Academic journal article Generations

The Influence of Nutritional Health on Physical Function: A Critical Relationship for Homebound Older Adults

Academic journal article Generations

The Influence of Nutritional Health on Physical Function: A Critical Relationship for Homebound Older Adults

Article excerpt

Among numerous modifiable factors that are associated with increased burden of physical disability, several nutrition-related determinants have been identified, such as nutritional risk (i.e., high risk for poor nutritional health) and poor nutritional health (i.e., overweight, unintended weight loss, and low dietary intake) (Ferraro et al., 2002; Sharkey and Haines, 2002). The growing numbers of vulnerable older people in the community disproportionately experience chronic health conditions, poor nutritional health, and functional decline. Chief among the subgroups with heightened vulnerability are women, minorities, the poor and near-poor, and those who are homebound, primarily as a result of illness, impairment, disability, and geographic isolation. However, few researchers have studied homebound older individuals because of special challenges and considerations-identification, recruitment and retention in die studies (e.g., fear and distrust of the researcher, cultural differences between the elder and the researcher, lack of understanding, and inconvenience). Given the limited understanding that exists as to the relationship between nutritional health and physical function among this homebound elders, this paper describes how poor nutritional health in such forms as obesity and low nutrient intakes from food may influence the decline in physical function and increased severity of disability among homebound older men and women. These relationships are especially important for the large pro- portion of particularly vulnerable homebound elders, such as women or racial or ethnic minorities, those who have a low income and limited education, or those who live alone.


Physical disability is often characterized by difficulty or inability to independently carry out essential tasks of daily living such as bathing, dressing, walking, shopping for groceries or personal items, preparing meals, cleaning, and housework. The progressive loss of function-development of disability-is often regarded as long-term physiological and functional consequences of chronic health conditions, with the passage through sequential stages of diminished physiological reserve and progressive loss of physical function. The effect of nutritional health and underlying pathology or impairments on physical disability may be through their impact on functional limitations (Sharkey et al., 2003; Sharkey et al., 2004). This effect is of great concern, considering that among a national sample of functionally independent people ages 70-74 years, 19 percent of men and 32 percent of women became disabled in a two-year period (Gill, Williams, and Tinetti, 1995).


The North Carolina Nutrition and Function Study (NAES) of homebound older adults was a multiple-year collaborative project between the School of Public Health at the University of North Carolina at Chapel Hill and providers of home-delivered meals for Older Americans Act (OAA) Nutrition Program in four North Carolina counties. The objective of the NAFS was to examine the influence of dietary intake and body mass index (BMI) on functional limitations among a probability sample of homebound older men and women who regularly received home-delivered meals. In the NAFS, functional limitation (i.e., lower-extremity physical performance) was assessed in the home using various measures (Guralnik et al., 1994; Gill et al., 1996).

Severity of disability in the NAFS was determined by self-reported level of difficulty (from no difficulty to complete dependence) in performing seven self-care tasks that were based on a modified version of the basic Activities of Daily Living (ADL) scale. These include bathing, dressing, personal grooming, transferring from bed to chair, walking across a room, eating, and using the toilet. As in many other studies, disability was defined as reporting a lot of difficulty or reporting being unable to perform the activity without assistance (Simonsick, Kasper, and Phillips, 1998). …

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