for overcoming problems with chewing, appetite loss, constipation, meal preparation, eating alone, and eating away from home. Recipes are also provided.
Ordering Information:
American Institute for Cancer Research
1759 R Street NW
Washington, DC 20009
Telephone: (800) 843-8114; Monday to Thursday, 9:00 am to 9:00 pm ET; Friday, 9:00 am to 5:00 pm ET.
Web Site: https://aicr.donortrust.com/bookform.asp?item=booklets

Healthy Eating in the Later Years
Linda Boeckner
Lincoln, NE: University of Nebraska-Lincoln, August 2000.
Electronic Version: http://www.ianr.unl.edu/pubs/foods/g1083.htm
Description: This publication discusses hydration, energy requirements, spices and flavorings, a modified Food Guide Pyramid and the Determine Your Nutritional Health Checklist.
Ordering information:
Extension Publications
IANR Communications & Information Technology
Box 830918
Lincoln, NE 68583-0918
Fax: (402) 472-0542
Web Site: http://www.ianr.unl.edu/pubs/foods/index.htm
Publication Number: G1083

Eating Well as We Age
Rockville, MD: Food and Drug Administration, 2000.
Electronic Version: http://www.fda.gov/opacom/lowlit/eatage.html
Description: Discusses ways older adults can overcome barriers to healthy eating and how to use food labels. Issues addressed include chewing problems, stomach upset, appetite loss, income, and physical initiations that impair ones ability to cook and shop for food.
Ordering Information: Available online only

Eating Well For Seniors
Stillwater, OK: Okalahoma Cooperative Extension Service, Oklahoma State University, 1996.
Electronic Versions: http://agweb.okstate.edu/pearl/fci/health/

Fit and Fabulous as You Mature
National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD: Weight-control Information Network, 2001. 14p.
Electronic Version: http://www.niddk.nih.gov/health/nutrit/fitfabmature/fitandfab.html
Description: This pamphlet is a component of the Sisters Together: Move More and Eat Better campaign. It discusses the benefits of exercise, tips for moving more, food label information, healthy food preparation, eating out and serving sizes. A sa mple 1,600 calorie menu is also included.
Ordering Information:
National Institute of Diabetes and Digestive and Kidney Diseases
1 Win Way
Bethesda, MD 20892-3665
Telephone: (877) 946-4627
Fax: (202) 828-1028
Email: win@info.niddk.nih.gov
Web Site: http://www.niddk.nih.gov/health/nutrit/pubs/winpubsorder.htm
NIH Publication No. 01-4927

For Women 65 Years and Older: A Healthy Diet
Washington, DC: The American College of Obstetricians and Gynecologists, 2001. 17 p.
Description: This pamphlet covers healthy eating for older adults and discusses the U.S. Department of Agriculture�s Food Guide Pyramid, the Nutrition Facts Panel, fat intake, nutrient needs, constipation, eating on a budget and Body Mass Index (BM I).
Ordering Information:
ACOG Distribution Center
PO Box 4800
Kearneysville, WV 25430-4500
Phone: (800) 762-2264, ext 830.
Fax (US and Canada): (800) 525-5562
Web Site: http://sales.acog.com

Making Work in the Kitchen Less Physically Strenuous.
Janice Herman.
Stillwater, OK: Okalahoma Cooperative Extension Service, Oklahoma State University, not dated.
3 p.
Electronic Version [PDF]: http://agweb.okstate.edu/pearl/fci/health/t-3127.pdf
Description: Discusses how to make food preparation tasks easier for those with physical limitations. Strategies include sitting while cooking, use of simple equipment to make cooking easier, dividing and freezing foods in small portions, and the use of convenience foods. Some kitchen safety tips for older adults are also included.
Ordering Information:
University Mailing Services
Oklahoma State University
Stillwater, OK 74078
Telephone: (405) 744-5385
Web Site: http://agweb.okstate.edu/pearl/fci/health/

