Progress 01/15/06 to 01/14/13

Outputs
Target Audience: Target audience is older adults participating in Georgia's Older Americans Act Nutrition Programs at senior centers throughout Georgia, as well as the very-old (centenarians). Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Doctoral students assisted with conducting this research, including Sohyun Park, now with CDC, Dawn Penn Brewer, now Assistant Professor at the University of Kentucky, and Kathryn Porter Starr, now a post-doctoral fellow at the School of Medicine, Duke University. Several masters' students also assisted with conducting this research, who went on to become pharmacists (Sara Fitzpatrick) or dietitians (Sara Hendrix, Melinda Bell, Tiffany Sellers Lommel, Christina Catlett, Alison Clune Berg, Jennifer Teems) or enrolled in doctoral programs (Alison Clune Berg in foods and nutrition, Alyson Haslam in epidemiology and biostatistics). Also, presentations about the findings were made at the local, state, national, and international levels by student and faculty engaged in the research. How have the results been disseminated to communities of interest? The curriculum for the resulting series of community-based interventions is available at the website, Live Well Age Well, www.livewellagewell.info. Other significant dissemination activities for the life of the project are annual meetings with the Georgia Division of Aging Services, in which results are shared and suggestions for future development and dissemination are discussed. Dissemination also occurs nationally through the American Society of Nutrition Annual Meetings. The most significant findings that influence the communities of interest are that low resource adults, such as older adults receiving services from senior seniors and congregate meals programs, are responsive to food and nutrition educational intervention programs and can significantly improve their food safety habits in their home, increase their intake of fruits, vegetables, whole grains, and foods and nutrients that promote bone health. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? University of Georgia worked closely with several faculty in the UGA department of foods and nutrition with expertise in aging, as well as with the Georgia Division of Aging Services which oversees the “aging services network” that includes wellness coordinators, other staff, Area Agencies on Aging, senior centers, congregate meals programs and home delivered meals programs throughout the state. In collaboration with the state, we developed a series of education interventions to improve food safety habits, and knowledge and intake of fruits, vegetables, whole grain foods, and foods and nutrients that promote bone health. In collaboration with the aging services network, we evaluated these education interventions in several studies that involved more than 2,000 participants state-wide. The results have been disseminated with the aging services network in Georgia, a website (www.livewellagewell.info) and nationally at conferences, as well as in peer-reviewed publications in the scientific literature. The major findings are that following these education interventions delivered at senior centers, participants were significantly more likely to: 1) wash their hands with water and soap for 20 seconds before eating and preparing food (Sellers et al., 2006), 2) suggest one or more correct ways to identify whole grain foods and to report an increased intake of whole grain bread, cereal, and crackers (Ellis et al., 2005), 3) increase their knowledge and intake of fruits and vegetables, and reduce barriers to intake (Hendrix et al., 2008), 4) increase their intake of calcium- and vitamin D-rich foods, use calcium- or vitamin D-containing supplements, increase physical activity, and increase fall prevention home safety behaviors (Teems et al., 2011), as well as improve their physical activity (Fitzpatrick et al., 2008, Porter et al., 2011), acute and chronic disease awareness and management regarding strokes and heart attacks (Bell et al., 2009), and diabetes (Redmond et al., 2006, Speer et al., 2008). Obesity was identified as a major problem associated with food insecurity, chronic disease, and impaired function (Brewer et al., 2010, Penn et al., 2009, Porter and Johnson, 2011), and barriers to successful management of chronic disease were also noted regarding weight management (Clune et al., 2010). Food insecurity remains a problem even among those receiving congregate meals and food stamps (Lee et al., 2010). From other samples of vulnerable older adults, namely centenarians, we reported several nutrition-related concerns that require additional studies to determine the most effective methods to monitor and intervention including anemia, vitamin B12 deficiency, vitamin D deficiency, and poor physical function (Haslam et al., 2012a, 2012b, Hausman et al., 2011, 2012).

