Identifying and Assessing Food Insecurity In Older Diverse Primary Care Patients

 描述(由申请人提供)：食品不安全，定义为不确定或有限地获得营养充足和安全的食物，对越来越多患有多种慢性病的老年患者的老年初级保健具有重要影响。据估计，60-75%的老年人患有MCC，其中许多是营养敏感型疾病(如糖尿病、高血压)，大约每11名老年人中就有一人食物不安全。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，错过了一餐，改变了所吃的食物，包括更高能量密度的食物，这些食物往往含有高附加糖和高脂肪。粮食不安全还导致糖尿病和高血压等慢性疾病的发展或恶化。然而，在初级保健中，食物不安全对患有MCC的老年患者的潜在影响一直被低估。有限的英语水平(LEP)以及与粮食不安全有关的社会耻辱和文化敏感性，以及参加缓解粮食不安全的补充营养援助计划(SNAP)，可能会成为初级保健环境中关于粮食不安全的沟通障碍。通过在初级保健环境中结合PhotoVoice来克服沟通障碍，可以加强老年MCC患者的临床评估和食物不安全的沟通。PhotoVoice是一种定性方法，它包括a)参与者拍照，以展示他们与健康问题有关的经验；b)通过分享照片对问题进行对话、反思和采取行动。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地交流的经验。这项建议的目的是1)描述在不同老年患者群体的初级保健实践中使用电子健康记录的不同老年MCC患者中食物不安全的流行率和相关的临床特征；2)评估PhotoVoice在诱导患者对其食物不安全的态度和行为方面的使用；3)评估将PhotoVoice作为老年初级保健环境中食物不安全的沟通和评估工具的可行性、可接受性和潜在影响。这项拟议的研究将有助于促进对各种老年MCC患者的影响的理解，食品不安全是健康的决定因素，他们容易受到不利健康后果的影响。这项研究的先导数据还将为开发一种基于老年初级保健的干预措施提供基础，该干预措施将结合PhotoVoice来解决与饮食有关的慢性疾病，并将在未来的应用中提出。PhotoVoice可以在促进围绕食品不安全等敏感话题的患者和提供者之间的沟通方面发挥重要作用，并可能是一种有用的以患者为中心的方法，使提供者能够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。

 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.