Meatless Menu Alternatives for Seniors
Baltimore, MD: Vegetarian Resource Group, not dated.
Description: This booklet includes a four-week lacto-ovo vegetarian menu set developed for the Meals on Wheels program. Quantity recipes are provided for some of the menu items and a few educational materials are included.
Ordering Information:
The Vegetarian Resource Group
PO Box 1463
Baltimore, MD 21203
Telephone: (410) 366-8343
E-mail: jeannie@vrg.org

Modified Food Pyramid for Mature (70+) Adults
Boston, MA: Tufts University, 1999.
Electronic Version (PDF): http://nutrition.tufts.edu/pdf/pyramid.pdf
Description: This modified Food Guide Pyramid is designed to address the special needs of people over the age of 70 years. This pyramid includes: a base of eight 8-ounce glasses of fluid; a narrower shape to reflect declining calorie needs; an emp hasis on nutrient-dense foods; a fiber icon; and a flag on the top of the pyramid to indicate a possible need for supplements.
Ordering Information (for poster size pyramid):
Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy
Attn: Patricia King
E-mail: patricia.king@tufts.edu

More Water, More Fiber, Fewer Calories: Reinventing the Food Pyramid for Older Adults
Gabriele Amersbach
Boston, MA: Tufts University, July 10, 2002
Web Site: http://nutrition.tufts.edu/feature/pyramid.shtml
Description: Describes how and why the Modified Food Pyramid for 70+ Adults differs from the traditional U.S. Department of Agriculture�s Food Guide Pyramid.

Nutrition and Aging
April C. Mason, et al.
West Lafayette, IN: Purdue University Cooperative Extension Service Purdue University, September 2001.
Electronic Version [PDF]: http://www.agcom.purdue.edu/AgCom/Pubs/CFS/CFS-605-W.pdf
Description: This publication provides mostly knowledge-focused information about the physical changes that occur with age, the nutrition needs of older adults, food and drug interactions and dietary supplement usage.
Ordering Information:
Purdue University Cooperative Extension Service
Media Distribution Center
1187 Service Building
West Lafayette IN 47907-1187
Telephone: (765) 494-6794
E-mail: Media_Order@mdc.ces.purdue.edu
Publication Number: CFS-605-W

Nutrition and Health for Older Americans: Food, Fitness, and Fun from 50 Forward Campaign
Chicago, IL: American Dietetic Association, 1998.
Description: Campaign materials include: black and white reproducible slicks that discuss the Older Americans Food Guide Pyramid, antioxidants, calcium, fiber, grains, protein, water/hydration, caring for older adults, and frequently asked questio ns; a brochure entitled "Staying Healthy - A Guide for Older Adults" that discusses healthy eating for seniors; and a color poster of the Older Americans Food Guide Pyramid.
Ordering Information:
American Dietetic Association
216 W. Jackson Boulevard
Chicago, IL 60606-6995
Telephone: (800) 877-1600 ext. 5000
Fax: (312) 899-4899
Web Site: http://www.eatright.com/catalog/older.html

Nutrition Education Fact Sheets
Kristin Hasting
Marietta, GA: Gerontological Nutritionists, a Practice Group of the American Dietetic Association, not dated.
Electronic Versions: http://trc.ucdavis.edu/gerinutr/Resources/TableofContents.htm
Description: Over 70 fact sheets pertaining to eating on a budget, eating challenges, dealing with weight loss or gain, diet and disease, medications and food safety. Publications are typically 1-2 pages in length, simple and use a large font.
Ordering Information: Available online only.

Nutrition Screening Initiative Materials
Washington, DC: Nutrition Screening Initiative, not dated.
Electronic Versions: http://www.aafp.org/nsi/strong.html
Features the DETERMINE Your Nutritional Health Checklist (printer-ready and interactive) and a brochure entitled "Strong and Healthy" that addresses risk factors identified by the Checklist and provides simple steps to improve nutritional healt h.
Ordering Information:
Nutrition Screening Initiative
P.O. Box 723
Waldorf, MD 20604.
Telephone: (202) 625-1662
E-mail: nsi@gmmb.com
Web Site: http://www.aafp.org/nsi/order.html