Publications

• Type: Journal Articles Status: Published Year Published: 2012 Citation: Haslam A, Hausman DB, Johnson MA, Davey A, Poon LW, Allen RH, Stabler SP; Georgia Centenarian Study. Prevalence and predictors of anemia in a population-based study of octogenarians and centenarians in Georgia. J Gerontol A Biol Sci Med Sci. 2012 Jan;67(1):100-6.
• Type: Journal Articles Status: Published Year Published: 2012 Citation: Haslam A, Hausman DB, Davey A, Elaine Cress M, Johnson MA, Poon LW. Associations between anemia and physical function in Georgia centenarians. J Am Geriatr Soc. 2012 Dec;60(12):2362-3.
• Type: Journal Articles Status: Published Year Published: 2012 Citation: Hausman DB, Fischer JG, Johnson MA. Protein, lipid, and hematological biomarkers in centenarians: definitions, interpretation and relationships with health. Maturitas. 2012 Mar;71(3):205-12. doi: 10.1016/j.maturitas.2011.12.002. Epub 2011 Dec 29. Review.

Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: Research is ongoing to better define outcomes measures that are related to dietary intake, changes in dietary intake, and other health promoting behaviors, particularly in older adults in congregate meal programs. Outputs include publication of the results and impact of a community-based fall and fracture prevention program; publication of the results and impact of a community-based physical activity intervention; publication of the results of a study concerning the relationship of obesity with emotional eating, depression, anxiety, and stress; and publication of the results of two studies to validate a revised food insecurity measure for older people. These results have been disseminated with the aging services network in Georgia and nationally at conferences, as well as in peer-reviewed publications in the scientific literature. The curriculum for the community-based interventions is available at our website, Live Well Age Well, www.livewellagewell.info and the revised food insecurity measure is available upon request. PARTICIPANTS: Mary Ann Johnson, Professor of Foods and Nutrition, The University of Georgia; Joan G. Fischer, Associate Professor of Foods and Nutrition, The University of Georgia; Jung Sun Lee, Associate Professor of Foods and Nutrition, The University of Georgia; Dorothy B. Hausman, Senior Research Scientist, Department of Foods and Nutrition, The University of Georgia; Kathryn N. Porter, PhD, RD, completed doctoral degree in May 2012, Department of Foods and Nutrition, The University of Georgia; Jennifer Teems, MS, RD, formerly with the Department of Foods and Nutrition, The University of Georgia; Mark Nord, Economic Research Service, United States Department of Agriculture; Arvine Brown, Georgia Division of Aging Services. Other partner organizations include the Georgia Division of Aging Services; the Northeast Georgia Area Agency on Aging; 40 senior centers throughout Georgia; 12 Wellness Coordinators affiliated with the 12 Area Agencies on Aging throughout Georgia. TARGET AUDIENCES: The target audiences include food and nutrition researchers; public health officials at the local, state, and national level; registered dietitians, social workers, and other professionals that provide home and community based services in the aging services network at the local, state, and national level; and older adults nearly all of whom are in needed of preventing and/or managing through improved eating habits and physical activity in order to manage chronic health problems, particularly those that are related to obesity and physical inactivity. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Following a community-based fall and fracture prevention intervention in congregate meal participants, there were significant increases (p<0.05) in the intake of calcium- and vitamin D-rich foods, the use of calcium- or vitamin D-containing supplements, days of week with physical activity and fall preventive home safety behaviors. This evaluation provides evidence that a multi-factorial fall prevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults (Teems et al., 2011). Following a community-based physical activity intervention in congregate meal participants, there were significant increases in both moderate physical activity and physical function (p<0.05), but a history of depression was a negative predictor of improvements in physical activity. These results provide an evidence base for the effectiveness of this intervention in improving moderate physical activity and physical function in a community setting (Porter et al., 2011) and also suggest that mental-health related factors need to be considered in health promotion programs for older adults. Following the theme of emotional and mental health concerns, Porter and Johnson (2011) reported that obesity in congregate meal participants is significantly correlated (p<0.05) with emotional eating, depression, anxiety, and stress. In collaboration with Dr. Jung Sun Lee, a revised food insecurity measure was shown to be valid (Lee et al., 2011a) and to be an appropriate outcome measure for documenting the benefits of congregate and home delivered meal programs in reducing food insecurity (Lee et al., 2011b). Together, this research suggests that community-based interventions in congregate meal participants do reduce food insecurity and improve nutrition, physical activity, and other health promoting behaviors, but that food insecurity, emotional eating, and mental health concerns need to be considered in the development, implementation, and evaluation of effective health promotion programs.

