Recruitment of volunteers for a home-delivered meals programme serving homebound older adults: a theoretically derived programme among faith communities.

OBJECTIVE: Home-delivered nutrition programmes that are federally subsidized by the US Administration on Aging seek to ensure that socially isolated older adults who are unable to purchase and prepare their own food have nutritious meals delivered to them regularly by both employed and volunteer staff. Unfortunately, there are long waiting lists in some neighbourhoods that are often due to a shortage of volunteers. The present paper describes a theoretically driven community-based project designed to increase volunteer participation in serving Meals on Wheels (MOW) clients. DESIGN: A Support Team model was applied in the project wherein existing social capital among religious faith communities, and social networks within those organizations, was joined with a local MOW programme to create a sustainable meal delivery route to vulnerable homebound older adults. SETTING: The programme participants were in one underserved neighbourhood in Birmingham, Alabama, an urban city in the south-eastern USA. SUBJECTS: The subjects under consideration are both MOW clients and volunteers. MOW clients are those individuals aged 60 years and above who qualify for the service; the volunteers are from community churches. RESULTS: One volunteer route, comprising six congregations that delivered meals to sixteen homebound older adults, was created. The route served more than 2000 meals in 2006 (the year the programme began) and continues to serve clients today. CONCLUSIONS: The programme's successful implementation provides evidence that reliance on theory is critical in planning and developing effective community-based programme interventions.

Disruptions in the organization of meal preparation and consumption among older cancer patients and their family caregivers.

OBJECTIVES: The purpose of this paper is to analyze the social organization of caring as gendered work as it relates to meal preparation and consumption activities surrounding older adult cancer patients and their caregivers. METHODS: Qualitative methods consisting of in-depth, semi-structured, face-to-face interviews with 30 older cancer patients (17 women and 13 men aged 68-90) and their caregivers were conducted separately. Participants were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancer. RESULTS: Major findings were that both patients and caregivers experienced distress surrounding food preparation and mealtime activities, and these varied according to the gender of both patients and caregivers and the relationship that existed between patients and caregivers. Of particular note, female patients experienced distress over not being able to fully participate in meal planning and cooking activities that were central to their self-identity. Related to this, male spouses experienced frustration over not being able to engage in cooking activities that met their wives' expectations. Female caregivers expressed tremendous discontent that the one they were caring for did not eat like they 'should'. DISCUSSION: Matters related to the organization of meals and food consumption activities may be a source of significant distress for patients and caregivers. Further research and greater attention from health care providers are warranted to evaluate the extent of such distress.

The contribution of social factors to undereating in older adults with cancer.

Inadequate nutrient intake is common in cancer patients and is associated with poor outcomes. Social factors may contribute to inadequate nutrient intake, although they have not been studied. The purpose of this study was to investigate social factors that may contribute to undereating in older adults with cancer. Participants included 30 patients, 17 women and 13 men, aged 70-99 years, who were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancers. Both participants and caregivers interpreted weight loss as a positive health outcome of cancer. Furthermore, some patients who had lost weight worked to keep the weight off by going on special diets. Patients and caregivers imbued certain foods with health-promoting qualities without corroborating scientific evidence. Cancer- and treatment-related alterations in self-identity due to changes in their bodies, in taste, and in the manner in which they must eat caused cancer patients to experience frustration and embarrassment, which led to reduced nutritional intake. Despite their compromised nutritional status, patients did not discuss food and eating habits with their physicians. Behaviors and attitudes of patients and caregivers may lead to negative changes in eating behaviors beyond the cancer itself or its treatment or sequelae. Many of these behaviors are potentially modifiable with appropriate education, communication, and intervention.

A multidimensional approach to understanding under-eating in homebound older adults: the importance of social factors.

PURPOSE: The purpose of this study was to identify relationships between medical, functional, economic, oral health, social, religious, and psychological factors and under-eating in homebound older adults. The focus of the study was on identifying potentially modifiable factors amenable to social and behavioral interventions. DESIGN AND METHODS: A total of 230 homebound older adults who were currently receiving home health services participated in interviews in their homes using a questionnaire to assess eating behaviors and factors that could possibly affect those eating behaviors. Interviewers measured height and weight, and participants completed three 24-hr dietary recalls. RESULTS: The mean age of participants was 79.1 years. The sample comprised 78% women and 38% African Americans. We found that 70% of participants were under-eating, defined as not consuming enough calories to maintain their current body weight. Participants who were at higher risk of under-eating included men, those receiving either infrequent care or very frequent care by a caregiver, those who had been hospitalized prior to receipt of home health services, and those with a higher body mass index. IMPLICATIONS: Findings from the study have implications for both practice and policy. Experts must develop evidence-based interventions targeted at under-eating in this particularly vulnerable and growing population of homebound older adults. This study provides an initial foundation for the development of targeted evidence-based behavioral nutritional interventions that are noninvasive and cost effective.

Developing, integrating, and perpetuating new ways of applying sociology to health, medicine, policy, and everyday life.