Senior Food Guide Pyramid, 2^nd edition
Senior Nutrition Awareness Project, Connecticut/Rhode Island Family Nutrition Program, not dated.
Description: This color handout includes a picture of SNAP�s Senior Food Guide Pyramid, information about food groups, serving recommendations and sizes, and the elderly�s increased need for calcium, vitamin D and vitamin B₁₂.
Ordering Information:
Senior Nutrition Awareness Project (SNAP)
URI Family Nutrition Program
106 Ranger Hall
Kingston, RI 02881
Telephone: (401) 874-2973.
Web Site: http://www.canr.uconn.edu/nusci/outrch/snap/snapub_sfgp.html

SNAP Handouts
Senior Nutrition Awareness Project
Kingston, RI: Connecticut/Rhode Island Family Nutrition Program, not dated.
Electronic Versions:

Fiber
Electronic Version [PDF]: http://www.canr.uconn.edu/nusci/outrch/snap/fiber.PDF
Description: These simple fact sheets provide basic nutrition information and are written in a large font.
Ordering Information:
Senior Nutrition Awareness Project (SNAP)
URI Family Nutrition Program
106 Ranger Hall
Kingston, RI 02881
Telephone: (401) 874-2973.

To Your Health! Food Safety for Seniors
FoodSafey.gov
NAL Call No.: TX531 T58 2000
Electronic Version [HTML]: http://www.foodsafety.gov/%7Efsg/sr2.html
Electronic Version [PDF]: http://www.foodsafety.gov/~acrobat/sr2.pdf
Description: Includes food safety information on "how times have changed", risk of food borne illness, safe food handling at home (featuring Fight BAC! Tips), eating out/take-out food, and thermometer use.
Ordering Information:
Federal Consumer Information Center
Department: WWW
Pueblo, Colorado 81009
Telephone: (888) 878-3256
Fax: (719) 948-9724
Web Site: http://www.pueblo.gsa.gov/results.tpl?id1=15&startat=1&--woSECTIONSdatarq=15&--SECTIONSword=ww
Publication No.: 601JJ

Curricula and Lesson Plans

Elder Nutrition and Food Safety Consumer Leaflets
Linda B. Bobroff and Luisa Oliver-Cordero,
University of Florida, Institute of Food and Agricultural Sciences, Department of Family, Youth, and Community Sciences, 2001.
Electronic Version: http://enafs.ifas.ufl.edu/ENAFS%20EDUCATIONAL%20MATERIAL.htm
Description: These leaflets are a component of the Elder Nutrition and Food Safety educational modules. These modules are designed for use at congregate meal sites and include: Unique Nutritional Needs of Elders, Healthy Living for Elders, Diabetes , Hypertension, and Healthy Eating for Elders. The modules were not available for review and inclusion in this list. However, a lesson introduction and several leaflets from the set are currently available electronically at the Web site address above. Ordering Information:
Linda Benjamin Bobroff, Ph.D., RD, LD/N
Dept of Family, Youth & Community Sciences
University of Florida
3038 McCarty Hall, PO Box 110310
Gainesville, FL 32611-0310
Telephone: (352) 392-1895 Ext 240
Fax: (352) 392-8196
E-mail: LBBobroff@mail.ifas.ufl.edu
Web Site: http://enafs.ifas.ufl.edu/home.htm

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This resource list was compiled by:

Alicia H. White, MS, RD
Food and Nutrition Information Center (FNIC), NAL/ARS/USDA

Acknowledgment is given to the following FNIC reviewers:

Shirley King Evans, EdM, RD
Shannon Fries, MPH, RD
Pamela Hartnett, MPH, RD, LD
Mary C. Herrup, BS, RD
Andrea T. Lindsey, MS

This publication was developed through a Cooperative Agreement between the Food and Nutrition Information Center and the Department of Nutrition and Food Science in the College of Agriculture and Natural Resources at the University of Maryland.

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Food and Nutrition Information Center
Agricultural Research Service, USDA
National Agricultural Library
10301 Baltimore Avenue, Room 105
Beltsville, MD 20705-2351
Phone: 301-504-5719
Fax: 301-504-6409
TTY: 301-504-6856
Comments: http://www.nal.usda.gov/fnic/fniccomments.html
Web site: http://www.nal.usda.gov/fnic

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