Publications

• Porter, K.N., Fischer, J.G., Johnson, M.A. 2011. Improved physical function and physical activity in older adults following a community-based intervention: Relationships with a history of depression. Maturitas. 70(3):290-4.
• Porter, K.N., Johnson, M.A. 2011. Obesity is more strongly associated with inappropriate eating behaviors than with mental health in older adults receiving congregate meals. J. Nutr. Gerontol. Geriatr. 30(4):403-15.
• Teems, J., Hausman, D.B., Fischer, J.G., Lee, J.S., Johnson, M.A. 2011. Fall and fracture preventive behavior increased following a community-based intervention in older adults in Georgia senior centers. J. Nutr. Gerontol. Geriatr. 30:72-85.
• Lee, J.S., Johnson, M.A., Brown, A., Nord, M. 2011. Food security of older adults requesting Older Americans Act Nutrition Program in Georgia can be validly measured using a short form of the U.S. Household Food Security Survey Module. J. Nutr. 141(7):1362-8.
• Lee, J.S., Johnson, M.A., Brown, A. 2011. Older Americans Act Nutrition Program improves participants' food security in Georgia. J. Nutr. Gerontol. Geriatr. 30(2):122-39.

Progress 01/01/10 to 12/31/10

Outputs
OUTPUTS: The paradoxical state of a relatively high prevalence of obesity among some food insecure populations has been termed the "food insecurity-obesity paradox." This paradox is of concern, because it may lead food assistance programs to question provision of food assistance to individuals who are obese. This paradox has been studied in children and adults, but less is known about the food insecurity-obesity paradox in older adults. One subpopulation of older adults that may be at particularly high risk for both food insecurity and obesity is recipients of congregate meals and other nutrition-related services from Older Americans Act Nutrition Programs (OAANP) that are provided through senior centers. OAA programs served 9 million Americans in 2006, about 19% of older adults, and target minority and low income senior. The goals of the OAANP include reducing food insecurity by providing nutritious meals and nutrition education, thus the OAANP is considered a food assistance program. Studies of congregate meal participants in Indiana and Georgia reported a prevalence of food insecurity of 18% to 20%, which is two to three times higher than the national average in the general older adult population. OAANP participants may also be at high risk for obesity and several physical limitations that are associated with food insecurity. For example, among older adults attending Georgia senior centers, of whom many receive congregate meals, the prevalence of obesity was 38% (BMI > 30 kg/m2) and some measures of obesity were associated with an increased risk of arthritis and joint pain (Penn et al., J Nutr Health Aging, 2009). This is alarming because arthritis is the leading cause of disability, and obesity is a common risk factor for the development of arthritis and disability. Physical limitations and disability are also risk factors for food insecurity. Given this situation, we explored the relationships of obesity and physical limitations with food insecurity among Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 621, median age = 76 years, 83% female, 36% black, and 64% white, convenience sample). Food insecurity was assessed using the modified 6-item US Household Food Security Survey Module; obesity was defined as Body Mass Index (BMI) or waist circumference (WC) class I or II obesity; and physical limitations (arthritis, joint pain, poor physical function, weight-related disability) were based on the Disablement Process. A series of multivariate logistic regression models found weight-related disability and obesity (WC class II) may be potential risk factors for food insecurity. Thus, obesity and weight-related disability may be risk factors to consider when assessing the risk of food insecurity and the need for food assistance in this vulnerable subgroup of older adults. PARTICIPANTS: Individuals: Mary Ann Johnson, PhD, principle investigator, supervises all aspects of projects, University of Georgia. Dorothy B. Hausman, PhD, fellow researcher, assists with research design, analysis, interpretation, and report writing, University of Georgia. Joan G. Fischer, PhD, RD, fellow researcher, assists with research design, analysis, interpretation, and report writing, University of Georgia. Jung Sun Lee, PhD, RD, fellow researcher, expert in food insecurity measurement. Partner Organizations: Georgia Division of Aging Services. Northeast Georgia Area Agency on Aging. Collaborators and contacts: Sudha Reddy, MS, RD, Georgia Division of Aging Services. Training or professional development: Dawn Penn Brewer, PhD, RD. Kathryn N. Porter, MS, RD, Christina Catlett, MS, RD, Ali Clune, MS, RD. TARGET AUDIENCES: Target audience are older adults participating in Georgia's Older Americans Act Nutrition Programs at senior centers throughout Georgia. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
1) The food insecurity-obesity paradox appears to exist in older adults attending senior centers that provide OAANP services in Georgia. 2) Obesity (especially high WC rather than high BMI), weight-related disability, and being black (vs. white) were robustly associated with food insecurity. Therefore, physical limitations within the cascade of the Disablement Process (arthritis, joint pain, poor physical function, and weight-related disability) should be considered and investigated as additional explanatory factors related to the food insecurity-obesity paradox. 3) The high prevalence of food insecurity, obesity, and weight-related disability suggest that these relationships are of real concern and that the OAA programs at senior centers should consider addressing these issues in a systematic way, such as by recognizing physical limitations and obesity as potential risk factors for food insecurity, not using obesity as a reason to limit or deny food assistance, developing improved methods of identifying those most in need of food assistance, continued health promotion programs that emphasize and model healthy eating and physical activity, and referral to physicians and dietitians for weight management.

