Pilot Study to Determine the Effect of a Nutrition/Food Safety Curriculum Targeting Older Adults who Participate in the SC Congregate Nutrition Program

NON-TECHNICAL SUMMARY: A large number of older South Carolinians are classified as malnourished because many have one or more chronic diseases, are poor, and/or live in a rural area. These conditions alone or in combination are having a significant impact on the overall health of our elders and their ability to live independently longer. Helping our elders to live independently could significantly decrease health care costs, particularly Medicare spending. According to one recent estimate, Medicare spent $42.2 billion on home care and nursing home care, representing roughly 20 percent of national spending on long-term care in 2005. At present, there are hundreds of health promotion programs targeting older adults. Many of these programs are not evidence-based. This project proposes to test the effect of a newly created nutrition/food safety curriculum using the existing federally- and state-funded congregate meals program to reach adults age 60 and older. This culturally and regionally tailored nutrition/food safety curriculum will be delivered to older adults attending 12 randomly selected congregate meal sites across South Carolina. This study has two objectives: (1) to determine if a series of eight one-hour nutrition/food safety education sessions that focus on healthful and safe food choices, simple and healthful food preparation practices, and safe food handling can be adapted and delivered across South Carolina to older adults attending congregate meal sites and (2) to determine the effect of exposure to the curriculum on the participant's health, as measured by weight and blood pressure change, and change in an established measure of health-related quality of life (VR-12) and nutrition (Mini-Nutritional Assessment). The eight sessions will be presented over consecutive weeks (eight weeks total) by Clemson University Extension Agents. Underpinning the curriculum is an educational model, Revised Bloom's Taxonomy (RBT), which is a sound learning taxonomy that assures the alignment of an educational curriculum so that the likelihood of positive outcomes will occur. This study will lay the groundwork for a statewide and possible regional and national evidence-based nutrition/food safety program that can be delivered to older adults, a group often at risk for nutritional compromise due to chronic illness, social inequality, social and psychological factors, and poor dietary practices. This project will have as its sample a group of poorer, rural older adults, many of whom will be members of minority groups. Historically, these individuals are at higher risk for health disparities and poorer health outcomes. Additionally, because of their rurality, they might have limited access to a variety of foods, such as out of season fruits and vegetables and higher quality meat and dairy products. A repository of healthy and safe recipes that incorporate regional foods that these older adults can afford and to which they have access will also be developed -- this is a form of health access in itself! The ultimate goal is to deliver the curriculum in all congregate nutrition sites across South Carolina after a thorough evaluation is completed to determine its effect.

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APPROACH: We propose to conduct a study to determine the effect of eight, one-hour education sessions (Cooking Healthy, Eating Smart) that focus on healthy and safe food choices, simple and healthy food preparation practices, and safe food handling delivered by Clemson Extension (CE) agents to older adults in 12 randomly selected congregate meal sites across the state of South Carolina. The Cooking Healthy, Eating Smart (CHES) curriculum uses as its theoretical underpinning Revised Bloom's Taxonomy. Cluster randomization in which congregate meal sites (clusters) will be randomized to the intervention (12 sites) or the control group (12 sites) rather than independent participants will be used as the research design to determine the effect of the curriculum. Determinants of effect will be changes in weight, blood pressure, nutritional health, knowledge of food safety, and health related quality of life (a measure of general health).