title: A multidimensional approach to understanding under-eating in homebound older adults: the importance of social factors.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA. jlocher@uab.edu
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.forename: Caroline O
authors.initials: CO
authors.lastname: Robinson
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.forename: Delia
authors.initials: D
authors.lastname: Smith West
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Burgio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002149:Energy Intake; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006304:Health Status; D006699:Home Care Services; D018577:Homebound Persons; D006801:Humans; D008297:Male; D044342:Malnutrition; D008875:Middle Aged; D009909:Oral Health; D012944:Social Support