Publications

• Brewer, D. P., Catlett, C. S., Porter, K. N., Lee, J. S., Hausman, D. B., Reddy, S., & Johnson, M. A. (2010). Physical limitations contribute to food insecurity and the food insecurity-obesity paradox in older adults at senior centers in Georgia. Journal of Nutrition for the Elderly, 29(2), 150-69.
• Clune, A., Fischer, J. G., Lee, J. S., Reddy, S., Johnson, M. A., & Hausman, D. B. (2010). Prevalence and predictors of recommendations to lose weight in overweight and obese older adults in Georgia senior centers. Preventive Medicine, 51(1), 27-30.
• Johnson, M. A., Hausman, D. B., Davey, A., Poon, L. W., Allen, R. H., & Stabler, S. P. (2010). Vitamin B12 deficiency in African American and white octogenarians and centenarians in Georgia. Journal of Nutrition, Health & Aging, 14(5), 339-45.
• Lee, J. S., Fischer, J. G., & Johnson, M. A. (2010). Food insecurity, food and nutrition programs, and aging: experiences from Georgia. Journal of Nutrition for the Elderly, 29(2), 116-49.

Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: We report on three areas for older adults. The first is our collaboration with the Georgia Division of Aging Services. Together we maintain a website called "Live Well Age Well" that provides evidence based information about nutrition, physical activity, health and well being for older adults and their families and caregivers. Information is disseminated via the internet (http://www.livewellagewell.info). The second area concerns bone health, falls, fractures, and osteoporosis. The prevalence of osteoporosis and low bone mass in Georgia is projected to increase and by the year 2010 will affect 300,000 and 1.4 million people, respectively. Osteoporosis-related fractures cost Georgia nearly $400 M annually, with the majority of costs incurred by older adults. One-third of adults over age 65 experience one or more fall(s) annually. Falls often result in bone fractures. Fracture and fall risk factors include hazards in the home environment, low calcium and/or vitamin D intake, and sedentary lifestyle. To address these problems, we developed, implemented, and evaluated a community-based intervention to reduce risk factors related to falls and fractures in older adults. Participants were a convenience sample from 40 senior centers in Georgia and they completed a pretest questionnaire, the intervention, and a posttest questionnaire (N = 693, mean age = 75, 84% female, 45% black). This intervention was based on the Health Belief Model and consisted of sixteen weekly sessions, eight focused on prevention of falls and fractures, and all sixteen included physical activity, such as chair exercises. Pre- and posttests were interviewer-administered and evaluated fall preventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. The intervention materials were disseminated at http://livewellagewell.info/study/materials.htm. The third area concerns stroke and cardiovascular disease. In Georgia, mortality from stroke is 16% higher and from cardiovascular disease is 9% higher than it is nationally. Although 75% of Georgia adults have two or more modifiable risk factors for cardiovascular disease, less than half recognize all major heart attack and stroke warning symptoms. To reduce disability and prevent death from cardiovascular events, high-risk population groups should be able to recognize symptoms and seek immediate medical attention. Therefore, we evaluated a 4-month education intervention in 40 senior centers in Georgia. The intervention focused on improving knowledge of heart attack and stroke