Identifying and Assessing Food Insecurity In Older Diverse Primary Care Patients

识别和评估老年多元化初级保健患者的粮食不安全状况

• 批准号: 8958749
• 负责人: Jane Jih
• 金额: $ 11.89万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8958749
• 关键词: Address; Affect; Age; Aging; American; Attitude; Behavior; Belief; Blood Pressure; Body mass index; California; Capsicum; Caring; Characteristics; Chinese People; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Clinical assessments; Communication; Communication Barriers; Communities; Coping Behavior; Data; Development; Diabetes Mellitus; Diet; Disease Management; Eating; Economics; Elderly; Electronic Health Record; Enrollment; Fatty acid glycerol esters; Food; Foundations; Future; Geriatric Assessment; Goals; Health; Healthcare; Hypertension; Internal Medicine; Intervention; Interview; Language; Limited English Proficiency; Malnutrition; Methodology; Outcome; Participant; Patients; Pharmaceutical Preparations; Population; Prevalence; Primary Health Care; Principal Investigator; Provider; Public Health; Research; Sampling; San Francisco; Secure; Self Management; Social Environment; Structure; Surveys; Telephone Interviews; Testing; Transcript; United States National Institutes of Health; Universities; Visit; Weight; Work; base; clinical practice; community setting; cost; experience; food security; innovation; lens; multiple chronic conditions; nutrition; patient oriented; patient population; primary care setting; programs; public health relevance; screening; social health determinants; social stigma; sugar; tool

 DESCRIPTION (provided by applicant): Food insecurity, defined as uncertain or limited access to nutritionally adequate and safe foods, has important implications in the geriatric primary care of growing numbers of older adult patients with multiple chronic conditions (MCC). An estimated 60-75% of older adults have MCC, many of which are nutrition sensitive conditions (e.g. diabetes, hypertension), and about one out of 11 older adults are food insecure. Food insecurity leads to malnutrition and unhealthy weight through reduced food intake, missed meals and alterations of food eaten including more energy-dense foods which are often high in added sugar and fat. Food insecurity also contributes to the development or exacerbation of chronic diseases such as diabetes and hypertension. Yet, the potential impact of food insecurity in older adult patients with MCC has been under- recognized in primary care. Limited English proficiency (LEP) and social stigma and cultural sensitivity attached to food insecurity and enrollment in the Supplemental Nutrition Assistance Program (SNAP) to alleviate food insecurity may contribute as barriers to communicate about food insecurity in the primary care setting. A geriatric approach to the clinical assessment and communication of food insecurity among older adult patients with MCC may be enhanced by incorporating Photovoice in the primary care setting to overcome communication barriers. Photovoice is a qualitative methodology which involves a) photo taking by participants to show their experiences relevant to the health issue and b) dialogue, reflection and action of the issue through sharing of photos. Photovoice has been used for participants to identify, represent and share experiences that may be otherwise difficult or sensitive to communicate by those from vulnerable or LEP populations. The aims of this proposal are to 1) describe the prevalence and associated clinical characteristics of food insecurity in a sample of diverse older adult patients with MCC using the electronic health record in a primary care practice with a diverse geriatric patient population; 2) assess the utilit of Photovoice for eliciting patient attitudes and behaviors regarding their food insecurity and 3) assess the feasibility, acceptability and potential impact of incorporating Photovoice as a communication and assessment tool for food insecurity in the geriatric primary care setting. The proposed study will help advance understanding of the impact of food insecurity as a determinant of health among diverse older adult patients with MCC who are vulnerable to adverse health outcomes. Pilot data from this study will also provide a foundation for the development of a geriatric primary care based intervention incorporating Photovoice to address diet-related chronic diseases to be proposed in future applications. Photovoice could have important applications in facilitating patient-provider communication around sensitive topics such as food insecurity and may be a useful patient-centered approach for providers to more fully assess the environmental and socio-cultural contexts that affect the health of vulnerable geriatric patients.

 描述（由申请人提供）：粮食不安全，定义为不确定或有限的获得营养充足和安全的食物，在老年初级保健中具有重要意义，越来越多的老年人患有多种慢性病（MCC）。据估计，60-75%的老年人患有MCC，其中许多是营养敏感性疾病（如糖尿病，高血压），大约每11名老年人中就有一名缺乏食物安全。粮食不安全导致营养不良和不健康的体重，因为食物摄入量减少、不吃饭和改变所吃的食物，包括能量密度更高的食物，这些食物往往含有大量的添加糖和脂肪。粮食无保障也会助长糖尿病和高血压等慢性病的发展或恶化。然而，食物不安全对老年MCC患者的潜在影响在初级保健中尚未得到充分认识。有限的英语水平（LEP）和社会耻辱和文化敏感性附加到粮食不安全和补充营养援助计划（SNAP），以减轻粮食不安全的招生可能有助于沟通的障碍，在初级保健环境中的粮食不安全。老年人的临床评估和沟通的食物不安全的老年人与MCC的成年患者之间的方法可以通过将Photovoice在初级保健环境中，以克服沟通障碍。“照片之声”是一种定性方法，涉及a）参与者拍照，展示他们与健康问题有关的经验，以及B）通过分享照片就该问题进行对话、思考和行动。Photovoice已被用于参与者识别，代表和分享那些来自弱势群体或LEP人群的人可能难以或敏感的经验。本提案的目的是：1）在具有不同老年患者人群的初级保健实践中，使用电子健康记录，描述不同老年MCC患者样本中食物不安全的患病率和相关临床特征; 2）评估Photovoice在引发患者对其食品不安全的态度和行为方面的效用，3）评估可行性，将Photovoice作为老年初级保健环境中粮食不安全的沟通和评估工具的可接受性和潜在影响。这项拟议的研究将有助于促进对粮食不安全的影响的理解，作为各种老年MCC患者健康的决定因素，这些患者容易受到不良健康结果的影响。这项研究的试点数据也将提供一个基础，为发展一个老年初级保健为基础的干预措施，结合Photovoice，以解决饮食相关的慢性疾病，在未来的应用中提出。Photovoice可以在促进患者与提供者之间围绕食品不安全等敏感话题进行沟通方面发挥重要作用，并且可能是一种有用的以患者为中心的方法，供提供者更全面地评估影响脆弱老年患者健康的环境和社会文化背景。