Differences in Psychosocial and Behavioral Variables by Dietary Screening Tool Risk Category in Older Adults

The Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.

The aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.

This study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.

Community-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).

DST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).

Multiple analysis of variance and χ² analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.

Participants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).

Older adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.