symptoms and on promoting lifestyle behaviors that prevent and manage cardiovascular disease and diabetes. Participants in a convenience sample completed a pretest questionnaire, the intervention, and a posttest questionnaire (N = 693, mean age, 75 years, 84% female, 45% black). The intervention materials were disseminated at http://livewellagewell.info/study/materials.htm. PARTICIPANTS: Individuals: Mary Ann Johnson, PhD, principle investigator, supervises all aspects of projects, University of Georgia. Dorothy B. Hausman, PhD, fellow researcher, assists with research design, analysis, interpretation, and report writing, University of Georgia. Joan G. Fischer, PhD, RD, fellow researcher, assists with research design, analysis, interpretation, and report writing, University of Georgia. Partner Organizations: Georgia Division of Aging Services. Northeast Georgia Area Agency on Aging. Collaborators and contacts: Michael G. Kimlin, PhD, University of Queensland, Brisbane, Australia. Sudha Reddy, MS, RD, Georgia Division of Aging Services. Training or professional development: Dawn Penn Brewer, PhD, RD. Kathryn N. Porter, MS, RD. Melinda Bell, MS, RD. Tiffany Lommel, MS, RD. Jennifer Teems, MS, RD. TARGET AUDIENCES: Target audience are older adults participating in Georgia's Older Americans Act Nutrition Programs at senior centers throughout Georgia. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
Following the intervention to reduce risk factors related to falls and fractures, there were significant (P < 0.01) increases in the intake of calcium- and vitamin D-rich foods, the use of calcium- or vitamin D-containing supplements, and following 7 to 8 of the 8 fall preventive behaviors, and decreases in overall modifiable fall- and fracture-related risk factors (&#8805; 4 to 5 risk factors: pre: 43% vs. post: 26%; P < 0.0001). This evaluation provides evidence that this multi-factorial fall prevention intervention improves several behaviors that may contribute to decreasing the risk of falls and fractures in older adults. Following the intervention to improve recognition of the symptoms of heart attack and stroke, the recognition of all 5 symptoms of heart attack increased from 29% at the pretest to 46% at the posttest, and recognition of all 5 symptoms of stroke increased from 42% at the pretest to 65% at the posttest (for both conditions, P < 0.001). In linear regression analyses, independent positive predictors of change in knowledge were younger age and higher education. Most risk factors for cardiovascular disease were not predictive. The results of this evaluation provide an evidence base for the effectiveness of this intervention in improving knowledge about heart attack and stroke symptoms, which may translate to greater preparedness in these older adults for response to cardiovascular events.

Publications

• Penn, D.M., Fischer, J.G., Lee, J.S., Hausman, D.B., Johnson, M.A. (2009). High BMI and waist circumference are associated with a high prevalence of comorbidities in older Americans Act programs in Georgia senior centers. Journal of Nutrition Health Aging, 13(9):827-32.
• Johnson, M. A., Kimlin, M. G., Porter, K. N. (2009). Vitamin D and injury prevention. American Journal of Lifestyle Medicine, September, doi:10.1177/1559827609348441.
• Bell, M., Lommel, T., Fischer, J.G., Lee, J.S., Reddy, S., Johnson, M.A. (2009). Improved recognition of heart attack and stroke symptoms following a community-based intervention in older adults. Preventing Chronic Disease, 6(2), http://www.cdc.gov/pcd/issues/2009/apr/08_0101.htm.