As a framework for presenting ideas on developing ways to make sociology more applicable, we focus on the recent state of medical sociology research. Data for this paper were generated through a content analysis of a twelve-year period (1993-2004) of the Journal of Health and Social Behavior (JHSB) and Social Science & Medicine (SSM). The analysis aims to determine if the content of JHSB and SSM reflect the breadth of the sub-discipline of medical sociology as well as the stated goals of the journals. The selected issues of JHSB and SSM were coded on the basis of the following attributes: (1) Primary Substantive Topic, (2) Methodology, (3) Data Type and Analytic Technique, and (4) Research and Policy Recommendations. We found that the orientation of JHSB articles was towards generating research and theory that shy away from policy, interdisciplinary approaches, and applied issues. SSM content tends to display more interdisciplinary breadth and variety, but also reflects a dearth of applied recommendations. Our discussion focuses on what JHSB and SSM could be. We present ideas on how the sociological discipline in general-and JHSB and SSM in particular-can help generate and nourish new forms of inquiry that can impact the way research questions are framed. We conclude that such a shift is needed in order to maximize the applicability of social scientific evidence to everyday life, and we share examples situated within a socio-medical context, where there is a particular need for the application of social evidence to practice.

Ethical issues involving research conducted with homebound older adults.

Conducting research in the home setting with homebound older adults presents distinct ethical and practical challenges that require special consideration. This article describes the methodological issues that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict and offers practical strategies for researchers to deal with these problems when studying this population. In writing this article, we draw on more than a decade of descriptive and intervention research focusing exclusively on the homebound older population in which the authors have collaborated. Therapeutic misconception and researcher role conflict may occur because of methodological issues related to the recruitment of participants, the "homebound" status of participants, and the home setting as the interview site. Particular care is required on the part of the researcher to address these ethical issues. This may be accomplished especially through clear communication during the informed consent process with participants and in scientific communication with colleagues.

Communicating laboratory test results for rheumatoid factor: what do patients and physicians want?

OBJECTIVE: This study aimed to explore patient and physician perspectives on current laboratory test reporting practices and to elicit ideas for improvement. METHODS: Two independent studies were conducted. The first solicited members of an online physician community for opinions on current laboratory test reporting practices and possible improvements. The second addressed the same topic, but solicited patient feedback, and included an evaluation of a mock laboratory test report for the rheumatoid factor blood test. RESULTS: Both physicians and patients expressed a desire for patient-friendly information on laboratory reports. Physicians expressed a need for education for patients around false-positive and false-negative results within laboratory reports, while patients sought context around the meaning of results, relevance to other tests, and follow-up steps. CONCLUSION: Physicians and patients see value in enhancing laboratory test reports to improve communication. While reports should include the context that patients value, they should also contain cautionary interpretation emphasized by physicians. Patient consultation on improving laboratory reports may help improve such patient-focused communication and promote greater patient understanding of health information, thereby increasing patient participation in their own health care and improving outcomes. PRACTICE IMPLICATIONS: Laboratory reports are typically designed by experts. Including patients in laboratory report design may facilitate communication and improve outcomes through better patient engagement.

The effect of the presence of others on caloric intake in homebound older adults.

BACKGROUND: Undernutrition in homebound older adults is a significant problem. The purpose of this study was to investigate the effect of the presence of others, both within the household and during meals, on caloric intake in homebound older adults. METHODS: In-depth interviews and three 24-hour dietary recalls were obtained from 50 older adults who were receiving home health services. Descriptive statistics were used to characterize participants, and hierarchical linear modeling was performed to evaluate predictors of caloric intake per meal. RESULTS: Participants' mean age was 77. Females composed 65% and African Americans composed 42% of the sample. Analyses are based on 553 meal observations. The majority (84%) of participants consumed all meals for each of the 3 days of data collection; however, they consumed an average of only 1305 calories per day. Hierarchical linear modeling analysis indicated that persons who had others present during meals consumed an average of 114.0 calories more per meal than those who ate alone (p =.009) and that women consumed 76.7 fewer calories per meal than did men (p =.045). The presence of others within the household had no effect on caloric intake. CONCLUSION: This research suggests that a simple and inexpensive way to increase caloric intake in homebound older adults is to make arrangements for family members or caregivers to eat with them.

Primary care physician attitudes and perceptions of the impact of FDA-proposed REMS policy on prescription of extended-release and long-acting opioids.

With increasing numbers of patients experiencing chronic pain, opioid therapy is becoming more common, leading to increases in concern about issues of abuse, diversion, and misuse. Further, the US Food and Drug Administration recently released a statement notifying sponsors and manufacturers of extended-release and long-acting opioids of the need to develop Risk Evaluation and Mitigation Strategies (REMS) programs in order to ensure that the benefits of this therapy choice outweigh the potential risks. There is little research on physician opinions concerning opioid-prescribing and education policies. To assess attitudes surrounding new opioid policies, a survey was designed and distributed to primary care physicians in October 2011. Data collected from 201 primary care physicians show that most are not familiar with the REMS requirements proposed by the Food and Drug Administration for extended-release and long-acting opioids; there is no consensus among primary care physicians on the impact of prescribing requirements on patient education and care; and increasing requirements for extended-release and long-acting opioid education may decrease opioid prescribing. Physician attitudes toward increased regulatory oversight of opioid therapy prescriptions should be taken into consideration by groups developing these interventions to ensure that they do not cause undue burden on already busy primary care physicians.