title: Diet quality and body mass index are associated with health care resource use in rural older adults.
abstract: Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.
authors.forename: Dara W
authors.initials: DW
authors.lastname: Ford
authors.forename: Terryl J
authors.initials: TJ
authors.lastname: Hartman
authors.forename: Christopher
authors.initials: C
authors.lastname: Still
authors.forename: Craig
authors.initials: C
authors.lastname: Wood
authors.forename: Diane C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: Regan
authors.initials: R
authors.lastname: Bailey
authors.forename: Helen
authors.initials: H
authors.lastname: Smiciklas-Wright
authors.forename: Donna L
authors.initials: DL
authors.lastname: Coffman
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Jensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D004032:Diet; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D015596:Nutrition Assessment; D009765:Obesity / Q000517:prevention & control; D010045:Outpatients / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D014675:Vegetables
keywords: Aging; Body mass index; Diet quality; Health care resource use
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