Progress 01/01/08 to 12/31/08

Outputs
OUTPUTS: The results and outcomes of the community-based interventions with older people at senior centers are disseminated in our "Community-based Intervention Report" that is accessible online. The report summarizes the outcomes of the intervention for the entire state and provides 12 individual summaries for each of the 12 Area Agencies on Aging (AAA) in Georgia. The results and outcomes are also disseminated at quarterly meetings with the 12 Wellness Coordinators from each AAA and the Georgia Division of Aging Services, and other meetings such as the Georgia Nutrition Council and the Georgia Dietetic Association. PARTICIPANTS: The individuals who worked on this project were graduate students and faculty in the department of foods and nutrition at the University of Georgia, as well as the 12 Wellness Coordinators located in each of Georgia's 12 Area Agencies on Aging. The partner organizations were the Georgia Division of Aging Services (State Unit on Aging), the Northeast Georgia Area Agency on Aging, and the eleven other Area Agencies on Aging in Georgia. Training and professional development activities include technical assistance provided by our staff at professional meetings (e.g., Georgia Nutrition Council, Georgia Dietetic Association, and/or Georgia Division of Aging Services Annual Meeting) on the development, implementation, and evaluation of the nutrition, physical activity, and health promotion programs. TARGET AUDIENCES: The target audience for these nutrition, physical activity, and health interventions are older adults who receive nutrition services at senior centers in Georgia. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
A community-based intervention was developed with the goal of improving nutrition, physical activity, and other health-related indices in the target audience of older adults. The specific goals of the intervention included promoting healthy eating on a budget, improving physical activity and physical function, and encouraging older people to talk with their doctor about their health and to have regular check-ups. The intervention was implemented and evaluated in all 12 of Georgia's Area Agencies on Aging in 40 senior centers that provide congregate meals and other nutrition and health services through the Older Americans Act Nutrition Program. The intervention consisted of 12 educator-led sessions with nutrition and health education and physical activity that were delivered at senior centers and lasted about one hour each. More than 3,500 older adults participated and the intervention was evaluated in a subset of participants (n = 815, convenience sample). Evaluation participants had an average age of 76 years, were mainly women (81%), and their race/ethnicity was white (62%), black (37%), and other (1%). The prevalence of chronic conditions was high: heart disease (31%), diabetes (33%), arthritis (70%), and high blood pressure (73%). The prevalence of food insecurity was about three times higher than the national average in older adults (19% vs. 6.5%) and varied considerably among the 12 Area Agencies on Aging, ranging from 6% to 37% of participants. These levels of food insecurity occurred despite most participants receiving congregate meals and a relatively high use of food stamps and food pantries. Problems with food insecurity have led to great interest in implementing the USDA Senior Farmers' Market Nutrition Program across the state, as well as improving access to and use of food stamps (supplemental nutrition assistance program). Following the intervention, participants made several behavioral changes that could potentially improve their overall health, well-being, and independence. Among the main outcomes were that 85% learned about healthy foods that are inexpensive, helping to alleviate rising food costs; 56% increased their fruit and vegetable intake, which can help lower blood pressure and strokes; 31% ate at least one additional calcium-rich food daily, which promotes bone health; 35% increased their physical activity by 10 minutes or more daily, which improves overall health; 41% improved their physical function, which may help delay nursing home admissions; and 79% had their medication reviewed by a health professional, which can improve medication safety and decrease medication-related problems. Among those participants with diabetes, 75% or more indicated that the intervention helped them maintain their blood sugar levels, control portion sizes of food, and space carbohydrates throughout the day. Overall, more than 95% of the participants indicated that the intervention was good, very good, or excellent. These science-based and evidence-based intervention materials and curriculum are publically available at http://www.livewellagewell.info/study/materials.htm#2008.

