This year was momentous in many ways, with changes in public health policy, indecisiveness on advancing US health care, and increasing interest in the importance of nutrition and physical activity for older adults. Topics in Clinical Nutrition 32.4 addresses some concerns for older Americans who are homebound, specifically food safety practices and vitamin D in household food supplies. With 47 million adults older than 65 years, the impending crisis to meet their health care needs should be addressed sooner rather than later.
In this issue, a project studying home-delivered meal (HDM) recipients provides insight into the risks of foodborne diseases and reveals data important for making changes. McWilliams et al examined information from 725 HDM recipients about ways that they address food safety. The investigators found problems with inadequate conditions of the kitchens of homebound seniors that were further compromised by incorrect refrigerator/freezer temperatures, vision problems, and confusion about storing food properly.
Another approach in the same cohort looked at their vitamin D intakes. Lashway et al investigated the food supplies of homebound older adults receiving HDM. Vitamin D content in their diets was primarily from milk, fish and shellfish, eggs and egg substitutes, and ready-to-eat cereals but in moderate amounts. To improve access to vitamin D, an addition to HDM programs provides another meal consisting of vitamin D-fortified milk and ready-to-eat cereal, pouches of tuna or salmon and vitamin D-fortified juice, and/or vitamin D supplements.
Case reviews report 2 concerns discussed in the literature that affect older adults. Siu-Man Sum and her colleagues report on the undisclosed usage of diet herbal supplements by an 81-year-old Chinese patient. The evidence for intervention is presented and discussed for taking supplements. However, supplement use should be disclosed to reduce risks for adverse diet herb-drug interactions. They also emphasize the need for registered dietitian nutritionists to provide dietary supplement education as part of comprehensive patient care.
Another evidence-based approach by Tiderencel and Brody explores the case of a patient with a diabetic heel ulcer. Evidence-based nutrition management for pressure ulcers exists, but this case review highlights a need for building a more detailed base of evidence to meet the micro- and macronutrient deficiencies.
Yahia et al discuss their experience in introducing Evidence-Based Nutrition Practice Guidelines for type 2 diabetes mellitus in Lebanon. The US Academy of Nutrition and Dietetics practice guidelines were taught and pilot-tested for application in Lebanon. Seventy-five patients received care using the guidelines, and clinical improvements were seen in their patients after 3, 6, and 12 months.
The effectiveness of prosthetic rehabilitation using oral devices was applied to 150 patients. The investigators used selected nutrition assessment parameters, the Mini Nutrition Assessment (MNA) instrument and body mass index (BMI) to examine nutritional-oral health. To see improved nutritional status, they recommend further research in a random sample of patients to measure malnutrition risk with these tools, BMI and MNA, before and after implants (partial and overdentures).
Drug-induced xerostomia or dry mouth in hemodialysis patients increases dental caries, oral lesions, and chewing and swallowing problems. Several factors affect nutritional status in hemodialysis patients. More attention should be paid to preventing potential problems and treating high-risk patients.
2017 is a celebratory 100th year for the profession with a second century full of potential opportunities for nutrition and dietetics practice. Thanks to all of our authors, reviewers, readers, and contributors for their continued inquiry and analysis of effective and dynamic practice.
-Judith A. Gilbride, PhD, RD, FAND, CDN
Editor