Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults.

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults.

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services. POSITION STATEMENT: It is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.

Residency redesign to accommodate trends in geriatrics: an RC-FM variance to establish a patient-centered medical home in an assisted living facility.

BACKGROUND AND OBJECTIVES: Family physicians are poised to provide medical care to older adults residing in the broad range of facilities now currently available to this population. To date, geriatric training has focused on skilled nursing facilities, particularly for the required Review Committee for Family Medicine (RC-FM) longitudinal experience. This article describes the development and evaluation of an RC-FM approved assisted living curricular variance to the current nursing home longitudinal experience with emphasis on the principles of the Patient-centered Medical Home (PCMH) model and an interprofessional team concept. METHODS: Second- and third-year family medicine residents were assigned as the primary care providers for two continuity patients in an assisted living facility. Patients were seen bimonthly within the construct of an interprofessional geriatric team. During the 2-year curricular variance, assessment of residents' skills, knowledge, and attitudes of the residents was conducted before and after the experience through direct skills observations, written testing, and focus groups. RESULTS: Of 18 geriatric competencies evaluated by direct observation, there was statistically significant improvement in seven areas. The composite score for these competencies was statistically significant. The attitudinal scores were initially high and remained high throughout the 2-year period. Knowledge testing was not significantly different before or after the experience. CONCLUSIONS: The assisted living facility is a viable clinical educational setting to develop geriatric competencies within a PCMH model. Providing geriatric clinical opportunities across the continuum of care can better prepare family medicine residents for future practice.

New developments in the management of hypertension.

The management of hypertension has evolved over the past decade. Isolated systolic blood pressure elevation, the most common form of uncontrolled hypertension, is recognized as a significant risk factor for vascular complications in patients with hypertension. Nutritional management of hypertension has moved beyond simply restricting sodium intake to ensuring that patients consume adequate amounts of the major food groups, particularly those containing calcium, potassium, and magnesium. Selective aldosterone receptor blockers are a new class of antihypertensive medication, and the angiotensin-receptor blocker class has several new additions. However, the main-stay of treatment remains a diuretic or a combination of a diuretic and either a beta blocker or an angiotensin-converting enzyme inhibitor. Hypertension is a significant risk factor for vascular complications of diabetes, and the target blood pressure in patients with diabetes or chronic renal disease and hypertension should be lower than that in patients with hypertension alone. Controlling hypertension in elderly patients can reduce their complications at least as much as it does those of younger patients with hypertension.