Publications

• Fitzpatrick, S.E., Reddy, S., Lommel, T.S., Fischer, J.G., Speer, E.M., Stephens, H., Park, S., Johnson, M.A. for the Georgia Community Intervention. (2008). Physical activity and physical function improved following a community-based intervention in older adults in Georgia senior centers. Journal of Nutrition for the Elderly, 27(1-2): 135-154.
• Hendrix, S.J., Fischer, J.G., Reddy, S., Lommel, T.S., Speer, E.M., Stephens, H., Park, S., Johnson, M.A. for the Georgia Community Intervention. (2008). Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers. Journal of Nutrition for the Elderly, 27(1-2): 155-178.
• Johnson, M.A., Davey, A., Park, S., Hausman, D.B., Poon, L.W. for the Georgia Centenarian Study. (2008). Age, race, and season predict vitamin D status in African American and white octogenarians and centenarians in Georgia, Journal of Health, Nutrition, and Aging, 12(10): 690-695.
• Johnson, M.A., Park, S., Penn, D., McClelland, J.W., Brown, K., Adler, A. (2008). Nutrition Education Issues for Older Adults. The Forum for Family and Consumer Issues, 13 (3). http://ncsu.edu/ffci/publications/2008/v13-n3-2008-winter/index-v13-n 3-winter-2008.php
• Johnson, M.A., Fischer, J.G., Park, S. (2008). Vitamin D deficiency and insufficiency in the Georgia Older Americans Act Nutrition Program. Journal of Nutrition for the Elderly, 27(1-2),29-46.
• Park, S., Johnson, M.A., Fischer, J.G. (2008). Practice guidelines for vitamin and mineral supplements for older adults: needs, barriers, and challenges. Journal of Nutrition for the Elderly, 27(3-4): 297-317.
• Speer, E.M., Reddy, S., Lommel, T.S., Fischer, J.G., Park, S., Johnson, M.A. for the Georgia Community Intervention. (2008). Diabetes self-management behaviors and A1c improved following a community-based intervention in older adults in Georgia senior centers. Journal of Nutrition for the Elderly, 27(1-2): 179-200.
• Johnson, M.A., Reddy, S., Fischer, J.G., Lee, J.S., Porter, K.N., Catlett, C., Richardson, J., Clune, A., Hausman, D., Badger, L., Lommel, T.S., Elbon, S.M. Live Healthy Georgia - Seniors Taking Charge: A Community Intervention Report. The University of Georgia and the Georgia Division of Aging Services, 2008, http://nutritionandaging.googlepages.com/communityinterventionreport2 008, http://www.livewellagewell.info/study/materials.htm#2008.

Progress 01/01/06 to 12/31/06

Outputs
Older adults represent the largest at-risk population for foodborne illnesses (Fey-Yensan et al., 2001) and many behavioral patterns that lead to foodborne illnesses in older adults can be prevented (Buzby, 2002). Also, chronic diseases, malnutrition, immobility, and poor access to medical care may increase susceptibility to and severity of foodborne illnesses (Kendal et al., 2006, 2003, Yang et al., 1998). One subgroup of older adults who might benefit from increasing their home food safety practices are those receiving congregate meals through the Older Americans Act Nutrition Program (OAANP), because of their high rates of chronic disease, physical disabilities, and low-income status (Millen et al., 2002). However, little is known about their home food safety practices. In our ongoing programs with congregate meal recipients in northeast Georgia, the Georgia Division of Aging Services recommended that food safety education be included in nutrition programs offered by OAANP. The first goal was to explore current home food safety practices by asking participants questions related to the four key FightBAC! messages. The second goal was to determine the effects of a nutrition education intervention on home food safety practices. A pre-test, educational intervention, post-test design was used to examine the effects of an educational intervention on improving home food safety practices in 136 older adults attending congregate meal sites in seniors centers affiliated with the Northeast Georgia Area Agency on Aging (mean age: 79 years; 74% female; 61% Caucasian). All intervention materials were developed in the Department of Foods and Nutrition, University of Georgia. At the pre-test, adherence to 16 home food safety practices ranged from 17% or less for checking temperatures of the refrigerator and cooked meats to 76% or more for other practices, such as washing hands with warm water and soap for 20 seconds before eating food, rinsing fresh fruits and vegetables with cold running water before eating them, cleaning countertops before preparing food, keeping raw meat, fish and poultry wrapped properly in the refrigerator so juices do not drip on other foods, and making sure eggs are cooked properly. Following the intervention, participants were more likely to wash their hands with warm water and soap for 20 seconds before eating (76% vs. 90%, P < 0.01) and preparing food (76% vs. 92%, P < 0.01). In a series of regression analyses, younger age was the most consistent predictor of adherence to home food safety practices at the pre-test, and older age was the most consistent predictor of improvements in adherence after the intervention. This intervention improved several aspects of home food safety practices; however, additional interventions are needed to increase home food safety practices in older adults. The curriculum is available (http://noahnet.myweb.uga.edu/plansfsafety.html) and the results of the study will be published in Journal of Nutrition for the Elderly in 2007 (authors: Tiffany Sellers, MS, RD, LD, Elizabeth Andress, PhD, Joan G. Fischer, PhD, RD, LD and Mary Ann Johnson, PhD).

Impacts
This evidence-based study documents the benefits of food safety education in improving home food safety practices in vulnerable older adults receiving nutrition-related services from their local senior centers. State and federal agencies strongly endorse the use of evidence-based programs for improving nutrition, physical activity, and health status in all population groups, including older adults. Thus, this study and its related materials add to the rather limited amount of evidence-based programs available for vulnerable older adults. The educational materials evaluated in this intervention are available for use by other educators. The impact can be quite large, given that older adults are the largest at-risk population for foodborne illnesses and age-related limitations in access to medical care, chronic diseases, malnutrition, and immobility may increase susceptibility to and severity of foodborne illnesses.

Publications

• Park, S., Johnson, M.A. (2006). Awareness of fish advisories and mercury exposure in women of childbearing age. Nutrition Reviews, 64(5 Pt 1), 250-6.
• Martin, P., Bishop, A., Poon, L., Johnson, M.A. (2006). Influence of personality and health behaviors on fatigue in late and very late life. Journals of Gerontology, B Psychological Sciences and Social Sciences, 61(3), P161-6.
• Park, S., Johnson, M.A. (2006). What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? Nutrition Reviews, 64(8), 373-378.
• Stein, E. M., Laing, E. M., Hall, D. B., Hausman, D. B., Kimlin, M. G., Johnson, M. A., Modelsky, C. M., Wilson, A. R., & Lewis, R. D. (2006). Serum 25-hydroxyvitamin D concentrations in girls aged 4-8 y living in the southeastern United States. American Journal of Clinical Nutrition, 83(1), 75-81.
• Stabler, S.P., Allen, R.H., Dolce, E.T., Johnson, M.A. (2006). Elevated serum S-adenosylhomocysteine in cobalamin-deficient elderly and response to treatment. American Journal of Clinical Nutrition, 84(6), 1422-9.
• Johnson, M.A., Hausman, D.B., Park, S., Davey, A., Poon, L.W. Vitamin D Status in Octogenarians and Centenarians in Georgia, In: Behavioral and Nutritional Resource Deficits among Centenarians, Gerontological Society of America, Dallas, TX, November, 2006. The Gerontologist, 46(Special Issue I), Session 250, page 342. (Abstract).
• Randall, G., P. Martin, Poon, L.W., Johnson, M.A. Mental health change in older adults: sexagenarians, octogenarians, and centenarians, Gerontological Society of America, Vitamin D Status in Octogenarians and Centenarians in Georgia, Dallas, TX, November, 2006. The Gerontologist, 46(Special Issue I), Session 127, page 205. (Abstract).
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